RC-16-1083 jy )
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Miami Shores Villageerr ry )` Ctlotl
10050 N.E.2nd Avenue NW
Miami Shores,FL 3313&0000 E 3
(305)795-2204
�:, Perr»I{t Stir Ap� � ,'.
ui Phone: 7..
Expiration: 01/18/2017
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Project Address Parcel Number Applicant
165 NW 92 Street 1131010331000
Miami Shores, FL 33150- Block: Lot: WE BUY MIAMI LLC
Owner Information Address Phone Cell
WE BUY MIAMI LLC 18800 NE 29 Avenue (432)349-4620
AVENTURA FL 33180-
Contractor(s) Phone Cell Phone
Valuation: $ 15,000.00
ETC UNLIMITED INC
_, __ _.._..:__.... ._....�._... � __.._.._.. Total qFeet: 400
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final PE Certification
Date Denied: Window Door Attachment
Type of Construction:INTERIOR REMODELING NEW KTI Occupancy:Single Family Framing
Stories: Exterior: Insulation
Front Setback: Rear Setback: Drywall Screw
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted:Yes Certificate Status: Review Electrical
Certificate Date: Additional Info: Review Electrical
Bond Return: Classification:Residential Review BuildingReview Planning
Fees Due Amount Pair Date Pay Type Amt Paid Amt Due Review Plumbing
CCF $9.00 Review Plumbing
COiCC Fee $6.00 Invoice# RC-416-59498 Review Structural
$ 04/21/2016 Cash $50.00 $496.50
DBPR Fee $6,75 Review Mechanical
DCA Fee $6.75 07/22/2016 Credit Card $496.50 $0.00
Education Surcharge $3.00
Permit Fee $450.00
Scanning Fee $9.00
Technology Fee $12.00
Total: $546.50
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 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 and zon' g. Fe,I authorize the above-named contractor to do the work stated.
July 22,2016
horized ' nature:0-Ver / pplicant / Contractor / Agent Date
Building Depa nt Copy
July 22,2016 1
R
tills unall" Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Oryx 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:
0
eAn employee`in the construction industry who employs one or more part-time or &R-time
eemploreqp,i*luding the owner,must obtain workers'compensation coverage. Corporate officers
or mehlbWff a limited liability company (LLC) in the construction industry may elect to be
exemp;
V•The officer owns at least 10 percent of the stock of the corporation,or in the case of
0•'an LLC,a statement attesting to the minimum 10 percent ownership;
' Z"The officer is listed as an officer of the corporation in the records of the Florida
...•.bepartment of State,Division of Corporations;and
V%he 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-)-9/S4e%k4f I
7 ' — Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me� day of S4-- �_,201� .
By who is personally known to me or has produced
as i
Notary.
Uco
SEAL:
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