DS-18-2535Location Address
Permit NO.: D5-09-18-2535
Miami Shores Village +'''iii'''*"`'"" -'', Permit Type: Driveways/Sidewalks/Slabs
10050
re
2 Ave
Miami Shores FL 33138 Work Classification: Addition/Alteration
305-795-2204 Permit Status: Approved'.
issue Date: 09/26/2018-) Expiration: 03/25/2019
Parcel Number
545 NW 111TH ST, Miami Shores, FL 33168 1121360210740
Contacts
KAREN MCCLENNEY Owner HOME OWNER Contractor
545 NW 111 ST, MIAMI SHORES, FL 331683331
I ma -
Description: REPAIR CRACKS AND RESURFACE SINGLE ASPHALT Valuation: $ 150.00
Inspection Requests:
DRIVEWAY 365'-762-4949
Total Sq Feet: 540.00
Fees Amount
Application Fee - Other 50.00
CCF 0.60
Concrete/asphalt/pavers, slabs, dways, 75.00
swalks
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 0.20
Notary Fee 5.00
Planning and Zoning Review Fee 35.00
Scanning Fee 9.00
Technology Fee 3.13
Total: 181.93
Permit Received By
Payments Amt Paid Inspections:
Total Fees
Check # 2462
Amount Due:
181.93
181.93
0.00
Inspection Type
Foundation
Building Final
Date
Building Department Copy
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
permit are uired for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
DAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
uctiorAao zoning. Futhermore, I authorize the above named contractor to do the work stated.
re: Owner /I Applicant / Contractor / Agent Date
September 26, 2018 Page 2 of 4
Miami Shores Villageg 'FlctIVED
BuildingDepartmentp SEP 22018
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 NoDS (L-) -
PERMIT APPLICATION Sub Permit No.
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
F-1 PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF [:]CANCELLATION SHOP
f
CONTRACTOR DRAWINGS
JOB ADDRESS: S /G ,
U(6. /?f S7J;6 j /
pp
City: Miami Shores County: Miami Dade Zip: 33 / C7
Folio/Parcel#: Is the Building Historically Designated: Yes NO V
Occupancy Type: Load: _
OWNER: Name (Fee SimplleTiitlehol
Address: . 4), VL/i
Construction Type: Flood Zone:
City: A"', s Udf:4
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
BFE: FIFE:
one#: ,,7 OS — 5 kO 3zzZ ,'
hone#:
ne#:
Certificate.of Competency #:
ne#:
P:
Address: City: State: Zip:
Value of Work for this Permit: $__ Square/Linear Footage of Work: 1 , 100/. -
EJ
i,
Type of Work: Addition Alteration El Repair/Replace Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ i2-tj , CO CCF $ CO/CC $
Scanning Fee $ Radon Fee $ `i ' 6D DBPR $ 2 Notary $
Technology Fee
Structural Reviews $
Revised02/24/2014)
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $
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 co y of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to tta ment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whic oc urs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will nqt b pr d nd a reinspection fee will be charged.
ER or AGENT
The foregoing instrumenfwas acknowledged before rare-tKis
2-S day of S +++ 20 1 by
tin Gh i' h T M4 is personally own to
me or who has produced .— ` as
identification and who did take an oath.
NOTARY PUBLIC:
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: EZ ign:_
Print: =_°' MY COMMISSION # GG 044602
rint:
Z Public Undervvriters
Seal: :;F;@c'=
BondedThruNotary
al:
APPROVED BY Plans Examiner Rt Zoning
Structural Review Clerk
Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER B ILDER DISCLOSURE STATEMENT
NAME: 440,# " 1, DATE:
ADDRESS:' _Z I` J [W I
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, RS 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 assm/yown 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.
I`-''
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 and contracts.
Initial___1r
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_ VV
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 bi2ounty or municipal ordinance.
Initial
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.
AIA -
8. 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
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.
j
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.mvfloridaIicense.com/dbpr/pro/ciIb/index.htm-1
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 )respofnsible for the proposed construction activity at the following address:
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 worker's 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 l
Y M l 'whoByV'1 l as personally known to me or who has
C
1mrnn
Pro ced h e nse or as identification.
X700 S
o N0:
N
z 2 oE3,o
z
C Nn
OWNER NOTARY
r
m o A N
o N
a
STATE OF (FLORIDA)
COUNTY OF (DADE)
The undersigned Affiant,
The attached survey, performed by
For address:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
hereby attest that
Name of survey.{Qfis company)
11 1 ,
1'
Performed on (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 y affect final inspections as applicable to this or other permits.
u her, Affiant` eth n u t. • n /f ,1
Property Ow/
ND
r Signature Property Owner Print Name
SWORN TO SUBSCRIBED before me this _ S day of
Affiant is _personally known to me, %produced _1 identi%ation.
Revised on 5/22/2009/ Revised on 6/12/09
r20' 'be
4-A'
MAHARAi K. GONZALEZ
MY COMMISSION # GG 044602
P := EXPIRES: November 2, 2020
4. Bonded Thru Notary Public Underwriters
gpq/ lqql7
9/25/2018 Property Search Application - Miami -Dade County
OFFICE OF THE PROPERTY APPRAISER
Summary Report
Property Information
Folio: 11-2136-021-0740
Property Address:
545 NW 111 ST
Miami Shores, FL 33168-3331
Owner KAREN MCCLENNEY
Mailing Address
545 NW 111 ST
MIAMI, FL 33168-3331
PA Primary Zone 0100 SINGLE FAMILY - GENERAL
Primary Land Use
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half 3/2/0
Floors 1
Living Units 1
Actual Area Sq.Ft
Living Area Sq. Ft
Adjusted Area 1,503 Sq.Ft
Lot Size 7,830 Sq. Ft
Year Built 1959
Assessment Information
Year 2018 2017 2016
Land Value $168,509 168,509 141,215
Building Value $93,787 93,787 93,787
XF Value $810 820 830
Market Value $263,106 263,1161 235,832
Assessed Value $96,262 94,283; 92,344
Benefits Information
Benefit Type 2018 2017 2016
Save Our Homes
Cap
Assessment
Reduction
166,844 $168,833 $143,488
Homestead Exemption 25,000 $25,000 $25,000
Second Homestead Exemption 25,000 $25,000 $25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
Short Legal Description
365241
WEST SHORES PB 42-18
LOT 15 BLK 4
LOT SIZE 58.000 X 135
OR 17772-0368 0897 1
Generated On : 9/25/2018
Taxable Value Information
20181 2017 2016
County
Exemption Value 50,000 50,000 50,000
Taxable Value 46,262 44,283 42,344
School Board
Exemption Value $25,000 $25,0001 25,000
Taxable Value $71,262 $69,283 67,344
City
Exemption Value 1 $50,000 50,0001 50,000
Taxable Value 46,262 44,283 42,344
Regional
Exemption Value 50,000 $50,000 50,000
Taxable Value 46,262 $44,283 42,344
Sales Information
Previous Sale Price OR Book -Page Qualification Description
08/01/1997 $82,000 17772-0368 !Sales which are qualified
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property
Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/in fold iscla ime r.a sp
Version:
Z
jr _o
L Q~
W —] L Z 1
Q rT)L'l
lie .
V
G
Z Z
Q
3 r
co QD
U)
t
r ,
r... .
GraphicScale
CQ 0' • 0' 10' ?0` •10'
0... ._.__ .... _— ... ..._. ftr 1
1_u r
1 " 0'
THE FLA FLOOD INFUI?ANCIf- RA1 E MAP DA"IED .3-2. ._-__w..9-4 -_. PUDDLISIiLBY'IIiF: F EI)I.IZAI.. f MP_R-
GENCY MANGEMEN7 AGENCY (I'.F.M.A.), DFL.m.1XI ES'I'Iir HEREIN DESCF2IBED LAND TO BF. SITUA'T'ED
WI I I IIN ZONE X
COMMUNI I Y No. 110635 PANEL No. 0090 SUFFIX: J
THIS SURVEY DOES NOT IREPI-EC7 OR DETERMINE OWNERSHIP.
EXAMINA'IION OF THE ABSTRACT OF: ,rrrLE WILL. HAVE TO BE MADE TO DEI ERMINE RECORDED
INSI RUMEN IS. IF ANY, AFFECTING THE PROPERTY 11.113 SURVEY IS SUBJCCT 1 O DEDICATIONS,
LIMI'TA'TIONS, RrSTRICTIONS, RESERVA1IONS OR EASEMENTS NOT SHOWN IN'THE PLAT' BOOK.
LEGAL DE.SCRIP1 IONS PROVIDED BY CLIENT OR All USI'ING '111 LE COMPANY.
Ill IF SI OWN, [)IcARINGS ARE REFERRED 10 AN ASS'UML'U MERIDIAN, BY SAID PLAT IN INE Dti-SCRIP IION
OF l iE PROPERTY.
IF SHOWN Et.EVATIONS ARE REFERRED TO N.G.V.D. OF 1929.
UNLESS 0111ERWISE NOTED, THIS FIRM IiAS NOT ATTEMPTED 10 LOCAI im FOOTINGS AND/OR
FOUNDATIONS.
e.. -,r . fl n..,..... rrararm +a xrr.. ne.N. s,m .zexwr.... mx,.n xx.mz.,`. ma,m+mrrvivn. ic.r•rrmnm.+•,.. . a.avn.wmFe. rr.. r.. n.r s..r .-..
OVtF l,t1)I 5
j) 1 CIC J Lr•.IC:
R) A
lmkm
FiR D WORK - Ill VISIONS
D:,le 8••18-•i 997
I=ir•Id noa< F.W.O.
1
5FAlr: OF I'LORIDA O,iCAR F OAFZ.CU51170 111 5 No, 5034
DAl. A ASBO!:IA 1 1 n, II:C t R b (?:f Ji
9708.1028
I I• 1 •rAl 111 •11111 ' : 'ill:l l! 1! oAl l Il f• :, I ALAI !'n V.. 1111-IAi'l l' i' : I l'.1 Al
CER 11FIED TU:
r
a ni
S (7 Ill 111 U O
n •
iii • • • •
W R:; a: rc P
3
Q•1 ri Irl f7 •
p• • • O
1C(.
l•tj j O ?i iF.•••
9 111 '• • • rc
U•1:„•••• wlsw•A% °,° s rc, wV •
O
i•
n
CI7
Ell U
a
IE:
o rc ui
n
x
q EIl 2
c7 z m 11a w
1 i- zjNJ
Ly
j U IY ¢ W U
U1. z
V
D
in U U
E7
u m allaRian?(i i'> ) n0
KAREN McCLENNEy1op"p-
NORTHERN TRUSTNK OF T-
ME:TROPOLIT'AN D
DADE COUN'T'Y T1TI
FIRST AMERICAN 1”
AM ma go Ift.
B A EZ tai A 9 s 0%wa I
LAPD SIJRVI`Y0 R,`, a I AHII I'I AIT 11 I!'
41r1:iW (slid At- r: L.ulq I1-0, IIIA
r g6rr.(ul'da.•, Inn,.I.,!11 r.1 , ., ,1: n.!
Iy
co
t_G1
LLI
D
f)
1 J
i
0
LI.1
I.I.1
17I'f''
Wo Irv)
r ,
r... .
GraphicScale
CQ 0' • 0' 10' ?0` •10'
0... ._.__ .... _— ... ..._. ftr 1
1_u r
1 " 0'
THE FLA FLOOD INFUI?ANCIf- RA1 E MAP DA"IED .3-2. ._-__w..9-4 -_. PUDDLISIiLBY'IIiF: F EI)I.IZAI.. f MP_R-
GENCY MANGEMEN7 AGENCY (I'.F.M.A.), DFL.m.1XI ES'I'Iir HEREIN DESCF2IBED LAND TO BF. SITUA'T'ED
WI I I IIN ZONE X
COMMUNI I Y No. 110635 PANEL No. 0090 SUFFIX: J
THIS SURVEY DOES NOT IREPI-EC7 OR DETERMINE OWNERSHIP.
EXAMINA'IION OF THE ABSTRACT OF: ,rrrLE WILL. HAVE TO BE MADE TO DEI ERMINE RECORDED
INSI RUMEN IS. IF ANY, AFFECTING THE PROPERTY 11.113 SURVEY IS SUBJCCT 1 O DEDICATIONS,
LIMI'TA'TIONS, RrSTRICTIONS, RESERVA1IONS OR EASEMENTS NOT SHOWN IN'THE PLAT' BOOK.
LEGAL DE.SCRIP1 IONS PROVIDED BY CLIENT OR All USI'ING '111 LE COMPANY.
Ill IF SI OWN, [)IcARINGS ARE REFERRED 10 AN ASS'UML'U MERIDIAN, BY SAID PLAT IN INE Dti-SCRIP IION
OF l iE PROPERTY.
IF SHOWN Et.EVATIONS ARE REFERRED TO N.G.V.D. OF 1929.
UNLESS 0111ERWISE NOTED, THIS FIRM IiAS NOT ATTEMPTED 10 LOCAI im FOOTINGS AND/OR
FOUNDATIONS.
e.. -,r . fl n..,..... rrararm +a xrr.. ne.N. s,m .zexwr.... mx,.n xx.mz.,`. ma,m+mrrvivn. ic.r•rrmnm.+•,.. . a.avn.wmFe. rr.. r.. n.r s..r .-..
OVtF l,t1)I 5
j) 1 CIC J Lr•.IC:
R) A
lmkm
FiR D WORK - Ill VISIONS
D:,le 8••18-•i 997
I=ir•Id noa< F.W.O.
1
5FAlr: OF I'LORIDA O,iCAR F OAFZ.CU51170 111 5 No, 5034
DAl. A ASBO!:IA 1 1 n, II:C t R b (?:f Ji
9708.1028
I I• 1 •rAl 111 •11111 ' : 'ill:l l! 1! oAl l Il f• :, I ALAI !'n V.. 1111-IAi'l l' i' : I l'.1 Al
CER 11FIED TU:
r
a ni
S (7 Ill 111 U O
n •
iii • • • •
W R:; a: rc P
3
Q•1 ri Irl f7 •
p• • • O
1C(.
l•tj j O ?i iF.•••
9 111 '• • • rc
U•1:„•••• wlsw•A% °,° s rc, wV •
O
i•
n
CI7
Ell U
a
IE:
o rc ui
n
x
q EIl 2
c7 z m 11a w
1 i- zjNJ
Ly
j U IY ¢ W U
U1. z
V
D
in U U
E7
u m allaRian?(i i'> ) n0
KAREN McCLENNEy1op"p-
NORTHERN TRUSTNK OF T-
ME:TROPOLIT'AN D
DADE COUN'T'Y T1TI
FIRST AMERICAN 1”
AM ma go Ift.
B A E Z tai A 9 s 0%wa I
LAPD SIJRVI`Y0 R,`, a I AHII I'I AIT 11 I!'
41r1:iW (slid At- r: L.ulq I1-0, IIIA
r g6rr.(ul'da.•, Inn,.I.,!11 r.1 , ., ,1: n.!
BOUNDARY SURVEY
LEGAL DESCRIPTION
Lot 15 Block 4 of " W E S T S H O R E S 11, according to
the Plat thereof as recorded in Plat Book 42 at Page 18
of the Public Records of D A D E County, Florida.
6
uV
I. .
leo LD
v!
L'T 10-
6
0
eyJ s;
tj.
is T = -f .,.,..r-T
IC)
fir• i , .r .. . • .
LOCA l-lQN •SKE•frH •
N 00 0... ..
0,1 a1 .. .
iW U
of1 a a '
uV.
3t'? "j ZO UJ
y
tt n w U U
tl
co
I O
nw
W
m
Ce. D Q