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DS-2-18-258, 125 NW 95 St` SHORES Lit a e 4'-FN EB �H 9J 'cLpRiDp' Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 125 NW 95 Street 1131010240320 MICHAEL JOHN LEWIS ALEXAN Miami Shores, FL Block: Lot: Owner Information Address MICHAEL JOHN LEWIS ALEXANDRA 125 NW 95 Street ------- MIAMI SHORES FL 33150- 125 NW 95 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone HOME OWNER In Review Date Approved:: In Review Date Denied: Type of Work: NEW DRIVEWAY CONCRETE SLAB Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due Amount Bond Type - Owners Bond $500.00 CC F $4.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $1.40 Notary Fee $5.00 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $5.60 Total: $654.20 Phone Cell Valuation: $ 7,000.00 Total Sq Feet: 603 Pay Date Pay Type Amt Paid Amt Due Invoice # DS-2-18-66302 02/01/2018 Cash $ 50.00 $ 604.20 02/01/2018 Check #: 645 $ 500.00 $ 104.20 02/21/2018 Credit Card $ 104.20 $ 0.00 Bond #: 3627 Ayauame Inspections: Inspection Type: Final Foundation Review Building Review Building Review Building Review Planning 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 alJ work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHPMCAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. s OWNERS AFFIDAVIT: 1 certify that all e f egoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoniq "FtFierrpoce rize the above -named contractor to do the work stated. -� - February 21, 2018 A� iattrrer>�wner / Applicant / Contractor / Agent Building Department Copy February 21, 2018 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 BUILDING PERMIT APPLICATION {BUILDING ❑ ELECTRIC ❑ ROOFING RECEIVED FEB 012018 FBC 2Un Master Permit No`. tJ cS i ?5 - 2 C Sub Permit No ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: L25 AW -if-) i ,# City: Miami Shores County: Miami Dade Zip: 3315 0 Folio/Parcel#: 1 •—,310/ -©02 Ll •— 032 p Is the Building Historically Designated: Yes NO _ X Occupancy Type: Og,;nEnl/Wzfd: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): Kjj±" L1'- >/5 C,�et �n A/EPhone#: 0 5H —7} 013J1 (0 Address: 12,5 JVi) C51W J" T City: MIAIVI1 )A�_5 State: ) L(Vc-laq Zip: 3660 Tenant/Lessee Name: A11 P • Phone#: Aj ZA Email:E�hn/I�PA(C�//UtmG1ll Cain . CONTRACTOR: Company Name: Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: -- 22Zip: Value of Work for this Permit: $ �. L-132) Square/Linear Footage of Work: C J Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: /1lF C) Aow Specify color of color thru tile: Submittal Fee $ - 00 Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $, Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ 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 be approved and a reinspection fee will be charged. Signature - Signature NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 1 day of _ ,20 by 1AL Y4a1'ZA �wht C c7 ally known , who is personally known to me or who has produced v,C M's as 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. identification and who did take an oath. as NOTARY PUBLIC: NOTARY PUBLIC: Sign: q,�\`�����e 1 I IC r�� Sig n: Print: Print: Seal: �: ti Seal: s-Z0nrr 964760 Z A ti BondedihocG.`���w �,�9apa;ryPWid o.o.. APPROVED BY 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: f% fi_Jl [ et�lS E.:lj",C_tO DATE: ( % ADDRESS: 12.5 AJ60 11,577t -7 kllfi-t-V Sh't)ag f 3- 1 0. 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. 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 14 L 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 �L 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. tnitial RL 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 by county or municipal ordinance. Initial A 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 ' ` L 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 -Al 9. 1 agree that, as the party legally and financially responsible for this proposed Construction activity, 1 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 ,4L 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.htmI Initial A/- 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: I�2_5 AJO g67'ft 5'T n1147-1l _Y�001616 - / 33150 Initial r � 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 4,--'- 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 05i!E, 20 //���11 � qq rr C �-D1z V z � By`r',`HM•�who was personally known to me or who has Produced there e e or b.- 1 1 \1 as identification. r�+�►141lllllf��>'r�� �ENIS G�Mtt11SS%p' :,Z : • �,zcch 6, y��S. NOTARY f� :,aF954760 ' 9 s,c�••'fb�Y��d thN �'f�� ' �0�� AXA&API COIF'10113iciiu. Slul LOT 12 0 0 0 BLOCK ON LINE ON LINE N90000'00"E 75,001 2,50' OF LOT 14 Lor to BLOCK 13 Lor13 LOT 14 BLOCK 0 BLOCK 10.13' 1. 2.84' BLOCK 75.0'(R) CORNER NO REVI W REQUI RED Florida Healt �iami-Dade COTMV'2" NO 10 O.S.TJD. & Well Program Application No,: Date: Signature I ­IOVE STORY CBS RES # 126 .Z an 27,4' 4 14.1 75.00' 5' SWK I I 91 ASPHALT PAVEMENT S 08 :NGO*C NW 95TH STREET Rw U M W Lj_j L1_ Ckl- Driveway Installation Project: - 125 NW 95t" St. Miami Shores, FL 33327 Main Material: - Concrete Driveway Build Projection: suttc�raGstia__ Concrete Sltrb side view !sl M 5cF1 TAPE Uulked with DC-!yl or Dimctic 2•1c) • e �C�rIL'utiP?:l��,s•1�c4t1fDr:.ttE�.t•• U . T OPEN DRAIN $�XK MAP OF BOXtJNDARY SURVEY NORTH SCALE: 1 "=20' 01� M LOT 13 N BLOCKS I �, O F LOT 12 BLOCK 5 ON LINE N90000'00"E 75.00' ON LINE 2.50' 1 1 (50. '�51 0.15' 00 v EAST 112 OF LOT 14 LOT 15 BLOCK 5 25.8' 1? 0 13.4' F, �! d- o N N r LOT 14 9.99' �C _< BLOCK 5 g 2' t g g, 10.13' D CD1 D ONE STORY CBS !� RES # 125 � I r 13.2' x n Cd 0.50' 27.4' 2.64' =L 3' 14.3' 10,3V 9.81' 3' 14. A I (50.00') BLOCK 7� 2.85 CORNER — 0 0 Lo Co C = FIP 1/2" NO ID T -zy I DATE to Ul) d I 1 (50.00') N90000'00"W 75.00' 5' SWK o 3' GUTTER ASPHALT PAVEMENT NW 95TH STREET RNV ! fH ALL FEUERRL LEGEND CERIIFlCATE OF AUTHORIZATION B LB-8013 ABBREVIATIONS: Survey Pros, Inc. A = ARC DISTANCE AC = AIR CONDITIONER PAD 8306 MILLS DRIVE SUITE 148, MIAMI, FL. 33183 BCR = BROWARD COUNTY RECORDS Tel: 305.767.6802 BLDG = BUILDING BM = BENCH MARK www. survey- pros.com BOB = BASIS OF BEARINGS CBS = CONCRETE BLOCK & STUCCO (C) = CALCULATED LOCATION MAP: C&G = CURB & GUTTER NOT TO SCALE CLF = CHAIN LINK FENCE COL = COLUMN D.E. = DRAINAGE EASEMENT D.M.E. = DRAINAGE & MAINTENANCE EASEMENT D/W = DRIVEWAY EB = ELECTRIC BOX ENC. = ENCROACHMENT EP = EDGE OF PAVEMENT EW = EDGE OF WATER FDH = FOUND DRILL HOLE FF = FINISHED FLOOR ELEVATION FIP_= FOUND IRON PIPE (NO ID) FIR = FOUND IRON ROD (NO ID) FN = FOUND NAIL (NO ID) FPL = FLORIDA POWER & LIGHT TRANSFORMER PAD L.E. = LANDSCAPE EASEMENT L.M.E. = LAKE MAINTENANCE EASEMENT (M) = MEASURED MDCR = MIAMI-DADE COUNTY RECORDS MH = MAN HOLE ML = MONUMENT LINE (P) = PLAT PB = PLAT BOOK PC = POINT OF CURVATURE PCP = PERMANENT CONTROL POINT PE = POOL EQUIPMENT PAD PG = PAGE • • • • • • • • • • • • • • • PI = POINT OF INTERSECTION PROPERTY ADDRESS: • • • • • • • • • • • PL = PLANTER POB = POINT OF BEGINNING POC = POINT OF COMMENCEMENT • • 125 NW 95TH STREET, MIAMI, FL. 33.5F1• • • • • • • • • • • • • PRC = POINT OF REVERSE CURVATURE PRM = PERMANENT REFERENCE MONUMENT • • • � • � � • � PT = POINT OF TANGENCY • • • • R = RADIUS DISTANCE LEGAL DESCRIPTION: • • • • • • (R) = RECORD • • • • • • R/W = RIGHT-OF-WAY LOT 15 AND THE EAST 1/2 OF LOT 04, BLOOK 5, OF B•NMAR PARK, ACCORDING TOP RES = RESIDENCE THE PLAT THEREOF, AS RECORDED OIIN `pL•AT*BOOK 17, 4 AGE• 11, OF Tt *"c l SIP = SIP LB#8023 RECORDS OF MIAMI-DADE COUNTY, FL0�21DA. • • • SNO = SET NAIL & DISK LB#8023 • • • STL = SURVEY TIE LINE SWK = SIDEWALK (TIP) = TYPICAL UB = UTILITY BOX SURVEYOR'S NOTES: U.E. = UTILITY EASEMENT W/F = WOOD FENCE 1. ELEVATIONS WHEN SHOWN REFER TO 1929 NATIONAL GEODETIC VERTICAL DATUM (NGVD 1929). 2. NO ATTEMPT WAS MADE TO LOCATE FOOTINGS/FOUNDATIONS, OR UNDERGROUND SYMBOLS: T = ❑ TELEPHONE RISER UTILITIES UNLESS OTHERWISE NOTED. 3. THE LANDS SHOWN HEREON HAVE NOT BEEN ABSTRACTED IN REGARDS TO 0 = CABLE TV RISER MATTERS OF INTEREST BY OTHER PARTIES, SUCH AS EASEMENTS, RIGHTS OF WAYS, E = WATER METER RESERVATIONS, ETC. ONLY PLATTED EASEMENTS ARE SHOWN- X 0.00 = ELEVATION 4. THIS SURVEY WAS PREPARED FOR AND CERTIFIED TO THE PARTY(IES) INDICATED (00') = ORIGINAL LOT DISTANCE HEREON AND IS NOT TRANSFERABLE OR ASSIGNABLE WITHOUT WRITTEN CONSENT OF A = CENTRAL ANGLE THIS FIRM. 5. ALL BOUNDARY LIMIT INDICATORS SET ARE STAMPED LB# 8023. = CENTER LINE 6. THE BOUNDARY LIMITS ESTABLISHED ON THIS SURVEY ARE BASED ON THE LEGAL wv DESCRIPTION PROVIDED BY THE CLIENT OR ITS REPRESENTATIVE. = WATER VALVE 7. FENCE OWNERSHIP IS NOT DETERMINED. Wj = CURB INLET 8. ADDITIONS OR DELETIONS TO THIS SURVEY MAP AND/OR REPORT BY SOMEONE OTHER THAN THE SIGNING PARTY(IES) IS PROHIBITED WITHOUT WRITTEN CONSENT OF THE SIGNING PARTY(IES). yUQ = FIRE HYDRANT 9. BEARINGS WHEN SHOWN ARE TO AN ASSUMED MERIDIAN. THE CENTERLINE OF NW Y = LIGHT POLE 95TH STREET HAS BEEN ASSIGNED A BEARING OF N 90'00'00" W. CERTIFIED TO: = CATCH BASIN = UTILITY POLE ALEXANDRA LEWIS DO = DRAINAGE MANHOLE = SEWER MANHOLE REVISION(S): —c = IRON FENCE -0 = WOOD FENCE —•— = CHAIN LINK FENCE — = OVERHEAD UTILITY WIRE 1:1 El 1:1 El x ASPHALT CONCRETE PAVERS TILES COVER SURVEYOR'S CERTIFICATE: I HEREBY CERTIFY THAT THIS SURVEY IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AS DATE OF ORIGINAL SURVEY 04108114 RECENTLY SURVEYED AND DRAWN UNDER MY DIRECTION AND MEETS THE INIMUM TEC NICAL STA ARDS SET FORTH BY THE FLORIDA STATE BOARD OF SURVEYORS AND MAPPERS IN CH PTER 5J-1 FL RIDA AD INISTRATIV� JOHf- 14040268 CODE PURSUANT TO SECTION 472.027 FLORIDA STATUE- - - DRAWN BY. NICK SEAL U AUTHENTIC COPIES OF THIS CAD FILE: LEW1S SURVEY SHALL BEAR THE ORIGINAL SIGNATURE AND _ SHEET 1 OF 1 RAISED SEAL OF THE NICOLAS DEL E TO ATTESTING REGISTERED PROFESSIONAL SURVEYOR & MAPPER SURVEYOR AND MAPPER STATE OF FLORIDA LIC. # 6945