PW-17-1247 L rF
e NO PW
Miami Shores Village � � �� F t }?/Jet;Pti 41ow CS
�.� 10050 N.E.2nd Avenue NE tt1ti SSf�lot3.PI1)}) 'WO
�
Miami Shores,FL 33138-0000 rm
Phone: (305)795 2204 �f,91 JflStatttS ,#PPRE3VED
Issue 0*� f2012017 Expiration: 09/18/2017
Project Address Parcel Number Applicant
271 NE 101 Street 1132060134810
Miami Shores, FL 33138- Block: Lot: ALEXANDRA SELZER
Owner Information Address Phone Cell
ALEXANDRA SELZER 271 NE 101 Street 305/446-0500
MIAMI SHORES FL 33138
271 NE 101 Street
MIAMI SHORES FL 33138
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
HOME OWNER
_..... _........ Total Sq Feet: 600
Scanning:3 Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.00
Invoice# PW-5-17-63934
DBPR Fee $0.00 06/20/2017 Credit Card $ 110.00 $0.00
DCA Fee $0.00
Education Surcharge $0.20
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $110.00
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 at all the egoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio nd oning. Futh e,I oriz the above-named contractor to do the work stated.
June 20, 2017
Aut orized Signature:Owner Applicant / Contractor / Agent Date
Building Department Copy
June 20,2017 1
010 RECEIVED
-�- Miami Shores Village MAY - 5 2017
Public Works Department
(305)795-2210
Public works forms are available from the building department,10050 NE 2nd Ave.,Miami Shores,FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property
Permit#: -ALA-0
" 1
Name of Applicant if utility see below):
—Sh�✓Q � s ��� ��-
pp ( tY )
Owner off the following described property:
Legal Description:Lot Block Subdivision
Folio#; 22i
Address: - �, ✓J13
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency#
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency#:
Reques s permi Sion to Inst I`describe ork,attach cepa top a if necessary)' e adjoining right of
wa : � �z_11 � l vG�l I/i
Type of Work: ESC Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER:Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration#:
Value of Work for this Permit: $ Square/Lineal Footage of Work:
***** Fees *****
Permit Fee$ 100.00
Notary$ Training/Education$0.20 Technology Fee$0.80 Scanning$
Bond$ (if required) Total Fee Now Due$ 1 1 0 - �
T
Bonding Company's Name(if applicable):
Bonding Company's Address:
City: State: ZIP:
Application is hereby made to obtain a public works permit to do the work in the right of way 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,regulation construction in
this jurisdiction. l understand that separate permits must be secured for
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with applicable laws regulating construction and specifically construction in the
right-of-way.
"WARNING TO APPLICANT:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value
exceeding$2,500,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 the
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 public works permit is issued. In the
absence of such posted notice,the inspection will not be approved and a reinspection will be charged.
&ao
30�
Signature Signature
A plicant or Authorized A nt Company/Utility Agent
The foregoing in trument as ac k owledged before The foregoing instrument was acknowledged before
me this d of 0 20_,by me this day of 20 by
who who
is personally kno rn to me or who has produced is personally known to me or who has produced
I&(MM-N[C 2T-_ias as
identification.+AOY1C1G 11ce"Se. identification.
NOTARY PUBLIC: NOTARY PUBLIC:
Si Sign:
Print: Print:
SEAL: ;=a;'"�'°'��. MAHARAI K.GONZ4 EZ SEAL:
My COMMISSION#GG 044602
.0- EXPIRES:November 2.
vemb2020
ke� oP Boded Thiu Notary Public Umerwriters
APPROVED BY: Public Works Director,or Designee
2017-04-15
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
R Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
;DOWNER BUILDER DISCLOSURE STATEMENT
NAME: > UI {�U ✓ DATE:
ADDRESS: ol
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 � .
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 andcontracts.
Initial 5'
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
S. I 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 andby county or municipal ordinance.
Initial A'1�.
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.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. f�
Initial ZI •S.
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. A
Initial
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.mvfloridalicense.com/dbpr/pro/cilb/index.html
Initial�O
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 responsi le for the proposed construction activity at the following address:
all 'i�E 10 e-A
Initial �' v
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of thein rmation 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 -� day ofIA. 20
By,�(`�, (r',� Y� Sckz— ZY who was personally known to me or who has b" t•,,.
$ID
t^ Z
Produced the icen or -CH "V as identification. Z y
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4b O
OWNER NOTARY N
C.I Lr� 11111111111111111111111111111111111111111 3111
Miami Shores Village C N 20 e 17R 1301357
►•• t ••••• Building Department OR er 30551 F°3 1419 Qpgsi
�,. 10050N.E.2nd Avenue RECORDED 05/30'/2 f1 ? 11-374-26�e HARVEY F'iJ� IVY CLERK OF C:1 URT
�LORIDp Miami Shores, Florida 33138 V�,T MIAMI-DARE COaUNTYY FLORIDA
Tel: (305) 795.2204 � FL str°�
Fax: (305) 756.8972 P �y, f
A-D oa
COVENANT OF CON �TRUCTION !IMHIN RIG T OF ° l� amwr
Whereas, (owner) S 4YOV6 — - ®C
hereinafter referred to as tb o1q f 4to
Homing described
RT-RUGER 91722U
property (address): 1N1.-. U
Legal Description: Lot Block Subdivision
Folio #
Regjje is permission to isn t )1( escribe work): m
GOA V �Q)1
Within the public right of way of (address)
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the
dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to
make repairs or maintain said items within public right of way including restoration of street by
reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall
constitute a lien against the above described property until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County
harmless from any and all liability, which may rise by virtue of permitting the installation of
these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,
within 60 days notice by the Village to do so. Failure to comply with this notice will result in the
Village causing the item(s) to be removed and a lien being placed on the property and/or
assessed against the Owner for all costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running
with the land and shall remain in full force and effect and be binding on the undersigned, their
heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in
the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village
(or his fully authorized representative).
Signature
Owner or Agent
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this day of , 20 , by
who is personally known to me or who has produced
1 as identification.
OTARY PUBLIC:
?��voCr
Sign:
Print: 'i MY COMMISSION#GG 044602 SEAL:
=w ;zc
Bonded Thru Notary Public Underwriters
BOUNDARY AND TOPOGRAPHIC SURVE'
- - - - - - - -- - -- - - -- - -- - - -- - - -- - -1 - -
15' ALLEY
9' PAVEMENT
F.N. � o F.N.
NO ID. NO ID.
0.60'
j I
�+ C7
�lb EAST HALF OF
v ® ::Ev( GfiEI o,° LOT 20
18.3' POOL of
I
10.05' 126'
> -< A/C W N ,ri 13.7'
2 c! 4J� Q N
O M
I> LEI I I I I I I I
'77 �
I
O "V o 46
> J 46o
z > 't 24.1' O
ONE STY. C.B.S. M = I
RES. N®.271 4 0' 03' {
F.E.=12.42 71 F L
0.42' 9.95' 20.2' P
o [:]H TER {
N 0.64'
ih N
� I
t7.4' I
I
F.I.P. 01/2" 00�� �95�. F.I.P. 01/2" I
NO ID. cP `�S. NO ID.
17 .
JU 2� 5' SWK -
;�
M ; M
10
' _ _ _ _ _
NE. 101st STREET °
20' PAVEMENT J N 9- 0 2911
MIAMI SHORES VILLAGE
is
1 . . Lu
PROPERTY ADDRESS: 271 NE. 101st STREET, MIAMI SHORES, FLORIDA 33138 �� �
g
111Mdi
LEGAL DESCRIPTION a a 0 0 a 0 a a 0
� 4
c3 � p,lc No�&
LOT 19 AND THE WEST # OF LOT 20, IN BLOCK 35, OF OF MIAMI d I
SHORES SECTION No. 1 AMENDED, ACCORDING TO THE PLAT THEREOF,
AS RECORDED IN PLAT BOOK 10, AT PAGE 70, OF THE PUBLIC
RECORDS OF MIAMI—DADE COUNTY, FLORIDA.
z
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6H
a a 0 0 a 9 a a a
�a951 7�
NE. 102nd STREET h 8
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z9 8 7 6 5 4 3 2 1 �
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N r7 viraiddd
z 13 15 1 20 21 22 23 z s 12,:! a a a
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NE. 101st STREET C W
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LOCA11ON SKETCH — "911liqV
N.T.S. 9 =oay
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NOTES: CO
—THE EXPECTED USE OF THE LAND, AS CLASSIFIED IN THE STANDARDS OF PRACTICE <
(51-17 FAC), IS 'RESIDENTIAL". THE MINIMUM RELATIVE DISTANCE ACCURACY FOR THIS TYPE
OF BOUNDARY SURVEY IS 1 FOOT IN 7,500 FEET. THE ACCURACY OBTAINED BY MEASUREMENT
�D/2 W' FELL IND DENTIFIED FEATURE CLOSED°DEPIcCT'TED ON FIGURE SKETCH FOUNDWEREE MEASURED TO TO THIS ESTIMATED� T gig
HORIZONTAL POSITIONAL ACCURACY OF 0.1 FEET. n
OCK —SDS SHOWN HEREON WERE NOT ABSTRACTED, THEREFORE THIS SURVEY IS SUBJECT TO
RNER EASEMENTS, RIGHT OF WAYS. AND OTHERS MATTERS WHICH MIGHT BE REFLECTED IN A FLOOD ELEVATION INFORMATION: a
SEARCH OF TITLE TO THE SUBJECT LANDS. c c�
—NO ATTEMPT WAS MADE TO LOCATE UNDERGROUND FOOTINGS OF ANY STRUCTURE. DATE or FIRM: 09-11-09 a a a a e a a a a
—THIS SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITY(ENTITIES) vi d
NAMED HEREON IN THE CERTIFICATION AND DOES NOT EXTEND TO ANY UNNAMED PARTY COMMUNITY No: 120652 a a I 1 5
—ELEVATIONS ARE REFERRED TO NATIONAL GEODETIC VERTICAL DATUM (1929) PANEL: 0302 SUFFIX: L
MIAMI—DADE COUNTY BENCHMARK No.N-397—R; LOCATOR No.3100; ELEVATIONm10.12' ZONE: x BASE FLOOD ELEVATION: N/A
ANTONIO FIORE ""'°cam OF7H1SSURVEY
BEAR E]dlD SEAL
OF W4T7p_MW-UND_SUWrrYOR
LAND SURVEYOR LAND PLANNER
1842 S.W. 124th Place, Miami, Florida 33175 - -
Phone: (305) 221-3040 Fax: (305) 221-9040
antonloflorepsm@jmail.com `7
I HEREBY CERTIFY THAT TENS BOUNDARY AND TOPOGRAPHIC SURVEY OF THE PROPERTY —
DESCRN3ED MOM IS TRUE AND CBCT TO THE BEST OF MY KNOWLEDGE AND BELIEF
AS RECENTLY SURVEYED AND DRAVM UNDER MY SUPMSION.THUS SURVEY OMIPUES
KITH THE STANDARDS OF PRACTICE SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL ANTONIOFIORE—
LAND SURVEYORS IN CHAPTER SJ-17 FLORIDA ADMINWRATIVE CODE.PURSUANT TO PROFESSIONAL SURVEYOR AND MAPPER No. 5194
SECTION 427.027 FLORIDA STATUTES. STATE OF FLORIDA
[:SCALE.- 1"=20'=DRAWN BY: F.A.L. 05-31-08FIELD BOOK: 17-0227 DATE: 01-46==17