RC-17-1095 Miami Shores Village Pelry .°a€ IC #14ln5ttflGton
10050 N.E.2nd Avenue NE
Werk ."� i [ on
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Permit SMtus:'APPROVW
FC^ORN�
Issue late 4 �4 t7` Expiration: 10/24/2017
Project Address Parcel Number Applicant
L74I NE 111 Street 1121360040070
Miami Shores, FL 33161-7047 Block: Lot: JOHN TISDELL
Owner Information Address Phone Cell
�l
=JOHNELL 74 NE 111 Street
MIAMI SHORES FL 33161-7047
Contractor(s) Phone Cell Phone Valuation: $ 625.00
HOME OWNER
_.__... .. - Total Sq Feet: 230
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Window Door Attachment
Date Denied: Framing
Type of Construction:REPLACE EXTERIOR TILES ON FR Occupancy:Single Family Insulation
Stories: Exterior: Drywall Screw
Front Setback: Rear Setback: Final PE Certification
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted:Yes Certificate Status: Review Building
Certificate Date:
Additional Info:REPLACE EXTERIOR TILES ON FR Review Planning
Review Electrical
Bond Return: Classification:Residential Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural
CCF $0.60 Review Mechanical
Invoice# RC-4-17-63755
DBPR Fee $2.00
DCA Fee $2.00 04/2712017 Credit Card $69.80 $50.00
Education Surcharge $0.20 04/20/2017 Credit Card $50.00 $0.00
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $119.60
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: certify at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni . Futhe ore,I aut4oriz ve-named contractor to do the work stated.
�- 1/ �Z� April 27, 2017
Authorized Signat ener.Ow / Applicant / Contractor / Agent Date
Building De airtment Copy
April 27,2017 1
r
Miami Shores Village 2x -F/®oaCk-t,j
AQP °1� Building Department
` 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 S{�
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20!1'
BUILDING Master Permit No. RC��— 1 C)
PERMIT APPLICATION sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL F]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
AIE- CONTRACTOR DRAWINGS
JOB ADDRESS:� JI E //( `7 i
City: Miami Shorties County: Miami Dade Zip:
Folio/Parcel#: / ] 3((00 V06 -7® Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER:Name(Fee Simple Titleholder):_ -3, I t��vc_ Phone#; 3°���7�G 6 17 Z
Address: �� NE- l& 67'. //--
City: MI Ayyi I _5 0/6?5 State: Zip: 3316 f
Tenant/Lessee Name: AJ 1A Phone#:
Email: --
CONTRACTOR:Company Name: IV/A Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
GG o�
Value of Work for this Permit:$ X • Square/Linear Footage of Work: >\ 0
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: REPLACE- i_:K E(z1,0rz_ 1 /-e-Ar C, pl;`J T�Jv�
Specify color of color thru tile:
Submittal Fee$ So on\dPermit Fee$ i n CCF$ D• L0 CO/CC$
Scanning Fee$ Radon Fee$ 2- DBPR$ Z Notary$
Technology Fee$ d VD Training/Education Fee$ _ !J • Z.0 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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 inspeZbepproved
' which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wil of 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
18 `1day
off• r-A ,20 '1 by day of ,20 by
zoh �-C 1 ,S&Nt who is personally known to ,who is personally known to
me or who has produced TAS4;?O� A-�_as me or who has produced as
identification and who did take an oath. 21212-010 identification and who did take an oath.
NOTAR BLIC: NOTARY PUBLIC:
Sign Sign:
Print: C Print:
Seal: Y ADYPRIETO Seal:
MY COMMI2019
SSION#FFCh 5 214031
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EXPIRES: 25,2019
Bond
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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06 L Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: + DATE: r
f Df�
ADDRESS:
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 1,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
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. I 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 riled 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.
Initial
5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction
Initial =0 9
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 "
t
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 workers on my property.
Initial-
B. 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 w'
9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,l 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 >y
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:/Avww.mvfloridalicense.com/dbpr/pro/cilb/index.html
Initial__
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:
�4 (\J:E I i 1 �S 'FL 33)�
Initial —"a
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 3
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 @ day of `� , 20 �
BYI��n �"�" rSA%(UL who was personally known to me or who has
Produced there License or :Pot Ss `e 2-12 ZOW as identification.
1 + ' YAWY M ETO
OWNER NOTARY My CONtluIISSION#I F 214031
. EXPIRES:Match 25,2019
•�,,R f ' Bonded ThN Notary Public Undorwdters
SORES
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Miami shores Village
logo Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
�L0 Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant, N , `S '�t� ,does hereby attest that
(Property owner
The attached survey, performed by D V Q !�-u e e -7—
(Name of surveyor's company)
For address: --74 /V"- M S ,
u
Performed on ' Z ' 120L3 (date of survey)is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
F her, ffiant say eth naught. f
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Pro erty Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this 20-t-�' day of
Affiant is personally known to me, produced ::D asspo �- as identificati
-exp Z121wzo
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otary
s,�'�"rv,••. YANADY PR
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MY COMMISSION#FF 214031
Revised(6/25/12)Revised on 5122/20091 Revised on 6/12109 •..• `°' BoEXPIRE :Maruh c ch 25,2019 ers
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, 2 N.w.7th STREET,BUTTE 202
PAMG.FLORIDA 33128 SURVEY NO.TELEPHONE,(388)
260.2880
FAX:(305)264.0229 (��
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SURVEYOR'S NOTE:
'there may be Easements recorded in the
Public Records not shown on this Survey
'llic pugiosc of this Survey is for use in obtaining•ritic Insurance
and financing and should not be used for Construction purpusc
5582 N.W. 7th STREET SUITE 202
(�J
TELMEPHONE�: (305)1220-3171 U �D SURVEY 3-0014485
No.
FAX (305): 264-02229 CCC
DRAW BY:l'oe'// LAND SURVEYORS SHEET No. / OF Z
Survey of Lot : 7 Block: 1
Subdivision: COLLEGE HEIGHTS
According to the Plat thereof as recorded in the Plat Book No. 42
at Page No. 8 of the public records of MIAMI-DADE County, Florida.
Property Address : 74 NE 111 ST, MIAMI SHORES, FL 33161
For: JOHN TISDELL Date: 12/08/200
LOCATION SKETCH Scale 1"= NT.S.
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ABBREVIATION AND MEANING LEGEN D T Y P I CAL
A- ARC F.F.E.- FINISHED FLOOR ELEVATION. P.R.C.- POINT OF REVERSE , . CLF-CHAIN LINK FENCE
A/C- AIR CONDITIONER PAD. F.N.D. FOUND NAIL& DISK . CURVE
A.E.- ANCHOR EASEMENT. FR- FRAME. P.B. PLAT BOOK. 727-7 C.B.S.WALL(C8W)
A/R- ALUMINUM ROOF. FT- FEET. PG.- PAGE. -0-0- IF=IRON FENCE
A/S., ALUMINIUM SHED, +j FNIP. FEDERAL NATIONAL PWY- PARKWAY. -0H- OVERHEAD UTILITY LINES
ASPH. ASPHALT. PRM- PERMANENT REFERENCE
B.C.- BLOCK CORNER.! ;; F.N.- FOUND NAIL MONUMENT.' VA-70 WF-WOOD FENCE
BLDG,- BULDINC, H.- HIGH (HEIGHT) P.L.S.- PROFESSIONAL LAND ■0.00 =EXISTING ELEVATIONS.
B.M.- BENCH MARK ItK&EG.- INGRESS AND EGRESS SURVEYOR.
B.O.O.- BASIS OF BEARINGS. y EASEMENT. R.- RECORDED DISTANCE. ®=PROPOSED ELEVATIONS.
C- CALCULATED G UP- LIGHT POLE RR.- RAIL ROAD.
C.B- CATCH BASIN. LF.E. LOWEST FLOOR ELEVATION. RES.- RESIDENCE.
C.B.S— CONCRETE®LOCK STRUCTUREL-M.E.- LAKE MAINTENANCE EASEMENT R/W- RIWT—OF—WAY.
CBW CONCRETE BLOCK WALL:. MINUTES. RAD.- RADIUS OF RADIAL S U R V E Y 0 R S ' S N O T E S_
CH- CHORD. M. MEASURED DISTANCE. R.P.- RADIUS PONT.
CH.B.- CHORD BEARINOL M/H- MANHOLE. RGE- RANGE. 1). IF SHOWN,BEAR INGS ARE RDMWIED TO AN ASSUMED
CL- CLEAR M/L- MONUMENT UNE SEC.- SECTION. MER0IAN.BY SAID PLAT IN TIE DESCRIPIION OF THE PROPERTY.F NOT,
C.L.F.- CHAIN LINK FENCE N.A.P.- NOT A PART OF. STY.- STORY. THEN BEARINGS ARE REFERRED TO COUNTY. TDWN$NIP MAPS.
C.M.E- CANAL MAINTENANCE NGVD- NATIONAL GEODETIC SWI.- SIDEWALK. y),IF SHOWN. ELEVATIONS ARE REFERRED TO
EASEMENTS. VERTICAL DATUM. S.I.P.- SET IRON PIPE L.B.
CONC. CONCRETE. N.- NORTH. /6044. BMS ELEV. FEET.
C.P. CONC. PORCH. N.T.S. NOT TO SCALE. S.- SOUTH. OF
C'&- CONCRETE SLAB. VNO.- NUMBER. '- SECONDS N.O.V.O. OF 1929.
D.E.- DRAINAGE EASEMENT. 0/S- OFFSET. T- TANGENT.
D.M.E.- DRAINAGE MAINTENANCE O:H.- OVERHEAD TWP-TOWNSHIP. 3). THIS IS A SPECIFIC PURPOSE SURVEY.
EASEMENTS O.H.L.- OVERHEAD UTILITY LINES UTIL• UTILITY.
DRIVE- DRIVEWAY OVH- OVERHANG U•P.- UTILITY POLE 4). THE CLOSURE IN THE BOUNDARY SURVEY IS
•- DEGREES. PVMT. PAVEMENT. W.M. WATER METER. ABOVE 1:7600 FT.
E- EAST. PL- PLANTER W.F.- WOOD FENCE I HEREBY CERTIFY: THAT THIS 'BOUNDARY SURVEY
E.T.P.- ELECTRIC TRANSFORM�p PAD P/L- PROPERTY UNE W. WOW SHED. OF THE PROPERTY DESCRIBED HEREON. AS
ELEV.- ELEVATION. PA
- PONT OF COMPOUND CURVE W/R- WOOD ROOF, RECENTLY SURVEYED AND DRAWN UNDER MY
ENCR.- ENCROACHMENT. P.C.- PONT OF CURVE. Q- CENTRAL ANGLE, SUPERVISION, COMPLIES WITH THE MINIMUM
F.H. FIRE HYDRANT. PT.- PONT OF TANGENCY. - CENTER UNE THE FLORIDA
O I STANDARDS AS SET FORTH BY
PROFESIONAL
F.I.P.- FOUND IRON PIPE POC,- PONT OF COMMENCEMENT. -0C - ANGLE. SURVEYORS IN CHAPTER 6 6FLORIDA�P
F.I.R.- FOUND IRON ROD. POB.- PONT OF BEGINNING. ADMINISTRATIVE CODE PURSUANT
LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY (SURVEY): TO 472.027, FLORIDA STATUTES.
THERE MAY BE EASEMENTS RECORDED IN THE PUBLIC RECORDS NOT SHOWN ON THIS SURVEY
s
THE PURPOSE OF THIS SURVEY IS FOR USE IN OBTAINING TITLE INSURANCE AND FINANCING AND
SHOULD NOT BE USED FOR CONSTRUCTION PURLS
EXAMINATIONS OF THE ABSTRACT OF TITLE WILL(HAVE TO BE MADE TO DETERLONE RECORDED
INSTRUMENTS,F ANY, AFFECTING THE PROPERTY. THIS SURVEY IS SUB.ECT TO DEDICATIONS, BY:
LIMITATIONS. RESRICTION
TS, RESERVATIONS OR EASEMENTS OF RECORD. LEGAL DESCRIPTIONS
PROVIDED BY CLIENT OR ATTESTING 711LE COMPANY. (V,5tV Z6F BARRA (DATE OF FIELD WORK)
B0tNDARY SURVEY MEANS A DRAVANO AND/OR A GRAPHIC REPRESENTATION OF THE SURVEY WORK /Z-v✓
PERFORMED IN THE F1110, COULD BE DRAWN AT A SHOWN SCALE AND/OR NOT TO SCAN PROFESSIONAL LAND SURVEYOR NO.
EASEMENTS AS SHOW ARE PER PLAT BOOK,UNLESS OTHO MSE SOW
THE TERM 'ENCROACHMENT' MEANS VISIBLE AND ABOVE GROUND ENCROACHMENTS. STATE OF FLORIDA (VAUD COPIES OF THIS SURVEY WILL BEAR
ARCHITECTS SHALL VERIFY ZONING REGULATIONS, RESTRICTIONS AND SETBACKS AND THEY WILL THE EMBOSSED SEAL OF THE ATTESTING_LAND SURVEYOR).
BE RESPONSIBLE OF SUBMITTING PLAT PLANS Y47H THE CORRECT INFORMATION FOR THEIR
APPROVAL FOR AUTHORIZATION TO AUTHORITIES IN A NEW CONSTRUCTIONS, UNLESS OTHERWISE
NOTED, THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTING AND/OR FOUNDATIONS. REVISED ON:
FENCE OWNERSHIP NOT DETERMINED.
THIS PLAN OF SURVEY, HAS BEEN PREPARED FOR THE EIIUSVE USE OF THE ENTITIES NAMED
HEREON. THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY. REVISED ON:
THE FNIP FLOOD MAPS HAVE DESIGNATED THE HEMNN DESCMBED LAND TO BE
FN'Situated in Zone: X Community/Panel/Suffix: 120652-0093-J
Date of Firm: 07/17/1995 Base Flood Elevation:
Certified to: JOHN TISDELL
FLORIDA TITLE EXPRESS E
ATTORNEYS TITLE INSURANCE FUND, INC.
FLAGSTAR BANK , FSB, ITS SUCCESSORS AND/OR ASSIGNSAL
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