FW-14-2424��I
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
j UILDING ❑ ELECTRIC ❑ ROOFING
NOV 0 4 `014
SBC 20 / L
Master Permit No.
La
Sub Permit No.
REVISION F-1 EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL EJPUBLIC WORKS ❑ CHANGE OF F-] CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: '4 � AC L'V ( ® % S `r
City: Miami Shores County Miami Dade Zia• *? 2 i. -o
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Tu
e 4- tf-c ir'/
Address: `1 4 &1 LA -j 10 f �; -q-
City:
City: ) k"'z vV,% e , State: ip: % S C
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:'� g-y�-, �, SKO-honeM 9 3 S-
Address: t t 4 LA—) I `�
City: 'W o C -t A-2- sed,,, State: zip: co b
Qualifier Name: Sr .f Q:0 w � ate. C-JCzLCk— Phone#: Cps-"'} 3-0 ( 3 y i
State Certification or Registration #: Certificate of Competency #: ® o -a q
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ ®® Square/Linear Footage of Work: 5-
Type of Work: ❑ Addition ❑ Alteration 153New ❑ Repair/Replace ❑ Demolition
Description of Work: �� � �. �� , y on,� (2
Specify color ofc�oll oar thru tile:
Submittal Fee $ -/(/ Permit Fee $ 1 GS -OD CCF $ 'Z s� CO/CC $
Scanning Fee $ Radon Fee $ ,0 �""4 � DBPR $ Notary $ CP
Technology Fee $ s Training/Education Fee $ Double Fee
Structural Reviews $ Bonds,22
TOTAL FEE NOW DUE $ 13' -Sr
(Revised02/24/2014)
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.
AL��_Jg
Signature Signature
WNER or AGENT CONTRACTOR
The foregoing instrument was ackno ledged before me this
-11 0r dayQ f ,�°f' 1,-' 'r�"' 20 by
1 �
"'who who is personally known to
me or who has produced as
identification and whoJ�� .� take an oat
�nry Avila
NOTARY PUBLIC:' 11�
. z COMMISSION f FFIS6104
' = EXPIRES; .wly 17, M18
''•; •� 1[ WjipppNNOTARY.COM
Sign:
Print:
Seal:
The foregoing instrument was acknowledged before me this
% v day of e 0-- 4.11/ 20 t % by
�� � S' 4 • Ci" — ho is personally known to
me or who has produced as
identification and who did tt th. Very Avila
NOTARY PUBLIC: *_ BION # FROM
• - p�RES: ,kdy 17, 2018
i►t�`��`�`
wwwANONNOTARY.COM
Sign:
Print:
Seal:
APPROVED BY 1 141 I Plans Examiner ]601L� Zoning
Structural Review Clerk
(Revised02/24/2014)
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 construction 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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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 anyperson allowed to work under this permit. Please check with your
insurance carrier 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
US �(o,l Pie J 42 e (i
Print Name:
Signature:
State of Florida )
County of Miami -Dade )
Sworn to an4 subscribed before me this
day of s Yn Z_,,L r , 20 K .
(SEAL)
EXPIRES: May 18,2D18
ftdWn"NalegtP&*Urge
Contractor
J �
Print Name: S10
f�
Signature: , _--ano-P
a
State of Florida)
County of Miami -Dade)
Sworn to and ubsc bed before me this
day of Se r , 20_!y
BY Se- 'r5S U �'A SC;'tyw1 c`00 a
EXPIRES: May 18.2D18
Bonded ThN N*W PuW Undernden
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Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
FOOD FENCE DETAIL
4x4 Post Spacing
Fences <= 5' high posts spaced at Ton center maximum
0.•60 Fences <=4' high posts spaced at6"on center maximum
0.66 ; .00. Fence must not exceed 5'in height
.;...0 FIr F n n n
May 2009
4x4 pressure treated
posts embedded Tinto
concrete footing 10"
diameter x 2'deep
ALL wood must be pressure treated I
All fasteners must be corrosion resistant L
No less than two fasteners in any connection
Ix pickets fastened
with two corrosion
resistant fasteners per
connection
2x4 horizontal
pressure treated.
wood members
with two corrosion
resistant fasteners
per connection
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CLIENT: JUSELAINER LEGER • • • • • • • """ •
PROPERTY ADDRESS: 47 NW 101 ST, MIAMI FL 33150
LEGAL DESCRIPTION: •. • .• •"• .•
LOT 13 AND THE EAST 2 OF LOT 12, BLOCK 2, NAVARRO SUBDIV1§I4IW *j�R0IAG Td f HE PLAT THEREOF
AS RECORDED IN PLAT BOOK 12, PAGE59, OF THE PUBLIC REeORBS-OF•MIAM ®AOL'eOUNTY, FLORIDA.
ELEVATION INFORMATION.
B.M. USED N-567 ELEVATIONS 10.54 LOCATED NE 104 ST & NORTH MIAMI AVE
BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY
DATED OR REVISED ON 9-11-09 THE HEREIN DESCRIBED
PROPERTY IS SITUATED WITHIN ZONE X BASE FLOOD ELEVATION N/A COMMUNITY 120652 PANEL NUMBER
0302 SUFFIX L
BOUNDARY SURVEY
CERTIFIED TO: CALE =1:20
JUSELAINE LEGER
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SURVEYOR'S NOTES:
I CER—ATE-AUTHINEZAn LA 7Ma NOT VAta WITRAT AV AUTHENIMAIFL ELECrnC,VIC 81GYATWE ARipAUMENT—
ELECTAJNaSEAL.
WL
'AV I LA
ociates ervices Inc.
and Surveyors & Engineers
CERTIFICATE OF AUTHORIZATION NO. 29056
} CERTIFICATE OF AUTHORIZATION NO. 76M
680 EAST 49TH STREET
HIALEAH, FL. 33013
.a PHONE:(305) 953-2600
EFRAIN C. LOPEZ., P.L.S. (10-16-2014)
PROFESSIONAL LAND SURVEYOR NO.: 2.300 STATE OF FLORIDA
(VALID COPIES OF THIS SURVEY WILL BEAR THE EMBOSSED SEAL OF THEATTESTING
LAND SURVEYOR).
SURVEYOR'S CERTIFICATION.
IHERESYCERTIFY.: THAT THEATTACHEDBOUNDARYSURVEYOFTHE ABOVE DESCRIBED—
PROPERTY, IS TRUEAND CORRECT TO THE BEST OF MY KNOWLEDGEAND BELIEF, AS
RECENTLY SURVEYED AND PLOTTED UNDER MYRESPONSIBLE DIRECTION, AND THAT THERE
ARE NO ABOVEGROUND ENCROACHMENTS UNLESS SHOWN THEREON. I FURTHER CERTIFY THIS
SURVEY MEETS THE STANDARDS -OF -PRACTICE FOR BOUNDARY -SURVEYS, PURSUANT TO
SECTION 472027, FLORIDA STATUTES, AND ADOPTED IN CHAPTER 5J-17050 FLORIDA
ADMINISTRATIVE CODE EFFECTIVE DATE JANUARY 1, 2010; AS AMENDED FEBRUARY 23, 2005.