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DS-14-247Miami Shores Village Building 6Departmento g �j 5 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �� 4 Tel: (305) 795.2204 Fax: (305) 756.8972 BY: INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING PERMIT APPLICATION Permit Typ=BUELDING Permit No. Master Permit No V-51 I '' 2y ROOFING JOB ADDRESS: S -Q;_ /cif: ? 7' _91%65-7- City: 91% tc7"City: Miami Shores County: Miami Dade Zip: 3 1 Folio/Parcel#: _'f"- 5Z 0f® _ 0.2-0 s ®q`70 Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titleholder):_i Address: /57S_ A144-) �P S City: /W / Tenant/Lessee Name: /V Vl HE)t_biA)e; _Z_v C. State: r-1- -1- Email: • co" Zone: Phnnafk• %il � �� CONTRACTOR: Company Name: J5-_b6Y' PAZ i QUh0Re"7" -fit% C. Phone#: Address: S/5' A)W -32 AVE 8.31,12- 8.31,12- 30 30 City: "1AA4 f State: rL Zip: 3.?12 55 Qualifier Name: X-flf i 4UC-A),00 Phone#: 614)ZQ 7- 7?,� State Certification or Registration #: 'Ell® 0,;2$ Certificate of Competency #: Contact Phone#: q4 y 24 -.,L -7X3 Email Address: d DESIGNER: Architect/Engineer: Phonek Value of Work for this Permit: $_P 90v Square/Linear Footage of Work: cga�� Type of Work: ❑Addition__QWteration ZfNew ❑Repair/Replace ❑Demolition Description of Work: Color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 6Z Bonding Company's Name (if aIpUcable) 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, - Signature Owner or Agent Contractor The fore ing instrument was acknowledged before me this ?,74 day of , 20Lf byZ4?!!!te�lfc ! , who is personally known to me or who has produced dentification and who did take an oath. The foregoing instrument was ac owledged before me •s day of`r����'+, 20 by who is personally/known to me or who has produced ' As identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: 4 e F-6;�I/.AWfe Print:�� ���� Wf I;SLY-5fi3 E OF FLORIDA 41.11, My Commission Expires: NOTARY PUBLIC -STATE OF FLORIDA My Commissi( tries: E. G. Budwick >•,• . E. G B Commissia udwick �, n# EE075890 Commission # EE075890 °. Expires: MAR. 20 2015 3''•.,,,.. Expires: MAR. 20 2015 so�Enr�rArEAtrrtcsoXMr,Co.]Nc APPROVED BY Plans Examiner I✓� �/ ��� �y Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Miami'shores village Building Department 10050 N.E.2nd Avenue Marrd Shares, 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 B. 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 EXEMPTION) 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 DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTIONI YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION <10 BUSINESS NAME: E� tZ Z 0 PH EM j -� c-. BUSINESS ADDRESS: Ny✓ 32- AyeCITY A4, & m STATE 1-Z04(JA ZIP CODE BUSINESS PHONE: ( 1 "91-7- -7 �F3 "� FAX NUMBER( J 1 31/ , - -7Z-0 �- CELL PHONE( �G) -1-Tl 000aQUALIFIEMS NAME: fZ'EI s y Do orr1yb o QUALIFIER'S LIC NUMBER: E>lovz1 E-MAIL ADDRESS (IF APPLICABLE): M C P" riff Cmatel on MUD BY NLDV/ RV 312aM MDV -®lwnctj-v�rywt CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY El 100281 EDEY PEREZ EQUIPMENT INC D.B.A.: OQqNDO KEISY Is certified under the provisions of Chapter 10 of Miami -Dade County VALID FOR CONTRACTING UNTIL09/30/2015 QUALIFYING TRADE(S) 0007 PAVING ENGINEERING Chases Danger P.E- Secretary of the Board DRIVER LICENSE CLASS E OQUENDC 912 E 31 ST HIALEAH. FL 33013-0000 DOS 09-01-1982 SEX F S';0:07-W2011 HGT 5-00 E< :_:,2'- 09-01-2019 SAFE Laf iVER 'Snt[ddw.N? ni d frYOto[ vataCle COME#i#f5 C!#i5ara 10 AOY 5rlr`nCti' }+acr SI!QJYPC tR' laa RESTR1C ONS: ACWF-M— lenses. 0-O--' Rearview W — ENDORSEMENTS: CLASS: £ - Any rwn�a mR ,4 vara wdt+a GVWR Mss V° 2%001 Am or any RV REPLACEMENT LICENSE REMARED YYf M t0 DAYS OF ADDRESS OR NAME CHANGE The State of FMrida ratans ae PropeM dofts h—IM Famti.. wea« � caa umu1� . �✓ �r Oreev ata.fnr�� -- sosttmosao t R<v Dale aa3td9 � ww�I.Rlt�ff2$DV OlmcOls�foe t C� 0 CERTIFICATE OF LIABILITY INSURANCEDATAIMIJDDIYYYYI __ 101124/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS •NQ W i:Frs'UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CEJ7TIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANI) THE CERTIFICATE HOLDER. IMPORTANT: if tits ceAtllcate holder Is an ADINTIONAL INSURED, the polkypae) must be endorsed. ff SUBROGATION IS WAIVED, subject to the terms and conditions of ttre pogcy, ceKaln pokles may require an endorsement. A sttlerttoat on this cortiflcato duos not corder rights to the eartfflemo heldor In you of sUth ondorsomad(s ) PRODUCER Chaplan & Castro Insurance 2552 NW 7 Street Miami, FL 33126 Phone (306)641-4009 Fax (305)848-1513 INSURED EDEY PEREZ EQUIPMENT INC 815 NW 32 AVE DOLORES CASTRO ._(3051541.4009 ISUp; CANAL INDEMNITY INSURANCE CO. 513 MIAMI, FLORIDA 33125_— _ INSURER F : _ � COVERAC,ES __ CERTIFICATE NUMBER: REINSION 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 RHOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS - CERTIFICATE. MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, GENERAL UAMUTY © COMMERCIAL GEWAALLIABIUITY A ❑ ❑ CLAIM -MADE © OCCUR I GL105465 GEML AGGREGATE LUT APPLIES PER: ❑ POLICY ❑ ❑ LOC AUTOAIOeILE IJABILIIY ❑ ANYALrra ��-^�� QALL OWINEO LJ AUTOSCMEOUL f P ❑ 14IRCDAUTOB ❑ AU gWAIEO ❑ UMBRELLA LIAR ❑ OCCUR ❑ E== L"B -aq. ❑ DED ❑ RETENTIONS WommRBCOYPENSATION - — - I AND EMPLOYERS' Luu3Lrry YIN, OFFICE�Rtt�6ER EX LNUDE Ot U E NIA; (Mondataro In NMI 111/2912014 111 /2912015 100,000.00 5,000.00 _ 1,000,000,00 I VEMICLES IAMeah ACORD 7/!, AddlWml Aernarks Schedule, It mare space is req%&odl REFILL OF SAND AND OIL CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI, FLORIDA 33130 ACORD 25 (2010/05) OF CANCELLATION _ 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 REPRESEAITAYNg --D- - J ORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10/T0 39dd NI WISVO IS NV-ldVHD ETS1609GOE EE=81 tPTOZ/LZ/10 PRODUCTS -COMPIOPAGG $P.1,O( S • 1=00 SINGLE LIMB BODILY INJURY (Per polsan) a BODILY INJURY (Per accident) $ ' PROPER�1' AMAGE S Perrrca WH OCCURRENCEI AGGREGATE - _ $ - I VEMICLES IAMeah ACORD 7/!, AddlWml Aernarks Schedule, It mare space is req%&odl REFILL OF SAND AND OIL CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI, FLORIDA 33130 ACORD 25 (2010/05) OF CANCELLATION _ 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 REPRESEAITAYNg --D- - J ORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10/T0 39dd NI WISVO IS NV-ldVHD ETS1609GOE EE=81 tPTOZ/LZ/10 ' 4 � CONSTRUCTION INDUSTRY EXEMPTION This certi5es that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 7/6/2013 EXPIRATION DATE: 7/5/2015 PERSON: OQUENDO KEISY FEIN: 201607153 BUSINESS NAME AND ADDRESS: EDEY PEREZ EQUIPMENT INC 912 E 31 ST HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: CONCRETE OR CEMENT STREET OR ROAD STREET OR ROAD CLEANER -DEBRIS WORK - FLOO CONSTRUCTION: P CONSTRUCTION: S REMOVAL - CONST Pursuant to Chaps 440.05(141 F.S.. an cfikaar of a corporation who daft exemption from tht chapter by Gang a N ofelection wMer9ds section may not recover bereft or cornpensation under the chapter Prasuwdto ChopW440.0.5(121 F.S., C of eRmUm to be ex=Mt- appgr o* vAVdn the soope of the business or #ads listed on the notice of election to be exempt Pursuant to Chapter 440.05(13). F.S., Notices of election to be amro and certificates of election to be exempt shag be subject to revocation if, at any tinne after to MM of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets tre requirements of this section for issuance of a certiticata. The department shall revoke a ate at any time for failure of to person named on to csttgcate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1809 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION " CERTIFICATE OF ELECTION TO 13E EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW ' • CONSTRUCTION INDUSTRY EXEMPTION This certifies that the indtiKW listed below has ekxftd to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 7/&2013 EXPIRA71ON DATE: 716=5 PERSON: PEREZ EDEY FEIN: 201807153 BUSINESS NAME AND ADDRESS: EDEY PEREZ EQUIPMENT INC 815 NW 32 AVE MIAMI FL 33125 SCOPES OF BUSINESS OR TRADE: CONCRETE OR CEMENT STREET OR ROAD STREET OR ROAD CLEANER-DEBRIS WORK - FLOO CONSTRUCTION: P CONSTRUCTION: S REMOVAL - CONST Pursuant to Chapter440.04141 F.S.. an officer of a oorpaelim whoelects wwwran flan Oft chaptarby ming a certificate of ern under gds section may net mover bamfits or campemogon urderthls dopM Pw=M to Chapter 440.05(12). F.S.. Cain of election to be exempt- apply only Mild. Om scope of the bushiess or bade fel an the rte of 01000 n to be exempt Pursuant to CtmpW 440.05(13). F.S., Nothcas of election M be exempt and eer' of election to be exarnpt dip ba subject to nevocafton ifat any time atter#w tft of the rmdoe or tlm issue of tivecartilicala, the person narrmd on the nodes or cm ffica no longer meets the requirements of this section for issuarwe of a eaThe departawd shall revalm a cartificM at any than forfailure of the person named on the carWh ate to meet the requirements of Oft serdian. DFS-F2-DVVC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 P Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PAY 4939451 BUSINESS NAME/LOCATION EDEY PEREZ EQUIPMENT INC 815 NW 32 AVE MIAMI FL 33125 LBT RECEIPT NO. EXPIRES W- MA SEPTEMBER 30, 2014 Must be displayed at piece of business Pursuant to County Code Chapter BA - Art. 9 & 10 SEC. TYPE OF BUSINESS EDIFY PEREZ EQUIPMENT INC 213 SERVICE BUSINESS By AX CO��F Employee(s) 1 $45.00 09/13/2013 CREDITCARD-13-008524 This loci Business Tai Receiptonly a ehhBhms o N to the Local Badness Tax. The Receipt Is amt a Room of as pehmit ora cedifi xrten the holder'sgm , de badness. Holler saw comply with any g or ragnlNwyhawsa rdr which apply to the busbom The RId;EIPT Na above most be dhsphryed an all ectal vabicJ+w-Wao ni-Dade Code Sec Ba -278. Fm ire infaramlium visit weww.miamhdas 003'760 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6834825 BUSINESS NAMEILOCATION EDEY PEREZ EQUIPMENT INC 815 NW 32 AVE MIAMI FL 33125 RECEIPTNO. EXPIRES RMEWSEPTEMBER 30, 2014 Must be displayed at place of business Pursuant to County Code Chapter SA - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS AYMENT RECEIVED EDEY PEREZ EQUIPMENT INC 198 SPECIALTY ENGINEERING CONTRACT:: TA twLLE= Worker(s) 2 E1100281 $45.00 49/12/2013 CREDITCARD-13-M340 lhfs Local Business Tax Receipt only cma� rad of the Local Business Tax. The Receipt Is not a Ifeense, pnongovamamenm lied rtwycartiffeadon � I. mare wmNeh e m fbebushom Rema toost CGM* with �Y t w The RECEIPT NB. above mho be lis WW on all commercial vehicles -8[Gami-Bede Code See 8a 278, For am ldmaision. visit, ,;. �� � � ,� Ali x N% P, S iu 4 N N NEW SIDEIA SEE DETAIL V 1 M� %' K LOT 19 EXISTING GREEN AREA NEW SIDEWALK SEE DETAIL— EXISTING ASPHALT PARKING TO REMAIN •\.SAS • \ .RECEIVED FEB 10 014 r r,>S71(q MJ EXISTING ONE STORY BU I LDI NG /////// 130.00' (R & M) LOT 20 BLK 23 EXISTING SITE PLAN SCALE: 1/16" = V-0" w D K NEW SIDEWALK FOR:' - 555 N.E. 87TH STREET MIAMI SHORES, FL 33138 ICE i -ate vdl.LAOE BY I DATE �C L,. i LDERAL. R;dE ,44u' REGJLAIIONS FQd ORPO 8 4141X COPE Fl i:R f°i; �:n" :gin•. u• . aueowwe ' NOTES 1. A MINIMUM OF r THICK SIDEWALK IS REQUIRED AT SIDEWALKS THROUGH DRIVEWAYS AND ON ALL COMMERCIAL SIDEWALK APPLICATIONS. 2. CONCRETE STRENGTH SHALL BE 3OW P.S.I. 3. THE USE OF REINFORCEMENT WILL NOT SE PERMITTED. 4, SIDEWALK SLOPES SHALL MEET THE REQUIREMENTS OF THE AMERICANS WITH DISABILITIES ACT (ADA} SIDEWALK DETAIL (-FYP) N.T.S. 3 /WW s,APJ SSSS NO 8 7 S'r. MMM/ S 0096 a 3