Loading...
ACT-14-2710 (2) Miami Shores Village CEIVE11 Building Department ®EC 1 I 014 s 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 1 Tel:(305)795-2204 Fax:(305)756-8972 '— _ ��``� INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 200 BUILDING Master Permit No. A cai •'tv 10 PER IT APPLICATION Sub Permit No. UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 3 G i - Ct I V�\ st- ,I City: Miami Shores County: Miami Dade Zia: 1�� Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Constru.Cctionn Type: /�'� Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder : j G c--! Phone#: Address:. City: State: EL Zip: Tenant/Lessee Name: 4 Phone#: Email: 11h7ok,©Lr CONTRACTOR:Company Name: 151" SOL Phone#: 1®5 8?5 64 55 Address: .TO NW �✓ City: til i dE M i State 1`(.C,1Z-1 U l4 Zip: '3 '1.'c 4ualifierName: ��T®tv�� DOMihI60S'Z Phone#: ��� �Q0 i_�0 { State Certification or Registration#: sE ca a Jompetency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: slue of Work for this`Perm -$-' (e::;'� ,®Y Square/linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition ,A, Description of Work: 4-t— 40 _t ,4 m 4vx� MW 1 X I—O Specify color of color thru tile: #j,'AOYa.A HT :R �k.y Submittal Fee$ Permit Fee$i C CCF$ y, �,q�@C Y+a M 't s Scanning Fee$ Radon Fee$ DBPR$ zza sroit •:, Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ .tsedo2/24/20141 0 4-) Bonding Company's Name(if applicable) DAW/V(W0.'% 1 Bonding Company's Address �/' k) LO City 1`/i( � ( State 1- Zip3 f" !- 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 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 020 / ,by day of dtJc1(2&-20=- by � e E a L who is personally known to �D/�/O r��ri) / rho is personally known to me or who has produced GO Q_ R-c✓F2 S �I e CS me or who has produced,-S f�. i I ys identification an o did take an oath. identification and who did take an oath. NOTARY PUB C: NOTARY PUBLIC: Sign: Sign T- 1 #Tint: . Print: J®A,nJb4= Seal: +. Sea -00 Notary PuWic State of FlorWa RUTH A.SYDAIN Joanna M Feliciano N"y PW*-Stat!d F "d My Commission FF 082753 11 27.2018 OF VV Evires 01n2=18 * *aLs(� - -r � x�. '•: • BoR0eAlMaii�►N�tloi�INiWYAW. 99 /(�� Plans Examiner 1-'r Zoning Structural Review Clerk (Revised02/24/2014) Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT ABILL—DO NOT PAY %-LBT-) 6785944 BUSINESS NAMEMOCATION RECEIPT NO. EXPIRES EL SOL AWNINGS DESIGN RENEWAL SEPTEMBER 30, 2015 CORP 6606876 Must be displayed at place of business 70 NW 31 ST Pursuant to County Code MIAMI,FL 33127 Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED EL SOL AWNINGS DESIGN CORP 196 SPECIALTY BUILDING BY TAX COLLECTOR CONTRACTOR- 45.00 09/12!2014 WDrker(s) 1 11 BS00044 0221-14-004890 This Local Business Tax Rec-*only confirms payment of the Local Business Tax.The Receipt is nota license, permit,ora certfication of the#older s qualifications,to do business.Holder must comply with any governmental or nongovermuemal regulatory laws and requirements which apply to the business. The RECEIPT N0.above mat be displayed on all commercial vehicles—Miami—Dade Code Sec 89-276. MIAMP For more information,visit www niamidade.aovflexcolhlct9r Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY M C CC NO: 11 BS00044 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES EL SOL AWNINGS DESIGN CORP NEW BUSINESS SEPTEMBER 30, 2015 70 NW 31 ST 741M94 MIAMI,FL 33127 Must be displayed at place of business Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS PAYMENT RECEIVED EL SOL AWNINGS DESIGN CORP SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR 77.65 09/12/2014 0221-14-004890 RestNcted to City of Miami Beach MIAM For more information,visit www.miamidade.aorkalmilector CERTIFICATE OF LIABILITY INSURANCE �"�' "MCMIMMOMMASAMATTMOF ONLYMOCONFEUND TWO t CATS DOS NOT MMATWELY OR N18ATMY AAAA,METOM ORALIM TM t AFFOMW BY TM Pig .aro BATH OFO MMLIN OM NOT COLTM M A COUfMa 7M MnHORMD TRiL°OR PROMM4 AND THE ATE t - arr xe u �ustvao esu oAt �SAW ii� � 1Ael 8 � P P sal est! A astMs doe8 iCoMy rVa Cel bolo bf ra a!sir s�. PRODifWR ' A9t 0224OU2 Not W 4 166W-373L oma Week FL 3312 s vzl' KDINAM A; ALteWAMssa SURPLUS hmnvj=COWM ©Sol Ott Dmign CORP O: 70 NW31at 1.FL 33127- (7"=4704 �— EMU .R: TLS TM—BTobeff-r'yiWTHF POLK=A emuToryer AWW rR T#IEPOUOY rrm.I+rotwiTlBcr 3AW .7MoRt lOPAWCONrRACrOROrNM NTVW" crTOV*U TFM ATELMIMEMMORIMYPFRT'AIKTem AFFMWUVT1r:PCUICM NMMM CrTO&LUET . aMCONDUMM�SMUMCSUCH .urseemrt ►RsYrfp . Fy amonaupALJTV r 3WW Am– - A ❑ L7 waswicE ® atkam y Y MAMOM004M mwwtftowppw ' i 4WD-OD O.. 10MMM4 1L1 MIG aA�rtu r 3a�Woop . 0 u.Ass ►TB eao.�.oa 4PLAtYffLITPBk Frs.00sAtni 3GWODMQ0 opom 0 n roc Q .eas�unY L..! Asp MM NMY aaalR+ VW M" i 0 Auroe 0 s 0..__. _0 O uum [3a s +ooc AUS WOUNIEW LV4M 1l rim h1 BBQ C 01A L Accmw : m"dowy -EA s EAT ►tncATaoxs,Yeegso�, LICENCE 11118 44 ATB liW.D�t CANCO.tAYM *W"AWOPTMEMqRDMnMpoiXMMQViCBAMMCME AAAMI$HORS WRIAGE TWOUVAnmOMETHEMOP.MONCEWLLOOOMMMMIm 1OMNE 2AYE ACGOV4VJMWM7WWOLj*YPRWASWW MlAAA 8HORE.FL 33138 AUT ATIYE ' 6' 19ACCMDGuluqmI AQ D } Ma AOORb no=and bgo am marks d AG= 02/04/2015 12:18 8504131970 WC EMPLOYEE ASST. PACE 01/02 JEFF ATWATER STATE OF FLORIDA CI6EF FINANCIAL OFFICER 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 belie has elected to be exempt from Florida Workers,Compensation law. EFFECTIVE DATE: 8119/2014 EXPIRATION DATE: 81182016 PERSON: DOMINGUEZ ANTONIO FEIN: 261821638 BUSINESS NAME AND ADDRESS: EL SOL AWNING DESIGN CORP 70 NW 31 ST. MIAMI FL 33127 SCOPES OF BUSINESS OR TRADE: SHEET METAL WORK- INSTALLATIO Pursuant to Ctrepter 440.08(14).F.S..an oMw of a earporatlon who elects exemption iron+this chapter by 6M a cmvmm of election under this section may not recover benefits or compensation under We chapter.Pursuant to Chapter 440.08(12 F.S..Certificates of election to be exempt...apply only within the scope of the txaitte®s or trade gated on the notice of election to be exempt Pursuard to Chapter 440.05(13),F.S.,Notices of election to be exempt and certNicxitss of etec Ort to be exempt shag be suboct to revocation H at anytime aft the fghr0 or the now or the bunroe of the certificate, the person named on Ore notice or certificate no longer meets the rents of this section for issuance of a c:erli etc.The department shag revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED W13 O IJESTIONS?(850)413-1608 t • ,gt�pR sES` .••• Miami S Building Department R 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner - Workers' Compensation Insurance Exemption HT 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.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore. ou may be personally liable for the worker compensation iniuries of any 2g on allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor Print Name: PA-V 64iQCI.1 Gj Print Name: dV A I IkW& Signature: — Sig State of Florida) State of Florida) County of Miami-Dade) , County of Miami-Dade) �� �a�i�BQ,��,. Sworn to d subscribed before me s Sworn to bscribed before me thi �` °° ..?'y day of t day of `VDASiiaByySinus N(SEAL) tMat 2 T of Id ca n produced Identifica onrodu