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REV-16-2214BUILDING PERMIT APPLICATION BUILDING Miami Shores Village 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 ❑ ELECTRIC ❑ ROOFING FBC 20 tLI S Master Permit No. Cc -5-15 • f t t 3 REVISION Sub Permit No. �1 ((:)-221 ❑ EXTENSION ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS ❑PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: City: j 2103 Ne lut Si Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: h e- BFE: FFE: OWNER: Name (Fee Simple Titleholder): 13UI-I00J'i✓ livi)tr-Sit4F—i.7 5 )NC.• Address: i St 5 Sn -il) ST . #4• 1LtS Phone#: gS4,2CAS1%vfv City: F -T . 1,kv Ph U _ Tenant/Lessee Name: *� State: Zip: 3333 Email: 14o3etsMAD )E 1Nve-STM T S,cayf Phone#: CONTRACTOR: Company Name: Address: •- 12 V4 Zy City: 1ilm,F-kit CoNvili-v -Ti0k) i.lt11tt -f) Wk -1 i°i State: Qualifier Name: Th zt0 _ s PPhorie#: 3us • ZA3 ` mica zip: 3.0( Q Phone#: State Certification or Registration #: GGA I`o I O%' 1 Certificate of Competency #: DESIGNER: Architect/Engineer: CA( ." ARUi II Ecru R E + b E S t Address: ZZ 00 -1,1 Mt HIM I M)E 5Qure- eftoym tix4f041 qu ALinearfobt web ii, etSi:SO nowraiminoZ New Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: +Liaoj2- JO15T 4 U)011- s H NL . (Sox -oil_ )w.5PF-&fibrL Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ 3 • CF 1 . Scanning Fee $ q CO Radon Fee $_.-" t,` -c-p0 Technology Fee $ �"` •Iraining/Edud'ation _Fee$ Structural Reviews $ eo (.-' (Revised02/24/2014) Notary $ trie Double Fee $ Bond $ TOTAL FEE NOW DUE$ CN) 4 Bonding Company's Name (if applicable) 1,1 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. 1 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 The foregoing instrumentwas acknowledged before me this 7.:?7.:?day of .`` VL1 , 20 (C , by (7CTrEF'"' t who is personally known to me or who has produce identification and who NOTARY PUBLIC: .,� 'Crgtetettretee4"-arag.° • MAMBELLA MURGO ► Ott otary Public • State of Florida 0 My Comm. Expires Jun 2, 2017 ► Commission 0 FF 029285 ► Sig. Print Seal: APPROVED BY (Revised02/24/2014) «-,W- ,111.1.111.111.111P1. Signature z, CONTRACTOR The foregging instrument was acknowledged before me this 3 r day of //) , 20 _ - • y gal/Pe-T-1rfii / � / h • s personally know' to me or who has • roduced `. as identifica NOTA ho id take Print. Seal: It Plans Examiner Structural Review 1ARIAVALENTIN MY COMMISSION S FF 951082 t UP,PES..Pdt / 7mn l'oF FSO. Bonded Thru Budget Notary Services Zoning Clerk 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 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: State of Florida County of Miami -Dade The foregoing was acknowledge before me this (09 By 5P12-1 CicF)PfgAc Iri.D G 4 c166 --460-e6- 081 -0 as identification. day of ljG i, T , 20 6 . who is personally known to me or has produced Notary: SEAL: SANDRA LUGO MY COMMISSION #FF065861 EXPIRES: OCT 24, 2017 08/17/2016 State of Florida County of Dade Construction Unlimited Group, Inc 7725 W29th Way #101, Hialeah Fl 33018, Licensed & Insured Before me this day personally appeared Rene Tazioli who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 1263 NE 94 ST, Miami Shores, FI 33138 Sworn by l=am/ *AA..• �``'CV Z off co' Persc J i t w ?/ /C • :;State Inge: `tet Or Prodi rd/Mine lum e kbli Type of Identification Produced ubscribed before me this 7th day of August. 2016, Print, Type or Name of Notary WV ATYIATEA c,ee, 1110AWC1A1 OFncIt> STAT! OF FtORK)A DEPARTMENT OF FINANCIAL SERVICES DMSIPN OF WORKERS' COMPENSATION ' CERTIFICATE OF ELECTION TO OE EXEMPT FROM FLORIDA WORKERS' COMPENSAT Ot4S PON tNOU ERY EXEMPTION TP CortA•s OMt t ingkatuall Wed Crlcwr has Mrd */ ip 1e ***Me WolumorCt EFFICTNE DATE PERSON!: T FEIN: 7AJ0232S l MITE© GROUP, INC IICEN CONTRA OR TRADE - 33:3D1 00000 TO *000 010 0001. 0 0 t 0001 0010 00000 **ft 00000000 0000 00 0000 00000 4000 100 000 000 11000010 000 00000 106 00000~ 0* +w[lgdt� \ 0 00000 *0000 0000 0+0 *- 04.00** 0 00 Iik kr 000000 EXPIATION DATE_ 7:29/1916 RENE cube2 July 27, 2016 NuHouse Investments 1263 NE 94th Street Miami Shore, FL 33138 Permit #: RC -5.15.1153 To the Village of Miami Shores Building Department: (arch itectu re+desig n) This letter of affidavit is to certify that the wood floor joists are properly supported from below, as per a visual inspection. All the structural floor elements are as per Florida Building Code 2014 requirements and specifications. The flooring was installed as per manufacturer specifications as well. All the Scope of Work delineated in the plans submitted for Permitting and that were subsequently approved have been completed by Owner based on visual inspection. To the best of my knowledge, belief and professional judgment those portions of the project outlined above meet the intent of the Florida Building Code and are in substantial accordance with the approval plans. You can reach us forariy other info. Thank You. Sincerely, l Jorge Alberto Pernas, AIA, Allied ASID, NCARB, LEED®AP President cube? (architecture+design) 2700 north miami avenue, unit 808 miami, florida 33127 t: 786.235.2720 e: info@cube2architecture.com aa -26001789 ib -26001134 • • 1, ,43 • --2! Miami Shores Village .... • • • ••.• . .. • •• • • .• ..• . • • • • • • • ••.. .... . . . • .... •••• . ... . • • •• •• •• . • • • • • • • • • . • • . • •• • • •• • ••.. • . • . •• . 12..C1 S-1 53 APPROVED TONING DEPT F3t_nGI DEPT 3 BY DATE 1 Miami Shores Village Building Department 10050 NE 2nd Ave. Miami Shores, FL 33138 305-795-2204 / Fax 305-756-8972 NOTICE TO MIAMI SHORES BUILDING DEPARTMENT OF EMPLOYMENT AS SPECIAL INSPECTOR UNDER THE FLORIDA BUILDING CODE. I (We) have been retained by A L( MOS, rd rs? 4,,to perform special inspector services under the Florida Building Code 5th Edition (2014) and Miami Dade County A ministrative Code at the 17 63 Imo, IP" 5% project on the below listed structure as of 7 /2 7 I /, (date). I am a registered architect/professional engineer licensed in the State of Florida. Process Number: _ Special Inspector for Reinforced Masonry, Section 2122.4 of the FBC 5th Edition (2014) _x_ Miami Dade County Administrative Code, Article II Section 8-22 Special Inspector for Trusses > 35 ft. long or 6 ft. high Steel Framing and Connections welded or bolted _ Soil Compaction Precast Attachments _ Roofing Applications, Lt. Weight. Insul.Conc. _x_ Other Floor joist and Floor sheathing ••••• • Note: Only the marked boxes apply. ••' • "" The following individual(s) employed by this firm or me is authorized representative tooperform inspection* 1. - l o gii# �' � �� 2. 3. 4. • • •• • • • • • • ••• • • • • •••• •••• • • • • • • •••• •••• • ••• • • *Special inspectors utilizing authorized representatives shall insure the authorized representative i%Qi4ified by • • • • ; education or licensure to perform the duties assign by Special Inspector. The qualifications shall jgcjiiie•licensure aha professional engineer or architect: graduation from an engineering education program in civil or ttructull enginiveringi graduation from an architectural education program; successful completion of the NCEES Fundagientais Examirtitti! • or registration as building inspector or general contractor. • • • • • • I (we) will notify the Miami Shores Building Department of any changes regarding authorized personnel performing inspection services. I (we), understand that a Special Inspector inspection log for each building must be displayed in a convenient location on the site for reference by the Miami Shores Building Department Inspector. All mandatory inspections, as required by the Florida Building Code, must be performed by the Miami Shores Building Department .Inspections performed by the Special Inspector hired by the owner are in addition to the mandatory inspections performed by the department. Further, upon completion of work under each Building Permit, I wi1l_submit to the Building Inspector at the time of the final inspection the completed inspection log form and .a'sealed statement indicating that, to the best of my knowledge, belief and professional judgment thos Ortions of the project outlined above meet the intent of the Florida Building Codearid are in substargiglaccotdarice with the approval plans. gned and Seal -d Date: 7 fZ -7 Name Address Engineer/4rchitect --A0 W� ,4' 760/1-1-7 Print /` Ala• ilev/- Mrj4 I ,FI 3312% • • • • •