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DS-09-22-2396Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 250 GRAND CONC, Miami Shores, FL 33138 Contacts Parcel Number 1132060136220 RALPH RAYBURN &W JAN M RAYBURN Owner HOME OWNER Contractor 250 GRAND CONCOURSE HOME OWNER Home: 3057961888 grandcommun@bellsouth.net Ins ection Requests: Description: DRIVEWAY WITH TRAVERTINE PAVERS ON A Valuation: $ 2,400.00 PATHWAY - SANDBASE 305-76-4949 Total ScFeet: 500.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 Concrete/asphalt/pavers, slabs, dways, $50.00 swalks DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.90 Planning and Zoning Review Fee $70.00 Scanning Fee $9.00 Technology Fee $10.00 Total: $195.70 Building Department Copy Payments Date Paid Amt Paid Total Fees $195.70 Credit Card 09/21/2022 $50.00 Credit Card 10/07/2022 $145.70 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. 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 truction and zoning. Futhermore, I authorize the above named contractor to do the work stated. PA Authorized SWnature: Owner / Applicant / Contractor / Agent Date October 07, 2022 Page 2 of 2 Miami Shores Village R-FcEzvED Building Department SECS 21 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972'__W INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20aQ ltoll BUILDING Master Permit No'�� .w&'ol3cVP PERMIT APPLICATION Sub Permit No. dBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ZSO Crz^.--D C0k'G0vn'3N City: Miami Shores County: Miami Dade Zip: 3 3/,3,--f Folio/Parcel#: l l 3 204013 VI'Lo Is the Building Historically Designated: Yes I60 Occupancy Type: i,e5 i . Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): iz( P K A k./ '7✓144hone#: Address: City: A4 ;4A4 . State: Tenant/Lessee Name: Email: G t cy.). 4 C Q im y1_ CONTRACTOR: Company Name: Address: City: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: _ e#: hone#: Zip: hone#: Certificate of Competency #: Phone#: Address: ! City: State: 1p. Value of Work for this Permit: $__ fi( Square/Linear Footage of Work: © S F Type of Work: ❑ Addition Alteration ew L3 Repair/Replace ❑ Demolition Description of Work: uc-tvA zu i �/t VZ iz7`ENC V </�C fZS lit// Specify color of color thru tile: Submittal Fee $ • Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Structural Reviews $ CF $ CO/CC $; D R $ `Y Notary $ Double Fee $ Bond $ TOTAL EE NOW DUE $ H5,10 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State MAW -Lender's Name (if applicable) MQgI ge Led Is Address N-- ,. arr State Zip — Zi 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to ,the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. l� Signature Signature NER or AGENT CONTRACTOR The foregoing instrument wasacknowledgedbefore me this The foregoing instrument w acknowledged before me this day of .` t r . 20 by day of ' by �g wt� who is personally known to yP Y� �� wh personally known to me or who has produced l•�E�1 /f 1 1 �' 1� ),-'C' as me or who has produced as identification and who did take an oath. identification and who take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ! � i� ��� � �) � (� t1 '. Sign: / Print: Cf ! C- J2 Print: Seal: v ••,�.. Seal: myc ?•' RES: April 1$ 2028 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: RtFLJ-/ — f11,1 �`I t zti DATE: ADDRESS: 250 (aAA.-N co(//L ; _ 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 — 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 /V 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.ii2iso understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits an nt cts. 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, ich viol xemption. Initial b' 7 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction A , ra. Initial6. 1 understand that I may not hire an unlicensed person to act as my contracf'or 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 byy%county or municipal ordinance. understand t. at it :s .recue acti:es o4 dErSeC person_ `.a've the proper vv e- o.,w .. 'c Cv, dufder permit that erco-ed'.aly .mp ies that _ne prope ty owner is provicing his or her o r: labor and materiais_. as a.. owner-ouiloe". n-ay be held liable anc subjected tc serious r ancia risk'.,' any injuries s-stainec by are Jn!:censed cerscr o- hiss or employees while v,-0 king c❑ my prooerty. My'nomeowner's nsurance may no; p ov- coverage for :hose iniu-les a ^. vvi 1fu acting z_ an o✓vner-bu der an-- am: aware of the limits of my inwrznce cove-agc for injuries tc wori_ers or. -r,,y property. E. understand tha. 7 may not delegate the responsibility for supervising work tic be a licensee contra=v,hc is not licenses to perform the work being done. Any person working on my building who is not licensed must v✓ork unce; my direct supervisior and must be employed by me, whit`': means that i must comply v✓ith iaws requiring the withholding of fedcra mccme tax and social security contributions under the Feoerai Insurance Contributions Act (FICA) and must provide workers compensation far the employee I understand that my failure to foilow these may subiect to serious financial risk. —� nit:ai S. agree that, as the party legally and financially responsible for this proposed Construction activity, will abldc by a!'. applicable iaws and requirement that govern owner -builders as well as employes aisc understanc tha, the Construction must comply with all applicable ,avrs, ordinances b d ^g codes, an,-: oning reg latiens.Z? �nitai : �L-� I& I 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. 1 also understand that may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.myfloridaIicense.com/dbpr/proicilb/index.htmI initial /' ,/& __. 1 am aware of; and consent to; an owner-buiider buildi-g permit applied for cn my same and Jnderstands that 1 am the party iegaily and financially responsible for ;he proposed construction: act;v'ty z, the following address: Initial ��C < . 12. i agree to notify Miami Shores Village immcdiateiy of any additions; deietidns, cr changes tc any of the information that 1 have provided on this disclosure. /f �n ti-•i �/ "_ Cr� Licensed contractors are reguiated by laws designed to protect the public. !f you contract with a person who does not have a license, the Constr4uction Industry Licensing Boarc and Department of Business anc Professional Regulation may be unable to assist you with any financial joss 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, mdi✓idea! 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 ve^fying whether the contractor is properly licensed and the status of the contractor's worke-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 ssuing the permit A copy of the property owners 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 er), !1 By i / 1 A—'K< i!� i�-I bL r) who was personally known to me or who has on. Property Search Application - Miami -Dade County Page 1 of 1 UPERTY P! Summary Report Property Information r olio: 11-3206-013-6220 1250 GRAND CONC Property Address: !Miami Shores, FL 33138-2853 Owner RALPH RAYBURN &W JAN M 250 GRAND CONCOURSE Mailing Address ._.__...... _..___.................. _...__..__.............___.._....................._........ MIAMI SHORES, FL 33138-2853 PA Primary Zone ........ .... ..... -....... ..... _..................... ........_........... 1300 SGL FAMILY - 2801-3000 SQ 0101 RESIDENTIAL -SINGLE Primary Land Use FAMILY: 1 UNIT _.._._..._______ ... ..___...W..._..................... .._....._._......-........__..................................................................._._ Beds / Baths / Half _................. _................... ........ 3/2/0 Assessment Information Year-�� ........................ ........._............................ i 2022i ............. ......................... 2021 2020 ,Land Value ............................... _.._.._............................. _.._.................... .................... .. $629,888 ...... ........ ........ ....___....._..._._.... ........................ ................................. $443,571 ........ ._........_--................... _.._...... ............... ................................... -_.. $443,571 ...... _... ............. __.._._.............__.._ Building Value $173,620 $130,778 $130,778 XF Value $27,310 $27,664 $28,016 Market Value $830,818 $602,013 $602,365 Assessed Value $230,939 $224,2131 _ $221,118 Benefits Information Benefit Type 2022 2021 2020 Save Our Homes Assessment Cap Reduction .......... $599,879 $377,800 $381,247 -_-...... _----- ........................................._................_.._............_..................................................................................................................... Homestead Exemption _......__.. ._._..._p....__..__..__.......__-_........._ $25,000 ........................_.......................................................i._ -...................................... $25,000 $25,000 Second .......... ........................ ........................ Exemption tion Homestead $25,0001 $25,000` $25,000 ................. ......... ..........._..__.. ..._.... ........ Note: Not all benefits are applicable to all Taxable Values (i.e. County, ;School Board, City, Regional). Short Legal Description Generated On : 9/21/2022 Taxable Value Information .......... ......................... County ........ ... ................ _........ _.... _.._..____...... _.... _..__-_----- Exemption Value 2022 ............................... __.... _ $500000,000 2021 I .._.......... 2020 -____........... ._.......... $50,000 Taxable Value $180939 _ �$174,213 $171,118 School Board Exemption Value I $25,000 $25,000 $25,000 Taxable Value $205,939 $199,213 $196,118 ...... .......................... ................................__..._...._._...__.__._...__....__......._.._...... _......__..____. .__._.._..__. City Exemption Value $50,000 $50,000 $50,000 Taxable Value $180,939 $174,213 $171,118 Regional ................................................................................................................_............................._........._.... ..................................................................................................................- Exemption Value $50,000 $50,000 $50,000 Taxable Value $180,939 $174,213 $171,118 Sales Information Previous Sale Price OR Book -Page Qualification Description 12/01/1988 _"..". ........ 11/01/1986 $124,500 $94,500 13928-0478 13098-1196 Sales which are qualified Sales which are qualified N'IAMI SHORES SEC 1 AMD PB 10-70 LOT 16 BLK 46 .LOT SIZE 96.950 X 130 'OR 13928-478 1288 1 The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disciaimer.asp Version: https://www.miamidade.gov/Apps/PA/propertysearcii/ 9/21 /2022 Miami Shores Village Building Department SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, J cw `� ✓loes hereby attest that (Property owner) The attached survey, performed by &�Ati C-o (Name of surveyor's company) For address: 2-5 �01 G9-ti c_(�LUp S(,;� Performed on (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. jueM,tayeth naught. � Property 0 ner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of ' 6` (' Affiant is personally known to me, produced or 11(e; MERLINE CHERY MY COMMISSION # HH 252206 �!'%jro�M1o?;• EXPIRES:Apro 12, 2026 Notary Revised on 5/22/2009/ Revised on 6/12/09 NOT VALTO-UNLESS EV..3CS5_D'NI?H SURVEYOR'S SEAL EVIScD: -_ .._.- BOUNDARY SURVEY �ccx� /)Q : �� l ? ?�t 7 it%c 7 97 LEGEND : FIP= Found Iron Pipe S.RC= SET 1/2" PIN & CAP L84769 F ti/ D=Found Nail & Disc S.PCP= SET PERMANENT CONTROL POINT L847B9 rt= CENTERLINE, P/L= PROPERTY LINE. O/L= ON LINE Elea'='ices used cn M.H.= MANHOLE, WM= WATER METER, PP-- POWER POLE C: •M h FC.= FENCE CORNER, R= RECORD, M= MEASURED e 1 ;r CHAIN LINK OR WIRE FENCE= - E - E ` ' ' WOOD FENCE= MASONRY WALLLOC'c `G= CONCRETE= KEN iT1I14`10E F. DP'4GE FAST. _ =- -D. E. DOTES: UNLESS OTHERWISE SHOWN, THE FOLLOWING NOTES APPLY. issuR__,"r- ONLY ON T::E VA= OF THE stevEY 1) Record and measured calls are in substantial agreement. 2) Bearings, if sho'h'n are based on Plat data. 3! The lands sjlc,An hereon were not abstracted for Easements or other recorded emcumbrances not shown i;n the Plal and :.;le same, if any may not be shown on this sketch. 4) Underground portions of Footings, Founda!ions or other improvcmer.ts were not located. 5) Elevations are based on National Geodetic Datum. 6) r,;erline of the fen: o. 7) 4V'all Ties to the face of the Wall. S Fence Ties are to the Ce- ;. -`_ _._ _--_ -_.-_ _..- -�.... _.___ ,.,_ ..-. �_-.-..,__.._----------A.Ctti `_ ., P.c...°L7 :`J . _, .SSA'.- _ , -.. o •--._ ____._. ., __._...�- L0CAr! T ON S K E T Cr- S C A L E . 'I T S CAdplft�L PqL AV ? p i— Na 'Vm a") �.v q- V a !u �?_' N t �� (•0� GN�''� � ,gip c% 9VM-0n!VQ oro CERTIFIED T0: RALPH RAYBURN AND JAN M. RAYBURN, 250 GRAND CONCOURSE, MIAMI SHORES, FLORIDA 33138., CHRISTOPHER P. KELLEY, P.A., ATTORNEYS' TITLE INSURANCE FUND, INC., FT MORTGAGE COMPANIES, ITS SUCCESSORS AND/OR ASSIGNS, ATIMA. P.O. BOX 80140, ATLANTA, GA. 30366. I =^1t and cou Permit # le re ulations. LEGAL DESCRIPTION: LOT 16 OF AN AMENDED PLAT OF MIAMI SHORES SFCTTnN NO. 1 SU BDIVISION ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10AT PAGE 70 OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIDA. I HEREBY CERTIFY That the survey represented hereon meets the minimum technical regwremenls adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to 'Section 472.027 Florida Stwules. there are no encroachments. bvertaps. easements appearing on the plat or vls!b!i; ea5emen!5 Other hen as shown hereon SINCE 1987 BLANCO, DANIAL & ASSOC. INC. EnginDers • Land Surveyors o Planners LB . L'--4789 555 NORTH SHORE DRIVE MIAMI BEACH FL. 33141 FLOOD ZONE: X ADIS N. NUNEZ v�I, 971?- r'•-_ :e'e� Land Surv=ycr I`i0. 5 DATE. SCALE. iC 924 _ 3 Fax' (305 865-78`10 SUFFIX: !DATE: �/2/94 Ei•S` , o,,)4 C011 r N T TV t,*r T;vr 7 p • 1 n R z D'N`!. BY: JOB No. - D_ 4 'r!AjN co �� ' 1 �, � k 'A. , � r - i' _ � �� '�Ay =� r ��.