WS-16-314 r2l (a Miami Shores Village JUL
Building Department
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 200
BUILDING Master Permit NoVy -7— 16— D-OB�
PERMIT APPLICATION Sub Permit No. WS a - k b -- '3 �
ME BUILDING ❑ELECTRIC ❑ ROOFING ( REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL [:]PUBLICWORKS 7❑`CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 103 NE 99TH STREET
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-2180 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee simple Titleholder):GEORGE FISHMAN Phone#:305-753-2503
Address:103 NE 99TH STREET
City: MIAMI SHORES state: FL Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email:
CONTRACTOR:Company Name: GMP CONTRACTORS Phone#: 786-443-3548
Address: 13500 SW 250TH STREET
city. HOMESTEAD state: FL Zip: 33092 Y,
Qualifier Name: ISSAC CABARELLIERO Phone#: 786-443-3548 76f 473
""
State Certification or Registration#: CGC1515142 Certificate of Competency#:
DESIGNER:Architect/Engineer: DEBOWSKY DESIGN GROUP Phone#: 305-495-2751
Address:4384 SW 13TH STREET city: MIAMI state: FL Zip: 33134
Value of Work for this Permit:$amIs JS010 Square/Linear Footage of Work: 200 SQFT
Type of Work: ❑ Addition ❑ Alteration ❑ New F Repair/Replace ❑ Demolition
Description of Work: S �
�'1,,- �. �. �I (Y►,�11 b2✓ gra�°�-��' +�.. �a , N
r
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ -3(� CA3 CCF$ CO/CC$
Scanning Fee$ �- Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ W CAl Bond$ ll
TOTAL FEE NOW DUE$ I (0 1 '60
(Revised02/24/2014)
Bonding Company's Name(if applicable) N/A
Bonding Company's Address N/A
City State Zip
Mortgage Lender's Name(if applicable) N/A
Mortgage Lender's Address N/A
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 rein pectlon fee will be charged.
r
Signature - Signature
OWNER or AGENT CONTRACTOR
The forggoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this
ZL
�r day of 20&by day of 20 by
G e® r:2 e Fi 6 F44W ,who is personally known to a r'c ho is personally known to
me or who has produced -�Zr1Ycr as me or who has produced vi15 t= as
identification and who did take an th. identification and who did take an oat .
NOTARY PUBLIC: a^No NOTARY PUBLIC:
Sign: '-e'& �
(�
Print: G I Print: /7
i s
Seal: vs�0 ne Seal:
VK-- 2 ti
Oy `kr� Irv ,
f
APPROVED BY Plans Examiner ping
J Structural Review Clerk
(Revisedo2/24/2014)
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795-2204 Fax: (305)758-8972
Inspection Number: INSP-265532 Permit Number. WS-2-16-314
Scheduled Inspection Date:August 19,2016 Permit Type:Windows/Shutters
Inspector. Mesa,Michel Inspection Type: Final
Owner. FISHMAN,GEORGE Work Classification:Window/Door Replacement
Job Address!103 NE 99 Street
Mlami Shores,FL 33138- Phone Number
Parcel Number 1132060132180
Project: <NONE>
Contractor. GMP CONTRACTORS Phone:(786)443-3548
Building Department Comments
INSTALLATION OF WINDOWS AND DOORS 26o m
erft
WINDOWS AND 3 DOORS INSPECT RCOMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP 252227.08/10/2016
5] NOT READY
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
winspedion fee is paid.
August 18,2016 For Inspections please call:(305)762-4949 Page 20 of 32
ti
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795.2204 Fax: (305)756.8972
Inspection Number. INSP-261955 Permit Number. WS-2-16-314
Scheduled Inspection Date:August 1%2016 Permit Type: WindowalShutters
Inspector. Mesa,Michel Inspection Type: Window Door Attachment
Owner: FISHMAN,GEORGE Work Classification: Window/Door Replacement
Job Address.103 NE 99 Stmt
Miami Shotes,FL 33138- Phone Number
Parcel Number 1132060132180
Project: <NONE>
Contractor. GMP CONTRACTORS Phone:(786)443.3548
NNW
Buliditt Comments
omments
INSTALLATION OF WINDOWS AND DOORS 26 Infractlo Pawed Comments
WINDOWS AND 3 DOORS INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP 260887.CREATED AS
REINSPECTION FOR INSP-260328.CREATED AS REINSPECTION FOR
INSP-252226.6-3-16
NOT AS PER NOA,NEED TO EXPOSE ALL WORK NEED TO INSTALL
Failed AS PER NOA AND RECALL WHEN READY.
06-13-2016
Met at the job site with Mike,The home owner and contractors reps.The
Correction ❑ project was not ready for inspection, Missing screws in several casement
Needed windows,the kitchen window has double buck on one side,the type A
window openings are not per N.O.A.The bottom sill of the window on the
laundry room Is not to code. Provide the following revision. buck detail for
double bucking.and structural detail for the center column between A type
Re-Inspection ❑ windows.The details should be submitted to the Village for review and
Fee approval.
6-27-16
No Additional Inspections can be scheduled until PARTIAL,PENDING DOUBLE WINDOWS WITH MULLIONS,NEED
re-inspection fee Is paid REVISIONS TO SHOW MULLIONS.
August 09,2016 For Inspections please call:(305)7624949 Page 12 of 34
MILTON CUBAS, P.E., INC.
1302 N.E. 125x`Street—
North Miami—Florida 33161
Phone(305)891-4174 Fax(305)891-4175
E-mail:miltoncubas@msn.com
June 27, 2016
To: City of Miami Shores Village
10050 NE 2nd Ave
Miami Shores,FL 33138
WE 103 NE 99' St
Miami Shores,FL 33138
Permit#: WS2016-314
Dear Building Official:
At the request and authorization of the client, an inspection was performed by Milton
Cubas, P.E., INC., in reference to the above address. The purpose of the inspection was to
determine the correct installation of the exterior windows and doors installed at the house.
Double buck is approved and properly anchored to substrate. I hereby attest that to the best of
my knowledge, belief and professional judgment, all exterior windows and doors were
installed properly and in accordance with Florida Building Code.
Should you have any questions or need any additional information please do not hesitate
to contact me.
Very truly yours,
MiWCubas,
Certification Authorization# 27267
F.L. Reg. P.E. # 51902
S.I. # 6999901
7
Ila
i
MIAMI-DAT�E MliM=
PRODUCT C G0 SECTION
DEPARTMENT OF REGULATORY AND E ) 11805 SW 26 Sft=4 Room 208
BOARD AND CODE ADMINISTRATION D T(786)315-2590 F(790315-2599
NOTICE OF ACCEPTANCE O www miamldede wdeconomx
Curr A Tech Corporation
930 West 23"s Street
Hialeah,IPL 33010
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 RER -
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 atmos 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.
RER 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.
DESCRIPTION:Extruded Aluminum Tube Mullion-L.M I.
APPROVAL DOCUMENT: Drawing No.M95-19A,titled"Aluminum Tube Mullions",sheets 1 through
6 of 6, dated 12/07/95, with revision F dated 01/29/16, prepared by Al Farooq Corporation,
sealed by Javad Ahmad, P.E., bearing the Miami--Dade County Product Control Revision stain
Notice of Acceptance number and expiration date by the Miami-Dade County Product Control Sec on
MISSILE IMPACT RATING:Large and Small lY unne Impact Resistant
LABELING: Each unit shall bear a permanent label with the manufacturers name or logo,
model/series,and following statement: "Miami-Dade County Product Control Approved", unless
noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there
no change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision
in the materials,use,andt or manufacture of the product or process.Misuse of this NOA as an end
of any product, for sales, advertising or any other purposes shall automatically terminate this NOA F
to comply with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Flori ,
followed by the expiration date may be displayed in advertising literature. If any portion of the O
displayed,then it shall be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacture or its
distributors and shall be available for inspection atetke jeb sitewa ttke reqpesteof the Building Official.
This NOA revises NOA#12-0430.02 and consiskof M pw 4-aid jy a pages E-1 and E-2,as well as
approval document mentioned above. • • • • • • • • •
.. ... .. . . . ..
The submitted documentation was reviewed by Manuel Perez,P.E.
••• • •••
.. . . .. . . . . .
NOA No.1S.0603.18
M I �� 19;tration Date: March 28,2018
1�� ... . . ... . Approval Date` February 18,2016
Page 1
. .. .. . . . .. ..
... . . . ... . . .
,
Cure A Tech Coraoration
NOTICE OF ACCEPTANCE: EVIDENCE SUBIY.QTTED
A. DRAWINGS
1. Manufacturer's die drawings and sections.
(Submitted under NOA's No. 08-0813.08 and 97-4423.05)
2. Drawing No. M95-19A, titled "Aluminum Tube Mullions", sheets 1 through 6 of 6,
dated 12/07/95, revision F, dated OU29/16,prepared by Al-Farooq Corporation, signed
and sealed by 7avad Ahmad,P.E.
B. TESTS
1. Test reports on: 1)Uniform Static Air Pressure Test,Loading per FBC,TAS 202-94
2)Large Missile Impact Test per-FBC,TAS 201-94
3)Cyclic Wind Pressure Loading per FBC,TAS 203-94
along with marked-up drawings and installation diagram.of aluminum fixed windows
mulled together, prepared by Fenestration Testing Laboratory, Inc., Test Report No.
FTL-5636,dated 06/12/08,signed and sealed by Carlos S.Rionda,P.E.
(Submitted wider NOW 08-0813.08)
2. Test reports on: l)Uniform Static Air Pressure Test,Loading per PA 202-94
along with installation diagram of aluminum fixed windows mulled together,prepared
by Hurricane Engineering & Testing Inc., Test Report No. BETI 96-1054, dated
02/01/96 signed and sealed by Hector Medina,P.E.
(Submitted under NOW 97-0423.05)
C. CALCULATIONS
1. Anchor verification calculations and structural analysis, complying with FBC 5m
Edition (2014), dated 02/09/16, prepared by MCY Engineering, Inc., signed and
sealed by Yiping Wang,P.E.
D. QUALITY ASSURANCE
1. Miami-Dade Department of Regulatory and Economic Resources(RER).
E. MATERIAL CERTIFICATIONS
1. None.
.. ... . . .. . . ..
. .. . . . . ... .
.. ... .. . . ..
• ••• ••• Manu P.L.
• • • ProductCon of Ex miner
.. . . .. . . . .
• •• NOA 603.18
Expiration Date: Mareb'28,2018
Approval Date: February 18,2016
.
V:
... . . . ... . .
I
Cury-A-Tech Corooration
NOTICE OF ACCEPTANCE: EVIDENCE SUBMPMD
F. STATEMENTS
1. Statement letter of conformance, complying with FBC-5a' Edition (2014), and of no
financial interest, dated May 29, 2015, issued by Al Farooq Corporation, signed and
sealed by Javad Ahmad,P.E.
2. Laboratory compliance letter for Test Report No. FTL-5636 issued by•Fenestration
Testing Laboratory,Inc.,dated 06112108,signed and sealed by Carlos S.Rionda,P.E.
(Submitted under NOA No. 08-1024.06)
3. Laboratory compliance letter for Test Report No. HETI-96-1054 issued by Hurricane
Engineering&Testing,Inc.,dated 02/01/96 signed and sealed by Hector Medina,P.E.
(Submitted under NOA No. 97-0423.05)
G. OTHERS
1. Notice of Acceptance No. 12=0430.02, issued to Cury-A-Tech Corporation for their
Extruded Aluminum Tube Mullion— L.M.I., approved on 08/02/12 and expiring on
031WI&
z
I se Q)z
.. ... . . . . . ..
. .. . . . . ... .
.. ... .. . . . .
Manuel P ez, L
096
• Soo
Product Contro=.18
or
•; ;. •; ; .• NOA No.
' " •'• Expiration Date: March 28,2018
Approval Date: February 18,2016
... Fi-2 . ... .
. . . . . . . . . .
. .. .. . . . .. ..
. ... . . . ... . .
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MATt]iiALS INCLUDING 8UT NOT L9BTE0 TO MAL SCREWS THAT
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FOR PARtHXxAR OP£NOR7 TH16 ltOA IS NOT VALID WITHOUT CORPORATE SEAL CML C
STEP 2 USE Ctl10E CdRiIY APPROVED GLAZING PROFS MWWG OF CIRN-A-TEdI CdtPORATION AND A LABEL AFF=- M 7=
ABOVE LAAO�• 3g�
MEp 3USE Cow==TO IAILLION AS PER PROD=APPROVAL A11OD1TCT RBV6413D n Q
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THRU iBY WOOD BUCKS INTO HOLLOW/FUED BLOCKS MUST SUSTAIN LOADS IMPOSED. IO
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MANAVA HAIR
4870 NW 167TH Street
Miami Gardens,FL 33014
SUITE LEASE AGREEMENT
This lease is made on the day of 2016,between Manava Hair and Accessories LLC"Manava Hair",
and "Lessee"
Manava Hair and Accessories LLC.Operates a commercial salon business on the Premises described
As 4870 NW 167 `Street Miami Gardens,FL 33014.
Lessee wishes to lease and occupy a portion of the Leased Premises in order to operate
Manava Hair shall lease to an area located on the Leased Premises designated as Suite ,
and furnished with salon equipment and furnishings at Manava Hair discretion.The area to be subleased to the Sub lessee
shall be referred to the Suite.The Sub lessee and all of his agents,invitees,customers or visitors shall have access to the
common areas of the Leased Premises,including the existing common customer waiting area.
1. SPACE:
Manava leases to the following salon suite:
❑ Studio 1: 8'0' x 15'4° 123 s.f.
❑ Studio 2: 7'0°x 15'4° 107 s.f.
❑ Studio 3: 7'0°x 15'4° 107 s.f.
❑ Studio 4: 7'0°x 15'4° 107 s.f.
❑ Studio 5: 7'0° x 15'4° 107 s.f.
❑ Studio 6: 7'0'x 157' 109 s.f.
❑ Studio 7: 7'0° x 157' 109 s.f.
❑ Studio 8: 7'0"x 157' 109 s.f.
2.TERM:
A. Primary Term:The primary term of this lease begins and ends as follows: Commencement Date:
Expiration Date:
3.AUTOMATIC RENEWAL AND NOTICE OF TERMINATION:
.. ... . . . . . ..
A. This lease automatically renews on a 6-mont basij uj�l s¢ lie ee:Qrovides Manava Hair written notice
of termination not less than 30 days before the Eviratio tete, ; •••
4.RENT: ... ...
Weekly Rent: Lessee will pay Manava Hair weekly ientan the pi*n®ymt of.4156/Week for first 4 months.
$250/week for 5"'and 6 months each full week during this lease. The first full week's rent is due and payable
not later than Thursday 5:00 pm.
... . . . . ... . .
•
Manava Haar&Salon Suite Lease Agreement • ;• page 1* #**
' MANAVA HAIR
4870 NW 167TH Street
Miami Gardens,FL 33014
SUITE LEASE AGREEMENT
This lease is made on the day of 2016,between Manava Hair and Accessories LLC"Manava Hair",
and "Lessee"
Manava Hair and Accessories LLC.Operates a commercial salon business on the Premises described
As 4870 NW 167 `Street Miami Gardens,FL 33014.
Lessee wishes to lease and occupy a portion of the Leased Premises in order to operate
Manava Hair shall lease to an area located on the Leased Premises designated as Suite ,
and famished with salon equipment and furnishings at Manava Hair discretion.The area to be subleased to the Sub lessee
shall be referred to the Suite.The Sub lessee and all of his agents,invitees,customers or visitors shall have access to the
common areas of the Leased Premises,including the existing common customer waiting area-
l. SPACE:
Manava leases to the following salon suite:
❑ Studio 1: 8'0"x 15'4" 123 s.f.
❑ Studio 2: 7'0" x 154" 107 s.f.
❑ Studio 3: 7'0" x 164" 107 s.f.
❑ Studio 4: 7'0"x 15'4" 107 s.f.
❑ Studio 5: 7'0"x 15'4" 107 s.f.
❑ Studio 6: 7'0" x 157" 109 s.f.
❑ Studio 7: 7'0" x 157" 109 s.f.
❑ Studio 8: 7'0" x 157" 109 s.f.
2.TERM:
A. Primary Term:The primary term of this lease begins and ends as follows: Commencement Date:
Expiration Date:
3.AUTOMATIC RENEWAL AND NOTICE OF TERMINATION:
•• ••• • • • • • ••
A. This lease automatically renews on a 6-mo•r th babid&MIM tels¢e provides Manava Hair written notice
of termination not less than 30 days before thepia;a ..•
4.RENT: ••• ••• •
Weekly Rent: Lessee will pay Manava Hair wee$10 nA t fi tttA Dun#. `0 week for first 4 months.
$250tweek for 50'and 6 months each full week during this lease. The Mt fell week s rent is due and payable
not later than Thursday 5:00 pm. ,•• • • • • •.. . •
Manava Hair&Salon Suite Lease Agreement .:. :.•'�i7lie�of�•.
Miami Shores Villagea
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 �5
Phone. (305)795-2204
Expiration: 09/05/2016
Project Address Parcel Number Applicant
103 NE 99 Street 1132060132180
Miami Shores, FL 33138- Block: Lot: GEORGE FISHMAN
Owner Information Address Phone Cell
GEORGE FISHMAN 103 NE 99 Street
MIAMI SHORES FL 33138-2340
Contractor(s) Phone Cell Phone $ 25,910.00
GMP CONTRACTORS (786)443-3548 Valuation:
--• Total Sq Feet: 900
Type of Work:INSTALLATION OF WINDOWS AND DOORS 2 Available Inspections:
No of Openings:29 Inspection Type:
Additional Info: Window Door Attachment
Classification:Residential Final
Scanning:6 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $15.60
(nVO1Ce# WS-2-16-58566
Change of Contractor Fee $75.00
DBPR Fee $5.85 03/09p2016 Credit Card $536.30 $0.00
DCA Fee $5.85
Education Surcharge $5.20
Permit Fee $390.00
Scanning Fee $18.00
Technology Fee $20.80
Total: $536.30
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
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 mys y agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOO OF and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information ' a ate d tha all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-na ct o do th work stated.
March 09,2016
Authorized Signature:Owner / Applicant n gent Date
Building Department Copy
March 09,2016 1
1
1,
' Miami Shores Village
Building Department rER 04 2010
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 * -
Tel:(305)795-2204 Fax:(305)756-8972 ---
INSPECTION LINE PHONE NUMBER:(305)762-4949 544
FBC20 ➢ y
BUILDING Master Permit No.Lksl (0-31(A
PERMIT APPLICATION Sub Permit No.
OBUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 2KENEWAL
❑PLUMBING ❑MECHANICAL [:]PUBLICWORKS CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 103 NE 99TH STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-2180 Is the Building Historically Designated:Yes NO X
Occupancy Type: 'E"Do"L Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):GEORGE FISHMAN Phone#:305-753-2503
Address:103 NE 99TH STREET
City. MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email:
CONTRACTOR:Company Name: GMP CONTRACTORS Phone#: 786-443-3548
Address: 13500 SW 250TH STREET
City; HOMESTEAD State: FL Zip: 33092
Qualifier Name: ISSAC CABARELLIERO Phone#: 786-443-3548
State Certification or Registration#. CGC1515142 Certificate of Competency#:
DESIGNER:Architect/Engineer: DEBOWSKY DESIGN GROUP Phone#: 305-495-2751
Address:4384 SW 13TH STREET City: MIAMI State: FL Zip: 33134
Value of Work for this Permit:ti������Z$,-
J Square/Linear Footage of Work: 900 SQFT
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition
Description of Work: INSTALLATION OF IMPACT WINDOWS AND DOORS
W1 u�r s 7� 00 P-S
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ •�V•� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ 1,
TOTAL FEE NOW DUE$ 4
(Revised02/24/2014) -.�. S (ia
�340.30
"Bonding Company's Name(if applicable) N/A
Bonding Company's Address N/A
City State Zip
Mortgage Lender's Name(if applicable) N/A
Mortgage Lender's Address N/A
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will no pproved and a reinspeLU=fee will be charged.
Signature - Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of20 by day of / � U 20 Z by
G ec T �.9e- '6s 14 1 ✓ ,who is personally known to J:s � � elro who is personally known to
—
me or who has produced E2, t4ur-- as me or who has producedP17lcr- as
identification and who did take an o nor identification and who did take an o
NOTARY PUBLIC: : ` NOTARY PUBLIC: �s� 1 i
Sign. Sign: -
Print: 6 /Z� P �9 i S Print: [/
Seal: L '1' al: v O O
V A.
s*.a•r**swss*s*s*ww*se+xas*rss •ss s• »cors*• w*>t� ares+�:e.xrr*�+rx�+sr+*s�s��ss»ses*rwwss«ss.e ��
APPROVED BY Plans Examiner oning
Structural Review Clerk
(Revised02/24/2014)
Miami shores Villag* e
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 785.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR/ARCHITECT
aN. 5n/a- f ,1461(o
tier's Now Taiioiciarj: qRJ,5�vays Phone 3
Owner's address: Lo
..
City: a. State: zip Code-'M I
i bb..Addr Igfwhmwo*is bOV dm): 6.m
City: —Ulaw$tiro_ State.__.Fl9rlda� Zip Code:
"hews company Nan.�:
Address. 106. Nj!:- #ac --st,
/C+�it�y�.1 :�M„tgp�p l /�_.�.f_.jd //�1 stateZip
(���r�{���.. Tp Code:
-3 3 f 3k
VIWQ�ISf s Na=. 4r�r.�r. iArr .iy r+r..........�+.ri LIH.Nu flli r-.._!�� l:-7-0
04
AmhkeW ENkmt o/Record Nam: v ne#:-3�.�.��.� 25 I
Address
City:_ ,116 A w1. _.. .. State:sF C- Vp : 3x.1..:?
DiwftWofk: 5
I hereby cerdfy that the worts has been abandoned and/or the contractorlarchltect Is
unable or unwilling to complete the contract. I hold the Building official and the
MI harmer for all legal involvement.
�! ROW Or
'the f ahmV n. bant ekno d before ma TMfaregoN me
th day of_ 2d }r `"rr 'Z,.��1 #his°�.�.�(lay of 20i5by
Who or v\"Osppm"/ D me or who hft profted
Sign:
v •. Notary Public State of Florida
Seel: ,,,����ii ... S�P��,`\\ MreCommissllion EE 198414
���//if lililfl\>>� g@� Expires MUMS
ACC> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
lli. ,--' 1 02/12/2016
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(les) 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 John A Lombardo
JAL Insurance Services PHONE . (954,)958-0878 p Ne: (954)958-0873
141 E.Commercial Blvd. ADDRESS: JALinsurance@aol.com
INSURER(S)AFFORDING COVERAGE MAIC 9
Fort Lauderdale FL 33334 INSURER A: MAXUM INDEMNITY COMPANY 26743 J
INSURED INSURER B
Caballeiro Corp dba:GMP Contractors INSURER C:
13500 SW 250th St INSURER D:
INSURER E
Homestead FL 33092 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.
INSR LTR TYPE OF INSURANCE L BR POLICY NUMBER A POLICY EFF POLICY EXP
LINrrs @�
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A AGE TO RENTED
CLAIMS-MADE FIOCCUR PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 5,000
A BDG0071475-04 02/01/2016 02/01/2017 PERSONAL&ADV INJURY $ 1,000,000
GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY❑JET El LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Me accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS PROPERTY DAMAGE $
NON-OWNED Per P.ERTYt
HIRED AUTOS AUTOS
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB HCLAIMS-MADE AGGREGATE $
DED I I RETENTION $
WORKERS COMPENSATION
OTH-
AND EMPLOYERS'LIABILITY YIN TPTER
ER
ANY PROPRIETOR/PARTNERIEXECUTIVE NIA E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required)
State Certified General Contractor CGC 1515142
CERTIFICATE HOLDER CANCELLATION
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
AUTHORIZED REPRESENTATIVE
Miami Shores FL 33138
0 1988-20ttACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
.... Miami Shores Village
Building Department
xpVMS 10050 N.E.2nd Avenue
AM
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 hunted 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 LOW YOU AC OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of `)a•/u�! ,20
By �a�, r^ /g U 17,o.1 who is personally known to me or has produced
I)rj--r,,. -kit-o-Is e as identification.
Notary: ��
MERALIS GONZALEZ
SEAL: MY COMMISSION#FF125MI
EXPIRES July 14,2018
t4moi5a Service con
I
1
.w
FEB 0 4 616
GMP CONTRACTORS_-_
ENGINEERING & CONSTRUCTION
13500 SW 250 ST#924733 PHONE(786)443 3548
HOMESTEAD,FLORIDA 33092 CGC1515142 FAX(305)396 5672
Gmpcontractorsi@gmail.com.com
Date:January 27,2016
State of:Florida.
County of-Miami-Dade.
Before me this day personally appeared Isaac Caballeiro_who,being duly sworn,
depose and says:
That he or she will be the only person working on the project located at 103 NH 99TH
Street Miami Shores, FL 33138.
Isaac Caballeiro
GMP Contractors
President
Sworn to (or affirmed) and subscribe before me this day of . 20
Byc ,G IP��
Personally know
Or produce Identification
Type of Identification produced
MERALIS GONZALEZ
/ My COMMISSION#FF125W1
EXPIRES July 14,2018
1407!398-0183 Service.t�m
Print,Type or Stamp Name of Notary
i