RC-18-3434 (2)aI`
�f
BUILDING
PERMIT APPLICATION
Miami Shores Village crlr-
Building Department V 1. 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201 9
CANCELLED Master Permit No. go-(e) -3 T 3
.�
Sub Permit No.
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL OPUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
,/ Q �i Q (�,,� CONTRACTOR DRAWINGS
JOB ADDRESS: 1.2 2 ' ` c 95-� cS I o e-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder)
Address: 42* /ve qc�,
City:
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
Mara �ao(�,ei1a�4a-�e,
State:
1G
ne#: '5:�6 i l?6 ki
Zip:�S 3339
c
e Phone#• — k^� 3 J o
M(,s �C, - m
Phone#:
Phone#:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Zip:
Address: MM City: State: Zip:
x Value of Work for this Permit: $ t'JbW ' �Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
l- Description of Work:
Specify color of color thru tile: '
Submittal Fee $ Permit Fee $ : CCF.$
Scanning Fee $ Radon Fee $ DBPR $� ` �n . n Notary $
Technology Fee $ A Training/Education Fee $ Double Fee $
Structural Reviews $
Bond $
TOTAL FEE NOW DUE $ 6 Cjo
(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
Zip
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.....
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 inspectn which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not e pproKd and a reinspection fee will be charged.
Signature kyt/IUIUI!�%/ Signature
OWNER or AGENT CONTRACTOR
The foregoing instru ent was acknowledged before me this
)�_dayof IvC��%I�20 �8 ,by
0ATZIN?AOLINTO-L& :XLT2M is
personally known to
me or who has produced �(ZI ��t° as
identification and who did take an oath.
NOTARY PUBL
Sign:
Print: MI.,,
Seal:
APPROVED BY
(Revised02/24/2014)
The foregoing instrument was acknowledged before me this
day of 20 by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
as
Seal:
SIY?4PIans
My COM
EXPIRE
************s*ssss**s*********s**s**�*�** Examiner � � ��'� Zonin>;
"Il�Jw �
Structural Review
Clerk
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: �'J�'�I "i rU DATE:
ADDRESS: t2q,,2_ NO 15-A S'1r—�
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; 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 as my own contractor with certain
restrictions even though I do not have a license. �/
Initial �1 et/ I
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.
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 Rf�V'
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 constructions.
"Initial N/
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 by county orinunicipal ordinance.
A Initial
-AK.
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. r-
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 regulatio s.o�
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:/Iwww.mvfloridalicense.com/dbpr/pro/cilb/index.html D 1�
Initial I l
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 responsible for the proposed construction activity at the following address:
ell,
Initial- ra
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the infor ation 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 workers 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 43 day of /KOYC'0?�Qf , 20 �y
By N��,?&QVN- who was personally known to me or who has
Produced there ense or _tL_DW
dA
OW ER
s identification.
NOTARY
!" SINDIA ALVAREZ
COMMISSION p GG 238273
.v EXPIRES: September 3, 2022
„oi...'�'' Bonded Thtu Nowt' Public Undelwitera
—� Coe
10050 N.E. SECOND AVENUE
p MIAMI SHORES, FLORIDA 33138-' 382
TELEPHONE: (305) 795-2207
TRAVIS HENOALL FAX: (3051 756-8972
Planning & Zoning Director N-
DEVELOPMENT ORDER
File Number: PZ-7-26-18-56
Property Address: 1292 NE 95th Street Miami Shor FL 33138
Property Owner/Applicant: Maria Paola Della Torre
Address: 1292 NE 95t' Street Miami Shores FL 33138
Agent: Jorge Guiterrez
Address: 12850 W SR84 #3-20, Davie, FL 33325
Whereas, the applicant Maria Paola Della Torre (Owner', has filed an application for site
plan review before the Planning Board on the above pro erty. The applicant sought
approval as follows: Pursuant to Articles IV, V and VI o 2Appendix A Zoning, Sec. 400
Schedule of Regulations and Sec. 600. Site plan review d approval required for a
garage conversion.
Whereas, a public hearing was held on July 26, 2018 and the Board, after having
considered the application and after hearing testimoilty and reviewing the evidence
entered, finds:
1. The application was made in a manner co sistent with the requirements of
the Land Development Code of Miami Sh)res Village.
2. The conditions on the property and the rej resentations made at the hearing
merit consideration and are consistent with the requirements of the Land
Development Code.
The Board requires that all further development of the roperty shall be performed in a
manner consistent with the site plan, drawings, and th conditions agreed upon at the
hearing:
1) Approval is granted as shown on the plans
approval.
2) Applicant to maintain two (2) legal parking
and made a part of this
on site.
Pagel of 2
VISIT US I www.miamishoresvillage.com
3) Applicant to apply for and obtain all
Building Department before beginning N
4) Applicant to apply for and obtain all
outside agencies.
building permits from the
permits and approvals' from
5) Applicant to obtain all required permits and approvals from the Miami -Dade
Department of Regulatory and Economic Resources, Environmental Plan
Review Division (DRER, EPRD) and the N. iami-Dade Department of Health
(DOH/HRS) as required.
6) Applicant to meet all applicable code provisions at the time of permitting.
7) This zoning permit will lapse and become i alid unless the work for which it
was approved is started within one (1) year of the signing of the development
order by the board chair, or if the work authorized by it is suspended or
abandoned for a period of at least one (1) year.
8) Applicant to complete a covenant in the orm of a "Declaration of Use"
assuring the property is used only for a s ngle family purpose, record the
covenant with the Miami -Dade County R order and provide the planning
director with a copy of the recorded docurric nt prior to the final inspection by
the Building Official.
9) The applicant creates a 5-foot landscape
garage space.
The application with conditions was passed and
the Planning and Zoning Board as follows:
Motion to approve subject to Staff recommendat:
area adjacent to the stucco and 5 feet clearance a
Affidavit of Consent by Ms. Hegedus, seconded
passed 3/0.
Mr. Snow
Yes
Mr. Bergman
Yes
Ms. Hegedus
Yes
Mr. Brady
Absent
Chairman Busta
Absent
912119,
Dad
Vice Chair,
in front of the converted
this 261h day of July, 2018 by
s, adding the window to the
the completing of the Owners
Mr. Bergeman and the Motion
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