DS-15-2951 3 3°3lmso,� Miami Shores Village r Petif( 8O � C� X151,
S� 10050 N.E.2nd Avenue NW ,� � � �� n
Miami Shores,FL 33138-0000 .� E
Phone: (305)795-2204
�
Expiration: 08/16/2016
p.
Project Address Parcel Number Applicant
21 NW 101 Street 1131010180220
Miami Shores, FL 33138- Block: Lot: FEDERICO GONZALEZ
Owner Information Address Phone Cell
FEDERICO GONZALEZ 21 NW 101 Street (786)302-3247
MIAMI SHORES FL 33150-
21 NW 101 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 5,000.00
RIVI CONSTRUCTION (305)253-4462 (786)518 1091
....... _. ..... _n _..., v: ..mm.. Total Sq Feet: 1500
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:REMOVAL OF EXISTING ASPHALT DRIVE Additional Info: Review Planning
Bond Return: Classification:Residential Review Building
Scanning:3
Fees Due Amount
Pay Date Pay Type e Amt Paid Amt Due
Bond Type-Contractors Bond $500.00
CCF Invoice# DS-1415-57856
$3.00 02/18/2016 Credit Card $647.26 $50.00
DBPR Fee $2.63
DCA Fee $2.63 11/23/2015 Credit Card $50.00 $0.00
Education Surcharge $1.00 Bond#:2990
Permit Fee $175.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $697.26
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in complia ice with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,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 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 a d z in . Futhermor ,I authorize the above-named co or to do the work stated.
U4 February 18, 2016
Authorized i atu er / plicant / Contractor / Agent Date
Building Department Copy
February 18,2016 1
\off Miami Shores Village
Building Department NOV 2 3 2015
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 2014
BUILDING Master Permit Nb. �S iS— a,R51
PERMIT APPLICATION Sub Permit N�.
UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
( / CONTRACTOR DRAWINGS
JOB ADDRESS:
Com: Miami Shores Countv: Miami Dade Zip: o
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
r_1 1 \ U
OWNER: Name(Fee Simple Titleholder): t"E' 4 'e 1rt C o �d�� 1 L,Z Phone#:-7 - �Q�,- ��-t-7
Address:'Z k •4J • �� _� '
f �
City:- Mt os S k we S State: �'L Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: K%j 1 6_6'V�YQ C4'1 0 A Phone#: 1 $i•'1411
Address: t 3 S Uj 11 g '4�' ` 0 g A
City: I&%&MI State: 'FLI Zip: �3 �
Qualifier Name: 6� aw.& aid je�L Phone'#:1�C. 14 it -Zd 8 3
State Certification or Registration#: l (rC ST 1 1 3 a o f Certificate of Competency#:I
DESIGNER:Architect/Engineer: —Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ � D C d Square/Linear Footage of Work: `.Sd f(-
Type of Work: ❑ Addition ❑ ``Alteration r❑ New EJRepair/Replace ❑ Demolition
Description of Work: �8 t" 0 vo✓k
Specify color of color thru tile:
Submittal Fee$ 50 mC Permit Fee$ ` • CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond; �CK) CK-)
TOTAL FEE NOW CUE$1 a ZCO
(Revised02/24/2014) r ;_ ,
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 instrument was acknowledged before me this
day of NOJeTmtr C- ,20 15, J by iq2 day of A,QAm—�l r 20 I,S , by
�CkQ z�,6y,�7dt42 –..who is personally known to Q, who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: l�
Print: ®. a Print:WN GR16W
► '
. Notary Public-State of Florida Seal: +`�= Norx y colic-State of Florida
Seal: ;•e Commission#FF 214497 « �:•= Commission#FF 214497
My Comm.Expires Jul 19 2019
f" o? P ,�.• My Comm.Expires Jul 19,2019
°wBonded through National Notary Assn. ' �� �°�� o?r Bonded through National Notary Assn.
1
APPROVED BY Plans Examiner G y c/ ` Zoning
Structural Review Clerk
(Revised02/24/2014)
n
n
w
I
r'R �`' _. '"^,� �� � r•a� "MISS - '� ,� - �" �; L �� ;fir.-Y'a. "�F" apt'.- y�-
sop-
a�
- ,•s .� _. - '., .+ gr .� � :ate �� �T+•,:� -�v�1"aw.a.., �;,
r
• '�»,. ...,h. . - x(1.;,0,_ _.. � =.' iii) r= g: .. .. .
4
s
�`"w ►� STATE OF FLORIDA
� . _ DEPARTMENT OF BUOz" NE!� A C
PROFESSIONAL REGULATIONf
a CGC1511384 ISSUED. ,
CERTIFIED GENERAL CONTRACT
BANDRICH, RICARDO LUIS
RIVI CONSTRUCTION INC
IS CERTIFIED -mer the provisions of Ct
Expiration date AUG 31, VIP
k :
?" ,.
aF
Awawe,_
a
' 44, Vp
2 A' i'�• .ate +K ,,�"' ' " .. .yam r vR°
x
4a
^; .. + •� �.. `',# l°� - i Mfr^
d
9
Local Business Tax Receipt
Miami-Dade County, State of Florida
-THIS IS NOT A BILL-DO NOT PAY LBT
5819140
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
RIVI CONSTRUCTION INC RENEWAL SEPTEMBER 30, 2016
13375 SW 128 ST 108A 6067441
MIAMI, FL 33186 Must be displayed at place of business
Pursuant to County Code
Chapter BA-Art.9&10
OWNER SEC_TYPE OF BUSINESS
PAYMENT RECEIVED
RIVI CONSTRUCTION INC 196 GENERAL BUILDING BY TAX COLLECTOR
CONTRACTOR 75.00 07/31/2015
Worker(s) 1 CGC1511384 GREDITCARD-15-039187
This focal Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license,
permit,or a certification of the holder's qualifications,to do business.Holder must conVIV with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT N0.above must be displayed an all commercial vehicles-Miami-Dade Code Sec 8a-276.
MIAMtm For more information.visit www.miami de. or aXcollectpr
}
s IY
5'
SI VIOA
AC 'Me C
lonf 2i
A '
i;
CERTIFICATE OF LIABILITYN
r
IS ISSUED ASA MATTER OPMORMAITON ONLY ANDCONFERS WilliamTHE CEIVIVICAM
CERTIVICATE DOES tWT AFTMUTNMY OR NEGATIVELY OR ALTER THE COV AFFORDED BY THE POUCMS
BELOW. TW CERTIFICATE OF MUMME DOES NOT CONSIMITE A CONTRACT BVW9EN TRE OWNG MURERf4.AUnfonzEo
REPMSENTATIVE OR PRODUCIP,AND THE CE KATE ER.
a e s tt
the Umm aand o0 s s c*d t.Astaftmadoallds d not ls 16 the
bOder ffin of . h
VVICT
-tum u w 4124 street
l 3
rMM&FL33179A t L 1 9� iF
lmaswilslm street
NUMI FL 33176 n-
_.
CEffrIFI
a
CATE MBER: ER-
T#!S TGTG ER FY ITMT� ICIES USTEIDGELOW = D' R " E
! 1 T . -it�Tw'tTl-IgrA DINS ANY TE f 1Tt d # tT T 4 T A6 T Tav it '�
CO
TIFI T Y A BE t9&U90 OR 11 TAlK Tk9 Its E DEY T S p 1 IST T ALL T T
EXLUSIONS AND CONDt'nONS OF S" LIM=SHOWN WAY HAVE W-"4M-1=20 By PAID CIAM&
LUA, Mw
KRI €
� wq��V�a� p�♦ p[�9 ,,
'IC `I 1-16-16 4-1117
r
.....
QVL AUVIRINAVE UP&T Appiffitfta
MN#)fflo
Au. 0"Ve F 1f1w"=of*!s
AUrM ' i
17
H meat
ft9ds
_...._ .... __.. _ .n..::.
QNS
n
arxOTH
TVIMNMPRIET"ARSMENEW: CL
MIT 71,
N6F J LWAROSIVENCLas~ACWO'1Ql« W [t
Ill itmes ummber.cocl611
X
ECERTIFICATE HOLDER CANCELLATtom
SHOW-0 ANY CRY of fAlwm Sham
OFA ASM DESCM9D
WE EMRAMM DATE � WILL EM DELNOW N
IGM NE SW Ave,
wshwo& 33t=
aml
PhamOMSS-2204
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: 8/14/2014 EXPIRATION DATE: 8/13/2016
PERSON: BANDRICH RICARDO L
FEIN: 760802076
BUSINESS NAME AND ADDRESS:
RIVI CONSTRUCTION INC
10303 SW 115 STREET
MIAMI FL 33176
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL
CONTRACTOR
Pursuard 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 fifmg of the notice or Ore 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 shy revoke a
DFS-F2-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609
♦ R�s D
Miami Shores Village
Lh4111 Building Department
�l
OR 10050 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insur nce Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Flde Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement f�r 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 aTiidavit 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: 77�"-1*
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this 1 day of OJ ,20 G J.
By FMC i,fir 6-011) W le-1, who is person illy known to me or has produ ed
as identification.
Notary:
,,, MAYEL
SEAL: o"aY PUB`S Notary PubWGRILLU
lic Stats of Florida
Commission#FF 2144 2019
iN, oP MY Comm.Expires Ju119,
•,9 P.• anal Notary Assn•
Rov®
Construction Inc.
13375 S.W. 128 Street#108 A
Miami, Florida 33186
Date: 11-19-15
State of Florida
County of DADE
Before me this day personally appeared Ricardo L Bandrich who,being duly sworn,deposes and says:
That he or she will be the only person working on the project located at: ;� ( N •W • 6 SO
Sworn to(or affirmed)and subscribed before me this lay of XLl m�et .20 1 S by
Personally Known
Produced Identification
Type of Identification Produced
//I" CLZ/�
Print,Type or Stamp Name of Notary
P•, MAYELIN GRILLO
4� V6
J4 Notary Public-Otate of Florida
Commission FF 214497
% " My Comm.Expir@s Jul 19,2019
Banded ftmo nal Notary Assn.
TEL:(786)-412-2383
5t�0�s
Miami Shores Village
Ing lBuilding Department
16050 N.E.2nd Avenue
IDp Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) F ea e�rt 44 (To A'�-Q ` -e"L hereinafter referred to as the
owner of the following described property (address):
Legal Description Lifilafevhaj Lot Block Subdivision
Folio# L
Requests permission to install (describe work): d Col t, eq y O &rt'C Paw or
Within the public right of way of(address) •W
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the
dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County
to make repairs or maintain said items within public right of way including restoration of
street by reason of the Owner's failure to do so, such expense shall'be paid by the Owner
or shall constitute a lien against the above described property until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade
County harmless from any and all liability, which may rise by virtue of permitting the
installation of these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,
within 60 days notice by the Village to do so. Failure to comply with this notice will result
in the Village causing the item(s) to be removed and a lien being placed on the property
and/or assessed against the Owner for all costs incurred in the removal and disposal of
the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant
running with the land and shall remain in full force and effect and be binding on the
undersigned, their heirs and assigns, until such time as this obligations has been
canceled by an affidavit filed in the Public Records of Dade County, Florida by the
Village Manager of Miami Shores Village (or his fully authorized representative).
Signature =� "
Owner or Agent
The foregoing instrument was acknowledged before me this 1® day of Fe 6f ILi 20 r (, by
who is personally known tome or who has produced
as identification and who diafa-ke an oath.
NOTARY PUBLI
Sign:
Print:
My Commission Expires. ,,�FaYPLBo, =National
N GRILLO
�.`�^ State of Florida
•E #FF 214497
oo-oaires Jul 19,2019
ational Notary Assn.
� �s- 2gS/
. , ..
• A minimum of two 12ft shade trees must be present
area fa
LOT 3 LOT 2 in rder to pave any portibQ3f the parkway/swe. /
BLK 2 BLK 2 T adjoining property ovMKp0posing to pav a f
ion of the parkway/swale shall plant suff ci nt 25-
" s de trees approved by the public works d
/.
•••• � 1r2"fIP to eeHA0AffWnfid144Ai1M : FtP
• ••• •••• NO Iia NO ID p
...... • 254
..•... 2 .of t
......
• I
••••• CL
• • •
•• D. T1 t
� • • ;d. J�,r LiJ I
• • • ' i C� UJ
1CFg
E.l2C.5,'41' VF,,pyP I 'LOT(�[ ( d i.� CO 0
BLK
'y � 7
Cd
-OT 14
00
_ x'
U�1Q� O� j t .x Q ON LI j' iN
t r" r f lPic i S+i r 0.5 J+ ONLINE dri veu-)::,y
b base cy�
1trr�roclC 3 Scram � +��' t,,,.• ;
insfoJI +rz rnrM q' In
3- e Pctver5 ���t i r)
IZ` ieIdmc-rc-k,- menax4rf�o 112,]F1 ui 0
{
/8 i riChe� -H-►1 c 1CNG ID
,� 'j f
25.0 1+2'Flf' r • �°
E)CPH Of f-endgihoj NO ID
Ps CHC inches
o
44
r r +r. �.
%I
APP,"
PP
Nov 2 3 2015
j
ZONING DEPT
- _ — -- BLDG DEPT l tJ
t �
SUB.IFCT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
a� l Nv�J IDI 5
0
NICs1
I
- s� :z:
A minimum ott+�•o• 2tt•�Yiac�e�ee�sr�xl�f bP�present
in the parkwl/swale frr eget i5 fee=of frontage
ku0 swale.
to ave a
�' LOT Lshade
fining property owner , �si g p l ,
OT 3 LLT 2 )f the parr=vayrsw,* s suff! ient f
BLK }'o d b ttSe Yks Le'dor
ee$alp � . }L �tht rtirii?hum regidirentent.
..
N 89°55'4 "E 81. '(M)4'
z 112"FIP �XJ 6355: F�,'r• 11.2"FIP
25.0 NO tD . . . . . . . . • NO ID
... . . . . ..
OX, FF 0 3' F
25,0° ,
)Ea OF �
_UDED
E. 25' QFto gLOT 16 UJ
f:
tl, LOT 15 , BLK2 �,�/
BLitce
OT 14
BLK 2
0-k anith kI � ' ON LI
ON LWEj
.212
0.
Acs�• F����das p,S•� �-L� � ;, `� ! � - - � �
d� t
r •
C�4Io ID 25.
...� 1/2"Fip r�
-f� �l
.� 0iVk SIU In
Miami Shor&I III ge
APPROVE � f/V.
ff �
ZONING DEPT
'73t_DG DEPT J t( W w n F. .•,.
}.,1 JRJF CT TO COMPLIANCE NTH ALL FEDERAL
!Y ANn COUNTY RULES AND REGULATIO
\J v c)
!tel t�rrn r r)(~r-.(:� l