DEMO-18-10654�
YN
BUILDING
PERMIT APPLICATION
*BUILDING ❑ ELECTRIC
Miami Shores Village
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
APR 2 3 2018
Q')
UFBC�201`=-
-1
Master Permit No. �� Q 0(05
CANCELLED
Sub Permit No.
❑ ROOFING REVISION EXTENSION MRENEWAL
❑PLUMBING 0 MECHANICAL []PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
�j CONTRACTOR DRAWINGS
JOB ADDRESS: 2oa CJJ I �,
Folio/Partei#:_ It- 121 is (y 6451 9646 is the Building Historically Designated: Yes NO
Occupancy Type: %'Q1Mf Load: Construction Type: 9b5 Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): P�✓ Ct, Phorie#: [7
Address:_ ��b5 SW 4!'8 s`T'
City: hKM1 !: State: i%
Tip:
Tenant/Lessee Name: _.
Email:
CONTRACTOR: Company Name: CQ 1i+.'924'GLS;t414fCh" Phone#: bs* 7914 3to6
Address: F, ! b
City:
Qualifier Name:
11ac%el
VW_6
State Certification or Registration #: Certificate of Competency #: _
i 6
DESIGNER: Architect/Engineer: Phone#:
Zip:
Address: i
City: State Zip:
Value of Work for this Permit: $ S. DOO Square/Linear Footage of Work: 2 &0v
Type of Work: El Addition El Alteration ❑ New
❑ Repair/Replace Demolition
Description of Work: 1Art riT
Specify color of color thru the:,
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
IRevisedo2/24/20141
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
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..... i <
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 Btro-RE RECORDING
YOUR -NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated vdrae`eXceeding $256.0'ihe opplicant must
promise in good faith that a copy of the notice of commencement.ond 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 posfer) 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 reinspecfion fee will be -charged.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2� dayof20by
�_p�1nY11 Z", who is personally known to
me or who has produced 'F-Lb�,— as
identificatl`&,and who did take an oath.
NOTARY PUBLIC:
Sign: Z
Print: \ '"
Nc,#Ary PAIII), IRMO of Floc a
Seal: 1 Coimmission~# FF 9466 77
Lf'y ow.m: aipires Dec, 29, 2019
, � V
Signature
CONTRACTOR
The foregoing instrurrlen� was acknoyledged before this
_ day of 26 by
Iv \� rhQp-1 irss, n��iy known to,.
�/+
me or who has produced i� S�s
identification and who„dl, take an oath. t
NOTARY PUBLIC:
.Print:
z
APPROVED BY Plans Examiner Zoning ,
fijkhl Structural Review Clerk
(Revised02/24/2014)
4/23/2018 Property Search Application - Miami -Dade County
OFFICE OF THE PROPERTY APPRAISE
Summary Report
Property Information
Folio:
11-2136-001-0640
Property Address:
200 NW 111 TER
Miami Shores, FL 33168-3325
Owner
J ENNIFER ZAGA
Mailing Address
6705 SW 53 ST
MIAMI, FL 33155 USA
PA Primary Zone
0700 SGL FAMILY - 1551-1700 SQ
Primary Land Use
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
2/2/0
Floors
1
Living Units
1
Actual Area
Sq.Ft
Living Area
Sq.Ft
Adjusted Area
1,891 Sq.Ft
Lot. Size
10,200 Sq.Ft
Year Built
1953
Assessment Information
Year
2017
2016
2015
Land Value
$218,998
$183,367
$183,367
Building Value
$131,981
$132,103
$132,226
XF Value
$1,271
$1,275
$1,066
Market Value
$352,250
$316,745
$316,659
Assessed Value
$352,250
$241,431
$219,483
Benefits Information
Benefit
Type
2017
2016
2015
Non -Homestead Cap
Assessment Reduction
1
1 $75,3141
$97,176
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
Short Legal Description i
NEW MIAMI SHORES ESTS PB 51-80
LOT 16 BLK 3
LOT SIZE 102.000 X 100
OR 13328-2866 0687 1
COC 25483-4163 02 2007 1
Generated On : 4/23/2018
Taxable Value Information
2017
2016
2015
County
Exemption Value
$0
$0
$0
Taxable Value
$352,250
$241,431
$219,483
School Board
Exemption Value
$0
$0
$0
Taxable Value
1 $352,250
$316,745
$316,659
City
Exemption Value
$0
$0
$0
Taxable Value
$352,2501
$241,431
$219,483
Regional
Exemption Value $0
$0 $0
Taxable Value $352,250
$241,431 $219,483
Sales Information
Previous
Price
O Book-
Qualification Description
Prev
e
Page
12/13/2016
$168,000
30423-0302
Financial inst or "In Lieu of Forclosure"
stated
11/10/2016
$258,000
30310-4514
Financial inst or "in Lieu of Forclosure"
stated
02/01/2007
$530,000
25483-4163
Sales which are qualified
06/01/1987 1
$53,300
13328-2866
1 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/info/disclaimer.asp
Version
Notice to Owner — Workers' Com
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or store part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officer
exempt if: s
or members of a limited liability company (LLC) in the construction industry may elect to r
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions arc valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State a
County of Miami -Dade
The foregoing was acknowledge before me this oZ3 day of � h�
By Z2hy)&�A n ACw y
F
who is personally known to me or has produced � as identification.
Rotary: ZRMIRM L DAME RI-DIA2
NOWY 10011o, Mats Of F' Ida
SEAL: CommissioN FF 946697
MY osmm. expires Doc. 29, 2019
GRAHAM BUILDING INSPECTIONS, Inc
Master Professional Inspector, Florida Association of Building Inspectors
(RPI #0194 Member since 1994)
Florida licensed Home Inspector # 3241
Dade County General residential contractor # 000017565
Florida Registered Residential Contractor # RR 282811799
845 NE 71 ST., MIAMI, FL 33138
E Mail: abisince 1990@amail.com. Cell: 305 776 3106
www.SFiainspectBuild.com
Date: 23 'N P r i 12 01 00
State of: F 1 o r A d _ 0
County of: M 1 arm
Before me this day personally appeared MICHAEL ROBERT GRAHAM who, being
duly sworn, deposes and says:
That MICHAEL ROBERT GRAHAM will be the only person working on the project
at: 2Dc- �W
n
C^--�
Signed by Michael R Graham
-AfD r I 1
Sworn to or affirmed and subscribed before me this 2,S day of 2018 by:
.�X.,P =Public
ALEZ
;+A+:
MY G 044602
Er 2, 2020. BondeUnderwriters
Produced identification: Type: J(— 1 1 i CJ')S-.Q'
(name of notary)