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RC-11-20-2541Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 190 NW 103RD ST, Miami Shores, FL 33150 1131010230010 Contacts Axel Bilbao Owner HOME OWNER Contractor 190 103 HOME OWNER Mobile: 7863564944 ..------- ...... �1' Inspection Requests: Description: floor tiles REPLACED 16-3290 Valuation: $ 4,500.00 762-4949 Total Sq Feet: a 0.00 Fees Amount Payments Date Paid Amt Paid 100% Permit Renewal Fee $135.00 Total Fees $135.00 Total: $135.00 Credit Card 11/19/2020 $135.00 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 c struct2n and zoning. Futhermore, I authorize the above named contractor to do the work stated. re: Owner / Applicant / Contractor / Agent Date November 19, 2020 Page 2 of 2 Miami Shores Village REc'EIVEr� Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 $Y: - . �. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949� FBC 201'9- BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I I O �j ( o 3 City: Miami Shores County: Miami Dade Zip: 3 3 [� Folio/Parcel#: 113 lot o 23, C010 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Namri3O-- e (Fee Simple Titleholder): il4sep Phone#: 'M 3S4 -yP/ Uri Address: �`IO NL% r�I'�o-3 City: i1 t i}'" ( rt� A t State: -FL— zip: 3"31,lu Tenant/Lessee Name: Email CONTRACTOR: Company Name: Address: City: Phone#: Phone#: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Zip: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: -V I oo Q i'Qs Specify color of color thru the: Submittal Fee $ Scanning Fee $ , Technology Fee $ Structural Reviews $ Permit Fee $ CCF $_ Radon Fee $ DBPR $ Training/Education Fee $ CO/CC $ Notary $, Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ IS, • OG (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 M. 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. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this —04 day of U C VC��pp1`n��10e l� 20 2G , by eL► Cal C--'A o BAD who is personally known to me or who has produced V- (.. -D L.— as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: -iC on 1�►���i�� Seal: AM SELENA ARANDA MY COMMISSION # GG 971705 :'••.`off-` EXPIRES: March 22, 2024 APPROVED BY Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of me or who has produced 20 , by who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: rY Plans Examiner Structural Review as Zoning 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 OWNER BUILDER DISCLOSURE STATEMENT NAME: &X0, 61 L84 DATE: 2 _ ADDRESS: 1 Yo +v W 103 pr A 4m1 4 kdo FL— 33ij 0 Do hereby petition the Village cf Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. /�J/� Initial )IVY' 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial_ 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption, Initial lW I 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. /'7 Initial 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 17y'l 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. 1 agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner -builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial—/ 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 85O.487.1395 or http://www.mvfloridalicense.com/dbpr/pro/cilb/index,html Initial_ G� 11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands that i am the party legally and financially responsible for the proposed construction activity at the following address: I fo /,JW 10) �r M141- > 4", jL Initial�J4-n 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this "1 t,� day of AUMI /fit. , 20 Oq__ By A ,Kt° GUS40NO $i L&O who was personally known to me or who has Produced there License or VL DL— as identification. NOTARY SELENA ARANDA My COMMI SHyD,.N.�# GG 971705 G/1rIRCJ; 22, 20 MIMh Z4 Bonded That Notary public Undemaiere Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FI 33138 Tel: 305-795-2204 Fax: 305-756-8972 1 /3/2018 Owner: 190 NW 103 Street Miami Shores FL 33150- Process No: RC-12-16-3290 Address: 190 NW 103 Street Dear Sir or Madam: Our records indicate that the above referenced permit application has expired. According to section 105.3.2 "Time limitation of application. An application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith or a permit has been issued." In order to serve you better, we need to keep our files up to date. Please be advised that an expired permit application will hinder your ability to obtain new permits, refinance or sell this property. It may also suspend a contractors permit privileges in Miami -Dade County. Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincere) C-0 Ismael Naranjo, CBO Building Director 305-795-2204 BUILDING PERMIT APPLICATION j BUILDING ❑ ELECTRIC Miami Shores Village Building Department JUL 01,2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F B C 20,, f� Master Permit No. 12r 3�� Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / Gild C City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: /f `` 5-zol -O z3 -ocy o Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: _ Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): C fZ- 45,7�- ZP Phone#: Address: f� /� 6)X 73 -� 13 0 5- City: State: z- Zip: Tenant/Lessee Name: Email Phone#: CONTRACTOR: Company Name: ;G"S e s Phone#: -;z Address: /�S'�/ S « S City: State: -� Zip:f Qualifier Name: ells lLl ✓y 5(- l/ r��ia�E'/"7 Phone#: State Certification or Registration #: G' /z .?elf Al Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: 61 l City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: zz!221 4�2 Type of Work: ❑ Addition Description of Work: Alteration ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $e (�-k- CCF $ Radon Fee $ Training/Education Fee $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ J 8 cc.-�' Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 0 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. Signatu ER or AGENT The foregoing instrument was acknowledged a me this day of 20 i by who is personally known to me or who has produced PL, vw_5 L�ic?� ias identification and who did take an oath. NOTARY PU Sign: Print: Seal: BONEFED THRU FLORIDA NOTARY, LLD Signature CONTRACTOR Fhe foregoing instrument was acknowledged before me this <�7 5- _ day of 2 e , 20 / ; _ by N• t S'� hh ��_ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: + SS Y.a S• 8 • F137966 Seal: =�y,sm�Q` DPI . UL 01, 2018 BONDED THRU . OF FL �.•' 1st FLORIDA NOTARY. LLD ************************************************************************************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Notice to Owner — Workers' Corn 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 lie 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: State of Fl( County of Miami -Dade The foregoing was acknowledge before me this day of 6�? 20��. By �T�j/J �. 7�5 who ' personally known to or has produced $#O N Notary Public State of Florida Joanna M Feliciano �j ,(� My Commission FF 082753 $p Ads Expires 0111212 118 DOME ENTERPRISES INC. 11341 SW 27 ST MIAMI, FL 33165 DATE 6/30/2015 STATE Florida County of Miami Dade Before me this day personally appeared Gustavo Schneider who,being duly sworn,deposes and says: That he or she will be the person working on the project located at 190 NW 103 ST Sworn to ( or Affirmed) and subscribed before me this 30 day of June 2015 by Gustavo Schneider Personally Know Or Produced Identification Type of Identification Produced JUL 01, 2018 ,ED THRU A NOTARY. LLO 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (3051 756-8972 DEC 0 5 zoos INSPECTION LINE PHONE NUMBER: (305) 762-4949 f r—"-- FBC 20YA 7 BUILDING Master Permit No.� l Zq 0 PERMIT APPLICATION Sub Permit No. C/BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 00 0-1) 110 City: Miami Shores County: Miami Dade Zip: 531lo Folio/Parcel#: Occupancy Type: Load: Construction Type: the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /"rX� �� �%� Phone#:8rvSf!'J�� Address: iqo NW 103 City: M I AM' 6-10 U) State: Zip: 3 3 E S'o Tenant/Lessee Name: Email: AA— 31 t^AP C, lti�,'J C-0I Phone#: CONTRACTOR: Company Name: Vni + �� ��OV Phone#: 30S ASS 4 Address: 7 L 2 J i�j Lk) S "- City: 10 1 ti 1, ( t State: A Zip: (Y r_1 �.� Qualifier Name: �-'V�?� r-i' �. i { (i 5 Phone#:(z 11 13!�'o - Ish'iU State Certification or Registration #: _ v 1 I `j \ Certificate of Competency #: DESIGNER: Architect/Engineer: Add Value of Work for this Permit: $ e#: City: State: Square/Linear Footage of Work: Zip: Type of Work: ❑A))ddition El Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: tom'- - op Specify color of color thru tile:. Submittal Fee $ Scanning Fee $ Technology Fee Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary; Double Fee $ Bond $ TOTAL FEE NOW DUE $ (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. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: 1 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 com encement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is is ed. 1 the absence of such posted notice, the inspection will not be appr�d a reinspection fee will be charged. A Signature �Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 2 day of *b6Z--N43;,-f— 20 1{0 by AYy\.- 1.3. w( Ao , who is personally known to me or who has produced �)GICA w'N s" as and who diO take an oath. NOTARY P BLIC: Sig P int: S ao, � T'r APPROVED BY (Revised02/24/2014) JAIME MANOTAS Notary Public . State of Florida MY Comm. Expires Aug 17, 2016 COmmIS9i00 # FF 1s15 y The foregoing instrument was acknowledged before me this day of 1'L— 20 �� by chi �r rr��J who is personally known to me or who has prodKed //�� as identificatich and vkhb did take an oath. NOTARY P bLIC: Print: Seal: a,�"�„(Is, MY COMMEtl1�T90T0 i26 a : ISSION t FF W2 * * EXPIRES: Sept fiber 2 r�s u>� � 7 311ded Thru BW *`**********************�***** Plans Examiner Zoning Structural Review Clerk Miami shores Village Building Department 10050 N.E2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Uwner — worKers, Compensation insurance exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. S 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. t Signature: _ Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this S day of C41+is 120 . BY---,4/c.+�1'C% M_ wh -Is— personally known re or has produced as identification. �otiraf ;peck, ELt.107 S'UTO Nota ry-My coMMISSION # FF =26 _ _._ ----- — ---" * *EXPIRES: September 27, 2019 �. �` gondedThru&id9et ryServkes SEAL: 'Tan Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 July 15, 2015 Permit No: RC15-1637 Building Critique Provide details and specifications for the structural floor system supporting the new tile floor. Ismael Naranjo Building Official Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. Miami Shores Village Building Department J 2 'g 901fr 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 V l� Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: FBC 20!'-4 Master Permit Nq�'_al Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ©A GE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): I e d ,%Li G' vL L) c, Phone#: 766 S/ V Address: City Tenant/Lessee Name: Email State: Zip: Phone#: �-t - `i IL — CONTRACTOR: Company Name: V Phone#: / Z 3 F0 13 q 0 Address: :712�2 0 i2 LN) 61 jn %a 4, 10 City: r A- State: 7 ( fti i c( Cti Zip: a 3 1 6.— Qualifier Name: G A- ( U Phone#:2h58p 3 v State Certification or Registration #: Certificate of Competency #: — DESIGNER: Architect/Engineer: (�_ t; (° l 'j ) `/ 5 3 Phone#: _ Address: City: State Value of Work for this Permit: $� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF S DBPR $ M ❑ Demolition CO/CC $ Notary $ J Double Fee $ Bond $ TOTAL FEE NOW DUE $ .1 06 90 (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 occu even (7) days after the building permit is sued. In a absence of such posted notice, the inspection will not be approved an a einspection fee will be charged. Signature or AGENT The foregoing instrum7en t was acknowledged before me this // day of % 20 b by �)C.— who is personally knownntto me or who has produced ��_ �'�-� 1 ()c( � identification and who did take an oath. Signa The foregoing insku-ment was acknowledged before me this / /day of ��j f)�1J 20 by Cof h'r ..ail JA 4 11O S wn�. me or who has produced s identification and who did take an oath. NOTARY P LIC: NOTARY PUBLIC: 47Sign: Sign: Print: Print: 'u� ' ,,,r+RgpTO r,j, 50f P`g J No.ory !"'.,tiLc State of Florida , till M Seal: • x Ser�nia A wa c,. '' MY COMMISSIO�aFF Seal: IR 2019 vc o° my Corn i i. on F 156750 " k t tF' iS'. $0(1t6lfb8f ri utaq f nb;r 2 2019 r Fore°� ExpiasOb.l3-:;G18 �trL:�i$u'tVIV 0,�36dA�2ermbar27,20►8 vii APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �1 ��►coRca CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) �,,,... 12/05/2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Westward Insurance Services (305) 418-841 1 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE 2500 NW 79`h Avenue COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 283 Dora! FL 33122 I INSURERS AFFORDING COVERAGE NAIC # Universal Group, Inc. 7228 NW 56 ST. Miami FL 33166 COVERAGES INSURER A: International Insurance Comp of Hannover INSURER B: INSURER C: INSURER D: INSURER E. 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD DATE MM/DO/YY DATE MM/DD/YY A ® GENERAL LIABILITY B106201 10/13/2016 10/13/2017 EACH OCCURENCE $1 ,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $100,000 COMMERICAL ® ❑❑ CLAIMS MADE ® OCCUR MED EXP (Any one person) $5,000 ❑❑ -- PERSONAL & ADV INJURY $1 U00,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 ® POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ (Each Occurrence) $ ❑ ANY AUTO BODILY INJURY (Per person) $ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS BODILY INJURY $ ❑ HIRED AUTOS (Per accident) ❑ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ ❑ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ❑ ANY AUTO OTHER THAN EA ACC - $ I ❑ AUTO ONLY: AGG I $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ ❑ ❑ OCCUR ❑ CLAIMS MADE I $ ❑ DEDUCTIBLE ❑ RETENTION $ $ WORKERS COMPENSATION AND ❑❑ OTH- ORY LIMITS ® EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PART NERIEXECU- TIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE t $ If yes, describe under E.L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS below ❑ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certified General Contractor & Roofing Contractor 190 NW 103 STREET, MIAMI SHORES, FL 33150 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Miami Shores Village Building Dept. EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO 10050 N. E: 2"d Avenue MAIL 30 DAYS WRITrEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Miami Shores Florida 33138 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATK)N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) @ ACORD CORPORATION 1988 mik't\ ol..V t I, VV VLI\I YIJI\ nuv ­ -1. vw, au,.,,, LICENSE NUMBER STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 MATOS, GABRIEL PIERRE UNIVERSAL GROUP INC 7228 NW 56TH STREET MIAMI FL 33166-4247 ISSUED: 0811112016 001155 C] L DISPLAY AS REQUIRED BY LAW SEO # L1608110002423 Laval Sassiness Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAV 6472567 BUSINESS NAMEMOCATION RECEIPT NO- EXPIRES UNIVERSAL GROUP AC RENEWAL SEPTEMBER 30, 2017 7228 NW 56 ST 6741772 Aust ba displayed at puce of business MIAMI FL 33166 Pursuant to County Code Chapter BA - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS UNIVERSAL GROUP INC 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR C/O MATOS, GABRIEL PIERRE CGC1517463 y75.00 09/15/2016 Worker(s) 1 CREDIFCARD-16-054017 This Local Business Tax Receipt only conlirms payment of the Local Business Tax. The Receipt is not a license. permit, or a certification of lite fielder s 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 8a-276. For more itdormation, visit wNrY Llrt�nidade.ga axcoilecior IMPORTANT STATE OF FLORIDA ` a5seanfMGl ip}g A3e (15i1dj f.5. sn dfilrr eta mpnaiun DEPARTdiENTOFFINANCIALSERVICES T�Fa # ur wem az n(o finis Ch3P r try fdA9 a cent sled DIVISION OF WORKERS* COMPERISATIOI ., e tt ,u cre awa�may carrw:rt#rzGsr ;F GONBTRUCTIONINOUSTRYEXEMPTION :D PA^"xt'Gu' �a�h{1'-l. S_cec�cMe,oce�na be-Ti_.. ELEC TO eF fYEURr .L ePpty a11tJ itfrmt iM Itcge of P.M t=z= G fr--- elaaNzneteotexC slab—n,M "n._X' M' C -' rRn � ROR n4 �aX,.z'ta'.a.^:rznoa t;av MT a g Pt,'� ,m to f=ti'yR"-E: aco.ts3C13?. F.S.. Ne4Ce5 d ekG�n l0 ce I:Ff LCiT:L tL1TL: +T`a.'V!u Ga'L'iAROp OASE= 3SprvN `' • Hc ese.'r.;rla'A ^.o�asrazas of cccWn to ee a To slug t e 3L';�7/"•G torev-.^%�rlirxt:I. 4+b:y t'sm a gar the 1:1109 cl the mice Of!I4213.s...3a2 4°NYC i'ESiCOil l'ATOS C✓EiUFl R f ` cert'6•9e. m, ♦X.:..ry n3.T,E'� O:1 the r1t`e. w0 cena=6 nO WM" rr'w^nS 1!!e n:9L^mmrerts d Nth (�, srrt[on fw i TRte of a �s rea*�. The dr r Vr.�em sh-1 m. " aCzRE" 9ei"L±*k9farfaHuxof ftfa rset5nn 0a rnn!e BUSINESS NAPAE AND ADDRESS: i E cani imfe fm o •ef the exrpdrernerlsof this ;coon. UNIVERSAL GROUP, INC UNIVERSAL CONSTRUCTION INC GABRIEL NIATOS MIAMI FL 33166 SCOPES OF 3USNIESS OR TRA LICENSED GENERAL LICENSED ROOFING, HEATING, VENTILATION, CONTRACTOR CONTRACTOR AIR-COND A - I-C, i->- VLGA " mm � � .^y-.~O1q STRUCTURAL COMPUTATIONS FOR '••' :...:. •: ...... . ...... • • • • • • .... . .. ..... ...... . . .... ..... ...... .... . . . . ...... .. . • ••• RESIDENCE AT 190 NW 103 ST. " ' MIAMI SHORES, FL. 'INVESTIGATE FLOOR CAPACITY WITH NEW TILE APPROVED COMBINED ENGINEERING SCIENCES G/ - -f— 13 CARLOS ENSENAT, PE 32566 CERTIFICATE OF AUTHORIZATION No, 9108 !% 1214 SW 12 CT. MIAMI, FL. 33135 ( 305 ) 856-6345 COMBINED ENGINEERING SCIENCE,$..:. ...... . ...... November 9 2015 .... . .. ..... ...... . . ..... . . . . .... .... ...... City of Miami Shores, Florida :••:•: •: . . . . ...... Re: Residence at 190 NW 103 St. Miami Shores, Fl. Gentlemen. We inspectected the floor system on the referenced residence, to evaluated the placecement of tile on the exsting floor. The residence appears to have been built in the 1950. The floor consist of wood joist. 2x10 at 24" o.c. The grade of the wood is Dade County Pine. The maximum observed floor span is 13 feet. Design superimposed loading on the floor is D. L. 15 psf LL 40 psf. Enclosed are computations that demonstrate that the floor system can support the placement of tiles havng a maximum weight of 5 psf. The floor system can support the placement of new tiles. Cordally, arlos Ensenat P.E. 1214 SW 12 COURT MIAMI, FLORIDA 33135 (305) 856-6345 COENSCOAOL.COM COMBINED ENGINEERING SCIENCES MI"AMI FLORIDA, using the "Settings" menu item and then using the "Printing & Title Block" selection. Wood Beam Project Title: Engineer: Project ID: Project Descr: Description : HOUSE FLOOR CODE REFERENCES Calculations per Load Combination Set: ASCE 7-10 Material Properties Analysis Method: Allowable Stress Design Fb - Tension Load Combination ASC E 7-10 Fb - Compr Fc - Prll Wood Species : Mixed Southern Pine - 2013 Addendum Fc - Perp Wood Grade ; Select Structural: 2" - 4" Thick : 6" Fv Ft Beam Bracing Beam is Fully Braced against lateral -torsion buckling D 0.03 L 0.08 Span - 13.0 ft Applied Loads Uniform Load : D = 0.030, L = 0.080 , Tributary Width =1.0 ft, (FLOOR) DESIGN SUMMARY Maximum Bending Stress Ratio = 0.6131 Section used for this span 2x10 fb : Actual = 1,303.61 psi FB : Allowable = 2,127.50psi Load Combination +D+L+H Location of maximum on span = 6.500ft Span # where maximum occurs = Span # 1 Maximum Deflection • • File = C ENERCALCPIkQ 49"2015, Bui16.1I'�21ENERCA 1 16.7.24, Ver:6.15WR* • • " • •••• • •• ••••• Y • . Y .. .. • • ... , . . % . . . . .... 1850 E : Aodtkl pf Elasticity : • • • •• psi 1850 psi Ebend- xz 1 t00 ksi 1700 psi Eminbend - xx t80 ksi 565 psi 175 psi 1100 psi Density 31.82 pcf Repetitive Member Stress Increase Service loads entered. Load Factors will be applied for calculations. Maximum Shear Stress Ratio Section used for this span fv : Actual Fv : Allowable Load Combination Location of maximum on span Span # where maximum occurs Max Downward Transient Deflection 0.327 in Ratio = 477 Max Upward Transient Deflection 0.000 in Ratio = 0 <360 Max Downward Total Deflection 0.449 in Ratio = 347 Max Upward Total Deflection 0.000 in Ratio = 0 <180 Overall Maximum Deflections Load Combination +D+L+H Vertical Reactions Load Combination Overall MAXimum Overall MINimum +D+H +D+L+H +D+Lr+H +D+S+H +D+0.750Lr+0.750L+H +D+0.750L+0.750S+H +D+0.60W+H Span- -Max-.--"--"--- — --------- Span Defl Location in Span— Load Combination- — --- -- 1 0.4492 6.547 Support notation : Far left is #1 Support1 Support2 0.715 - - -- --- - 0.715 0,117 0.117 0.195 0.195 0.715 0.715 0.195 0.195 0,195 0.195 0,585 0.585 0.585 0.585 0,195 0.195 Desinn C = 0.390 :1 2x10 68.27 psi 175.00 psi +D+L+H 12.241 ft Span # 1 Max. +" Defl Location in Span 0.0000 0.000 Values in KIPS COMBINED ENGINEERING SCIENCES MIAMI FLORIDA using the "Settings" menu item and then using the "Printing & Title Block" selection. Wood Beam Project Title: Engineer: Proiect ID: Protect Descr: • • • File = G�P_FjQ�f 21ENERCA-1 • :. WQ AWI,2015, Bu 2 , Ver:6.1 WgRA • Me Description: HOUSE FLOOR • • • • • • Vertical Reactions Su rt notation Far left is #1 Support • Values in KIPS • • • ---------------- 60 Load Combination Support 1 Support 2 • • • • . • • .... • • +D+0.7 E+H ----- - 0.195 +D+0.750Lr+0.750L+0.450W+H 0.585 0.585 • • • • +D+0.750L+0.750S+0.450W+H 0.585 0.585 • : • • • . • • • +D+0.750L+0.750S+0.5250E+H 0.585 0.585 : 900 : • • • • +0.60D+0.60W+0.60H 0.117 0.117 • • • .' ; • ; +0.60D40.70E+0.60H 0.117 0,117 • • D Only 0.195 0.195 Lr Only L Only 0.520 0.520 S Only W Only E Only H Only Miami Shores Village `5°Rcs 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 toRivp Project Address 190 NW 103 Street Miami Shores, FL 33150- Owner Information RED RIVER USA LP Parcel Number Applicant 1131010230010 RED RIVER USA LP Block: Lot: 3250 NE 1 Avenue MIAMI FL 33137- 3250 NE 1 Avenue MIAMI FL 33137- Contractor(s) Phone Cell Phone UNIVERSAL GROUP INC (305)796-9556 Phone Cell I Valuation: Total Sq Feet: 1100 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: FLOORING OF TILES Occupancy: Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Yes Certificate Status: Certificate Date: Additional Info: Bond Return : Classification: Residential Fees Due Amount CCF $3.00 DBPR Fee $2.03 DCA Fee $2.03 Education Surcharge $1.00 Notary Fee $5.00 Permit Fee $135.00 Plan Review Fee (Engineer) $80.00 Plan Review Fee (Engineer) $120.00 Scanning Fee $9.00 Technology Fee $4.00 Total: $361.06 Pay Date Pay Type Amt Paid Amt Due Invoice # RC-7-15-56177 02/11/2016 Credit Card $ 311.06 $ 50.00 07/01/2015 Credit Card $ 50.00 $ 0.00 Avaname inspections: Inspection Type: (Final PE Certification Window Door Attachment Insulation Drywall Screw Fill Cells Columns Window and Door Buck Review Planning Review Building Review Building Review Building Review Plumbing Review Mechanical Review Electrical Review Structural Review Structural 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 stri nformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I as me esponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRIC , PLU rBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. 1)7 i OWNERS AFFIDAVI : y that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z �uermore, I authorize the above -named contractor to do the work stated. February 11, 2016 Authoriz Signature: Owner / Applicant / Contractor / Agent Building bepartment Copy February 11, 2016 1