PL-16-1919BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS:
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
RECF:resmp,
JUL 11 2Ot6
BY:
FBC((2O1
Master Permit No. PL(,P —'19 19
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
/6//(I`L.(D8 s
City: Miami Shores County:
//Z) 3 (mar Zzd
Folio/Parcel#:
Miami Dade Zip: 33 /ca
Is the Building Historically Designated: Yes NO k
Occupancy Type: Load: Construction Type: _ Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): PAUL L-Fk4 (3 Phone#:.3 O' 6 so4
S -1 -
Address: 2 I y
City: 114A ciamAi J1{ -0W 5
Tenant/Lessee Name:
Email:
State:
L
(FalA L p (am( O. %:'lest, L , c cM1
CONTRACTCrR: Company Name: _`4/1 ; el'c
Address: (g. LC' W �b pc
City: L(LA- "i
Qualifier Name:
Phone#:
Zip: 7j&//
SC-1/'CPhone#:
- State: C 1 Zip: 3 1-4?
Phone#: tL
/
/`
("Certificate of Competency #: / OO D 27 c>
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address: City:
Value of Work for this Permit: $ _ 16c) . U
Phone#:
State: Zip:
Square/Linear Footage of Work:
Type of Work: ❑ Addition n AlterationL' I-N€w ` ❑ Repair/Replace ❑ Demolition
Description of Work:
)vs --/c.4 / >\Q_.L } Pr k
}
Specify color of color thru tile: „,
Submittal Fee $sb Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF 5
DBPR $
4
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable) •
Bonding Company's Address a. _
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 `
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 3-0•I
1)lai\ 4.tN.1) , who is personally known to t9 lJI "'ITu -, who is personallyknown to
me or who has produced as me or who has1�
teproduced IYi17S c-- as
Signature
The foregoing instrument was acknowledged before me this
, 20 I to , by
, 20 Ica , by
identification and who did take an oath.
NOTA 'Y PU: - C:
Sign:
Print:
Seal:
,esys, J. DIAZ
+. a' MY COMMISSION Y FF 161380
• i•= EXPIRES: January 18, 2019
PL k\ r Bonded Thru Notary Public Underwriters
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
ea%ei
�..'• 1 otic', • c`
II.%• s.40 •
**********************************************************************************/ *314* ************
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
Zoning
Clerk
BERNIE'S SPRINKLERS, INC.
3531 N.W. 170th Street, Opa-Locka, FL 33056
Dade: (305) 620-1111 Broward: (954) 438-8808
Fax (305) 620-6776
Date: 1 I (lje
State of
FLo2li-
County of r I A-711 1 "
Before me this day personally appeared
says:
l) e7 '`einr 2§ sworn, deposes and
That he or she will be the only person v Irking! Ctf prcvt1located
Personally know
OR Produced Identification
Type of Identification Produced 6t—
Print, Type or Stamp Name of Notary
Miami Shores Viiiage
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: (9
4P14. ------
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this v' day of c.,/ y , 20 /, .
who is personally known to me or has produced
gricicn 01;v-ef- A.c.ek C as identification.
Netary:
SEAL:
By �'�.•dL f)cf /de Z_
Raul Valdez
Notary Public
State of Florida
My Commission Expires 8/11/19
Commission No. FF 908737
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13911V 97 AV SITE 2.60• • L4MI.FLR/DA ,;31 ••
TELEPHONE: (305) 264-2660
FAX: (305) 264-0229
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DRAWNsBY: AL. •
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SURVEYORS NOTE:
Ntutt '14runJurz-
LAND SURVEYORS
BOUNDARY SURVEY
SCALE =1' = 20'
• • • • • • • • A) Asphalt Drive Encroaching onto Right-of-way on the South side of Property.
• • • • • • �) Overhead Utility Line Encroaching onto Subject Property on the North side of
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•••Lert4
BLOCK -216
LOT -3
BLOCK - 216
U.P.
SURVEY No. 15-00012704
SHEET N
LO
BLOCK -216
RIP 3/4'h
NO CAP
0.50'CL. I
0.50'CL.
Y
LOT -13
BLOCK - 216
DeS1
9.70
4s(
'0
15 ALLEY (N.A.P.)
11' ASP
75.00' PVMy' a;
co
w
F.I.P 3/4'
NO CAP
i
ONE STORY
RES. # 161
LOT -14
BLOCK -216
18.40'
1.60'CL.
RECD/V :D
14t l JUL 1'1 2016
N BY: 1,!'
LOT Lor 1s
BLIP '6cm
1.52 L.
VED
" We�1
nrve r
h
19.50' 4.85
0
14.50'
rtSenSor
112)1 112-•
ifq
NG
15.70'
2 Zp•1C C
27 �C' c
lec -r ; cVc u
URAL:
0
F.I.P 3/4"
NO CAP
24' PWY
BY
DATE
150'
5' CONC. SWK
B.C.
BING
N.E. 108th SIRE- E.
16' ASPHALT
PVMr.
B`. BG
NO CAP
ij
SURVEYOR'S NOTE: ` r ` i • L;.: EDER,�L,
. There may be Easements recorded in the Public Records not shown on this Survey.
S U J t n �7 V l:.. M I t t I V E Y Y
- The purpose of this Survey is for use in obtaining Title Insurance and Financing and should not be used for ConsMon Durgpses. �' ��; i' y RULES AND 1 E u J %� (d N S
IF 11
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• • •'1255 W67 AV SUTNE 204
CAAit, FLORIDA 331720 • •
TELEPHONE: (305) 264-2660
FAX: (305) 264-0229
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W 4
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Y
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SURVEYOR'S NOTE:
A'gntt 3itrut1Jarz
LAND SURVEYORS
BOUNDARY SURVEY
SCALE =1"= 20'
• • •• •
• • a,`Aspha1 Drive Encroaching onto Right-of-way on the South side of Property.
o o • • B) Overhead Utility Line Encroaching onto Subject Property on the North side of
• • • • • % spelty,
• • • ••• ••
•
LOT -4 LOT -3
BLOCK - 216 BLOCK - 216
U.P.
SURVEY No. 15.000y2�' 1
SHEET No. 2
LOil.T-2
i, q BLO67Kit h i
Vi
F.I.P 3/4"
NO CAP
J AT
0.50'CL. �?
Y.- --x--
1
1.60'CL.
geo
k'
•
6.1E oci
E. OF
iO4
0.50'CL.
a
LOT- 13
BLOCK -216
E:T\P ;D
11 2018
I2 t
DeSt�.7
er-
13ur4tey4
-2."We��
21.70' G�
. o
ONE STORY
RES. #161 A
LOT- 14 18.40'
BLOCK -216 Ao
n
LOT -15
19.50' 4.85
PA; r►S'e:ASOr
1.52'CL.
hPP QYW
ZON. •6i
14.LIURAL
102674. CV41U
F.I.P 3/4"
NO CAP
5' CONC. SWK
24' PWY
V.)
N.E. 908th STREET
16' ASPHALT
PVMT.
frIEWAN.
SURVEYOR'S NOTE: SUBJECT TO CC!„y L At li S Iif.H. Alit , EDERAL,
- There may be Easements recorded in the Public Records not shown on this Survey.
- The purpose of this Survey is for use in obtaining Title Insurance and Financing and should not be used for Constructigi 'e. AND COUNTY! Nita ANC. RIGULX1.1011$