Loading...
RC-14-1249P Miami Shores Village CEIVE Building Department JUN 13 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 331388 Tel: (305) 795-2204 Fax: (305) 756-8972 -- - INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2010 BUILDING Master Permit No. PER IT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: <?gQ & ,`2`% . City: Miami Shores County: Miami Dade ZipZ? % Folio/Parcel#:_ J/®�®® �% 4 '7'6 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder) Address: g e4 AI E 17 Construction Type: Flood Zone: I'd4 ch& AL// cl911- BFE: FFE: City: State:! Zip: /moiEL Tenant/Lessee Name: AZ Phone#: Email: CONTRACTOR: Company Name: �IZ.EIN � �C���` ` �yi�' (KYJ Phone#:(. Address: 1�Z�'1 K)E -7 -5-:. 1 City: �-k ° S e"KMe - State: �— (-- Zip: ( Qualifier Name: 2� (911-43E, PvalJq---k)k 4— Phone#: Ef �Cb State Certification or Registration M. c4b� LnE�-I�( -11 Certificate of Competency #: DESIGNER: Architect/Engineer: L -e\e �i® Phone#: Address: City: State: Value of Work for this Permit: $,_ A() Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 2 `l3�C� � ,�� C-eA,� 7 - Specify Specify color of color thru tile: 60 Submittal Fee $Permit Fee $ Scanning Fee $ Technology Fee Structural Reviews (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip City State Zi 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 commerriment must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued int e bsence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. I Signature OWNER or AGENT The foregoing instrument was acknowledged before me this ci day of Yy-) 1-:1' `- 20 , by who is personally known to me or who has produced 45-k— l I as CONTRACTOR The foregoi ft instrument was acknowledged before me this day of JC)z? = , 20 by -S,f�� ____,who is personally known to me or who has produced/!!;, identification and who did take an oath. identification and who didtake an oath. //ii/,�� NOTARY PUBLIC: NOTARY PUBLIC: l\\`\\`\\`Jt1iiiii/r// Sign: �` ®� ��v®X, - Sign: g Print: LIU ., Notaryof Florida Seal: ', .. �4'� Seal:no`ommin =Joanne FF on FF 082753 04 A F, A A 0W%-0A*%AW%0V%-i APPROVED BY "� ` Plans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014) N 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: 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 iniuries of any person 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 RE CONTENTS. Owner / Print Name: 016 CJ Ir) C Print Name: Signature: Signature: - 7 3,5 ignature•_73.s '�/L/ y) r - State of Florida ) County of Miami -Dade) Sworn t9 and subscribed before me this J_3 day of , 20_�_'_. Lo Expires OiM2l2018 THIS NOTICE AND UNDERSTAND ITS ,�, (V 4"Wy State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this day of , 20_; Notary Pups Joanna M Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223462 Permit Number: RC -6-14-1249 Scheduled Inspection Date: November 18, 2014 Inspector: Rodriguez, Jorge Owner: CLEEK, RONALD Job Address: 882 NE 97 Street Miami Shores, FL Project: <NONE> Contractor: ARENAS CONSTRUCTION Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060142700 Phone: (305)300-3103 rsunamg uepartment comments REMODEL 2 BATHROOMS AND ADJACENT CLOSETS Infractio Passed comments INSPECTOR COMMENTS False November 17, 2014 For Inspections please call: (305)762-4949 Page 34 of 45 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 17, 2014 For Inspections please call: (305)762-4949 Page 34 of 45 �.�I I f.: