DS-16-1915 (2) Miami Shores Village "yp8low
10050 N.E.2nd Avenue NEWk,C1,
Miami Shores,FL 33138-0000
Phone: (305)795-2204 <..._-
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sa : � Expiration: 01/1712017
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Project Address Parcel Number Applicant
620 NE 101 Street 1132060172130
SIMONE MAYER
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
SIMONE MAYER 620 NE 101 Street
MIAMI SHORES FL 33138-2468
Contractors) Phone Cell Phone Valuation: $ 7,000.00
ONE STOP PAVING INC 786-299-1354
Total Sq Feet: 840
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:NEW BRICK PAVER DRIVEWAY Additional Info: Review Building
Bond Return: Classification:Residential Review Planning
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00 Invoice# DS-7-16-60538
CCF $4.20 07/11/2016 Check#:1471 $50.00 $599.20
DBPR Fee $2.00
DCA Fee $2.00 07/21/2016 Check#:1482 $599.20 $0.00
Education Surcharge $1.40 Bond#:3152
Permit Fee $125.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $649.20
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 zoning. Futhermore,I authorize the above-nam c r to do the work stated.
July 21,2016
Authorized Signature:Owner ! Applicant / Contractor / Agent Date
Building Department Copy
July 21,2016 1
o
Miami Shores Village 0T, 11VZD
Building Department JUL I'l HIS
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20M
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP
(02-0 CONTRACTOR DRAWINGS
JOB ADDRESS: 4)& /0/ Sf
City: Miami Shores County: Miami Dade Zia: 3!3138,
Folio/Parcel#: /1 32069 0/7 2/31) Is the Building Historically Designated:Yes NO
Occupancy Type:Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): S/--yJ0e;e 40 Phone#:
Address: &2 D N 6 /0/ S t
City: A4_ 3 11VlPC State: Zip: 3 3
Tenant/Lessee Name: Phone#:
Email-
CONTRACTOR:Company Name: One s1��/� ��c Phone* 7-56 0'" 13-5
Address: 146.3 oue 17.3 S/
City: A) A..f re,-Ac A State: —7-cr- Zip: 33V,6 2
Qualifier Name: i lo1 O-z4S A- Phone#• 72+0:9' 201 135y
State Certification or Registration#: Z'i/4-0 O Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 7P 00. Square/Linear Footage of Work: 6 46)
Type of Work: El Addition
'' //❑ Alteration // New ❑ Repair/Replace ❑ Demolition
Description of Work: Ns r
Specify color of color thru tile:
Submittal Fee$SD • Permit Fee S 1CCF$ CO/CC$
Scanning Fee$ Radon Fee$ Q DBPR$ Notary$
Technology Fee$ '�® Training/Education Fee$, Double Fee$
Structural Reviews$ Bond$ �5d�
TOTAL FEE NOW DUE$ • 2-0
(Revised02/24/2014) 5q(::T. Zo
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$250, 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 �1 Signature
OW R or AGENT CONTRACTOR
The foregoing instrument was a knowledged before me this The foregoing instrument was cknowledged befor me this
day of JiJ t 20 by ��day of "r.) 20 t .by
127 V h -+S/who is personally known to '- d S Ge S c 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.
NOTARYAPUUC- NOTARY P UC:
Sign: Sign:
Print: no Print: �
Y p�e `SAY P���
,,���`•-;'`'�`. B/�ABAAOSOBAINO ;�:•••.,�,c;: BARBAROSOBAINO
Seal: :., .- MY COMMISSION#FF 195634 Seal: .: MY COMMISSION#FF 195634
mQ: EXPIRES:February 3,2019 1 Qe EXPIRES:February 3,2919
Bonded Thru Notary Public Undewriters q °` Bonded Thru Notary Public Undervvnters
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At
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revisedo2/24/2014)
e
0
T Cortgfv aW QwlifyHtg Board
BUSINESS CERTIFICATE OF COMPETENCY
IT
ONE STOP PAMNG INC
�s m
Is mrbTW under the protons of chapter 10 of W=W)ade Courtly
` aka {
QUAUFYING TRADES)
0007 PAVING ENGINEERING
» OOOg EXCAU&GRADING ENG
0010 LAND CLEAR&GRUBY
Aftm K Servs P.E. /
Senewy alum Board onset
a ccody rdabm aL weedy ri
Municipal Contractor's Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A BH_[-DO NOT PAY
CC NO: e231500 C]
BUSINESS NAME/LOCATION RECEIPT NO.
ONE STOP PAVING INC 16(
EXPIRES
1463 NE 173 ST SEPTEMBER 30, 2016
NORTH MIAMI BEACH,R. 33162 7470378
Pursuant to County Code
Sac 10-24
OWNER TYPE OF BUSINESS
ONE STOP PAVING INC SPECIALTY ENGINEERING PAYMENT RECEIVED
CONTRACTOR BY TAX COLLECTOR
225.00 08/12/2015
0237-15-000170
This receipt 13 not valid in tdefoilowiull MaRicipalhtas:Avemara,Demt
Miami Gardens,Miami L Patoretto Bey,pi"emsel SIMIF Isla Beack T�ofof C
Bay
fin.visit
Local Business Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOT A BILL-DO NOT PAY
5092135 L B::T]
BUSINESS NAMEMOCATION RESP,NO.
1463 NEONE 173 STING INCRENEWAL SEPTEBEEXPIRES 2016
NORTH MIAMI BEACH,FL Must be displayed at place of business
33162 Pursuant to County Code
Chapter BA-Art 9&10
OWNER SEC.TYPE OF BUSINESS
ONE STOP PAVING INC 198 SPECIALTY PAYMENT RECEIVED
ENGINEERING BY Tax COLLECTOR
Worker(s) 1 E2315W CONTRACT 45.00 08/12/2015
0237-15-OW170
This local Business Tax Receipt only conlimrs paymew of Me Local Busleass Tax.The Ilecolpt is no a license,
Pwmk or a cormication at am holders gsaMcatices,to do imidness:Holder mustcomply with any governmental
wok The RECOPi NO.agave mot w�reqs which apply to the hoohtays.
M displayed on all commercial vehicles-Mla,*Dade��go
For more Crmadm v&H
®tie
N ; Paving Inc .
Project/Dote: Services Performed For:
06/29/2016 FOH INC.
Project.TRAVERTIN DRNEWAY 620 NE 101 ST
IaKEB@FOH.CC MIAMI SHORES,FL 33138
3: (305)498-4211 ATT:MIKE BERMUDEZ
Scope of Work for DRIVEWAY TRAVERTIN
✓ New pavers M SQFT
✓ Dion&-excavate(remove soil or any pavement material)
✓ Level and compact soil
✓ Apply Lime Rock for base,leveled and compacted
✓ Apply Sand,leveled and compacted
✓ Install Pavers type:y Cement Color
✓ Install cement border 6x6
®
✓ Remove all trash:grass,dirt,concrete,asphalt or any other paving from working areas/not
including tree roots,P.V.0 tubing or other.
4— Subtotal•$6,720.00
❑ Permit pulling$300 O iaml),$400 (Bmoardl),$350 (Corral Gabler)
[DOES NOT INCLUDE CITY FEES]
Grand Total:$7,020.00
'White Cement Color pavers it is an additional$0.25/SQFT
Notice to Client
Dade and Broward county budding code requires that any sidewalk that are part of an entry must be 6"of
thickness.Any sidewalk that is not 6"thick MUST be replaced and will add an additional cost of$950.00(up
to 5 sections of 5 ft.wide&6"inches deep).Per additional section is$]50.00 each.For Cities that require
color$ 0.00 additional°charge.
Fee Schedule
P
_cat
Conditions percentageTotal Paid Date
r T_
1�Payment Upon Contract Acceptance 33%
2nd Payment After 1st Inspection(If permit applies) 33.33%
3W Payment(After Final Inspection) 33.33%
Terms and Conditions
• Contractor is not responsible for damage to any underground pipes that are not up to
county codes.
• Contractor is not responsible for any lawn damages due to lack of space for materials
and supplies.
• Contractor is not responsible for any additional grass installments requested by the
city in order to pass inspection.
• Contractor is not responsible for any additional changes requested by the city.All extra
labor not stated on the proposal is on owner's expense.
• A one year warranty applies to the pavers installed; however, contractor is not
responsible for any damages caused by water leakages,tree roots,or negligence of the
owner.
• Contractor has 6 months to complete the job.As soon as a payment is made your labor
will be scheduled for the next 4-7 working days.Unless client has paid for rush labor it
will not be considered as such.
• In case of early termination by client,the amount already spent on the project including
permit process will be deducted from the deposit payment.Client will be refunded the
remaining balance.
• Payments via credit/debit cards are accepted; however, a processing fee will be
charged. A card authorization form should be filled out and signed by customer.
Reoccurring payments will be made to card on the specified due dates.
• All extra materials required to be added by the city will be charged separately.
*PROPOSAL VALID FOR 60 DA YS! '
By signing this you have read the forgoing proposed contract and accept the same on the terms and
conditions stated.
.Approved by: Cloos Coll Accepted by:X �V
7`r'
♦51��,��s yi
s
Miami shores Village
Building Department
artment
�^ y�
10050 N.E.2nd Avenue
�IARMiami 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 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:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this 5 day of ,20
By M On P ��� P✓ who is personally known to me or has produced
as identification.
?--.)Src_b/1{/�� tY'P�B`,..
BARB ARO SOBRINO
Notary: ` �Gt N `-� ;= MY COMMISSION N FF 195634
'os EXPIRES:February 3 2019
cc'
SEAL:
Bonded Thru Notary Public undervrt to s
One
Paving Inc .
TO: 6"��Qy�ni S`/1 are S Q PROJECT: 17r iV.QtJ�r®-
NAME: NAME:
ADDRESS: ADDRESS: O s
PHONE: ,es 36
FAX: DATE
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CAR6;;�� DATE:_
:"i6`. BARBAROSOBRINO
,= MY COMMISSION#FF 195634
p EXPIRES:February 3,2019
Bonded Thro NotarlPablic UndervrrRers
Gt v!d/ Vo/
Miami hores Village
14 u"N Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
�R1Dp' Tel: (305)795.2204
Fax: (305)756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant, &e-ny`^-V does hereby attest that
(Property owner) II _I
The attached survey, performed by �-���.,A-c Cw s�l
(Name of surveyor's company) ---�� "
For address: 6 Z 0 0 1 1 sf �.b v+-�' ��Ii1.tT*�s 3 3t 3 $
Performed on 1'7 110 (date of survey)is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Fu er, nt say eth naught.
xA S l ✓Y\J h-e GC I
Property Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this_qday of �`'1`� :2 u I
Affiant is_personally known to me, produced ldentificati
BARBARO SOBRINO
.: MY COMMISSION#FF 195634
EXPIRES:February 3,2019
p c4c'' Bonded Thru Notary Public Underwr ter Notary
Revised on 5/22120091 Revised on 6/12109jQ
Miami Shores Village., K �4� 9 457 (IPss) �
QR �%1� J111�t�t F`3 't�7 tll'`3s)
RUORDEU U7/IIJ1171:16 11-1-24'.2-2
10050 Northeast Second Avenue HARVEY{ [f 14 IFa P CLERK 0� t•Oj sRT
Miami Shores,Florida 33138-2382 I`fARVE RUV t::IIiJh1L r FLORIDAOFZ-
Telephone:(305)795-2207
Fax:(305)756-8972
www.miamishoresvillage.com
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, J r ✓✓)Ohe CIW-0 ✓ , hereinafter referred to as the Owner of the following
described property: Am!) PL a T C 1iJ,-r SSic Q f� 15-- 1¢ {s $ 9/o �eZlIdIl
Legal description/Polio#: // 3 26 6 617 Z/3 0 IK K /V 3 Q(, C y//
Lot /ia 5, I'r� Block 10 3 Subdivision a r S �J�S Sic q
Tax Folio#: It 370& 017 213 p
Requests permission to install:
C-" Asphalt,concrete, brick pavers
❑ Landscaping
o Other
Within the public road right of may of (, Zy AJ / D s f M.ctry>7 ' J�iJ"�t 3 3f3 p
(address)
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 Rem(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).
SIGNED, SEALED E AN CK OWLEDGE on this day of
BARBAROSOBRINO E
MY COMMISSION#FF 195634 St✓j 1O�r P a 7
'MJQo= EXPIRES:February 3,2019
Bonded Tfn Notary PrbGc Underwiters (owner)
1I
SIGNED, SEALED,AND DELIVERED in the presence of \Jb'�
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