RC-16-1775 (2) Miami Shores Village P8i711/t Thy ,) este a((, nS tIC(ICflon
3� fr 10050 N.E.2nd Avenue NE &
Wo C1414s0caoom Alto fttii ,,-
""' Miami Shores,FL 33138 0000 fetus:APPR(�UED
" Phone: (305)795-2204 a
Expiration: 01/0212017
Project Address Parcel Number Applicant
520 NE 102 Street 1132060171060
Miami Shores, FL Block: Lot: LYNN FRANzosA
t
Owner Information Address Phone Cell
LYNN FRANZOSA 520 NE 102 ST
...
MIAMI SHORES FL 33138-2455L ,
Contractor(s) Phone Cell Phone Valuation: $ 18,000.00
54)410-4695
JMEC CONSTRUCTION, LLC (9 _ _ _ Total Sq Feet: 200
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final PE Certification
Date Denied:
Window Door Attachment
Type of Construction:REMODEL 2 BATHROOMS AS PER Occupancy: 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 Planning
Certificate Date: Additional Info: Review Structural
Bond Return: Classification:Residential � Review Building Review Mechanical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical
CCF $10.80 Review Plumbing
CO/CC Fee Invoice# RC-6-16-60342 i
$50.00
DBPR Fee 07/06/2016 Credit Card $615.00 $50.00
$8,10
DCA Fee $8.10 06/27/2016 Check*4085 $50.00 $0.00
Education Surcharge $3.60
Permit Fee $540.00
Scanning Fee $30.00
Technology Fee $14.40
Total: $665.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in complia ce 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 worc.
OWNERS AFFIDAVIT: I certify that all the foregoing information is urate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-n ra r o do the work stated.
July 06, 2016
Authorized Signature:Owner / Applicant / Co)*rXtor / Agent Date
Building Department Copy
July 06,2016 1
Miami Shores Village
U
4' Building Department JUN 2 7 201
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972 1
t�(4
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 14 _
BUILDING Master Permit N
PERMIT APPLICATION Sub Permit o.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTEN ION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANC LLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:-51� Q Z
City: Miami Shores County: Miami Dade Zip: 0�9'1
Folio/Parcel#: Is the Building Historically Designated:Yes—N 0
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): o Ck Phone#:
Address: 1F
City: �-10�' —State: FF Zip: '33 1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: � Ec- 600G--muC Com'_ P one#:
to _
Address: < c1 At
City: '--?C-u.A�l(A® ACO--� State:E Zip:-�)� y� _
Qualifier Name: \, L ` N��� l 0 Phone#:l�`�'�
z
State Certification or Registration O S G Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: QCT
Type of Work: ❑ Addition ❑ Alteration ❑ New epair/Replace ❑ Demolition
Description of Work:�e\P-kQ 1 C �1 G1 t't,1 x-49 `
Specify color of color thru tile:
Submittal Fee$ F3" (76 Permit Fee$ qZ W ' GQ) CCF$ ® CO/CC$ nu
Scanning Fee$ ® l Radon Fee$ �_j . DBPR$ " Notary$
Technology Fee$ �" �t Training/Education Fee$ Com® Double Fee$
Structural Reviews$ 5D 1 Bond$
TOTAL FEE NOW DUE$ I
(Revised02/24/2014)
Bonding Company's Name(if applicable) 1
a
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.
Signatur Signature
OWNE AGENT CO TRACTOR
The foregoing instrument was acknowledged before me this The foregoing in men was acknowledged before me this
_1_ day of ✓ V,Q ,20 f �' by d�ay^o v,4 20 1 b by
yd's �" fx K o�41- ,who is personally known to (�IL�- \�\ I ho 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.
NOTZPU NOTARY PUBLIC:
Sign: _ Sign: �L
Print: L�vice es- «� `� Print: LZL L-)
Seal: '�Y°"�. UUIRIIFARLEY Seal: � � LAURA
.•"'•. MY COMMISSION#FF 188027
MY COMMISSION#FF 18827 * EXPIRES:March 16,2019
o* EXPIRES:March 16,2D19 "'� �c�oa•�' B*nM Thru Budget Notary Servua
►#G,W\ B lThroBudgetNotarySerric�
T
*IAPPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
J*MoEoC
2511 N.W. 17th In suite #4
Pompano Beach,F1.33064
06/09/2016
State of Florida
County of Dade
Before me this day personally appeared Eric Finkelstein who
\being duly sworn, deposes and says ,that he will be the only person
working on the project located at 520.ne 102 st. Miami Shores
Sworn to and subscribed before me this--15----day of-june------2016
C: c �pCod S(o�
Personally known
Print name-Laura Farley
-P!Ai, LAURAFAFM
# * MY COMMISSION 9 FF 188027
EXPIRES:March 16,2019
'9r xq ��T Bonded Thru Budget Notary Services
♦ ORE
19 Z�
s� Miami Shores Village
Noll .....
Building Department
10050 N.E.2nd Avenue
LORIDp' Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insura ce Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Flo 'da 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 Employer7acts Brochure:
An employer in the construction industry who employs one or more part-tie or full-time
employees, including the owner,must obtain workers' compensation coverage. C rporate 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 doles 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 NOTI E AND UNDERSTAND ITS
CONTENTS.
Signatur
canA -:er
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of �l/� ,20 ?
By who is personally known to me or has produc d
as identification.
Notary:
1�,ttY Pum LAURA FAFLHY
�: •
SEAL: MY COMMISSION I}FF 1N21
* * EXPIRES:Match 16,2019
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