Loading...
DC-14-2016BUILDING 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 BUILDING ❑ ELECTRIC ❑ ROOFING SEP 1 2�1 BY: FBC 20 10 Master Permit No. PC- 1 O- 13 -.24 5 1 Sub Permit No. DS JLA"Z01�0 ❑ REVISION ❑ EXTENSION F-1 RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 55 5 ^%C- q 3 ST City: Miami Shores County: Miami Dade Zip: 331310 Folio/Parcel#: 11, 3206 - 0 0 -10.20 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): VV i otj )" Vto Ir I IJ A Phone#: 286 `ZO - 4^O f Address: 555 NF- q ST- City: TCity: rt I AH 1 S4,0 9L T -S State: -RL Zip: 3 3 ? 3 8 Tenant/Lessee Name: Phone#: 3-A6'260 - 4901 Email: AM A 1 ca— MO Lt v1 Q Q me . C -OM CONTRACTOR: Company Name: Pe i5oaA C4 IJ CAF -TV COQ Phone#: Address: 2-0:5 4 5 N W 45 A v e City: KIAHI C.AQ,PENS —State: -47 L Zip: 'J3©55 Qualifier Name: 11ANuc-L 991270 6ZA Phone#: State Certification or Registration #: Certificate of Competency #: 0 5 d 5 00 3�. DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 4l 6 00.00 Square/Linear Footage of Work: 13 z Type of Work: ❑ Addition ❑ Alteration JK New ❑ Repair/Replace ❑ Demolition Description of Work: '9QIUg WAY COQ TWO CAP, 5 9'W 'A 10' L& C AC* 500 usAL)4-, A'PP00ACki `?a1000 psi C.otcx-g—+ tbty' ibey 6�'1. r0.5S IO&Wep-An Specify color of color thru tile: Submittal Fee $ ® Permit Fee $ CCF $ CO/CC $ Scanning Fee $. o- Radon Fee $ DBPf$ Notary $ (79 Technology Fee $ ® Training/Education Fee $ ® Double Fee $ �R`d Structural Reviews $ Bond $ 6W.' - 00 TOTAL FEE NOW DUE $ I IG -":10 (Revised02/24/2014) 1 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 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 " SJ.-' — NER or GENT The foregoing instrument was acknowledged before me this o`?o� day of ?UST' , 20 (4 by V 1�1 Cll®U �l who is personally known to me orwho has produced fL DL -4 H49D$10b7S7010 as identification and who did take an oath. NOTARY PUBLIC: NATALIA VELEZ Print: S'S1ehl#EC-8354E Seal: -? EXPIRES October 17, 2014 Signature CONTRACTOR The foregoing instrument was acknowledged before me this G day of k)o 0 201J by nV� oei:6 ('a , who is personally known to me or who has produced -Ft DW 0 160S4{i9Ecl?2.9 identification and who did take an oath. NOTARY PUBLIC: Sign: Print: —1110 ZAI IA 'Alml Seal: *' '''= MY COMMISSION # EE035105 ��R,�.� EXPIRES October 17, 2014 (407)398.0153 Ffod&NatarySerolea.com �k**47�k*�k�k*�k4*�k*�k APPROVED BY Plans Examiner &J— < Zoning Structural Review Clerk (Revised02/24/2014) t 2 03,°27/2014 04:26 3056276976 E E INSURANCE AGENCY Agp" CERTIFICATE OF LiA13iLITY INSURANCE DATE (mm=NYYy) 007=14 F .O. R inRnttmea Agemy. C'dtp. 4613 NW I991" 5t Miami Gardens, Fi, 33055 pti. (305)627-696 _ FAX Q iNSURM. DEBOORA CONCRETE CORP. M1$ i"iW 8154" AVE i IAKIGARDENS, n33095 TRE CSRTMCATE BOLVrA TaL9 CERTtMCATE DOES NOT AMEND, EXTENT► OR ALTER AP VROEDBy 110.15MVIIAiILbPGU®w- IAL3URERS A"ORDMG COVERAGE NAiCB Twig nni ie.m of I NSi IRANra I vwso BELOW HAVE BEEN ISSUED 0 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTwiTHSTANMNS ANY REQUIREMENT, TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH OVEa Town THis awnp1CATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFO9010 BY THE POLICIES DES MRD meRaN is Summer TO ALL THE TERMS EXCLUSIONS AND CO OP SUCH POLICIES, %AV LIMITS SHOWN MAY DAVE BEEN REDUCED BY PAID CLAIMS. OM LTA AW1 I NVD iNSURANG5 F'QUVT NUMBER POLICYPOLICY FPPtYl9111? EXPIRATION LIMFTS DATE (MM/DDM°YYy DATE (MMODA'Y" 01A5 - 08fAGt20T8 . UCTSI OPS R& SATE P OP 500.0 ❑CAMMERCIAL GE'.N M%L LiABILIY LlLIGIAW MADE ® t W;W _ && AOV INJURY EACH R. IRE r $900.000 0 M n. $ L006 GE Vi AGGREGATE LIMiT APPLIES PER Tele LICY ❑ PROIWr ❑ LOG03M E LV+61LmI 0 ANY AUTO S BiNED E+INOL 61Mii BODILY INJURY S 0 ALL OWNED AUTO$ Pet pwzwA 0 SCHEDULED AVrOS Sr M HIRED AUTOS BODILY INJURY Cl NON-OWN110 AUTOS 0 PROPERTY DAMAGE (Per ecellsenU $ 0 ABILITY ❑ANY AUTO OTWM TWAN$ &Q- 0 E3 AUTO ONLY; i 35A M81RELLA LIA L 0 OCCUR ❑ CLAIMS MADE W14 OCCURRENCE S ❑ DEDUCTIBLE $ S 0 RETENTION $ W>G OTHER TORY IMre woRKE 's 1 LIABILITY ANY PROPifaT•ORIP� .L. r. EA EMPPLOY6E OFFiCERIMMER EXCLUDE Iye9, deser" uro L - r01.10 L MIT P IAL PROVISIONS Piftw, OTMR GARAGE KEEPERS PWRWW ftledDR 9100 per mug DESCRIPTION OF OPERATlO KOCAT IONW4MCLESIEXCLUSIONEB ASD 8Y ENDORSEWNTIOPEGIAL PROVIS10N8- FiNISiH COMM Contractor Licer►se No. 06BSM 12 Miami Shores %Allege 10050 NE 2 R AVE Miami Shotes, Fi. 33135 SHDLRIt ANY OF TR ASM MMIUD POWES BE CMCWD WN THE VMRATION MMTHERMP, THE ISSUING iN$VRER WILL EOUVOR TO MAIL -W— DAYS WRMM W=- TO THE CWFICATE HOLDER NAMED TOTHQWrI eUTPAILURETODOSON SHAUWSENOORU"TIONORUABILOYOFAMKINGUPON THE INSURER, tISASOM CA RPPMEWAT MM ALTHft1X' T1r"1:9;WTATM . 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 constriction 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. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance camer since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: I ctiM 1 Print Name: H v r Signature: 9 C� Signature: State of Florida ) County of Miami -Dade) oZ Sworn to and subscribed before me this t9 day of AA Lks , 20j_11L_. By U Yt`Xl i NdifiCi f1. DL* M4507fo 10 Contractor State of Florida ) County of Miami -Dade) Sworn to and subscribed before me this day of , 20111 i` +' Il iii ILIkIt. EXPIRES October 17, 2014"= Nip COMPAISsivN 9 EEMU FloddareamrvseMee.com %% _ .. v' EXPIRES October 17, 2014 NN JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * 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: 5/212013 PERSON: DEBORA FEIN: 202476062 BUSINESS NAME AND ADDRESS: DEBORA CONCRETE CORP 20515 NW 45 AVE. EXPIRATION DATE: 5/2/2015 MANUEL MIAMI GARDENS FL 33055 SCOPES OF BUSINESS OR TRADE: CONCRETE OR CEMENT WORK - FLOO Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election th be exempt shad be subject to revocation if, at arty time after the filing of the notice or the issuance of the certificate, the person named on the notice or cartificate no longer meets the requirements of this section for issuance of a oertificate. The department shall revoke a certificate at any time for failure of the person named on the carlificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 004303 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOTA BILL — DO'NOT PAY 6005854 LBT BUSINESS NAmE/LOCATION RECEIPT NO. EXPIRES DEBORA CONCRETE CORP RENEWAL SEPTEMBER 30, 2015 20515 NWA AVE 6266548 Must be displayed at place of business MIAMI GARDENS FL 33055 Pursuant to Courrty Code Chapter SA — Art 9 & 10 OWNER SEC. TYPE OF BUSINESS DEBORP CONCRETE CORP 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR Worker(s) 1 056S00312 $45.00 07/29/2014 CHECK21-14-038165 This Local Business Tait Receipt only confirms payment of the Local Business Tax The Receipt is not a license, permit or a certification of the holders qualifications, to do business. Holder mast comply with any governmental or nongovemmer tal regulatory laws and requirements which apply to the business. . The RECEIPT NO. above must be displayed on all commercial vehicles —Nfiami-DadeCode Sec ga-276. For more information, visit wwwxdamidade.govhaxcoI►ecbnr TQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY DS 50031 Z DEBORA CONCRETE CORP MANUEL is certified under the provisions of Chapter 10 of Miami -Dade County L---ij- L -j I Coyic-re+e 61acks 0000.. 0000 0000 0000.. I ED Ell El0000 0000.. 0000 0000 0000.. 0000 0000.. 0000.. 0000.. •0000 0000 0000 000000 0000.. 0000.. 000000 000 0 0 • 0000 Material: 3,000 psi Concrete Mix Fiber Mesh Orass WAweavi wilcm4-e- bloc-,-"... IL - .— �) RECEIVED ZONING DEPT VIX4 . I SEP 16 2014 SLOG DEPT SUBJECT TO COMPLIANCE VON ALL FEDERAL STATE AND COLYM RULES AND REGULATIONS 10 C V° � �j _0 m rn n U � � W •E .. Q19al cf) Moa-- O�� -00 O �- a v, 4G]y s Pa AN, R,KVI CW FINAL .� - J+� 0 0 0 0 000::0 APPROVAL •....� :.:::. . 0000.. 0000 0000. . DEPARTMENT OF ENVIRONMENTAL 660:60 RESOURCES MANAGEMENT 0060 0000.. 0000 . 0000. CORE REVIEWER (PRINT)• Q0000 00:00' R1(i1olA1UME DATE �;/ • • • • • • • 0000.. 0000.. . . . .0000. li i (Y1 Zo Iy Dt)- g L�L Ij i i I 0000867744 II� La00000 0 MU � � C� Phone: (305) 552-7504 � 14317 S.W. 45th Tern. Fax: (305) 229-8068 i • _ 40f9Bsi011lai Llad.$I 44S or & Mapper Miami, Florida 33175 PROPERTY ADDRE55: 555 NE 931 -d -*5t. Miami Shores, :L. 3t 1-18 LEGAL DESCRIPTION: Lot 20 and the We5l Wof•Loi 21 , 5foc1c'!66, of MIAMI 5HORE5 SECTION TWO, according to the plat thereof a5 recorded in Plat Book 10, at Page 37, of the Public Records of Miami Dade County, Florida. • . • l• ALLEY KETC OF SURVEY (Boundary Survey) SCALE 1"=20' • •. . •. • •....• ev.5pna2 rave." ABOVE GROUND ENCROACHMENT5*NOTED: N/A 7.5' TOTAL R!W //2'LP• • i q��zb,CS I l/2'l.OPn. Cil °' • n`x °.• • Ike di ° • —'• • • DATE OF FIELD wORK: July 23, 20 / 3 REVISED ON 9- / 1-09 THE HEREIN DESCRIBED PROPERTY IS SITUADED WHIN: .i d•• • •• REVISED Ox. Nm, 4, 2013 —• • •• —•i - • •°••• 4'C.LF. y PQ PANEL NUMBER 120652 SUFFU( Ldescdued Property is 10 the best Of my ke-dedge ww beast, a 4ue and correct represemedon. of a Pew survey Par(aae0 urger my 17.80 LEGAL NOTES d4aat=,Md alp —ahithe NrW—T-WoulStandardsasset 0.05, CL °'9.a •Roam Bev: 9.64'0 _ 9•!i I B\O. TITLE VALL HAVE TO BE MADE TO DETS M NE RECORDED INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THISSURVEY 1S suaiwTTO DEDICATION, LWITATIONS. RESTRICTIONS, RESERVATIONS >< 2/.65' 17.60' SURVEY S LIMITED TO THE COST OF THE SURVEY. UNDERGROUND ENCROACHMENTS. IF ANY, ARE NOT SHOWN. THIS FIRM KU NOT ATTEMPTED TO LOCATE FOOTNG AND/OR FOUNDATION$ AND= 94 ARTURO R TOIRAC P.S.M. 3102 I�0&Lot Law I 4'GLF. 4'C.L!' \ / 50LoE O I West !/2 of Lot Zl ` ' 4 BOCK 56 9 �t- 20 9.65' /270 b / a•32�\ W. {/2 of Lot 2/ x o i 17.00' �.. 10.40 +B• m 14.90 �, U) ONE STORY '0.35' SCK- 56 a C.B.S. I la BLOCA m Res. # 555 I B A K Remamc L. F Elev: 10.66 N I LOT- cana. slay --� F. F Elev: l l . 16 °• 3.0x3.5' x Garage Elev. 5.99'. \ z�9a a -`moo � 14.80 10.404'C.B.S. r Wa/f 0co= stnI g3'--'T" Walk I 4 I F. 75.00' (R) (Nl) Cane, ° z2'Parkway � M j Nr— -- 93r_d�St. l -56 ler of 2/ NOTE: ev.5pna2 rave." ABOVE GROUND ENCROACHMENT5*NOTED: N/A 7.5' TOTAL R!W tA5EMENT5 ACCORDING TO THE PLAT HEREON: N/A ALLEY ACCORDING TO THE PLAT HEREON: N/A ELEVATION5 ARE REFERRED TO MIAMI DADE COUNTY 5M# N/A ELEV.= N/A OF N.G.V.D. Or 1929 BASED ON THE FLOOD INSURENCE RATE MAP OF THE FEDERAL EMERGENCY AGENCY DATE OF FIELD wORK: July 23, 20 / 3 REVISED ON 9- / 1-09 THE HEREIN DESCRIBED PROPERTY IS SITUADED WHIN: CERTIFIED TO: REVISED Ox. Nm, 4, 2013 Frederick 5utherland ZONE X BASE FLOOD ELEV. A11A COMMUNr Y NUMBER. 0306 I hO MbY aBNb mai the attached Sketch oTSa W of the lame Veronica Mohna PANEL NUMBER 120652 SUFFU( Ldescdued Property is 10 the best Of my ke-dedge ww beast, a 4ue and correct represemedon. of a Pew survey Par(aae0 urger my Southern Tide Group, Inc. LEGAL NOTES d4aat=,Md alp —ahithe NrW—T-WoulStandardsasset ancago Title lrrsurance Co. T THIS SURVEY DOES NOT REFLECT OR 02OWNERSHIP. EXAMINATION OF TME ABSTRACT OF mnn by ins dda Board m Proteesiorwl &W4"= and Mappers in FwTFRWE chapter w7.0s0 tMr 6J-17.052 F.A.C. pursuant to Section 472027 Residential Financial Corporation TITLE VALL HAVE TO BE MADE TO DETS M NE RECORDED INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THISSURVEY 1S suaiwTTO DEDICATION, LWITATIONS. RESTRICTIONS, RESERVATIONS F. S. 15AOAI ATIMA OR EASEMENTS OF RECORDS. LEGAL DESCRIPTION PROVIDED BY CLIENT. THE LLABUTY OF THIS SURVEY S LIMITED TO THE COST OF THE SURVEY. UNDERGROUND ENCROACHMENTS. IF ANY, ARE NOT SHOWN. THIS FIRM KU NOT ATTEMPTED TO LOCATE FOOTNG AND/OR FOUNDATION$ AND= 94 ARTURO R TOIRAC P.S.M. 3102 UNDERGROUND IMPROVEMENTS OF ANY NATURE IF SHOVAI BEARINGS ARE REFERRED TOAN ASSUMED MERIDIAN. IF SHOWN ELEVATIONS ARE REFERRED TO N.G.VD. OF 1926 THE CLOSURE N THE Net vawwtwwd the atgneaue and the ongiaet emuosed beet pia BOUNDARY SURVEY S ABOVE 1:10000 Florida Licensed Sury Weap Mapper t er_eun urn wnnn.-.....•,...,..