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DOCK-13-1912uM\0SaS'y� I I a - Miami Shores Village Budding Department Mo N.E.2nd Avenue, llWiami Shama, Fly 33138 Tel: (305) 795.2204 Fax: (305) 756 .8972 �81\" 0 ' ,�1 DOPECTIOWS PHONE NUM ML- (30S) 762.4949 0 BUILDING-*&WAA9_4*U* PERMIT APPLICATION PermitTie. • BUILDING JOB ADDRESS: ®� 1 me Alf FBC ZO IC) Permit No. Master Permit No..20 --j ei- 12- I Z f wMi Sham Courcy: Daae Folio/Panmlt � z,� - C 2- q — ell I t) � � 3�_ k the Badding M torlcdy Designated: Yes —NO OWNER: Name (Fee Simple CC zoae:_��� city: State• Tenant2e�e Nsimee �+: Email: CONTRACTOR: Company Name: Address: `l 1 1 Af % J` i A Y 7 atr n a State: Quaiiter Name: may, (2�# @. ls�'` Phone#; � � % � s t � % State Ceraification or Registry ne # c' � �{ 2 Cwt ffi"w ot'Cogd q � Contact 1': Email Address: DE91GNEB: ArdotecUEngineer: ��'C,ArC ,� M Vag Z Phone#: 27 Vahte of Work for this Permit: F &PwtMineaf00tWe of Work: Tgpe of Work: kAddidOn OAlteration ONew ORepair/Replace Dem%dbn of Work: PjD /A. a o 0 Of— /A /%I s e -rte w n . WLMMONon Coltif thru kk. Bflbmittai Fee $ZA, Permit Fee $ CCF $ CO/CC $ _ St�htting Fee $ Radon Fee $ DBPR $ N0taxT $ T / fncadon Fee $ Bond $ Techaoiogy Fee $ Doable Fee $ Sttvetaral Review $ — TOTAL FEE NOW DUE $ 7?7 Bonding Company's Name (if applicable) Bonding Company's Address city State zip Mortgage Lender's Name (if applicable) Mortgage L order's Address ��(7 City CI�J�® State Al; nmJ g vv 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, BOME'RS, BEATERS, TANKS and Arlt CONDITIONERS, ETC_... OWNER'S AFP'mAVIT: 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 COMMENCEMENT MAY RESULT IN YOUR IMPROVEMENTS TO YOUR PROPERTY. IF YI FINANCING, CONSULT WITH YOUR LENDER OR RECORDING YOUR NOTICE OF COMMENCEMENT:' RECORD A NOTICE OF PAYING TWICE FOR )U INTEND TO OBTAIN AN ATTORNEY BEFORE Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant Hurst 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 cer7ted copy of the recorded notice of conwnemement must be posted at the job site for the ,first inspection which occurs even (7) days gfter the building permit is issued. In. the absence of such posted notice; the inspection will not be approvedeinspection fee will be charged. t, pff or A The foregoing instrument was acknowl, ged before me tin day of . 201, bye C%�y= who is personally knows to me or who has produced NOTARY I wdid take an oath. 17 Signature � COniraCtor The foregoing instrument was acknowledged before me this11 tst Any of 20 13 by 2� e if tleA l eg Who is mrsonally known to me or who hftproducW as identification and whb did take an oath. NOTARY PUBLIC: LEANDRA MARTINEZ Sign: =*_ Commission # EE 844798 2016 igl ' . „ , 9ond80 ftm %y Fain I--.- My -vanc804My Commission Expires:" 17 r I ip MY '4 Structural Review (Revised 3/1212012)ORevised 07n 0/07kRevhW 0fin0R009)(RevJsed 3/15/09) W COMMISSION 1 EE 140714 EXPIRES: FeDruary 23, 2016 Bonded 11= Notely P •Undonvr�ere Clerk Aug 22 13 02:43p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756 .8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD 13. - COPY OF LOCAL BUSINESS TAX RECEIPT C. _____..._COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION EITHER CERTIFICATE OR EXCEMPTION IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEP D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 rrrarrarrrrrrarrrrrrrrrrraasrarrarrrrrrrarrararrrarrrrrrrrrrrrarrrrrarrrrrarrrrrrrarrrrrrr� COMPLETF nnNTRArTncwa uarnsrrwr2...1 BUSINESS NAME: BUSINESS ADDRESS: _ ��%� ,741/e, CITY STATE --E-4:- ZIP CODE BUSINESS PHONE: �� ��� - �Q %� FAX NUMBER ( j 2EL &la—� CELL PHONE!� D QUALIFIER'S NAME: L° QUALIFIER'S LIC NUMBER: �CO `J 72- E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLOV ! RV 3126(09 MLDv Aug 22 13 02:44p FROM :RLL POWER MRINE BOATLIFfS An FR}S 4-942-5339 Aug. 20 2013 09:50AM P1 'Y •t , o ` 12-05-2012 JEFF ATWATER STATE OF FL(JF11bq cHtFi'PJNANCuu oFF10ER STATE OF FINANCIAL .SERVICES DIVISION OF VVOFtKERS- COPAPENSATION CERTIFICATE OF ELECTION TO HE EXBWT• FROM FLORIDA WORKERS COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below h8S elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE; 01/20/2,012 PERSON: HENLEY FEiN: 245409429 BUSINESS NAME AND ADDRESS: ZANE R HENLEY LLC 2640 NE M AVENUE POMPANO BCH FL 33064 SCOPES OF BUSINESS 413 TRADE: 1-• LICENSED GENERAL CONTRACTOR EXPIRATION DAT'. 01/2012015 ZANE j n csiva pY: Patsuaat to ehaprer aso , Q51rtZ f.S•, as ofllser of a corporetioa who olncrs Caampt'on from Alis eftaprar by filing a unifieale at eleatiaa wader thla seCtiaa Ray not recaver bannefin or Campdasdtfoh V414" this cha;rler. Facwawt la CbaP(Br 44p,a$ir2), F.S.. Carlltrtalot of 41 ECttOq la )n traaTPf .. apply el election of Arte DtlSJ 1391est at ll a Ahad an the aalice I elaetloa to be BXemPt, PI9ea111 to Gabler 44(1.0$1181, F.S.. fJotiaea of eleceba, Se h0 ea4rtJFt ivd B;�ItrIC1in510 cenilie re be 1099f i shall o, sabjeet to ra f tht,A If, at oaY time Char be If1Jae of Ibc not,49 or The istaeaea of the nrNticactl the persaa oaaaa ea the aorroe N named oa tangar msaL rbp rngairements of lull tlCit011 for lsaaa4Ca of a rtfM1CaAe. The 48DerlWeni 13*'W "v a' a se'r C0 at any time far fafary of tpA JOA aamaa oa rRe ce/tFRte[e to mael few Iegahomeolz of Ibts cecliaa. OWC-252 CERTIFICATE DF ELECTION rO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-ICOS SrgrE OF FLORrDA PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE OEPARTMBNT OF FINANCIAL S£RVOM DMSION OF WORKERS' COMPENSATION . CONSTRUCTION INDUSTRY. CE=RTIFICATE OF ELECTION TO BE RXeMPT FROM FG.ORIDA WORXeRV COMPENSATION LAIN EFFEt:1'IVE0 01/20/2013 EXPIRrraTION OATS; 01/20/201S PERSON. ZANE, R Het4LEY FFIN 205409429 BUSINESS NAA4E AND ADDRESS: FARE R HSh4EY LLC 2it+W NE 7111 AVENUE POMPAK0 SCry Ft. 33084 SCOPE OF a3llSINESS OR TRADE 1 • Jesus"? cExMat CONMACTOR IMPORTANT - OPtlrSaaln to Chapter 44005(14). F,S„ 811 officer of a corporation who elects exemption from ,this chapter by filing a certificate of election D chapter, 1- ander this section (nay not recover bcnetits or compensetion under this H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be L Rxempt.. Apply only within the SC1Jpe Of die busirm!IS or trade listed an the notice of election to be exempt. E ilurSVent to Chapter 440.05113). F.S., Notices of election to be exempt and certif1010s of election to be 9xernpt Shell be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, Ike person framed pit the notice or wtifiaafa no longer meets the reatliremants of this Section for issuance of a certificate. The deparlment Shell revoke a ceutlficate at any time for fWlure of 'die Person rwmed an the Certificate to meet the r84Uilerrtfne3 Df thi6 of&ST10or87 (850) 419-1609 CUT HERE Carry bottom portion or, the job, keep upper Portion for yoU'r recants. OWC-152 CERTIFICATE OF ELECTION TO BE EX%WT REVISED 01-11 Aug 22 13 02:43p FROM :ALL POWER MARINE BOATL I FTS p.4 Aug. 20 2013 09:50AM P2 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100. Ft. 1-4uderdale,•FL 33301-1895--954-831-4000 VALID OCTOBER 1, 2013 THROUGH • SEPTEMBER 30, 2014 DBA: Business Name: Business Type:COZAME R HENLEY LLC Receipt #:1Et1Ei3NT hLCA?yTpACTOR (GEA xOP) Owner Name: za_ta8 A HENLEY Business Ope1106:04/13/20.00 Business LoCatlan: 2840 NE 7 AVE State:/County/CertfReg:CGC005472 POMPAVO SEAC.X Exemption Corte: Busingss Phone: 954 - 788 -6672 Rooms seats Employees Machines profs sslon8ls 2 Humber of Machines: - . Vending Type: 1. t27. nt Trensfer FBA ,NSF Fee Penalty Prier Ye" Cost Total Paid _...00 0.00 0.00 0.00 0.00 0.00 27.9C THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is Wed,for the:Nvit p e:ge of doing business within Browerd County arid is non -regulatory ;n nature, You must meet all County and/or Municipality planning WHEN VAUOATED and zoning requirements. This Business Tax Receipt must be transferred wizen the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that ` it is in compliance with 5tat6 or local laws and mqulations. Mailing Address. ZANE2840 H I37 LETAVE Y.1C Receipt #ICE -12-00003615 - 2840 N$ 7 AVE POMPANO BEACHr FL 33064 Faid 07/09/2QL3 27.00 Aug 22 13 02:43p M43 p.3 -=:i.r 4,e,,,._ae _ya���5•a�7 `'�.sF=�F. a STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL, REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD =- LICENSE NBR SEQ#L12060601255 06 06 2012 110414811 CGCOOS472 The GENERAL CONTRACTOR Named below IS CERTIFIED f Under the provisions of Chapter 489 rrs. Expiration date: AUG 31, 2014 HENLEY, ZANE R ZANE LLC 2 R.R. . EENT EH AVENUE POMPANO BEACH FL 33064 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW {EN LAWSON SECRETARY Aug 22 13 02A3p p.2 '4 CERTIFICATE OF LIABILITY INSURANCE R DATE("��DAIVCE 8/21/2013 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 REPRESENTATJVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poilcy(is$) 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 this cerMcate does not confer rights to the certificate holder In lieu of such endorsement(s1. PRODUCER MeaCT FaBees Jackson Insurance Agency (305 PHONE (305)824-3+164 FAx 2075 West 76th St (305)822-9535MAIL fba®z@ acksona 7 gency.coin Hialeah FL 33016 INsuR s AFFOROBIo COVERAGE NAI INSURED INSURERA-ZlO ds Of London Zane R. Hent INSURERS: ey / Zane R. Henley LT,C 2840 NE 7TH AVENUE INsuRERc: POMPANO BEACH FL 33064 - -- - ..cru urIUA 1 t NUNIBER: 2013-2014 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. VACLAIMS-MADE PE OF INSURANCEAM MM POLICY NUMBER POLICV Am sm EFF POLICY ©� ILITY D LIMITS IAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 T OCCUR 004528 /1/2013 /1/2014 APREMISES Ea nce 5 100, 000 M90 EXP (Any onePmari S n 1.11AMAPPLIES PER: AUTOMOBILE UA83LITY ANY ALTO ALL OWNEDED AUTOS HIRcDAUTED AUTOS UM564 EXC-MADE WORKERS COMPENSATION AND EMPLOYERS• LIMILrrY ANY YfN O ICEMMEMBPRIETER�EXCLUDED?XN J A QAandatory In NMI DESCRIPW)ON OF OPERATIONS J LOCATIONS! VEHICLES (Attach ACORD 101, AddMonai Rsma*s Schedule, It more apsM In mquVed) This certificate is Solely for the use as " 14vidence of Insurance,, PERSONAL&ADV INJURY 15 1,000,000 GENERALAGGREGAT_ $ 2, 000, 0001 I PRODUCTS -COMPA) AGG IS 1,000, 0001 S BODILY INJURY (Per person) Is; BODILY INJURY (Peres Wmv) S PROPERTY AT13E S eceident a EACH OCCURRENCE $ Sandra@marineboatAlifts , COm SHOULD ANY THE ABOVE DESCRIBED POLICIES BE CANCELLED AFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 HE 2 Avenue AUTHORIZED REPPESMaATIVE Miami Shor®s „ TL 33138 Ed Jac)cson/FANNTE T~ ACORD i6 (aa10jM L--�—� INS825 rmir"I n1 ®1988 2x111 ACORD CORPORATION. All rights reserved. Thea Aftnan nuns. and Inan or& *anlatamrl n mr*a wf ILMRrl �a�� s�o�� v� 10050 N.E. SECOND AVE. MIAMI SHORES, FLORIDA 33138-2382 Telephone: (305) 795-2207 Fax: (305) 756-8972 DAVID A. DACQUISTO, AICP PLANNI G & ZONING DIRECTOR DEVELOPMENT ORDER File Number: PZ -4-13-201322 Property Address: 1039 NE 104" St. Property Owner/Applicant: Noel Franz Address: 1039 NE 104th Street, Miami Shares, 33138 Whereas, the applicant Noel Franz (Owner), has filed an application for site plan review before the Planning Board on the above property. The applicant sought approval as follows: Special site plan review and approval. Dock and boat lift. Whereas, a public hearing was held on June 27, 2013 and the Board, after having considered the application and after hearing testimony and reviewing the evidence entered, finds: 1. The application was made in a manner consistent with the requirements of the Land Development Code of Miami Shores Village. 2. The conditions on the property and the representations made at the hearing merit consideration and are consistent with the requirements of the Land Development Code. The Board requires that all further development of the property shall be performed in a manner consistent with the site plan, drawings, and the conditions agreed upon at the hearing: 1) Approval is granted for a dock and boat lift. 2) Applicant to secure final approval from the Department of Regulatory and Economic Resources, Environmental Resources Management and the Army Corps of Engineers, before a building permit will be issued. 3) Applicant to obtain a building permit before commencing work. 4) Applicant to meet all applicable code provisions at the time of permitting. 5) Applicant to add not less than four (4) reflectors, (2) at the end of the dock at the farthest extension into the bay and two (2) on the outer boat lift guide posts. 5) Applicant to add not less than two (2) lights at the end of the dock at the farthest extension into the bay. Page l of 2 DO PZ -4-13-201322 Franz 6) Applicant to provide engineering report to the satisfaction of the building official prior to receiving final on permit. The application with conditions was passed and adopted this 27`h day of June, 2013 by the Planning and Zoning Board as follows: Mr. Abramitis YES W. Busta YES Mr. Reese YES Mr. Zelkowitz YES Chairman Fernandez YEs Date Page 2 of 2 DO PZ -4-13-201322 Franz Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: Dt" 13 -I � I Structural Critique Sheet t ni c -v I`( P L6 --CE Do� , (� SPG M 111Lf/i3 S '3 4- r101 - US—c"- Page 1 of 1 STOPPED REVIEW Plan review Is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. Mehdi Asraf