DEMO-17-492 N DEMO.22-17-492,
Miami Shores Villag® M ' Ty l emolftir�ir� ,
t
►c+ 10050 N.E.2nd AvenueWorkCtassrfrcaho& (0�`
""'`� Miami Shores,FL 33138-0000 � �
yF<o - Phone: (305)795-2204
Pef�if Sietus:APPROIIII
317
Issue Date: 1 ,17' Expiration: 103/2017
Project Address Parcel Number Applicant
9430 BISCAYNE Boulevard 1132060410030
Miami Shores, FL 33138- Block: Lot: ALBATROSS 9430 LLC
Owner Information Address Phone Cell
ALBATROSS 9430 LLC 9430 BISCAYNE Boulevard (786)262-2305
MIAMI SHORES FL 33138-
9430 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 3,200.00
IMPRECO CORP (786)262-2305 Total Sq Feet: 2476 j.
Type of Demo:Building Available Inspections:
Additional Info:REMOVE DRIWALL ON WALLS AND CEILING Inspection Type:
Classification:Residential Final
Scanning:3
Review Electrical
Review Electrical
Review Building
Review Mechanical
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40
Invoice# DEMO-2-17-63073
DBPR Fee $4.50 03/07/2017 Credit Card $274.40 $50.00
DCA Fee $4.50
Education Surcharge $0.80 02/24/2017 Credit Card $50.00 $0.00
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $324.40
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 ce ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an oni ermore,I authorize the above-named contractor to do the work stated.
v March 07, 2017
Authoriz gn ure:Owner / Applicant / Contractor / Agent Date
Building epartment Copy
March 07, 2017 1
r
� I
Y
Power of Attorney I�� ��
FE�
1. Principal and Attorney-in-Fact pljl,
I, Jacobo Choroszczucha, on behalf of Albatross 9430 LLC , a Florida Limited L bility Company, appoint
Miguel Deich, FL Driver License D21454048290-0, as my attorney-in-fact to act for Albatross 9430 LLC
in any lawful way with respect to the powers delegated in Part 4 below.
2. Delegation of A�thority
My attorney-in-fact may'delegate, in writing, any authority granted under this power of attorney to a
person he selects. Any ',Isuch delegation shall state the period during which it is valid and specify the
extent of the delegation.
3. Effective Dates;
This power of attorney isll not durable. It shall begin on February 22"d and shall continue until terminated in
writing.
4. Powers of the Attorney-in-Fact
I grant my attorney-in-fact power to act on regarding the property Albatross 9430 LLC owes in 9430
Biscayne Boulevard, MiImi Shores, FL 33138, in the following matters:
Act for Albatross 9430 MLC in any manner to deal with all or any part of any interest in real property that 1
own in 9430 Biscayne Boulevard, Miami Shores, FL 33138, at the time of execution of this document,
under such terms, conditions, and covenants as my attorney-in-fact deems proper. My attorney-in-fact's
powers include but are not limited to the power to:
a) Maintain, repair, improve, insure, rent, lease, and pay or contest taxes or assessments or
permissions or licenses on any estate or interest in real property I own or claim to own.
b) Prosecute, defend, intervene in, submit to arbitration, and to anything he needs to do before
authorities of the city of Miami Shores and/or Miami Dade County or/and State of Florida with no
limitations, or a4cept a compromise with respect to any claim in favor of or against me based on
or involving the real estate property of 9430 Biscayne Boulevard, Miami Shores, Florida, 33138.
5. Severability
If any provision of this document is ruled unenforceable, the remaining provisions shall stay in effect.
1 understand the importance of the powers I delegate to my attorney-in-fact in this document. 1 recognize
that the document gives,my attorney-in-fact broad powers over my assets.
Signed: This 22"d day of February 2017
State of: Flori ty of: Miami Dade
Signatur
Jacobo C sz zuchaj� Manager/Member of Albatross 9430 LLC
ID Number and Type: Uruguay Passport# 1.209.199-8
Page 1
t
Witnesses
On the date written above, the principal declared to me that this instrument is his power of attorney, and
that willingly executed it as a free and voluntary act. The principal signed this instrument in my presence.
Witness 1/ f
1 f!
Signature:
Name: V\a
Witness 2
Signature: €
fi
Name: e
Certificate of Acknowledgment of Notary Public
State of Florida)
ss
County of Miami Dade)
On February 22nd , 2017 before me, Jose Nicenboim a notary public in and for said state, personally
appeared Jacobo Choroszczucha, as Manager and member of Albatross 9430 LLC, a Florida Limited
Liability Company, personally known to me to be the person whose name is subscribed to the within
instrument, and acknowledged to me that he executed the same in his authorized capacity and that by his
signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the
instrument.
WITNESS my hand and official seal.
E&INCE OMA
AIoWy Ps>aic-8ti< of FWW
• Comis.ton A►4WO
, I�6. Notary Pub c for the State of
Nn0ld WOW Aloglf Assu.
My commission expires
Page 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 331389
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 '
FBC 20t-
3
BUILDING Master Permit No-_L 'W o n
PERMIT APPLICATION Sub Permit No.
70BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 9430 BISCAYNE BLVD
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: 11-3206-041-0030 is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ALBATROSS 9430 LLC. Phone#:
Address: 9430 BISCAYNE BLVD
Cit,. MIAMI SHORES VILLAGE State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: IMPRECO CORP. Phone#: 786-262 2.305
Address: 20200 W COUNTRY CLUB DR. #109
Cit,_ AVENTURA State: FL Zip: 33180
Qualifier Name: DANIEL J. SERRANO Phone#: 786-262 2305
State Certification or Registration#: CGC 1516768 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$3,200.00 Square/Linear Footage of Work: 2476 SgFt
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace 0 Demolition
Description of Work: Remove driwall on Walls and ceilings
Specify color of color thru tile:
Submittal Fee$ 1 Permit Fee$ C�oCCF$ 2— CO/cc$
Scanning Fee$ Radon Fee$ e—1 • 5cd DBPR$ ILI • Notary$
Technology Fee$ 210
Training/Education Fee$ m Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 2
(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 grid a reinspection fee will be charged.
Signature (/ Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrum t was acknowledged before me this
-2- day of Q .20 17 by Z day of -r-E? 20 1- ,by
Ivw vPOx G V l .who is personally known to 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.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
.�Y Pvzo`, .eif JORGE ISI GATALDO
Seal: :•'•: '* JORGE DI CATALDO
WCOI OH# 21FF 1M Seal: * MYCOA9195M#FF217M
EXPIRES:JoW9,2111a ,,1 EXPIRES.Jam►9,2018
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APPROVED BY i' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
IMPRECO CORP
CGC 1516768
20200 W Country Club Dr#109
Aventura—Florida 33180
Phone 786-262-2305
danielserranol 958@gmaii.com
March 6, 2017
State of Florida
County of Miami-Dade
Before me this day personally appeared Daniel J. Serrano who, being duly sworn,
deposes and say:
That he will be the only person working on the project located at 9430 Biscayne
Blvd., Miami Shores Village
Sworn to (or affirmed) and subscribed before me this 06 day of March. 2017, by
Daniel J. Serrano
Personally Know....... ............................................
cation........................................
Type of Identification Produced.................................
JORGE DI GATA M
* MYCOhIIIIIINION#FF21 nEXPIRES:Jmuary 9, 18
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Print, Type or Stamp Name of Notary
Miami shores Village
Building Department
��O1t1U�` 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
rf , - ;77,x,,:
,,
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:
caner
State of Florida Ub
County of Miami-Dade
The foregoing was acknowledge before me this day of RORN ,20A.
By EL �f1(A who is personally known to me or has produced
as id cation.
Notary:
°tiPar QE DI CATALDO
SEAL: o* IN COMMISSION#FF 217M
EXPIRES:Jmuary 9,2018
IPA EXPIRES:
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