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FW-10-7431NIi9 eanLo5 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING Owner's Name (Fee Simple Titleholder) Owner's Address y •• raw 11 7e,- r- City r-1 i r s State Tenant/Lessee Name Email Contractor's Address Double Fee $ Radon $ 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 No. V.A.) I C) 1 Lk S Master Permit No. G`G l o s GI -, or-r -o Phone # . •-t.ti . s=1 go3 Zip 3315 Phone # Job Address (where the work is being done) ti <=1 w 1 t 1 -f --- . City Miami Shores Village County Miami -Dade Zip 2 ,3‘, 3 FOLIO / PARCEL # Is Building Historically Designated YES NO )C Flood Zone w Contractor's Company Name < ili os MIO Phone # ; 366 - Hry • l rct3 City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 1 IS00 Square / Linear Footage Of Work: 17 5? Type of Work: ❑Addition ❑Alteration ViNew ❑ Repair/Replace ❑ Demolition Describe Work: t-.a c w PC .f Pte, --;w, ... t- a.F ?' mac,, --4 5 &e e4- Fencp k ► f L ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Notary $ Training/Education Fee $ C� ; Technology Fee $ 1 Scanning $ 3 DPBR $ Bond $ Violation date: Structural Review. $ Total Fee Now Due $ 134. an See Reverse side -* 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 COM1VIENCEMENT 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 , ,uv Owne . r gent The foregoing instrument was acknowledged before me this g1 day of i •LL , 20 LL, by OPs &t 0-11:10 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: APPROVED BY ' Plans Examiner (Revised 07 /10 /07)(Revised 06/10/2009) Signature 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: 0011111111/" ,,, ......... k ,. t My Commission Expiredrn :4A- : - ass G� ` ? ? ** ** * * * * *** * * * ** * ** r * ***�45fMkt4 t+tl��k4** * * * * ** ** * * * * * *** **** r * *** * * * ** *** * *** ****art* x** ** * * * * ** r r*** *** Sign: Print: My Commission Expires: 9 Zoning Engineer Clerk checked Inspection Number: INSP - 141929 Permit Number: FW -4 -10 -743 Scheduled Inspection Date: October 25, 2010 Inspector: Bruhn, Norman Owner: CHAMORRO, CARLOS Job Address: 439 NW 111 Terrace Miami Shores, FL 33168 -3327 Project: <NONE> Contractor: HOME OWNER Building Department Comments 5 FT HIGH WOOD FENCE Passed1 / r Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ec October 22, 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: Fence/Wall Inspection Type: Final Work Classification: Wood Fence Phone Number Parcel Number 1121360010460 Page 3 of 26 OWNER BUILDER DISCLOSURE STATEMENT NAME: G cd r- 1aS G' b - or t - O Miami Shores Village Bu ilding Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DATE: t ' -t • . o ADDRESS: y °► t 1 -r Do ,c 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.CA 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. Initial G •G • 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. Initial C • G • 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. 1 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 • G• • 4. I understand that 1 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 C. • G . Initial G • G• • 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 and by county or municipal ordinance. Initial G . G . 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, maybe 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 G . G . 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 Intemal 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 htto:/ lwww. mvtloridalicense .com/dbodarolaib/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: 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. 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 t , 20 LO By CAOWS G44 4 who was personally known to me or who has as identification. Initial G • G • Initial G • G • Initial G G • Initial / •G • Initial / • G , Retum to: (endose self addressed stamped envelope) This Instrument Prepared by: JEROME HURTAK ESQ. 10800 BISCAYNE BLVD, STE 520 MIAMI, FL 33161 Property Appraisers Parcel Identification (Folio) Number(s):11 2136-001-0460 Space Above This tine for Processing Data CFN 2010R0100584 OR RECORDED 02/12/2010 HARVEY RUVIN, CLERK DEE► TAX 1,080.00 WARRANTY DEED (Statutory Form - Section 689.02, F.S.) THIS INDENTURE, made this 2a day of January, 2Q,10 , Between JOANNE RABY VOLLMAR, as Personal Representative of the Estate of ULLIAN RA and as T tec of the Lillian Raby Testamentary Trust of add .3 7,A q ?7�j � i? -(' , of the County of State of Florida, Grantor, and CARLOS CHAMORRO whose post office address is 439 NW 111 Terrace Miami Shores Florida 33168 of the County of Miami-Dade WITNESSETH: 1111111 11111 11111 11111 11111 111111111111111111111111111111111111111111111 BK 27182 P s 3303 - 3304; (lass) 14:32:53 OF COURT, MIAMI -DADE COUNTY, FLORIDA , State of Florida, Grantee, That said Grantors, for and in consideration of the sum of TEN DOLLARS ($10.00), and other good and valuable considerations to said Grantors in hand paid by said Grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the said Grantee, and Grantee's heirs and assigns for ever, the following described land, situate, lying and being in ** County, Florida, to-wit ** MIAMI-DADE LOT 30, BLOCK 2, NEW MIAMI SHORES ESTATES, according to the Plat thereof, as recorded In Plat Book 51 , at page 80, of the Public Records of Miami-Dade County, Florida SUBJECT ALSO TO restrictive covenants of record, if any, . which are not specifically: reimposed or extended hereby. and said Grantors do hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. This conveyance is made pursuant to the Court Order entered in the case styled IN RE: THE ESTATE OF ULLIAN RABY, DECEASED, File # 07-3494, Div 4, Probate Division, in the Circuit Court of the 11 Judicial Circuit In and For Miami -Dade County, Florida, dated January 10, 2010, authorizing the conveyance of the subject property to the Grantee named herein, a copy of which is attached hereto as Exhibit A. IN WITNESS WHEREOF, Grantors have hereunto set their hands and seals the day and year first above written. Signed, seated and delivered in our presence: Print Name: Ili 14 J J . if E/4 ' Print Name STATE OF FLO , %, COUNTY OF %% //) /— / The foregoing instrument was acknowledged before me this 29th day of January 2010 , b Joanne Raby Vollmar as Personal Representative of the Estate of Lillian Raby and as Trustee of the Lillian Raby Testamentary Trust, Grantor who are personalty known to me or have produced their Florida Drivers' Licenses, No. respectively, and who did (did not) take an oath. WITNESS y hand and official seal in the County and State last aforesaid this) day ofe i/i Printed Name /CAD Notary Public, State of Florida at Large My commission expires: NOTARY PUBLIC- STAMOF FLORIDA Ana M. Falero ,;,• Commission #DD787246 %.,,;,,,.•' Expires: MAY 18, 2(i 2 BONDED THRO ATLANTIC BONDING CO., INC BOOK 27182 PAGE 3304 LAST PAGE /0//..../ras J ne Raby Vol ` ar, as Personal • resentative of the Estate of Lillian Raby and as Trustee of the Lillian Raby Testamentary Trust, Grantor 7210 S.W. 126th. COURT, MIAMI, FLORIDA 33183 PROPERTY ADDRESS: 439 N.W. 111th. TERRACE, MIAMI SHORES, FLORIDA 33168 LEGAL DESCRIPTION: LOT 30, BLOCK 2, OF NEW MIAMI SHORES STATES ", ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 51, PAGE 80, OF THE P NICMCWIWED;)19ENEUDADE COUNTY, FLORIDA. 8 STALLED ON ALLEY MUST TRASH CANS, T REE O TRIMMINGS, ETC. • • • • ' • • • • • • �C �Gt'�GG ci n v--,4- 5 —�`' RECORD SURVEY SCALE 1"= 20' • • • AF ST •••• • • 0101 w Q • r � • s •• • § Z 0.. 1. - 1 • •••• • •••• G7 W SL' A • ARC DISTANCE A/C • AIR CONCmmowER PAD. A.E. • ANCHOR EASEMENT. ASPH. • ASPHALT. S C • BLOCK CORNER. • BUILDING. 8.M. - BENCH MARK C � OF BEARINGS. (C) CALCULATED DIMENSION. • • CATCH BASIN. CMS. - CONCRETE BLOCK STRUCTURE.' C.B.S.W • CONCRETE BLOCK WALL. e • CENTRAL ANGLE ® • PROPOSED ELEVATION. '3 L S90'00'00"W b— —11/41- 176. _Nag F.I.P. 03/4" 8.0.8. (B /C) CH • CHORD DISTANCE. CH. B. - CHORD BEARING. C/L OTL CENTER UNE. C.P. • CHAIN MC FENCE. C.M.E. • CANAL. MAINTENANCE CONC. • CONCRETE C.P. • CONCRETE POST. C.S. • CONCRETE SLAB. O.E • DRE INNAGE EASEMENT. • DRAINAGE & MAINTENANCE EASEMENT. NOLO • =STING ELEVATION. ANIANO J. GARCIA, PLSM. LAND SURVEYOR & PLANNER •• •• • • • • • • • 4021 • 'orb • • • • • LOT 31, � 'IBLOCK 2 1 W10- VISUAL ENCROACHMENTS NOTED: NONE. OTST. • DISTANCE DR. • DRIVE DR, W. • DRIVE WAY. E • FART. ELEV. • ELEVATION. ENCR. • ENCROACHED. ET.P. - - FOUND 09 ELECIIC ILL HO OK F.O.H. 0.1. HOLE ( � F.F.E • FINISHED FLOOR ELEV TIOK F.H.. PIKE NYDRANT. F.LP. • FUND RON PIPE. F.LR. • FOUND LION ROD. F.N. • FOUND NAIL. FT. • FEET. 91-0E -CHAIN LINK FENCE. F.I.P. F.I.P. 0/ " o !CL ';ViTH ALL FEDERAL ES f` D ' LEGAL NOTES THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP. EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT TO DEDICATIONS, UMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORDS. LEGAL DESCRIPTION PROVIDED BY CUENT. THE LIABILITY OF THIS SURVEY IS UNITED TO THE COST OF THE SURVEY UNDERGROUND ENCROACHMENTS, IF ANY, ARE NOT SHOWN FIRM HAS NOT ATTEMPTED TO LOCATE FOOTING AND /OR FOUNDATIONS AND /OR UNDERGROUND IMPROVEMENTS OF ANY NATUR IF SHOWN, BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN. IF SHOWN, ELEVATIONS ARE REFERRED TO N,G.V.D. OF 1929. LEGEND UP 2T'1Q' WIDE ALLEY g RESIDENCE SF IN. & E0. E • INGRESS & EGRESS EASEMENT. LB. • LICENSED BUSINESS. P.E. .E. • LOWEST FLOOR 119109. LYE. - LIKE MAURQU 910 EA5 000. R P. • LIGHT POLE M • IMMURED 004090400. MINUTES 1.1/1 OR Y • ME MONUMENT UNE. N- NORTH. NAP.O • NOT A PART OF. VSS',P • WOOD FENCE ® - C.B.S WALL OE S90 °00'00 "W 75.00' (M &R) Le , -- cp LOT 30, BLOCK 2 S .W. ASP 'DATE OF FIELD WORK REVISED ON REVISED 0 ASPHALT PAVEMENT 111th. TERRACE (50' TOTAL R/W) ANNA NOT S ES THAT THIS SURVEY OF THE PROPERTY ED HEREON WAS MADE UNDO/ MY SUPERVISION THAT THE SAME MEETS THE MINIMUM TECHNICAL ANDARDS SET FORTH BY THE FLORIDA BOARD .. SURVEYORS AND MAPPERS IN FLORIDA ADMINISTRATIVE �' •. SECTION 47Y�t OUT THE SIG OF A FLORIDA UC TH6 DESC C AND ABB F ANT,, ATUTpr ". 9.0.mD. - NATIONAL GEODETIC PL - VERRCAL DATUM. P • N.T.S. • NOT TO SCALE. P NO. OR NUMBER. P199 O.E. • _ UTILITY LINES. 0/S • OFF SET. ° P.O.C. 0.9.8. • OFFICIAL RECORD BDOK.P.RC. P8. - PLAT BOOR. PAY. P .C. -POINT OF CWNATURE P.C.C. • POINT OF COMPOUND PROP. CURVE. P.T. - PvMT. PG. a PERMANENT CONTROL POINT. P.L.S.M 5105 AND THE ORIGINAL ED SURVEYOR AND tz.3'/ S90 °00'00 "W 75.00' (M &R) SIDEWALK 0.20 CL PLANTER OR PIACE. R - PROPERIY 110. (9) - PROFTSSQLE IN. SUMO. RAO. PAOTTESSOWL LAO RD. SIMON & RAPPER. RES. • POINT OF BEGINNING. ROE. - POINT OF COMMENCEMENT. R.L.S. • POINT OF REVERSE CURVE. • PERMANENT REFERENCE R.P. MONUMENT R - ._.......... COB. • PROPERLY CORNER. R/W • 91 OF WAY. POINT OF TANGENCY. S • SOUTH. PAVEMENT. SECONDS. - PARR - WAY. SEC. • SECTION. PH. (305) 856-4566 FAX. (305) 595 -1454 F.I.P. -•• T.0 4"- 0.30' CL . 1 0 1 0 0 LOT 29, 'BLOCK 2 ti co F.I.P. f%" THERE MAY BE EASEMENTS AND /OR OTHER INSTRUMENTS AFFECTING THIS PROPERTY, RECORDED IN THE PUBLIC RECORDS NOT SHOWN ON THIS SURVEY. THE PURPOSE OF THIS SURVEY IS FOR USE IN OBTAINING TITLE INSURANCE AND FINANCING AND SHOULD NOT BE USED FOR CONSTRUCTION PURPOSES OR PLANS. CERTIFIED TO: LOS CHAMORRO. RIFIRST TITLE SERVICES, CORP. HERN TITLE INSURANCE CORP. LLS FARGO BANK, N.A. ITS SUCCESSORS AND /OR ASSIGNS, ATIMA. ORDER NO. 10 -0020 RADIUS. S.I.P. • SET 1000 PIPE RECORDED DIMENSION. WITH CAP P.LS 5105 • RADIAL. S.P. • SCREENED PORCH. • R0A0. ST. • STREET. • RESIDENCE STY. • STORY. • RANGE. S.W.R. • SIDE WAIL • REGISTERED LAND T - TANGENT. SURVEYOR. TINS • TOWNSHIP. • RADIUS POUR. U.E. • LARRY EASEMENT. U.P. • UTILITY POLE DIY. • UTILITY. W -WEST. W.F. • W000 FENCE W.M. • WATER METER. W.V. • WATER vALVE. • 5' -0" d.v • d • • • y • • •• • •• O4 • • • • • • ••• • • • •• • • i •• • a • .,. 4 ' •`.i••• • d �� . • ' •• • • . .•u • ,. ••• • i • • 0 5Mn0W 130X WOOt7 Na i7e1AAL • • • •• • • • • • • P05T5 AID 5PAC1 ' » -0" ON CENTER, •• ••• • • • • • • • • • • • • ••• • • • • • • • • • • ••• • • • • • • • • • • • •• • • • • • • • • • • • • • • •• •• • •• •• ••• • • • ••• • • A. 4" X 4" PI 55UEE 11A1W PO51'5 13, 4" nOG Ap PLANKS FA5TNe13 WITH (2) COM5ION 5I5TANT FA5TNEp pip CONNECTION C. 2" X 4" HORIZONTAL PM5510 11ASt7 W0013 MDM13M5 WITH (2) CO O51ON 1 5I5TANT rAA5V5 MP CONNECTION P, 4" X 4" Pt 55UIt 11 A1e17 P051'5 MC3EE2 t7 2 INTO CONCM FOOTING (10" PIA. X 24" SEEP) • ••* FENCE 15 5' -0" HIGH, '--' ......... -- -- -- ---' ^^~^^^-^^`^ ......~.. rmO[ [me �^[~\ , �Kk� |�\^ �`~U�� NN /5 F fOrA. | | 1781-0U