RC-10-20-2226, 10682 NE 11th CtMiami Shores Village
�I (�-Z3 Building Department
r_/ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
(v Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
I2Er1'EIVED
O C T 10 2020
BY:_6D
FBC 20 1� wtt-v
Master Permit No. k?C— 10. 2 Q - 222(.0
❑ REVISION
Sub Permit No.
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
JOB ADDRESS: I Q(De�3 Q�-_— 11 4
City: Miami Shores 11 County: Miami Dade Zip: 2:;?> l ��
Folio/Parcel#: 1-QW)Q -� �► Q5 �� Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
7,'(,o s�' 7 I0S_3
OWNER: Name (Fee Simple Titleholder): 2yn i 5 e-A' Phone#: _;05-
Address Ofp �� N. E . 117N C,.-t f i ywt i Gj Novas
City: M i dN►i ��'wome;' state: FLokzi v t> Zip: 33138
Tenant/Lessee Name: l A Phone#:
Email: CONTRACTOR: Company Name: iL.T k �ov�ST2uc.`� i �n Phone#: -7$6 - 255 -6124
Address: Z 330 '!�_7w
City: State: Zip: 3 14S
Qualifier Name: R i C_ -4cdlo 151>2-% I__�,-jEf2_ Phone#: _'79 Zc;S G124
State Certification or Registration M � G' 50673-7 Certificate of Competency #:
DESIGNER: Architect/Engineer: N %ice Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Z 20�. Square/Linear Footage of Work: I�
Type of Work: ❑ Addition Alterati ❑ New Repair/Replace ❑ Demolition
Specify color of color thru tile: " /A
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
CCF $
CO/CC $
DBPR $ Notary $
Technology Fee $,
Structural Reviews $
Training/Education Fee $
Double Fee $
ft
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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. 1 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. N /I
Signature
ZX 19WNEYOrAGENT
The foregoing instrument was acknowledged before me this
A 7'* day of 20 24 by
�jZr'li cJriVBt� --,who isTp-ersonally kn to
me or who has produced fJ�d as
identification and who did take an oath.
NOTARY
Sign:
The foregoing instrument was acknowledged before me this
•tit
_ day of
�20 22, by
1 C�4&who i persona y known o
me or who has produced _ P ZX . as
identification and who did take an oath.
NOTARY PUBLIC:
Sig
Print: QU�(.►NE 2��E5
i 1`- MY COMMISSION # G 20217s' Seal:
_ Seal 1 - —
N ; }� EXPIRES: June 1 riders i
s: •� o ' gorded Thru NAY public Undere JACOMLINE REYES
1 MY COMMISSION # GG 08273E•
= EXPIRES: June 11, 2021
APPROVED BY Plans Examiner Zoning
C+r.. r+u ro l 0—A nu, ri n►L
CFN: 20200501595 BOOK 32085 PAGE 4365
DATE:09/03/2020 04:19:25 PM
DEED DOC 2,316.60
HARVEY RUVIN, CLERK OF COURT, MIA -DADS CTY
"* DommmPirpamd By and ARWR to:
BXZIMM rxrw Cc"
Jose A Juara
340 Sevilla Ave
Coral Gablar,Florida 33134
Parcel m Number. 11-2232-028-0500
Consideration: $386,100.00
Warranty Deed
This Indenture, Made this 1st day of September, 2020 A.D., Between FL Miami Shores, LLC, a Florida
Limited Liability Company whose address is: 7934 West Drive # 905, North Bay Village, Florida 33141 of
the county of Miami -Dade, state of Florida, grantor, and Sami Springer, a single man whose address is: 10682
NE 11th Court, Miami Shores, FL 33138 of the county of Miami -Dade, state of Florida, grantee.
Witnealeth that the. GRANTOR for and to consideration of the sums of
-----TEN DOLLARS ($10)------- DOLLARS,
and other good and valuable consideration to GRANTOR to hand paid by GRANTEE, the receipt whereof is hereby w3mowle4ged, has
granted, bargained and sold to the said GRANTEE and GRANTEE'S heirs, mocesaors and assigns forever, the following described laud,
sidmte, lying and being in the county of Miami -Dade state of Florida to wit:
Lot 22, Block 3, Miami Shores Estates, according to the map or plot thereof, as recorded in Plat Book
47, Page(s) 58, of the Public Records of Miami -Dade County, Florida.
Subject to Conditions, restrictions, limitations and easements of record, WWXPS hereby renaposing same, and real property taxes
for the year 2020 and subsequent years.
The property address Is 10682 NE lath Court, Miami Shores, n 33138
wad the granter does hereby A* warrant the title to said lend, and will defend the same opunat lawN claims of all persons whomsoever.
In Witness Whereof, the grantor has hereunto set its heed and seal the dry sed year first above written.
Signed, sealed and delivered in our presence: -
FL Miami Shores, LLC, a Florida
Limited Liability Company
By:. tseal)
Mark A Illo MGR
P.O. Addtw 7934 weld Drim APW 90SNorth Hay Vtage, FL 33141
Printed fie: 9' -4 s C
Witn
STATE OF Florida
COUNTY OF Miami -Dade
The foregoing instrument was acimowledged before me by mesas of X physical presence or online notarization, this
fat day of September, 2020 by Mark A Mouz, MGR of FL Miami Sh9vap LLC, a Florida Limited
Liability Company who is pereonaily has pJoa bid )�u.+�'�1 C a.` ram' J f/,Sc`, 0�7" as idenvicatioa.
,yk-.
Prin N e:
No try blic
M ssiou Exph= / /
ARTEK CONSTRUCTION MANAGEMENT , CORP.
2330 SW 29TH AVENUE - MIAMI FLORIDA 33145 - CGC1506737
October 2, 2020
State of Florida
County of Miami Dade
Before me, this day personally appeared who, being
duly sworn, deposes and says:
That he will be the only person working on the project located at:
10682 NE 11 Ct, Miami Shores, F1 33138
--A
Sworn to (or affirmed) and subscribed before me this 2
by Richard Springer.
Personally know-.e*-4
day of 04. , 2020,
JACQUEUNE RMS
my commam # GG 082736
Print, Type, or stamp Name of Notary 1-i EVIRES. June il, 2021
Wr4W rNu Not9y POW UWW'ftm �1
VOICE: (786) 256-6124
E-MAIL: artokconstruction@hotmall.com
"Enhancing people's lives through extraordinary construction work solutions "
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 (ILLC) in the construction industry may elect to be
exempt if -
I , 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.
7
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND NDERSTAND 1TS
CONTENTS.
Signature:
Own
State of Florida r
County of Miami -Dade
The foregoing vvas acknowledge before me this Wr 1 day of
...— , i 20?e�o.
By 50AOii Spe; ry;sa- who is per, soUaill _Lnown to me or has produced
as identification.
Notary:
Qla�
SEAL:
JACQUELINE REYES
EXPIRES. June K 2021
4"MrVVN0tWyPudic WdVWdWM
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
10682 NE 11TH CT, Miami Shores, FL 33138 1122320280500
'ontacts
SAMI SPRINGER Owner ARTEK CONSTRUCTION MANAGEMENT Contractor
10682 NE 11TH CT, Miami Shores, FL 33138 CO
RICHARD SPRINGER
2330 SW 29 AVE, MIAMI, FL 33415
Business: 7862556124 artekconstruction@hotmail.com
Other:3054435778
Inspection Requests:
Description: REMOVAL OF INTERIOR FINISH (KNOCK DOWN)ON Valuation: $ 12,200.00 ,
CEILINGS & WALLS TO SMOOTH FINISH. REPLACING DAMAGED
EXISTING CABINETS (NO ELECTRICAL AND/OR PLUMBING) Total Sq Feet: 0.00 �sr r
Fees
Amount
Application Fee - Other
$50.00
CCF
$7.80
DBPR Fee
$5.49
DCA Fee
$3.66
Education Surcharge
$2.60
Permit Fee
$316.00
Scanning Fee
$9.00
Technology Fee
$9.15
Work Without Permit Fee
$366.00
Work Without Permit Fee - Plus $100
$100.00
Total:
$869.70
Payments
Date Paid Amt Paid
Total Fees
$869.70
Credit Card
10/01/2020 $50.00
Credit Card
06/07/2021 $819.70
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 foregoin 'formation is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I autho ' the above named contractor to do the work stated.
6-7-21
Authorized Signature: Owner / Applicant / ` 4ractY / Agent Date
June 07, 2021 1 Page 2 of 2
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