RC-14-2248 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
FBC 20 [0
BUILDING v Master Permit No. C: L� t
T
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �� I �� r � S��%�'��1
City: Miami Shores County: Miami Dade Zip: 3 L
Folio/Parcel#: 11-320(, — 0 /�— ,33/U Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Coo/ ' `
nstruuction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee
/ VSimple Titleholder): �'(j/ V L r Phone#: 305-40 (,7— ��75—
Address: 9�7 `1/� c;24aee r/
In
City: i �t 7 h D AC Pf State: lac/ Zip: 3 d
Tenant/Lessee Name: n Phone#:
Email: edA•� C/ /M i /4 4"" C 0 /7V
CONTRACTOR:Company Name:_ Cc IA"e � Phone#:
Address: 364t5' A W 27 fl.
City: l��lw, oc. 1A —yyg State: Zip: 166
Qualifier Name: b7t.c7-Zi Phone#:
State Certification or Registration#: 52-5:qG lb 12. 4 66 Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: 2 City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
/ —1 DemolitionType of Work: 1:1 Addition ❑ Alteration ❑ New 21-'Repair/Replace
Description of Work: 'keo%4ce 9f9WR00/A 4oq
n l
*V- R e R ec.� dt.ks t l e s s w Gc t' It't-a
Specify color of color thru tile:
Submittal Fee$ � �) Permit Fee$ 1��• CCF CO/CC$
Scanning Fee$ ( Radon Fee$ DBPR$ • Notary$
Technology Fee$ �—� �� Training/Education Fee$ .(gip Double Fee$
Structural Reviews$ �� Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State 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.
1
Signature Signature
OWN or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instru;T;;
was
acknowledged before me this
day of i t( _ 20 by �b
� day of l 20 �� by
who is personally known to Al Y1,4
f 2 jJh' who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY LIC: NOTARY PUB
::
Sign: 1 '�ifil /a e, Sign:
Print: tl'G� �' -� Print: --'-�l'Cti c
Seal: Seal.
RICARDO IRIARTEF39t8-0
ICARDO :i�IARTE
€ MY COMMISSION#FF088736
� COMMISSION#FF088736
EXPIRESFe uary 2,2018**FloridaNS i .c0/ Floridallotaryservice.com
APPROVED BY �-S Plans Examiner Zoning
Structural Review evlew Clerk
(Revised02/24/2014)
Property Search Application - Miami-Dade County Page 1 of 8
�} Y
M1. 3
Address Owner Name Folio
SEARCH:
901 NE 97 ST Suite Q
PROPERTY INFORMATION
Folio: 11-3206-014-3310
Sub-Division:
MIAMI SHORES SEC 2
Property Address
901 NE 97 ST
Miami Shores, FL 33138-2529
Owner
MIA41 1 LLC
Mailing Address
9840 NE 2 AVE
MIAMI SHORES , FL 33138
Primary Zone
1100 SGL FAMILY-2301-2500 SQ
Primary Land Use
0101 RESIDENTIAL-SINGLE FAMILY: 1 UNIT
Beds/Baths/Half 3/3/0
Floors 1
Living Units 1
Actual Area
http://www.miamidade.gov/propertysearch/ 10/14/2014
Electronic Articles of Organization FLED 8 00 AM
For January 08 2014
Florida Limited Liability Company sec. Of state
thampton
Article I
The name of the Limited Liability Company is:
MIA41 1 LLC
Article II
The street address of the principal office of the Limited Liability Company is:
9840 NE 2ND AVE
MIAMI SHORES, FL. US 33138
The mailing address of the Limited Liability Company is:
9840 NE 2ND AVE
MIAMI SHORES, FL. US 33138
Article III
The name and Florida street address of the registered agent is:
EDWARD MILLER
190 NE 111 ST.
MIAMI SHORES, FL. 33161
Having been named as registered agent and to accept service of process for the above stated limited
liability company at the place designated in this certificate, I hereby accept the appointment as registered
agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes
relating to the proper and complete performance of my duties, and I am familiar with and accept the
obligations of my position as registered agent.
Registered Agent Signature: EDWARD MILLER
r `
Article IV L14000004032
The name and address oferson s authorized to manage LLC: FILED 8:00 AM
p g January 08 2014
Title: MGRM Sec. Of State
EDWARD MILLER thampton
190 NE 111 ST.
MIAMI SHORES, FL. 33161 US
Title: MGRM
ALEKXEY SABIDO
190 NE 111 ST.
MIAMI SHORES, FL. 33161 US
Title: MGRM
NESTOR ALBERTO JIMENEZ
3845 NW 57 PL
VIRGINIA GARDENS, FL. 33166 US
Title: MGRM
RAFAEL GIAMPETRUZZI
3845 NW 57 PL
VIRGINIA GARDENS, FL. 33166 US
Article V
The effective date for this Limited Liability Company shall be:
01/08/2014
Signature of member or an authorized representative
Electronic Signature: EDWARD MILLER
I am the member or authorized representative submitting these Articles of Organization and affirm that the
facts stated herein are true. I am aware that false information submitted in a document to the Department
of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to
file an annual report between January 1 st and May 1 st in the calendar year following formation of the LLC
and every year thereafter to maintain "active" status.
5t►oRFs t?t
Miami shores V
Building Department
4PXOR1Dp' 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 i£
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 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.
Own Contractor
Print Name: Print Name:
Signature: Signature:
State of Florida) State of Florida
County of Miami-Dade) County of Miami-Dade)
Sworn to and scribed before me this Sworn to s b cribe before me this
day 201_v. day of 20
pug Notary Public State of Florida
BJ / By r° �� Maxine Y GoTa7
c My commission i:t;ts 39239
?�Po°
Expires 09130r2016
(SEAL) r No Notary PubligState of Florida ( AL)
Type of Identification produced Maxine Y Gorr. z e of I entification pro uced
o y
V, pow Expires 09/30/2016