RC-10-20-2305 (2)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
730 NE 94TH ST, Miami Shores, FL 33138 1132060141690
Contacts
MARTA GIERCZYK Owner Marta Gierczyk Applicant
730 NE 94 ST 730 94th ST NE 730, Miami Shores, FL 33138
Mobile: 305-639-0194 MARTAGIERCZYK@GMAIL.COM martagierczyk@gmail.com
HOME OWNER Contractor
HOME OWNER
markacampbellarchitect33138@gmai
Isom
........... -------__ _..
Inspection Requests:
Description: KITCHEN REMODEL REPLACE CABINETS COUNTER Valuation: $ 14,000.00 305-762-4949
e TOPS, ADD TILE
Total Sq Feet: 116.00
Fees
Amount
Application Fee - Other
$150.00
CCF
$8.40
DBPR Fee
$6.30
DCA Fee
$4.20
Education Surcharge
$2.80
Permit Fee
$270.00
Scanning Fee
$9.00
Technology Fee
$10.50
Total:
$461.20
Payments
Date Paid Amt Paid
Total Fees
$461.20
Credit Card
10/09/2020 $150.00
Credit Card
11/03/2020 $311.20
Amount Due:
$0.00
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 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. Futhermore, I authorize the above named contractor to do the work stated.
Authorize4ign�ltui'@: Owner / Applicant / Contractor / Agent Date
November 03, 2020 Page 2 of 2
Permit NO.:
Miami Shores Village Permit Type Burk
10050 NE 2 Ave H.
fi
Miami Shores FL 33138 P4,
305-795-2204 re', Per
Expiration: 05/03/2021
Location Address Parcel Number
730 NE 94TH ST, Miami Shores, FL 33138 1132060141690
Contacts
MARTA GIERCZYK Owner Marta Gierczyk Applicant
730 NE 94 ST 730 94th ST NE 730, Miami Shores, FL 33138
Mobile: 305-639-0194 MARTAGIERCZYK@GMAIL.COM martagierczyk@gmail.com
HOME OWNER Contractor
HOME OWNER
markacampbellarchitect33138@gmai
I.Com
I Inspection Re uests
3
i Description: KITCHEN REMODEL REPLACE CABINETS COUNTER Valuation: $ 14,000.00
[ TOPS, ADD TILE
4949 #
36S-76?
Total Sq Feet: 116.00 \
Fees
Amount
Application Fee - Other
$150.00
CCF
$8.40
DBPR Fee
$6.30
DCA Fee
$4.20
Education Surcharge
$2.80
Permit Fee
$270.00
Scanning Fee
$9.00
Technology Fee
$10.50
Total:
$461.20
Payments
Date Paid Amt Paid
Total Fees
$461.20
Credit Card
10/09/2020 $150.00
Credit Card
11/03/2020 $311.20
Amount Due:
$0.00
Applicant Copy
For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/.
Requests must be received by 3pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,
public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES.
November 03, 2020 Page 1 of 2
--_r
BUILDING
PERMIT APPLICATION
Miami Shores Village Ri�:cFivFn
Building Department riC,T 09 2020
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY: -----
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 26;^) O
Master Permit No. C- �6 " 2 ,3bS
Sub Permit No.
0 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 730 N E 94th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3206-014-1690 Is the Building Historically Designated: Yes NO U
Occupancy Type: residential Load: single family Construction Type: Flood Zone: x`m ....... BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Marta Gierczyk
Address:6801 Indian Creek Drive apt. 408
City: Miami Beach _ _ State: Florida
Phone#:305-639-0194
zip: 33141
Tenant/Lessee Name: NA Phone#: NA
Email: NA Mck�yY 0,
4
CONTRACTOR: Company Name: NA --OWNER BUILDER FORM Phone#:
Address:
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: $14,000 Square/Linear Footage of Work: 1 1 6 sq.ft.
Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
kitchen remodel (replacement of cabinets, counter tops, adding tile, replacing sink, light fixtures, etc.)
Specify color of color thru tile:
Submittal Fee $ �o 0-' Permit Fee $ CCF $ CO/CC $
Scanning Fee $ n Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ r7
TOTAL FEE NOW DUE $ f`>✓
(Revised02/24/2014)
4 -'r
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) United Wholesale Mortgage
Mortgage Lender's Address 585 South Blvd E
City Pontiac State Michigan
Zip
Zip48341
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 The foregoing instrument was acknowledged before me this
8_k1^, day of bC-tob'e(- 20 2o , by
is personally known to
me or who has produced Dv-,wo-r"s as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: S'e �'- VAn i ryw)C{G
Seal:
APPROVED BY
(Revised02/24/2014)
SELENA ARANDA
MY COMMISSION # GG 971705
EXPIRES: March 22. 2024
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
Structural Review
Zoning
Clerk
Prepared IT.
Norman C. Powell
Attorney at Law
Law Office of Norman C. Powell
1666 Kennedy Causeway Suite 420
North Bay Village, FL 33141
786-275-6923
and return to:
Law Office of Brian D. Smith
420 Lincoln Road
Suite 248
Miami Beach, Florida 33139
(Space Abow This Line For Reo"ng Data l
Warranty Deed
CFN: 20200518609 BOOK 32098 PAGE 1895
DATE:09/15/2020 09:42:50 AM
DEED DOC 3,300.00
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
This Warranty Deed made this 28th day of August, 2020 between Arturo Dovalina, a single man whose post office
address is c/o Law Office of Norman C. Powell, 1666 J. F. Kennedy CSWY, Suite 420, North Bay Village, FL 33141,
grantor, and Enrique Garcia, Jr. and Marta D. Gierczyk, husband and wife whose post office address is 730 N.E. 94th
Street, Miami Shores, FL 33138, grantee:
(Wheomw used herein the teems "gauttor" and "grantee" inchute ald the parties to this instrument and the heirs, lepi representatives, and assigns of individuals,
and the successors and assigns of corporations, trusts and trustees)
Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO/ 100 DOLLARS ($10.00) and other
good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged,
has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, the following described land,
situate, lying and being in Miami -Dade County, Florida to -wit:
West 1/2 of Lot 12 and all of Lot 13, Block 65, of MIAMI SHORES SECTION NO.3, according to
the Plat thereof as recorded In Plat Book 10, Page 37 of the Public Records of M1andi Dade County,
Florida.
Parcel Identification Number: 11-3206.014-1690
A/K/A 730 N.E. 94th Street, Miami Shares, Florida 33139
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 lawfully seized of said land in fee 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 lawful claims of all persons whomsoever; and that said land is free of all
encumbrances, except taxes accruing subsequent to December 31, 2019.
In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written.
DoubteTlm*°
CFN: 20200518609 BOOK 32098 PAGE 1896
Signed, sealed and delivered in our presence:
State of Florida
County of Miami -Dade
The foregoing instrument was acknowledged before me by means of [XI physical presence or U online notarization, this
28th day of August, 2020 by Arturo Dovalina, who U is personally known or [XI has produced a driver's license as
identification. k _ iI
[Notary Seal]
t v NORMAN C. POWELL
?.NOTARY PUBLIC
STATE OF FLORIDA
CoraYrGG936342
Expires i mn/ %A
Notary
Printed Name:
My Commission Expires:
Warranty Deed - Page 2 QoubiaTime°
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
q j i OWNER BUILDER DISCLOSURE STATEMENT
NAME: C�ari Q, L' QY L� IL DATE: tli I0& 1 ;,02.0
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 pecple 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�a13
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 H. ()
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. 1`3 -
5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
Initial h . (--U
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 —IA • (,r,
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.
Initial `" r -
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 • (7.
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.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. 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 worker's 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 lti day of O car , 20 20
By� �e �2y �_- tJOVA-a 'Dam Aq who was personally known to me or who has
Produced there Licens r 'D(_iver IS �--'k Ce V) Se as identification.
V• ''4� ;. SELEIVA ARANDA
• MY COMMISSION # GG 971 705
EXPIRES., March 22, 2024
": 0 V1%V E R NOTARY Bonded Thm No Public Underwriters