PL-15-40 Miami Shores Village
Building Department �A� ®9 V® 4
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 Master Permit No. .P el
PERMIT APPLICATION sub Permit No.
r-IBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑■ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 93 NW 96 Street
City: Miami Shores County: Miami Dade Zip: 331150
Folio/Parcel#:11-3101-033-0380 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: X BFE: FFE:
OWNER.Name(Fee Simple Titleholder):Eddie A. Alvarado/Elizabeth J. rlo Phone#:786.376.1232
Address:93 NW 96 Street
City: Miami Shores state: Flori Zip: 33150
Tenant/Lessee Name: N/A = Phone#: N/A
Email: Eaalvarado72@gmail.com
CONTRACTOR:Company Name: STAT IDES Conpect Wns, Inc. Phone#: 954.963.0082
Address: 13640 NW 19th Aven e, Bay No. 15
City: Opa Lockatate: Florida zip: 33054
Qualifier Name: Teresa Solomon Phone#:
State Certification or Registration#: SM0971262 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$3,500.00 Square/Linear Footage of Work: 300
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition
Description of Work: Install new drainfield system for existing septic system (west side). Miami
Shores and Dade County/HRS permits.
Specify color of color thru tile:
Submittal Fee$ 7� Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double FeL$
Structural Reviews$ Bond$ ` • 0
TOTAL FEE NOW DUE$ 1 q.
(Revised02/24/2014) 6; rc�;1 r C�b
Bonding`Company's Name(if applicable) N/A
i
Bonding Company's Address N/A
City State Zip
Mortgage Lender's Name(if applicable) N/A
Mortgage Lender's Address N/A
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 62Q, Signature
OWNER or GENT CONTRACTOR
The f roing instru ent was acknowledged before mg this The foregoing instrument was acknowledged before me this
day of T Lam. 20 ,by _9 day of 20 y
Djdh)11 who is personally known to ho is
me or who has produc@d � r;�V k10 �t5 II t! oa me or who has produced as
identification nd whoidid take an oath. identification and who did take an oath.
NOTARY PUB IC: Iq NOTARY PUBLIC:
i^
Sign: Sign:
Print: Prin
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Nota v Pu Notary Public State of Florida
Seal: Notary Public state of Florida Seal. ,o�
Ed Vega =° `r Joanna M Feliciano
my commissionEE 102314 y , o My CommissionF 082753
Expires 06/12/2015 9j"oF�oF Expires 01/12/2018
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
�' Miami shores
Village
.... �,
am
Building Department
�pR ► 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.
f: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.
Owner Contractor
L
Print Name: ZO m o Print Name: ng6en C
-th CO
Signature: d \6r^o II CJ ® 1' 'E a Signature: T.��e Sc� qn�v
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State of Florida) < cn z Z State of Florida) M,z,�4
County of Miami-Dade)
W U w County of Miami-Dade) ' :W
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Sworn to and subscrit�ed before me this I CC � s Sworn to and subscribed before me this
day of DtCg tnW ,20 1 > ! day of ,20_0
By GSQS,2--== :T Bydc—
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(SEAL) Tie-CJ<' CS'."`"_ = �; ` !(SEAL) kr J
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Type of Identification produced T entification produced