FW-12-175Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PRONE NUMBER: (305) 762.4949
U DING
PERMIT APPLICATION
FBC 20
Permit No l
Master Permit No.
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): 4 n0 e ( go lot rc Phone#: ?Of- 33?-113.2
Address: /V/ 41J L( ?fee
City: M/a 4.19 State: _( Zip: 3,713
Tenant/Lessee Name: n Afie 1 So eta re , ] Phone#: 3t f - gay-ft-Nei
Email: G5.)4 R V OLDS 14 ��aMgJ m rofl
JOB ADDRESS: g;/ ®( ir Ave__
City: Miami Shores County: Miami Dade
zip: 3.713r
Folio/Parcel #:
Is the Building Historically Designated: Yes NO
Flood Zone:
CONTRACTOR: Company Name: °Mil P Oast p10,41/5 1p✓Qe+C 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: $ 0200.- 00 Square/Linear Footage of Work: 08 /
❑Repair/Replace UDemolition
1
Type of Work: Addition
Description of Work:
of °� zdef'cor
DAlteration
New
***** ****x:** ** *:x******* ***+x+ +x****+r*+x***Fees***a ******** *********+x********* ** ***********
Submittal Fee $ Permit Fee $ /0 0Cr4 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
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 # . prov • n fee will be charged.
Signature
Owner or Agent
Signature
j Contractor
The of instrument was ac owledg bef �mye 's / The foregoing instrument was acknowledged before me this
e
day o , 201 l; by A , day of , 20 _, by
and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
NOT
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
Sign:
Print:
My 1 •mmission Expires:
**** *** **** ** * **** * ** ** *****3K* * * * **** ***** ** * *** * * * *** ** *** **
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
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: Ay.P i 5). , t'e P , DATE:
ADDRESS: 70/ 4/F. r( P
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 a my own
contractor with certain restrictions even though I do not have a license.
Initial
7
At
2. I understand that building permits are not required to be signed by a property owner unless he or she i responsible nsible 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 thaz'may protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed in his or her na e 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 licens mbers 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 a ` o 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 substantiall, improved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or, t• •Ily
improved it for sale or`iease, which violates the exemption.
• Initial
5. I understand that, as the'owner- builder, ,I must provide direct, onsite supervision of the construction.
Initial
. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons worki 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
00111'00 c-3§0?
tOst
A, aet R
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.
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is ot 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 abid> •y 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 Intemal Refenue 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.mvforidalicense.com /dbor /pro /cilbfinde r I
Initial
11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands tha
legally and financially responsible for the proposed construction activity at the following address:
Initial
m the party
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informa
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. 1 Was acknowledged before me this l day of (� , 20 J
who was personally known to me or who has
Produced re License or ;, identificatio
By AVO CA(1A
Y ' u•••,• CLAUDIA V. CUBILLDS
e`er E Notary Public - State of Florida
My Comm. Expires Sep 23, Q, P , 2015
••s'°L ` ` BondeCommission hrough Natio .al N� Assn.
Ef7M1T P:'
Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
10
41
BLDG DEPT
•41:=0iL 11.
SUBJECT 10 CCMPI !ANCE WI rHN ALL
STATE ANU CD UN 1 `f HLLES AND EEC
FEDERAL
I ILATIONS
LEGAL DESCRIPTION:
LOT 1 1, AND THE SOUTHWESTERLY 25 PELT OF LOT 10, OP BLACK 87,
OF MANE SHORES SECTION FOUR AMENDED', ACCORDING TO THE PLAT
THEREOF, AS RECORDED IN FLAT BOOK 15, AT PAGE 14.OP THE PUBLIC
RECORDS OF MIAMI -DADE COUNTY. FLORIDA.
PROPERTY ADDRESS:
FOLIO No. 1 I - 320G-017-0240
9701 N. E. 4th AVENUE
MAUI SHORES, FLORIDA 33138
CERTIFIED TD:
- ANG15. SOLARI
- OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
- THE LAW OFFICE OP JEMMY s. HERSH, P.A. 1,02 =ST
GENERAL, NOTES:
LEGAL DESCRIPTION PROVIDED BY OTHERS.
EXAMI4ATION OF THE ABSTRACT OF THE TTIE WALL HAVE
TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IP ANY
AFFECT THIS PROPERTY.
THE LANDS SHOWN HEREON WERE MOT AOBTRACTED FOR
EASEMENT OR OTHER RECORDED
ENCUMBERANCES NOT SHOWN ON THE PLAT.
me PURPose OF THIS SURVEY 15 MR THE USE IN OBTAINING
TILE INSURANCE AND PINANONG
AND SHOULD NOT BE USED FOR OTHERCONSTRucrjON,
PERMITTING DESIGN, MANY OTHER PURPOSE WITHOUT
THE WRRftN CONSENT OF LANDMARK SURVEYING 6 As90CV,TES, INC.
UNDERGROUND PORTIONS OF FOOTING, FOUNDATIONS OR OTHER
IMPROVENEMS WERE NOT LOCATED.
ONLY VIS1L9.E AND ABOVE GROUND ENCROACHMENTS LOCATED
WALL TIES ARE THE FACE OP THE WAIL
PI NCE OWNERSIir NOT DETERMINED.
BEARINGS REFS TO UNe NOTED AS B.R.
BOUNDARY SURVEY MEANS A DRAWING AND/CJR GRAPHIC
REPRESENTATION OP THE SURVEY WORK. PHtFORMED IN.
THE FTELD.
TO E.
COULD BE DRAWN ATA SHOWN SCALE AND/OR MOT
SCAL
NO IDENTIPICAT1ON FOUND ON PROPERTY CORNERS UNLESS NOTED.
NOT VALID UNLESS SEA= WITH THE SIGNINGS SURVEYORS eNISOSSED SEAL_
DIMENSIONS SHOWN ARE PLAT AND MEASURED UNLESS OfHERWT3ED SHOWN
ELEVATIONS iF SHOWN ARE BASED UPON N.G V 0 1929 UNLESS OTHCAW15
NOTED.
THIS I5 A BOUNDARY SURVEY UNLESS CTITERWISE NOTED.
TI Nis BOHNDARY•SIJRVEY HAS BELL PREPARED FOR THe EXCLUSIVE use OF
THE ENTITIES wave HEREON THE CERTIFICATIONS DO NOT EXTEND TO ANY
UNNAMED PARTIES.
MAP OF SURVEY
iJblL'C'>;i
g
LOCATION MAP 0
NOT TO SCALE
a�4A.A4 tAbae. 'F
Pactover y
4p 00
AE REVIAT:OII9 AND LEGENDS
At
APPEL
AWN
S.C.
c.G
gik
a
a�n
PA
PG.
PrP
OENOTIN KWHMASA
.OLS 011S =CRETE NOM STUCCO
`i
d CRESvAuercur
.DENOTES CENSORS
orimmOrENTfra
GAUNT
-mum NEASURE
-MOM RECORD
.wm.
NNSOTE3 UMW U To
- 0010115 Putt =A
-mare) eAse
PB RNANNTCWRROL
PONT
:C=7.0,04.011 oP INSIMING
— — .wares WOOD MACE
.01NOTIS CNN Um(TARCE
—o- - NalorG tie
o - OB1otE9roUXD IRON MOOD.)
-0ENO EI WO NAL MO OSC
CERTIPTCATI ON:
SURVEYORS C t R T R I C P Z I O N , I HERESY Gomm-THAT T r OUNA65 SURVEf
S ATRUCAND 0 RR4Cr R0'RMOITAION OF ASLRVErPREPAR,`D UNMAN
DIRECTION. INS COMPUES ROTH TheMRNTMUM TECHNICAL STA:WARD3, AS SO
NORM WILE SEAM Of 'LONGA 80ARD Of PR PESSIONAL LAND5URV8DR5 I7
CHAPTER G :GI7- 6. NORM ADW+YSiRATNe CODE- TO 472.027
PLORI0A5YATUM.
SGN D PORTIE FIRM
E. T VAUD%SNOUT : i No. or noRcA
NO ....: SiGNATUREAi® AUTHSRYATED
OECTRONCSEN.ANKNTHIS MAP 15 NOT D NOHOW THE 5IGNATLREAAID
ORNNAR.RASO,SEAL or* LK,✓SL5E81w:Am ARO MAPPER.
9
24
SAD terbti
t-
a
ALL BEABJNGS AND DISTANCES SHOWN HEREON ARE RECORD
AND MEASURED UNLESS OTHERWISE NOTr.
0909 -01 1
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:1132060170240
Owner's Name: ANGEL SOLARI
Job Address: 9701 4 Avenue
Miami Shores, FL 33138 -2481
Owner's Phone:
Total Square Feet:
Total Job Valuation:
28
$ 200.00
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 2/1/2012 : Yes
Comments: