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RC-13-2504 46 T-2 t Miami Shores Village NOV 0 5 2013 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)76ZA949 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No.�(/a l Permit Type: Ei DING0 ROOFING JOB ADDRESS: 7S Ne 1 O I S+reef City. Miami Shores County: Miami Dade Zip: 33)3 1 Folio/Parcel#: 906 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): � `F'V Z/ennl owid son Phone#: 305- 9FLY177 Address: 75 NE 10) J$-e e City: M am Aorts State: FL Zip: ?3)34? Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:Nr)(—))_o Phone#: -- Address: City: State: P Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ _ ®®o-� Square/Linear Footage of Work: Type of Work: ❑Addition IiiAlteration ❑New U(Repair/Replace_I ❑Demolition Description of Work: �0' )ACS ;4-Aen cgbjne�r .., Remove 5e" ®r(1 no*-IyealLnq Y,4 r_ e 1 wa1 : Rai Igce k`f` en own4en J Color thru tile: xxxxxxx���xxxx�xxx�x�xxxxxxxxxxxxxxxx�xFeesxxxxxxxuxxxx�:��x��x�x�x�xx�x������xxx��x��x� Submittal Fee$ 'QV Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ f , , tonding 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDMONERS,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 inspecti will not be approved and a reinspection fee will be charged A Signature t Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 30 The foregoing instrument was acknowledged before me this day of -��� ,20�,by c!Pi i dY��0►"1 ds e� day of ,20_,by who i k6rsonall known tom r who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: P MARCI LAWMAN NOTARY PUBLIC: �'"'�►•'°°�� * W 00WISSION#FF 034616 Sign: EXPIRES:July 9,2017 Sign: —,. Sftes Print- W McH Print: My Commission Expires: �9�)� My Commission Expires: �xxa:xxx�xaax�xxxx�xxxx�a:xxxxx�x� x� �x�x x��xmx�x��x�*a��x�x�x�x�x�xxsaxxxmxm��x�xxxx�uxxxxx�x:x�x�:xxxxx�xxx�xx�xxx�xx oe APPROVED BY ° 13 Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10=09)(Revised 3/15/09) o s Miami Shores Village .... o... Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 RiDA Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: � Cti ®tits n DATE: )IIS IQ013 ADDRESS: 15 NE l®l P eef, f 1 1� , 6rvj 33X Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,FS 489.103(7). And I have read and understood the following disclosure statement,which entities me to work as my own contractor,I further understand thaf I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exeMption allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must sUpervise the construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a cost of$25,000.00 or less(The new form states 75,000).The building must be for your own use and occupancy.It may not be built for sale or lease.If you sell or lease a building you have built yourself within one year after the construction is complete,the law will presume that you built for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on your building who is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and with-holdings tax and provide workers' compensation for that employee,all as prescribed by law.Your construction must comply with all applicable laws,ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain restrictions even though I do not have a license. Initial 11 r 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. / Infial ' " 3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial -4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve a commercial building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy.It may not be built or substantially improved for sale or lease. If a building or residence that I have bulk or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease,which violates the exemption. Ini /Y fly tial 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. �y�, _ Initial r�� 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence.It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that ' erroneously implies that the property owner is providing his or her own labor and materials.I,as an owner-builder,may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial B. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by me,which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employee.I understand that my failure to follow these may subject to serious financial risk. Initial 9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all applicable laws and requirement that govern owner-builders as well as employers.I also understand that the Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations. ~ Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the internal Revenue Service,the United States Small Business Administration,and the Florida Department of Revenues.I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htti):/hvww.mvfloddalicense.com/dbprlpro/c*ilbfindex.htmI Initial 11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial vlPv- 12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the information that I have provided on this disclosure. ' Initial Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who does not have a license,the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license,the notarized signature of the property owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued. n� Was acknowledged before me this day of "� M�� ,20 �3 By �� who was personally known to me or who has Produced ther License r w�xeL_, uow m a-r s as identification. Je OWNER UULIC Commission # '9g"'•.-EE113059.. j • . ..... ®Q'�•�• CJR' ���� STATE OF FLORIDA DEPARTMENT OF BUSINESS' AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH •� TALLAHASSEEMONROE STRFLT32399-0783 PHILIZAIRE, GERARD LOUIS BILI GREEN CONSTRUCTION SERVICES LLC 16118 OPAL CREEK DRIVE WESTON FL 33331 # C3 L743 STATE OF FLORIDA AC2 Congratulations! With this license you become one of the nearly one million DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers,from boxers to barbeque restaurants, and they keep Florida's economy strong. CFC1427945 06/2$ -12 110409421 Every day we work to improve the way we do business in order to serve you better.; For information about our services,please log onto www.myfloridalicense.com. CERTIFIED 1� MMING CONTRACTOR There you can find more information about our divisions and the regulations that PHILIZAIRE, GLRARD ,LOL3IS impact you,subscribe to department newsletters and learn more about the BILT GREEN C6NrTRU£TIQN SERVICES Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. IS CERTIFIED under the provisions of cn.489 as Thank you for doing business in Florida,and congratulations on your new license! Expiration date: AUG 31, 2014 L12 0 62 8 0 0 615 DETACH HERE ®e m e ® ® o u• c AC6177432 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEW L12062800615 .. - LICENSE NBR 106/28/2012 1110409421 ICFC1427945r The PLUMING CONTRACTOR Named-below IS CERTIFIED Under the provisions of Chapter 489~ Expiration date: AUG 31, 2014 PHILIZAIRE, GERARD LOUIS BILT GREEN CONSTRUCTION SERVICES'TQ C 16118 OPAL CREEK DRIVE WESTON FL 33331 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW r4��R CERTIFICATE OF LIABILITY INSURANCE D /DD 111/12/12/2001313 �.� 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. If SUBROGATION 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 CONTACT Marilyn Dean NAME: �' BOLT Insurance Agency PHONE (941)952-7517 n No):941-296-8694 7241 Delainey Court ADDRIE ,mdean®boltinsurance.com INSURERS AFFORDING COVERAGE NAIL# Sarasota FL 34240 INSURERA:Ta co Underwriters, Inc. INSURED INSURERB: Bilt Green Construction Services LLC, DBA: INSURER C: 16118 Opal Creek Dr INSURER D. INSURER E Weston FL 33331 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1311751976 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. INSR ADDL SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVQ POLICY NUMBER MM/DDlYYYY) (MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMIETORENTED 100,000 PREMISES Ea occurrence $ A CLAIMS-MADE OCCUR IHCEK /27/2013 3/27/2014 ME D EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,0 0 0 X I POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N I FR ANY PROPRIETORIPARTNEWEXECUTIVEE.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S It yes,describe under DESCRIPTION Ol'OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Marilyn Dean/MDEAN ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(2oioo5).ot The ACORD name and logo are registered marks of ACORD Report Viewer Page 1 of 1 1 , 0 j� :� �'--.._/1 000% l i L j JEFF ATWATER I CHIEF FINANCIAL OFFICER STATE OF FLORIDA I DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION '•CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW" CONSTRUCTION INDUSTRY EXEMPTION t This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. = EFFECTIVE DATE: 9/10/2013 EXPIRATION DATE: 9/10/2015 i I PERSON: PHILIZAIRE GERARD L FEIN: 262061266 BUSINESS NAME AND ADDRESS: BILT GREEN CONSTRUCTION SERVICES LLC I { ! 16118 OPAL CREEK DR WESTON FL 33331 SCOPES OF BUSINESS OR TRADE: LICENSED CONTRACTOR ERAL CONTRACTORLICENSED Pwsuanl to Crlapler 414005f I Or F S.an Off.O,of a COrporeUOn who¢lett,@aempFon i 0� inns chat pier by liking a cen,ricare 01 e'ecl:on under this section may 4 -1 iCCOver benefit,Or COnnin-satgn under in.chapter Pursuanl to Chaplet 443 051`a.F S C n41COIOs of election to be exempt apply only-thin the&cope ! of the business or trade listed on the notice of elechon to be=nhpt Pursuant to Chapter 440 05.131.F 5 Not—of eiecton:o be exempt and CisnZilies of I at to be exempt shall ba subiect to re rnon.1.81 any tune after the filing o1 the notice�,in.issuance Of the—ficate the person named on the hotice or Cena-le no longer meets the r"u-nients of tris section for Issuance of a ceno caste The oepanmenl Shan revoke a CennKale a!any tune for failure of the W.Sun named on the Cenrin:ale tp meet me requirements of this section i f I DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07.12 OLIESTIONS?(850)413-1609 i t t I { i { i t I t { { I, https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER... 11/12/2013) BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2013 THROUGH SEPTEMBER 30,2014 DBA: Receipt#:GENERAL CONTRACTOR (CERT Business Name:BLOT GREEN CONSTRUCTION SERVICES Business Type:GENERAL CONTRACTOR) Owner Name:GERARD LOUIS PHILIZAIRE Business Opened:05/05/2009 Business Location: 16118 OPAL CREEK DR State/County/Cert/Reg:CGC1515377 WESTON Exemption Code: Business Phone: 786-488-9096 Rooms Seats Employees Machines Professionals 3 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.001 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: GERARD LOUIS PHILIZAIRE Receipt #033-12-00001133 16118 OPAL CREEK DR Paid07/10/2013 27.00 WESTON, FL 33331 2013 - 2014 MEA Home Planner Printout Page 2 of 10 Adook Ago WON NOV 052013 1.1 M 75 NE 101 Kitchen-MM Wall L E 0000-5290-7184 24.-119:: .. . . ........................................................................ ..... .............................. ...... ................................................... 777= .................... . ........... .............. ............ .................... 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ANY AND ALL CLOTH AND RUBBER "WROOM RECEPTACLE ON 20 AMP CKT INSULATED CONDUCTORS TO BE REPLACED. AND G.F1 PROTECTED NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F I PROTECTED RECEPTACLE. PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. http://kitchenplanner.ikea.com/US/LWages/Printouts/VPUISummaryPrintout.hbn 10/30/2013 IKEA Home Planner Printout Page 1 of 10 WOL Exi565 Dove 75 NE 101 Kitchen-West Wall 0000-5290-7184 �, 1 X2112: I un OM M lm to U7 r ...... i::::.`:i .. .::::::::;:<:>::;::;:::... Caen ; :.::....;......:..:...::.:.. M to <> ................... .. s "5 '. 3.71SJI6' 2:#.1:12 1. :1.St1:6 26:113 1:'18' 0:1:511'6 All measurement in inches NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F..I PROTECTED RECEPTACLE. PUT D/IN RECEPTACLE UNDER SINK. 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