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FW-16-2620 Permit NO. FW-9-16-2620 �sK°Rrys y� Miami Shores Village Permit Type:FencetWall' 10050 N.E.2nd Avenue NW Work Classification:Wood Fence Miami Shores,FL 33138-0000 Per I Phone: (305)795-2204 Permit Status:APPROVED F(ORtDQ' Issue Date:9/27/2016 Expiration: 03126/2017 Project Address Parcel Number Applicant 102 NW 106 Street 1121360080010 Miami Shores, FL 33150-1248 Block: Lot: NATALIA HIRN Owner Information Address Phone Cell NATALIA HIRN 102 NW 106 Street (786)566-9669 MIAMI SHORES FL 33150-1248 102 NW 106 Street MIAMI SHORES FL 33150-1248 Contractor(s) Phone Cell Phone Valuation: $ 2,800.00 HOME OWNER Total Sq Feet: 210 Approved: Available Inspections: Comments: Inspection Type: Date Approved: : Final Date Denied: Foundation Type of Construction:Wood Fence Additional Info:TO REPLACE PERMIT NUMBER BP2 Review Planning Classification:Residential Scanning: 1 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# FW-9-16-61438 DBPR Fee $3.15 09/27/2016 Credit Card $ 179.10 $50.00 DCA Fee $3.15 Education Surcharge $0.60 09/22/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee-Wire&Wood $210.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $229.10 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 To`regoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a=dFhere, I authoriz ab contractor to do the work stated. September 27, 2016 Auth&izpd Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy September 27, 2016 1 . . ... . . . ... .. .. . . . .. .. . ' WHO'D'FE'N'CES . . . . ... . . . ... . . . . ... . . . • . . .... ..•. . ..• ... .. . . . . . ... .. Wood Posts 2" X4" Wood kad 4'-0" High or Less = 6'-0" O.C. 5'-0" High or Less = 5'-0" O.C. Owner' s Side I" X 6" or III Xa v vll Wood NL-t5 2915 Fences 2915.1 Wood fences, so located on a property that by zoning regulations they cannot be used as a wall of a building, shall be constructed to meet the following minimum specifications. Concrete (a) Fences not exceeding 5 feet in height shall be constructed to meet the following minimum requirements: from nominal 4 inch by 4 inch by 8 feet-0 inch long III ° ° = I I posts spaced 5 fee--0 inches on centers, having a fiber stress of 21-0" I=I I $ a HE 1200 p.s.i. in bending, and shall be III= a I= I I embedded 2 feet-0 inches into a II I 3'-O" concrete rooting 1 foot-0 inches in I I I=I II=III diameter and 3 feet-0 inches deep. _ Other components shall be designed to comply with the III=II ° III=III provisions of this Chapter and 1=1 I E Chapter 23. (b) Fences not exceeding 5 feet and 4 III=III feet in height respectively shall be III=II Ell I I=III constructed as provided in III III—I I —III—III paragraph 2915.1 (a) herein, except that the spacing of posts may be increased to 5 feet-0 inches and 6 feet-0 inches on centers for these heights. L Concurred •:• :, ,; esKETC11 OF BOUNDARY SURVEY SCALE: l Zo FOR: Louis Castaneda. JOB No. 02-01-02-1 • •• •• 102 N.W. 106th Street Miami FL" • • 02-01-2002 • ..: ; ; • • PROP.ADD. ' .. .. • • ;SQR ATE • , , Y • ••• : M e Block 204 of II I Q SIOA1 ics.4", according LEGAL DESCRIPTION: Lot 1 DUNNING S MIAMI� SH R�$, TK to the Plat thereof, as recorded in Plat Book 48 Page 20, of the Public Records of Miami- 106 iami- 406 S_r?_EET Dade County, Florida. 7' — • ASPH,d(.T PaJE-c%A,;ETIT • . • • .. • „ .. • • . • • OC A-T1oN 'MA,4P� ... .. I 0 F(oo-� ��oj 5 51ti1 k '7 FR I T" x.81, O TREET r.t l F� ' ao` �\ 3 5 ¢ 3 Z O c t} O O •I I lS LC.E Y Q 0` a `n ! N I 3O 3 IL 13 t4- 51 45' _ O z 7.0.55' 11-- i \'� T.I 04' r i N.W. i o s s-rp)F_ET Rcs. Ul 1Dto N ! 1 0 Z.1, / U J �•�� 1 1 � N_ 1r ^IV � Q - � r co Q ABBREVIATIONS i� — f ENC=MCROACIIMENT(BASED ON APPARENT PIIYSICAL USES SWK�IDEWALJC,CLF=:IWN LINK FENCE,k=PROPERTY LINE,N/D=NAIL Q DISC,IP4RON PIPE,F=FOUND,STY"STORY, J A/C­AIR CONDITIONING UNrr,PC-POINT OF CURVATURE,rr=POINT OF TANGENCY,DAI=DRILL IIOL.E,W/F=WOOD FENCE,RES--RESIDENCE,WNt"AR,CONC=CONCRrM • I RAV-RICIrr-0E-WAY,tCFMER LINE,O=DIAM!TRA(TYP)-YPICAI, M � • �{ S-SFT,EYE-flNISHF.D FLOOR ELEVATION, ( }•M FA$URFD,(C}CAI.CUTA'IT:D,(RrRECORD,CM�UTNAII,WN-ROUND NAIL,WI-r=PIAILJ&TINTAR,N-NAIL, V) ti PRC-POINT OF REVERSE CURV )FF SIT,P1M1P'OWF7t POIJ�IJP=IJCHT POI.F�WM-WATER M6'1'FR.CJB"CATCH BASIN,PB•�P(aT BOOK,PC."PACE NTS=NOT TO SCALE, X �� ` E,-PCC-poUfT OFCOMPOUND CURVE,POC-POINT OF COMMENCE.POB-POINT OF BECINNLNC,CB-CHORD BIAItINC N I SURVEYOR'S NOTES: I)FEMA NFIP MOOD%ONE: X;2)THE SUR VFV OV 771F.PROPFXFY SHOWN HFRKON IS IN ACCORDANCE WITH THE LEGAL.DESCRIPTION FURNtS111'D BY CIdFM;TJ UNLESS NOTED, B PROPERTY CORNER MONUMFNTS IIAVE NO I.D.;4)ALLSTRACr OFTTTIX NOT REVIEWVD;NO SEARCH OF TIE PUBLIC RECORDS WAS DONT;FOR EASEMENTS OR ANY OTHER RECORDED 'Q Q w IMMUMENIS TIIAT MAY AFFECT TRE PROPERTY;S)BELOW SURFACE YMUCTURF.4,IMPROVEMENTS AND UTILITIES WERE NOT LOCATED;E)TINS SURVEY 1S FOR MORTGAGE (T O j i PURPOSES ONLY,NOT TO BE USE FOR CON,tiTRUC17(NI;7)NOT VALID WITHOUTTHE SIGNATURE.AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. D\ � �42' 1{ 1 HEREBY CERTIFY THAT THIS SKETCH OF?vVN'1'i(,y SURVEY"OF T11E ABOVE DESCRIBED PROPERTY IS A TRUE AND CORRECT REPRESENTATION OF AFIELD SURVEY MADE 0 / �. :,y 1 ff UNDER MY DIRECTION AND MEET'S THE"MtNIMUI(IECIWICAI,STANDARDS"AS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS INCHAPTER I R 5 , �R P �O/ - 61C17-6,Fld)R1DA ADMINISTRATIVE CODE,PURSUANT TO SF.(TION 472-427,FTARIDA STAMPS All wMo 'l'7, 58s� 'C FREEDOM OF LAND CORP. Surveying Services t,B4515 E 1' 7575 W.FLAGLER STREET,SUITE 207 MIAMI, FLORIDA 33144 R1QUE 11. A P.O.BOX 65-3706 (305)266-4451 Registered urveyor No.5133 MIAMI,FL.33265 FAX(305)262-5007 STATE OF FLORIDA Q y� DRIVER FLORIDA LICENSE --The Setnsh ne State--- t: OUIS ESPINOSA CASTANEDA . 102 NW 106 STREET ea MIAMI .SHORES, FL 33150-0000 06-04--23 M 5-0A A U5-19-1993 r` 0235-525-23-204-0 06-04-1999 JJJ CLASS: E SAFE DRIVER 100-//UO-0000 .> 3057370 me,( tray 1pg o'3 t'�p� �"�►O y' "r?�Y fy.90. Yt -11�O�uyFO ✓ s �cc e X8 .0`- 0.10 t<_ S a�� OR �,,e Village of Miami ShoresBuilding Permitlives10050 NE 2nd Avenue ... Miami Shores, FL 33138 Permit Number: BP2002-294 Phone: 305-795-2204 fi R ► Printed:2/12/2002 Page 1 of 1 Applicant: LUIS CASTAnEDA Owner: DONNELLY BLANCHE Contractor GATOR FENCE CONTRACTOR COAEldress: 3220 NW 95 ST "**" Local Phone: Cellular: Parcel # 1121360050080 Legal Description: DUNNINGS MIAMI SHORES EXT NO 1 PB 41-51 LOT 8 BLK Job Address: 102 NE 106 ST Fees: Description Amount FEE2002-855 Building Permit Application Fe$60.00 FEE2002-856 CCF $1.80 Total Fees: $66.80 FEE2002-857 Notary Fee $5.00 Total Receipts: $0.00 Total Fees: $66.80 Permit Status: Approved Permit Expiration: 8/11/2002 Construction Value: $2,800.00 Work: WOOD FENCE If there is no permit package accessible on the job-site for inspectors to verifili. tharo-„u h^ - fee is$50.00,which mus' .111131 g5 5 09 0E 00 :1v10000E 9 0.1 5111E 1100011 ao� This Permit is granted to the c - '�"0�- Ifu - —�.--_ — ordinances pertaining thereto ani ------ — ` and approved by the proper mun Nov authorization. A further conditior 'V•N'luegsuor►eN ordinances and regulations perta ItI DINSWO�aH by his agents,servants or emplo; �---� Sav�`toa- Signed: 1 do 3Hl of § In consideration of the issuance l6[7AS / �7 with the plans,drawings,stateme 31` G myself,my agent,servants or eml "� Z -U OC90-0 009vi.69-906 Signed: I ��� 66-to 'dHO:) U010Va1N00 3ON3c1 11:110i” MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date Time Type Insp'n 0" Permit No. C;q) Name dQ—z Addr Company Phone# C) pector FoEID§ tor: N4ajne&Date. For Approved Correction ❑ Re-Insp'n Fee ❑ A 5�0 PEPdMTF APPLICATION nu umM Master Permit No. ,L t;G Subsidiary Permit No. Thejollwwing steps must be taken to obtain Step 1. Complete the attached permit application which must be signed+the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done,a roofing application must be submitted along with this permit application. Step Z. Submit the completed application with all necessary documents to the Building,Planning and Zoning Department for processing. During the processing of your application,you may be asked to submit additional information. 1 Job Address: I®7, /V-l� (90/, S r •/ �f�®�S r � f 6 Address Apt. City y State Zip-7- Folio Number Description of Work V b ©d 61, Ce Lot Block 0""C. Zee Ct,Ye' Subdivision PB PG Zoning Linear Feet Current Use of Property �� • c C6- lVOaSS y:e Feet J® 2 Units Floors Proposed Use of Property 'Value of Work C o� Bldg Value Po P rtY Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE ( PERMIT CHANGE (✓) TYPE OF MANAGEMENT ) Building Chg.Contractor New Construction Enclosure Electrical Renewal Alteration Exterior Repair Mechanical Revision Alteration Interior Demolish Plumbing Extension Relocation of Structure Shell Only LPGX Supplement Foundation Only Add'l Attachment Roofing Reinspection Other Add'l Detachment Fence Other Other ARCHITECT ENGINEER Name Name License No. License No. - Address Address G Telephone Telephone Fax Fax PROPERTY OWNER CONTRACTOR (� Name / ►` S lT Name �on, -Fe�C e Address v License No. /' 5 C2®- t®z /V Sr Address C� Home Telephone Owl ® 3 21 o v&-f ,f �'T i's. •�_ Mz Business Telephone Telephonep Fax Fax Qualifier Name Page 2 7�WL.ATTON IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m.to 6:00 p.m.,and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN,NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES,AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the streettsidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a constriction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building,Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services(HRS)approval is required for applications involving septic tanks. Department of Environmental Resources Management(DERM)and/or Miami-Dade Water and Sewer Department(MDWASD)approval is required for applications involving sewers. AFFIDAVIT Application is hereby made to obtain a permit to do work and installation as indicated. I,the OWNER of the property,certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I the OWNER of the property, have disclosed all information related to an work at the o performed in the or twelve pr perry Y property P� Pn months to the Building Official. Further,I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50%) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50%) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. a WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for ° improvements to your property. If you are spending more than $2,500 or intend to obtain financing,you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 11 Floor,(305)679-1078. Once recorded,the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713-35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE O ORIDA,CO F MIAMI-DADS STATE OF FLORIDA,COUNTY OF MIAMI-DADE Signature of Owner Signature o Contractor/Qualifier t'--U U i 's d ©ao a 2 a Print Name Print Name Sw tt subscribed before me this day of S to an ubscribed before me this `-' day of lJ e 9 gnature of tary Pu li -- SEAL Signa o o n Pu lic State o onda o SPRY PtiO ANGELA oNB BECK 1P 1 OFRCIALNOTARY SEAL SEAL: O ;rc i0 00,,,sa ANGELA M BECKER 2 i * CC766697 Z I n COssNasaaN NUMBER w Q yr !Q-- WV COWA 8,2002 c*n + Q CC786697 F `O4 9jx p &VSSION EXPIRES Of,f_, ® {�►®V, 15,200 Personally OR,ProducedIdentification. 1� 5R,Produced Identificattionn Type of Identification Producef �I lI 1, l",®!�� n� 1&ype of Identification Producedl�l I i, 1 i i . I I t Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. ELECTRICAL TYPE QTY. TYPE QTY. TYPE QTY. TYPE QTY. Minimum Fee Dryer Outlet,Appliance Service Repair A/C Central 1-3 Ton Fan Outlet,Wall Service,Temporary A/C Central 4-7 Ton Fire Pump Outlet,Switch Signs A/C Central 8-15 Ton Fixture-Fluorescent Oven Space Heater(kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Ibbs A/C Central 20+Ton Flood Lights Plugmold/Strip Subfeeds,No.of Amps A/C Window FPL-Load Central Posts Swim Pool,Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool,Residential Chiller Generators,etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator,Comm.(p/PH) Temp Serv.,Construction Compactor Low-volt,Burglar Refrigerator,Domestic Temp for Test-30 days Deep Freezer Low-volt,Fire Renew-Temp Service Demolition Low volt,Intercom/Teleph. Repair Circuits Dishwasher Low-volt,Television Service,Number of Amps MECHANICAL T Y P El QTY. TYPE QTY. TYPE QTY. 'rypi-,, Q-1-Y. Minimum Fee Condensate Drain Generator Refrigeration,Tons A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost A/C Wal m.Tons Dryer Vents,Number of Paint Booth Ventilation,Cost Air Handler,Tons Ductwork,Cost of Piping,Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Processfflressure Piping Bath Fan-Vented,# Fireplaces,Number of Pressure Vessel tPLUMBING TYPE QTY. TYPE Q'j-Y. TYPE QTY. TYPE Q'ry. A/C Condensate Drains,Roof Miscellaneous Fixture Soakage Pit Bath Tub Drinlung Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair f Cap-Fixture Fountain Pump and Abandon S rinkler System 6 Cap-Water Gas-Appliance Pump,Domestic Supply,AC Well Cap-Sewer Gas-Natural Pump,Fire Stand Temporary Toilet Catch Basin Gas-Propane Pump,Re-circulate Temporary Water Closet. Clothes Washer Gas Piping Pump,Replace-Pool Urinal p Dental Chair Grease Trap Pump,Sprinkler Utility-Sewer Discharge Well Ice Maker Pump,Sump Utility-Water Dishwasher Indirect Wastes Relay Repair Vacuum Pum Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater i Drainfield,4"Tile/Res. Lavatory Septic Tank Water Heater New Drains,Area Meter Set(Gas) Sewer Connection Water Re-pipe Drains,Floor Minimum Fee Shower Water Service Drains,French Miscellaneous Equipment Sink Well,Supply RECEIVED AND REVIEWED BY: DATE: � l Y Page 4 PERMIT APPLICATION OFFICE USE ONLY ❑ OWNER-BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL (Attach) (Attach) (Attach) ❑ FIRE DEPARTMENT ❑ HRS/DERM APPROVAL ❑ BPR APPROVAL(Restaurants) APPROVAL(Commercial/ (Septic/Sewer) multi-family) t ❑ CONCURRENCY ❑ IMPACT FEE ❑ CONTRACTOR REGISTRATION (New Construction) (New Construction) (On File) ❑ OTHER ❑ OTHER (Specify&Attach) (Specify&Attach) i $3.00 per page(Scanning Fee) $ Miami Shores Village $ Bond $ Metropolitan Dade County (C.C.F.) $ Pl (sqA=x/1000 x 0.60) Inspector State Educational Fund $ (¢.005/sgA) State DCA(Radon) $ (¢.01/sqA) Code Enforcement Fine $ l Zoning Review $ TOTAL $ o (� REVIEWED AND PREPARED BY: DATE: 1 SECTION BY DATE CONDITION OF APPROVAL Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official ®uej Revised July 2001 10050 N.E. 2-AVE.,MIAMI SHORES,FL• (305) 795-2207 •FAX(305) 756-8972•http://www.miamishoresvillage.com REC Miami Shores Village CE2 2016 Building Department artment sx. _ 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 20 WA BUILDING Master Permit No. :C 21a ZO PERMIT APPLICATION Sub Permit No. F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: G Z AM) L Cy c City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ' � ` J Phone#: -21i" G Co 7 Address: i G� f�-1 LAJ I GZ9 City: q�kCx-S State: F2 Zip: 33 1 S G Tenant/Lessee Name: N ( A- Phone#: Email: /fes CONTRACTOR:Company Name: ( b` Phone#: Address: City: State Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: 2 Type of Work: ❑ Addition ❑ Alteration/ ❑ New ❑ Repair/Replace ❑ Demolition '7 Description of Work: `-Ad/ti® �'Ci1� �C.�1 �CJJ T� _� 12 0 Z L ZQ Specify color �off(color thru tile: �v Submittal Fee$ ` `� � Permit Fee$�(0' CAD CCF$ CO/CC$ 10 Scanning Fee$ • Radon Fee$3• DBPR / Notary$ V� Technology Fee$ 2" Training/Education Fee$ �® Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ U d (Rev1sed02/24/2014) 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 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 22 day of ���-'t`Q1M�)'� 20�J by day of 20 ,by ci f` who is personally known to who is personally known to me or who has produced r ly'Q,+1 1 � as me or who has produced as identificatio d who did to an oath. identification and who did take an oath. NOTARY UBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: YANADY PRIETO Seal: Seal: MY CQMMISSION#FF 214031 EXPIRES:March 25,2019 Bonded Thru Notary Public Underwriters k&k k+k kk+k k kk rkk rk rk rkk*k R+k*k k k#k kk k k k+k+k Ne k rk k k*k k k k#**k*k k#+k k k 8e k k k k+k&k kk k k k k rkk k rk rkffi#k*k+k k k# k 711, APPROVED BY �' Plans ExaminerZoning Structural Review Clerk (ReAsed02/24/2014) Miami Shores Village a o Building Department 10050 N.E.2nd Avenue R � Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: i'�-`r� DATE: -1 ` LT 2_0 t QO ADDRESS: Z Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,F.S 489.103(7).And I have read and understood the following disclosure statement,which entitles me to work as my own contractor;I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must supervise the construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a cost of$25,000.00 or less(The new form states 75,000).The building must be for your own use and occupancy.It may not be built for sale or lease.If you sell or lease a building you have built yourself within one year after the construction is complete,the law will presume that you built for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on your building who is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and with-holdings tax and provide workers'compensation for that employee,all as prescribed by law.Your construction must comply with all applicable laws,ordinances,buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain restrictions even though I do not have a license. 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial�� 3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name.I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve a commercial building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease.If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete,the law will presume that I built or substantially improved it for sale or lease,which violates the exemption. 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. Initial 6. 1 understand that i may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence.It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial f�— J 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that erroneously implies that the property owner is providing his or her own labor and materials.I,as an owner-builder,may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property.My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initi� 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by me,which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employee.I understand that my failure to follow these may subject to serious financial risk. Initial C v 9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all applicable laws and requirement that govern owner-builders as well as employers.I also understand that the Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations. Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,the United States Small Business Administration,and the Florida Department of Revenues.I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.myforidalicense.com/dbpr/pro/cilb/index.htmi Initial �1r 11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the information that I have provided on this disclosure. Initial----"*- Licensed nitial ---"*-Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who does not have a license,the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit.A copy of the property owner's driver license,the notarized signature of the property owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 22' day of Se _ 20 lO By P `�V who was personally known to me or who has Produced there License or Lt Ce s'e as identifi ation. �Xfl• 3'Z I-Zo YAWYPRIETO MY(AMMISSION#FF 214031 d = EXPIRES:March 25,2019 Bonded 7h-Notary Publc Undenartters OWNER