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RC-11-160041111—U1k BUILDING PERMIT APPLICATION Master Permit No. FBC 20 1a Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): C K fr0Pe �t 1-4-e- Phone#: 30 2i- G``t 2- Address: 2O % 4tIE Qs ` set 11 7 City: lit ,S r State: G Zip: 3 3 / 3 S Tenant/Lessee Name: Phone #: 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 RECEIVED AUG 3 0 2 1 Permit No. 62I 1 ^ ( `o Email: V U. W. K7 1j te5, cowl JOB ADDRESS: / 6&1,5) A/1-- 11 AV City: Miami Shores County: Folio/Parcel #: / ! / C 74 Is the Building Historically Designated: Yes XCONTRACTOR: Co Address: Qt 1S- NI - City: 6 1) d ''L State: Miami Dade Zip: 3,-2- /.36, NO Flood Zone: mpany Name: ("Mk 0.s01-3S CT-1G G k Phone #: Zip: -3-5°C) Qualifier Name: 050P62-- eckL N mug' Phone #: '2)(2,2-7-2- \ 1(P Certificate of Competency #: 1\1 State Certification or Registration #: 1" Contact Phone #: Ct S 75- 2- Email Address: DESIGNER: Architect/Engineer: o/ //t,tl �t= c6„4 t€ 45 Phone #: 54=573 3.5 Value of Work for this Permit: $ TSU Square/Linear Footage of Work: 28 Type of Work: ❑Addition OAlteration ONew 'epair/Replace Description of Work: re 12 l rr c (/1C-r f ,'viii i -porch cc/w 61 n s ODemolition Submittal Fee $ Permit Fee $ /,..) o Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ $' .1. 6 0 ' 12 0 • TOTAL FEE NOW DUE $ O `• CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ 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 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 It' Signature Contractor The foregoing instrument was acknowledged before me this /1., day of , 20 L1_, by UJ cK l -105.aJ , day of 44,t en, , 201 t , by C SAC e.Clt e. Je /r , who is ersonally known to me or who has produced who is pe onally known o me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: PA Sign: IN l'or Print: My Commission Expires: MT TATE OF FLORIDA s \ .. orge Ortiz Sign: Print: `'`eevy f ®ri i .myAgmatAltittidepsiotaAL. `Iil e""%,,,, George Ortiz r Commission #1)1057953 ? Comm ission I D D95 7 953 ;, E• • Expires: FES. 03 2014 ** * * * * * * * * * * * * * * * * * * * * * *oAAIDk xxxa*xxx ***40 Drlkia om Mci* **** ** u*x*xx*xxx*** APPROVED BY (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner /` /( Zoning Structural Review Clerk Al SEP 1 f 211 9J BY:... CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) J PROPERTY OWNER: ` t- t'/ /[ ®, %`T� 4�4i b �/_ G PERMIT # /�` — /1 0 0 / ADDRESS: 11)4.1Y f f 4f. FOLIO NUMBER: // 2 2 3 BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS) CO // C)61e) r, 2-00 COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPAL STRUCTURE (attach appraisal): 01 V Y ,/��% of AA, 4:V1 OWNERS SIGNATURE: PLANREVIEWER: PLAN REVIEWER SIGNATURE: Created on June 2009 DATE: Jve DATE: ?"-C6- « SUBSTANTIAL IMPROVEMENT / DAMAGE LIST (NOTE: THIS LIST IS INTENDED FOR GUIDANCE ONLY, AND IS NOT ALL INCLUSIVE) ITEMS TO BE INCLUDED ALL STRUCTUAL ELEMENTS, INCLUDING Foundations including; Spread footing, Continuous footing, isolated footing, piles and pile caps Slabs including; Monolithic, floating, elevated Walls including; Exterior walls, Bearing walls, Shear walls Beams, Tie Beams, Columns and Posts Wood decking, Floor and Roof Sheathing Trusses, Joist Windows /Doors ALL BUILDING ELEMENTS, INCLUDING Interior Partitions, Walls, Columns Drywall, Ceilings, Built in Furniture, Cabinets, Vanities All Fixtures Flooring, Tile, Carpet, Stone, Linoleum, ect. All Finishes including Drywall, Paint, Stucco Plaster, Paneling, Tile, Marble, and Moldings Roofing Material ALL HARDWARE ALL UTILITY and SERVICE EQUIPMENT HVAC Electrical System and Equipment Plumbing System and Equipment Security System and Equipment Central Vacuum System Plumbing Fixtures Lighting Fixtures and Ceiling Fans Water Systems including Softeners /Filtration Created on June 2009 ALSO: All Labor and other Costs associated with Demolition, Removing, Replacing, Installing Building or Altering Building Components Construction Management / Supervision Overhead and Profit Equivalent cost for: Donated Materials Volunteer Labor (including owners and friends) Any Improvements Beyond Pre - damaged Condition, including; Utility Upgrades Code Upgrades ITEMS TO BE EXCLUDED Plans and Specifications Survey Costs Elevation Certificate Costs Permit fees Debris Removal Items not considered to be REAL Property Rugs, Furniture, Refrigerator, Appliances not Built -in Outside Improvements, Including; Landscaping Sidewalks Patios Fences Yard lights Sheds Gazebos Irrigation Pool Miami -Dade My Home My Home mia • ade.gov Show Me: Property Information Search By: Select Item 0 Text only Property Appraiser Tax Estimator Property Appraiser Tax Comparison Portability S.O.H. Calculator Summary Details: Folio No.: 11 -2232- 028 -0630 Property: 10618 NE 11 AVE Mailing C K PROPERTY Address: SOLUTIONS LLC Living Units: 209 NE 95 ST #7 MIAMI Adi Sq Footage: SHORES FL Lot Size: 33138- Propert y Information: Primary Zone: 1000 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/2 Floors: 1 Living Units: 1 Adi Sq Footage: 3,011 Lot Size: 9,750 SQ FT Year Built: 1951 $50,000/ $208,342 MIAMI SHORES City: ESTATES PB 47 -58 LOT Legal 13 BLK 4 LOT SIZE Description: 75.000 X 130 OR 20185- 0785 01 2002 1 OR 27664 -3326 0311 12 Assessment Information: Year: 2011 2010 Land Value: $97,911 $58,443 Building Value: $247,346 $247,804 Market Value: $345,257 $306,247 Assessed Value: $258,342 $254,525 Exemption Information: Year: 2011 2010 Homestead: $25,000 $25,000 2n Homestead: YES YES < Taxable Value Information: Year: 2011 2010 Applied Applied Taxing Authority: Exemption / Taxable Exemption/ Taxable Value: Value: Regional: $50,000/ $208,342 $50,000/ $204,525 County: $50,000/ $208,342 $50,000/ $204,525 City: $50,000/ $208,342 $50,000/ $204,525 School Board: $25,000/ $233,342 $25,000/ $229,525 Sale Information: to filf1„ Page 1 of 2 ACTIVE TOOL: SELECT Aerial Photography - 2009 0 113 ft My Home 1 Property Information 1 Property Taxes My Neiahborhood 1 Property Appraiser Home 1 Using Our Site 'Phone Directory 1 Privacy I Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. Legend Property N Boundary Selected N Property �✓ Street Highway Miami -Dade County Water http: / /gisims2 miamidade .gov /MyHome /propmap.asp 9/16/2011 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Folio Number:1122320280630 Owner's Name: CK PROPERTY SOLUTIONS, LLC Job Address: 10618 11 Avenue Miami Shores, FL 33138- Owner's Phone: Total Square Feet: Total Job Valuation: 28 $ 500.00 Contractor(s) GAIA CONSTRUCTION Phone (954)882 -2672 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 8/30/2011: Yes Comments: nu0 IV LuI I u.4.41141 111)' I u 4 U 1 It I art CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 08/18/11 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: lithe certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed If SUBROGATION 1S WANED, 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 Ileu of such endorsement(s). PRODUCER Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266 -6493 Fax (305)262 -0679 CONTACT NAME: MARTA ALONSO PHONE (A1C. No. Est): (305) 266 6493 FAx 305 262 -0679 ) (A FAX No): ( ) ADDRESS: martaQflorida bankersinsurance.com PRODUCER CUSTOMER ID * INSURER(S) AFFORDING COVERAGE NAIC # INSURED GAIA CONSTRUCTION, INC 915 NE 8 St Ste. # 201 HALLANDALE BEACH, FL 33009- (954)882 -2672 INSURERA: AMERICAN VEHICLE INSURANCE COMPANY GL- 0504005442 -01 INSURER B : 07/16/2012 INSURER C : $ 1,000.000.00 INSURER D : $ 100.000.00 INSURER E : MED EXP (My one person) INSURER F : ❑ • CLAIMS -MADE n OCCUR IFICATE NUMBER: THIS IS TO CERTIFYTHAT 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR INSR SURF WVD POLICY NUMBER (MWDD /Y YYY) (MMIDD/YYYY) LIMITS A GENERAL LIABILITY GL- 0504005442 -01 07/16/2011 07/16/2012 EACH OCCURRENCE $ 1,000.000.00 DAMAGE 1012EN I EL/ PREMISES (Ea occurrence) $ 100.000.00 COMMERCIAL GENERAL LIABILITY MED EXP (My one person) $ 5.000.00 ❑ • CLAIMS -MADE n OCCUR ❑ PERSONAL & ADV INJURY $ 1,000.000.00 ❑ GENERAL AGGREGATE $ 1,000.000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 1,000.000.00 $ J POLICY ❑ PRO- EC ❑ LOC AUTOMOBILE LIABILITY ❑ 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 LIAB ❑ OCCUR ❑ ❑ EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ ❑ DEDUCTIBLE ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N N ! A W C STATU- OTH- I—I TORY LIMITS I—I ER E.L. EACH ACCIDENT $ ANY PROPRIE r0RIPARTNERIEXECUU VE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe unde DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES, FL 33138 954 - 239 -3914 ACORD 25 (2009/09) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD