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RECj ; �1 i.��-'r
Miami Shores Village A G 01 -?0;9
PJ� BuildingDepartment
BY:
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10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 —,1 I
INSPECTION LINE PHONE NUMBER: (305) 762-4949 r„ t�{-
FBC 20 1-4
BUILDING Master PermitNo.tW d9`1 `[341
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0 /" % )O�
mi
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): �Q�S �1/Gtlj � ��L�4QO Phone#:
Address: ; )VY JO,�?s—' S
City: Oruom
Tenant/Lessee Name:
Email: /7�L6
CONTRACTOR: Company Name:
Address:
State:Zip:
Phone#:
one#:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration M Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ r lOO Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Re air/Replace 1 ❑ Demolitio
Description of Work: 1t2r7G° r Pn — ' iG�ah'1'&0AMk
In LX&Ale d>,- z;("fVeV f3'0104cni
Specify color of color thru tile: \s
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $�
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(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 $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.
1 i
Signature Signature
OWNER or AGENT CONTRACTOR
The foreg /nginstrument was acknowledged before me this The foregoing instrument was acknowledged before me this
0 I day of 'PlU GU .s`T 20 r-1 by day of 20 , by
^ /� uvz
ITV Tip I v 1 I �— T ,who is personally know Nam, who is personally known to
me or who has produced C` — D U L `� as me or who has produced
identification and who did take an oath.
NOTARY LIC:
Sign:
Pri t: S( r.1v1 P
Seal: ---
SINDIA ALVAREZ
MY COMMISSION # GG 238273
GYoiRr.q. 3entember 3. 2022
APPROVED BY
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal:
as
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 BUILDER DISCLOSURE STATEMENT
NAME:.
DATE: �4
ADDRESS:�D
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; 1 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 alicense. //
Initial i
2. 1 understand that building permits are not required to be signed by a property owner unless h rore 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 and contracts.
Initial
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 1 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 G-
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
is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance.
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. 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
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.
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/dbpr/pro/cilb/index.html
Initial-
1
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 01 day of.PVGUS' , 20_�
BylAy Ib NL(3440-'O— 14WOI� Nay`" who was personally known tome or who has
Produced there License or
;I�
OWN
as identification.
NOTARY
„�. SINDIA ALVAREZ
4p. MY COMMISSION # GG 238273
;: a= EXPIRES: September 3, 2022
e of FLU: Bonded Thm Notary Pubf Undervrtilers
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Accepted By:
Property Address: Notes: NO NOTES
210 N.E. 102 Street
Miami Shores, FLORIDA 33138
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Property Search Application - Miami -Dade County Page 1 of 1
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OFFICE OF THE PROPEP Y APPRAISER
Summary Report
Property Information
Folio:
11-3206-048-0010
Property Address:
210 NE 102 ST
Miami Shores, FL 33138-2427
Owner
CASSIA LAWRENCE
DAVE LAWRENCE
Mailing Address
210 NE 102 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
0900 SGL FAMILY - 1901-2100 SQ
Primary Land Use
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
3/3/0
Floors
1
Living Units
1
Actual Area
3,200 Sq.Ft
Living Area
2,220 Sq.Ft
Adjusted Area
2,630 Sq.Ft
Lot Size
10,618.4 Sq.Ft
Year Built
1981
Assessment Information
Year
2019
2018
2017
Land Value
$318,242
$318,242
$318,242
Building Value
$293,640
$222,708
$225,759
XF Value
$22,691
$22,881
$23,071
Market Value
$634,573
$563,831
$567,072
Assessed Value
$634,573
$563,831
$567,072
Benefits Information
Benefit Type 2019 2018 2017
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
VAZQUEZ SUB
PB 115-23
LOT 1 BLK 1
LOT SIZE 81.68 X 130
OR 20464-1152 05 2002 4
Generated On : 8/1/
Taxable Value Information
2019
2018 2
County
Exemption Value
$0
$0
Taxable Value
$634,573
$563,831
$567.
School Board
Exemption Value
$0
$0
Taxable Value
$634,573
$563,831
$567.
City
Exemption Value
$0
$0
Taxable Value
$634,573
$563,831
$567.
Regional
Exemption Value
$0
$0
Taxable Value
$634,573
$563,831
$567
Sales Information
Previous
OR Book-
Price
Qualification Description
Sale
Page
05/09/2018
$750,000
30996-4811
Qual by exam of deed
Corrective, tax or QCD; min
02/17/2017
$100
30430-3622
consideration
Corrective, tax or QCD; min
01/12/2015
$100
29510-0165
consideration
Corrective, tax or QCD; min
11/07/2014
$100
29510-0164
consideration
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 Appra
Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.govfiinfo/disclaimer.asp
s://www8.miamidade. gov/Apps/PA/propertysearch/
8/1/2019