RC-11-968BUILDING
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 APPLICATION
FBC 20
Permit Type: BUILDING ROOFING
r
Permit No,o I —,'�'r 'K
Master Permit No
OWNER: Name (Fee Simple Titleholder): 00 6 -F-, lam, Phone #: 3 0 S— - 76, y
Address: O , z
City: M + cD JIA L S State: L Zip: 3
Tenant/Lessee Name: Phone #:
Email: C b r + e.1�- l�o� , c ° r►•,
JOB ADDRESS: 10 �® G- � 5 �; T
City: Miami Shores County: Miami Dade Zip: ; j 5
Folio/Parcel #:
Is the Building Ilistorically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: t-(- Phone #: 3 05 ' ? 6 9 - J6 Y y
Address: ° /� `L q I S i v'7
City: b !TM ► g1'+N &Z 5 State: f -- Zip: _
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #: _
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: DAddition Alteration ONew ORepair/Replace ODemolition
Description of Work: AL' 9�--- P LAc..t= Cg45 -4 k t S G1 A g,01ASIV
cS <� iL 1, C.-a /Z- i L C %:�
411 nl Ew R l.� �,/J F,•e� -� c� tF 4Z-A t S T. -f b LN-aA -' . S
Submittal Fee �__�� Permit Fee $ D CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 1
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
.. . 9f
"S
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
zip
i ,
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
er or Agent
The foregoing instrument was was acknowledged before me this
day of , 20 ! by (X"7
who is personally known to me or who has produced V'— l -1
As identification and who did take an oath.
NOTARY PUBLIC: S Si /V'' / /,,
`� .•pig''• �`
03 � 12012
Sign: _
Print:
My Commission Expires: ''.�C'l,9 • D d .. ..
Signature,
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _, by ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
s4 YdhaYeYde9c4rd: Y$e &4nY� Y9e�:FtkeR4e Y�eY�YoY Yk3 :,�.Y��Y�k�.de9ededl4r4e�Y�Yk YsF7k3c Y. 4�Y& aY�Y4nt3a4nYir4e4rBe4e�Tr8i�Y4e4e4e4c�Fr9r�Y�Y3e�4rar4e�& ��Y: Y3e3e�Y :'e9e�Y�Y9F9e3:9F�k�4eFrde3:d. k�Y�Y
APPROVED BY �y_�'�l! Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
1 k 4
Miami Shores Village
B�ritdin �rDeparttment
- liami Shores, Fl0_rida`33138 x
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
IAIE.f
ADDRESS: �- �/ ji��' r
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, KS 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 initlal 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. j�,
Initial�
2. 1 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. 1 understand that as an owner builder, I am the responsible party of record on a permit I understand that II 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. 1 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 ors tantially
improved it for sale or lease, which violates the exemption.
Initial
5. 1 understand that as the owner- builder, I must provide direct, onsite supervision of the construction.
Initi al
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
7 I understand -that rt is frequent practices of unlicensed persons.to have the property owner obtain an owner builder permit that
, r !mAn P t O e ts- b lib -- oivn k�Etor�4 t alai R1 r ult �#�e tl 4
����ae�; �' '.r. .z.� y >�� .�+ra�= :t7�•�'
awi3er- brJikJef aiitl am aware of tf�e limits bf ' rnsutance sous €a "e fbr in'" ' Y prsiR2rfy = > - _
- rny' g iunes-to�orkers on'm
Initial_
8. 1 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_it1h laws. requInrQ;the withhoidmg , federal income tan and
srtciaLsecur�tj coL igns undet the red� l lnstxa se rtnT ons:Act ft and tt�u t rvSd wrvr cdmpet7saHoa for
i3ae atoy€ t unatastd thatiyihneotooudse CIA risk
9. 1 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. 1 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 htta:/ hrr ww. mvfloddalicense .com/dbar /aro /cilbrindex.html
Initial
11. 1 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:
Initial
12. 1 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 Ices 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 dam'`? , 20�
By 1AiTAUk, who was personally known tome or who has
Produced there License or -C l _ ast'a;it
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Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Several properties in Miami Shores Village are located in a Special Flood Hazard Area (SFHA)
as determined by the Flood Insurance Rate Map (FIRM). Development in a SFHA requires
special attention to help protect life and property in the unfortunate event of a flood. Miami
Shores Village Flood Damage Prevention Ordinance requires that the Building Department
determine if a structure will be "Substantially Improved" prior to issuing any permits for
improvement or repair.
"Substantial Improvement" is defined in Miami Shores Village Flood Damage Prevention
Ordinance as follows:
"any reconstruction, rehabilitation, addition, or other improvement of a structure, the
cost of which equals or exceeds 50 percent of the market value of the structure before the "start
of construction" of the improvement. This term includes structures that have incurred
"substantial damage" regardless of the actual repair work performed."
The starting date to determine cumulative costs will be 12 months prior to the issuance of any
permit under consideration. All future work considered would require appropriate approvals prior
to construction. All cumulative costs will be re- evaluated at the time the permits are issued.
Q: Why was the 50% figure chosen as the substantial improvement threshold?
A: The 50% threshold was chosen as a compromise between the extremes of 1) prohibiting all
investment to structure in SFHA and 2) allowing structures to be improved in any fashion
without regard to the hazard present. In the first alternative there is potential for causing
hardship to those who have located in a SFHA without knowledge of the risk because the
structure was constructed prior to the designation of the area as flood prone. These individual
could not improve their structures as damage or age contributed to their deterioration. The
second alternative provides no mechanism to ensure that increased investment in SFHA will
receive needed protection from flood risk, thus contributing to the increased peril of life and
property. The threshold is thus a compromise at a halfway point.
"Market Value" is defined in Miami Shores Village Flood Damage Prevention Ordinance as
follows:
" the building value, which is the property value excluding the land value and that of the
detached accessory structures and other improvements on site (as agreed to between a willing
buyer and seller) as established by what the local real estate market will bear. Market value can
be established by an independent certified appraisal (other than a limited or curbside
appraisal, or one based on income approach), Actual Cash Value (replacement cost
depreciated for age and quality of construction of building), or adjusted tax - assessed values."
Note: The "Market Value" does not include the value of the land or other improvements on the
property. (ie: pool, gazebo etc.)
Created on June 2009
# ? It
A "substantially improved" structure in a Flood Zone must be brought into compliance with
Miami Shores Village Flood Damage Prevention Ordinance for new construction. This means a
residential structure must be elevated to or above the level of the 100 -year or base flood and a
commercial structure must be effectively "flood proofed" and meet other applicable
requirements. These regulations are based upon the Federal Emergency Management Agency
(FEMA) requirements and affect your flood insurance costs. Existing residential structures can
be "substantially improved" by interior renovations or new additions or other improvements.
EXAMPLE: In order to determine whether a proposed construction project would be classified
as a substantial improvement, the market value of the building needs to be determined. This
value is found on the official tax assessor's card for the property or may be obtained by a
licensed property appraiser. That number is then divided by 2 to determine the substantial
improvement threshold.
Therefore, a home with a market value of $100,000.00 could have no more than $50.000 worth
of new construction /renovations and /or repairs before the house would have to be elevated
above the 100 year base flood elevation as shown on the Flood Insurance Rate Maps.
It is the responsibility of the Building Department staff to ensure that the market value estimates
are accurate and the cost estimate reflects the actual costs to fully repair the damage and make
any other improvements to the structure. The staff requires that the permit applicant or owner of
the building supply the proposed construction cost estimate, or contractor's contract, to make
the determination. The staff then uses the latest "Means Square Foot Costs" and "Means
Construction Cost Data" books to determine the accuracy of the estimate. These are nationally
accepted manuals, which itemize all components involved with construction. The manual
provides adjustment rates to handle the varying construction costs throughout the country.
Q: What should be included in a contractor's estimate?
A: Basically, the only items that are not included in the cost include plans, specifications,
surveys and permit fees. All materials that are permanently a part of the structure should be
included in the cost estimate. These items include, but are not limited to: windows, doors,
hardwood floors, wall to wall carpeting, sheetrock, lumber, roofing material, footings, pilings,
kitchen cabinets and counter tops, bathroom vanities, tiling, plumbing fixtures, new furnaces, hot
water heaters, heating and air conditioning systems, electrical work and labor. The cost of all
materials involved in new construction or replacing and restoring a structure to its pre - damaged
condition must be included. Even if volunteer labor or self -labor is used, it must be estimated
based on minimum -hour wage scales for the type of construction work that is done.
Created on June 2009
4 a e
CUMULATIVE SUBSTANTIAL IMPROVEMENT
VERIFICATION WORK SHEET
In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all
improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed
improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished
materials (include those donated), labor (including volunteer and self - performed), construction supervision and
management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is
attached for your reference. (A Copy of the Contract must be attached)
PROPERTY OWNER:
PERMIT
ADDRESS:
FOLIO NUMBER: FLOOD ZONE:
BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL:
COST OF PAST IMPROVEMENTS (12 MONTHS):
COST OF PROPOSED IMPROVEMENTS:
(ATTACH COPY OF CONTRACT)
TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed):
VALUE OF PRINCIPAL STRUCTURE (attach appraisal):
OWNERS SIGNATURE: DATE:
PLANREVIEWER•
PLAN REVIEWER SIGNATURE: DATE:
Created on June 2009
SUBSTANTIAL IMPROVEMENT / DAMAGE LIST
(NOTE. THIS LIST IS INTENDED FOR GUIDANCE ONLY, AND IS NOT ALL INCLUSIVE)
ITEMS TO BE INCLUDED
ALL STRUCTUAL ELEMENTS,
INCLUDING
Foundations including;
Spread footing, Continuous footing,
isolated footing, piles and pile caps
Slabs including; Monolithic, floating,
elevated
Walls including; Exterior walls, Bearing
walls, Shear walls
Beams, Tie Beams, Columns and Posts
Wood decking, Floor and Roof Sheathing
Trusses, Joist
Windows /Doors
ALL BUILDING ELEMENTS, INCLUDING
Interior Partitions, Walls, Columns
Drywall, Ceilings,
Built in Furniture, Cabinets, Vanities
All Fixtures
Flooring, Tile, Carpet, Stone, Linoleum,
ect.
All Finishes including Drywall, Paint,
Stucco Plaster, Paneling, Tile, Marble,
and Moldings
Roofing Material
ALL HARDWARE
ALL UTILITY and SERVICE
EQUIPMENT
HVAC
Electrical System and Equipment
Plumbing System and Equipment
Security System and Equipment
Central Vacuum System
Plumbing Fixtures
Lighting Fixtures and Ceiling Fans
Water Systems including
Softeners /Filtration
Created on June 2009
ALSO:
All Labor and other Costs associated with
Demolition, Removing, Replacing,
Installing Building or Altering Building
Components
Construction Management / Supervision
Overhead and Profit
Equivalent cost for:
Donated Materials
Volunteer Labor (including owners and
friends)
Any Improvements Beyond Pre - damaged
Condition, including;
Utility Upgrades
Code Upgrades
ITEMS TO BE EXCLUDED
Plans and Specifications
Survey Costs
Elevation Certificate Costs
Permit fees
Debris Removal
Items not considered to be REAL Property
Rugs, Furniture, Refrigerator,
Appliances not Built -in
Outside Improvements, Including;
Landscaping
Sidewalks
Patios
Fences
Yard lights
Sheds
Gazebos
Irrigation
Pool
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APPROVED
BY
1?ATE
ZONING DEPT
BLDG DEPT
St#UFCT TO COMM MiC E WIN AL FMM
STATE AND COUNTY RULES AND REGUlLAWNS
INSP;f�IONNRECORD
I.ffAl
Tank
Pressure Test
Final Hood
Final Vkbntilation
Final Pool Heater
Final Vacuum
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1
Interior
Final
Tin Cap
Roof in
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rinal ,nutters
Rails and Guai
DA comMian
• DC
Soil Bearin G
Soil Treatment
Floor Elevation
Insulation
INSP
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Intercom
Intercom
Alarm Finai -7
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-
RECORD
INSPECTION DATE INSP
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2nd Rough
Top Out
Fire Sprinklers
Se tic Tan
Sewer Hook -u
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NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE. AT TIME OF FIRST INSPECTION
PERMIT NO TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby-'Ives notice that Improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
Is provided in this Notice of Commencement.
OR Bk 27721. Ps 17961 (Ipp)
RECORDED 06/14/2011 13 =2E - -4�9
HARVEY RUVINP . CLERi4 OF. COURT
MIAMI -DADE COUNTYP FLORIDA
LAST PAGE
above reserved for use of recording office
1. Legal description of property and street/address: /m 3 S ME StOa! T An • -0 0 r SW_42ef
2. Description of Improvement: 11 iwe j frc,"— 0iff Z
3.Owner(s) name and address: A J000"_ La S r d k- IQ 3!C A K !f f X;'2aeT . /+-4 - i Xs t X.
Interest In property:
Name and address of fee simple titleholder:
4. Contractor's name, address and phone number OV-0ty r✓L. 1 o i el °l STS . n�+ ..�w► .
�o2�s
5. Surety: (Payment bond required by owner from contractor, if any) �n
Name, address and phone number: /mss ,�..E c- S
Amount of bond
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner Upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7., Florida Statutes,
Name; address and phone number.
8. In addition to himself. Owners designates the following persons) to receive a copy of the Lienor's Notice as provided in Section
Name, address and phone number:
9. Expiration date of this Notice of Commencement::
(the expiration date is 1 year from the bate of recording unless a different date. Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT
Signature(s) of Owners) or Owner(s)' Authorized Officer/Director/Partner/Manager ,
Prepared By. :.XL P.repared`By
Print Name aA". . 64.0 .STICI- b Print Name
Title /Office >} osc- * s _ffs - :S',�� Titie /Office
STATE OF FLORIDA •''""` r gs40��
COUNTY OF MIAMI -FADE l ,l 1
The fo going i ent w acknow edg before me this ` day of
Ck ❑ individually, or Was for v.
El Personally known, or P produced the following type of identification: i L=c -
Signature of Notary Public:
Print Name:
(SEAL)
a*TARY PUBLIC - STATE OF FLORIDA
VERIFICATION PURSUANT TO SECTION 92525. FLORIDA.STATUTES Ig Linda M. i tneni
Under penalties of perjury, I declare that I have read the foregoing and N Commission # DD842267
that the facts stated in it are true, to the best of my knowledge and belief. Expires: DEC. 02;2012
)NOED THN AT(A1MMG BOMBING CO..1A.
Signatures ) or Owner(s)'s Authorized .Qfficer/ Director /Partner/Manager. who:signed above:
By By
123.0752 P -
�aL
STATE OF FLORIN, CO LINTY CIF i�DE
I HEREBY WTFY W gig ig a its OW<atffa€
YNAT
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