DEMO-02-19-356, 9353 NE 9th AveMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
9353 NE 9TH AVE, Miami Shores, FL 33138 1132060010040
Contacts
.. �..�..� Inspection Requests
Description: DEMOLITION ON TWO BATHROOMS 11 Valuation: $ 2,500.00
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Scanning Fee
$9.00
Technology Fee
$1.25
Walls, Signs, Other Demolition Fee
$50.00
Tota I :
$116.65
Payments
Date Paid Amt Paid
Total Fees
$116.65
Credit Card
02/14/2019 $50.00
Cash
03/11/2019 $66.65
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above narr]pd gontr9ctor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
March 11, 2019 Page 2 of 2
3� Miami Shores Village
Building Department 4.
/ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 FEB 14 2019
Tel: (305) 795-2204 Fax: (305) 756-89720-�
INSPECTION LINE PHONE NUMBER: (305) 762-4949 l 1
FBC 20r-i
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
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): 135 ��o y i Gam! L LC Phone#: -3o5 °-
Address: % / S %'
City: J & e- -'A'r State: Icz Zip: y
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: ,Z.75ot s-
City
0
Qualifier Name: 'r—gL
State Certification or Registration #:
DESIGNER: Architect/Engineer: _
P Imo►/ \ s G rw-p
r
ne#: 30 5c�G 1 jaD
_State: rL Zip: 530 52—
Phone#: 10�'- x7,--104)0
ificate of Competency #:
ne#:
Address: City: State: Zip:
v�
Value of Work for this Permit: $ ! 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace IDDemolition
Description of Work: L'!K a l' �' ®� �GtJ o '6Ay6 iy'0®"/
Specify color of color thru.tile:
Submittal Fee $ Permit Fee $ 100 'CO CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $ //
TOTAL FEE NOW DUE $ 66 - 6 E�
(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
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 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 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 reinspecticta fee will be charged.
Signature r��?a�—���� Signatur(,Z�
OWNER or AGENT
The foregoing instrument was acknowledged before me this
L1L 5 day ofpp F-G v r by
7Lr4SGt- Crf.��I?!� who s personally own to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
-day off C T by
%.G iVJq o is personally nown to
me or who has produced A as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
�& --
Print: i
Seal: �� EXPIRES Motch 06, 2021 Seal:
I I r �tary V NoPublic 6%W of Florida
Elston Allen
My Corrordaioe tits =380 ,
****** ** *** ****************************** ****■ *AxPilil401W. ********* **********
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
2/14/2019
Miami -Dade Official Records -Print Document
RETURN T*
TRANS -STATE TITLE tWURANCE AC"CY, U.0
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305-'83'1.WO
CFN: 20190070039BOOK 31313 PAGE 2826
DATE:02/0512019 08:54:07 AM
DEED DOC 2,052.00
HARVEY RUVIN, CLERK OF COURT, MIA -DADS CTY
GUARDIAWS DEW
TWINDEWUM,meowtodonft, � of Jaswary 2DI9 been ItUrl0ft J. L RST. @Bd:3kli*W0 i3
by and ftWO W "W pudift. Gwgrogram of Date C"V, fntt., a fwdo aw an, party Of
#re ft pact 10 SMft a, LM a Rife 9MW 1181641Y may, SW NE 93 Sb*M, tii ni Stwres, FL 33438. party of
the semw part:
WITNESSM#
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w =wWwation of ttx: sum of 51t3:w Arad outer 90 acid VAQW wwwwatkKk in han0 POK
es, teIftes, , cosh. and codiffm 1w iowest to p fy of the se=d pap, hb#* i* helm wo
Ass*w forewerr, In #w mW property in t ts+i ooe Cu*, t 'trxWo desceAwd as
Lot 4 of MAO LYN FtF:Jt' Orh WMd" to ft ptat #hit€; reWded in #fit Book 41, at Pap $, d 0a W*
Records of Daft C ttintp, Rodit.
Follot 11.321 1 A#
Sewtomm taxes for 2019 wW su yeas.
TtOC*—l4ERwith and .Wngulwthe wwnef fthmdkww*,.aced apouftwxor in anyWas appedoWng
to 0* Mai property.
TO RAVE AND TO iOt Ow awe to ft- pedyr of ft and patt, h` Ti fee skrv* fir.
AND ft party of Me thst pot does emenarst to and Wth the pady offtar secoW part, lr MWAhetr WIN w d aa3iQ K 00
in all O&W tsrrslh*wy to and 4s ark sbW this cx Neyacss . 9se osdso of ttre Above OW46 OW MA the laws of t
have been foOmed and oK VWd wft In ae fo"M, that the party of Me ttrst past Is tawWy a of #se pmpeq
comeyed harreby in fee skmft aroma has 9ocxt 60d aad WaM audiorly to se# wW + saki lsod, and hereby w wranta
the We t1watrs and vA deland #te sauce against the: i wrW cbkm c att mow.
IIN�(j'i��f TNES�SS VOIER�E(;OF. party
p ttse first peat, Havie to,t: LesMejt�. RwWwM d � %mate by and ttsr Lo, her
't` �iEsWlw%� Gwwe fl�il�,t PmWsm of ii:Su t , e. h" Set its hWtd WW Wall on ft day Mid year *# above
wwi tterl-
STATE OF fLORIDAiCf3tJt>tW OF M111AMI-BADE
�" WORE we the day p��} �S. �gw�yap�pCy Hk*,, % ttl 04W b�eeiin�s d* swam: s #131 t� is 4W
lei w ins rA woNsHip t RAtA :� ilV m ` � . me. of #* pwowty a marreft at.Lafkw.11 oo
exaccst d the fam9aling kw umsK who is petsonslIlly iunsrw) to mom aft actmowilefted'tefars Owt he .. I*
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Tt SS"hand aced owkw ;sedtkr the C:o Ww State hw 8110" id ��" day of s ��tliNitt
Tfft lydtVArtent iafedby
Stir,* C. Hirte, Attorney ftr Guandt s,
of Dart Caft, Inch
WOO NW 5&d Sheet, Stilts 402
Milami. k"Wds 33166
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https://www2.m iami-dadecierk.com/official records/Pri ntDocument.aspx?QS=YaoUfOzxryl h9ufN EEQ5eOBfgdgYaeQD EGa3uB%2bn5Abj6FCEH BKAgmTAFdN... 1/1
Electronic Articles of Organization
For
Florida Limited Liability Company
Article I
The name of the Limited Liability Company is:
9353 FLORIDA, LLC
Article II
L19000010426
FILED 8:00 AM
January 08 2019
Sec. Of Stale
vherring
The street address of the principal office of the Limited Liability Company is:
9353 NE 9TH AVE.
MIAMI SHORES, FL. 33138
The mailing address of the Limited Liability Company is:
560 NE 93RD STREET
MIAMI SHORES, FL. 33138
Article III
The name and Florida street address of the registered agent is:
GARY A BODZIN
18205 BISCAYNE BLVD SUITE 2201
AVENTURA, FL. 33160
Having been named as registered agent and to accept service of process for the above stated limited
liability company at the place designated in this certificate, I hereby accept the appointment as registered
agent and agree to act m this capacity. I further agree to comply with the provisions of all statutes
relating to the proper and complete performance of my duties, and I am familiax wish and accept the
obligations of my position as registered agent.
Registered Agent Signature: GARY A. BODZIN
Article IV L19000010426
The name and address of person(s) authorized to manage LLC: FILED Janus 8:00 M
Title: AMBR Sec. Of Stale
TERESA CARDENAS vherring
560 NE 93RD STREET
MIAMI SHORES, FL. 33138
Signature of member or an authorized representative
Electronic Signature: TERESA CARDENAS
I am the member or authorized representative submitting these Articles of Organization and affirm that the
facts stated herein are true. I am aware that false information submitted in a document to the Department
of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to
file an annual report between January 1 st and May 1 st in the calendar year following formation of the LLC
and every year thereafter to maintain "active" status.
T"vq17' ir-� 7, 7 Tom.
License #: CGC1527091 CFC1430157 CCC1331744
27501 S. DIXIE HWY., SUITE 403, NARANJA, FL 33032 Office #: 305-257-1000
Date: �— I —I q
State of Florida
County of Miami Dade
Before me this day personally appeared Ppm--L t VA
Deposes and says:
That he will be the only person working on the project located at:
q 353 ►A C- q ftvE
Contractor Signature
Sworn to (or affirmed) and subscribed before on this -1 day of-F(qo
Personally known _ V—
l� , N,
Stamp and Sign AV Pfft- Notary Public S" of FlWorlft
Elston Allen y gon"
eN r
My Cwwasion 00 222380,
�4.00� =ExPM0512&W=
Vat/
0% Zo%
who, being duly sworn,
2019.
Notice to Owner — Workers' Com
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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•.
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this I/ UE day of ` f% , 20.
By ��YE �{ rG�� ✓(QS who is p rsonally known to a or has produced
Q as identification.
Notary:'•.avi
LAW
SEAL: EXPIRES MwO 06, 2021