FW-01-22-219Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
PermitNO.: FW-01-22-219
Permit Type: Fence/Wall
Work Classification: Wood Fence
Permit Status: Approved
Issue Date:01/27/2022 Expiration:07/27/2022
Location Address
Parcel Number
357 NE 97TH ST, Miami Shores, FL 33138
1132060135750
Contacts
sue-
Kristy Johnson
Owner
HOMEOWNER
Contractor
35797
HOME OWNER
Business: 3052135328 kristy0713@aol.com
Inspection Requests:
Description: REPAIR AND REPLACE EXISTING WOOD FENCE,
Valuation: $ 2,500.00
305-762-4949
ADD BACK GATE
, Total Sq Feet: 0.00
Fees Amount
Payments Date Paid
Amt Paid
50% Renewal Fee $62.50
Total Fees
$62.50
Credit Card 01/27/2022
$62.50
Total: $62.50
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 AFFIDA# I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
reguloting constru n,pnd zoning. Futhermore, I authorize the above named contractor to do the work stated.
Owner I Applicant / Contractor / Agent
Date
January 27, 2022 Page 2 of 2
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
NHTUTM
J4 2 7 2022 I U
FBC 20'
Master Permit No. tc f,'-/� I 22 21e�
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
F-JPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
C(ONTRACTO
JOB ADDRESS:
❑ CANCELLATION ❑ SHOP
DRAWINGS
Folio/Parcel#i:
L
-37-10
^ 0l3 -57TU
Is the Building Historically Designated: Yes
Occupancy Type:
Load:
Construction Type:
Flood Zone: BFE: _
OWNER: Name (Fee Simple
City: I II I IL/1 4 t ICY KA
Tenant/Lessee Name::, 1
k
Email: r1)0-71
State: SE= Zip:
0
CONTRACTOR: Company Name: ram_ Phone#t:
Address:
City: state:
Qualifier Name: Phone
State Certification or Registration M Certificate of Competency M
DESIGNER: Architect/Engineer: Phone
NO
FFE:
-2/3 -?3a
Address: City: State: Zip:
�7
Value of Work for this Permit: $ 00 Square/Linear Footage of Work: I ZJ�
Tvoe of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Training/Education Fee $
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 pasted notice, the
inspection will not be approve and spection fee will be charged.
Signature Signature
ER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
u I 9 -4 day of A 20 22 . by
T(}I{l i ?% is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Li
Print:
day of
me or who has produced
20. by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal: Seal:
..........
-`. MY COMMISSION It GG 238273
' rdEXPIRES: September 3, 2022
NoUryMUNletlirdlftYlg6i§
APPROVED BY
Plans Examiner
as
Zoning
(RevisedD2/24/2014)
Structural Review
Clerk
January 26, 2022
Kristy Johnson
357 N E 971^ Street
Miami Shores, FL 33138
RE: Permit No. FW-10-20-2469 (Fence)
To Whom It May Concern:
Please allow this letter to serve as a request to extend the above fence permit. Due to delay of
materials caused by supply -chain issues, delays due to labor shortages cause by COVID and issues
caused by our pergola contractor, several aspects of our pool project (Permit # BPP-09-20-1957) were
delayed. For this reason, the fence installation was correspondingly delayed. However, the fence
construction will start next week.
Thank you,
Krist nson
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PAGE 2 OF 2
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JOB No. 20-05357 CLIENT: JASON R ALDERMAN & KRISTY M JOHNSON
PROPERTY ADDRESS 357 NE 97 STMIAMI. SHORES FL 33138
LEGAL DESCRIPTION: (FURNISHED BY CLIENT)
LOT 18 & ER/2 OF LOT 17 BLOCK 42
SUBDIVISION AN AMENDED PLAT OF MIAMI SHORES SECTION 1
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 AT PAGE 70
OF THE PUBLIC RECORDS OF MIAMI—DARE COUNTY, FLORIDA.
SUBJECT TO ALL RESTRICTIONS, RESERVATIONS, EASEMENTS AND RIGHT—OF—WAY OF RECORD
ENCROACHMENTS IF ANY, NOT LOCATED.
SURVEYOR'S NOTES:
UNDERGROUND
I-) F SNOW, ENVIDS AM MOO ARE ROOM TO SAID RAT N LEGAL OM-ARDN
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BASED ON THE FLOOD INSURANCE PARE MAP OF THE FEDERAL EMERGENCY IgNNIIGEMENE AGENCY OARED OR
REMSED ON 09-11-09 THE HEREIN DESCRISED PROPERTY IS STIUATEO WIMIN ZONE x
BASE ROOD ELEVATION N/A COMMUNTIY 120652 PANEL NUMBER 0302 S,Mx L •
ELEVAOONS(WHEN SHOWN) REFER TO N.G.V.O., 1929,
COUNTY BENCHMARK USED N-6O.T'R EIEYATIONS &O6' FEET B.M. L IRON ME 96 5F
WE 6 AVE
CERTIFIED T4
JASON R AIDERNAN & KRISTY M JOHNSON
SURVEY OATS: 05-13—=0
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J08 No. CEFIR aATE MLL.B. 8064 20-05357
STATE OF FLOMDA
Main Una: (308) 901-1317 SCALE, V = 20'
Fax: (305) 201-1323 JBOUMDARY SUR
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JOB NO. 20-05357 CUENT: JASON R ALDERMAN & KRISTY M JOHNSON
PROPERTY ADDRESS 357 NE 97 ST. MIAMI SHORES FL 33138
LEGAL DESCRIPTION: (FURNISHED BY CLIENT)
LOT 18 & Et/2 OF LOT 17 BLOCK 42
SUBDMSION AN AMENDED PLAT OF MIAMI SHORES SECTION 1
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 AT PAGE 70
OF THE PUBLIC RECORDS OF MIAMI-DARE COUNTY, FLORIDA.
SUBJECT TO ALL RESTRICTIONS, RESERVATIONS, EASEMENTS AND RIGHT-OF-WAY OF RECORD, UNDERGROUND
ENCROACHMENTS IF ANY, NOT LOCATED.
SURVEYOR'S NOTES:
9YA1L aTAnxa uo uHENR uE REFER®ro vn TUT x 1EG:1 DEYJ�WN.
2- TE IEIAIM CmSRS IN TE FND IE19116D 9DIRLVN 6 BETFN 1NOk 1 FOOT N T$DO FFEF ME/R (9.BRiBVN.
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aER1oT H:RTdDE scETPe IN1xs a tPEE AIO nuns
BASED ON THE RDOD D15URAFKE RATE WP OF THE MERAL EMEROENCY W UENT A OE DATED OR
RUyEO ON 09-11'09 T E HEREIN DESCRIBED PROPERTY IS SI = WITHIN ZONE x
BASE MOD E£VATION NIA COMMUNITY 120652 FARE. NUMBER 0302 S,,r, L •
EEVAT (WHEN SHOWN) REFER M N.6.V.0.. 1929,
COUNTY ,ENCHWRK USED N-603-R MUNW ONS &08' FEET B.M. MATON NE BB ST
NE 6 AYE le tl 9Y
�TQ
DAWN R AIDFRM & KRISN M JOHNSON
sum�EY urE; os-u-ww
SUWEY PoD,B011: DD-IB-al21
PfofaMene ryFYefF. MmPn
CER STATES F RM M
STATE 0 MPow
Yelp : (3 5) 9 1-IM T
F.(D0.5) 801-1321
LEONARDO MAOUEIRA, P.S.M
CERN M ND.IS: 699Y
STATE OF FLORIN
'NW MO WIIHWT THE SMAW K OME AND THE ORONA
M SEAL OF A FEDRIW LL^EfLSm WU R AND WPPpi.-
04
FENCE & GATE DESCRIPTION & DETAIL
Jason Alderman & Kristy Johnston
357 NE 97th St
Miami Shores, FL 33138
Wood Fence & Gates - Total 125 If.
Fence Material: Pressure Treated 5/4 X 6" Beveled Edge Deck Boards, attached with 2--2.5"
Ceramic Coated Hex Head Exterior Screws to each Post.
Posts: Pressure Treated #2 Southern Pine 4" x 4" x 8'h, each set in High Strength Concrete
24" deep in a 10" wide hole on a 4' center 0
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Fence Gates: Three (3) 40" Walk thru Gates, built on 1" x 2" Galvanized ifeei frarab°"°: ° :000
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with welded hinges that attach directly to the posts. All gates covered with PT
5/4 Deck Lumber in a Horizontal Pattern to match rest of fence and attached with
exterior coated screws, 2 per each attachment
Driveway Entry Gate: Sliding Drive Thru Gate across driveway 6' High x 15' long constructed
with a 2" x 2" Galvanized Steel frame then covered with same PT 5/4 Beveled
Edge Deck Lumber attached in same Horizontal Pattern with exterior coated
self -taping screws 2 for each attachment. Gate to slide on top concrete slab
with metal V-Rail attached to slab with 3" Tap -cons
FENCE DETAIL
Overall height of fence and gates to be 6' built with 4x4 PT Wood posts set on a 4 ft centers,
514 x6" fence planks Installed on both sides in a horizontal shadow box pattern
Total Linear Feet 125 including all fence and gates
4" x 411x 8' Fence posts, set on a 4' center, for all running fence, set in a footer at a depth of
24" by 10" diameter in High Strength Concrete
Fence material is Pressure Treated 514 x 6" Beveled Edge Deck Lumber run in a Horizontal
Double -Sided Shadowbox Pattern with Approx. 1.5-2" spacing between each board.
Each board fastened to posts with 2-2.5" Ceramic Coated Hex Head Deck Screws 0 W two �2)0 000
00 0
screws per each board per each attachment ° °
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Three - 38"w X 68"h Single Walk thru Gates Frames, built with 1" x 2" Gwvhdized°ftea1 wit
one vertical support in center, all gate joints welded with 2 female side of hinges welded
directly to the frame, which then attaches to the posts with the 5" threaded Male that's
screwed directly into the post. All gates frames covered with PT 5/4 Deck lumber, attached
with exterior coated screws two per each board per point of attachment with latch; Each
Finished gate to be 42" wide x 72" high including Wood covering
Drive in Gate Frame Detail
View Looking in from Street with Gate Sliding to the Left; Frame 70" high from bottom of 3"
wheels to top of frame by 15' long with 2' tail on left side; Gate Frame constructed from 16ga.
Galvanized Steel with all welded joints & Three horizontal vertical supports of same material;
3" wheels welded to bottom of frame and set in 3 ft. from each end of the frame to slide on
Steel V-Rail; Double Wheel Roller guide attached to 4"x6"x8' PT wood post to support gate;
Finished gate to be 15' long x 72" high from grade including Wood covering
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MA
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
RJEMAIVED
JUL 2 12021
BY:
FBC 20
Master Permit No.��-►v 20-a�
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 357 NE 97th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3206-013-5750 Is the Building Historically Designated: Yes NO XX
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Kristy Johnson Phone#: 305-213-5328
Address: 357 NE 97th Street
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: D/a Phone#:
Email: kristy07l3@aol.com
CONTRACTOR: Company Name: Phone#:
Address:
City: State:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency M _
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:
Type of Work: ❑ Addition
Description of Work:
Zip:
Footage of Work:
❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color tlrru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
CO/CC $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ _
f�'•
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City St
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
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 a rove nd a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
21 day of 77U1 209\ by
Ki S opoo Is personally known to
me or who has produced FL— D L, as
identification and who did take an oath.
NOTARY PUBLIC:
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: � , ^ Sign:_
Print: YC n cA al r 1 Print:
Seal: •M:: SELENA ARANDA Seal:
`• MY COMMISSION # GG 971705
';;'•rr EXPIRES: March 22, 2024
APPROVED BY W Plans Examiner
as
##kk#k#k######k##############k##kk#
Zoning
Structural Review
(Rev1sed02/24/2014)
Clerk
KRISTY JOHNSON
357 N.E. 971 Street
Miami Shores, FL 33138
July 20, 2021
Miami Shores Village
Building Department
10050 NE 2"d Avenue
Miami Shores, FL 33138
RE: Permit No. FW-10-20-2469
To Whom It May Concern:
Please allow this letter to serve as a request to extend the above -referenced fence
permit. I need additional time to complete the fence. Please feel free to contact me if you
wish to discuss this further. You can reach me by telephone at (305) 213-5328 or email at
kristy07l3@aol.com.
Sincerely,
09-
Kristy Johnson
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
3S7 NE 97TH ST, Miami Shores, FL 33138
Contacts
Kristy Johnson Owner
35797
Business: 3052135328 kristy07l3@aol.com
Issue Date: 02/18/2021
Parcel Number
1132060135750
HOMEOWNER
Permit NO.: FW-10-20-2469
Permit Type: Fence/Wall
Work Classification: Wood Fence
Permit Status: Approved
Expiration: 08/18/2021
Description: REPAIR AND REPLACE EXISTING WOOD FENCE, Valuation: $ 2,500.00 Ins Re nests:
ADD BACK GATE Total Scl Feet: 0.00J�
"
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DSPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$3.13
Wire and Wood Fence Fee
$75.00
Total:
$178.53
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$178.53
Credit Card
02/18/2021 $128.53
Credit Card
10/28/2020 $50.00
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.
r7Tj I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
a ning. Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent
Date
February 18, 2021 Page 2 of 2
Miami Shores Village I2ECEIvED
Ap Building Department °CT 2 7 2020
\b\ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY.
Tel: (305) 795-2204 Fax: (305) 756-8972
CAt t✓ INSPECTION LINE PHONE NUMBER: (30S) 762-4949
�j FBC 20Ft
BUILDING Master Permit No. FVj-10- 20 -2-j-(aTl
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [-]PUBLICWORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
' CONTRACTOR DRAWINGS
JOB ADDRESS: 3S'] ' `t v `� ,�\+ r{�
Folio/Parcel#:11
^ J7-0`P — 0 I3-57J o
Is the Building Historically Designated: Yes
NO
Occupancy Type:
Load: Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee S
Address: -L.1J / Y
City: ho tkwMl
Tenant/Lessee Name:
Email: K(ISi-
CONTRACTOR: Company Name: n Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: n City: State: Zip:
Value of Work for this Permit: $ /-�� Square/Linear Footage of Work: 1125;
Type of Work: ❑ Addition ❑ Alteration ❑ New X Repair/Replace ❑ Demolition
Description of Work: re cal/ 42K 1.1"11/1) f-:Cal(
Specify color of color thru
Submittal Fee
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Training/Education Fee $
CO/CC $
Notary
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ L e S5
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
2C
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 L Z Signature
OWNER or AGENT CONTRACTOR
The fore omg instrument was acknowledged before me this
2day ofnOJCtai� . 20 0 by
4!2!L4 J cywsoo , who is personally known to
m e or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of .20 by
as me or who has produced
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
as
SiSign:
Print: /!�4 TI0✓C,l�IO Print:
Seal: �tsx Troy Tolentino Seal:
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG233105
s►saee�r�Wsa t6i�rt�gri/Q QQF.grwrwwwrt+s+rsrt*rtrtrtrt+rtrt*ss4r�r�es�ywrrtsrwtrrrsrrr�WrrrrtWrW�rrs�sr�ass�wrwsa
APPROVED BY 'L i� Plans Examiner i(3 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: l ��I U DATE: (�
ADDRESS:.J.S � I jr, 9j . 1 ((i 1' 114 h l J I l y-V FL_Z3
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 entities 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,OD0). 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
3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. 1 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. _
InitialImaalso
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I 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, w ' h v lates the exemption.
Initial
S. I 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 an by county r 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. 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 andm 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 and rstand 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 regulatio s.
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 t e Florida Construction Industry
Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbprlpro/cilbAndex.htmi
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:
5-2 W 97t' Ji-,/Yliu,vv L�' Fr✓ 331-V
Initial r t�
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the infor Ion 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 OC+dbe ir , 20 20
By KriSN Marie who was personally known to me or who has
Produced ther 'cense or We s %—( CeVIG-C as identification.
OWNER
't'"' SELENA
COMMISSION
ARANDA
• - MY COMMISSION # GG 971105
EXPIRES: March 22, 2024
NOTARY '`•od's°"` Bonamnw rraa y Rmic unaemaa s
2 `r(
�01I I
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
F-IPLUMBING ❑ MECHANICAL
JOB ADDRESS: 357 NE 97th Street
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
❑ ROOFING
[—]PUBLICWORKS
.:... , - IVED
102022
�FTBC 20 g,
Master Permit No.��1'/�`v��- o l - eq�"" 21 /
` / Sub Permit No.'1✓TIJ�/ " U2-22 ��
�j REVISION
/j❑CHANGE OF
CONTRACTOR
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County:
Miami Dade Zip:
Folio/Parcel#:11-3206-013-5750
Is the Building Historically Designated: Yes NO XX
Occupancy Type: Load: Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Krlsty Johnson
Phone#: 305-213-5328
Address: 357 NE 97th Street
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: n/a
Phone#:
Email: kristy07l3@aol.com
CONTRACTOR: Company Name:
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: $
Square/Linear Footage of Work: ar
TypeofWork: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: Cru9zr nod rt.0 14CS
-e-XIL S I Its �'e ou- I. Ljdr/ Pe- nc-(-- �1
0-CU Via,-T a t-r
0rvi�,eA/ ; Nn r AfS Ac.nje. w
Lac-&Ao_OCS 10nA101/ ni,��c�.�
Specify color of c or thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
CO/CC $
Notary $
Double Fee $
�nd�• � o c�,A �e �
TOTAL FEE NOW DUE $ -ef -/n. 36
(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 approugd and afe*pection fee will be charged.
Signature \ /]// l Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
1
CN day of � , 20 Z2— by
W—JIZA)-7`i SOdt►ASI-J'1Aho is personally known to
me or who has produced 4:::Z—02AJC—*— as
identification and who did take an oath.
NOTARY PUBLIC:
Print: uoa
Seal: 1 ro.sW:s3y1
�gStN3�
APPROVED BY
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:
r##r►rr►rrrrrt►r►sr►k�
Z Plans Examiner
as
i#►►#4##k4#k##k##k►k#iki###
Zoning
(Revised02/24/2014)
Structural Review
Clerk
BUILDING
PERMIT APPLICATION
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
1TT9COT�
FEB 2 5 2022
FB",,O rf
Master Permit No.��— Y/
�J Sub Permit Nv�q —oZ-
"BUILDING ❑ ELECTRIC ❑ ROOFING l (tEVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑] CHANGE OF ❑ CANCELLATION ❑ SHOP
!�/�' � CONTRACTOR DRAWINGS
JOB ADDRESS: ,59 � N vL' G"I ?` 1�
Folio/Parcel#: I If ^ 32UI 'U 13--S7,T-D Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: _Flood Zone: BFE: t�{ 9 �tFFE:
OWNER: Name (Fee Simple Titleholder): 1A0 �'�r r+�� Phone#tIotl - 3 r3.2V
nHH'a«. 's? 1Vr`; 4�r .sfr
City: _
Tenan
Email:
CONTI
Address:
City: State:
Qualifier Name: Phone
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New P-' I ❑ RepaLir/Repl ce ❑ Dem
Description of Work: , Cei��'�-� abo � ' Q 1 LTA/' a I ' �'ing:�
S
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
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 Lenders Name (if applicable)
Mortgage Lenders Address
City
State
HE
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. 1 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.
LSignature Signature
RorAGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of _ P 20 2 �, by day of , 20 by
r'tP(Z.4 suly o is p rsonally known to N5� who is personally known to
me or who has produced �'L as me or who has produced as
identification and who did take an oath.
NOTARY BLIC:
Si
Print: S1 I�Ft�I
Seal:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
/J.VARE2
MY COMMISSION N CO 238273
022
�F S; Seplember 9,
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..ry
APPROVED BY 3's' 22— Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RECEIVED
KRISTY JOHNSON
357 N.E.971 Street
Miami Shores, FL 33138
March 8, 2022
Miami Shores Village
Building Department
10050 NE 2°d Avenue
Miami Shores, FL 33138
RE: Permit No. REV 02-22-524
To Whom It May Concern:
BY:. Q
%J-01-&T-2tcj
Please allow this letter to serve as a request to withdraw the revision application
reference above. I no longer need to revise the plans for FW-01-22-219.
Please feel free to contact me if you wish to discuss this further. You can reach me
by telephone at (305) 213-5328 or email at kristy07l3@aol.com.
Sincerely,
Kristy Johnson