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DS-10-885FO. REBAR O.H. H . 0 J 0 0 ui N N.a D. 105 139)4 ST. ASPHA LT N 1-. 0 J SCALE : l" = 20' C A 10 A L EIW 35' (-N.15 D. • 0 0 iri N 0 WOOD POLE FD. REBAR .7d 0 CLR. • SET l.R Protect Address Parcel Number Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 ARNETT HEPBURN Address 131 NW 104 ST MIAMI SHORES FL 33150 -1239 (305)757 -2949 Valuation: Total Sq Feet: $ 1,100.00 616 Contractor(s) HOME OWNER Phone Cell Phone Approved: Yes Comments: DOES NOT MEET ZONING REQUIEMENTS HOWEVER THIS IS AN JUST AN OVERLAY TO AN EX Date Approved: 5/18/2010 : Yes Date Denied: Type of Work: REPAVE DRIVEWAY Bond Retum : Additional Info: BUILDING Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $0.40 $5.00 $125.00 $3.00 $1.60 $136.20 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: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Expiration: 11/15 /2010 Phone Amt Paid Amt Due Pay Date Pay Type Invoice # DS -5-10 -37929 05/18/2010 Check #: 1211 $ 50.00 $ 86.20 05/20/2010 Check #: 1212 $ 86.20 $ 0.00 Applicant Available Inspections: Sidewalk Inspection Type: Final Landscaping Foundation May 20, 2010 Date Cell May 20, 2010 1 _ BUILDING PERMIT APPLICATION FBC 20 Contact Phone Value of Work For this Permit $ ( r Cam Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit Type BUILDING ROOFING I _ Owner's Name (Fee Simple Titleholder) A ell 4. V • 1 ' , / 1 Phone # 3 ©r. 7 57 ..•� T q Owner's Address 1 .1 M Vt \ Q City M t a.✓M' t 51 6 rr4 State 19 Tenant/Lessee Name N 1 Pc Email h" f Ip4p1O gQi0J2il,t$O0. , d1e � vv • (0 ( 31 N Job Address (where the work is being done) City Miami Shores Villa e FOLIO / PARCEL # Is Building Historically Designated YES NO E -mail Zip 3 3 t 5 Phone # tJ' Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: See Reverse side -+ MAY 201 BY: ✓ Permit Nol) S 10 — %" - S - 5 Master Permit No. County Miami - Dade Zip Flood Zone 0 "-J ne # Contractor's Company Name Contractor's Address City - State Zip �• Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. (4. Type of Work: DAddition DAlteration DNew -% Repair/Replace ❑ Demolition Describe Work: RQ i! a t' 19. ✓ t J Ln/ Gt ./ ******** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * ** * * * * * * * *** * * * * * * * * * * * * * * * * ** Submittal Fee $ 5 .C D Permit Fee $ /oL5 CCF $ 116 CO /CC $ 5-13-121- ID Notary $ Training/Education Fee $ s 90 Technology Fee $ td0 Scanning $ Radon $ © DPBR $ G Bond $ 6 Double Fee $ Violation date: Q D Structural Review. $ Total Fee Now Due $ 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, P LUMBING, 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 CONIlVIENCEMENT 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 reins i ection fee will be charged. Signature Sign: Print: `/ _/ / , i Owner or Agent �j The foregoing instrument was acknowledged before me this 1 O day of VAA- , 2010, by Atit%l CC1 1 , who is personally known to me or who has produced PL t D As identification and who did take an oath. NOTARY PUBLIC: � � ` ` ' d Q I a l�� ® d t :` y My Commission Exp ires: V . . '• � ,, ; � � ai �i � i��� \‘ ,, APPROVED BY Plans Examiner (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _ , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Clerk checked COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, #V'p' e. $ 14-ep 1 a raereinafter referred to as the Owner of the following (owner) descripepfoperty: / , 1 L a ' 7,0 E c'-5� 1 ac� l o+ 1, Legal description/folio#: Lot BI9gk.. 1 '2— Subdivision Tax Folio #: Requests permission to install: 1/A sphalt, concrete, brick pavers Landscaping Other M iami Shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 W h e public road right of n o � 1 ...e.L O ��l 1 n , (address) IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and /or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGN D, SEALED, EXECUTED AND ACKNOWLEDGE on this 1 /ll SIGNED. SEALED, AND DELIVERED in the presence of: ti o -4_13 Cal day of (owner) Please read and initial each paragraph. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. M iami 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: i ✓ n at $ t) Y11 DATE: 5 71 ADDRESS: i ■ 1 O - 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. 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. Initial Initial 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 Est 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 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. Initial� 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 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.mytloridalicense.com /dbpr /pro /cilb /index.html Initial 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: Was acknowledged before me this f ?S day of , 20 ( 0 Initial By who was personally known to me or who has Produced there License or as t 4cg tjpation. OWNER - ` °'` Go •• . • . .. .... (4 .„, /7„ /- TE i O \ \ � 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 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. • LOT 19 BLOCK 126 FIR 1/2° CB NO ID WALL 18.2' 2 0' CHAIN LINK bc FEN4 2.0' FIP 3/4" NO ID 5 CONC. WALK 0 z ••••••■ 10.4' CONC. BOUNDARY SURVEY 1.7g MAY 1 8 2010 QJA 20 0 10 20 9' ASPHALT PAVEMENT 15' ALLEY RN/ S89°38'12' 75.00(P&M) 25.00' x x ' 25.00TP) ) 1 FIP-3/4f 14?" cl BLOCK 126 ::■?. _ ' 4 NO ID ' , • '71 D 510 _ 5 ..... ) 5' CHAIN LINK FENCE WES i 17.9' I HALF OF ° -s--.----- I\:i all Snores Village i F COVERED N.) CONC. 7... CONC. ....4, LOT 21 ik BLOCK fR 3 P(.7)\,./ED I BY 126 \IING DEPT 17.9' CONC. POOL PATIO 10.2' 9.2'9); ( 16.7' ONE STORY RESIDENCE #131 32.1' - 10.37 - - COVERED CONC. NORTH PM/ LINE ASPHALT PARKING La 0 0 CONC. 20' 20' ASPHALT ROAD 75.00' TOTAL R/W • 25.7' 5.5' 14.0' .- FIP 3/4" NO ID 25.00IP) 1 7 N89°35 55 W 75.00(P) 48 N89°35'55"W 74.907 NW la4771-1 RTRFFT CONC. UP • MFG DEPT z [ k CO s1.11 1JECT CCMPILIANCE WITH ALL FEDERAL Si'' -- AND (2(1,UN Ili RULES AND REGULATIONS 13.2' 0 k 0 I 63 k (23 I 40 EAST HALF OF k I I I LOT 21 I NOT k BLOCK 126 """ 1\) INCLUDED I l\ ▪ ) I • 1;2 13.1' ( IN FEET ) 1 INCHES = 20 FT. • LOT 22 BLOCK 126 ty CAP `.] EGI ' 4 0 14 ,,• 4 \„ LEGEND 0 - FOUND 3/4" IRON PIPE Planning and Zoning Criteria Owner's Name: ARNETT HEPBURN Job Address: 131 104 Street Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Miami Shores, FL Folio Number:1121360131400 Owner's Phone: Total Square Feet: Total Job Valuation: (305)757 -2949 616 $ 1,100.00 Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 5/18/2010: Yes Comments: DOES NOT MEET ZONING REQUIEMENTS HOWEVER THIS IS AN JUST AN OVERLAY TO AN EXISTING PARKING AREA AND IS THEREFORE BEING APPROVED Inspection Number: INSP - 144292 Permit Number: DS -5 -10 -885 Scheduled Inspection Date: June 07, 2010 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Owner: HEPBURN, ARNETT Work Classification: Addition /Alteration Job Address: 131 NW 104 Street Miami Shores, FL Inspector: Rodriguez, Jorge Project: <NONE> Contractor: HOME OWNER Building Department Comments ASPHALT OVERLAY IN SWALE. Passed 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- 143813. Aspalt averlay permit but new asphalt installed. Aspalt is not bound just loose rocks. Subgrade must be graded prior to laying asphalt. NB June 04, 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 Phone Number (305)757 -2949 Parcel Number 1121360131400 Page 13 of 24