DEMO-06-19-1271, 9353 NE 9th AveMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
3353 NE 9TH AVE, Miami Shores, FL 33138 1132060010040
:ontacts
9353 FLORIDA LLC Owner BANANAS GROUP, INC. Contractor
RAFAELLEYVA
27501 S DIXIE HWY 403, NARANJA, FL 33032
Business:3052571000 eallen.bananas@gmail.com
a
mm _ Ins ection Re uests
Description: PLUMBING DEMOLITION ON TWO BATHROOMS j Valuation: $ 800.00
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Scanning Fee
$3.00
Technology Fee
$1.25
Walls, Signs, Other Demolition Fee
$50.00
Total:
$109.05
Payments
Date Paid Amt Paid
Total Fees
$109.05
Credit Card
06/04/2019 $50.00
Credit Card
10/08/2019 $59.05
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 named contractor to do the work stated.
AutWorized Signature: Owner / Applicant / Contractor / Agent Date
October 08, 2019 Page 2 of 2
kb � �01 I "- -.
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑BUILDING ❑ ELECTRIC ❑ ROOFING
gECEI'VE�'
J N 0 4 019
BY ��
FBC 20 ! .�
Master Permit No.�o l - lL
Sub Permit No m l 9 - 1.27) 1
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
� CONTRACTOR DRAWINGS
JOB ADDRESS: -63 "F_ ` (� I'�
City: Miami Shores County: Miami Dade Zip: 33 13 9
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: JJ Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder):-:�DPhone#:
Address: ) -21 fn a t�- I Sjr
City:-1mt State: Zip: 3-3141
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:b ,r' ' '`� `, � R -}"' `-� Phone#: �5( OW
Address: r s. i xi 1. / W
t; es✓& -
City: N A A40-1A, State: 1- L Zip: 7�
Qualifier Name: �� (,,iaJ�-- /�--7 Phone#:
State Certification or Registration #: 1 ®(") / Certificate of Competency #:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ 25 �) 6 C? ,-
hone#:
City:
Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ Alteration )) ❑ New ❑Repair/Replace Demolition
Description of Work: c'" Sf / 7R� �s7/0 xt-A ✓J e3 _oc) 6Cc71 YC><>" i � S;„,
e
Specify color of color thru tile. -
Submittal Fee ,$ M) Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $.
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 7 • QG
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) ays after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspectio ee will be charged.
Signature ` Signatu
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
{I '?� day of f r ua r 20 by
Ttrf_S4 Grzgen _ wh �persollyown to
me or who has produced
identification and who did take an oath.
as
The foregoing instrument was acknowledged before mm�e+ this
day of �as� C�i by
who is ersonally kn5to
me or who has produced N A as
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLICkK::
Sign: Sign:� c -
Print: Print:l�
Seal: ;q''►►' SANDRA D r�
Seal:
MY COMMISSION #R GG07524e Notary Public Stara of Florida
EXPIRES Mardi 06. 2021 . Elston Allen
t�Ex Commission"0512 t3Ci 22W80
Expires t)5l2t1/2o22
APPROVED BY p S e9 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Rw
7
License #: CGC1527091 CFC1430157 CCC1331744
27501 S. DIXIE HWY., SUITE 403, NARANIA, FL 33032 Office #: 305-257-1000
Date: 0` 1 ` q
State of Florida
County of Miami Dade
Before me this day personally appeared FCL �Cu, VA who, being duly sworn,
Deposes and says:
That he will be the only person working on the project located at:
q 3)53 rJC R Avg
Contractor Signature
Sworn to (or affirmed) and subscribed before on this -1 day of -Feb , 2019.
Personally known V_
1� ANeiv
Stamp and Sign
Notary Public Stalls of Flkwxft
Elston Alien
+ Ex Commission GAG 2223f30
�Ij Expires 03/28/2022
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:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this ay of tJ 20.
By_ E 5 i �� ��5 who is p rsonally known to me or has produced
as identification.
r?1P*1N 161&'�r�i►'%tom.
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