DS-07-23-1748 CancelledMiami Shores Village o 2 � DI E
Building Department JUL 14 ?Ors
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 By
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
Fe
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
PBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ell
Cit : Miami Shares Coun Miami Dade Zi : .3
Folio/Parcel#: 0I `~ Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: G FFE:
OWNER: Name (Fee Simple Titleholder): ,R� a W 10 (` Phone#:
Address:
r
State Zip:
City:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Dll� Phone#'
Address:
Email:
Qualifier Name: Phone4:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit: $ .add Square/Linear Footage of Work:
Type of Work: ❑ Addition E�j: Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: v /`
�._ . -4 Z. zf /! d I.1C I. / 5 ■ �c�► S
Specify color of color thru tile:
Submittal Fee $ �- CO _ Permit Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $.
DCA Fee $
Training/Education Fee $
CCF $_
DBPR $
P&Z Review $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised04/05/2022)
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 a (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap ed and a rei pection fee will be charged.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
1 day of t y v� 20 `� , by
BtwD�W-s� who is personally known to
me or who has produced 0 vt'— as
identification and who
NOTARY PUBLIC:
Sign:
Print:
Seal:
s,
APPROVED BY
(Revised04/05/2022)
take an oath.
t_
Signature
CONTRACTOR
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:
HEBERTMARTINEZ Seal:
MY COMMISSION # HH 323276
EXPIRES: October 18, 2026 11
as
Plans Examiner Zoning
Structural Review Clerk
NAME 090 Lr
ADDRESS: V J Alr- I l
JUL 14 2023
Miarmi Shores Village
Building Department
10050 WE'2nd Avenue
Miami Shoi-esjlori.da 33138
795.2204
Fax: (305) 755,8972
71\ DATE: 2 ` / T — 2,
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 48,9.103(7). And:I have
read and understood the.foiiowing disclosure statement, which.esttities.rne to work as my own contractor; l furthet understand thati 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 ex, eption:tpthe lacy: The. exemption
allows you; as the owner of your property, to act as your own contractor'euen though Ou do not have a tice.hse. 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 buildirfg: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 riot 6e ibrsilt for sale or
la;tae. if you sell or. tease;a Wild) ngyau have Wilt yourself u+rithin one year.after the construction IS complete, the law will presume.that :you built
for sale or Wage,.Oldh is a.vidfation of this exemption. You may not hire an uriijjcertsed person is a contractor. ft•fs:yooi resportsibifrty to make
sure the people employed by you have licenses required by state law and by county or murllcipoi licensing ordinances. Any: person working on
your building who is not licensedmust work under your supervision and must be employed by you, which means that you must docluct-RIX.A artd
with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must corno.ly With all
applicable laws, ordinances; buildings codes and zoning regulations:
R1ease read:oOd'thi pl ea'h;pa agra.pti.
1; I understand that3tate 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 specif ies that i, as the. owner of the property listed, may act" my own contractor with certain
restciiiion5ev'enthbitgh Fdo rrothaive,411cehse,
Initial
,..
2.. I undei;ter►d ihaf bpiiding�pernitt3>afe oat requlred`to be.slgned;by a property Droner urlless;he or stl�as reS.ptarrsible for the etrnsttuctton an
1s 4othiring a IicEh52'Liicohtract.dr to assume resppi $If lli y.
Initial
3, : I understand that, as an. owner builder, I am the responsible pet`ty,'of record on.a permit,.lunderstand that I may protect myself from potential
:financial risk by hiring a licensed contractor and having the pe'rmif filed'Whis 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,
lnitial��
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I rnayalso build or improve a commercial
building If the casts do not exceed $75,Q00. The building or residence rnust he for my use or occupancy. It may not be built or substantially
improved far 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 tease, which violates the exemption.
Initial��
S. f ireders�qd that, a-' the owner -builder, I rhpst provide direct, onsite,supery sign of tlie,construction.
Initial
I understand that may not hire.an unlicensed person to act as my contractor or to supervise persons wprlur%g 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
7. 1 understand that it is frequent practices of unIke nsed 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 hetd liable. and subjected to
serious financial risk for any injuries sustained by an unlicensed person or his or empioyees.while working on my property. My hameow ner's
insurance may riot provide coverage for those injuries. l am willfuily acting as an owner -builder and am aware of the limits of my insurance
coverage for injuries to workers on my property.
Initi
ad
& t undeestah. d that t, may'not dalegate'thra responsibility. for supervising work to be a licensed contractor wha is not ;Iice nses 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 requfring the withholding of federal income tax and social securitycontributions under the
Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee..) understand that my failure to follow
these may subject to serious financial risk.
Initial
I agree -than, as'.the party legally and ffnancially:responslbfefor this -proposed CorrstrUction activity ,Lwiil abide by, allappl table laws and
-requirementthat govern owner-builders:as well as employers. I:a.lso understand that the
Constructlori must0mpf,VWithall applic6h. laws, ordinances, buiidarigcodes.,-and.zoning regplatlorm
initial
1Q., l understand that I may obtain more:inforinationrcgarding my.obligations as an employer from the internal Revenue Service, the United States
Smalt Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry
Licensing:Soard.at 856.487.1305 or htto://www.mvfioridallcensg.�omjdbpr/pro/cilb/index.htrni �f
lnitial�R./ f
11.: I am.aware of.'and i oraSent:to; an or+iner-bdilder iui[ding permit applied4or ist;my:rra(ne and:understi posthat I am the party
1ega11:y and financially responsible for the pro
posed construction.activity:atthe following address:
�- - -
Initial
A_�Y,
12. 1:agree to natifyWorni:5horesVilfage immediately of any additions,. deletions, or changes to any of.the infoirmatlo that:1 .have pe vided•on
this disclosure..
Initial'
Licensed contractors are regulated by I.aws.dssigned to protect: the:p..ublic:- If you contract with. a person who does:not-have a license,,the
6pnstr4uctian industryClcen3ing Bbara a'nd.Departt?i ' nt of Business and Profs siohal Regulation maybe urtable.to•asslst ypu prith ar,y tnancial
loss that you sustain.ava result°.of contractor maybe In civil: court. It is aiso:linportant for you to understand that, if an unlicensed contractor or
employee of awindi004al or:fi'rrn is injured while working on:90ur property, you may be held liable for damages. If you obtain an owner -builder
permit.and wish.to: hire a•licensed contractor; .you.W.ili be respohsiblefpr verifying:whether the contractors§ properly`I.icerised ®nd tti;e Status of
the contractor's wWkers,cprn:pensation coverage.
Before:a:kiuiiding petrrritcan lye issued,'this•disclosure:statement must be tompleted.and signed by:.the.property owner and returned to'the.local
permkttrn,g agency :respnh5ible for Is psrmit.,A copy of rile property owner's di fiver license, the notarized signature of:#hg property
owner; or other type of verification acceptable to the local permitting agei cy:is required w.heh the permit is issued,
Was ack,nowlodged, beforg:me this . �� day of
By l� i� A lb �� who was p rsar7ally known to me or who has.
Produced Cher cen a'or—
OWNER
as identifr~ati011,
°f ""=. HEBERTMARTINEZ
MY COMMISSION # HH 323276
NOTARY ;;�eF t EVIRES:Octpber 18, 2026
LEGAL DESCRIPTION OF: 305 NE 91ST ST, MIAMI SHORES, FL, 33138
LOTS 13 AND 14, BLOCK 4B, MIAMI SHORES, SECTION NO. 1, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT
BOOK 10, PAGE 70, OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIDA. FnbTm-na- unn�
TO: I�lf t JUL 14 2023
DAVID DOWSON
FLOOD ZONE:
My-
12086CO302L
ZONE: X
EFF: 09/11 /2009
SURVEY NOTES:
- DRIVEWAY AND CONCRETE WALK CROSSES THE BOUNDARY LINE ON SOUTHERLY SIDE OF LOT AS
SHOWN.
- FENCES LIE NEAR BOUNDARY LINES AS SHOWN, OWNERSHIP NOT DETERMINED.
- WALL CROSS THE BOUNDARY LINE ON EASTERLY SIDE OF LOT AS SHOWN.
FIELD
COPY
THIS MUST BE OI
JOB AT TIME O
INSPECTION
Miami Shores Village Building Department
Zoning Dept. Date
tluild'ing Dept. Date
Subject to compliance wit 1 ai,
State and Coun r S.
Permlt#� 91
LEGEND
AIC
,AIR CONDITIONER
W&I
-WATERMETER
AL
;ARCLENGTH
(C)
-CALCULATED
(M)
-MEASURED
Paa
• 0INTOFSEGINNING
RaC.
-POINTOFCOMMENCFMENT
&
-AND
P.B.
-PLAT8009
PG
-PAGE.
U.E.
-UFILITYEASEMENT
LfE
-VRAINACSMSEMENT
P01.
-PUSLICUTILITYEASEMENr
L.A.E.
=LIMiTEDACCESS EASEMENT
LM,E,
-LAKE MAINTENANCEEASEMENT
O.H.E
-OVERHEAD EASEMENT
R
-RADIUS
(R)
-RECORD
O,R,8.
-OFFICIAL RECORDS BOOK
Sq.Et.
-SQIIAREFEET
Ac
ACRES
DB
-DEED BOOK:
(D)
-DEED:
(P)
-PLAT
EOW
-EDGE OF WATER
TOB
-TOP OFSANK:
OHL
-OVERHEADVNE
CIO
-CLEANOUT
ELEV
-ELEVATION
FF
-FINISHED FLOOR
LS
-UCENSEDSUR,VEYOR
L8
-LICENSE08USINESS
PSM
-PROFESSIONAL SURVEYOR&MAPPER
x —
-FENCE
#
-NUMBER
f
-PLUS.ORmNUS
ASPHALT
C
-CONCRETE
-PAVER/BRINCK
-WOOD
-UGHTPOLE
-WELL
>I
-WATER VALVE
-CENTERLINE
-CATCH BASIN
`rr
-FIREHYDRANT
.>
-11T]LRlAOLE
-MANHOLE
-ELEVATION
SOMEITEMS IN LEGEND MAY NOT
APPEAR ON DRAWING,
GENERAL NOTES:
1)THISSURVEVISBASED.UPONT#ECMINFORAIAT10NSYCLIENT, N08WFK: SEARCH OFTHEPUBLICRKQRO.HASMENMADEBYTHI50FFiCEUNLES507HFJ . SENOTED.
2)iFTH15SUM H4S855NPREPARED FORTHE PURPOSFSOFAWRTGAGETRAN5ACTMJTSSCAPE 15UMITEOTOTHEDETERMINATxaNOrr 1E DMOEW(ES, NO Fi1TURECONSTRU(RQNSHAti1.BE BASBn UPON THIS
SLMVWMWREtstMAIMNGAPPMVALANWW.:UPDATES):Romt4txaNSUWEvj%:LLC.NEXGEN5l#AWN(�•LLC,A55UME5NOR 5KASOLTTYF(vERm'feuLTIWGMOMFAILIH3ETOADWPJ TOTH1S
CLAUSE3)'A.FENCFSSHOWNHERTTLATiVEi ONAREILLU5OFTHEIRGENERALPO5T1'IONONLI;:FENEVIECSHOMARNi EiOGENM&t ALWEOFFENCE.MMOFACEW(.LNOTOAMA BERESPON51&1:FORGES
RSULTINGNY50LELYONTHEIRPW!' CALEtI<LATIONSHIPTOTHEMONUMENtfDBOUNOARYLINE5.4)GRAPHICREPREMgTAT)ONSMAYHAVEBEEN004C 18I)TOMORECLEAWY.ILLUSTRATEMEASURED REIATINSHIPS-
OIMEN51DN5SHALLHAVE PRECEDtNCEOVERSCAIMPOSLTIONS.5)UNDERG.90UND.1MPROVEMENT5HAVENMBEEN LACMDE)(CEPTASSI'MFICALLY%IOWN:6)ELEVAIK) 5AREBASEDU05NNAMNALGEODETIC
VEROZALDATUM (N.G.V0.1929)ORNORTkAMERICANVERTICALDATUM {NAVQ19M8 71ALL BOUNDARYAND CONTRtOi DIMENSIONS SHOMAREIFIELDMEASUR.EDAND CORRFSPONDTORECORD INFOt3MATK)V
UNLESS SPECIFICALLY NOTED DTH ERM SE:, B) CORNERS SHDWN A S SET' ARE 501" RODS I DE NTIFIED WITH A R.ASTICCAP MARKEDLS ILICENSEDSUR1ttFKiRL)
SCALE:9 '=30'
POIN,
INTERSEC'
FOUND
AND
- ALL ANGLES AND DISTANCES SHOWN HEREON ARE BOTH RECORD AND MEASURED UNLESS OTHERWISE NOTED
jhe survey map S. report or the copies thereof ara,not valid without the dlpltal'slpnature
nd seal of a Florida llcensed aarrveyor and mapper
Date of Field Work : 06711-2022 �N�"„ .� . •�i''by�.
Drayun By: Oleg 0
Order *: 181762 's
Last Revision Date: None 'RALWM'ROFO"nv+°occMe�g
Boundary Survey prepared by: LB8111NSURVEYING,
_ � WIMW W"� * ?
NexGen Surveying, LLC EXGRN i ITAFasCx
561-SOB-6272 YAYF Q6 y
i FCO!i1421Ocjlethorpe Rd LLCWest Palm Beach, FL 33405