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RC-04-22-876Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1248 NE 99TH ST, Miami Shores, FL 33138 Contacts Permit NO.: RC-04-22-876 Permit Type: Building (Residential) Work Classification: Alteration Permit Status: Approved Issue Date:OS/12/2022 Expiration:11/14/2022 Parcel Number 1132050090170 MARILYN&JOSEPH CHARLES Owner 1248 NE 99 ST, MIAMI SHORES, FL 331382643 Mobile: 3057106227 Other:3057514669 sluyter construction Applicant greg Sluyter 237 Ne 102 street, miami shores, FL 33138 Business:9703799730 sluyterconstruction@gmail.com SLUYTER CONSTRUCTION Contractor GREG ALLEN SLUYTER 237 NE 102 ST, MIAMI SHORES, FL 33138 Business:9703799730 sluyterconstructfon@gmail.com Description: BATHROOM RENOVATIN ALL FIXTURES SAME Valuation: $ 16,000.00 Ir - Ins ection Rectnests: LOCATION - - TotalSq Fee[: 0.00 305-762-4949 Fees Amount Application Fee - Other $50.00 CCF $9.60 Certificte of Completion for Single Fam $50.00 and Duplex DBPR Fee $7.20 DCA Fee $4.80 Education Surcharge $3.20 Permit Fee $430.00 Scanning Fee $12.00 Technology Fee $12.00 Total: $578.80 Payments Date Paid Amt Paid Total Fees $578.80 Credit Card 05/12/2022 $578.30 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws 79ning. Futhermore, I authorize the above named contractor to do the work stated. Applicant / Contractor / Agent Date May 12, 2022 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION dBUILDING ❑ ELECTRIC ❑ ROOFING PLUMBING ❑ MECHANICAL [:]PUBLICWORKS jPR 7�02 FBBC 20 ZO- l_ Master Permit No. K$/ U _ G L ` 8 Sub Permit N ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I i4 Q N C A S 1 City' Miami Shores _� County: Miami Dade Zip: 30 A Folio/Parcel#: ]j-3 Z .,, f)t)! " t>j 7 (7 Is the Building Historically Designated: Yes NO X Occupancy Type: S. FA(4Load: Construction Type: $ Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Title Addeo«- / 2_-t T' DES r City: Tenarl/Lessee Name: i Email: ' c: olesi5e gca) r. CONTRACTOR: Company Name: S Address: Z % 'fk) ,� ) L City: N fAeg 1 S' Qualifier Name: GI State Certification or DESIGNER: Architect/Engineer: #: C State: 3bS T5l �F664 Clio mc� zip: 3 31 _TP Phone# Phone#: 11% 14 7.3C f—l__ Zip: 3 313 A of Competency #: State: Zip: Value of Work for this Permit:$ /6DcC Square/Linear Footage of Work: TypeofWork: ❑ Addition ❑ Alteration ❑ New. 2 Repair/Replace Description of W11orh i7 L ,.Aim t ❑ Demolition Specify color of color thru tile: Submittal Fee $ � ' �-A Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Structural Reviews (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address city State Mortgage Lenders 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) 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 Signature A& OWNSJ orA ENT 3�ONTRACTOR 61 The`fo�regoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 ;3 o , by e&ay of l20 )-� by �vho is personally known to -i,L who i rsonally known me or wh as produced as me or has prod4ld as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: C . Print: Z. Print: r Seal: '' MY COMMISSION # HH 053232 Seal: •• "� ':." CLARISSA A RODRIGUEZ °=' EXPIRES: December Dber 30, 2024 "P•,f�,'` �j MY COMMISSION # HH 053232 BoMed Th. Notary Publk Underwilers ;'S£'97'0' EXPIRES: December 30, 2024 tttiiitiii#tt###;;;titittiitiiiitiii####;#######;###;#;ii;iiit �i:1r'xi#t n lli�i if iitttttti#; APPROVED BY £� `� l Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk Property Search Application - Miami -Dade County Page 1 of 2 OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-3205-009-0170 1248 NE 99 ST Property Address: Miami Shores, FL 33138-2643 JOSEPH G CHARLES TRS JOSEPH AND MARILYN CHARLES Owner REV LIVING ENTIRETIES TR MARILYN G CHARLES TRS 1248 NE 99 ST Mailing Address MIAMI SHORES, FL 33138 USA PA Primary Zone 1400 SGL FAMILY - 3001-3250 SO 0101 RESIDENTIAL -SINGLE Primary Land Use FAMILY: 1 UNIT Beds / Baths I Half 3/3/0 Floors 2 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 2,906 Sq.Ft Lot Size 10,900 Sq.Ft Year Built 1949 Assessment Information Year 2021 2020 2019 Land Value $411,778 $411,778 $411,778 Building Value $217,950 $217,950 $217,950 XF Value $9,240 $9,356 $9,471 Market Value $638,968 $639,084 $639,199 Assessed Value $301,316 $297,156 $290,476 Benefits Information Benefit Type 2021 2020 2019 Save Our Homes Assessment $337,652 $341,928 $348,723 Cap Reduction Homestead Exemption $25,000 $25,000 $26,000 Second Exemption $25,000 $25,000 $25,000 Homestead Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description EARLETON SHORES PB 43-80 LOT 5 & W25FT LOT 4 BLK 2 LOT SIZE IRREGULAR OR 10073 1973 74 0678 4 Generated On : 4/6/2022 Taxable Value Information 20211 202011 2019 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $251,3161 $247,156 $240,476 School Board Exemption Value 1 $25.000 $25,000 $25,000 Taxable Value 1 $276,316 $272,156 $265,476 city Exemption Value $50,000 $50.000 $50,000 Taxable Value 1 $251,316 $247,1561 $240,476 Regional Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value $251,316 $247,156 $240,476 Sales Information Previous Price OR Book - Qualification Description Sale Pa 9a Corrective, tax or QCD; min 11/19/2015 $100 29893-2909 consideration The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hhp://w .miamidade.gov/info/disclaimer.asp https://www.miamidade.gov/Apps/PA/propertysearch/ 4/6/2022 #liwaad suoµe n6aa pue sauna Juno(] pue alelS eiaPa� Ile gl!M aou woo of loafgnS aleQ ldap 6wppg GTE(] lda(] 6uiuoz luawlieda(] 6uippng 96epiA s},aJogS !WBIw V �t/(d 'Q-71 C) -3-)NAVII ?� Pijyf o AdOO uiO OZZ07 9 0 ac�tl _p 1-9 CAR-L S R sk%)—F( sc� pluegb , plm\� _• S}iowifL Co.�STl'Luc-T\D.n' �e-�A�Is. ,i �S.AlL5t1owc2 WaLlS Ta bE Yy DurolydCk o.,�t-,) - ALL - Ntw y 0000 O 0 000000 0000 0 0 ° 0 0000 0 0 0 0 00 0 0 000000 0000 000000 0 0 000000 ° 0 000000 ° 0 0000 0600 00000 0 0 0000 0 0 0000 O 0 00000 000 0 000000 000000 0 0 0 0 00 0 0 0 00 00 ° ° 0 000000 090900 0 00 0 0 0 0 O 0 0 0 0 0 000000 00 0 O 0 0 0 0 00 O 0 0 O 00 p 0 0 00 0 NA1zLF-S R esl DE-Nc In, cz2tcR L- P►AA BATHROOM RECEPTACLE ON 20 AMP CKI AND G.F.I PROTECTED ter! NG (D I ELELI-RICALRtvIEW � R2Z APPROVED, DATE -S,nc1le— y0Ft)C SC6-. cAE:- 5k: j4Xt a a o0a00 o a 000000 0 0 e 00000a 0 0 0 o a 0 0 00000 o 00000a o • 00000a a 0 0 00000a 0000 000000 o ooeo e • 0 ° e ooeo o 0 0 O •O 0 0 000000 0000 000000 0 0 ooe•o0 ° O 000000 ° 0 0000 0000 00000 0 0 0000 • • 0.00 0 0 00000 000 0 000000 000000 0 0 0 0 00 • 0 00 00 0 ° ° 0 00.000 000000 0 0o O 0 0 0 0 e 0 0 0 0 00 0 0 0 000000 0 0 0 0 0 0 00 0 00 0 0 0 °0 0 Notice to Owner - Workers' Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 on Insurance Exem Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Star § 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 (LLQ 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'.. k JJ (1 er State of Florida County of Miami -Dade The foregoing was acknowledge before me this lI day of , 20ex a . By 4- i 1yn/ G. Clot 1r5 who is personally known to me or has produced as identification I SEAL: Uhrtin J. MaKschnis Comm.tHH03/590 w SDI Zvi VJSL(Iu I• scKe �uE� I Greg Sluyter, Owner _ k SLTRYTN R 970-379-973000NS SluyterConstruction@gmaiI.com Date:5/5/2022 State of_Florida County of Dade Before me this day personally appeared_Greg Sluyter who, being duly sworn, deposes and says: 61 That he or she will be the only person worldng on the project located at:_1248 ne 99 st Miami Shores, FI 33138 Sworn to (or affirmed) and subscribed before me this day of . 20ZZby Co2f�Ca S wY � f�2 Personally know Or Produced Identification Type of Identification Produced Type or Stamp Name of Notary Licensed and Insured Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PL-04-22-878 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Issue Date: 05/25/2022 Expiration: 11/28/2022 Location Address 1248 NE 99TH ST, Miami Shores, FL 33138 Contacts Parcel Number 1132050090170 MARILYN & JOSEPH CHARLES Owner sluyter construction Applicant 1248 NE 99 ST, MIAMI SHORES, FL 331382643 greg Sluyter Mobile: 3057106227 237 Ne 102 street, miami shores, FL 33138 Other: 3057514669 Business: 9703799730 sluyterconstruction@gmail.com MOTZ PLUMBING LLC Contractor LEE MICHAEL MOTZ 820 NE 23 ST, NORTH MIAMI, FL 33161 Business: 3059924223 - Inspection Requests: Description: NEW COPPER WATER LINES, TIE INTO EXISTING Valuation: $ 4,500.00 DRAINAGE. ALL FIXTURES SAME LOCAIRON BATHROOM 305-762-4949 RENOVAITON. Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $3.00 DBPR Fee $2.36 DCA Fee $2.00 Education Surcharge $1.00 Permit Fee $107.50 Scanning Fee $3.00 Technology Fee 53.94 Total: $172.80 Building Department Copy Payments Date Paid Amt Paid Total Fees $172.80 Credit Card 05/25/2022 $172.80 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 regulatin nstruc' n a d zonin Futhermore, I authorize the abov Ia/fined coot actor to do the work stated. l HZ r Z Aut rized ature: Own r / Applicant / bont4ehr / Ag nt Date May 25, 2022 Page 2 of 2 Miami Shores Village M��14j 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 Master Permit No. C'"1`Z� eac PERMIT APPLICATION sub Permit No, f L 01'- 2-i-n:�8 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 12fPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: o4 `C NE City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 —3 Z C j -, i}f1 q T U `-)0 Is the Building Historically Designated: Yes NO Occupancy Type: S. i-*41-oad: yl-Construction Type: C_t `SS Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /°` 14r) IV/\. 4N )-eJ Phone#: !�OS 3 `CZ „/) /Z (Ced) Address: /Z`i16 DL`i- PC1 -sr 3os751—`//obY( Nam) city: Mom, S� .0 . Sr State: A L, Zip: 3 31-TL? Tenant/Lessee Name: Email: ec.roles IE; �r m 1. L-0 , CONTRACTOR: Company Name: I "l + --2- 1) V "f —4 -- Phone#: 3F,� 1 QZ' f 2-2 Address: '814" ItiF, � -)"J S City:V` DPT l Zvi(A Qualifier Name: I ^r_ State Certification or Registration #: DESIGNER: Architect/Engineer: _ Zip: 311 �, t Phone#: 1cate of Competency #: Phone#: State: Zip: Value of Work for this Permit: $ 1500 D Square/LinearrFF000ttage of Work: Type of Work: ❑ Addition El Alteration ❑ . New � Repair/Replace Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ wsw�� Technology Fee $ Training/Education Fee $ Structural Reviews ❑ Demolition CCF $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ (Revised02/24/2024) TOTAL FEE NOW DUE $ it -7 7 , ��kQ Bonding Company's Name (if applicable) /V/ f 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. l 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 aoaroved and a reinsaection fee will be charged. 47- 3 Signature OVAER or AGENT The foregoing instrument was acknowledged before me this day of 20 by o is personally known to me or who as produced 12)7 as identification and who did take an oath. NOTARY PUBLIC: Seal: MY COMMISSION SSION # HH 053232 EVIRES:December 30, 2024 �'•rFOFi��. APPROVED BY Signatu CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 . y LLL who is personally known to me or who has produced �� as identification and who did take an oath. NOTARY PUBLIC: Sign: Print Seal: ' MY COMMISSION # HH 053232 off: EXPIRES: December 30. 2024 t �':aFw Bonded ThrU N0WN Nft l WMflbM Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk 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. Star § 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 ip questing•a permit under this workers' compensation exemption and has acknowledge that he or she will not use daplabo' aft time employeelf or svbconi actors 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. er State of Florida County of Miami Dade The forego' was acknowledge before me this l day of , 20 ZA BAll� I rt/ lT 64oyrleS who is personally known to me or has produced y ahf r CP44P C 06q0?5Y7 /g �re9 as identification. - _ - i�2 Notary - SEAL fti in J. MaCKK*nlo _A COMINN034590 _ - s�inee}�rl�sg�nn�t�� .Z nihaM 305-992-4223 license# CFC1429581 MOTZ PLUMBING LLC May 18th 2022 State of Florida Village of Miami Shores Before me this day personally appeared Lee Motz who, being duly sworn, deposes and says: That he will be the only person working o the project located at: 1248 ne 99th street contractor signature Sworn to (or affirmed) and subscribed before me this i4�day of t' I11 ,20-11- by Leek e it �L,, I H F,t:z J Personally know Produced id Type of id FL f).,vr. I,unce rint type or stamp name of notary Notary Public State o/ Florida Luis Javier Lavelle My Commission 1� Exp.�1112026 rf thvl� !a 0!938 .!,dU9 j"ah"! ;lisvrm.11�-ivrL ,iu.! Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit No.: EL-04-22-877 Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: Approved Issue Date:05/25/2022 Expiration:11/28/2022 Location Address Parcel Number 1248 NE 99TH ST, Miami Shores, FL 33138 1132050090170 Contacts MARILYN & JOSEPH CHARLES Owner sluyter construction Applicant 1248 NE 99 5T, MIAMI SHORES, FL 331382643 greg Sluyter Mobile: 3057106227 237 Ne 102 street, miami shores, FL 33138 Other: 3057514669 Business: 9703799730 sluyterconstruction agmail.cam ZAP ELECTRIC, INC. Contractor ANDRES BARROSO 3890 W 4 AVE, HIALEH, FL 33012 Business: 78639213 Description: BATHROOM RENOVATION, ELECTRICAL WORK, Valuation: $ 400.00 Inspection Requests: REPLACESINKGFI. 305-762-4949 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 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 Payments Date Paid Arm Paid Total Fees $110.30 Credit Card 05/25/2022 $110.30 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, 1 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. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws d zoning. Futhermore, I aut a the above d contracto to do the work stated. �1 nf� 7�77 q-2s'i2i Applicant / Contra9tog / Agent Date May 25, 2022 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 ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS p M � M 0 T M p YR 0 6 2022 a FBC 20 Master Permit No. 2�\ 4- 2— 9--I(o Sub Permit No7EL-(34 L 2-- y� ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: , iLf � t,,�C A R -�i City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ll 3 Z t,5 , VE>Q — C) (7 l7 Is the Building Historically Designated: Yes NO Occupancy Type: S. 1-I�MLoad: Construction Type: t3 ,S Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): �f�}(^) Iun. C'^1� Phone#: --�'Q�> 751—`F6C4 (Fer�E� Address: % Z Yi �l � i Y305 - � `I 'S City: //yJ�i Tenant/Lessee Name: Email: (:.wtoles I5(Avylw I,C-0 CONTRACTOR: Address: 1 City: q f Qualifier Name: State: 4�7t' Zip: 3 31 3 State Certification or Registration #: G C 13 ✓?i L) Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: Value of Work for this Permit: $ y96 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace n Description of Work: Specify color of color thru Submittal Fee Scanning Fee $ Technology Fee )t" 9A-er L UP f'ro tile: Permit Fee $ Radon Fee $ Training/Education Fee $ CCF M ❑ Demolition CO/Cc $ DBPR $ Notary Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ /, 1- 3,-) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) _ Mortgage Lender's Address City State E. 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. 'L n Signature � "' L ( ,vim ' cum.-� �T Si atu ' g O NEAI*AGENT g CONTRACTOR The foregoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this 4&ay of 20 a a�by ay of 1, 20 �2atiy 11�A is personally known to �S f P Y'��1 h rsonally known to me or who 4 produced i as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: k. rr77 ' Print: V Print: lam'_ Seal: """•'•' CIARISSA A RODRIGUEZ Seal: M'••°tCU�ISSA A RODRIGUEZ "R•` MYCOMMISSION 053232 may°• MY COMMISSION # HH 053232 EXPIRES: December 30,2024 ,: EXPIRES: December 30. 2024 Bonded Thru Notary Publk Undenvdlers •'�::;'os.y°p' BoMed Thou NMety P.GicUodenMta �»»»s*s»»ss»»sss*s/»s»rr»rrrsrrrssss*»***rsrsas:ssssss»s»ss»»s APPROVED BY / �D�C L 51'2- Plans Examiner rr»rrrrrrsrs»s»»»ss»assss»»»ss Zoning Structural Review (Revised02/2412014) Clerk 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 repesting.a permit under this workers' compensation exemption and has acknowledge that he or she will not use .*1abo�'part-fl= employeelf 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: L&Z:� q er State of Florida County of Miami Dade 4 The foregoing was acknowledge before me this l day of / , 20 07� B ' t / A,1 6 C4f who is personally known to me or has produced Y 04, X is e&iO& o? a/f7 asi dentification. - - Notary: Z SEAL: Martin J. MacKechnie _ Comm.#HH034590 s= Fni ffi: Aua. 2o. 2024 ZAP ELECTRIC, INC. 3890 W 4T" AVE, HIALEAH, FL 33012 (786) 343-8930 May 241h, 2022 State of Florida Village of Miami Shores Before me this day personally appeared Andres Barroso who, being duty sworn, Deposes and says: That he will be the only person working on the project located at: NE 99th Stre Andros Barroso (Contractor) Sworn to (or affirmed) and subscribed before me this 24th day of May, 2022. By Andres Barroso Personally Known Notary Signature SUSSYANGUERA Jd *; MY COMMISSION # HH 044789 EXPIRES: September 21, NO •'� a's�i °�`601WW ibru PW* lhldef W1it9n