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PL-11-21-2937, 1298 NE 95th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 1298 NE 95TH ST, Miami Shores, FL 33138 1132060144030 Contacts Yuri Morales Owner Yuri Morales Applicant 302 Ne 92 st, Miami, FL 33138 302 Ne 92 st, Miami, FL 33138 Business: 3057903849 yurimorales@gmail.com Business: 3057903849 yurimorales@gmail.com Mobile: 3057903849 Mobile: 3057903849 GREENLAND CONSTRUCTION & Contractor ENGINEERING L.L.0 ARIEL DIAZ 5440 NW 172 ST, MIAMI, FL 33055 Description: DRAINAGE SYSTEM AS DESCRIBED ON PLANS Valuation: $ 8,000.00Ins ection Requests: Total Sq Feet: 1.00 Fees Amount Application Fee - Other $50.00 CCF $4.80 DBPR Fee $4.20 DCA Fee $2.80 Education Surcharge $1.60 Permit Fee $230.00 Scanning Fee $3.00 Technology Fee $7.00 Total: $303.40 Building Department Copy Payments Date Paid Amt Paid Total Fees $303.40 Credit Card 03/09/2022 $303.40 Amount Due: $0.00 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 regulatinQcpnstructfon and zoning. uth rmore, I authorize the above named contractor to do the work stated. Authorized March 09, 2022 / Applicant / Contractor ! Agent Date Page 2 of 2 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 PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING NR 10 f121 FCC 20.0 Master Permit No. C - o-i - Sub Permit No.:F� ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS:1298 NE 95 St, City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-014-4030 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: new Flood Zone: BFE: FFE: OWNER: Name (Fee simple Tiitleholder):YURI HUMBERTO MORALES Phone#:305 790 3849 Address:1298 NE 95 St City: Miami Shores State: FL Zip: Tenant/Lessee Name: Phone#: Email: iNrv� ��-� `^�►�� v ' CN L7 CONTRACTOR: Company Name: Greenland Construction & Engineering LLc Phone#: 786-256-1920 Address: 5440 Nw 172 St City: Miami State: FI Zip: 33055 Qualifier Name: Ariel Diaz Phone#: 786 2561920 State Certification or Registration #: CUC1225384 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ R K27-00 n Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 0 New ❑ Repair/Replace ❑ Demolition Description of Work: Drainage system as described on plans. Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $.� �U Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip City State 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 reinspection fee will be charged. -A Signature Signature OWNER or AGENT / CONTRACTOR The foregoing instrument was acknowledged before me this daayvof W o �'t-lUl�� 20 7 , by l�� ( I "�'-'42A4JES , who is personally known to me or who has produced as The foregoing instrument was acknowledged before me this ►► — day of .(3 20 J by I�-�C-�► - �t-p.� L -,_� ,perswho is personally known to me or who has produce Lk— L.CL`— identification and who did take an oath. identification and who did take an oath. NOTARY P LIC: NOTARY PUB Sign: Sign: Print: Cj r-1 t> Print: - Seal• Seal: ALVAREZ - , — SINi7!A AI.VAR Z iaFl SINDIA MY COMMISSION # GG 2.38273 fw cot,%ji5"'0'd # GG 238273 EXPi 2E&.September 3, 2022 �'r,•�..•2`,'• ember 3, 2022 "ry EXPIRES: Sep I�- k & ,:,° Bonded Thru Notary Public Underwriters )p, APPROVED BY 1 �1 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 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. "/ COPY OF QUALIFIER'S STATE LICENCES B. I% COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ■rrrrrrrrrrrrrrrrnrrrrrrrrrfrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ BUSINESS NAME: BUSINESS ADDRESS: ;L(K p NW 0 Z `C CITY 01 STATE ZIP BUSINESS PHONE: 1 9� 1 FAX NUMBER r CELL PHONE () 25(0 (1 ZD QUALIFIER'S NAME: R (� i QUALIFIER'S LIC NUMBER: C L) C- 1 2 2" 0 C Ron DeSantis, Governor STATE OF FLORIDA Halsey Beshears, Secretary DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE UNDERGROUND UTILITY & EXCAVATION CO HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES lit DIAZ, ARIEL GREENLAND CONSTRUCTION & ENGINEERING L.L.C. 5440 NW 172 ST MIAMI FL 33055 LICENSE NUMBER: CUC1225384 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense. corn Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. Floridapr 004671 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 6447395 ou37NESS NAMEXOCATION RECEIPT NO. GREENLAND CONSTRUCTION & ENGINEERINGIMEWAL 5440 NW 172ND ST 7572309 MIAMI FL 33055 EXPIRES SEPTEMBER 30, 2022 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS GREENLAND CONSTRUCTION & ENGINEERING LLC 196 SPECIALTY ENGINEERING CONTRACT PAYMENT RECEIVED C/O ARIEL DIAZ QUALIFIER CUC1225384 BYTAX COLLECTOR Worker(s) $75.00 09/0212021 INT-21-373638 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sac 8a-276. For more information, visit www.miamidade.govltaxcollector Ron DeSantis, Governor STATE OF FLORIDA Halsey Beshears, Secretary AFlorida ka DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES DIAZ, ARIEL GREENLAND CONSTRUCTION & ENGINEERING L.L.C. 5440 NORTHWEST 172ND STREET M IAM 1 FL 33055 LICENSE NUMBER: CGC1516309 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. 002512 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6447395 BUSINESS NAMMOCATION RECEIPT NO. EXPIRES GREENLAND CONSTRUCTION & ENGINEERINCEWAL SEPTEMBER 30, 2022 5440 NW 172ND ST 6715883 Must be displayed at place of business MIAMI FL 33055 Pursuant to County Code Chapter 8A - Art. 9 & 10 S. OWNER GREENLAND CONSTRUCTION & ENGINEERING SEC. TYPE OF BUSINESS PAYMENT RECEIVED LLC 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR C/O ARIEL DIAZ QUALIFIER CGC1516309 $75.00 09/02/2021 Worker(s) 1 INT-21-373638 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ra-276. For more information, visit wvvw.miamidade.gov/taxcollector ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDOlYYYY) 9/29/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONKE INSURED, the policy(ies) must be endorsed. If SUBROGATION IS 1 , subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Simple Employer Solutions 11, Inc PH A&No Ext): 941-761-2882 �(AII941-896-3178 ADDRESS: rmooreoprodigyresults.com 2722 Manatee Ave W INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Normandy Insurance Company 13012 Bradenton Florida 34205 INSURED INSURER B : INSURER C : PEOProdigy, Inc INSURER D : 2722 Manatee Ave W INSURER E : INSURER F : Bradenton 34205 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIMY) (MM/DDNYYY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE DOCCUR EACH OCCURRENCE $ RENTED - PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO JECT ❑ LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A NHFL0053042021 5/23/2021 5/23/2022 X STATUTE I I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy provides coverage to leased employees in Florida but not subcontractors of: Greenland Construction & Engineering LLC Effective: 5/14/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2nd AVE Miami Shores FL 33138�L� ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD