FW-16-1372 R,
Miami Shores Village i i'6.Al i=enCel�a11
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
AP`RCI
"0 Phone: (305)795-2204
2
��Q16 Expiration: 11/27/2016
Lim
Project Address Parcel Number Applicant
10208 NE 4 Avenue 1132060135101
CORY GITTNER
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
CORY GITTNER 9999 NE 2 Avenue
MIAMI SHORES FL 33138-
9999 NE 2 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,500.00
WILCON CO (786)399-8855
_......,,. ., .. _ _... ........ ..._ _ _,,. ._ _ .., ..... _.._.. Total Sq Feet: 45
Approved: Available Inspections:
Comments:
D : Inspection Type:
Date Approved:
Final
Date Denied: Foundation
Type of Construction:Wood Fence Additional Info: Review Planning
Classification:Residential Scanning:3 Review Building
Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# FW-5-16-59845
DBPR Fee $2.00 05/31/2016 Check*2474 $ 116.20 $0.00
DCA Fee $2.00
Education Surcharge $0.40
Permit Fee-Wire&Wood $100.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $116.20
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify th II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and oni uthermo I au orize the above-named contractor to do the work stated.
May 31, 2016
Authoriz i nature: wner / icant / Contractor / Agent Date
Building Department Copy
May 31,2016 1
Miami Shores Village MAY 19 2016
Building Department .�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 -1 ,
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
'BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
r—JPLUMBING F-I MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 402-® IK AIF ItThat'e– '
City: Miami Shores County: Miami Dade Zip: ?7?t( q-
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 0 Phone#:
Address: 102-0 X/r d �
City: State Zip:
Tenant/Lessee Name: Phone#: SAS Va ®'W7
Email:
CONTRACTOR:Company Name:` �l/1 Phone#:
Address: �fn� ter; l M "
City: State: C4 Zip:
Qualifier Name: r 4w U12-- Phone#:
State Certification or Registration#: L�& / 4-7(-f Z Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ CT6 Square/Linear Footage of Work: '
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
i
`
Description of Work:4 T e� &,,O c1/7 Ff'rice— S '4rt.4_
Specify color of color thru tile:
Submittal Fee$ Permit Fee$I� ' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ �7 -LL> DBPR$ –�� Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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$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
_ga
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
e day of to 0& ,20 L 4 by ��day of 01 A^( 20 r J' ,by
Cq c. r rz- who is p6inalAhown to KJ%�,�ii tt,L who is p sonal nown 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
`,
DENA CRUZ
NOTARY PUBLIC: NOTARY PUBLIC: Notary Public-State of
• w• Commission#FF 20
My Comm.Expires Apr,
,,�'• � "', Barded throughNationalN-'-
Sign- Si
Print: Print ^' �^
,.``"v''n""''., DENA CRUZ
Seal: moo` �e��L Notary Public-State of Florida Seal: r State of Florida
Commission#FF 204543 ,n#FF 204543
pares A r 7,2019.
My Comm.Expires Apr 7,2019 p
'•:};o� ° ,iational Notary Assn.
*xsx****• r R *aaixt *r*****ste yew*� *awyu► *air** * r
APPROVED BY l/ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
WILCON
GENERAL CONTRAC'I'D R
C..8TRUCTION ,
LICENSED & INSUREDENr
CIZC# 1512642
WILLIAM CRUZ DESION-SUILD
9636 ME STH Ave RV. CELL 786-399-BBSB
MIAMI 91.4aRegi FL, 33138 orptur- 305-496'998Z
'Date: 11�_1710 WCRUZz3@H13TMAIL.CI3M
State of r/.
County of Dade
Before me this day personally appeared who, being duly sworn, deposes and says.-
I
That fie or she will be the only person wording on the project at 4T11
,Sworn to ( or affirmed) and subscribed before me this day of —,20&, by
Personally Know
Or produced Identification A<
i ype of Identification produced
Fi-nn i, type or stamp of 4NOW
cost ami 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 Exem tion
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 ii
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 ibis 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,parttime employees or subcontractors.
BY SIGNING BEL W YO 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 OC.'zT_day of ��� ,20 Z" .
By (—q� 2-`��`�NIIIIIINp1/z. who is personally known to me or has produced
_
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30-A
SEAL �6•ova ` ¢�:•�i`