DS-16-1487Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
D -5-.
ays►Sidewaks
7c Classificatkin: New:
pus APPROVED
Parcel Number
Expiration: 05/14/2017
Applicant
349 NE 102 Street
Miami Shores, FL 33138-
1132060135080
Block: Lot:
CELINE TERRY
Owner Information
Address
Phone
CeII
CELINE TERRY
349 NE 102 Street
MIAMI SHHORES FL 33138-
(954)610-1561
349 NE 102 Street
MIAMI SHHORES FL 33138 -
Valuation:
Total Sq Feet:
$ 700.00
51.60
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Work: STEPPING STONES/CONCRETE TILES PL Additional Info:
Bond Return :
Scanning: 3
Classification: Residential
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$5.00
$100.00
$9.00
$0.80
$119.60
Pay Date Pay Type Amt Paid Amt Due
Invoice # DS -5-16-59973
11/15/2016 Check #: 1905 $ 119.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
Review Planning
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
constructiorjPaiQd zoing. Futhermore, I authorize the above-named contractor to do the work stated.
orized Signature
/ Applicant / Contractor / Agent
Building Department Copy
November 15, 2016
Date
November 15, 2016 1
I 1(0
BUILDING
PERMIT APPLICATION
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
FBC 21304
Master Permit No f `t 1
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 3'1
02- Si . (V1.111L,re; l 33131'
City: Miami Shores County: Miami Dade Zip: 3 .) I33
Folio/Parcel#: Is the Building Historically Designated: Yes NO Y.
Occupancy Type: Load: Construction Type: Flood Zone: ili 0 BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Ce (t 10'e Sl'\J 'vAc,e Phone#: CI 5 'f - oO -6-6/
Address: 3`'i 1 Ne 10 ,
City: 'Mk C i(Y\ 1 S'V1 brea State: 'T Zip: 3 3 '3(
Tenant/Lessee Name: Phone#:7 Z/ 6/ `-' I S(,/
Email: tlPit' 5G{u.vt. y C_' itA- f ct( • (l,.f
CONTRACTOR: Company Name: Cell' 1,e_ (Uwt4Pr)
Address: SC( c+. ,- s.c 10; v'Q.._
City: ' State: Zip: `'
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: 0 01A -e Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ -TOO Square/Linear Footage of Work: . C )( 11- ._CA
Phone#: ?Sy —6(O' 6/
Type of Work: ❑ Addition ❑ Alteration ❑ New I ,/f ❑ Repair/Replace ❑ Demolition
Description of Work rPS-lvkeS/Co vt Crd'% 11 ks P 1 a �'PG'� a►�i So ' I — n 6} ixe it (Liz A - V.1
Specify color of color thru tile: C a i Cre -' Co(Or /p' y
Submittal Fee $ 0CC —
Permit Fee $ / CO CCF $ • (O 0 colas
q
Scanning Fee $ ` Radon Fee $ 2- DBPR $ -- //^^���Notary $
Technology Fee $ 0 Training/Education Fee $ a Z tJ Double Fee $
Structural Reviews $ Bond $ 0
TOTAL FEE NOW DUE $ / / Co 0
(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 $2S00, 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 / VV\I �� ,j�Signature
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�(3 dray of MA'?
, who is personally known to , who is personally known to
, 20 ' , by day of , 20 , by
me or who has produced F t.._brd \ R lACJ. NS as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
l -P FAX (C2 7.
Seal: o #1 ooei Notary P„oiic State of FondalnSindia Alvarez
�� o¢ My Commission FF 156750
v4'or0o¢` Expires 09103/2018
**********+ is '7+4)&kkg)k >M"A��N' Y*Y7eiii' **i****************************************** ******** •3# **
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
J IV/ I
Zoning
Clerk
k
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: C e 4 D ne_ --17f' r j DATE: MR1 25/ 2 O( L
ADDRESS:341g 1\JC `c 2- I�f 601; J�('lb't3 FL -l J 3/3 2)--.1
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 las 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. I 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.
Initis
2. I 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 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 0.,,
4. I 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 0 Y(r
5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
Initial
6. I 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
d
w
7. I 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.
Initial
8. I 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 n
9. I 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 C
10. I 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 htt,://www.mvfloridalicense.com/dbpr/pro/cilb/index.html
Initial 115)7
11. I 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:
3 i Me (0L 34 . M I otri6
Initial
12. I 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 OW
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 3 ( day of MfM , 20
By Q J t\K -1 i
who was personally known to me or who has
Produced there License or —D -12-0,„K c fir`° sT. as identification.
"A","^",
4.0
Po*
Notary ?auric State of Florida
Sindia Alvarez
My Commission FF 156750
Expires 09/03/2018
NOTARY
231316 P MI
37.50'
3750'
NOT VALID UNLESS EMBOSSED WITH
SURVEYOR'S SEAL
REVISED.
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LOCATION SKETCH
SCALE: NTS
N.E. 3rd AVENUE
98. 30.10
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114.90'(R&M)
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23.05'
AIC
17.35'
21.60'
2
0.70'
4 50'
27.60'
114.90'(R&M)
SO.L.F
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ABBREVIATIONS.
SWC.SIDEWLLK. CBS•CONCRETE BLOCK STRUCTURE. CLF.CHAIN LINK FENCE. PL.PROPERTY LINE, POEM:MANAGE UTILITY EASEM ENT IPMRON PIPE.
F.FOUN0. A/C.A1R COMMONER PAD. P/ .PROPERTY CORNER 0)1.000100 HOLE. WF.NOODEN FENCE. RES.RESIDENCE, CL -CLEAR. R0•REBAR.
UE.UTIUTY EASEMENT. CONC 000406ETE SLAB. RDWRIGHT OF WAY. DE.DRAR4AOE EASEMENT CIL.AM
CENTER LINE. 0.DITER. TYP.TYPICAL.
M.MEASURED. R.RECORDED. ENCR.ENCROACHMENT. COMP.COMPUTER. ASAU.ASPHALT. N)O.NAIL & OISC. S.EET FEE.FINISX FLOOR ELEVATION.
O)S.OFFSET. PIP.ROY ER POLE. OHP.OVERHEA0 PONERLINE. NM.VA TER METER
NOOD FENCE.
MASONRriN 1.1 11 1 I I r I I I ELEVATION BASED ON LOC. # 3100
MAINTENANCE DRAINAGE EASEMENT.M&D.E I CBM#N-397 ELV. 9.80' TYPE OF SURVEY: BOUNDARY SURVEY
SURVEYOR'S NOTES' 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE
AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT
COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5)
UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC
VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL
RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 9)
CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING
INFORMATION. 10) EXAMINATION OF THE ABSTRACT OFTHLE WILL HAVE TO BE MADE TO DETERMINE RECORDED
INSTRUMENTS. IF ANY, AFFECTING THIS PROPERTY.
Additions or deletions to survey maps or reports by other than the signing party or parties is prohibited
without written consent of the signing party or parties.
BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB PAGE
0
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1.30'
ENCR
PROPERTY ADDRESS: 349 N.E. 102ND ST., MIAMI SHORES, FL. 33138.
10 ;Ct,lr'IJr`I`ICE WI f1-1 ALL FEDERAL
0.1N ,r,;';
(r1 L_5, .._, �rIC r
LEGAL DESCRIPTION: LOT 18 & THE WEST 1/2 OF LOT 19
BLOCK 37
•
•
•
••
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•
OF AMENDED PLAT OF MIAMI SHORES SECTION 1 SUBDIVISION
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 AT PAGE 70
OF THE PUBLIC RECORDS MIAMI—DADE COUNTY, FLORIDA
I HEREBY CERTIFY That the survey represented
thereon meets the minimum technical requirements
adopted by the STATE OF FLORIDA Board of Land
Surveyors pursuant to Section 472.027 Florida
Statutes
There are no encroachments, overlaps, easements
appearing on the plat or visible easements other than
as shown hereon. _
ADIS N. NUNEZ
REGISTERED LAND SURVEYOR
STATE OF FLORIDA #5924
SINCE 1987
BL.ANGO SURVEYORS ING.
Engineers • Land Surveyors • Planners • LB # 0007059
555 NORTH SHORE DRIVE
MIAMI BEACH, FL 33141
(305) 865-1200 Email: biancosulveyorsIrrc yahoo;com Fax: (305) 865-7810
FLOOD ZONE: %
PANEL: 0302
SUFFIX: L DATE:9/11/09 BASEN/A
SCALE:
COMMUNITY# 120652
OWN. BY.
F
DAl'E;. /13
J1"=20' F. Blanco
JOB No
13-164
Mission:
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts.
HEALTH
Vision : To be the Healthiest State in the Nation
Rick Scott
Govemor
Celeste Philip, MD, MPH
Surgeon General and Secretary
July 14, 2016
Celine Terry
349 NE 102 Street
Miami, FL 33138
RE: Contingency Letter
Application Document No: AP1246891
Centrax Permit Number: 13 -SM -1693157
OSTDS Number:
349 NE 102 St
Miami, FL 33138
Lot:18 Block:37 Subdivision: Miami Shores
Dear Applicant:
This will acknowledge receipt of an application dated 07/05/2016 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
From a review of your completed application, it has been determined that your existing system
appears to meet the minimum standards of F.A.C. 64E-6'for the proposed use. It is approved
for use with the plans submitted to this office. If this system should fail, causing an unsanitary
condition to exist, steps must be taken to bring the system into compliance immediately.
Department approval of the system does not guarantee satisfactory performance for any
specific period of time. Any change in material facts which served as a basis for issuance of
this approval requires the applicant to modify the permit application. Such modification may
result in this approval being made null and void. Issuance of this approval does not exempt the
applicant from compliance with other Federal, State, or Local Permitting required for
development of this property.
NO OBJECTION FOR PAVERS ADDITION IN BACK YARD
If you have any questions on this matter, please call our office at (305) 623-3500.
Sincerely,
Gerard Philizaire, Engineering Specialist II
Florida Department of Health
in DADE COUNTY
1725 NW 167 St, Opa Locka, FL 33056
PHONE: (305) 623-3500 . FAX: (305) 623-3645
www.FlorldasHealth.com
TWITTER:HealthyFLA
FACEBOOK: FLDepartmentofHealth
YOUTUBE: fldoh