FW-17-708 V'V4 \1-1013
� T/,&/,7 .
TO
Miami Shores Villager " ,P #7t# ? 'FQ11>
10050 N.E.2nd Avenue NEy
Wca, f� 11ood.F [1CO
Miami Shores,FL 33138-0000
PROVED
Phone: (305)795-2204
R Issue date �/1612ti17 Expiration: 09/1212017
Project Address Parcel Number Applicant
70 NE 96 Street 1132060130620
KENNETH LANGE NORA LANGE
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
KENNETH LANGE NORA LANGE 70 NE 96 Street
MIAMI SHORES FL 33138-
70 NE 96 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,800.00
HOME OWNER
Total Sq Feet: 102
Approved: Available Inspections:
Comments:
D : Inspection Type:
Date Approved:
Final
Date Denied: Foundation
Type of Construction:Wood Fence Additional Info:replace west and east wood fence Review Planning
Classification:Residential Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# FW-3-17-63329
DBPR Fee $2.00 03/16/2017 Credit Card $73.20 $50.00
DCA Fee $2.00
Education Surcharge $0.40 03/16/2017 Credit Card $50.00 $0.00
Notary Fee $5.00
Permit Fee-Wire&Wood $102.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $123.20
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-named contractor to do the work stated.
�,�� March 16,2017
Authorized Sign re:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 16,2017 1
{
Miami Shores Village �=
M Ai ;
Building Department
Fr Q/tA
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
BUILDING Master Permit NoTIA1 11
PERMIT APPLICATION Sub Permit No.
E9`BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0O /j 1& 5
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes U/ NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
N0tzA Lr�4Aj Cz _
OWNER:Name(Fee Simple Titleholder): k FE Il L r� N G E Phone#: 30 — 7 6-1 - EI
Address: 70 tjC 9t, 57—
City: M► .A m 'Skl cry E 5 State: F Zip: '33-1.3 9
Tenant/Lessee Name: Phone#:
Email: '�i C..in
fPW LM 6 fLcv.CzH.fie A_. .-coti
CONTRACTOR:Company Name: ouj ja a aa L 66W 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:$ I '00 Square/Linear Footage of Work: i oil
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ElDemolition
Description of Work: Re PL:t1,C.iW 60 e:�,j 4&�® C- a:rL r jd r1jj 4 i=j=_*Aj,( , mss' /e F a A S i '6'n
Specify color of color thru tile:
Submittal Fee$ I Permit Fee$ CCF$ 117-(2 CO/CC$
Scanning Fee$ Radon Fee$ Z_ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ 4o_Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ ^Z l6
(ReAsed02/24/2014)
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 1N412-A Lag ri end ��4Signa re
OWNER or AGENT CONTRqCTOR
The foregoing instrument was acknowledged before me this The foregoin ' strument was acknowledged before me this
day of Al A 2C_0 20 /-1 by day o 20 by
NLS- L'P�V .who is personally known to who is personally known to
me or who has produced P— peiyr{� as me or who has produced as
identification and who did take an oath. ���liY019fI61/Odi9 identification and who did take n oath.
NOTARY PUBLIC: a�X \�\,••'pp� s/SS NOTARY PUBLIC:
• �archs o2 �y
y0 TO'Iro
Sign: = F �-°: = Sign:
Print: a 4'aPn _�x Print:
®P ndenvriteR Q, ���
Seal: tee``°,STgT•....���p`\�� Seal:
APPROVED BY I I 1 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
0 Miami Shores Village
a„ Building Department
10050 N.E.2nd Avenue
Rm�'y Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: ()9A CAN GF DATE: /SB a -7
ADDRESS: '70 AJ 1?6 ST Ml'Gt ml 61--1® 17—C- S /—1 u'31 3�
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.
Initial `p ..
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 --A .
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 III. 4, ,
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.
Initial
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.
4
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.1,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 r workers on my property.
Initial-
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 `7h . 1�
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-'-h . _�- .
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.mvfioridalicense.com/dbpr/pro/cilb/index.htmI
Initial -e
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 -n 6z
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 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 r5 da of r , 20
�����,' XPIRES•'•bO`��
ztGo
p� I =w; s / m SU-=
By i V � who was personally known to me or who has
;�\�Ol�yi�`; �''mid °•. ��:��V\`�
Produced there License or ��� as identifi tft=tit .a 'ii,,, B ioi�+� �`�a�
y:yam
�, WNER NOTARY �s'•`.rsrvy�ti
psis'/�It�_
♦SORES Df
Miami shores Village
Evil
Building Department
10050 N.E.2nd Avenue
�lOR1DA Fences Good Side Out. The vertical and horizontal Miami Shores, Florida 33138
supporting members of a fence shall face the Tel: (305) 795.2204
interior of the plot on which the fence is located Fax: (305) 756.8972
and the finished side shall face the adjoining
lot or any abutting right-of-way.
WOOD FENCE DETAIL 9°. ,••,,,
Shadow Box "':" •• °• ••••••
❑ Vertical Picket •,•, •.
❑ Board on Board •'••°•
Fences < = 6' high posts spaced at 4' on center maximum .,.°°° *eve•
Fences < = 5' high posts spaced at 5' on center maximum •
Fences < =4' high posts spaced at 6' on center maximum ••• :"
•
Fence must not exceed 6' in height •• ••• +
Fence Good Side
Out.The vertical 1x pickets fastened
and horizontal with two corrosion
f resistant fasteners per
supporting connection
members of a
fence shall face
the interior of the
plot on which the 2x4 horizontal
fence is located
pressure treated
and the finished wood members
side shall face the with two corrosion
adjoining lot or TXresistant fasteners
any abutting right- per connection
of-way.
4x4 pressure treated
posts embedded 2'into
concrete footing 10"
diameter x 2'deep
ALL wood must be pressure treated
All fasteners must be corrosion resistant
No less than two fasteners in any connection
Revised 10/14/2016AS
n"
LOCATION SKETCH
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4 ':c{ ;ac; . •• -90 .
Property Address:70 NE 96 ST, Miami :••.:• •
Shores, FL.33138 •
I RII ' '..' . ... • • •
m 142.50 (FSM)
j I Legal Description: Lot 3 and Lot 4, Block
rn
o j 5,of MIAMI SHORES,SECTION 1,
according to the Amended Plat thereof,
ABBREVIATIONS:
swc=Slo Ce _ 10 as recorded in Plat Book 10,at Page 70,
EVv4LIS S�Ol1CRE7ESLOCKSTRUCTURE CLF�HAINUNKFENCEPL-PROPERTY UNE•DUE=ORAINAGEUiILfIYEgSEMEWE Ip=IRONPIPE
• - O_ ' T�0
F=FOUND,AIC=AIR CONDmONER PAD,PIC=PROPERTY CORNER,DIH�RILLED HOLE•N9F=iAD00EN FENCE RES=RESIDENCE CL CLEAR RB=REBAA o NZ of the Public Records of Miami-Dade
UE=UTILITY EASEMENT, CONC--CONCRETE SLAB, RAM1cRIGHT OF YJAY, DE=DRAINAGE EASEMENT C/L=CFNTEA LINE, 0=0IAM �•tV
! TER,TYP=TYP1cAL, - County, Florida.
M=MFJISUREO.R=RECORDED,ENCR=ENCROACHMENT COMP=CONFUTER,ASH=ASPHALT•NID=NAIL&DISC,S=SET•FEE=FINISH FLOOR ELEVATION,
01S=OFFSET•P/P=PON,ERPOLE,OHP-OVERHEAOPOWERUNE,VMI=MTERMETER n `'�� �� _
MASONRrW4LL= ELEVATION BASED ON LOC.# _Co
.'r,t•.v,t•-t,•::t;.�•t:.•,••t :•-t,v..t,:.
NOT VALID UNLESS EMBOSSED Y{tITH 1,1511111
MAINTENANCEgDFWNAGEEASEMENT=M&D.E. CBM# EW TYPE OF SURVEY:BOU14DARY SURVEY
— SURVEY-ETR'-S-SEAL, -- t I HEREBY CERTIFY That the survey
• .represented SINCE 1987
- SURVEYOR'S NOTES: 1)- OWNERSHIP SUBJECT TO OPINION OF TITLE. 2)NOT VALID WITHOUT THE SIGNATURE' thetean meets the minimum technical requirements BLAIVGO SURVEYORS INc.
ANIL AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER 3) THE SURVEY DEPICTED HERE IS NOT adopted by the STATE OF FLORIDA Board of Land
— s COVERED;BY PROFESSIONAL LIABILITY INSURANCE, 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. . 5). Surveyors pursuant to Section 472.027 Florida Engineers•Land Surveyors•Planners-LB#0007059
UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC Statutes.
VERTICAL:DATUM OF 19,29_ 7) OWNERSHIP. OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL. There are no encroachments, overlaps, easements 555 NORTH SHORE DRIVE
s RESTRICTIONS NOT SHOWN ON THIS SURVEYTHATMAY BE FOUND IN THE PUBLIC RECORDS OFTHIS COUNTY,.9) appearing an the plat or visible easements otherthan MIAMI BEACH,FL 33141
CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORT( FOR BUILDING AND ZONING asshownhereon. (305) 865-1200 Email:blancosurveyorsinC9yahc,6,c0m Fax: (306)865-7810
INFORMATION. 10)EXAM INA71ON OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED
REVI�ED: INSTRUMENTS,IFANY,AFFECTINGTHIS PROPERTY-
Additions or deletions to survey maps or report FLOOD ZONE:}( SuFFDc:� DATE:
s by other than the signing p9/11/O9 BASE: N/A
arty or parties is prohibited 120652
without written consent of thesigaingparty orparties. AAU�_- PANEL: 0302 COMMUNITY#
BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE.09-JAID fes= REGISTERED LAND SURVEYOR DATE: SCALE DWN.BY: JOB No
PAGE STATE OF FLORIDA#5924 9/30/16 1n=2a P.51ancc 16-801