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DGT-12-18-3615, 480 NE 103rd StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:01/04/2019 Expiration: 06/04/2019 Location Address Parcel Number 480 NE 103RD ST, Miami Shores, FL 33138 1132060170710 Contacts GEORGE M SCOTT JR Owner HOME OWNER Contractor 480 NE 103 ST, MIAMI SHORES, FL 331382457 HOME OWNER Other:8133629468 Inspection Requests: Description: NEW PERGOLA Valuation: $ 1,000.00 1 Total So Feet: 224.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $6.00 DCA Fee $4.00 Education Surcharge $0.20 Gazebos, Trellises and Pergolas Fee $250.00 Notary Fee $5.00 Planning and Zoning Review Fee $35.00 Scanning Fee $12.00 Structural Review ($45) $45.00 Technology Fee $10.00 Total: $417.80 Payments Date Paid Credit Card 12/06/2018 Credit Card jAmtPaidTotalFees 01/04/2019 Amount Due: Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a ping. Futhermore, I authorize the above named contractor to do the work stated. (l af-a- C' `4— ',t') lr r orize Si ture: Owner / Applicant / Contractor / Agent Date January 04, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village (= vr Building Department' �'$ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138_s_ Tel: (305) 795-2204 Fax: (305) 756-8972 711 INSPECTION LINE PHONE NUMBER: (305) 762-4949 6-2 FBC 20 !Df- Master Permit No. Za 0 R - 3 (2D (S Sub Permit No BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP c [[qq CONTRACTOR DRAWINGS JOB ADDRESS: `► Z) 1"' I; 1 o � r City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO k Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):yle-O C sg= � - C'o Phone#: ( .3(,7 r Address: A/ 3 City: 1 &!nn t o d"e-5 State: Zip: -7 i 3 Tenant/Lessee Name: Phone#: Email: 2-J 41v\ S w A P 2=.G ✓i11Ac L' �. ;y v.-- CONTRACTOR: Company Name: O �^^Vv'c� Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: (� \ City: Stat Value of Work for this Permit: $ OW - D� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace Description of Work: Specify color of color thru tile:, Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Permit Fee $ � W - CCF $_ Radon Fee $ DBPR $ Training/Education Fee $ Zip: ❑ Demolition CO/CC $. Notary $ S C Double Fee $ Bond $ TOTAL FEE NOW DUE $� �� FjV 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. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this D day of t�L 120 (9 , by c�'{�I_ - � ,who is personally known to me or who has produced and who did take an oath. NOTARY P B C: Sign: Print: Seal: APPROVED BY DIA ALVAREZ MY COMMISSION # GG 233273 EXPIRES: September 3, 2022 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: 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: ����Y���. GJ DATE: fa- r ADDRESS: A 5 E) Aj `r � 7 =,�� 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 1, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. 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 /� 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. a 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. i Initial 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. I, 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.myfloridaIicense.com/dbpr/pro/cilb/index.htmI Initial 11. I 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: Initial_ C_� 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information 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 day of ti2-L otrr ; 20 E By�cXi' �Et--I ��' who was personally known to me or who has Produced there License or -t-4— -DO Va- IL OWNER as identification. SIMpiA ALVAREI N OTA R ; aR` r COMMISSION # GG 238273 2 <� EXPIRES' Sept 3rs Ordered By: NE,07Ih 51 Proudly Serving lowNE 1051h St tic loilh St the Florida Real N`'°'r`'s' - Estate Community m m 6rt. for Over 20 Years a A t: rmP6mDmoiecao9i WWW.MELANDSERVICES.COM N. E 103rd STREET -t 4 -'D . 24 ' ASPHAL T PAVFMENT p g 018 h LO 2P PARKWAY r-z� 5',CONCRETE . : NJQ°QO'0 `E��7S.00'iPXN�I t F.l�.1/2' • • • • • • SIOEWAtI K• '.I 7703'(hf) ' •• A 0.40- WIDE J COW. RIBBON ONIFL ` K V v L�6' t oil X • • �C��� F.LP.I/Z' • •• • • a •••••• • •••• •••• • • • 0000 0000 —9.97,' � •••••• •••• • • • • A • • • • • • 6.60- +0J4• ••.••• • ••••• tj d M £ o.saA V ONE STORY � o v oRESIDENCE Z R1 p o #480zi ry 9.8? _.—LW FL to.19' • IJ.70'•• •� .1 r 4p �• "j� • CDNC. , . PLANYER. • CGWCRE,TE ' /J90' 0.85' ay FL I 9' ASPHALT PAVEMENT o N Accepted By: Property Address: 480 N.E. 103 Street Miami Shores, FLORIDA 33138-2457 SURVEYOR'S CFRiIFICAT1011:1 MERFHY CERTIFYT REPRE:,FMA AS SET OF 4 SURYp�.pREPARFA UIDER FT 53-17, S. A$SET=11 7 l:V 1HE SfAT2T�eµn T7 5]-17, RQ'tIDA ADMItJSTR?T1NT`Cj�E PUt5U4•�TT SIGNED f tr rt�r��7 EFRAIN LOIIf.2 STATEOFrIO_(�rDA nWn„ NOT VA 1Y[THOtlr N O FLE dC $t� t•WPISNOTVALIDWMH U13h '�NIDI MAWER. tAr l s'SW,MuYSLR%ZYISATRUEu CORREcr M.E. Land Surveying, Inc. DIRECTION. THt5CO."3LIEStIrTHT l-Il<lt(•IU:ATECFTIICAL A0o=CFPR0FESS10tIALLN'J SLAIEYORSIIICINPTER 10665 SW 190th Street 3472.027, RORIDA STATUTES. Suite 3110 Miami, FL 33157 FOR THE FIRM Phone: (305) 740-3319 P.S.M. N.. 6792 Fax: (305) 669-3190 11ATUI3E MM AU IDMCA= a MMJIC SEAL u V/On THIS F ORIGINAL RAISED SEAL OF A LICENSED SIAVEYOR AND LB#: 7989 Surveyor's Legend PROPERTY UNE STRUCTURE iN0 POUND IRON PIPE B.R. BEARING REFERENCE TEL TELEPHONE FACILITIES / LONE. BLOCK WALL PIN AS NOTED ON PUT L CENTRAL ANOLC OR DELTA U.P. UTILITY POLE —X—X— CHAIN -LINK FENCE OR WIRE FENCE LB/ LICENSE It - BUSINESS R RADIUS OR RADIAL E.U.B. ELECTRIC UTILITY BOX WOOD FENCE LS/ LICENSE / - SURVEYOR RAD. RADIAL TIE SDP. SEPTIC TANK IRON FENCE CALC CALCULATED POINT N.R. NON RADIAL D.F. DRAINr1ELO --^ •--- EASEMENT SET SET PIN TYP. TYPICAL A/C AIR CONDITIONER — - — CENTER LINE A CONTROL POINT I.R. IRON ROD S/W SIDEWALK ® WOOD DECK CONCRETE MONUMENT I.P. IRON PIPE DWY DRIVEWAY e, BENCHMARK N&D NAIL h DISK SCR. SCREEN CONCRETE CLEV ELEVATION PK NAIL PARKER-KALON NAIL CAR GARAGE rJ �J77'J7 ASPHALT P.T. POINT Or TANGENCY D.H. DRILL HOLE (HCL ENCLOSURE P.C. PoNrr Or CURVATURE O WELL N.T.S. NOT TO SCALE BRICK / TILE P.R.M. PERMANENT RCFERENCC MONUVENT FIRE HYDRANT r.F. FIN141SHED FLOOR P.C.G. Pon,, Or COMPOUND CURVATURC O M,H. MANHOLE T.O.B. TOP OF BANK WATER P.R.C. POINT OF REVERSE CURVATURE O.H.L. OVERHEAD UNCS E.O.W. EDGE OP WATER APPROXIMATE EDGE OF WATER P.0.0. POINT OF BEGINNING rX TRANSFORMER C.O.P EOGC OF PAVEMENT � COVERED AREA P.O.C. POINT OF COMMENCEMENT CAN CABLE TV RISER C.V.G. CONCRETE VALLEY CUTTER P.C.P. PERMANENT CONTROL POINT W.M. WATER METER B.S.L BUILDING SETBACK LINE Q TREE M FIELD MEASURED P/C POOL EQUIPMENT S,1.L. SURVEY TIE UNE >irT POWER POLE P PUTTED MEASUREMENT CONC. CONCRETE SUB CENTER LINE � Illo CATCH BASIN D OECD ESMT EASEMENT R/W RIGHT-OF-WAY C.U.E. COUNTY UnUtY EASEMENT C CALCULATED D.C. DRAINAGE EASEMENT P.U.E. PUBLIC UTILITY EASEMENT I.E./E.E. INGRESS / EGRESS EASEMENT L.M.E. LAKE OR LANDSCAPE UMNT. C:IAT. LEIS. LANDSCAPE BUFFER EASEMENT C.M.E. CANAL VAINTENANCE EAWMENT • V.E. UTNIY EASEMENT R.O.E. ROOF OVERHANG EASEMENT L.A,E, LIMITED ACCESS EASEMENT ANCHOq CASEMELI7 • • • • • Y a,E. • • • Property Address: General Notes: •• . :„• '• 1.) The Legal Description used to perform this survey was supplied by others. • • • • • • • • • 480 N.E. 103 Street This survey does not determine or is not to imply ownership • • • • • • • • Miami Shores, FLORIDA 33138- 2.) This survey only shows above ground improvements. • • • • • • • • Underground utilities, footings, or encroachments are not located on this survey map• • • • 2457 3.) If there is a septic tank, well, or drain field on this survey, 0000 • • • • the location of such items was shown to us by others and the information was not verified. Flood Information: 4.) Examination of the abstract of IND will have to be made to determine recorded insTnTrTy'ent?, g any, effeitthTsIrlo4e rty,The lands shown herein were not abstracted for easement or other recorded encumforanc•s not shown ondhe plat Community Number: 120652 5.) Wall ties are done to the face of the wall. • • • • • • • 6.) Fence ownership is not determined. • • • Panel Number: 12086CO302L 7.) Bearings referenced to line noted B.R • • • • Suffix: L 8.) Dimensions shown are platted and measured unless otherwise shown. • • • • • • Date of Firm Index: 09/11 /2009 9.) No identification found on property corners unless noted. • • • Flood Zone: X 10.) Not valid unless sealed with the signing surveyors embossed seal. • • • • • • 11.) Boundary survey means a drawing and/or graphic representation of the survey work performed in lht"fipW,%W?d Base Flood Elevation: be drawn at a shown scale and/or not to scale Date of Field Work: 02/02/2016 12) Elevations if shown are based upon NGVD 1929 unless otherwise noted Date of Completion 02/03/2016 13.) This is a BOUNDARY SURVEY unless otherwise noted. 14.) This survey is exclusive for the use of the parties to whom it is certified. The certifications do not extend to any un named parties. 15.) This survey shall not be used for constructiontpermitting purposes without written consent from the land surveyor who has signed and sealed this survey. Legal Description: Lot 3 and the West 25 feet of lot 2, of Block 92, of Amended Plat of Miami Shores Section No. 4, according to the plat thereof, as recorded in Plat Book 15, Page 14, of the public records of Miami -Dade County, FLORIDA Printing Instructions: Certified To: While viewing the survey in any PDF Reader, select the File George M Scott Jr and Natalie Zagury Drop -down and select "Print". Select a color printer, if Mellex Title Services, LLC available; or at least one with 8.5" x 14" (legal) paper. Fidelity National Title Insurance Company Select ALL for Print Range, and the # of copies you would Navy Federal Credit Union like to print out. its successors and/or assigns as their interest may appear. Under the "Page Scaling" please make sure you have selected "None". Please copy below for policy preparation purposes Do not check the "Auto -rotate and Centers' box. only: This policy does not insure against loss or damage by reason of The following Check the "Choose Paper size by PDF" checkbox, then exceptions: Any rights, easements, interests, or claims which may exist by reason Click OK to print. of, or reflected by, the following facts shown on the survey prepared by_ EFRAIN LOPEZ dated 0210312016 bearing .Cob # B-14119 : a, NO NOTES M.E. Land Surveying, Inc. 10665 SW 190th Street, Suite 3110 Miami, FL 33157 _ Phone: (305) 740-3319 _ Fax: (305) 669-3190" LB#: 7989 Survey #:B-141 l9 Client File #: 16-3820 Pace 2 of 2 Not valid without all DD"PA 2"X6" RAFTER (TYP.) 012-16'+/— O.C. 3"X8" BEAM_ ENO DESIGN BY OWNER MOUNT POST TO EXIST. CONC. PATIO W/ SIMPSON ABW66Z OR EQUIV. SECURE MOUNTING BRACKET USING }" THREADED ROD, WASH. AND NUT. DRILL I'X4-4" DEEP HOLE INTO CONC. W/ THREADED ROD EPDXIED 4" MIN. 3"X8' BEAM END DESIGN BY OWNER (2) EA. j"X12" CAR. BOLT, WASHER, LOCK WASH. AND NUT (2) EA. a"X12" CAR. BOLT, WASHER, LOCK WASH. AND NUT EXIST, CONC. PATIO (BELOW) SIMPSON H2.5AZ OR EQUIV. 1 PER CROSSING (TYP.) (2) EA. I"X12" CAR. BOLT, SIMPSON HUC38 WASHER, LOCK WASH. AND NUT OR EQUIV. FASTEN TO EXIST. STRUCTURE USING J" GALV. MASONRY —6"X6' POST EXPANSION ANCHORS EMBEDED 1-4" MIN. 14'-0" EXIST. CONC. PATIO — cL. O —0 t/ — BOT. OF EAVE EXISTING HOUSE (SCHEM.) SIMPSON HUC38 OR EQUIV, FASTEN TO EXIST. STRUCTURE USING }" GALV. MASONRY EXPANSION ANCHORS EMBEDED 1—}" MIN. EXISTING HOUSE • • •• • • • • • ••• ••• • a • • • : • ' ' : : ' STAN H95AZ • • • • OR EQUIV. • 1 PER CROSSING (TYP.) ALTERNATE SIDES OF JVFWR AS. SHOWN • •• • •• • • • a • • • • — --r• �T— i • 1 4'-0— • a . • Design Notes 1, WOOD MEMBERS AND FASTENERS DESIGNED USING ALLOWABLE STRESS DESIGN METHOD TO MEET ASCE 7-10- AND FBC 2014 WIND DESIGN CRITERW 1.1. RISK CAT. I do OPEN 1.2. INT. PRESSURE COEFF = 0.0 1.3. ROOF LIVE LOAD: N/A 1.4. 160MPH VEL. ZONE 1.5. EXP. C 2. EXIST. CONCRETE PATIO ASSUMED TO BE ADEQUATE TO RESIST COMPUTED UPLIFT FORCE OF 747.6 LBS PER COLUMN 3. ALL STRUCTURAL WOOD MEMBERS SHALL BE NO.2 PRESSURE TREATED SOUTHERN YELLOW PINE OR EASTERN RED —CEDAR 4. ALL FASTENERS SHALL BE HOT DIPPED ZINC COATED GALVANIZED STEEL OR STAINLESS. 5. SPECIFIED SIMPSON STRONG —TIE WOOD CONSTRUCTION CONNECTORS SHOWN. CONNECTORS TO BE INSTALLED PER MAN. SPECIFICATIONS. CUT SHEETS ARE AVAIL. AT WWW.STRONGTIE.COM No. L Revision/Issue Date "— Nam. and Me— JEFF LITTLEJOHN, P.E. 3658 DWIGHT DAVIS DR. TALLAHASSEE, FL 32312 850-363-8644 to/ -I "1/ %.-,c7 :t$b3133 R+a)sot Nam. and Addrsa SCOTT RESIDENCE 480 N.E. 103 STREET MIAMI SHORES, FL 33138 rz,. s PERGOLA ADDITION DaW 0/17/2017 1 OF 1 sods 1/4' - 1'