DS-19-2289Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: DS -09-19-2289
Permit Type: Driveways/Sidewalks/Slabs
F—I(IP [Xul-u Work Ctassifcaffo New
Permit Status: Approved
Usue Date: 10/07/2019 1 Expiration: 04/06/2020
Parcel Number
30 NE 93RD ST, Miami Shores, FL 33138 1132060130200
Contacts
Jude Faccidomo Owner HOME OWNER Contractor
30 NE 93 ST, Miami Shores, FL 33138 HOME OWNER
Business: 3057257598
Description: PLAIN CONCRETE DRIVEWAY TO REPLACE
PERMIT#DS-01-19-128
REPLACED DS -01-19-128
Please take a look at the approved plans. Make sure slab
Fees Amount
50% Renewal Fee $25.00
Application Fee - Other $50.00
Total: $75.00
Valuation: $ 5,000.00 Inspection Reuests:rTS--762-4,9491
Total Sq Feet: 10500.00
Payments
Date Paid Amt Paid
Total Fees
$75.00
Check # 1608
10/07/2019 $25.00
Credit Card
09/30/2019 $50.00
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of thisp , I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the ans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepti this permit I assume respons' ility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are requj d r ELECTRICAL, PLUMBIN ,MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNER I certify that all a foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulatin nstruc on and zoning. F ermore, I authorize the above named contractor to do the work stated.
Authorized Signafgre: Owner / Applicant / Contractor / Agent
October 07,
Date
Page 2 of 2
Miami Shores Village
"T
Building Buildin Department
g p
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
F --]BUILDING ❑ ELECTRIC ❑ ROOFING
Master Permit No
Sub Permit No.
RECEIVED
SE I
A-�'
✓ k'r\
FBC 201`4 -
❑ REVISION ❑ EXTENSION [—]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/� / CONTRACTOR DRAWINGS
JOB ADDRESS: 16 ' `� 9 � j
City: Miami Shores County: Miami Dade Zip: ) -j / J (I
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): j 61 t Grn C (� 1 lil I U '�Phone#: 7 Zf 7 V Gj
Address: 11 U P( % _I 3 k },
City: I i✓►f) I J h E /J-) State: 1 l.- Zip: 7ty
Tenant/Lessee Name:
Email: rjJ I) � R
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
W
V/
one#:
Phone#:
Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer:
one#:
Zip:
Address: City: State: Zip:
Value of Work for this Permit: $ art%Linearfootra$e. of work: -41% � � o
Type of Work: El Addition El Alteration ^ Ne 0 Ri pair/Replace ❑ Demolition
rincrrin4inn n4 \A/nr4• 'Y 1 / 1 i I i 1 I /� , 1 0
;ad
Specify color of color thru tile:� �•, `' S'
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $2 J�
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 i --k - 1.
0 R or AGENT
The foregoin instrument was acknowledged before me this
J4tl' day o((f�� l�� �' 120 1 1 , , by
1 •'tGICC 'd0 m0 who is personally known to
m or who has produced ��- as
identific ion nd o take an oath\\`\\`\�N����Y
OTARY PUBLI �� AN:: ••••.F� !
�� • • 1 vov
v� GH 25, �O�•
Sign:
Print: V"VIXp *GG2!<T268
Wed %V
Seal: //�_/rjl/-GC unde
STAiE?F 1%\0
�
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20, by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
=Sign:
Print:
Seal:
**�************ss:**:********:s* **sass****�**sssss�*******:ssssss*s*s***s**s*ss**ss**ss:*sss******
�� : ��
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department
OWNER BUILDER DISCLOSURE STATEMENT
NAME: _Ci'DATE:)
ADDRESS: 30 K) F_ 1� J _S
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
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 s 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 heo s e is r ponsible 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 understa d that I may protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name instefofyname. I also understand that the
contractor is required by law to be licensed in Florida and to list his or license numbers on permicts.
Initial
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilso build or improve a commercial
building if the costs do not exceed $75,000. The building or residence must be for my use or o
ay not be built or substantially
improved for sale or lease. If a building or residence that I have built or substantially improved myleased within 1 year after the
construction is complete, the law will presume that I built or substantially improved it for sale or leolates the exemption.
41� tsiii;rH�r►f>j Initial
Ito I
Ivri &std'nd that, as the owner -builder, I must provide direct, onsite supervision of the constructio
Initial
6' ' "I undersfiA that I may not hire an unlicensed person to act as my contractor or to supervise pers w ing on my building or residence. It
R
is imy r'dsponsibility to ensure that the persons whom I employ have the license required by law and un or municipal ordinance.
,��h �" Initial
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 ad am aware of the limits of my insurance
coverage for injuries to workers on my property.
Initial
8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contra or 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 employ . I u erstand that my failure to follow
these may subject to serious financial risk.
Initial
9. 1 agree that, as the party legally and financially responsible for this proposed Construction activity, ill 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 regulapernal
Initial
10. 1 understand that I may obtain more information regarding my obligations as an employer from thvenue Service, the United States
Small Business Administration, and the Florida Department of Revenues. I also understand that I may n the Florida Construction Industry
Licensing Board at 850.487.1395 or http://www.mvfloridalicense.com/dbpr/pro/cilb/index.htmi
Initial
11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and underst nds that I am the party
legally and financially res ionsible for the proposed construction activity at the following address:
12. !agree to notify Miami Shores village immediately of any additions, deletions, or changes to any of ff e i r ation that I have provided on
this disclosure.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a perso who does not have a license, the
Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may tk 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 3O day of 20
By �YA�C� �� mp who was personally known to me or who has
Produced there License or a) 1,
s identification
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111PUBL C WORKS REVIEW.
S . -civ .-. L� . -
�— Florida Health Miami -Dade C my
ol
_.� Application No.:
1
L Date:
i14
CT TO CO^.1PL ANCE U;' FH FALL FFCERAL
v ^ '� - u ,TONs� Scanned by CamScanner
Jr
Mlsslon:
Tn protect, promote & improve the health
All people in Florida through integrated
state, county & community efforts.
ori a
HEALTH
Vision: To be the Healthiest State in the Nation
January 10, 2019
(Maria de Brusos)
1250 NE 204 Terrace
Miami, FL 33179
RE: Contingency Letter
Application Document No: AP1388714
Centrax Permit Number: 13 -SC -1910385
OSTDS Number:
30 NE 93 St
Miami, FL 33138
Lot:8 9 Block:2 Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 12/18/2018 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
Ron DeSantis
Governor
NO OBJECTION letter issued by Gerard Philizaire for a DRIVE WAY INSTALLATION ONLY.
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.
If you have any questions on this matter, please call our office at (305) 623-3500.
Sincerely,
Gerard Philizairri, Engineering Specialist II
Florida Department of Health www.FloridasHealth.com
in DADE COUNTY TWITTER:HealthyFLA
1725 NW 167 St, Opa Locka, FL 33056 FACEBOOK:FLDepartmentofHealth
PHONE: (305) 623-3500. FAX: (305) 623-3645 1 YOUTUBE: fldoh
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 an am aware of the limits of my insurance
coverage for injuries to workers on my property. (� n
In
8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contc or who is not licenses to perform the
work being done. Any person working on my building who is not licensed must work under my di c supervision and must be employed by
me, which means that I must comply with laws requiring the withholding of federal income tax an ocial security contributions under the
Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employ . I understand that my failure to follow
these may subject to serious financial risk. 1-1')
Initia
9. 1 agree that, as the party legally and financially responsible for this proposed Construction actin
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 regul
10. 1 understand that I may obtain more information regarding my obligations as an employer from t
Small Business Administration, and the Florida Department of Revenues. I also understand that I
Licensing Board at 850.487.1395 or http://www.mvfloridalicense.com/dbpr/pro/cilb/index.html
Initia
11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and
legally and financially responsible for tosed construction activity at the following address:
r`13' --i7
12. 1 agree to notify Miami Shores viiiage immediately of any additions, deletions, or changes to any
this disclosure.
II abide by all applicable laws and
*nal Revenue Service, the United States
,ntact the Florida Construction Industry
Is that I am the party
(1?
pf&rjnation that I have provided on
Licensed contractors are regulated bylaws designed to protect the public. If you contract with a perso�who does not have a license, the
Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may 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 3Oti) day of S4e � , 20 l °
BAy_ f 6,(C%66t R�Ywho was personally known to me or who has
ration. `, �oR/Fr0 �i/''�i
•. Gµ25,?�� d
fIGG 28120
Pc�o; 40
C
i l �•�''% BpndedSec'I CS
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
p ++ OWNER BUILDER DISCLOSURE STATEMENT
J
NAME: , � 4/ ��,C,l. o •,, DATE: _q/30111
rol o j --
ADDRESS:
3U �
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, marshe
wn contractor with certain
restrictions even though I do not have a license. Initial2. 1 understand that building permits are not required to be signed by a property owner unless heponsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Initia
3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I undenj that I may protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name inste o my own name. I also understand that the
contractor is required bylaw to be licensed in Florida and to list his or license numbers on permits a d cprytracts.
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuildi* 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 mys f 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 lea is violates the exemption.
Initial
5!`�t?I uricJdrstand that, as the owner -builder, I must provide direct, onsite supervision of the constructi
ae
k` r,4'C� �'' ''• Initial
I understand that I may not hire an unlicensed person to act as my contractor or to supervise pers
s wor ng on my building or residence. It
.is fny responsibility to ensure that the persons whom I employ have the license required by law an
y u ty or municipal ordinance.
Z. Initial
ifr►tis:i