FW-19-2942Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
�r21j111j1JI3i i
Issue Date:12/23/2019
Location Address Parcel Number
117 NW 103RD ST, Miami Shores, FL 33150 1121360131570
Contacts
Permit NO.: FW-12-19-2942
Permit Type: Fence/Wall
Work Classification: Wood Fence
Permit Status: Approved
Expiration: 06/22/2020
SILVANA KISHIMOTO Owner HOME OWNER Contractor
117 NW 103 ST, miami shores, FL 33150 HOME OWNER
Mobile: 7574707323 silvana703@icloud.com
Description: WOOD FENCE WITH ALUMINUM FRAME Valuation: $ 4,000.00 Inspection Requests:
49
Total Sq Feet: 0.00 11
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$3.00
DCA Fee
$2.00
Education Surcharge
$0.80
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$5.00
Wire and Wood Fence Fee
$150.00
Total:
$257.20
Payments
Date Paid Amt Paid
Total Fees
$257.20
Credit Card
12/13/2019 $50.00
Check # 1505
12/23/2019 $207.20
Amount Due:
$0.00
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 specifi tions submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myseI4 agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS`ROQFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informs on is accurate and th it a work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the �b ve named contractor o o the work stated.
Authorized Signature: Owner / Applicant / Contractor / Ag&rA v Date
December 23, 2019 Page 2 of 2
Miami Shores Village
ENTEnED
BUILDING
PERMIT APPLICATION
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
DEC 13 2019
13y:
Fsc Zorn C°n''
Master Permit
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
\ A I 2 �^ CONTRACTOR DRAWINGS
JOB ADDRESS: I N V" ( OJ ?;�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction f'T Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �� 11V�YLOL r-vSTlfI 1'y1�D Phone#:
Address: N wl1 2
City: 1 ^ I ` -q�1 \ State: i^ Zip: 33 1S b
Tenant/Lessee Name: __. Phone#:�U�
Email: r71 \LV lr'� --•i- J Lc---) I C L 0 ub • coin
CONTRACTOR: Company Name:
Address:
City: State:
Qualifier Name:
State Certification or Registration #:
ne#:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Ad
Value of Work for this Permit: $__::
Type of Work: ❑ Addition ❑
Description of Work: u-jG 0 d
Specify color of color thru the:
Submittal Fee
Scanning Fee $
n 1-1 ,New
"P
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
City:
State: Zip:
it Footage of Work: %_o d !•/r-t,0
❑ Repair/Replace Ej Demolition
CCF $ CO/CC $ _
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ G B�
(Revised02/24/2014)
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 $1500, 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 a approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrumen was acknowledged before moe� this
to day of d V 20 ' I by
S'i1ya�lcl IS�IYui404ho is personally known to
me or wl}� has prptluced I ) � as
who Nd take an oath.
NOT
I`oEP101—�/-M
�0��Y PRIFTD///i%
ON VZ
0 au
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: A iS *- Zr Print:
1
Seal: ( j// ...0��,`�
\ Seal:
as
v
APPROVED BY Plans Examiner 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 BUILD
ER DISCLOSURE STATEMENT n
NAME: & 1�QYIG� ):�,SC(DATE: -- 4'
ADDRESS:
Do hereby petition the VWage of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.5 4891103(7). And i have
read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that 1 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. tt may not .be built for sale or
Eerie. if you sell or lease a building you have built yourself within one year after the construction is complete, the law wW 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. yY
Initial 0
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 Qoontracts.
4. 1 understand that t may build or improve a one family or two -fatuity 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_
6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my bui"ding or residence. it
is my responsibilityto ensure that the persons whom I employ have the license required bylaw, and b, county or municipal ordinance.
initia1\`�_—�
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. 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
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
i agree that, as the party legally and financially responsible for this proposed Construction activity, I wi'l 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.myfloridalicense.com/dbprlpro/cilbfindex,html
Initial
11. 1 am aware of, and consent to; an owner -builder building permit app:;ed for in my name and understands that I am the party
legally and financially responsible for the proposed construction activity at the following address:
Tia U W 1 03 J 1 /� f_T_
Initial (JD—
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that 1 have provided on
this disclosure.
initial__S1�
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 retumed 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 Z SA-0 day of NOV , 20 )1 T
By �& `V0111 1 , �i Sk yU� p � o who was personally known to me or who has
\`\�N�\, Y PRl qj���i
Pro ced there License or as identification. �� yP ••• !Fro �X
a��� H z Nam,'
NGG 287268
OWNER TARY moo,: d e 0�: Q
� yP ? p 4ded %N .,• ��
Thit_instrta m pnysamd by:
Ralph Kaal. Esquire
Ralph Kew[, P.A.
1940 HanfW Sheet Strils904
H*&wd, Florida 33020
OurF9e:20119.1165
Remm oa
Paul Slinomm
Working Title LLC
2030 S. Douglas Rd. Ste 103
Cortd:G*hk Florida 33134
General Warranty Deed
CFN: 20190740710 BOOK 31705 PAGE 4137
DATE:11/26/2019 02:44:22 PM
DEED DOC 2,160.00
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
Made this 1311.day of November, 2019 by 'Vincent R. Levros, a married mad, whose post
office address is:150 LATEN 'KNIGHT RD, Cranston, RI 02921, hereinafter -called the grantor,
to: Silvana Elizabeth Mieko Kishimoto Milla, A Married Woman, Joined By .Spouse Angel M
Martinez, a married • man, whose post office address is: 117'NW 103 Street, Miami Shores,
FL 33150 hereinafter- called the grantee;
(Whenever used herein the term grantor" and "grantee" include all the parties to
this instrurrnent and the heirs, legal representatives and assigns of individuals; and.
the successors and assigns of corporations)
WITNESSETH: that the grantor, for and in consideration of the sum of Ten and 00/100 Dollars
(Si0.00), and other variable considerations, -,receipt whereof is hereby acknowledged, hereby
grants, bargains, sells, aliens, remises; releases, conveys and confirms unto the grantee, all that
certain land situated in Miami Shores, Florida, viz:
Lot 22 and the East % of Lot 21, in Block 127, of AMENDED PLAT Of
SECTION N0.3 of Miami Shores,according to the plat thereof, as recorded
In Plat Book. 1.0, Page 47; of the Public Records of MiamrDade County,
Florida.
Said property is notthe homestead of the Grantor -under the laws and constitution ofthe State of
Florida in that neither: Grantor nor any members of the household of Grantor reside thereon.
Parcel 1D Number. 11-2.136-013-1570
Together with all the tenements; hereditaments and appurtenances thereto belonging or
in anywise appertaining.
To Have -and to Hold, the same in fee simple forever.
And the grantor hereby covenants with .said grantee that -the grantor is- lawfully seized of
said land in fee simple; that the grantor has good right and lawful authority to sell and convey
said land; that the. grantor hereby fully warrants the title to said land and will defend the same
against the lawful claims of all persons whomsoever; and that said land is free of all
encumbrances, except otaxes accruing subsequent to .
In Witness Whereof, the said grantor has signed and sealed these presents the day and
year first above written.
Signed, Sealed and Delivered in Our Presence:
17
, ��ta �_" 411/_
Print e: V C e-v o Vincent R. Levros
1
Print Nam
State of Florida
COUNTY OF: Miami -Dade
I HEREBY CERTIFY that the foregoing instrument was acknowled ed bef= me on this
day of November, 2019 by Vincent R. Levros, a married man, are ersonally known to me
or who have produced as identification.
n4t
No Public, State of Florida
RALPH S. FIGARO
MY COMMISSION # G0170000
EXPIRES: December 20, 2021
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Ordered By:
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LOT 4 LOT 3 LOT 2
_ — — BLOCK 127 BLOCK 127 — BLOCK 127
0 9.50' ASPHALT ALLEY
75.00' P 4 ry�
F. P. 112" 0 33.0• o. 1 1.�y y . P. 1/2"
(NO. ID) K 4,p' `' S C FAIN tl
cl r ^N� 0.�t-
6' WOOD I �. \\,,C(
FENCE I r I r' `�7'1
EAST 112 OF x ( LOT 22 x
LOT 21 X Y BLOCK 127 Z ; •
BLOCK 127 J • • •
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W • J b �� Phu �+ �C Z U I ..eeee •Ye• •
Z U V :ai IZ x • e•eees Q Z = I ..eeee •
2� UL` eeee • e �eeee�
CJ • • •eeee. • •
OLj—
c. *see • .eeee
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N E `. CONC �\1.50' _ .. _ � ��` • • � •eeee
�� ee ee •.eeee
If a e e
O I _ M _.�.. � ee
16.40' 18.05' 16.50' e
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•eeee .N0.40 C C pO 2.6'- 1.45 0.30'x
e•�e;�
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Q 17.50'_ p O 5.6' ®N 17.50' w J a : • • • • ;
J O N x > 4.00'I 17.95' ' V- J •••'
lLj m w 5' CHAIN UNK 0 m
FENCE io ONE STORY Y
1.00' I RESIDENCE �' z
0 # 117 N J
Z W
NLZ
Fo 29.50• H{ y •� U W
0.60 INUTILE - 14
Ire• 1 5¢• In1
11. Lo 13.25' }_ 0.70'
=o ,r ---NICE '� CONC CBS '1.30'
'n _ 4.25'
' _ p 19.90' y o
Clry"� ^ I 2.6'^�
A N C4 CON G
{ �{ �� DRIVEI�JAY
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o' 105.40'(P),
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F. P 12. Ik ON M 75.00 P� 5' CS wPP F.I.- �1,r F.I.P. 112"
(NO.ID) LIGHT POLE 19.70' (NO.ID) (NO. ID)
NC C,�. ar' PARKWAY
42.0'
• 2' CONC VALLEY GUTTER
h
75' RIGHT-OF-WAY (BY PLAT)
44'f ASPHALT PAVEMENT
N.W. 103rd STREET
Accepted By:
Property Address: Notes:
117 N.W. 103 Street
Miami Shores, FLORIDA 33150
SURVEYOR'SCERTIFII-ATION:I HERBY'I TIFY THAT THIS BOUNDARY SURVEY IS A TRUE AND M.E. Land Surveying, Inc.
CORRECT REPRESENTATION OF A r' � ,,;Y Ec ,�' 41� UNDER MY DIRECTION. THIS COMPLIES
WITH THE MINIMUM TECHNICAL'TH BY THE STATE OF FLORIDA BOARD OF 10665 SW 190th Street
PROFESSIONAL LAND SURVEY't`..6at• 1'0, r/ THROUGHSFI7--052, FLORIDA
ADMINISTRATIVE CODE Pt. %r•.-r�:�v-: 'CIASTATUES- Suite 3110
SIGNED �I * FOR THE FIRM Miami, FL 33157
EFRAIN LOp 77t!T-T _ Phone: (305) 740-3319
STATE OF FLO�'t*` �, V.S.M. No. 6792 Fax: (305) 669-3190
NOTVAUDWITHOUTAND AtrIHt3JT�- _ ATURE AND AUTHENTICATED LB#: 7989
MAP
ELECTRONIC F ALI
CENSED NRTHIS IS ,SEDSURVEYORIWDMAW''iUT THE 916NATURE AND THE ORIGINAL
RAISED SEAL O
�y.
Surves O:B-64624
I
C'heut 1•I:e 4 19-0174
Page I of 2 Not valid without all palges