PW-10-20-2252Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
229 NE 101ST ST, Miami Shores, FL 33138 1132060134790 l
Contacts
RAUL NOBILI Owner VIP CONSTRUCTION GROUP LLC Contractor
352 NE 98 ST, MIAMI SHORES, FL 331382410 RICHARD OSPINA
5890 SW 19 ST, MIAMI, FL 33155
Business: 7865251739 3
Inspection Requests:
Description: DRIVEWAY PAVING Valuation: $ 2 500.00
305-762-4949
TotalSq Feet: 528.00
Fees
Amount
Education Surcharge
$0.60
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$112.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$112.10
Check # 9400
10/15/2020 $112.10
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
regulating c96 tructioh,and zoning. Futhermore, I authorize the above named contractor to do the work stated.
l ' UP // i 0
Applicant / Contractor / Agent
Date
October 15, 2020 Page 2 of 2
FZECEIVED
-s..- Miami Shores Village 0 C T 0 5 2020
Public Works Department
30 95 22 0 BY:
( 5)7 1 -
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Name of Applicant (if utility see below): Raul Nobili
Owner off the following described property:
Legal Description: Lot Block
Folio #; 1132060134790
Address: 229 NE 101 Street - Miami Shores, FL 33138
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone:
State Certification or Registration #:
Email:
Subdivision
State:
Permit#:?yJ_ V0_ 20- 122-IS 2
ZIP:
Certificate of Competency #
CONTRACTOR NAME: VIP Construction Group, LLC - (Richard F. Ospina)
Qualifier/Authorized Agent:
Address: 6890 SW 19 ST,
City: Miami State: FL Zip: 33155
Telephone: 786-525-1739 Email: allrichin@aol.com ` tic, Vxi - tC,Ioud.. Go"
State Certification or Registration #:L15000000948 Certificate of Competency #:CGC1519571
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: Drive way paving - 528 Sqf. Detals and Measurement enclosed
Type of Work: ■❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration-#:
State: ZIP:
Email:
Value of Work for this Permit: $2500
Permit Fee $ 100.00
Notary $
Bond $
Square/Lineal Footage of Work: 528 Sqf
***** Fees*****
Training/Education $ 0.20 Technology Fee $ 0.80 Scanning
(if required) Total Fee Now Due $ (( •• 1�
Bonding Company's Name (if applicable).
Bonding Company's Address:
City:
State:
Application is hereby made to obtain a public works permit to do the work in the right of way and
installations as indicated. 1 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, regulation construction in
this jurisdiction. I understand that separate permits must be secured for
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with applicable laws regulating construction and specifically construction in the
right-of-way.
"WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value
exceeding $2,500, 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 the
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 public works permit is issued. In the
absence of s[lch pghteAnotice, the inspection will not be approved and a reinspection will be charged.
Signature I A Iq
A plicant i' 1 horized Agent
The foregoing instwment wh acknowledged before
me this day of 5fj*, _, 20 71& , by
7y, i k t who
is personally known to me or who has produced
�L17I✓ as
identification. f.\ pt u L N f[,A l G I
NOTARY PUBIX.. �
Sign:
Print:
SEAJOSE VUIL
Notary Public - State of F:orida
Commission p GG 934755
ad My Comm. Expires Nov 25, 202
Bonded through National Notary Assn.
Signature
The foregoigg instrume as acknowledged before
me this '30_121ay 20 26 , by
(-33t who
is personally knWn to me or afho has produced
1—L17L_ as
identification.
)? !1- - 0 ,; /
NOTARY PU
Sign: '
Print:
SEAL•
t►�" °4,'' JOSE VIJIL
' Notary Public - State of Florida
Commission k GG 934755
My Comm. Expires Nov 25, 2023
Bonded through National Notary Assn,
******************************************
MY
APPROVED BY: it L,o Public Works Director, or Designee
2017-04-15
www.Vii)ConstructionGrout).com
CONTRACTOR PROPOSAL
LIC. # CGC 1519571
Date: September 25, 2020
State: Florida
County: Dade
Before me this day personally appeared Richard Ospina who being duly sworn,
Deposes and say:
That he will be the only person working on the project located at: 229 NE 98 ST, Miami Shores,
F133138 and 352 NST
Sworn to and suscribed before me, this ",Q day of -Sf2 4c, �o e� , 2020
Personally known
Or Produced Identification C f � J C
Type of Identification Produced
JACK VICTOR OSPINA
Notary Public — State of Florida
Commission # GG 165653
T; My Comm. Expires Mar 31, 2022
80MW through Natio4 Noary Assn.
Prilt, Ty or Stamp of Notary
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' oensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNBELOWOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENI / l
Signature:
State of Florida
County of Miami -Dade
The for oing was ackr
By
Notary:
SEAL:
before me this day of , 20
who is persona y known to me or has produced
as
COMMISSIbN # GG 103959
EXPIRES: May 11, 2021
,d Thni N®t@ry Public Underwriters
1
Ron DeSantis, Governor
STATE OF FLORIDA
Halsey Beshears, Secretary
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE
PROVISIONS OF CHAPTER 489, FLORIDA STATUTES
OSPINA, RICHARD FRANK
VIP CONSTRUCTION GROUP, LLC
6890 SOUTHWEST 19TH STREET
MIAMI FL 33155
LICENSE NUMBER: CGC1519571
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.
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
6982129
BUSINESS NAME&OCATION
VIP CONSTRUCTION GROUP
LLC
6890 SW 19TH ST
MIAMI, FL 33155
OWNER
VIP CONSTRUCTION GROUP LLC
C/O JACK OSPINA MGR
Worker(s)
RECEIPT NO.
RENEWAL
7257710
EXPIRES
SEPTEMBER 30, 2021
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
SEC. TYPE OF BUSINESS
196 GENERAL BUILDING
CONTRACTOR
CGC1519571
PAYMENT RECEIVED
BY TAX COLLECTOR
75.00 07/18/2020
GREDITCARD-20-056307
This Local Business Tax Receipt only coa6rms payment of the Local Business Taw The Receipt is no a license,
permit, or a certiscation of the Adder's quaHBcations, to do busioom Holder must comply with any governmental
or nongovetamentai regulatory laws and requirements wbich apply to the businoss.
The RECEIPT NO. above meet be displayed on all commercial vsMcles — Miami —Dade Coda Sec 88—M
MIAMMADON For more loiormation, visit wyniviniamidedegovitaxcoll
ACORU® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD(YYYY)
09/18/2020
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 ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, 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
CONTACT
ONT Ray Guell
A Quick & Easy Assurance Group,lnc.
7229 Coral Way
PHONE !: (305) 662-7030 N, , (305) 267-1197
EL
AD-MAIDREESS: rayguell@aol.com
INSURER($) AFFORDING COVERAGE
NAIC M
INSURERA: UNITED SPECIALTY INSURANCE COMPANY
Miami FL 33155
INSURED
INSURER B :
—
INSURER c :
VIP Construction Group, LLC, You Design, LLC
_
INSURER D :
6890 SW 19 St
INSURER E :
INSURER F :
Miami FL 33155
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.
LTRR
TYPE OF INSURANCE
ADDLSUBRIMMIPoucY
POLICY NUMBER
EFF
Y EXP
POLICY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
Y
DCGO4149-03
12/07/2019
12/07/2020
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
_
PERSONAL & ADV INJURY
$ 1,000,000
_GENI.
X
AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
_
$ 2,000,000
Hired and Non -owned
$ 1,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COMBINED SINGLE L M T
Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
lOPEERR Y DAMAGE
$
_
UMBRELLA LIAB
EXCESS LIA6
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECUTIVE ❑
OFFICERIMEMBER EXCLUDED?
(Mandy In NH)
If yes. describe under
DESCRIPTION OF OPERATIONS below
N N A
PER O
STATUTEI ER
E.L.EACH ACCIDENT
$
EL. DISEASE - EA EMPLOYE
$
E.L. DISEASE -POLICY LIMIT
—
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more specs is required)
License #CGC1519571
L9L1z1#i4 IkW_11L91'.l
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores Village Bldg Dept ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
10050 NE 2nd AVE
Miami Shores FL 33138 •�•••�t�
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
F
JIMMY PATRONIS
CHIEF FINANICAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 2/6/2019
PERSON: RICHARD F OSPINA
FEIN: 472672571
BUSINESS NAME AND ADDRESS:
VIP CONSTRUCTION GROUP, LLC
6890 SW 19 ST
MIAMI, FL 33155
SCOPE OF BUSINESS OR TRADE:
Licensed General Contractor Licensed Roofing Contractor
EXPIRATION DATE: 2/5/2021
EMAIL: RICHARD@VIPCGROUP.COM
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply
only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available
from the building department,
i0050 NE 2"4 Ave., Miami Shores, FL 3313F
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (hereby referred to as the owner) Raul Nobili
Of the following described property:
Legal Description: Lot Block - Subdivision
Address: 229 NE 101 St. - Miami Shores, FL 33138
CCFN 202E. R0541482
UP ilk 32113 P<a� 1346--134 3 Pjs,
k"l-C ORDER 09/2U'20;20 i 4 a 2 t. °'&4
HARVEY RUVINY CLERK (]F NURi
`iafaCil PsiiflL CfMUNTYe FLORIDA
Folio a; 1132660134790
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way:
Driveway paving details enclosed
IN CONSIDERATION of the approval of this permit by the village, the owner agrees as follows.
I. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it
becomes necessary for Miami Shores Village or Miami -Dade County to make repairs or maintain said items within the public
right of way including restoration of the street by reason of the Owner's failure to do so, such expense shall be paid by the
Owner or shall constitute a lien against the above described property until paid.
2. The owner does herby agree to indemnify and hold Miami Shores Village or Miami -Dade County harmless from any and all
liability, which may rise by virtue of permitting the installation of these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 14 days' notice by the
Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien
being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the
item(s).
The undersigned further agrees that these conditions shall be. deemed a covenant running with the land and shall remain in
full force and effect and be binding on the undersigned, their heirs and assigns until such time as this obligation has been
cancelled y an affidavit filed in the Public Records of Miami -Dade County, Florida by the Village Manager of Miami Shores
Village (or�is fully, atathortzed representative).
Signatur
State of
County
The
egoing instrument
was acknowledged before me this ,; __ day of -' ts�. 20, I- by
:who is personally known to me or who has produced
as identification.
NOTARY P _.EGG
_ -I
Sign: C,0k" ISS4ae'r9
Print: SEAL
Documents are recorded at the Clerk of the Courts,
MIAMI-DADE COUNTY RECORDER, COURTHOURSE EAST-,
22 N.W. First Street, 1st Floor, Miami, FL 33128,
2017-04-11
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229 NE 101 St.
Parkway
Paving Cut View
Border Retainer Cement
Casting with 3/8 rebar
°°°°~°
~
=°°°°
Compacted Ground Level
229 NE 101 St.
Paving Plan View
+--Paving Sand
-PILIAAlLiOt0 iQ F�5
229 NE 101 St.
Parkway
Paving Cut View
Border Retainer - Gernent
Casting with 3,18 ebar
4" X 4;.
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Ccnlpactei Grourid Level
229 NE 101 St
Paving Plan View
$- -- -24 feet
44 feet
:----- Paving
--- Paving Sant!
• — Compacted Gravel