DS-14-2589 r r n �4�-A
� c Miami Shores l Village�
Building --
D
g epartment
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 NOV 2 5 2014
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949 _
C 2010 s-
BUILDING Master Permit No.a-5 t q-►_a i ?q
PERMIT APPLICATION Sub Permit No.
xr(UILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP
/f 1 / CONTRACTOR DRAWINGS
JOB ADDRESS: I�o J�� �/®�� ��
City: Miami Shores County Miami Dade Zio• 3316p
Folio/Parcel#: II �� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): O A--ti�- (040t Phone#
Address: ( ® AW 2d T.
City: iq/�l` �� /State: fi ✓ Zip:
Tenant/Lessee am /r Phone# `—
Email: / •C G
L000F
CONTRACTOR:Company Name: TA// `JI�� K- Cry&ntl41 Phone#: .75
Address: -+ _ ®b //
City: State• Zip:33,?oV-
Quallfler Name: Phone#:q64-473
State Certification or Registration#: CSC !Sl 706 Certificate of Competency#: eZ6
DESIGNER:-Architect/Engineer: Phone#:
Address• State: Z�ip:
Value of Work for this Permit:$�-/ � Square/Linear Footage of Work:-__
Type of Work: ❑ Addition .
� Alteration F-1New ❑ Repair/Replace ❑ Demolition
Description of Work: `•
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ •�® CCF S-- CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
TechnologyFee$ Training/Education Education Fee
� $ Double Fee$
Structural Reviews$ Bond$ V
TOTAL fEE IVOW DUE$ q b ' 00
(ReviseM2/24/2014) �G U
4 • °
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrumen was acknowledged before me this
01 f' day of A6 20 /S( .by �� day
^offA' % J . 20 by
Rabe& Coki!--n ,who is personally known to ULliit I/I who is personally known to
FL—or who has produced L—JqL as me or who has roduced /L��. �G f�Z'000°0 A??Aas
identification and who did„ta „ n oat' + identifica on and w o id take,4n oat
DYpVP 11GUEL EDUA• : Notary Public- aNOTARYP C: - NOTA PUBLIC: - . My Comm.Expire17COMM ;9j c c�°;:�`, Commission#Bonded Through Natsn.
Sign:— Sign:
Print:`4iay o6L/t Print,--,/
Seal: Seal:
*sus*as�a��s�sa�s�x�ssffiu*.x��w��ssas��s six*a��a�sq�ax�a�+ss�xss�*�a�s�s*$�s�x�x��a.a�s��xs+�a��sa�a�a�.m�:g+►a�*a�»+xa��e�*tix�eea��/•a�aa�*��r��wa�
APPROVED BY (y� ` Plans Examiner ` Zoning
Structural Review Clerk
(Revised02/24/2014)
• ,t�oR sV
1211 n„�j�lJ Miami shores Village
Building Department
�OR1DA 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 injuries of M 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
Print Name: ® AeIL. Print Name:
� y
Signature: Signature-
State of Florida) State of Florida)
County of Miami-Dade) l County of Miami-Dade}
Sworn to and scribed before me this 4 %. Sworn to and subscribed before me this
day,of ,20 day of ,20 .
ByAl By
(SEAL) (SEAL)
-
Type of Identification uc T e of Identification prod
LQW'1Notary Public State of 10r�a
Sindia Alvarez
,j
My Commission FF 156750Expires 08/03/2016
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FAX-P05) SHEET No 1 of 2
ORAMBY-AA LMD SURVEYORS
SURVEY OF LOT 11.BLOCK 219,OF MIAMI SHORES EXTENSION,ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 43,
PAGE 40,OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY,FLORIDA.
PROPERTY ADDRESS: 190 NW 110 ST.MIAMI SHORES,FL 33168
FOR: ROBERT CONEN
LOCATION SKETCH smie v=NT.s.
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I►RBREVIATION AND MEANING LEGEND TYP{CAL
A=RRC FNIP.=FEDERAL NATIONAL INSURANCE RAD.=RADIUS OF RADIAL —OIL-OVERHEAD UTILITY LINES
AIC=AIR CONDITIONER PAD PROGRAM ROE. RANGE
RANGE
AE-ANCHOR EASEMENT IN.SEG.-INGRESS AND EGRESS R.P.-RADIUS PONT 22 C.B.S.=WALL ICBM
AIR a ALUMINIUM ROOF EASEMENT R.O.E.m ROOF OVERHANG .amp C.LF.-CHAIN LINK FENCE
AIS=ALUMINIUM SHED LF.E.m LOWEST FLOOR ELEVATION EASEMENT
ASPH.=ASPHALT L.M.E.n LAKE MAINTENANCE EASEMENT W W-RIGHT—OF—WAY -p-p- LF.-IRON FENCE
B.C.=BLOCKCORNER LP.=LIGHT POLE SEC.-SECTION
B.C.R. BROWARD COUNTY RECORDS M.=MEASURED DISTANCE &LP.a SET IRON PIPE LB.#8044 -tr-/f W.F.=WOOD FENCE
B.M.=BENCH MARK Mf" MANHOLE SINK.-SIDEWALK
8,0.0.=OASIS OF BEARINGS NAP.-NOTA PARE OF T-TANGENT ■ICAO -EXISTING ELEVATIONS
C-CALCULATED NGVD=NATIONAL GEODETIC VERTICAL TWP=TOWNSHIP
C.B.=CATCH BASIN DATUM U.E.-UTILITY EASEMENT
C.B.W.-CONCRETE BLOCK WALL N.T.S.=NOT TO SCALE U.P.-UTILITY POLE SURVEYOR'S NOTIEIS
CH a CHORD O.KL a OVERHEAD UTILITY LINES W.M.=WATER METER 1)IF SHOWN.BEARINGS ARE REFERRED TO AN ASSUMED
CK&=CHORD BEARING O.R.B.a OFFICIAL RECORD BOOK W.R.=WOOD ROOF MIIANBY SAID PLAT IN THE DESCRIPTION OF THE
CL=CLEAR OPS=OFFSET W.S.=WOOD SHED PROPERTY IF NOT THEN BEARINGS ARE REFERRED TO
C.LF.=CHAIN LINK FENCE ONH.=OVERHANG ejC a ANGLE COUNN TOWNSHIP MAPS.
C.MLE.=CANAL MAINTENANCE P.B.-PLAT.SOOK
EASEMENTS P.C.=PONT OF CURVE A=CENTRAL ANGLE 21 THIS IS SURE IN T PURPOSE SURVEY.
CONC.=CODE P.C.C.=POINT OF COMPOUND CURVE 1'THE CLOSURE W THE BOUNDARY SURVEY IS ABOVE
C.P.-CONCRETE PORCH PL=PLANTER g =CENTERLINE 1:75
C.S.=CONCRETE SLAB P.L&aPROFESSIONAL.LAND If =MONUMENT LINE 4)IF SHOWN.ELEVATIONS ARE REFERRED TO
coUNrr
O.E.-DRAINAGE EASEMENT SURVEYOR
D.M.E.a DRAINAGEMAINTENANCE P.O.&.-PONT OF BEGI 4MG ALL ELEVATIONS SHOWN ARE REFERRED TO
EASEMENTS P.O.C_=PONT OF COMMENCEMENT NATIONAL.GEODETIC VERTICAL:DATUM OF 1928
DRIVE.DRIVEWAY P.P.=POWER ROLE MIAMI DADE COUNTY SENCH MARK NO 310D
ENCFt a tS+ICROA IMENT P.P.S..g POOL PUMP SLAB LOCATOR NO.SSG
E.T.P.=ELECTRICTRAN O PAD P.R.C.=POINT OF REVERSE CURVE ELEVATION 10.78 FEET OF N.G.V_O OF 1929
T.F.E.-FINISHED FLOOR ELEVATION PRM=PERMANENT REFERENCE
F.H.=FIRE HYDRANT MONUMENT
NUIYENT
F.I.P..a FOUND IRON PIPE PT.-POINT OF TANGENCY S. RMmI s CERTI>1=1"r�_
FAR=FOUND IRON ROD PVMT.=PAVEMENT
F.N.=FOUND NAB. PWY a PARKWAY I HEREBY CERTIFY.THAT THIS'SOUNDARYSURVEY'OF
F.N.O.m FOUND NAB.&DISK R=WORD DISTANCE THE PROPERTY DESCRIBED HEREON,AS RECENTLY
SURVEYED AND DRAWN UNDER MY SUPERVISION,
COMPLIES WITHTHE MINIMUM TECHNICAL STANDARDS
AS SET FORTH BYTHE FLORIDA BOARD OF
-THERE MAY BE EASEMENTS RECORDED IN THE RUBRIC RECORDS NOTSHOWN ON THIS SURVEY. PROFESSIONAL LAND SURVEYORS IN CHAPTER 6IG17.A
-THE PURPOSE OF'THIS SURVEY IS FOR USE N OBTAINING TITLE INSURANCE AND FINANCING.AND SHOULD NOT SE FLORIDAADMINETRATNE CODE PURSUANT TO 47ZM7.
USED FOR CONSTRUCTION PURPOSES. FLORMASTATUTE&
-TDLAMINATIONS OFTHEABSTRACf OFTITLE WILL"AMETO BE MADE TO DETERMINE RECORDED INSTRUMENTS.FANY,
ASNTHE 7 RVEY E I BT EICESEV.A0NSORE $OF RECORD,ANDLELAL DESCRIPTIONS PROVIDDSY CUM ORATFSTINOTITLE COMPANY
BOUNDARY SURVEY MEANS ADRAWINGAND I ORAGRAPHIC REPRESENTATION OF THE SURVEYWYORK PERFORMED N
THE FIELD,COULD BE DRAWNATA SHOWN SCALEAND TOR NOTTO SCALEAylr—
EA89MENTSASSNOWNARE .i f.
PER PLAT BOOK UNLESS OTHERWISE SHOWN.