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DS-09-2001BUILDING PERMIT APPLICATION FBC 2004 Job Address (where the work is being done) O 6S5 Value of Work For this Permit $ Type of Work: Describe Work: 3 y 6 ❑ d4 tion DAlterati In Submittal Fee $•� SD. 00 Permit Fee $ Notary $ 5-00 Training/Education Fee $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. __ -� — )1 Master Permit 1.1o. Permit Type (circle): Building Roofing Owner's Name (Fee Simple Titleholder) 11 J Y ��.�� Phone # 9 1 ° Ss') - C lO 79 Owner's Address 3 r ' , A k City 0 i �Y� '� State R. Zip ty p 33 I3 Tenant/Lessee Name Phone # Square / Linear Footage Of Work: ❑New Repair/Replace ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** x** *** F ef************ ** * * **** * **** * * ***** CCF $ 1. CO /CC Technology Fee I$ • Scanning $ ' G Radon $ DPBR $ l Bond $500 1 Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side - 1:7-: 0 3 2000 BY:o__ a_moe City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO V Contractor's Company N ame l� Y' e Ph one # P Y Ow' Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # f3©0 i6ld mplition Zoning $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 1� Owner or Agent The fore�trument was acly lief:, e me this 3 day of , 20 09 by WO 9 4r , day of , 20 _ , by or who has produced � r/1 who is personally known to me or who has produced i tification and who did take an oath. as identification and who did take an oath. UBLIC: NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 07/10/07) Signature Contractor The foregoing instrument was acknowledged before me this Sign: Gtiw � 1S a Print: j ,o 0 t My Commission Expires: : x*** ************ ***********•x *********** *********************** **** /dry w r/oi Plans Examiner Engineer Zoning r s Inspection Number: INSP- 152063 Permit Number: DS -12 -09 -2001 Scheduled Inspection Date: October 13, 2010 Inspector: Bruhn, Norman Owner: LAZAR, DAVID Job Address: 10635 NE 11 Avenue Project: <NONE> Miami Shores, FL 33138 -2120 Contractor: HOME OWNER Building Department Comments INSTALL NEW PATIO AND DRIVEWAY PAVERS Passed 9 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 130747. Clean street and remove excess construction debri. NB /leer OK kx- ..52:67/ cL October 12, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1122320280350 Page 14 of 23 OWNER BUILDER DISCLOSURE STATEMENT NAME: 1 �- Y DATE: /6- O ADDRESS: I OAS P t i) /*. 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 fora 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. I 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. 5. I understand that, as the owner - builder, I must provide direct, onsite supervisron of the construction. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Initial a 2. I 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 a 3. I 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. I 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 '' Initial 0? 6. I 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!! 7. 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 8. I 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. InitiaLa 1 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem 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 1 13 1 2, 10. 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. I also understand that I may contact the Florida Construction Industry Licensing Board at 850 .487.1395 or http:/ lwww. mvfloridalicense .com/dbpr/pro%lb/iindex.html Intial___ 11. I 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: 12. I 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 contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed 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 3 day of ayietai90(720001 ByatvJ OWNER Initial who was personally known to me or who has identification. NOTARY c� of NOTARY 1��C� V, 110s tylt+ ' = , a Cow' '� Tog 1 , 2011 �''n.n•• P BONp£� Snores V i1,7 APP 7OvIED BY DATE ZONING DEPT ( r9 BLDG DEPT I 1%17 7 SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND PFGULATONS Charlie Crist Governor David Lazer 10635 NE 11 Ave Miami, FL 33138 RE: Contingency Letter Application Document No: AP909967 Centrax Permit Number: 13 -SC- 969362 OSTDS Number: 10635 NW 11 Ave Miami, FL 33138 Lot: 7 Block: 3 Dear Applicant: Enclosures cc: May 11, 2009 Subdivision: Miami Shores Sincerely, Miami -Dade County Health Department 1725 NW 167th St, Opa Locka, FL 33056 Phone: (786) 315 -2444 Fax: (786) 315 -2090 Ana M. Viamonte Ros M.D., StatBuf geginOVDCt41....v - ..... • • • • • •• • •••1•. • This will acknowledge receipt of an application dated 02/03/2009 for a permi °'e ens onsite sewage treatment and disposal system located on the above referenced property. There is no increase in sewage flow, no change in characteristics compromising the integrity or function of the system. From a review of your completed application, it has been determined that your existing system is adequate for the proposed use.. AP909967 is approved for the installation of an open patio. If you have any questions on this matter, please call our office at (786) 315 -2444 ph Piv <rger, Engineer Specialist II _CMgW{Cfc gi DEC 0 3 2009 U� •.•.•. • • • 111.. •.••.. • • • 1111.. • • ..••1. • • • • •.•.. 000000 • • • 1111.• •••••• • • e� 6 e 81 / - � j li a0 $ $ oa I U o $ x 8 - x e • • ••• • ;' • • • • • •• • • '•• • • • • • S • • • • • • • • • • • • ••• • • • • J08.No.: 482 -08 F.B. No.:49 -08 DRAWN BY: J.R.A SURVEYOR'S NOTES: 11 COS • Comb Blodt Masks. Per Fish Ray ELbdia Fleld R- Roma For t 0E- Cossets 1=1v Duna Wen 031. Dodo Wind m.F• ride 1c f• () NATIONAL FLOOD INSURANCE DATA: Canmulty -Panel No.: 120852 - 0093 -J Flood Zone : AE Base Flood Ele : 8.00 feet Finn Date : 7/17/95 CAIINE Air. Po SCALE 1 = • • • •• • • • � •i• •i• N �r 1'Nth► Coub i •• 75' 18 4 75' 5 7 1o' 7a' •• • 1T • • yg. 75' • • • • KO •• • • • no 76' • '5. • • •, LEGAL DESOOPTION: Lot 7 Sods 3 of "MIAMI. SHORES ESTATES" according to the Plat thereof as recorded In Plat Book 47 at Page 58 of the Public Records of Miami -Dade County. Florida. FLORIDA INTERNATIONAL LAND SURVEYORS, INC. Taw 75' •• . 75 NE 11th. Avenue 5581 KW. 1514 Strut. Suns 213 DATE 12 - 01 - 08 W31 LAKES, FLQEDA 33014 RENSO4: PH. -488 -0880 FAX 305 -828 -2318 PH.303 -828 -2058 e5' :1 13 •• 12 3j • Ne' • I HEREBY CERTIFY: that the attached BOUNDARY SURVEY of the above described property Is correct to the best of my knowledge and belief as recently surveyed under my direction, and meets the intent of the l Ininum Technical Standards cat forth by the Florida Board of Professional Land Surveyors and Mappers in Chapter 81017 -8, Florida Admindstrotive Code, Pursuant to Section 472.027 of Florida Statutes Domination description of was furnished of tIe will heave to be made to determined recorded instruments, if any, affecting the property. . Legal desmlFUon subject to any dedlcatkn, limitations, restricthms, reservation, or easemente of record . Bearings, if any, shown hereon are based upon an assumed value of N/A . Elevations N any, shown hereon are relative to N.O.V.D. 1929 Benchmark No. B -28 -RA Elevation 17.23 feet located at NE 104th. St. and US Hwy jEt Mtami -Dade County, Florida . Underground Improvements and utilities, If any, not located. . Fences armership by visual means only. Legal ownership not determined . This survey has been prepared for the excusive use of the entitles named hereon and the certification does not extended to any unnamed party. . This survey does not reflect any existing. improvement of any kind that maybe hidden and therefore not ascertainable by visual inspection as a result of overgrowth vegetattion or fill material in the subject property. . Not valid unless sealed with an embossed surveyors seal. FLOEIA INTERNATIONAL LAND SURVEYORS, INC. BY: VICENTE A. TOME Reg. Land Surveyor No. 3103 State of Florida. One Story CBS No. 10835 F.F.Elev.o 6.47' Lowest F. Elev.. 5.87' Porch . Avenu 11th ....... ... ............................ 80.00 ((R&F) Found 1/2 "0 Iron Pipe (No ID) iscruiroauty Found Reber 1/2"0 r .4 Found Reber 1/2 "0 (No ID) SCALE1 ° =20' oe 149' Pwkray Reber 1/2°0 (No ID) Found Reber 1/2 "0 (No 10) _ r 5 io IA I:re giriae-1 LO Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Owner's Name: DAVID LAZAR Job Address: 10635 11 Avenue Miami Shores, FL 33138 -2120 Permit NO. DS -12 -09 -2001 Wo* was bon. N om. Issued F�cpires: N t Is Folio Number:1122320280350 Owner's Phone: Total Square Feet: 800 Total Job Valuation: $ 2,450.00 Contractor(s) Phone Primary Contractor HOME OWNER Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 12/8/2009 Comments: PAVERS CAN NOT BE LOCATED WITHIN 10 FEET OF SIDE LOT LINE. END OF FLARE TO BE LOCATED NOT LESS THAN 3 FEET FROM EXTENSION OF SIDE LOT LINE. FLARE CAN NOT EXCEED 2 FEET IN WIDTH.