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PL-14-845va BUILDING PERMIT APPLICATION 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 APR 2 4 2014 Master Permit No. W— [/ Ll ?ff Sub Permit No. 10/6 JOB ADDRESS: / � �- X, "C 7-,f .5 - City: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee SimplleTiiitleholder): Crl Phone#:®S� �� S 24 Address: City: tvv*%,State: C911- Zip: Tenant/Lessee Name: Phone#: Email: ®i&.� C- CONTRACTOR: Company Name: "-' aPeon, 4E Phone#: Address: S%Z D s w // 3 City: / Ct h / tate: F/G� 4 zip:.,?, 3 -/ y L Qualifier Name: ►- /'-� Ct � d o e w k Phone#: State Certification or Registration M (f FC O 5-7 fc 3 ci Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ i a o"® Square/Linear Footage of Work: Type of Work: ❑ Addition ElAlteration ❑ New Repair/Replace ❑ Demolition Description of Work: To /,tto �C, o, Q ,,4'7<< Q �.. ,ri Specify color of color thru tile: Submittal Fee $ L60 `60 Permit Fee $ /®'u, CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 69,6c) BUILDING ELECTRIC [:] ROOFING [—] REVISION EXTENSION RENEWAL ]PLUMBING MECHANICAL DPUBLICWORKS [:] CHANGE CONTRACTOR CANCELLATION SHOP DRAWINGS JOB ADDRESS: / � �- X, "C 7-,f .5 - City: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee SimplleTiiitleholder): Crl Phone#:®S� �� S 24 Address: City: tvv*%,State: C911- Zip: Tenant/Lessee Name: Phone#: Email: ®i&.� C- CONTRACTOR: Company Name: "-' aPeon, 4E Phone#: Address: S%Z D s w // 3 City: / Ct h / tate: F/G� 4 zip:.,?, 3 -/ y L Qualifier Name: ►- /'-� Ct � d o e w k Phone#: State Certification or Registration M (f FC O 5-7 fc 3 ci Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ i a o"® Square/Linear Footage of Work: Type of Work: ❑ Addition ElAlteration ❑ New Repair/Replace ❑ Demolition Description of Work: To /,tto �C, o, Q ,,4'7<< Q �.. ,ri Specify color of color thru tile: Submittal Fee $ L60 `60 Permit Fee $ /®'u, CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 69,6c) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State a Zip Zip of 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 inspectiot be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this this day of f r 20 % by who is personally known to me or who has produced*) ( As identification and who did take an oath. NOTARY PUBLIC: Signature Contractor The foregoing instrument was acknowledged before me �� day of 20 A/ byAy�/I;Jr-g&�V vV who l is personally known to me or who has produced/ Sd(� l 00T-�1(d as identification and who did take an oath. NOTARY PUBLIC: Sign Sign: rint: IryP girz% � M Feliciano y Commis if : My Commission FF 082753 M o ssioi� state of F►cnaa ExpUeso111212018 Joanna M Feliciano My Commission FF 082753 x�pd� Expireso1H212018 APPROVED BY -"oo �- Y>Z1-N Plans Examiner Structural Review (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Zoning Clerk a0za Local Business Tax Receipt Miami -Dade County, State of FloridaLB THIS IS NOT A BILL - 00 NOT PAY 4918869 tOt> 86 NAMIULOCATION RECErT NO. EXPIRES mmWAL SEPTEMBER 30, 1684 201 ARIVIANDO 6840 MN 46 AVE gg 3$074 Must be displayed at p� of busirms 1 _ Pumuart to County Code MIAMI GARDENS FL 33055 Chapter BA - Art. s & 10 SEC, TYPE OF SUSMESS PAYMENT RECEIVED OWNER 116 PLUMBING CONTRACTOR BY TAX COIJECTOR PENA ARMANDO CFC05M $40.0007/24/20113 Worker(s) 1 FPPU06-13-Cn,,'1'Z9 ofag Lecal Bo lee Tae. The Receipt is not a lkeos-a. This Leeal Bpsiae�Tax Receipt 0*Pasta dttbusioess Holder cempfi vWh airy Ilegemr'"`�°�i or permid er a c s,sh to the busioem The', RECEIPT N0. above amst he 41131110yed On aR emmerclal roldclee-Rlllefii-Dada Code Secfia-s76 Far mkaitdarosloo,visit 411 K= IAWSON SZOMARY 01 CERTIFICATE OF LIABILITY INSURANCE °A �°"Y""' /14 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 cordficate holder is an ADDITIONAL INSURED, the policoes) must be endorsed. if SUBROGATION IS WAIVED, subject to the terns 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 Iteu of such endorsement(s). PRODUCER CONTACT MARCO SUAREZ -NAM PHONE (305)884-8664Nof:___ (305)8846977 °A�L9 framaMObensouth.net ag, _ —..._ DRESS• Suarez &Associates 7400 N.W. South River Drive, #B1A INSURER(S) AFFORDING COVERAGE NAIC # Medley, FL 33166 INSURER A: CANOPIUS INSURANCE COMPANY Phone (305)8848664 Fax (305)8846977 INSURED INSURER B: SOUTHERN INSURANCE COMPANY INSURER C: ARMANDO PENA PLUMBING (INDIVIDUAL) INSURER 0: 16840 NW 46 AVE INSURER E: OPA LOCKA FL 33055 LIABILITY ❑ ANY AUTO ❑ AALL UTOS OWNED ❑ SCHEDULED OS F-1HIRED AUTOS ❑ AUTO NED ❑ ❑ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD R POLICY NUMBER POLICY EFF MMtDD POLICY EXP LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY QPREMISESS ❑ ❑ CLAIMS -MADE WOCCUR OUS009036867-1 09/23/2013 09/23/2014 EACH OCCURRENCE $ 1,000,000.00 DAMAGE(RENTED 100,000.00 occurrence)$ MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO- ❑ LOC _CTAUTOMOBILE PRODUCTS - COMP/OP AGO $ 1,000,000.00 $ LIABILITY ❑ ANY AUTO ❑ AALL UTOS OWNED ❑ SCHEDULED OS F-1HIRED AUTOS ❑ AUTO NED ❑ ❑ CO &Wgf INGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per acddent $ P ,'gRg ,DAMAGE $ $ ❑ UMBREI LA UAB ❑ OUR ❑ EXCESS UAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ❑ If yyes describe under DEWRIPTION OF OPERATIONS below N / A PWC007746-13 09/23/2013 09/23/2014 ❑ IW ST IMI - ❑ ETM 100,000.00 EL EACH ACCIDENT $ 500,000.00 E L DISEASE - EA EMPLOY $ 100,000.00 EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more space is required) LICENSE #CFC 057939 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE EXPIRATION I ABOVE rNO E[?�POLICIES BE CANCELLED BEFORE rE THERICE WILL BE DELMERED IN THE POVI,4iONS. a ( � e (919tt-200ACORD CORPOMTIOtVAI rights reserved. ACORD 25 (2010105) OF The ACORD name and logo are registered marks of ACORD • Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (30795-2204 Fax: (305)756-8972 Inspection Number: INSP-212791 Permit Number. PL -4-14-845 Inspection Date: May 21, 2014 Permit Type: Plumbing - Residential Inspector Diaz, Osvaldo Inspection Typlps�� Owner. MCCOY, CINDY Work Classification: Addition/Alteration Job Address: 145 NE 98 Street 4 1 tJ0VL­( 405)213-5721 Miami Shores, FL 33138- Phone Number (3 Parcel Number 1132060132311 Project <NONE> Contractor ARMANDO PENA Phone: (786)265-5474 --------- -- REPLACEMENT OF KITCHEN SINK AND DISHWASHER Iniractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-212077. no one home %- JO) Failed ❑ Correction Needed ❑ Re -inspection ❑ Fee Nb Additional Inspections can be scheduled until re-Inspecpon fee is paid. For Inspections please call: (305)762-4949 May 21, 2014 Page 1 of 1 I-101" 11It;[!� Miami Shores Village7BY: 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 PERMIT APPLICATION Permit Type: UILDING 2 A /J JOB ADDRESS: !� Ld ( / e3 � Permit No. Master Permit ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple T-tleh)lder : �` v� �% Phone#: Address: City. State: Tenant/Lessee Name: Phone#: Email: Vup_�_ CONTRACTOR: Company Name: _ Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer. Phone#: OR Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition DAlteration DNew (ReW/Replace dDemolition of Work: °. _,4 ® Color thru tele: Submittal Fee $ fL - ()C-) Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ S', ®Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ MOM Bonding.Company's Name (itapplicable) 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 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 / Contractor The foregoing instrument was acknowledged beige me this � =L- The foregoing instrument was acknowledged before me this day of 20 &, byn, g Me Co, day of .20 _, by who is personally known to me or who has produced)&1eS+A1:r jJ who is personally known to 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: Sign: J y Commis n i :� �` .manna M�Fel�ieno�►�. �.r_� �YCommlasbn FF 082753 APPROVED BY 14 Oc T Plans Examiner Structural Review Sign: Print: My Commission Expires: (Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Zoning Clerk 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 Ct%,J, NAME: mC c ,© .d DATE: ZDf ADDRESS: KS ry � -1 & -�� Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, RS 489.103(7). And I have read and understood the following disclosure statement, which entities me to work as my own contractor, I further understand thaf 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. Initial_�� 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. l may also build or improve a commercial building if the costs do not exceed $75,040. 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 ,�- 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. C.�>r Initial 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. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. . Initial .,�Y I 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 average for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance average for Injuries to workers on my property. Initial v I 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 - OA --- I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner -builders as well as employers. I also understand that the Constriction must comply with all applicable laws, ordinances, building codes, and zoning regulations. 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 850.487.1395 or,hftp:/hvww.mygoridalicense.com/dbpr/pro/cilbrindex.html initial ' 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 fiiponsible for th p nstructio activity at the following address: a 70 Initial 02. 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 contractors 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 owners 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 _g:;s day of , 20 By_C j,,d fPe tl�, _ who was personally known to me or who has Produced there License or { � U; rdd (! A I Z Uq as identification. MtR OTARY r�r*+r+,rtiM++w Nomry Putdlo State of Florlde . Joanna M Fc owano My Catemiaelon FF 082793 Bxpires01HB/20tti / c- -) , �9 I oQ (Y 05 FEB 2 4 20% PERS MIT#: kr--141- Miami Shares Villa is APPROVED DATE ZONING DEFrTI BLDG DEPT SUBJECT TO COMPLONM Wtf H Al I remm STATE ANO CCUWY RULE9 AMD 14 .1 VA -%%im + . - fig-C--" -Ak- OtibWa- 0,rQ N%) &I&cIQz*L Qtfqw-e- 9:�7�