DS-12-19-2943, 117 NW 103rd StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
117 NW 103RD ST, Miami Shores, FL 33150 1121360131570
Contacts
Silvana Kishimoto Owner ANGEL MARTINEZ Owner
117 NW 103 ST, Miami shores, FL 33150 117 NW 103 ST, Miami, FL 33150
skishimoto20194@yahoo.com Mobile:5712155028 SIVINELANDSCAPINGI@GMAIL.COM
HOME OWNER Contractor
HOME OWNER
Inspection Requests:
Description: NEW PATIO DECK AND REPLACE DRIVE WAY I Valuation: $ 3,000.00
` � 305 7ii2-4949
TotalSq Feet: 2,700.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
Concrete/asphalt/pavers, slabs, dways,
$175.00
swalks
DBPR Fee
$3.38
DCA Fee
$2.25
Education Surcharge
$0.60
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$5.63
Total
$282.66
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$282.66
Check # 2223
06/15/2021 $282.66
Amount Due:
$0.00
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.
OWNERSkFFIDAVIT: I certify that�l the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating; nstruction and zoning. Fu ermore, I authorize the above named contractor to do the work stated.
4e 1 li i
Signature: Owner / Applicant / Contractor / Agent Date
June 15, 2021 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village ENTnRED
Building Department
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
—F-�B�C 201-T G� 2
Master Permit No. �7 — � — L 1,'J
Sub Permit No
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I I �— , v —) 10
City: Miami Shores County: Miami Dade Zip: 3
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: onstruction Type: Flood Zone: BFE: FIFE:
J�� Q O c�OWNER: Name (Fee Simple Titleholder): h =Phone#: �� L �'�� �d ��y �Z3
Address: �� � N � � � � �
City:
Tenz
Email
State:
Name:
CONTRACTOR: Company Name:
Address
33 ism
Phone#:
INVUJACL
ne#:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip: _
Value of Work for this Permit: $ � 3000 Square/Linear Footage of Work: K ZJ
Type of Work: ElAddition El,(Alteration E New []Repair/Replace ❑ Demolition
Description of Work: '�. v- �"� T �`- �I� r` _,e �J
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ 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 b proved and a reinspection will be charged.
Signature Signature
OWNER or AGENT
The foregoing instrumwas acknowledged before me this
day of 20 by
'J'4'�; who is personally known to
me or fia has prod d _ �� as
identifi ation and ho did take an oat \`\NDI PRl,, /
• �MISSIOiy S
OTA Y PUBLIC ••4� �GN25,°i'
Sign: � i�. �� Z ', 2 #GG 267265
., i �y '• d �� J 0�y� 4Q' .
°ded 1h� i�,•
Print: i a
Seal: i�fiBC/� STAM'—
CONTRACTOR
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:
Seal:
as
APPROVED BY 1�'ti�l�'� (�2I Plans Examiner l� �1 Zoning
Structural Review Clerk
(Revised02/24/2014)
Rah KMOL a4wre
Raft Kenol, P.A.
1940H t SVOL 6403%
HOr MXAFbft3M
Ourft 2l"9.1165
Retum tx
Paul siirsom m
Waking Tide iL.0
2030 s: Douglas Rd Ste 103
Cat GOMM Fla" 33134
General Warranty Deed
CFN: 20190740710 BOOK 31705 PAGE 4137
DATE:11/26/2019 02:44:22 PM
DEED DOC 2,160.00
HARVEY RUVIN, CLERK OF COURT, MtA-DARE CTY
Made this 13'1' .day of November, 2019 by Vincent R. Levros, a married man, whose post
office address is: 750 LATER -KbtiGHT RD, Cranston, RI 02921, hereinafter. called the grantor,
to: Silvana EIizabeth Mieko Kishimoto Milla, A Married Woman, Joined By -Spouse Angel M
Martinez, a married - man, whose post office address is: 117 NW 103 Street, Miami Shores,
FL 33150 hereinafter called the grantor
(Whenever used herein the term"grantor" and "grantee include all the parties to
this instrlunent and the heirs, legal representatives and assigns of individuals; and.
the successors and assigns of corporations)
WI TNESSETH: that the grantor, for and in consideration of the sum of and 00/100_ Dollars
(SIO 00), and other variable considerations,. receipt whereof is hereby acknowledged, hereby
grants, bargains, sells, aliens, remises; releases, conveys and confirms unto the grantee, all that
certain land situated in Miami Shores, Florida, viz:
Lot 22 and the But j3. of Lot 21, in Block 127, of AMENDED PLAT OV
SECTION N0.3 of Miami Shores, according to the plat thereof, as recorded
In Plat Book 1.0, Page 47; of the Public Records of Miami -Dade County,
Florida.
Said ;property is not the homestead of the Grantor under the laws and constitution of the State of
Florida in that neither Grantor nor any members of the household of Grantor reside thereon.
Parcel ID Number. 11-2136-013-15.70
Together with all the tenements, hereditaments and appurtenances thereto belonging or
in anywise appertaining.
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfwlly seized of
said land in flee simple; that the grantor has good right and lawful authority to sell and convey
said land; that the grantor hereby fully warrants the title to said land and will defend the same
against the lawfW claims of all persons whomsoever; and that said land is free of all
encumbrances; except :taxes accruing subsequent to .
In Witness Whereof, the said grantor has signed and sealed these presents the day and
year first above written.
Signed, Sealed and Delivered in Our Presence:
.1,7'x 4f,7
Print e: i a v v Vincent R. Levros
i
State of Florida
COUNTY OF: Miami -Dade
I HEREBY CERTIFY that the foregoing instrument was acknowled ed beI• me on this
day of November, 2019 by Vincent R. Levros, a married man, ar ersonally known to me
or who have produced as identification.
g A So
Not Pub ic, State of Florida
RALPH s. FIGARO
MY COMMISSION # GGI70000
EXPIRES: Deeember 20, 2021
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756,8972
OWN BUILDER DISCLOSURE STATEMENT
NAME: W_11 I - DATE:
ADDRESS:
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 n contractor with certain
restrictions even though I do not have a license. ✓j/�
Initial
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
5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
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. It
is my responsibility to ensure that the persons whom I employ have the license required by law and �y coupty or municipal ordinance.
Initial f#, ��(\
I 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. A —Kt
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. u
Initial ►1► ` /(l
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
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:
Initial
12. !agree to notify Miami Shores V-diage immediately of any additions, deletions, or changes to any of the information that I have provided on
this disclosure. )
Initial4=
✓(
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
1
�` By ' �� I I �A . I I(A �#It -- 11) who was personally known to me or who has
Produced there License or as identification.
OWNER N AR.
G
1__; day of -� Cc .20 � 1
A.
• .0a� BondeO"blihsg��•'
�i�o��ypUBCICeUVI
43�
��1�N1111itImiliO�
Mission:
Ron DeSantis
Governor
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts.
H Ee,"%rLT
Vision: To be the Healthiest State in the Nation
Angel Martinez
117 NW 103
Miami, FL 33150
RE: Contingency Letter
Application Document No: AP1470434
Centrax Permit Number: 13-SC-2043366
OSTDS Number:
117NW103St
Miami, FL 33150
Scott A. Rivkees, MD
State Surgeon General
April 13, 2021
LotA Block:127 Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 02/27/2020 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
Reviewed on 04/13/2021. No objection for Driveway Installation (front and Back) as per your Site
Plan. NO BEDROOM ADDITION. NO FLOW INCREASE.
From a review of your completed application, it has been determined that your existing system
appears to meet the minimum standards of F.A.C. 64E-6 for the proposed use. It is approved for
use with the plans submitted to this office. If this system should fail, causing an unsanitary
condition to exist, steps must be taken to bring the system into compliance immediately.
Department approval of the system does not guarantee satisfactory performance for any specific
period of time. Any change in material facts which served as a basis for issuance of this approval
requires the applicant to modify the permit application. Such modification may result in this
approval being made null and void. Issuance of this approval does not exempt the applicant from
compliance with other Federal, State, or Local Permitting required for development of this
property.
If you have any questions on this matter, please call our office at (305) 623-3500.
Sincerely,
Yt, cW ,Sorrra,
Yliana Serra, Engineering Specialist II
Florida Department of Health www.FloridaMealth.gov
in DADE COUNTY TWITTER:HealthyFLA
1725 NW 167 St, Opa Locka, FL 33056 FACEBOOK:FLDepartmentofHealth
PHONE: (305) 623-3500 FAX: (305) 623-3645 YOUTUBE: fldoh
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%amiFI 33157
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LOT 4 LOT 3 LOT 2 •.'.•' '..' '
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I 44'f ASPHALT PAVEMENT
N.W. 103rd STREET
Accepted By _
Property Address: --
117 N W 103 Street
Miami Shores, FLORIDA 33150
--All— I HERBY fERTIFY THAT THIS BOUNDARY SURVEY IS A TRUE AND
�FY(I�r OFASU fFIR , CDUNDERMYOIRECTiON THISCOMM.IES
KITH THE N.U.MrTy..H;C. - FORTH BY THE STATE OF FLORIDA BOARDCF
PNOTE=SIOHAE IAND SURYE x . Ci Ict y"Ir. THRWp45JI17-052.FLORIDA
QNTTVECOOEPUR TyT.fA'1,.ry -Ul ATUES
SIGNED FOR THE FIRM
EFRAIN LOP v
STATE OF FIL _ mr. •, t P.&M. No. 6792
NOTVAUDW NOUTANDAUTHENTI6{ nP IC SIONATUREAHDAUTHENTICATEO
ELECTRONIC SEA:-0—TH,S MAP Ie - VAUO VYITHOUT THE e16HATUREANoTHEOA3G—
RASED SEA OF A LICENSfD SUR VFIDR ANO MAPPER
Notes: NO NOTFS
M E Land Surveying, Inc.
10665 SW 190th Street
Suite 3110
Miami, FL 33157
ME LAND
Phone (305) 740-3319
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Fax (305) 669-3190
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