DS-10-1545iami Shores Village
Building Department
0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
'SPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATIO
FBC 20
Permit Type: BUILDING ROO_
Owner's Name (Fee Simple Titleholder) " . 4lv'
t T�
Owner's Address t !�' (_/J ( c+ L
City /u4A 1 �EG��E S State
Tenant/ Lessee Name
Email (• Cow
Job Address (wiere the work is being
City _ Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contra
s Company Nance
Contractor's Ad
Flood Zon6-1
Olt act
Value of Work For this Permit $
Type of Work:
Describe Work:
❑Addition
Square / Linear Footage Of Work:
T New ❑ Repair,
/Replace
Demolition
N
Submittal ee S
Notary S•
Scanning $
Double Fee $
Structural Review. $
"***X **i;:( *h*** Fes* J; h**** ***- *****- A.-k•kk***************-1,* 4**-k***
Permit Fee $
Training/Education Fee $
Radon $
DPBR $
CCF $ tm CO /CC $
ttA
hnology Fee $
Bond $
Violation date:
"Total Fee Now Due $
Bonding Company's Name (if appliea e).
Binding Company's;Address
Citv
State
Zip
Mortgage Lender's Name (if:applioable)
Mortgage Lender's Address,
City State Zip
Application is hereby made to obt *nit to do the work and nstallatia „s indicated. I certify that no work or installation has
commenced prior to the issuance a hermit and that all work will be parzned to meet the strds of all laws regulating
coast ucticn iCt this jurisdiction. 1 understand that a separate permit must be secured for ELECTRICALAWRK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
L-4_^
OWNER'S AFFIDAV� : rtify that all the foregoing information is emirate and that all work will be done in compliance with all
applicable laws regulating cbi niction and :zoning.,
"WAR:NING TO OWNER. YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY REE$ULT IN YOUR PAYING CE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU -INTEND TO AIN
FINANCING, CONSULT WITII YOUR LENDER OR AN ATTOENE ... EFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to AI ant: As a condition to the issuance of a building permit with an esiirnated value exceeding $2500, the applicant rnust
promise in good faith that a copy -of -the notice of ccinniencemeht and construction lien law brochure will be deliver-ea' to the person
whose property is subject to attachment: A1s6, a Certified copy of the recorded notice ofcrmmencement must be ',piped at the job site
fc�r the first inspection which occurs seven (7) days after the building permit is issued In the absence of sucb=sPvsted notice the
inspection will not' be approved and a reinspeciwn fee will be charged
Signature
Owner or Agent
Signature
Contractor
The foregoing instrument was acknowledged before me this
, 20 _,'by
who is personally known to Me or who has produced
,aiidentification and who did take an oath.
NOTARY PUBLIC.
day of
Sign:
Print:
My Commission Expires:
Sign'
Print:
My Commission Expires:
k;:**- ;r:,e****** :21.kir***** it :.4ire:ir'k*** -A,:rkirkir;4;!** irk* * ** *— ..i*-;,**-ki:*********— *'r:'is N-****i.*?r -. 'k'k kkk:Yk;; k;k : *;t kk-.': A::** -k is l; !: ;r* **
APPROVED 13Y
Engineer
(Revised 07 /1O /a7)(Revised 06 %102009)
Zoning
Clerk checked
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: " t� t((�• A A) DATE: 4301
ADDRESS: 4z w f t S'T
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
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.
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 ,_'�P�
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
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 govern 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 .myfioridalicense.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:
1-:2 . w (co-"- v,
Initial =\
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 TT—ilk-
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 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'Q day of ALS ,Ds-1-- , 20 t
who was personally known to me or who has
Produced there License or 1
OWNER
-Oral identification.
• • ••• • • • •i ••
Leandro #7,61-riallitlez PE
• ••• • :: : :•
11-3'0 11th Street #4G jj
Miami Beach, F.-I'Gr4
Tel.: (786) 39:0i-•
Leafer7@gmail.com
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BLOCK • 219
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PROJECT: DAVID HOGAN
PROI •
#. ECT 1020
LOCATION:
42 NW 110TH ST
DATE: 9/16/10
CALCULATED BY:
LF
CHECKED BY: LF
SHEET #:
1
2-
SCALE: N.T.S.
OF:
DESCRIPTION:
I<E Y ei-i4"/
REVISION:
A
B
D
26* PYVY
STREET:
1
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75.00'
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17.25' I 1 C S
it 1010' tt
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0.70'
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pool- ------->
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10.02' :3.40'
17.30'
•, •
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25.33'
ONE STORY
RES. 142
12.45'
22.00'
W.
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BLOCK - 219
8 C1. 1,
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BLOCK • 219
LOT • 29
(414031.rOCKr ...3°
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cloRVEV ENCROACHMENT vorEs
4 st4:10 TN toll OF oaoPARTY comene le .....•/yEVIAY ENCROACHING ONTO RIGHT OF WA Y 0*Y'
Lor 28
BLOCK • 419
LOT - 3
BLOCK - 219
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Co-lcre- 4-e
LEANDRO FERNANDEZ, P.E.
ENGINEER FLORIDA REGISTRATION
NUMBER: PE 71519
Charlie Crist
Governor
Ana M. Viamonte Ros, M.D., M.P.H.
State Surgeon General
December 01, 2010
David John Hogan
42 NW 110 St
Miami, FL 33168
RE: Contingency Letter
Application Document No: AP985928
Centrax Permit Number: 13 -SC- 1289727
OSTDS Number:
42 NW 110 St
Miami, FL 33168
Lot: Na Block: Na Subdivision: Na
Dear Applicant:
This will acknowledge receipt of an application dated 11/30/2010 for a permit to use an existing
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..
This permit is granted for construction of a concrete slab that will have no impact on the
unobstructed area.
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Sincerely,
ecialist II
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 Fax: (305) 623 -3645
Charlie Crist
Governor
Ana M. Viamonte Ros, M.D., M.P.H.
State Surgeon General
December 01, 2010
David John Hogan
42 NW 110 St
Miami, FL 33168
RE: Contingency Letter
Application Document No: AP985928
Centrax Permit Number: 13 -SC- 1289727
OSTDS Number:
42 NW 110 St
Miami, FL 33168
Lot: Na Block: Na Subdivision: Na
Dear Applicant:
This will acknowledge receipt of an application dated 11/30/2010 for a permit to use an existing
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..
This permit is granted for construction of a concrete slab that will have no impact on the
unobstructed area.
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 Fax: (305) 623 -3645
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
Permit NO. DS -8 -10 -1545
Issue Date: Not Issued
Expires:Not Issued
Folio Number:1121360030040
Owner's Name: DAVID HOGAN
Job Address: 42 110 Street
Miami Shores, FL 33138 -4319
Owner's Phone:
Total Square Feet:
Total Job Valuation:
0
$ 1,000.00
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 11/18/2010 : Yes
Comments: DIMENSION THE PLAN, SHOW DIMENSIONS OF SLAP AND SHOW DISTANCE FROM PROPERTY LINES
TO FIX LOCATION.
11/18/10
NEW PLAN OK
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:1121360030040
Owner's Name: DAVID HOGAN
Job Address: 42 110 Street
Miami Shores, FL 33138 -4319
Owner's Phone:
Total Square Feet:
Total Job Valuation:
0
$ 1,000.00
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 8/31/2010
Comments: DIMENSION THE PLAN, SHOW DIMENSIONS OF SLAP AND SHOW DISTANCE FROM PROPERTY LINES
TO FIX LOCATION.
Permit No: 10 - /CO
Job Name
9-�
, 2010
Miami Shores Village
Building Department
4 Building Critique Sheet
eti *owe; /
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
Atouttle , 4' 14/0-PeveYej
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
Miami Shores Viiiage
Building Department
RECEIPT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
PERMIT #: �� _ 1S-14 s— DATE: 11 11 0 1 i
1, \ -)4,0 1A.C6A1\)
o Contractor
o Owner
o Architect
Picked up 2 sets of plans and (other) C �-CC- � d'''� .Sh
Address: V-) j ‘04-
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL: