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MC-14-1975 f Miami Shores Village CI Building Department APR 1;7 2015 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 201 ' BUILDING Master Permit No. & PERMIT APPLICATION Sub Permit No.mui-1 —I OrlS ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING JaMECHANICAL ❑PUBLIC WORKS [] CHANGE OF ❑ CANCELLATION ❑ SHOP `CONTRACTOR DRAWINGS CN City: Miami Shores County Miami Dade Zin• 1 g Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE•: OWNER:Name(Fee Simple Titleholder): Phone#:30S C Address: Al6 ( e r City: State: Zi Tenant/Lessee Name: Phone#: Email: s� CONTRACTOR:Company Name: uTr 1114/h C 1�}��- � C„Phone#: r Address: t 7 5w 6 City: Ma; "> ---State: L Zip: Qualifier Name: ►-rl� ias e-'4Z Phone :o State Certification or Registration#: C Ar I -7 "7 C-7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Re lace p El Demolition Specify color of color thru tile.- Submittal ile:Submittal Fee$ Permit Fee$AS•(30 CCF$ 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 zonjng. "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 pbrmit with an estimated value exceeding$250.0, 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 reinspect' n fee will be charged. Signature Signature OWNER or AGENT CO R The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of20 by ( G day of Pk—O(Z(l_. 201 ,by )jf::�40 00 c1�,who is personally known to A,42A-914 A Q4"IM who is personally known to me or who has produced/SZ QZ/ me or who has produced_a TJ2L\)W—UKQr=-esti as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: S n: Print: _,�aY pts Notary Public Stats of Florida , Notary Public State of Florida Joanna M Feliciano Seal: Sindla Alvarez ° a My Commission FF 082753 My Commission FF 158750 �bOFpVoExpires 01/12/2018 Orp Exptrea09l0312018 APPROVED BY l-�'Plans Examiner Zoning Structural Review Clerk (Revispd02/24/20141 AC�"jjr& CERTIFICATE OF LIABILITY INSURANCE 5/1ii2015 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: N the certificate holder Is an ADDITIONAL INSURED,the polloy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsemerd. A statement on this certificate does not confer rights to the certificate holder in lieu of such endoreement(s). PRODUCER PTL INSURANCE ASSOC. , INC. PHS .305-262-7094 Arc No:305-262-4907 7201 CORAL WAY MIAMI, FL.' 33155 ADDRESS: wsuRerttej aFFolmlNo coveaaoe NAICS INSURERA:ATLANTIC SPECIALTY LINES, INC. INSURED DYNAMIC AIRF'LON CORP. INSURER S: INSURER C: 13727 SN 152ND ST #213 INSURER D: MIAMI, FL 33177 INSURER E 305-510-4014 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. TR TYPE OF INSURANCER ADM POLICY NUMBER LMRS GENERAL LIABILITY EACH OCCURRENCE s 1, 00,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occ Mwm $ 100,000 CLAIMS-MADE ®OCCUR MED EXP(Any one n) $ 5,000 A CPS2224378 04/22/15 04/22/16 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEPL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG $ 2,000,000 R M0-POLICY LOC $ AUTOMOBILE LIABILITY Ea aeddent $ ANYAUTO BODILY INJURY(Per person) $ � OOSWNED SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS AUTNONAUTOS -OWNED Per eoddent $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YINY MI ANY PROPRIETOMPARINIEREXE UTNE MIA E.L.EACH ACCIDENT $ o>�c� E)CUIDso? n In K" EL DISEASE-EA EMPLOYEE$ iT describe cadet DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (Attach ACORD 101,Addlttonel Remarks Schedule,N more specs is requires AIR CONDITIONING CONTRACTOR CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2NS AVE THE EXPIRATIONDATE EREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES, FL 33138 ACCORDANCE WITH P LfCY PROVISIONS. AUTHOR PRESENTATIV ©1988-2010 CORD. TION. AJI rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD IJ iSCF@S 1i A.A26001388 March 30,2015 Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 Narrative for deslan chanae to Perm#drawings Permit Number: RC 14-951 Address: 1275 NE 94th Street Structural Reviewer, The change to the permit drawings includes the addition of a terrace built wjth a concrete slab and masonry wall in the second floor of the house.This addition replaces approximately half the proposed roof trusses of the roof over the Dining Room and outdoor spaces in the first floor. The new slab will sit exactly on top of the tie-beams that would have partially supported the proposed roof.The beams are located on the top of the exterior walls for the Dining Room. The masonry walls in the terrace will be built at the appropriate heights to match the profile of the roof on the north and west sides.On the east side,the terrace will have a wire-cable railing. The change also includes the relocation of the condenser units to a location above the Flood Zone of 9.0 feet N.G.V.D. 0000 If you have any questions and/or comments,please do not hesitate to(Ion f ept me VU bmajl ••• .. • •••• • (vbruce@ai-associates.netl or call me at 305-310-5030. 006000 0000.. 0000 . 00000. 0000.. 0000 0000 Sincerely, •••••• 00000• ••••• . . • 0. 0000. 0000.. • • 0000.. 0000 0000 0 0000.. • • • . 0000.. 0000.. • 0000.. •••• 0 0000 • 0000 Victor J. Bruce A.I. ., LEED R AP (Architect of Record for this project) AR-0017103 ABI associates, Inc. 370 NE 1010 Street Miami Shores,Florida 33138 telephone 305-310-5030 fax 1-877-408-8280 email vbruce@ai-associates.net a M AMIAMI-RADE COUNTY W M PRODUCT CONTROL SECTION DEPARTMENT OF PF.RNIITTING,ENVIRONMENT,AND REGULATORY 11805 SW 26 Street,Room 208 AFFAM(PERA) Miami,Florida 33175-2474 BOARD AND CODE ADMINiST RATION DIVISION T(786)315-2590 F(786)31525-94 NOTICE OF ACCEPTANCE(NOA) www.miamidadcaaW era Tremeo Inc. 23150 Commerce Park Dr. Beachwood,OH 44122 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials.The documentation submitted has been reviewed and accepted by Miami-Dade County PERA -Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction(AHJ). This NOA shall not be valid after the expiration date stated below. The Miami-Dade County Product Control Section(In Miami Dade County)and/or the AHJ(in areas other than Miami Dade County)reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke,modify, or suspend the use of such product or material within their jurisdiction. PERA reserves the right to revoke this acceptance,if it is determined by Miami-Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein,and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: :Vulimm 350NFSL/351NF,35ONF R/350NF-R and 35ONF SL/350NF4L Waterproofing Systems LABELING:Each unit shall bear a permanent label with the manufacturer's name or logo,city,state and following statement:"Miami-Dade County Product Control Approved",unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this produq.... 00 TERMINATION of this NOA will occur after the expiration date or if there has been aatyision of•' •• :• change in the materials,use,and/or manufacture of the product or process.Misuse of Ois NOA as a;• •• endorsement of any product,for sales,advertising or any other purposes shall automd*dW terminate, •. 0000 . 0000.. this NOA.Failure to comply with any section of this NOA shall be cause for terminat�pj, remoygW NOA. 00.00• 000000 0000. ADVERTISEMENT: The NOA number preceded by the words Miami-Dade Ctll�t jf;Florida,.Add • followed by the expiration date may be displayed in advertising literature. If any p*r%on of the Nb�1�is •`• displayed,then it shall be done in its entirety. 0000:. INSPECTION:A copy of this entire NOA shall be provided to the user by the manfacVjr or its••• ;0 0 0 0; distributors and shall be available for inspection at the job site at the request of the BuilQing'Official:"' • 0000 This NOA consists of pages 1 through 6. The submitted documentation was reviewed by Jorge L.Acebo. NOA No.:11-0516.02 Expiration Date: 09AW17 Approval Date: 09/06/12 Page 1 of 6 i WATERPROOFING SYSTEM APPROVAL at Roofing Sub-Cgtenory Waterproofing j Materials: Polyurethane f� Maximum Design Pressure: -815 psf t f TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: Test Product Product Dimensions Specification Description Vulkem®350NF-SL 5,55 gallon drums ASTM C957 One-part,low VOC self-leveling ASTM C836 polyurethane base coat waterproofing 4 membrane. Do Not Apply to Vertical Surfaces. Vulkem®35 INF 5,55 gallon drums ASTM C957 Two-part,low VOC Aliphatic polyurethane topcoat waterproofing membrane for providing chemical and UV resistance to coating system. Vulkem®350NF-R Available in 5 and ASTM C836 One-part,low VOC roller-grade 55 gallon drums polyurethane base coat waterproofing membrane. Vulkem®#191 Various Proprietary A one part interlaminar primer for use when applying a fresh coat of Vulkem urethane after preceding coat has been exposed for 24 hours or longer and/or C has lost its surface tack. TRADE NAMES OF PRODUCTS MANUFACTURED BY OTHERS: Test Product Product Dimensions Specification Description Aggregate Pre-packaged bags N/A 2040 or 40-50 mesh silica sand or alumina oxide,which imparts the non-slip texture and contributes fm••• wear resistance. • • •••• foe*:* Increte Thin-Crete® Available in 50 lb. Proprietary Polymer modified OIN--set grout Of •• Grout bag ceramic tile or pa*M:'• .... .•• •••••, Ceramic Tile Min 12 in.x 12 in. ANSI A137.1 Ceramic plaza.deck walking tiles Axs ;•••• x 1/2 in.thick water absorption maxi• . •• .... ••.•• ...... . •• ..... EVIDENCE SUBMITTED: ..•..' •.:.•• •••••• Test ...... Producto • Test Agency Test Identifier SpecificationDig 0900' PRI Construction Materials Technologies LLC TRE-041-02-01 TAS 114J••••;04/24/1;... :"•': TRE-042-02-01 ASTM C836 02/OVJ:. TRE-043-02-01 ASTM C836 02/04/11 TRE-044-02-01 ASTM C957 03/25/11 Underwriters Laboratories TGFU.R10845 UL790 10/18/11 NOA No.:11-0516.02 Expiration Date: 09AW17 Approval Date: 09AW12 Page 2 of 6 f d i 0 APPROVED APPLICATIONS: Deck Type 3 Concrete Decks,Roof Plaza Decks,Parking Decks, Deck Description: Min.2500 psi,structural concrete System Type F(1): Vulkem 350NF-SL/351NF Substrate Surfaces must be clean,dry and sound. Remove dust,non-compatible curing Preparation: compounds,form release agents and other surface contaminants. Substrate shall be free of voids,spalls,honeycombs,fins and protrusions. Concrete should be prepared by necessary means to achieve a CSP 2—3 per ICR1 guidelines. Primer: Primer not required. Base Coat: Mix thoroughly and apply Vulkem 35ONF-R or 350NF-SL at 40 wet mils to the entire area to be coated including detail coats but excluding expansion joints. Vulkem 35ONF-R should be rolled or brushed and 35ONF-SL can be applied using a V-notched squeegee or airless sprayer followed by back roll or roller alone. Do not apply 350NF-SL to vertical surfaces. Allow base coat to properly cure per manufacturer's application instructions before proceeding. Do Not Apply 35ONF SL to Vertical Surfaces. Top-Coat Mix material per manufacturers application instructions. Apply Vulkem 351 with brush,roller or airless sprayer at minimum 15 wet mils thickness. While wet, immediately broadcast 40-50 mesh silica sand*or aluminum oxide and back roll to evenly distribute aggregate and ensure it is fully encapsulated by the membrane. Care should be taken to ensure aggregate is oven dried and free of iron or other contaminates. Integrity Test: Required,and shall be performed in accordance with ASTM D 5957.Water maybe maintained for a period longer than 24 hours if required. Surfacing: N/A Maximum Design j Pressure: -815 psf(See General Limitation#9) *The seeding ofthe aggregate shall be with an even,light broadcast short of or just to refusal.Any'1 G aggregate must be removed prior to recoating.Back roll aggregate where indicated. : .'. •• ••..•• 1 ♦ • 1 • •••• •••• • • • • • • :00*0: • •••• NOA No.:11-016.02 Expiratlon Date: 09/06/17 Approval Date: 09/06/12 Page 3 of 6 Deck Type 3 Concrete Decks,Roof Plaza Decks,Parking Decks, Deck Description: Mn.2500 psi,structural concrete System Types F(2) Vulkem 350NF-R/350NF-R Substrate Surfaces must be clean,dry and sound. Remove dust,non-compatible curing Preparation: compounds,form release agents and other surface contaminants. Substrate shall be free of voids,spalls,honeycombs,fins and protrusions. Concrete should be prepared by necessary means to achieve a CSP 2-3 per ICRI guidelines. Primer: Primer not required. If Vulkem 350NF-R has cured greater than 24 hours or the surface becomes contaminated,it should be cleaned then primed with Primer 191 prior to applying next coat. Base Coat: Mix thoroughly and apply Vulkem 350NF-R at 60 wet mils by roller or brush to the entire area to be coated including detail coats but excluding expansion joints. Vertical or sloped areas may require more than one coat. Allow base coat to properly cure per manufacturer's application instructions before proceeding. Top Coat: Mix material per manufacturers application instructions. Apply Vulkem 350NF- R with brush,roller or airless sprayer at minimum 10 wet mils thickness. While wet,immediately broadcast 20-40 mesh silica sand* into Vulkem 350NF-R at a rate of 12.5 lbs.per gallon of 350NF-R. Allow to cure per manufacturer's application instructions before proceeding. Integrity Test: Required,and shall be performed in accordance with ASTM D 5957.Water maybe maintained for a period longer than 24 hours if required. Surfacing: Ceramic plaza deck tiles(12"x 12"x'/<")fully embedded into Increte Systems Thin-Crete Grout as directed by the manufacturer,applied to the top of Vulkem 35ONF-R fully sanded coating with a 1/4"notched trowel. Maximum Design Pressure: -597.5 psf(See General Limitation#9) *The seeding of the aggregate shall be with an even,light broadcast short of or just to refusal.Any loose aggregate must be removed prior to recoating.Back roll aggregate where indicated. 0000 0000 ....�. 0000 • 0000.. 0000 0000.. 0000.. • 0000.. 0000 0000 • • 0000 0000 0000• 0000•• • •• 0000• •• •• 0000 ••••�• 0000•• • • • • • • 0000•• 0000•• • • • 0000•• •• • •••• • • •••• NOA No.: 11-0516.02 hpggpE Expiration Date: 09/06/17 JAPPROVED] Approval Date: 09/06/12 Page 4 of 6 Deck Type 3 Concrete Decks,Roof Plaza Decks,Parking Decks, Deck Description: Min.2500 psi,structural concrete System Types F(3): 350NF-SL/350NF-SL Substrate Surfaces must be clean,dry and sound. Remove dust,non-compatible curing Preparation: compounds,form release agents and other surface contaminants. Substrate shall be free of voids,spalls,honeycombs,fms and protrusions. Concrete should be prepared by necessary means to achieve a CSP 2-3 per ICRI guidelines. Primer: Primer is not required. If Vulkem 350NF-SL has cured greater than 24 hours or gets contaminated,it should be cleaned then primed with Primer 191 prior to applying next coat. Base Coat: Mix thoroughly and apply Vulkem 350NF-SL at 60 wet mils by V-notched squeegee or airless sprayer followed by back roll or by roller or brush alone to the entire area to be coated including detail coats but excluding expansion joints. Sloped areas may require more than one coat. Do not apply 350NF-SL to vertical surfaces. Allow base coat to properly cure per manufacturer's application instructions before proceeding. Top Coat: Mix material per manufacturers application instructions. Apply Vulkem 350NF- SL by V-notched squeegee or airless sprayer followed by back roll or by roller or brush alone at minimum 10 wet mils thickness. While wet,immediately broadcast 20-40 mesh silica sand*into Vulkem 350NF-SL at a rate of 12.5 lbs. per gallon of 350NF-SL. Allow to cure per manufacturer's application instructions before proceeding. Do not apply 35ONF-SL to vertical surfaces. Integrity Test: Required,and shall be performed in accordance with ASTM D 5957.Water maybe maintained for a period longer than 24 hours if required. Surfacing: Ceramic plaza deck tiles(12"x 12"x'/a")fully embedded into Increte Systems Thin-Crete Grout as directed by the manufacturer,applied to the top of Vulkem 350NF-R fully sanded coating with a 1/4"notched trowel. Maximum Design Pressure: -620 psf(See General Limitation#9) •••• *The seeding of the aggregate shall be with an even,light broadcast short of or just to mesal.Anx Jggse �.• aggregate must be removed prior to recoating.Back roll aggregate where indicated. eo*•Oo • •••• •••• ••••• •••••• • •• ••••• NOA No.:11-0516.02 F I Z Z-0 e►DE cOU� Expiration Date: 09/06/17 ••• Approval Date: 09/06/12 Page 5 of 6 GENERAL LumATioxs: ! 1. Fire classification is not part of this acceptance,refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. A copy of the integrity test report described herein in accordance with ASTM D5957 shall be provided to the Building Official for review at time of final inspection. 3. Contractor shall submit to the Building Official for review the system specifications and details. C Submission of these documents,as well as the proper application and installation of all materials shall be the sole responsibility of the contractor. f4. Flashings shall be installed according to the manufacturers published standard details,specific details,approved by Tremco,Inc.and shall be submitted to the Building Official for review. f S. All work shall be performed by a Contractor licensed to do roofing/waterproofing. Contactor shall be approved by Tremco. 6. All attachment and sizing of perimeter nailers,metal profile,and/or flashing termination designs shall conform with Roofing Application Standard RAS 111 and the wind load requirements of applicable Building Code. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing Application Standard RAS 117.Calculations prepared,signed and sealed by a Florida registered Professional Engineer,Registered Architect,or Registered Roof Consultant (When this limitation is specifically referred within this NOA,General Limitation#9 will not be applieable.) 8. A non-skid surfacing is required for all pedestrian areas,plaza decks or balconies. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones(i.e. field,perimeters,and corners).Neither rational analysis,nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones(i.e.perimeters,extended corners and corners). (When this limitation is specifically referred within this NOA,General Limitation#7 will not be applicable.) 10. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 9N-3 of the Florida Administrative Code. 0000 11. All approved products listed herein shall be labeled and shall bear the imprint pr idgntifiabl'�40400 0440+0 marking of the manufacturer's name or logo and following statement:"Miami-fVA County 0444 0 Product Control Approved"or the Miami-Dade County Product Control Seal as4mwgi belowa•• 000000 040.0. 0 • 144444 444• 4440 0000 0000 • 0 END OF THIS ACCEPTANCE ••0••. 4 00 00 . . . ....0 444444 4 00 • • .*000: 0 0 0000 4 • • • 444444 . 4 4444 . 4 4444 NOA No.:11-0516.02 Expiration Date: 09/06/17 Approval Date: 09AW12 Page 6 of 6 . i : Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 7023187 C. LBT BUSINESS NAME/LOCATION RECEIPT NO. NESS CARMEL LLC RENEWAL EXPIRES 15456 SW 117 W SEPTEMBER 30, 2016 MIAMI FL 33196 7299266 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS NESS CARMEL LLC 213 SERVICE BUSINESS PAYMENT RECEIVED Employee(s) i BY TAX COLLECTOR $75.00 07/21/2015 CHECK21-15-101565 This Lineal Business Tax Receipt only confers payment of the local Business Tax.The Receipt is not a licensepermit or a , or noagovernme�maal tionreg la the hotels s qualiNcationm,to do busineeL Holder must comply with any governments, regulatory laws and requirements which apply to the business. / The RECEPr N0.above must be displayed on all commercial vehicles-Miami-Bade Code Sec 88-276, For more lutormation,visit My udwjdadagM ftXggH ..., a ------------------------------------ Po. i � r i t g 8t y i. Y ! i 1 i ! w Y P R mom i f L0 1 ' 1( Ness Carmel LLC 15456 SW 117 Lane Miami Fl. 33196 Date: 11/18/2015 State of Florida Miami Dade County Before me this day appeared Steve J.Martinez who being duly sworn,deposes and says: That he or she will be the only person working on the project located at 1275 N.E. 94 Street Miami Shores Fl. Sworn to or affirmed and subscribed before me this 18 day of November 2016 by Personally Known Or Identification ProducedCARLO ENRIQUE LEIVA Notary Public-State of Florida R, My Comm.Expires Sep 11.2018 T e of ID Produced "° Commission # FF'140787 Bonded Through National Notary Assn. Print or Stamp Name of Notary •• 1 son ME Miami Shores Village Building Department R10050 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: er State of FlorIC J County of Miami-Dade The foregoing was acknowledge before me this 14 day of By � ,p.'5 /-76 e k who is personally known to me or has produced L as identification. CARLO ENRIQUE LEIVA 5 ®m. ; Notary Public-State of Florida { Notary: m , •_My Comm.Expires Sep 19,2018 ?. Commission # FF,1407?7 r SEAL: Bonded Through National Notary Assn.r,