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DS10-1534Cusp (L . 5u2v t LYer,1ON r►.T BUILDING PEST APPLICATION FBC 20 Permit Type: B Owner's Name (Fee Simple Titleholder) Owner's. Address ( /(,k Qty AttallAi SCE c. State. MiamiShores IVill Building Department ti 0050 N.E.2nd Avenue, Miami Shores, Florida 33135 Tel: (305) 795.2204 Fax: (305):756`8972 INSPECTION'S PHONE NUMBER: `(305) 762.4949 ROOFIN t Permit No. Zip C ,j Tenant/Lessee Name . Phone # Email a itt 64 tit ( . C � .FOLIO / PARCEL # Is Building Historically Designated TES :. NO WETS Master Permit No. Phone # ®7 Job Address (where the work is•berng, done City Miami Shores Village County Miami- Dade'.. Zip 3 3/ 34 .F Zone Contractor. s Cotn an Name "° " Phone # Contractor's Address 'Value of Work For this Permit $ Type of Work;: °Addition Describe Work yi t y Submittal Fee $ c °Alteration Ferric Fee $ Training/Education Fee $ Notary $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date. Structural Review. $ City State Zip . Qualifier Name Phone # State Certificate or Registration No Certificate of Competency No, Contact Phone F -mail Architect/Engineer's Nam (if applicable) Phone # Square / Linear Footage Of Work 5 ❑New. [S. Repair/Replace °" Demolition s K P f tctc // ea'tcr * ** *Fees * * ** * *4t* *4e ** * * * *.** * ** * * * *. * ** / o c, Total Fee Now Due $ * * * * * * * * ** CCF $ • . CO /CC $ Technology Fee $ Bond$ See Reverse side -÷ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 5 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 cc installation has commenced prior to the issuance of a permit and that all work will be performed to Ales: the standards of all laws regulating constmctien in this jun Nand that a separate permit must be secured for ELAM PdCAL-WORK, PLUMBING, SIGNS, WELLS, POOLS, /As ° RS, HEATERS, TAWS and AIR. CONDITIONERS, ETC..... Thc fore oingingiu d iy of A 42 • • who is perso • , . 8 IA • • ,d/ inner Is -7.: r• 1 fly knoixn to me or *lic has produced M'iden take, an Oath. ' .1 (Revisec10 710107)-(Revid 00/10,200) ent Engineer Signature My Commission Expires: Contractor j OWNER'S AfF1D* -, t , e foregoing information is accurate and that all work will b done in compliance with a ll L applicable laws regt4 ,......1..,,..,,, ;., 1 ..,, ing. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAX RESULT IN YOUR PAYING TWICE FOR _ . , , IMPROVEMENTS TO YOUR. PROPERTY. IF YOU INTEND TO OI3TAIN - , FINANCING, CONSULT WITII YOUR LENDER OR AN ATTOMEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to' Applwant: As a condamit,to the issuance ofalnalding paw* with an estimated value exceechng $2500, the applicant Must . promise in good faith that a copyVrthe notice of commencement and construction hen 41414 brocham will be delivered to the Person whose property is subject w attachment Also, a certified copy of the recorded notice Of commenctintiMt must be posted at the job site L; , for the first inspect' :.Mspection w A not Sjgmtur n which occurs .seven (7) days afier the building perrnit issued. In the It#se of such posted notice, the approved a retareinspectionfe will be charged. oxyledged . .re me this The foregoing instrument was' acknowledged before me this day of , 20 by who is pexsonally knOWII to me or who has produced on and who did as identification and who did take an oath. ?IOTA BLIC: Sign: Print: M y commission Expires: -E ( 1• Ay v 40 it 1■, ://d)kl ■-' . 4 ‘ ... •itqr /**** .** ii/f/111141 ,... APPROVED BY ,.. ...„.. . ' Plans Examiner • . '''''C' •t ' . , Clerk checked DRIVEWAY AND WALK WAY REPLACE WITH CONCRETE IN SAME EXACT PLACE Passed Inspector Comments 7/c ' 0111 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP - 150491 Permit Number: DS -8 -10 -1534 I Inspection Date: October 28, 2010 Inspector: Bruhn, Norman Owner: HAGHAYEGH, ALIREZA Job Address: 1271 NE 97 Street Project: <NONE> Miami Shores, FL 33138 -2559 Contractor: HOME OWNER Building Deaartment Comments October 29, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132050090430 For Inspections please call: (305)762 -4949 Page 1 of 1 Charlie Crist Governor Ana Haghayegh 567 Grand Concourse Miami, FL 33138 RE: Contingency Letter Application Document No: AP979022 Centrax Permit Number: 13-SC- 1279288 OSTDS Number: 1271 NE 97 St Miami, FL 33138 Lot: 18 Block: 3 Subdivision: 2.-This project entails : "RE- SURFACE EXISTING DRIVEWAY " October 15, 2010 Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General z Inv z 1 BY: ....................... Dear Applicant: This will acknowledge receipt of an application dated 09/17/2010 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. 1. -There is no increase in sewage flow, change in characteristics compromising the integrity or function of the system installation. From a review of your completed application, it has been determined that your existing system is adequate for the proposed use : " APPROVED ". G/P If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Sincerely, Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 Fax: (305) 623 -3645 Jos weer Specialist II PART II - SITEPLAN T� Scale: Each block represents 10 feet and 1 inch = 40 feet. <} = =� 1111rBraM111 vLI 1 0 -4- e(tY S .;( Sor,n oil eon Notes: Site Plan submitted by: Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION P Permit Application Number 1211 ' scil ST Sfi oRES 33 (, Exr STN 6 t C S S l ei t° tociaKthic PATE- ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used) (Stock Number 5744- 002 - 4015 -6) Signature Not Approved Go rvr -.c roe- Tale Date County Health Department Page 2 of 4 6 j. at' ' 1: • • . 0. ••■i■ . . • 4 •• . • ••■ L. • ••• • • 1 •••• AUG 2 7 2610 ,?' , --, , . .CAtt4.1.61.11.14t.S.Tor r pion. . 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T 1 19)(( ; ...t 9 't• a' t•. 1 • I 0i0..111,1q4 T'A POLLUTION t • 0..101 011 Foc.....es 0 AP PR 0 /.1 OWN R BUILDER DISCLOSURE STATEMENT NAME: lY° 430..1r-DA "\ DATE: gr a-' 0 n' ADDRESS: 1 C AjG 9 Ati2L -1 � (fir , ( 33/8 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; !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. 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. 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. 5. I understand that, as the owner- builder, I must provide direct, onsite supervision 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 Initial 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 Ii «-ns: umbers on permits and contracts. 4. I understand that I may build or improve a one family or two - family residence or a farm outbuilding. I may also bui d 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 'r tantially improved it for sale or lease, which violates the exemption. 1 - Initial Initial Initial ld 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 unty or municipal ordinance. r 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. 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. 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 : / /www.mvfloridalicense.com /dbpr /pro /cilb /index.html 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: 11 nic 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information tha 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 retumed to the local permitting agency responsible for issuing 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 V day of By who was personally known to me or who has Produced the icense or 1 ow Initial 7911d 4o j ^, A�R1F �, • �� °l Initial k 20 l D ,R,i entification. Initial " ()I CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those exc uded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER: L C u2 t— 2. 0 5 60 O PERMIT # ADDRESS: FOLIO NUMBER: FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: ! ($ -{sap, (ATTACH COPY OF CONTRACT) VALUE OF PRINCIPAL STRUCTURE (attach appraisal): OWNERS SIGNATURE: PLAN REVIEWER: 11 -12 -08 it 6 3 poo., oo EAST OF FL.CCCL: TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): $ Cl 10-6 , 00 1246,2tisco PLAN REVIEWER SIGNATURE: DATE: DATE: d-,/ _to Primary Zone: 1400 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 4/4 Floors: 1 Living Units: 1 Ad] Sq Footage: 3,075 Lot Size: 8,175 SO FT Year Built: 1952 $0/$344,848 5 53 42 EARLETON City: SHORES PB 43-80 LOT Legal 18 BLK 3 LOT SIZE Description: 75.000 X 109 OR 17546 - 2972 0297 1 OR 26995- _ 3932 0709 12 Year 2010 2009 1271 NE 97 ST Applied Applied Taxing Authority: Exem�ptil n/ Exem n/ 12725 NW 711-1 AVE MIAMI Value: Value: Regional: $0/$344,848 $0/$409,014 County: $0/$344,848 $0/$409,014 City: $0/$344,848 $0/$409,014 School Board: $0/$344,848 $0/$409,014 _ - rte-- ■ =MEM EIECEIMFAT Sales Qualification • Desc'ion: /2009 .205 000 1271 NE 97 ST reeds to or from financial institutions AUREZA HAGHAYEGH Address: Folio No.: 11- 3205 - 009 -0439 Property: 1271 NE 97 ST Mailing AUREZA HAGHAYEGH Address: 12725 NW 711-1 AVE MIAMI FL 33168- aEll 2010 2009 EgEME $98,636 MEINg Build • Value: t <.264,801 $344 848 c r r Miami -Dade My Home My Home r??i sr73id cue. 9 Show Me: Property Information Search By: Select Item - ® Text only Property Appraiser Tax Estimator Property Appraiser Tax Comparison Summary Details: Property Information: Assessment Information: Taxable Value Information: Sale Information: Additional Information: C lick here to see more information for this proDerty: Community Development District C.nmmimity Rertavelnnment Area ACTIVE TOOL: SELECT Aerial Photography - 2009 My Home 1 Property Information 1 Property Taxe$ 1 My Neighborhood 1 Property Appraiser Home 1 Using Our Mel Phone Directory 1 Privacy 1 Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmester. 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