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BPP-07-19-1606, 910 NE 99th St (3)Miami 'resVillage B - i�Av!Tnuemlamiepartment 1 50 N.E.2nd Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION *BUILDING (-1 ELECTRIC ❑ ROOFING CE.AtV1P,,I:) UL 111 201 FB�)C 201 - 1 Master Permit No. j m I Sub Permit No. ❑ REVISION ❑ EXTENSION (❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS [] CHANGE OF CANCELLATION ❑ SHOP n CONTRACTOR DRAWINGS JOB ADDRESS: -1k s 1ry_ ---P—+ 2 City_: Miami Shores County: Miami Dade Zip: -3 3 138 Folio/Parcel#: ) I— 3 Z016- 0 (4' 3y RD Is the Building Historically Designated: Yes NO Occupancy Type: i Load: Construction Type: Flood Zone: BFE: _ FFE: OWNER: Name (Fee Simple Titleholder): ns V- ( Use- Phone#: Address: q-- 20 N • RDa-. j I20ei d City: l awo Qj�(�[� State: F I_ Zip: 331 (4 0 Tenant/Lessee Name: Email: 4 CONTRACTOR: Company Address: S­C/60 6 '-d' C Al hone#: lne#:1P City: C-�c_�� State: Zip:` Qualifier Name: ci ��'CXf` 1� /� �- Phone#: %o C� State Certification or Registration / 1/5 9 Certificate of Competency #: DESIGNER: Arch iitect/Enginee r. V l c n+c T�-U ►,)co Phone#: 3/3O5 p^SCo 3� Address: O6 1O PW _109 C+ City: Wiat State: FL Zip:-331-18 a� Value of Work for this Permit: $ � M Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ElRepair/Replace ❑ Demolition /54 Description of Work: kpto �.Ui fil (Y11 n 17 0 0�� f Specify color of color thr tile-0 �� i Permit Fee $ �96. CCF $ 2-1b ,5 .+CO/CC Scanning Fee $ (� Radon Fee $ (b Sb DBPR Pota'ry $ Technology Fee $ ' p Training/Education Fee $ 20 Double Fee $ Structural Reviews $ �S ' Bond TOTAL FEE NOW DUE $ i k Z&9 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State M Zip Application is hereby maloeto 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 an estimated value exceeding $2500, the applicant must promise in good faith that o copy of the notice of commencement and construction lien low 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 approve and a reinspection fee will be charged. Signature I " ' ' Signature OWNER or AGENT / CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me thl ' da of T� `` 4'1 '�' , 20 � by a day of 3-D J 20 J�. b V' LUG wh eronally known to 9 �1r�i Y ` (�1 �.. who is personally known me or who has produced as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: y*i I APPROVED W, identification and who did take an oath. NOTARY PUBLIC: Sign: K Oj � . y SPrint: Seal: J. v tl ;.11 1 rn m Cn 7rn m u c— V- r N C5 o� cr, A 0 Plans Examiner Zoning /1)/1 Structural Review (Revised02/24/2014) Clerk L.A Building Construction Corp 5o6o E 8th Lane Hialeah, FL 33013 786-287-0114 / CGC1515968 July 18th, 2019 State of Fo i ('d a. County of H(`OW),' Dg e. Before me this day Personally appeared V I a If Who, being duly sworn deposes and says: That he or she will be the only person working on the project located at: 910 N6aatA a+fetf Iam Shares,1--( 23t3 Signature .1h Sworn to ( or affirmed) and subsbribed before me this ZD day of .2019 By J[gdirnjf Personally Known Porduced Identification Type of identification produced Type, rint oi Stamp Name of Notary KELLY J VILLA My COMMISSION # GG071524 EXPAES February 26, 2021 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. Owner State of County of Miami -Dade AA The foregoing was acknowledge before me thiszbA day of 7 20(q. By : -Ld nS )lam (Ce.y S who is personally known to me or has produced as identification. Notary:_ J• wou ;i°` Y�14 KELL.Y J VILLA SEAL: My COMMISSION # GG071524 EXPIRES February 26, 2021 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned H, &x5 m � • VRMSfi is/are the fee simple owner(s) ofthefollowing described property situated and beingg in Miami Shores Village, Florida: Address: `l +V C(�► �j—%u Whereas, the undersigned owners} Al"S - u - Sl desire to utilize said Lot(s) as a single building site, and he undersigned owner(s) do(es) hereby declare and agree as follows: I. That the property will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. II. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the required enclosure is not on the subject property where the pool is located. III. That if any of our adjoining neighbors remove any portion of their fence or wall, or if our/my property shall fail to meet code requirements for pool barriers, we, as owners will immediately installs a protective enclosure to meet code requirements and will obtain a permit for such fence. IV. That, I/we, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is damaged or removed by any case. NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive c venant concerning the use, enjoyment and title to the above property and shall constitute a covenant r ning with the land and shall be binding upon the un ersigned, his/her successors and assigns and mayfly be released by Miami Shores Village, or its succe ors, in accordance of said Village then in effect. OWNERISIGN & PRINT OWNER SIGN & PRINT I Hereby Certify that on this day personally appeared before me 1 Iu15 (f and has produced ID # 9�(sa�Q q tCIAAas identification and he/she acknowledge that he/she executed the foregoing, freely and voluvArily, for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this 1 day of !LJ 2019 C- r\ t NOTARYVUBLIS STATE OF FLORIDA (Revised 05/2209 Miami shores Village Building Department r? 10050 N.E.2nd Avenue . Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at 910 )E Rat' S±ne-e - Miami Shores, FL, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues and the Florida Building Code R4101.17. Please initial the method(s) to be used: The pool will be equipped with an approved safety pool cover that complies with ASTM F1346-91. (Submit Manufacturer's Specifications). A continuous, one-piece (child) barrier meeting the requirements of Florida Building Code R4101.17.1.15 will protect the pool perimeter. The plans shall show the fence location and method of attachment, including one end that shall not be removable without the aid of tools. (Submit Manufacturer's Specifications). A combination of non -dwelling walls and fences (screen enclosure, child fence, masonry fence walls, chain link or wood fence, etc.) will protect the pool perimeter. The plans must specify the type and location of all non dwelling walls. Florida Building Code, R4101.17.1 Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code, R4101.17.1.9 (Submit Manufacturer's Specifications). Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all doors will be equipped with a self -latching device with positive mechanical latching/locking installed a min. 54" above the threshold. If this option is selected, submit plans showing all types and location of all perimeter protection. The plans must also show the location and type of all openings, and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Code, the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements, and upon expiration of the permit, the pool shall be presumed to be unsafe. I understand that not having a of the above installed will constitute a violation of Chapter 515, F.S ., and will be considere as committing a misdemeanor of the second egree, punishable as prove inSection 775.082 o Section 775.083 F.S . This form must be signed v the owner/agentrand tbd prime contractor. GNATURE AND DATE OWNER'S SIUNATURE AND DATE NTRACTOR'S NAME JP�EASE PRINT) TARY Wary Public Sate of Floride 1Nma PCue my commission GG 252299 Expires 2/22/2022 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION Date _ Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as C11 Ci N qs ' s w . , located at kM 414A In accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminaAe the need for obtaining a permit and erecting and approved barrier prior to final inspe¢fion and use of the pool. Legal Owner ol Note: This certification is to be submitted with a swimming pool permit application in duplicate.