DS-13-1834Miami Shores village
Building Department AUG 12 2013
"Wo N.E.2W Avenin Kumi . ply 33138
Td: (305) 795MW Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762A949
BUILDING P FBC 20.1 C)
PERMIT APPLICA est N � �
TION Master Petit No. G
Permit Type: BUILDING ROOFING
1011 ADDRESS:
City: 19tH; eh. m Co
D the BoQ * Mmrjwy Designated: Yes NO
OWNER: Name (Fee Simple Titleholder).—_ M 6U- L
d ivg j 'Sr
—LA i
s
r -L,
Teantli ewee Name:
W p p Phone#:
CONTRACTOR: Company Name:4/6r .-
Address:'
- - tI state.
QaaV&Nam.
State Cerrtification or Registration --"—
Catificate of CQmpeteAcy
EmaO Address: a
OEM'N»B ArcbitexVBngiaees:
Phone#:
Valle of Work for ft Permit: $_ ; Ott SquaraLAmear,E
aotage of work: �21Type of Work: OAddition OAlteration ew .ORep*Ateph" MesnoWon
Din of wo e' c 4 h, �� Pte. si
Subttodttal Fa —� .Permit Fee $
CCF $. CO/CC $
Fee $ Radon Fee $DBPR $ N
Notary$ T�alning/Eftention Fee $ Tecbnotogy Fee $ —
Double Fee $ Sftdw al Review $
TOTAL FEE NOW DUE $
r
Bonding Company's Name (if applicable) ' 1
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
Application is hereby made to obtain a peumit 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, BOH4RS, 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 an
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 bdtND 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 commencemeet and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a cen V%d copy of the recorded notice of commencement must be posted at the job site
for the firstction which rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will be appy d a reinspection fee will be charged.
SiSignatu>re,
Owner or Agent
The foregoing instrument was acknowledged before me this
kz—
day of _,a 20 13by U'hAaA,c—L&CL47��
Who has produced!
My Commission Lbtpires:
The foregoing instrument was acknowledged before the this,,,
day of .20 -�+ by —
who is personally known to ire or who ha&produc W
as identification and whb did take ao o}th.
NOTAR,V pumia
(Revised 3n2/2D12XRavised 07nWWrXRevhW 060=09)(Ravind MUM)
Sign:
Print:
My Commission Expires:
;�J—
,� 3 zamag
ae*
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
1 OWNER BUILDER DISCLOSURE STATEME T
NAME: ��'l4VAC I � t DATE:
ADDRESS: _ A 3
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 IGsted, may act as my own
contractor with certain restrictions even though I do not have a license.
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 4_
3. 1 understand that, as an owner builder, l am the responsible party of mord on a permit I understand that I protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed In his or her name ins d 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
S , 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 bwnlding 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 substaptialty
Improved it for sate or lease, which violates the exemption.
• Ipitial� ,
5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
Initial GL ---
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.
rd I
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. 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 ficensed 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 workersco nsation for
the employee. I understand that my failure to follow these may subject to serious financial risk.
Initial
I agree that, as the party Dally 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. v
Initial
10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internet 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 Ucensing Board at 850.487.1395 or httoJMw.mvholdalicense.com/dbpr/pro/clibrmdox.hftd /
Initial W
11. 1 am aware of, and consent to, an owner -builder building permft applied for in my name and understands that I am the party
Dally and financially responsible for the proposed construction activity at the following address:
In(tl
12. I agree to notary Miami Shorss Village immediately of any additions, deletions, or changes to any of the informatigo that at I
have provided on this disclosure. �`.s
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 CorstOuction 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 gwner and
returned to the local permitting agency responsible for issuing the permit A copy of the property owner's driver licerse, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is requirpd when
the permit is issued.
Was acknowledged before me this 89. day of . 20 I'S
v
BL LSakr JA- who. was rsonally no o me or who has
rt
LOT 19mr JIM
BLOCK 5C 0�py
ITY
E zT ¢� —
_ S`:cres `Jiilag9_�
APPgO`,,EL) I BY DATE
ZONING DEP iOOA
DL DG DEPT 1J
U_.J�CT i O • t;P,!PI;: IC lti! (I I ALL FEUERAL
1 �2. 4' ALUMINUM
14 N `FENCE
ASPHALT`.
DRIVEWAY
/
.AREA UNDER �-
G1i
rrl
0
Po
LZ
LOT 21
BLOCK 5
h'6946'391E
152.56(P)
151.351(hf) v
�c $1
40.10'.
LOT 20
BLOCK 5
i
,
0
, g2
oe
,lo,
i�
Bearing, if any, shown based on Plat Meridian (reference) NORTH R N89046'39"E
REVISIONS: FLOOD ZONE COMM. No. PANEL
10/02/12 Septic tank located and elevations added VE 120652 0306
06/12/13 Survey Updatd
48 —
TANK
SUP
A,N
P a/
5' C.L.F. P c
� •Js.
1'xf' COLUMN
OF
jA+
11t
� Pr /lyr0
Notes:
- Septic Tank location as indicated by others
This property described as:
rS�P�P Lot 20, Block 5,
5.5 REPLAT OF TRACT "C"
MIAMI SHORES BAY PARK ESTATES,
according to the Plat thereof
as recorded in Plat Book 64, Page 97,
of the Public Records of Miami -Dade County, Florida.
"THIS SURVEY DECLARATION IS MADE ON THE FIELD
DATE INDICATED, TO THE OWNER(S) LISTED. IT IS NOT
TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR
SUBSEQUENT OWNERS."
SUFFIX: ELEVATION NOTE: (IF APPLICABLE) Not valid unless
L.F.Elev.= 9.06' (lowest habitable floor elevation). it. bears the
L sgnature and the
Elevation shown hereon refer to N.G.V. ' 1929. original raised seal
Lowest adjacent grade elevation= 6.4'
F.I.R.M.DATE F.I.R.M.INDEX BASE ELEV. of Florida licensed
BM, # B -26 -RA (Miami -Dade Co.) Elev.= 17,23_. Surveyor and
09/11/09 09/11/09 + 11.00' N.G.V.D. Garage Elev.= 7.11' Erp.= N/A Mapper.
Certified to:
Mark Llerena
Address:
1550 N.E. 103rd Street, Miami Shores, FL. 33138
TOPOGRAPHIC & BOUNDARY SURVEY.
I HEREBY CERTIFY: that this surrey meets the
minimum technical standards as set forth by the
FLORIDA BO ESSI L SURVEYORS
AND MAPP RS in pter 5J-1 lorida Administrative
Code, pursuan o Section •.027 Florida Statutes.
OVtOlVES 06/12/13
1ON,XL SURVEYOR AND
No. 4327. State of Florida.
Alvarez, Aiguesvives and Associates, Inc.
Surveyors, Mappers and Land Planners
5701 S.W. 107th Avenue #204, Miami, FL 33173
Phone 305.385.0385 Fax 305.385.0623
L.B. No. 6867 / E-mail: fastsurvey@aol.com
Field Date Scale: Drawn by: Drwg. No.
06/10/13 1 1 "= 2.5' RIC 1 13-19957
LEGEND
'S
A2 m
m °
ASPH = Asphalt
BM - Bench Mark
$ S�u.
BRG
= Bearing
$
0CAN
= Cable
W2:o
X2 0
CB
as
in
= Catch b
E o w >. 3 E!
CBS
= Concrete Block Structure
c r W R L
CH
= Chord
: >> $
Chatta = Chattahoochee
1 d u I i
Cr
= Center Line
c
$ c �3
CLF
= Chain Link Fence
g
$ w
CL.
= Gear
°c $ $ ° x
CONC.= Concrete
D
= Delta
,
0
= Diameter
c m s 3
DH
= Drill Hole
c o
DME
= Drainage & Maintenantm
c 1 .,i $ eav
' ° `6
E.B.
Easement
= Electric Box
WC vE a.c
4; m� � $
m 1°
1-01
c e
$o E S$ 8 .2
Enc.
- Encroachment
E 1_ a
F.F.
= Finish Floor
W � j io S m
F.H.
= Fire Hydrant
0.12 E v' C m m
e $ a
F.I.R.
= Found Iron Rebar
a
FPL
= Florida Power & Light
n c $ ,�°
F.I.P.
= Found Iron Pipe
m A a = E >, io c
c o' 2 *�i E A m "
F.N.
L.P.
= Found Nail
= Light Pole
CLc g W °� c �c
M
= Measured
e c
M.F.
= Metal Fence
CL M
0o m is
M.H.
- Manhole
r� $ r m C e g$ N
P(1
=Monument Line
o $ L $ 12 tS a
MON.
= Monument
c a' o a S E
N/A
= Not Applicable
3zor�n:nva'
N/D
= Nall &Disc
NTS
= Not to Scale
m
o/s
= offset
O.U.L. = Overhead Utility Lines
�OH
= Overhang
r
P
= Plat
PB
= Plat Book
`o
8 $ Q
PC
= Point of Curvature
cm °c 1
P.C.C.= irvvatuu�ompound
Cu
° S °c
PCP
PG
= Permanent Control Point
= Page
c v
a W
P.I.
= Point of Intersection
r qiti
°
p
= Property Line
PL
= Planter
S a o $
P.O.B. - Point of Beginning
a i 5
P.O.C.= Point of Commencement
ce
P.P.
= Power Pole
m
A
P.R.M.= Permanent Reference
Monument
CL
v
P.R.C.
= Point of Reverse
Curvature
�, �,$
Y.' 5 vac v
PT
= Point of Tangency
c S$ E m$
R
= Radius
w c 2 ri S' a
R/R
= Railroad
I° . $ E
$
PSM
- Professional Surveyor
Mapper
w m 9 m °'
-5
m $'d c a m 9
RMV
= Right -of -Way
E a e a
SWK
= Sidewalk
13 m a 0 $
Sec.
- Section
- Typical
f9
E 6
ITYP)
m gi m .16
T
= Tangent
s em o m a eo E
a� a ° B r
U.E.
= Utility Easement
io
�+ 8 oE
W.F.
W.M.
= Wood Fence
= Water Meter
m S e --L a o
W.V.
= Water Valve
W� m at
0
m m m
$ $ m g�
oa c $ � g J
/
=Denotes Spot
Elevations Taken
Zs a as C
Alvarez, Aiguesvives and Associates, Inc.
Surveyors, Mappers and Land Planners
5701 S.W. 107th Avenue #204, Miami, FL 33173
Phone 305.385.0385 Fax 305.385.0623
L.B. No. 6867 / E-mail: fastsurvey@aol.com
Field Date Scale: Drawn by: Drwg. No.
06/10/13 1 1 "= 2.5' RIC 1 13-19957
nspection Number: INS P-197179
Inspection Date: September 25, 2013
Inspector: Naranjo, Ismael
Owner: LLERENA, MARK
Job Address: 1550 NE 103 Street
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Permit Number: DS -8-13-1834
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (786)981-1301
Parcel Number 1132050310110
CONCRETE SQUARES WITH GRASS IN MIDDLE NEW
DRIVEWAY
Infractio Passed Comments
INSPECTOR COMMENTS False
Passed
_Inspector Comments
Failed El
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
For Inspections please call: (305)762-4949
January 28, 2014 Page 1 of 1