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PL-15-2314 t►��fi � via\ ?� \ �\�\\ \ '��' � \� � Miami Shores Village 10050 N.E.2nd Avenue NE \ lilfi Ifflf - Miami Shores,FL 33138-0000 " 4 Phone: (305)795-2204 \ r \ MTE®N Expiration: 05/14/201 Project Address Parcel Number Applicant 775 NE 97 Street 1132060142330 ALINA NUNE9 Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ALINA NUNES 775 NE 97 Street MIAMI SHORES FL 33138- 775 NE 97 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation:$ 1,500.00 DIAL PLUMBING CORP (305)221-8569 (786)412-6720 Total Scl Feet: 00 Type of Work:ADD SHOWER TO EXISTING BATHROOM Available Inspections: Type of Piping: Inspection Type: Additional Info: Bond Return: Top OutFinal Classification: Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# PL-9-15-57048 $3.38 09/11/2015 Credit Card $50.00 DCA Fee $3.38 $418.96 Education Surcharge $0.40 11/16/2015 Credit Card $418.96 $0.00 Permit Fee $225.00 Scanning Fee $9.00 Technology Fee $1.60 Work without Permit Fee $225.00 Total: $468.96 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertainingthereto and in strict conformity with the Tans drawings,y p statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS, DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVI 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 i thermore, I authorize the above-named contractor to do the work stated. r" November 16, 2015 Authorized Signa ure: ner / pplicant / Contractor / Agent Date Building Departme Copy November 16,2015 1 4. r Miami Shores Village SEP 112015 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B'Y'- --- - Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014' BUILDING Master Permit No. .. � PERMIT APPLICATION Sub Permit No. VIBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ) y CONTRACTOR DRAWINGS JOB ADDRESS: I /�" E T � 7 City: Miami Shores County: Miami Dade Zip: 331 -3 F Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): !V L( i L) Aj e.- 2-- Phone#: Address: ' C e City: N I p�'l State: I- l-- Zip: X Tenant/Lessee Name: cPhone#: Email: ALiNN 1Uvtj'e+ 1"L , Colli CONTRACTOR:Company Name: 62EIG a>O( 1 17c=9 S CQ(7 Phone#: S Address:14(9 2y &(Ag 104 !S;& City: hi/)444 r State: Zip: --g3 /0(0 Qualifier Name: aDR,64 `04F1-/ rl-eo` Phone#:305- '224 -z"?1 State Certification or Registration#: C40 o•S/ *77-7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: ttK� Value of Work for this Permit:$ ��l1 r� Square/Linear Footage of Work: Type of Work: ❑ Addition A� Alteration ❑1NNew ❑ Repair/Replace ❑ Demolition Description of Work: ` �`2 iL� T�Cr7Y✓� M ilOA0+4tp ayk.,.r+n:.uta .+llw..1►.-+aks. �uW ,..,+iR...,�n. n= , - y Specify olor of color t4ru tile: Submittal e$—. ,�� "1� PerrrHt eCCF$ Scanning e$ Radon-Fee$ DBPR$ Notary$ Technology Fee$ ' Training/Education Fee$ Double Fee$ �,!^.�� Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (C1 (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address )K-tZ 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. Signatur Signature da4ll V- x-41 OWNER or AG NT CONTRA The foregoing instrument was acknowle eforce a this The foregoing instrument was ac nowledged before me this O -`cTa of 20 ��+ b � da of v 20 Y • Y � Y �J by J T Lt y1/A A/]e- ,who is personally known to A� y o UP who is personally known to me or who has produce Q �05T�. as me or who has produced�d . ..fes i�c tea CO as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: J,)X'a' c , Print: Print: �w.� IV�ir9cQ r1Jlr? Seal �a"" STEPHANIE M.BUTLER Mary Public:-Slim of Florida Seal: • My Conon.Wap "Nov S.2015 �. Comanlaiion#EE 110666 P""°�e ° VfRIE NAVARRETE „" Aun: .` `=�-`Notary,Public-State'of,Florida ******* E********************* GII;�` � '�."hpoH•��` �i01fltRISS1 E J7) �*�r� APPROVED BY - Plans Examiner Zoning Structural Review Clerk (Revi sed02 f 24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD �C�GC1510111 The GENERAL CONTRACTOR � r Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 LAFFITTE,JORGE GLADES BUILDERS CORP 14629 SW 104TH STREET#428 MIAMI FL 33186 ISSUED OW9/2014 DISPLAY AS REQUIRED BY LAW SEQa L1405290002160 Local Business Tax Receipt Miami-Dade County, State of Florida —THIS IS NOT ABILL—DO NOT PAY LBT.-I 6608609 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES GLADES BUILDERS CORP RENEWAL SEPTEMBER 30, 2016 15174 SW 157 TER 6879218 MIAMI,FL 33187 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED GLADES BUILDERS CORP 196 GENERAL BUILDING BY TAX COLLECTOR CONTRACTOR 75.00 08/17/2015 Worker(s) 1 CGC1510777 CREDITCARD-15-041199 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above most be displayed on all commercial vehicles-Miami-Dade Code Sec 6a-276. MIAM For more information,visit www miamidade govAoxcollector '® CERTIFICATE OF LIABILITY INSURANCE108M712015 DATE(INWDD/YYYY) AC.� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. 9SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C ACT Ibet SBrranO REEL INSURANCE AGENCY PONE 954 956-0006 Fax 958.4555 D1B1A1 COVER ALL INSURANCE ` ihelrRls0covemllinsurance.net 5800 W.ATLANTIC BLVD. J uRERISI AFFORDING COVERAGE._ --- MARGATE FL.33063 W • ACCIDENT INSURANCE CO. 11573 INSURED R GLADES BUILDERS CORP. 14629 SW 104TH.STREET,0209 INSURER MIAMI,FL.33186 INSURER INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN8R LTD TYPE OF INSURANCE NUMBER POt.ICY EFF PO CY EXP LIMITS GENERAL LUUMITYOCCURRENCE _ 304 404 _ DAMAGE TO RENTED 1QI) A X !.OMMERCIAL GENE��LIABILITY CLAIMS-MADE LX J OCCUR CPP001457401 ,00 �l0512015 0610612016 MED EXP An one arson $5,00 PERSONAL 3 ADV INJURY S 300.004 t GENERAL AGGREGATE $300,009 GEN'L AGGREGATE LM APPLIES PER: PRODUCTS-COMP/OP AGG S 340)444 X )POLICY PRO• LOC INGLE LIMITAUTOMOBILE LIABILRY COMBINED S ANY AUTO BODILY INJURY(Per person) S ALL OWNED !SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS I NON-OWNED PROPERTY DAMAGE 'i S HIRED AUTOS AUTOS 1=— _......_. ------ UMBRELLA -__UMBRELLA LIAR _ OCCUR EACN OCCURRENCE EXCESS LIAR CLAIMS-MADE i AGGREGATE _.� ED BETEtalQNS S WORKERS COMPENSATION TnRY WC STATLI OTH- AND EMPLOYERS'LIABILnY Y N{ ANY PROPRIETORIPARTNERIEXECUT E-L EACH ACCENT S OFFICERlMEMBER EXCLUDED? N i A! —' (Mandatory M NH) E.L.DISEASE-EA EMPLOYEE If yes,describe undo,PE I I E.L.DISEASE-POLICY LIMIT { I i 4 S jDESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(A#wh ACORO 101,AddWonai Remarks Schadtde,N mors space is rpWnd) GENERAL CONTRACTOR E CERTIFICATE HOLDER CANCELLATION MIAMI SNORES VILLAGE BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOT" WILL BE DELIVERED IN 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL 33138 AUTHORIMO lTWSENj�TIVE ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 2S(2010105) The ACORD name and logo are registered marks of ACORD J 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: 6/6/2014 EXPIRATION DATE: 6/5/2016 PERSON: LAFFITTE JORGE FEIN: 271808924 BUSINESS NAME AND ADDRESS: GLADES BUILDERS CORP 15174 SW 157 TERRACE MIAMI FL 33187 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 S 04C 192 6 seen Miami shores Village - �� Building Department OR{DA 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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. --_ Signature: (y r Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this `"day of ,20 CJ. BY �Juxie- 1- who is personally known to me or has produced as identification. Nota a--� SEAL: STEPKWE M.fWUR 140tuy POk-SWe of Fulda • • My Coma.Eitot Nom►5,2015 CoffOle a I EE 1106M •„ .,N flooded NMWW Not�ryr / t Glades Builders Corp Dream It,Draw it,Cct It Built September 11,2015 State Of Florida County of Miami Dade Before me this day appeared Jorge Laffitte who, being duly sworn deposes and says; That he or she will be the only person working on the project located at, 775 NE 97 Street Miami Shores, A. 33138 Sworn to(or affirmed)and subscribe before me this 11 day of September 11, 2015, by Personally known Or Produce Identification Type of Identification Produce ,i11A1/1/ tPnY V f RIE NAVARRETE, Notary Public-State of Florida `- My comm.t;xpir s Nov 8,2016 %„� commission#EE 850254 pill I Print,Type or Stamp Name of Notary AJ t 14629 SW 104th ST/Suite#209/Miami,FL 33186/(305)794-3789