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DS-02-20-380ENIrERED Vp BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (30S) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 7624949 ❑BUILDING ❑ ELECTRIC ❑ ROOFING FEB 2 2:;77 FBC 200� Master Permit No. QC—W-1p 10(93 Sub Permit No.:)S —CR—i)' 3�O ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: P5 M k ��Vmma Occupancy Type: Load: OWNER: Name (Fee Simple City: Email: Name: '{ V I (GIs the Building Historically Designated: Yes _ NO Construction Type: �Flood Zone: BFE: FFE: Tt miles J. -1-:> M'1 n nc -4nY City: ( State: -FL Zip: 'Z�3131 Qualifier Name: // ! r '7 Phone#: State Certification or Registration #: l_..� C 1 = ) �2 !� Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: Statee: ��Zip: V I f W...4 fn rl,• Vj • $ �lN squa Wor . — [ • 1 rtA-- Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition V*Nn�t11/A�f — f)&%IGC%` Specify color of color thru Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ CCF $_ DBPR S CO/CC $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ _ (RevSed02/24/2014) 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage lender's Name (I( 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. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS. FURNACES, BOILERS, HEATERS, YANKS, 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 an 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 ottachment. 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 4NERENT The foregoing instrument was acknowledged before me this LS-�- day of (.J . 20 , by -R� W l 1 ho is personally known to —+r me or who has produced —y) 11- as identification and who did take an oath. NOTARY P C42- fitlo�Z4 �- ANGELICA BAUTISTA Notary Public - State of Florida Commission A GG 930159 'orr� My Comm. Expires Nov 7, 2023 s «� «««r «• «r EhftliQM9 iffleMm APPROVED BY lfievised02/24/2014l Signature CONTRACTOR The foregoing instrument was acknowledged before me this �eg _ �� - day of _ Z- . 20 2.(l . by _ who ii►s�personally known to me or who has produced C, 1(/ J r `�' �i'-� as identification and who did take an oath. NOTARY PUBLIC: 01 Sign: Prin Se I:F,,"* ANGELICA BAUTiSTA 1 Notary Public - state of Florida Commission # GG 930t59 My Comm. Expires Nov 7 02 «�u>d8600 NINW41 1�oia`ryAss •fit•«s.«���««««««� Z SZ4--'O' Plans Examiner Structural Review Zoning Clerk �� Miami Shores Village Building Department 10050 N.E.2nd Avenue 4�''�+►r� Fr Miami Shores, Florida 33138 �LtDRtUp' Tel: (305) 795,2204 Fax: (305) 756.8972 Notice to Owner -- Workers' Compensation Insurance Exemption -77 Florida Law requires Workers' Compensation insurance co�crage under Chapter 440 of the Florida Statutes, Fla. Stet. § 4�t0.05 allows corporate officers in the construction industry to exempt them5chc` from this regtiircmcnt for any construction project prior to obtaining a building pennit. 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 norkcrs' comtpensation coverage. Corporate officers or ntcntbers of a limited liability company ti.t-C) in the construction industry may elect to be exempt if: i. The officer O%vns at least 10 percent of the stock of the corporation, or in the case of an LLC. a statement aucsting 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. Di-, ision 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 alto++cd to work on )our project. In these circumstances. Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day tabor, part-time employees or subcontractors. BY SIGNING BELOW YOLFi ACKNOWLEDGE THAT YOU HAVE READ THiS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: O+vner State of Florida County of Miami -Dade The foregoing was acknowledge before me this Zo ._ day of 22 ' 201�v B ,�L who is personally known to me or has produced Y-. as identification. Notary: - r" ---- + �t tary Public - State of Florida SEAL: ! Commission ff GG 930159 ofv My Comm. Expires Nov 7, 2023 Bonded through National Notary Assn. OneCore Construction Management Contract No. OneCore DAY-EL-001-2019 0,1-SAI.— Co OneCore cM-.h ,n;an lbtrriarts mil DateO Z 20/Z0ZD state of + 1 or l of ot- County of M toLalt - Doide Before me this day personally appearedQ who, being duly swom, deposes and says: That he will be the only person working on the project located at: 175 NW 98TH Street Miami Shores, Florida 33180 � /'� /-;// - 4 Contractor Signature Sworn to (or affirmed) and subscribed before me this day of Oa 20 20 , by Z'Gt� & Personally Know z Or Produced Identification Type of Identification Produced 1, ANGELICA BAUTISTA Notary Public - State of Florida fir` Commission 0 GG 930159 My Comm. Expires Nov 7, 2023 Bonded through National Notary Assn. OneCore Construction Management 999 Brickell Avenue, Suite 1001, Miami, FI 3313 (305) 690 37 85 info@gnecorecm.com - www.onecoregm.com Mission: To protect. promote 8 inprm the heailh or ail peope In Florida thta* irge0ed state. ality & cmwT1J* efforts, Indira Rad 999 Brickell Avenue 1001 Miami, FL 33131 HEALTH Vision: To be Use Healthiest Stab in die Nation June 15, 2020 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: AP1508973 Centrax Permit Number: 13-SC-2089795 175 NW 98 Street Miami, FL 33150 Lot: 25 26 Block: 1 Subdivision: Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 06/09/2020 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. New Driveway. No Objection Letter Issued by Loanis Gonzalez on 06/15/2020 Ron Desantls Governor SaM A. Riwlteas, QD State Surgeon General This office has reviewed and verified the floor plan and site plan you submitted, for the proposed remodeling addition or modification to your single-family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessment, or modification, replacement, or upgrade authorization is required. Because an inspection or evaluation of the existing septic system was not conducted, the Department cannot attest to the existing systems current condition, size, or adequacy to serve the proposed use. You may request a voluntary inspection and assessment of your system from a licensed septic tank contractor or plumber, or a person certified under section 381.0101, Florida Statutes. If you have any questions, please call our office at (305) 623-3500. R Loanisnialez EngineeY Specialist II Department of Health in Dade County Fludde Department of Health VnVW. 0ddabealtb.Sar In Dade County - -. Florida TWITTER.HealutyFtA PHONE: (305) 623-3500 FACEBOOKFLDepartmentorHealth YOUTUBE: flooh I/,. (ND 11 MIAMI SH( PUBLIC W APPRO EDC JUL,? CRY SURVEY SCALE: 1" - 20' S VILLAGE S REVIEW _DATE � O a0 N � 0 LL LL O •°, m cw i I co z �- E a � r � a H OC CJ w u a 0 O 1 o _o z U a _ O J _ P R lb I LOCATION SKETCH Flp (NO 10) (N.T.S.) o 09w~/2401m4-4rw.^. 924 : Aoe # 9. cTper, Piolil:'1��2 100.00' (R & M) CONC kiii ONE STORY RESIDENCE N' 175 c xr LOT 2s qp a r NO m) V 29.0 P ����/ zm NW 98th STREET 20.00' (BO.OD- TOTAL R/W) Rerr7Ove NDl@Nonu9L60UIDAaanrtaRPAffiRIf ONBI THIS SURVEY IS NOT 64TENDED FOR NEITHER DESIGN OR CONSTRUCTION PURPOSES LZOALDPSCRIMON: (FURNISHED BY CU" _ _._.. -- -- DIAT D V 17 PA 11 [1F 7)1F PURIIC RECEIVED J 1 1 2020 Miami Shores Village B� ' Public Works Department (305)795-2210 Public works forms are available from the building department, 10050 NE 2n0 Ave., Miami Shores, FL 3 38 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permitil: DS- DZ- ?o 38d W -6 V Name of Applicant (if utility see below): X PIN 2ZN 'lZ1y� Owner off the following descrZ ibed property: t Legal Description: Lot Z5 Block cL Subdivision Folio it; —3 0 — Z — oizo Address: Ja.5 N -1 fn Sfiftbr4.HIfAW 5iii7p--,T! is UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration ti: CONTRACTOR NAM City: r v I Telephone: O — State Certification or Regist to way: Email: Type of Work: ❑ Paving ❑ utility ❑ Landscape ❑ Antenna DESIGNER: Architect/Engineer: Address: City: Telephone: Registration #: State: Email: State: State: 912 Certificate of Competency # ZIP: of Competency #: separate page if necessary) in the adjoining right of ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Other: ZIP: Value of Work for this Permit: $ 322 00 � Square/Lineal Footage of Work:,3i ""` Fees ..... Permit Fee $100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, 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 the 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 public works permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature Applicant a orized Agent The foregoing instrume,t was acknowledged before met/t)7y (o day off 20 by w +/ CCU// ftO is ersonally known to me or who has produced as identification. Signature a//0�r Company/Utility Agent The foregoing instrumen as acknowledged before me this ddy of z 120 2�7 by H ia> who is personally known to rife or who has produced identification. as Sign: 4 � Sign: 4n °kl� /� Prl — I of}t�Tid7i3 Print: I4,/GC-G!C/r /.sA07"47 9 . SE�.��•"•, ANGELICA BAUTISTA SEAL• F, •- Notary Publl[ - State of Florida r 'a✓ ANGELICA BAUTISTA • Commission 0 GG 930159 .?� • ': Notary Public - State of Florida 'w M1 My Comm. Expires Nov 7, 2023'a®�f Commission R GG 930t59 Bonded through National Notary Assn. ?a n?F My Comm Expires N 7 20 ov 23 9onded through Nallonal Notary Assn, APPROVED BY: f Public Works Director, or Designee +k-I X 2017-04-15 � � f V aCN 4--,! M Li CZ)Ce oC>_ N G_ Uj t0.) ac ti. W rZ c> C x Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) 1TO\ `� � hereinafter r ferred to as the owner of the following described property � address): 6i8 Ibm -�1 J0 Legal Description MZ PALot 150 Z( Block s Subdivision Folio 4 11 ^ ? tO( -Q-2-y --0 i2o Requests permission to install (describe work): DRIyf:,Vjb�N Within the public right of way of (address) 19fS t-J M L i S 9A�25f(I 32�157� IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). Signature, :)r Agent Th kforegoing ins rum nt was acknowledged before me this day of I V n G , 20 A who is personally known to me or who has produced as identification and who did take an oath. NOTARY/PIUBLI Sign: o;►r"�''., ANGELICA BAUTISTA _ nda Print: of �! 7�9 '� Commission 0 GG 930159 M Commission Expires: , .. of �.•: Y omm. xp res o� , 2023 y p Boded through National Notary Assn.