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DS-03-20-613Miami Shores Village �g Building Department ozo� o v adw 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 QdAIa Daitl Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201'T BUILDING Master PermitNoT.>s— c)3-20-(03 PERMIT APPLICATION Sub Permit No. �UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1©(0-3I ti-% 7 )( c+ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): -e " N `' /?" SS 1 r A",re • IQIO �Lr E �� opcelcIl City: Tenant/Lessee Name: Phone#: Email: 331J F CONTRACTOR: Company Name: S. i T 4 /Lt,,41- 6y� Phone#: 30� • S �'7- Iv 8S Address: t I GhtE City:�f1t rO�S State: ��tp'i Zip: Qualifier Name: M-�(R-,fl-1 pJ y MPM. �C d7A Phone#: 301C%SO' 9//3 State Certification or Registration #: 66 C ($ 25 /zS 2 Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State:Zip: value of Work for this Permit: $ Soots Square/Linear Footage of Work: r/OiJ '$ Q Pt Type of Work: ❑ Addition ❑ Alteration /+❑ New n� ������SRy"" ❑ Repair/Replace I ❑ Demolition hI Description of Work: f��_wl DycY I OX/-f- - e �' Cye�,-4c N2 r �r s4:D 3� f,,,P Specify color of color thru Submittal Fee Scanning Fee $ Technology Fee Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $CO/cc $ DBPR $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with on estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature C-.\� - - r'-, -4. -9, A. 9, OWNER or T The foregoing instruments was acknowledged before me this day of /7az C , 20 by .�F e/t%/l%/a 49 sl/ /— , w is personally nown to me or who ha,s-modurad..,.. as identificatio Tkorw di � ,n�otofFlonda Any Comm?ss�or C=G IM84 NOTARY PU Expires 02128/2022 Sign: Pri nt: 4,h a %W t? ^,C4� dP Seal: Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 ZV , by % ho is1,11111 1 onally kno n to me or who has pr uc as R Notary Public Statp r f rl,,,y(ja identification and hakLAan 16abb.Pere2 ~' Co'"Imisyson GG NOTARY PUBLIC: °` Ex� res 02/28/2022 Sign: Print: Ah,q 7174 AZc-J �Q/ P e7 Seal: bf7 �( , ✓ APPROVED BY �—Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner— Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers, Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division. of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature.4 aJQ w r State of Florida County of Miami -Dade 4. The foregoing was acknowledge before me this. � day of ^\ � P_ , 20 70 . BY who i personally kEo to me or has produced as identification. Npvffy Ptonda Maria Perez SEAL: c nwnission GG 191084 ,,. E Rir 02/28/2022 � ''r. :•.. � - � � . !. � - -. � s. ' • +tit :...:' "• 1 {� _ �' ti`t�` (� � 'i'aa7 � b •acY .': t17e." ..� K � �: 3'� K:.N ii }�,,;� Date 6- 8 `20 State f �joA cat, CouMA'eAt of bprof 335-815-1513Vol wh i.stl�riOrbu!dersl;%.cote r iil�O�isl1�3P,ttOrhtts'rl�rsl:c.com t.:.._,,, Before me this day personally appeared _ P�aviad-4 kAew who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: G 3� VF flr r�Ps Mr/�►�l �ko 1 33i�� lane Lz� Contractor Signafure Sworn to (or affirmed) and subscribed before me this day of \*J . 20 W , by Personally know -- - / OR Produced Identification Type of Identification Produced �e Pa.Notary Public Stale of Flanda Ana Maria Perez My Cornrntasion GG 191084 a,,,d€xpires O2/2&2022 Print, T e or S p Name of Nota To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Kelly Villa 1469 Fairway Road Hollywood, FL 33026 RbMaa HEALTH Vldon : To be the Healthiest State in the Nation RE: Contingency letter Application Document No: AP1481652 Centrax Permit Number: 13-SC-2059365 OSTDS Number: 10634 NE 11 Ct Miami, FL 33138 Lot:16 Block:3 Dear Applicant: April 30, 2020 Ron DeSantls Governor Scott A. Rrvkees, MD State Surgeon General RECEIVED MAY 12 2020 Subdivision: Miami Shores Estates..., . : This will acknowledge receipt of an application dated 04/29/2020 for a permit to use'ari e-Xistinge onsite sewage treatment and disposal system located on the above referenced property, •" Reviewed on 04/30/2020. No objection for driveway replacement as per your Site Pidn."Grainfield must remain uncovered of any material. NO BEDROOM ADDITION. NO FLOW INCRE,4�Sf. , From a review of your completed application, it has been determined that your existing -system • appears to meet the minimum standards of F.A.C. 64E-6 for the proposed use. It is approved for " use with the plans submitted to this office. If this system should fail, causing an unsanitary condition to exist, steps must be taken to bring the system into compliance immediately. Department approval of the system does not guarantee satisfactory performance for any specific period of time. Any change in material facts which served as a basis for issuance of this approval requires the applicant to modify the permit application. Such modification may result in this approval being made null and void. Issuance of this approval does not exempt the applicant from compliance with other Federal, State, or Local Permitting required for development of this property. If you have any questions on this matter, please call our office at (305) 623-3500. Sincerely, Gerard Philizaire, Environmental Manager Florida Department of Hearth v .Floridakealth.Sov in'DADE COUNTY l f1 ^^I TWITTER:Heal,hyFLA Nx loath f111Af1flt .• o I O m, s. coo I f c s $ A v _ >c A i1 r- 4 — • c a ' r[ T � r — Is.so' J4.60' gPt �+ 6. e-so T z c Le m C,m.4 �nis n s.50' T 7. 0' z C ' C J8. 60, a BRICK J o 17.0' I 1 � � 1 uBtC W VILLAG \. � �RK� R -,VIE �9 4.80 96', 1,30.00 '(M)(P) 1 T �► . S. - r) t C. (n W vil- S, Ij } "THIS SURVEY DECLARATION IS MADE 0ED H SIELD NOT DATE INDICATED, TO THE OWNERS) TRANSFERABLESUBSEtaUENT OWNERS-- OR -! is O �100, � 1 60 /y� IZ 00' J 1.64' !o Poop I o 22. oo' - $ 43.80' b� • - + � Q- j0' Q� 50' � J 90 R1!-,CEIVE1D MAY 2 6 2020 I IBA'' I I I i I This prcQet*j described as MIAM1 SHORES ESTATES I LG- '6 3!_�) CK 3 ACCORDING TO T:-tE PLAT THER=OP AS RECORDED IN PLAT BOOK47 I A.' :)AGE 58 GF THE PUBLIC RECORDS I OF DADE COUNTY FLORIDA I Ce+"Mfed ?a I OWNER .1ENNA R R.aSSIF 3 H I NOUREDD!NE RASSIF AdCress 10E34 VE It 1 CT MIAMI SHORES FL 33133 Elevations shown •efer to N.G.V D 1929 ` • t too +♦ee•e •eoep• p o Bearing, If any, 511oW11 based ort___Piat tVtendlan (reference) NIA flt-VISiI)NJ 90UNOARr SURVEY is the IItINLiNAI NuPANt�No$UffIX JN, oivaG,junles9 I'Uti916 L ouaa Inn At: - mgnatwe and the 1 It M INUt X 9ASE EIEV onyinai �a�sc.1 enai t 1 it M UA I t of f wndu iicnnsn.l UB / I i I U:1 UJ I I I uu • a i r N.G V 0 5wvnyur and MaPPer I HEREBY CENrIrN that Iha sower me standdrds oly; -��xM; set � oy trio FLORIOA f3ll.�f:K JI-•V+;O�E°'^` SURvErORS ANO MAPPERS UI .►Vtrr 5j. It? tionda gdm,n�str'bve Coda. pursu4necaon.j: Q21 floes t'E� AIFIVES 03/04�aSURVEYOR ANDPR SSION MAPPER No 4327 State of Florlda� 0 ogee t000 U U q r y > 090 V 1:' • 1 ♦ U U • p 1 E V 4 p• - a es o .Iaoep • s e• ..op•o 0 o • r JU d 4 ! UW 1fi $ U S J U ti U b c oro c , U U U U U U