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CC-16-947 (2)Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. CC -4-16-947 Permit Type: Commercial Construction Work Classification: Repair Permit Status: APPROVED Issue Date: 412912016 Expiration: 10/26/2016 Parcel Number Applicant 9101 PARK Drive Miami Shores, FL 1132060141370 Block: Lot: 9101 PARK DRIVE, LLC Owner Information Address 9101 PARK DRIVE MIAMI SHORES FL 33138 Phone CeII Contractor(s) ARCO CONSTRUCTION Phone 305-892-6507 Cell Phone Valuation: Total Sq Feet: $ 7,300.00 28 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: REPLACE FOUR COLUMNS SUPPC Stories: Front Setback: Left Setback: Plans Submitted: Yes Certification Date: Bond Return : Scanninq: 5 Occupancy Load: Exterior: Rear Setback: Right Setback: Certification Status: Additional Info: Classification: Commercial Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Plan Review Fee (Engineer) Scanning Fee Technology Fee Total: Amount $4.80 $3.29 $3.29 $1.60 $5.00 $219.00 $120.00 $15.00 $6.40 $378.38 Pay Date Pay Type Amt Paid Amt Due Invoice # CC -4-16-59348 04/08/2016 Check #: 7066 $ 50.00 $ 328.38 04/29/2016 Check #: 7210 $ 328.38 $ 0.00 Available Inspections: Inspection Type: Final Review Structural Review Building 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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -nam-. contractor to do the work stated. Authorized Signature: Owner / Applicant / `tractor / Agent April 29, 2016 Building Department Copy Date April 29, 2016 1 LETTER OF COMPLIANCE March 29, 2017 Miami Shores Village Building and Zoning Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 Attn: Building Official Project: Residence 9101 Park Drive Miami Shores, Florida Dear Sir; Edward A. LANDERS, P.E. CONSULTING ENGINEERS 444 Permit #CC -4-16-947 1, Edward A. Landers, P.E., Professional Engineer with the State of Florida, having performed and approved the required inspections, as indicated, hereby attest that to the best of my knowledge, belief and professional judgment, the repairs at the above referenced structure are in compliance with the approved plans and other approved permit documents. I also attest that to the best of my knowledge, belief and professional judgement, the approved permit plans represent the as -build condition of the structural and envelope component of said structure and all comments and corrections requested by the Miami Shores Village Building Department have been accomplished by the contractor. This document is being prepared in accordance with Section 105.13.4.1 of the Florida Building Code 2014 Edition and is being submitted to the Miami Shores Village Building Department at the time of the final inspection for the above referenced structure. Should you have any questions or need any additional information please do not hesitate to contact me. Very truly •urs .��`'��������'''�• /•. cS� ��• No 38398 Edward A. Landers, PiiE*.: * ¢ :.-o'.u- ��'.. STATE ............................... F .; -SS N 7850 NW 146TH STREET, SUITE 509 * MIAMI LAKES FL 33016 * PHN: (305)823-3938 * FAX: (305)823-9355 \\6 L(9' BUILDING PERMIT APPLICATION OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL 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 RECEIVEL» APR 08 Zi16 - Master Permit No. Sub Permit No. FBC 20 Q-0-1 6 4°7 (-1� El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ci J D 1 P41/1( 60 -- City: Miami Shores County: Miami Dade Zip: 33 >3e Folio/Parcel#: Is the Building Historically Designated:.Yes NO Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): OA -'172. cr'l in/ Address: Cla 00 Al $Cif ()VC , fL City: r1 . CIA o ✓e s J State: rL Zip: 3 3 13 R Tenant/Lessee Name: Phone#: Email: BFE: FFE: Phone#: 3C7s - S' a.36.2 CONTRACTOR: Company Name: ,,4-e .Y/ cor. Address: /2 �{/F / f \►- �/ City: fir. ; 11 ore_ --2 State: L^ Qualifier Name: l�ec'Prr�V!`—f'�7 State Certification or Registration #: C'IA& /'27 DESIGNER: Architect/Engineer: /.., /i a..cr, Phone#: gg589`297 Zip: 31"-a, Phone#: � g 12�, p�- I Certificate of Competency #: --Phone#: 30.�c� Z3 3 LA City: t%. t K� o State: Address: 7. cO ANA/ / L6 *C. Value of Work for this Permit: $ 7-300 Type of Work: ❑ Addition ❑ Alteration Square/Linear Footage of Work: ❑ New Description of Work: 14 e_ to pt ✓ L©(..c r--04 (1*H;QQt .,.� ,Repair/Replace ❑ Demolition 'zc Jin e /71j i� g) (�1O2- b Specify color of color thru tile: Submittal Fee $ Permit Fee $ CO Scanning Fee $ 5 Radon Fee $ CCF $ (. Bo co/as ab DBPR $ 3 29 Notary$ C Technology Fee $ 6 • '40 Training/Education Fee $ \ . Go Double Fee $ Structural Reviews $ ‘2..0 (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ " 38 Bonding Company's Name (if applicable) Bonding Company's Address ..ri / V/ 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." ,r_ 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 app ved and a reinspection fee will be charged. Signature 0 NER or AGENT The foregoing instrument was acknowledged before me this day of Fro , 20 /6 , by 24r �rrrz d/j , who is personally known to me or who has produced as identification and wholdid take an oath. NOTARY PUBLIC: Sign. Print: Seal: ._L ******** olysir Pi, ,� Notary Public State of Florida Joanna M Feliciano My Commission FF 082753 140,1Expires01/12/201S APPROVED BY (Revised02/24/2014) rata Signatur COQ OR ��c The foregoing instrument knowledged before me this 68 day of NP21 , 20 ( , by , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIf SIT Print Nb to 0.) e Seal: *********** ****************************************** Plans Examiner • tNotary Public State of Florida Sindia Alvarez My Commission FF 156750 OF Expires 09/03/2018 * **'* ** **** **************** Zoning Structural Review Clerk Arco Construction Corporation April 08, 2016 State of Florida County of Miami Dade Before me this day personally appeared Lester Jensen who, being duly sworn, deposes and says: All work to be performed by Lester Jensen or licensed and insured subcontractors. Sworn to (or affirmed) and ubscribed before me this 0 g day of Ptel,, ( 20 1 A ,by Personally know Or Produced Identification Type of Identification Produced Print, Type or Stamp Name of Notary 040f F c'4, Notary Public State of Florida Sindia Alvarez f My Commission FF 156750 140, coo Expires 09/03/2018 General Contractors/CGC1505163/1665 N.E. 137th Terrace/N. Miami, FL 33181 305.892-6507 Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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 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 /c day of /3 , 20 . By 6 c 77 Grp who is personally known to me or has produced Notar(r•� SEAL: as identification. it P`,4 Notary Public State of Florida 7.. Joanna M Feliciano My Commission FF 082753 or r1,0*- Expires 01/12/2018