Loading...
WS-11-1748 (2)Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Ia�rl tvl7cs�� FBC2Ot Permit No. k` 9 - l - //- 1 79? Master Permit No. Permit Type: BUILDING ROOFING /3-771 //s t JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 3 3/ ' Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Address: City: ice./ iv, t4/- ( ( Phone #: �2 -Q 3/ -6' 6$ cc vt,1 C S Y'L° State: � L--- Zip: '3 , i sd Tenant/Lessee Name: Phone #: Email: t St C ct o [ C P. �cf.6 v� i" l ✓tI r O @ wi �t Et . (tow, CONTRACTOR: Company Name: Address: 6' z (q s, w, City: !et vv1 Qualifier Name: e% L( S vt e sly c o rr SI-V(4 1rd vl 2 7erc� P. / State: r /�- Ve fqz �e7 C Certificate of Competency #: d e Si-of Co14 S4W4e,f/c14 o coowt Phone #: Q'W6- 2 9%' l Z49 Zip: 33! 3tf Phone #: State Certification or Registration #: 6 150 5-2-0e Contact Phone #: '786- Z9°/ - q ZO Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition DAlteration ❑New ❑Repair/ Replace ❑Demolition r C Cb vZ( &L Y L Uy'1CPI)a) Description of Work: � Color thru tile: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 pos -d at the job site for the first inspection which occurs seven (7) days after the building permit is issued. the absence of suc posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or gen The fore oing instrument was acknowledged before me this day of A , 20 it , byi�W &Mr /1 tL , who is personally known to me or who has produced L Y(Y As identification and who did take an oath. NOTARY PUB Sign: Print: My Commission HENRYQONZALEZ * MYCOMMISSION # EE 221667 d),- EXPIRES: August 9, 2016 -14.0F s. •� Bonded Thin Budget Nanny Spices Signature The fo day of Contractor trument was acknowledged be ,20 ➢'L,by who is personally known to me or who has produced _ n ntification and who did take an oath. 1 NOTARY P t' IC: 'Au •r Sign: Print: My Commission Expir Yp ;(►g••;�o HEN iYGO�.EZ * MY COMMISSION # EE 221657 EXPIRES: August 9, 2016 l i t m O 4 Bonded Ito B tbbnny Services ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Plans Examiner Structural Review (Revised 5 /2 /2012)(Revised 3/12/2012) )(Revised 06 /10 /2009XRevised 3 /15 /09XRevised 7/10/2007) Zoning Clerk • r. X Vl/ r hteti Gt 'C Miami Shores V,iiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. WS— q- //" /7y2 Owner's Name (Fee Simple Title Holder): t�N&c41 Go 4 i e ? _ Phone #: //'Z -61/e 665i Owner's Address: / .S"4 .f. ICl/, < r f 51- City: ,/l4 t a Emit SJ ores- State : L— Job Address (Of where work is being done): Zip Code: 31 c? /1/4S—‘7? / /%s f City: Miami Shores State: Florida Zip Code: -31 / Contractor's Company Name: (' S % Oo sf i Phone #: 3o s'- 4f 4 2 - 279? Address: ¥ Z f 4 So fry, z rpv t� City: /'l (CLCA,, State: 1--- Zip Code: 3 3 ! 34 Qualifier's Name : O7 q-‘ Ve lq z t c-t e Z Lic. Number: C.- G► c / Sp s of Architect/ Engineer of Record Name: Phone #: Address: City: State: Zip Code: Describe Work: cat. cto I hereby certify that the work has been abandoned and/or the contractor /architect is unable or unwilling to complete the contract. I hold the Buil r Officia nd the Miami Shores harmless for all legal invol ' ent. Signature wnerorAgent The foregoing in trument was aknowledged before me thisA day of V ,20) by iOw% cnzell.#Z_ Who is personally known to me or who has produced rt_ ► ' �( ( as indentification. Notary Pu Sign: Seal: GONZAlEZ MISSION t EE 221657 * EXPIRES: August 9, 2016 Bonded T1uu 8 Notary Swims Signature The for mg instru ent was aknowledged befor this ?P day of �v r� 201 by Ar uL who is personally known to me or who h. uced 'Q,l'I L as indentiification. Contractor or Architect Notary Publi Sign: Seal: * MYCOMMISSION #EE221657 EXPIRES: August 9, 2016 nor Elated Tim Budget *lay Services 3 in STATE Of FLO T :� Pt Leaned below _ Erlitb er Ltie provi minim kration date; 31, map MIAMI-DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 500295-1 2011 LOCAL BUSINESS TAX RECEIPT 2012 FIRST-CLASS MIAMI-DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE EXPIRES SEPT. 30, 2012 PAID MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 PERMIT NO, 2311 '11-ilS IS NOT A HILL DO NOT PAY RENEWAL 522402-7 Buttlits §refenglitkUCTION INC STATtlicnt105208 4214 SW 2 TERR 33134 MIAMI mint STOP CONSTRUCTION INC WORKER/S secireme%EffeRWL BUILDING CONTRACTOR 1 THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. ET DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING. LAWS OF THE COUNTY OR CITIES, NOR DOES IT EXEMPT THE MOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMTDADE COUNTY TAX c0uEcT0840/11/2011 09010140001 000049.50 SEE OTHER SIDE DO NOT FORWARD ONE STOP CONSTRUCTION INC JESUS D VELAZQUEZ PRES 4214 SW 2 TERR MIAMI FL 33134 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS` COMPENSATION 03 -09 -2011 * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW :ONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE 03/09/2011 EXPIRATION DATE: 03/08/2013 PERSON: VELAZQUEZ JESUS FEIN: 043736889 BUSINESS NAME AND ADDRESS: ONE STOP CONSTRUCTION INC 4214 SW 2ND TERRACE MIAMI FL 33124 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 06114y. r.S„ an officer of a corporation who elects exemption Item this chapter by filing a certilleate of election under this section may not recover benefits or compensation nedor this chapter. Pursuant to Chaplet 440.051121, F.S. , Carticales of hieCORn to bo exempt..• apply only within the scope of the busluess or Redo listed on the notice of election to he 000001. Pursuant to Chaplet 440.064131, F.5., Modena ai election lo be axempi and Catildlemas el Election to he exempt shalt no $eblect la revocation 11, xl eny Time atter We filing of the notice or the issuance al the certificate, the person named on the notice Or cetlHicare nu longer meets the requirements of ibis section lot Issaaace of o eerlilIcout. The department shall revoke n cenilieare at any time for failure of the person named oa the cartiticalo to meet the requirements of this section. : -252 CEHTIFtCATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (8501 4U -1609 '° .-c �t. `° CERTIFICATE OF LIABILITY INSURANCE aaai/ DATE(MM/DD/YYYY) 08/29/2012 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(Iles) 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 thls certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ALL CITY INSURANCE INC - ACI 7200 CORPORATE CENTER DR SUITE 316 MIAMI FL 33126 CONTACT JAVIER GUTIERREZ PHONE (305) 463 -9431 F (305) 629 -7808 (fir, 41'1 Ert)' ( Nap E-MAIL SS. JGUTIERREZ @ALLCITYINS.COM AnDEE PRODUCER 201549 _rUSTOMnn ID #• INSURER(S) AFFORDING COVERAGE NAIC # INSURED ONE STOP CONSTRUCTION, INC. 4214 SW 2ND TERR MIAMI FL 33134- INSURER A MID- CONTINENT CASUALTY CO INSURER B: 04GL842303 INSURER C • $ 1,000,000 INSURER D : $ 100,000 INSURER E: CLAIMS -MADE INSURER F : $ EXCLUDED COVERAGES CERTIFICATE NUMBER:16 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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. INSR LTR TYPE OF INSURANCE ADDL N,co SUER m pD Iry NUMBER POLICY EFF (MM/ne/YVYY) 02/18/2012 EX POLICY P (MMIDDNYVV) 02/18 /2013 LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR 04GL842303 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISFS occurrence) $ 100,000 CLAIMS -MADE (Fa MED EXP (Any one person) $ EXCLUDED GENL GE PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE UMIT APPLIES POLICY PF a PER: LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA UAB EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS N /A WC STATU- OTH- TORY LIMITS FP E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ below E.L DISEASE - POUCY UMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION Al COMMWJ CITY OF MIAMI SHORES BUILDING & ZONING DEPT. 10050 NE 2ND AVE MIAMI SHORES FL 33138- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD