RC-14-2031 (5) Miami Shores Village
Building Department OCT 7 '21114
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 1®
BUILDING Master Permit No. O—` - I
PERMIT APPLICATION Sub Permit No.
FE]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 358 NE 94 ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:1132060136150 Is the Building Historically Designated:Yes NO X
Occupancy Type: SGL FML Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):JONATHAN C. BUCKLAND Phone#:
Address:358 NE 94 ST
City. MIAMI SHORES State: FLZip; 33138
Tenant/Lessee Name: Q Phone#:
Email: Com/SS� !S 7q7— 0-5 d,9
CONTRACTOR:Company Name: VICTORY ENGINEERS&GENERAL CONTRACTORS Phone#: 305-2445424
Address: 7500 NW 25 ST, SUITE 241
City; MIAMI State: FL Zip; 33122
Qualifier Name: VINAYAGAR BALAKRISHNAN M. Phone#: 305-244-5424
State Certification or Registration#: CGC-1515 166 Certificate of Competency#: CGC- 1515 166
DESIGNER:Architect/Engineer: FLORIDA INTERNATIONAL ENGINEERING Phone#: 305-378-1991
Address:7500 NW 25 ST, SUITE 241 City; MIAMI State: FL Zip: 33122
Value of Work for this Permit:$�,i �+3j 0 4®° Square/linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: INTERIOR REMODEL, ADD NEW BATHROOM, KITCHEN REMODEL, BATHROOM
REMODEL, RELOCATE LAUNDRY ROOM
Specify color of color thru tile:
Submittal Fee$ '� Permit Fee$a�� r CCF$ ® ° D CO/CC$
--�� o'
Scanning Fee$ "'��qq I _Cly J Radon Fee$ ' r 9 DBPR Notary$
Technology Fee$ I tt Training/Education Fee$ -D- e90 Double Fee$
Structural Reviews$ �1 �o . Bond$ 0
TOTAL FEE NOW DUE$ ,
(Revised02/24/2014)
t ,i ♦ 1
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.
(11�
Signature Signature
s--
OWNE t or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of QS1%(Z- ,20 (1:1 .by A� day of5����`�' ,20 by
-J'V W 14 ��EcS> ta.c�CPQ,who is personally known to �V� GcH g� - � ('who is personally known to
VF—
me or who has produced as me or who has produced as
identification ad ho did take an oath. identification and who did take an oath.
NOTARY PUBL
C.
NOTARY PUBLIC:
Sign: Sign:_ J
Print: v c state d ROOM Print:
J.f-ug% SinidfaAl�arez ORLANDO LEON MEJIA
Seal: My commission FF 166700 Seal:
�lW, SWM909J0312016 C*mrnission s EE 170026
My C"f"i Sion(Flor"
Meich 2010
APPROVED BY Plans Examiner Zoning
L9 10 P� Structural Review Clerk
(Revised02/24/2014)
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
CGC1515166
The GENERAL CONTRACTOR 4'
Named below IS CERTIFIED '
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
BALAKRISHNAN,VINAYAGAR 1 r •
VICTORY ENGINEERS AND GENERAL CONTRACTORS LLC •
7500 NW 25 STREET,SUITE 241 =
MIAMI FC 33122k
ISSUED: 09/23/2014 DISPLAYAS REQUIRED BY LAW SEQI# L1409230000M
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
CCC1328728
The ROOFING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
BALAKRISHNAN,VINAYAGAR M `. •
VICTORY ENGINEERS AND GENERAL CONTRACT_ORS LLC
7500 NW 25,STREET
SUITE 241
MIAMI FL 33122• •
ISSUED: 09/23/2014 DISPLAYAS REQUIRED BY LAW SEQ# L14092300ON49
aosrn
Local Business Tax Receipt
Miami—Dada County,, State of Florida
?HIS 15 NOTA BILL - DO NOT PAY
LBT,
6725395 b�+
SUSIN89B NAMWWCATION fWCEIPT No. EXPIRES
VICTORY ENGINEERS&GENERAL CONTRACTORS LONEWAL SEPTEMBER 30, 2015
7500 MIN 25 ST#241 6998828 Must be displayed at Place of busirress
MIAMI FL 33122° Putsuw to County Cods
9hapter8A-Art:9&10
OWNER. SEC.TYPE OF BUSINESS
!96 SPECWI.TY BUI1 C11NG.COidTRAG7 DR PA=1CFV,itW0V60
VICTORY 1:l ONEERS&GENEM BA resat rc tLEcroa
CONTRACjORS LLC GCC13?6728 $75.00 07/25/2014
Wgrker(s) 3UMRCARQ-14-029923
TMsLocdBudn=TaxRecoWanlyeadmmpymntaitte LacW BndnewTax.The Receipt is not a licease.,
pemrtt m n eertlRcadiorr d*e hold0=4002=9oas,Ua do blrsk=&Nohiermast amaplp witb env gevemmentol
ei nongaver�eatal tegnlaUary lawsnte wbiob apply to the bnsiaess
%RECEIPT 00.above mustbadispiaW on off commercbd vehicles-Mleml-CledaCode See Be-211
For more bticrmatloa vi8ltwww.mtanddaft wAaxoollectar
t1tl8821
Local Business Tax Receipt
Miami-Dade County, State of Florida
-1141S IS,'NOTABILL - Do NOT PAY
LBT,,,
6603014,
BUSINESS NAMStLOC.NnON RECEIPT NO. EXPIRES
VKMRY' ERS I-mGINEa-NERAL CONTIM,CrOI±»S L INANEWAL S90TENIBE030, 20'15
7500 NW 25 ST#241 6873740
- Must be displayed at place of busiaesa
MU1M1 FL 33122, Pursuant to Courcy'Code
ChapW SA-rArt.9&10
OWNER SEC,TYPE Of BUSINESS PAYMENT RECEIVED
VICTORY ENGINEERS&GENERAL 136 GENERAL BUILDING CONTRACTOR BY TAX T RECETOK
COI�TRa4CTORS LLC CGC1575766, 875.00 07/25/2014
Worker(s) 3 CREDRCARD-14--029923
•lids Leat 1% Tax Receipt only cnnRrma papaasnt olthe Local BasiaessTax.The Recetptis nota lh=q.
pemdt.are cerd6raDl"altbe bolder s to do budnem HaWetmmttoomplywitb wy sovemmentaI
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JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
**CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This Certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 5/7/2014 EXPIRATION DATE: 5/6/2016
PERSON: VINAYAGAR BALAKRISHNAN M
FEIN: 260650258
BUSINESS NAME AND ADDRESS:
VICTORY ENGINEERS AND GI
7500 NW 25 STREET,STE 241
MIAMI FL 33122
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL LICENSED ROOFING
CONTRACTOR CONTRACTOR
Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may
not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope
of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or
certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609
Aw
onto Miami shores V illage
Building Department
Rte' 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 m 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 fora 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 youy be
nig
Rersonally liable for the worker co enation injuries of any person allowed to work under this rmit. 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 Contractor
Print Name: Print Name:4 V �
Signature: Signature: r�
State of Florida) State of Florida
County of Miami-Dade} County of Miami-Dade}
Sworn to and subscribed b Sworn to and ubscribed before me this
day of LIC day of CC
By �Q► ATE OF FLORIDA By'�`.ru�. �••� •:"��" N O ^�LEON
035A
V
(SEAL) E>r 2/12018 MY Commission Expires
(SEAL} , March 30, 2016
`'
Type of Identification produced �5�31�0 T of Idezitifrcation produced
CFN:20140636026 BOOK 29307 PAGE 1197
�. DATE:09/12I2014 01:52:39 PM
DEED DOC 4,500.00
HARVEY RUVIN,CLERK OF COURT,MIA DADE CTY
Return to:
Instrument Prepared By:
CHRISTOPHER P.KELLEY,Esquire
11098 Biscayne Boulevard,Suite 205
Miami,FL 33161
Folio No. 11-3206-013-6150
WARRANTY DEED
THIS INDENTURE, Made this j�day of cl, , 2014, Between, CARLOS
CABRERA and ELIZABETH CABRERA, husband and wife, GRANTORS, and JONATHAN
CONVERSE BUCKLAND and CASSIDY DANG BUCKLAND,as Tenants by the Entirety,whose
post office address is 358 N.E. 94 Street, Miami Shores, FL 33138. GRANTEES,
WITNESSETH, That said GRANTORS, for and in consideration of the sum of Ten and
No/100($10.00)Dollars,and other good and valuable considerations to said GRANTORS in hand
paid by said GRANTEES,the receipt whereof is hereby acknowledged, have granted, bargained
and sold to the said GRANTEES, and GRANTEES' heirs and assigns forever, the following
described land, situate, lying and being in Miami-Dade County, Florida to-wit:
Lots 5 and 6, less the West 15 feet of Lot 6, Block 46,AMENDED PLAT OF MIAMI
SHORES SECTION NO. 1,according to the Plat thereof,recorded in Plat Book 10,
at Page 70, of the Public Records of Miami-Dade County, Florida
SUBJECT TO: Applicable zoning and/or restrictions and prohibitions imposed by
governmental authority; Conditions, Restrictions limitations, reservations,
easements, and other matters appearing on records, if any; Utility easements of
record,taxes for the year 2014 and subsequent years.
and said GRANTORS do hereby fully warrant the title to said land, and will defend the same
against the lawful claims of all persons whomsoever.
IN WITNESS WHEREOF, GRANTORS have hereunto set their hands and seals the day
and year first above written.
4sig, saWndelivered in our presence: 64114
V CARLOS CABRERA Grantor
358 NE 94 Street
Print N e Miami Shores, FL 33138
W Name
L7EuTIST®IEp
Print Name
CFN:20140636026 BOOK 29307 PACE 1198
Page 2
Warranty Deed-Cabrera to Buckland
Signed,sealed,an delivered in our presence: i'��"�
L
Wane me E ETH CABRERA Grantor
-���"a SS• 358 NE 94 Street
Print Pmq Miami Shores, FL 33138
Yet,
witness Name
Print Name
STATE OF FLORIDA )
COUNTY OF MIAMI-DADE }
I HEREBY CERTIFY that on this day,before me,an officer duly authorized in the State and
County aforesaid to take acknowledgments, personally appeared CARLOS CABRERA, who
produced f n L as identification, and who executed the foregoing
instrument and acknowledged before me that he executed the same.
WITNESS my hand and official seal in the Cod e last aforesaid is d
unty ay
of 2014.
NOT UB ,State of FLORID Large
My Commission Expires:
p 'pyla
ao `ems Notalp Public State of Rori6a
Christopher P;<elley
�,��p�$•r 6Ay C"Miss.on EE 93335
ExO'eys
STATE OF LOUISIANA }
COUNTY OF
I HEREBY CERTIFY that on this day,before me,an officer duly authorized in the State and
County aforesaid to take ac knowledgments,personally appeared ELIZABETH CABRERA,who
produced ,/— L 171 as identification, and who executed the foregoing
instrument and acknowledged before me that she executed the same.
WITNESS my hand and official sea]in the County and State last Ovesaid this 2-j day
of &4S' .2014.
NOTARY PUBLIC,State of LOUISIANA
My Commission Expires:
MOM
fte Of Lawww'i
"0.p{a���A.1 t•�((' •.t. .
t
:FN:20140636026 BOOK 29307 PAGE 1199
MIAMI SHORES VILLAGE
E
Building Department
10050 NE 2 Ave, Miami Shores Fl, 33138
Tel: 305-795-2204- Fax: 305-756-8972
Permit No. REOC-7-14-1446
Certificate of Re-Occupancy
Address:358 NE 94 Street
City: Miami Shores Village
State: Florida
Zip: 33138
This Certificate verifies that the reference property has been inspected by Miami Shores
Village and has been determined to presently comply with schedule of regulations of
Miami Shores Land and Development Code pertaining sdlely to the requirement that
each one-family dwelling Is used and intended to be usey for a one-family dwelling
purpose only; however, this certificate does not constitute any representation or
warranty as to the condition of the dwelling or other strictures on the premises
described herein, or any aspect of such condition, and interested persons are advised
and encouraged to matte their own inspections of the premises in order to determine the
condition thereof.
Building Approval:
l
E,
JU
d Miami Shores Village
SSP 16 2014
Building Department BY:__ y
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
BUILDING �, Master Permit No.
PERMIT APPLIC� TION Sub Permit No.
[:] ELE RIC ROOFING ❑ R ISION ❑ EXTENSION RENEWAL
i
❑PLUMBING [:] MEC ANICAL [:]PUBLICWORKS CHANGE OF ❑CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 358 NE 94 T
City: Miami Shore i Coun i Dade zip:
Folio/Parcel#:113206013 150 Is th uildin istorically Designated:Yes NO X
Occupancy Type: SGL FML L ad: ,Constr coon Type: FT' da Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder)':JONA ON C,13"UCKLAND
Phone#:
Address:358 NE 94 ST
City: MIAMI SHORES state: FL Am
33138
Tenant/Lessee Name:
Email:
,Y
CONTRACTOR:Company N RYE &GENR NTR fi0 hone#: 305-244- 424
i
Address: 7500 N T U E
City: MIAMI ae. _ zip: 33122'1
Qualifier Name: VING ALAKRI NAN M. Phone#: 305-244- 424
State Certification o Registrati CCC-- -8728 Ce ica mpetency#: CCC-132 8728
DESIGNER:Archie Engineer. ORIDAI! ATIOI LEN N RI` Phone#: 305-3 8-1991
Address:7500.. 25 ST, UI �' 'Clty: MIAMI state:�_zip: 33122
Value of Work for this Permit:$ �0 �� ware/Linear Footage of Work: �
Type of Work: ❑ Addition ❑ Alteratio ❑>IVew RepairJRepl ❑ Demolition -
Description of Work: 9 AT-ROOF—1 - —
4t-rU ��
Specify color of color thru tile:
slufaFFee LO Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ 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.
Signature Signature\J '
OWNER or 4GENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of x. ,iM��` 20 14 by i h day of '�� 'a� 20 (� ,by
X who is personally known to 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 PUBLIC: NOTARY PUBLIC:
Sign• Sign:
Print: ARMIA BRYM OK09nM Print:
ppT�yp�g� ,,� ►';�•., ORLANDO LEON MEJ1A
Seal: Seal: Commission#,,EE 175035
3TATEOFFLORIDA My Commission E«p,res
• a,p; Maralh 30, 2O t 6
E VWN u121201e
.7 APPROVED BY flans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
I