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RC-11-7631 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 165 NE 109 Street Miami Shores, FL 33161 -7041 1121360040500 Block: Lot: MANUELA MERINO 1 Owner Information Address Phone Cell MANUELA MERINO 165 NE 109 Street MIAMI SHORES FL 33161 -7041 (786)314 -6238 Contractor(s) HOME OWNER Phone CeII Phone Valuation: Total Sq Feet: $ 300.00 0 1 Approved: Yes Comments: NEED BUILDING PLANS WITH DETAILS Date Approved: 5/10/2011: Yes Date Denied: 5/2/2011 Type of Construction: BBQ INSTALLED IN BACKYARD Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Work without Permit Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $6.00 $0.80 $100.00 $211.60 Pay Date Pay Type Invoice # RC -5 -11 -40762 05/23/2011 Check #: 2132 05/06/2011 Credit Card Amt Paid Amt Due $ 161.60 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use 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: 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. Futhermore, I authorize the above -named contractor to do the work stated. May 23, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date May 23, 2011 1 Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Vie f 0 2 2011 BY: emee Permit No. ( 1 '7765 Master Permit No. Permit Type: BUILDING ROOFING Q +' OWNER: Name (Fee Simple Titleholder): i (,� ' (3. e'Y'L V C1) Phone #:.1 f� C �i► (`i �� 3 Address: 1 b i ®C141 City: 1" `16.1Vk -L( re.") State: CW Yt u G Zip: Tenant/Lessee Name: K.; r Phone#: Email: v ' a d yY") elt t t✓1 e `9 (6) VICA 1 P)L A . Csurfr—i JOB ADDRESS: ?CA✓Y�'1 City: Folio/Parcel #: 3`?2(3 4 Miami Shores County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: CAA J{\ ./€.4 • Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 30 0.°D Square/Linear Footage of Work: Type of Work: ❑Addition pp�er,, ❑Alteration II (� New C `� epair/Replace UDemolition Description of Work: 01 I Y) SA-cJ \€ C\) —L `1-k L CIA d it ******************** �x: x�x�x�x�nx��xx��x�xx:*** Feesa�**** x��x: x�xx��x�xa�* �x�x�x* �x�x�xx��x�x ** ******** **** *�x **** S_ot�OfV Submittal Fee ': �' — Permit Fee $ / ©Ld, CCF $ CO /CC $ Scanning Fee $� Radon Fee $ DBPR $ Bond $ Notary $ _ Training/Education Fee $ Technology Fee $ od 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, 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 Owner or Agent Contractor The foregoing instrument was acknowledged before me this The The foregoing instrument was acknowledged before me this day of t y's 1 , 201L , by " t\ .0 ii. day of , 20 _, by who is personally known to me or who has produced 9 who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLI Sign: Print: My Commission Expires: APPROVED BY NOTARY PUBLIC: V;; •• °r Sign: • rf /!O• co : �! O i ¢ Print: � r : CO ; My Commission Expires: %,(1)..‘'/57'• 3 Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) * le**** * * * * * * * * * * * ** * * * * * * * * * * * ** / d /� Zonin g "( Clerk 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: bOXtUE1 C { `'-'ill O DATE: 1 d� / )014_ ADDRESS: A o - ti 104411 s Il ICU1rt,t, k-Dre/J, 231( CJ 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. 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 1-4 , 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 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. �p Initial P e h 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 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. 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 114 ILL 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. 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 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 M 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. t J 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.mvfloridalicense.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 propos construction activity at the following address: �S ►� no s� v�, e3 3 I� rrj p� Initial • 1 " 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. 1 Initial 1" 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 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 l} day of 1)'( , 20 /t4,� By f l atiu. rlit21 tiv who was personally known to me or who has Produced there License or c D „I• /= Oyu �= v� ': 141 ? STATE OF (FLORIDA) COUNTY OF (DADE) The undersigned Affiant Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT avaJ 1.)>/lQdoes hereby attest that (Property owner) The attached survey, performed by (Name of surveyor's company) For address: LOS (109 ��, 1' C �lC v� ' 'Y€ ) rt•?3 1'!, Performed on 1 _ Vt.' (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Further, Affiantay -th naughty h 01,c civet) Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of Affiant is personally known to me, produced as identification. Notary Revised on 5/22/2009/ Revised on 6/12/09 1 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 Folio Number:1121360040500 Owner's Name: MANUELA MERINO Job Address: 165 109 Street Miami Shores, FL 33161 -7041 Owner's Phone: Total Square Feet: Total Job Valuation: 0 $ 300.00 Contractor(s) HOME OWNER Phone Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Comments: NEED BUILDING PLANS WITH DETAILS Date Denied: 5/2/2011 Zvi 7J) Permit No: 11 -70 Job Name , 2011 Miami Shores Vivage Building Department %ac,�i � ���/Building Criti99ue Sheet C e�%� C'-i✓t, thec ,% .c. /7/014, i g. l ltd 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 674 ,c.b. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 NiE b 4-1161-1 vic‘‘ o_A_c sko re/Nr n • 3 1G a-arc C oA/C OFIT 4S fig - 7 L flAY 0 fi 2011 BY: ...... 2 kr■I %DC—. Miami Shores Village APPROVED ZONING DEPT BLDG DEPT AIM WAN DATE • 1111,11 CT TO COMP( IANCE WITH ALL FEDERAL - cOlINTY !ill! FS AND REGULATIONS Q- \A CX : a ',re YYTh L U.1 CL. 11/4\r) _11 yCyCl 1 ? LO V-to,e-S V-Ci•-- Vrj•-Nt\O ck- C wctviC. 1 a r\cD co \)e YE (vv.\ e vt. c k This Lot COLL G accordi ther Plat B of t Dade d lac IGH I t -the as: Page 1. of 2 ■ I 'It': , If' CI -:........ .....,.... _...10.t.... i 1 1 A -. ....,17 ... -. ..... .... ___. 1