The URL can be used to link to this page

EL-14-305 Miami Shores Village '-CEIVED Building Departments 12914 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax: (305)756.8972 " - -- INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. R—I `_I'_3o 5 PERMIT APPLICATION Master Permit No. V-C I (03 Permit Type: Electrical JOB ADDRESS: E1�73y �If A�/ City: Miami Shores County: Miami Dade Zip: 3213t Folio/Parcel#: Is the Building Historically Designate�:� l NO 4z Flood Zone: OWNER:Name(Fee Simple Titleholder): ,""' Gtoj Phone#: Address: r City: State: Zip: ��3fi Tenant/Lessee Name: Phone#:5 5/®e/ -sodZ— Email: !?!��',�+ Z�lz�'S CONTRACTOR: Company Name:�� -Cysi �✓� Phone#:2d� DC7 J Address: y , , ,aa•®r ��a�c, r City:,/fZ:A2 Wia State: 'X ✓ Zip: f �_ Qualifier Name: L Z, ,k n-- Phone#: State Certification or Registration#: �E ®�:�J-® Certificate of Competency#: �._ ®cam 05�� Contact Phone#:, t/ Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 4�;'S? 62 o Square/Linear Footage of Work: 3",r) Type of Work: ❑Address ��.,,�� ❑�' 'eP A lst+Alterations� ❑New QlRepair/Replace ❑ emolition Description of Work: )rz_ -4_ -2211 Z --jE2 ra-J9 Submittal Fee$��'�`� Permit Fee$ A-4 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ �CH Bonding Company's Name(if applicable) r 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 . N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENF79 Notice to Applicant. As a condition to the issuance of a building pe>,Mit'y;ith 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 Signature /,,-,7V Tl\ Owner or Agent I t-A Contractor The foregoing instrument was acknowledged before me this ` ` The foregoing instrument was acknowledged before me this I day of V-Q3 ,201'A 'by M A Nl.Lk. LAM A?fLZ- day of -920 4 ,by ��Lm 566-, VV2, who is personally known to me or who has produced 0—1 who is personally known to me or who has produced (es-L P As identification and who did take an oath. 4,;A49186Mification and who did take an oath. NOTARY PUBLIC: NO Y 1h. ' �i�y's�>> Sign: r Sig33 o - _�� p D: d) Print: Prim, My Commission Expires: M Coo non Ex APPROVED BY /�� ' T Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) DATE(MM AC�® 2/18 2/ 013 �,,, CERTIFICATE OF LIABILITY INSURANCE 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). CONTACT PRODUCER NAME: QUINTANA&ASSOCIATES OF MIAMI INC. PHONE305-46-506 FAX A/C No 305-445-8153 5200 S W 8 ST SUITE 250 E-MAIL ADDRESS: MIAMI FLA 33134 INSURERS AFFORDING COVERAGE NAIC# INSURER A: FEDERATED NATIONAL INS COMPANY INSURED INSURER B: SEMPER INC. INSURER C: 283 GRAND CANAL DRIVE INSURER D: MIAMI FL 33144 INSURER E: 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 LICY EXP TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/uDCDYY MM/DD/YYYY LIMITS LTR GENERAL LIABILITY GL0504010999-00 8/06/2013 8/06/2014 EACH OCCURRENCE $ 1,000,000 _3F COMMERCIAL GENERAL LIABILITY PREMISES Ea once $ 100,000 ccurre A CLAIMS-MADE a OCCUR MED EXP Any oneperson) $ 51000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS Per accident UMBRELLA U A13 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN RY LIMITS FR ANY PROPRIETOR/PARTNER/EXE-11— N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER 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/VEHICLES(AQach ACORD 101,Additional Remarks Schedule,If more space is required) ELECTRICAL WORK WITHIN BUILDING POLICY SUBJECT TO POLICY TERMS AND CONDITIONS. CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 N E 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHORIZED REP ENTATNE r -- FAX(305)756-8972 8-2010 AdbRD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Local Business Tax Receipt Miami—Dade County, State of Florida - –THIS IS NOT ABILL–DO NOT PAY �ILBT-/ 5584322 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SEMPER INC RENEWAL SEPTEMBER 30, 2014 283 GRAND CANAL DR 5824132 Must be displayed at place of business MIAMI, FL 33144 Pursuant to County Code Chapter 8A–Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED SEMPER INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR 75.00 08/05/2013 Worker(s) 1 05E000580 0224-13-000632 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,of a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0,above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a-276. MIAMFA�j For more information,visit. .^., iamidade novitaxcollector Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida –THIS IS NOT A BILL–DO NOT PAY M C CC NO: 05E000580 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SEMPER INC NEW BUSINESS SEPTEMBER 30, 2014 283 GRAND CANAL DR 7435553 MIAMI,FL 33144 Must be displayed at place of business Pursuant to County Code Chapter 8A–Art.9&10 OWNER TYPE OF BUSINESS PAYMENT RECEIVED SEMPER INC ELECTRICAL CONTRACTOR BY TAX COLLECTOR 200.00 08/05/2013 0224-13-000632 MIAMI-W For more information,visit ww r miamidade movite-01leetor M0 Miami Shores Village __-- J ! ' Building Department IAN 14 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel: (305)795.2204 Fax:(305)756.8972 Vb INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20 BUILDING Permit No. U PERMIT APPLICATION Master Permit No& ! -63 Permit Type: BUILDING ROOFING JOB ADDRESS: ez5c) .'� zal City: MiamiShoresCounty: Miami Dade Zip: I�FY Folio/Parcel#: /,3 d®&®I 6.'C) Is the Building Historically Designated:Yes NO Flood Zone: /VO OWNER:Name(Fee Simple Titleholder):'r� /t/ P1 IWAe-A ' 2� Phone#: 3 �y l Address: City: r ' o State:_ � Zip: Tenant/Lessee Name: -� Phone#: Email: CONTRACTOR:Company Name: Phone#: Address: City: State: gip: Qualifier Name: /`� Phone#: State Certification or Registration#: J t��rt � p ompetency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: s� Value of Work for this Permit:$ /'j ox Square/Linear Footage of Work: o t!74_1 Type of Work: ❑Addition ❑Alterati ❑New 4Repair/Replace ❑Demolition Description of Work: Ae-M ® �i 100, yr ` COZOT thru tile: f-, Zf ��u��x�x��:��x��x�xx�xx:xxxxxx�Feesxxxxxxxxxxxxxxxxxxxx��x�xxxx�x��xxxx��xxx�� Submittal Fee$ �Q OC� Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$. �� 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 RECORoD .. 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whicoccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ppr ed and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoi g instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of)Mt1�,20 1�-,by} CA Ue < <.G tG1 ICE t T, `qday of ,20_,by who is personally known to me or who has p')I- 'edL D who is personally known to me or who has produced As identification and wl}o'did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 0 3 S � Sign: °� Sign: is:N411 Print: - Print: My Commission Expires: = ��\ }�:��\ My Commission Expires: APPROVED BY /Lg/t Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 5tIt0 Miami Shores Village Building Department "" 10050 N.E.2nd Avenue °zee Miami Shores, Florida 33138 �Conivp Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: //�'�7 fir! "*7 f$ e!$e''- DATE: ADDRESS: /"/-,/ .J7" �� ` ` - Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,RS 489.103(7). And I have read and understood the following disclosure statement,which entitles me to work as my own contractor;I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must sGpervise the construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a cost of$25,000.00 or less(The new farm states 75,000).The building must be for your own use and occupancy.It may not be built for sale or lease.If you sell or lease a building you have built yourself within one year after the construction is complete,the law will presume that you built for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on your building who is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and with-holdings tax and provide workers' compensation for that employee,all as prescribed by law,Your construction must comply with all applicable laws,ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as)Tiyyn contractor with certain restrictions even though I do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible f e construction and is not hiring a licensed contractor to assume responsibility. Initi 3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understand the may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licenseEyvpieft on permits and contracts. Initial -4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may Iso build or improve a commercial building If the costs do not exceed$75,000.The building or residence must be for my use or occupancy.It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or tubs ally improved it for sale or lease,which violates the exemption. Initial 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. Initia 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my builinor residence.It is my responsibility to ensure that the persons whom I employ have the license required by law and by�c�ou_n' municipal ordinance. In