DS-13-1837Miami Shores 'Village
Building Department
1"0 N.E.21W Avenue,
Td: (30S) 795.21A4Fax: �� �� 33138
MORMON'S PHONE NUMBERMU. (305 (305) 72
762.4949
BUILDING
PERMIT APPLICATION
Permit TW:
JOB ADDRESS:
BUILDING
AUG i 3 2013
- - -LL
FDC 20 Q
Permit No. %-1 LY—
Master Permit No. JZC.J q
ROOFING
Or lAmi S'g County. WI$Ty �At11� Daffe
FoliOfteel: r
h the Bail ft qy Ded atak Yes � NO od Zotm:
OWNER: Name (Fee Simple Titleholder):_ /4 �®tr- I �r;�i �- 1
P1rono
Adtess: * � ��C b i, r »
'40/n,471 .S cI r 'ls State:
TOOK-eoe Name:
Email:
CONTRACTOR: Company Name• ��� f� � �lG / / Phone#•
Address:
2 fier Name. state
State Certification or Registration Ceatificate of CQmpet�cy
Contacts Emati Address:
D>G1ViB: ArcbiteottBngim;er:
Value of Work for this Permdt: $—.20 SquareffAmor.$' d Work: TOO OO
Type of Wab 13Addidan pgheration UNew DRep�P
air lace
Dufti0don of Work:
Submittal Fee $�-g-151 Permit Fee Q (). CCF
CO/CC $
scamftFee $ - Radon Fee $ DSPs $$
N0' $ Traioing/Edacation Fee $ Tom, Fee $
Double Fee $ SUvdnral Review $---
TOTAL FEE NOW DUE $
r .
Bonding Company's Name (if applicable)
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 permit to do the work and installations as indicated. I cel 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
II&ROVEMENIN 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 certtied copy of the recorded notice of commencement must be posted at the job site
for the first inspe on which occurs seven ) days colter the building permit is issued. In the absence of such posted notice, the
inspection will note approved and a®ret ction fee will be charged.
Sigmatrae___ V ✓ Signature
Owner or Agent
The forego' instnmaent was acknowledged before me this
day of 1 .20L, by r
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY WMIC: ►►„u,,..
Sign:
Print:
My Commission Expires:
APPROVED BY
The foregoing instrument was acknowledged bef<me me this
day of .20- by
Who is pe muffly known to me or who hupro"
as identification and who did take an opth.
NOTARY PUBLIC:
Structural Review
(Revised 3/12/20120evised 07J1M0WevW 0610 lOb9)(Revised 3/15109)
Sign:
Print:
My Commission Expires:
«I
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
nspection Number: INS P-197197 Permit Number: DS -8-13-1837
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
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Foundation
Work Classification: Addition/Alteration
Phone Number (786)981-1301
Parcel Number 1132050310110
ADD PAVER UNDER GAZABO AND AT POOL ADGE AND
Infractio Passed Comments
INSPECTOR COMMENTS False
STEP AVER EXISTING FOUNDATION
nspector Comments
Passed
Q
_
c�
-
Failed
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
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 l DATE• % _3h 7
ADDRESS:
Do hereby petition the Yliage of Miami Shores to act as my own antra or pursuant to the taws of the State of Florida, KS 469.103(7).
And I have read and understood the following disclosure statement, which entitles me to work as my own contractor, l further
understand that I as the owner must appear in person to complete all applications.
State Law requires construction to be done by a license 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 onefamily or twro 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 yourown use and
occupancy. It may not be built for sale or lease. ff.you-sali or 18M a building you' have bulk yourself within onO year atter the
construction is,Wnplets theiawwillipmume thahyou 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 employe by you have licenses require by state
law and by county or municipal licensing ordinances. Any person working on your building who Is not license must work under your
supervision and must be employe by you, which means that you must deduct FICA and with -holdings tax and provide workers'
compensation forthat employee, all as" prescribed bylaw. Your construction tion must Comply with all applliAble leave, ordinances,
buildings codes and zoning reghilator.
Please read and inIdal each paragraph.
i. 1 understand that state law requires construction to be done by a licensed contractor and have.applied for an owner -bulkier
permit under an exemption from the law. The exemption spedfies that I, as the owner of the property One, may act as my own
cordracaor with certain restrictions even though I do not have a license.
I
2. 1 understand that building permits are not required to be signed by s property owner unties he or she is responsible for
c orsfiructon and a not hiring a licensed contractor to assume responsibility.
Initial .
1'e
3. I widerstand that, as an owner bull* I am the resp*We party of record on a permit I un deWW d trat 1 may protect myself
from potential financial rsk by hiring a lichen conftft and having the permit tiled in his. or her more instead of my own
name. low understand that the contractor is required by few to be licensed in Floride and to tilt his or Rem numbers on
permiw and =ft*.
initial�,�
4. I undemend that 1 may build or improve a one family or two-famlly resklirrce or a iamb outbuilding. I may also build or improve
a commercial bubng if the costs do not w=ed $75,000. The building or residence must be for my use or ,ircy. It may
nol be Wit or substantially improved for sale or Imo. t a banding or residence that I have bunk or subsmntiaily 6nproved
myseft Is sold or lease within 1 year after the construction is complete, to law will presume that I bunric�r
improve it for sale or lege, which vtolae the exemption.
trIsl
5. 1 understand that, as the owner -builder, I must provide direct onsite supervision of the construction. —
1
6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervee 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 ordinaries.
Initikk,
I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that
erronensly impIld that the property owner Is providing his or her own labor and materials. I, as an ownes-lwpderiAja 4e held
liable, and subjected to serious Inandal risk for any k*Aes sustained by an unlicensed person or his or employees while
workincg on my property. My homeowner's Insurance may not provide coverage for those Injuries. I am willFull i - acting as an
owner -builder and am aware of the limis 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 Iloersed contractor who IS not noerses to
perform the workbdng-done. Any person working, on my bugdlig who s not licensed must work under my direct supervision
and must be employed by me, whichrreift that 1 must cmmpl}i i6 laws n quifi4 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_
I agree that, as the party legally and finandelly responsible for this prod Corstrudion ly, I win abide by an applicable
laws and requirement that' govem owner -builders as well, as employers. I also understand th&ft
Construction must comply with an applicable laws, ordinances, building ding c odes, ' and zoning regulations. q
initial . In/
10. 1 understand that I may obtain more Idonmallon regarding my obligations as an employer from the Internal Revenue Sarcine, the
United Slates Smarr Business Administration, and the Florida Departmentof Revenues. I also understand that i may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or hbdANww mvnoridalioerse.mWdborbroldld hbnl
Inlfial
11. 1 am aware of, and consent to; an owner -binder building permit applied for to my name and understands that I am the party
legally and financially responsible for the proposed construction add* at the following addrew.
tntfial t%
12. 1 agree to nobly Miami Shores Village Immediately of any additions, deletions, or doves to any of the Information that I
have provided on this disclosure.
initdal
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a
license, the Coratroludion Industry Licensing Board and Department of Business and Professional Regulation may be unable to
asset you with any finandel loss that you sustain as a result of contreotor may be in civic c cqA it Is also WOW for you to
understand that, 9 an unlicensed contractor or employee of an Irdiaidualor firm Is Injured while wore ft cn your prom, you may
be held liable for damages. If you obtain an owner-bunder permit and wish to hire a licensed contractor, you will be responsible for
verity M whether the contractor Is properly licensed and the status of the contractor's workers compensation coverage.
Before a building permit can be Issued, this dsdosure 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 owrVi driver license, the
notarized signature of the property owner, or other type of verification acceptable to the local pamtitling agency is required when
the permit Is rued.
1.
Was acknowledged before me this is day of 201
By— �'� who was personally known to me or who has
Produced there License or
OWNER
=''
�5
Ar
AJ
N E. 103rd STREET
4 98"..�
Bearing, if any, shown based on Plat Meridian (reference) NORTH R N89°46'39"E
REVISIONS: FLOOD ZONE COMM. No.
10/02/12 Septic tank located and elevations added
06/12/13 Survey UpdateZZ-f VE 120652
F.I.R.M.DATE F.I.R.M.INDEX
09 /11 /09 1 09/11/09
"THIS SURVEY DECLARA i ION IS MADE ON THE FIELD
DATE INDICATED, TO THE OWNER(S) LISTED. IT IS NOT
TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR
SUBSEQUENT OWNERS."
PANEL No.
SUFFIX:
ELEVATION NOTE: (IF APPLICABLE)
s
rvot vaso unies
it bears the
0306
L
L.F.Elev = 9.06' (lowest habitable floor elevation).
signatura and the
Elevation shown hereon refer to N G.V.D. 1929.
original raised seal
BASE ELEV.
Lowest adjacent grade elevation=- 6A .
of Florida licensed
gM. # B -26 -RA (Miami -Dade Co.) Elev= 17,23'.
Surveyor and
+ 11.001 N.G.V.D'
Garage Elev.= 7.11' Er:r,=N/A
Mapper.
Notes:
- Septic Tank location as indicated by others
This property described as:
Lot 20, Block 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.
Address:
1550 N.E. 103rd Street, Miami Shores, FL. 33138
TOPOGRAPHIC & BOUNDARY SURVEY.
I HEREBY CERTIFY: that this survey meets the
minimum technical standards as set forth by the
FLORIDA BO ESSI L SURVEYORS
AND MAPP RS in!Sectlon
pter 5J-1 lodda Administrative
Code, pursuan o 027 Florida Statutes.
IVES 06/12/13
P OFESS ONXL SURVEYOR AND
MAPPER No. 4327. State of Florida.
8 LEGEND
o
ASPH = Asphalt
p BM = Bench Mark
a 5 c BRG = Bearing
'om CAN = Cable TV
m o CB = Catch basin
m n..m co e
E o w 3 CBS =Concrete Block Structure
c t a' s ICH = Chord
�E > 8 $ Chatta= Chattahoochee
f°o Cr = Center Line
S' $ E o CLF = Chain Link Fence
$$�8$0
CL. =Clear
$ J g _ 0 CONC.= Concrete
E S D = Delta
€ c o c 0 �m 0 = Diameter
$ S 8 m m w . ; DH = Drill Hole
o ° c o 0 � C DME - Drainage & Maintenance
e«�ei'im
8 m m L° m Easement
m E.B. = Electric Box
$ v
E C '° WC W to
c $ c io « F.F. - Finish Floor Encroachment
m C i W g m °c m F.H. =Fire Hydrant
E W m 33F.I.R. = Found Iron Rebar
Z 2 8 0 > 8 v FPL = Florida Power & Light
'a o 2 9 8 m E W F.I.P. = Found Iron Pipe
B y 10 a a' E a W o F.N. = Found Nail
o a, 6m E n m W L.P. - Light Pole
Qc °m W c's r E M - Measured
a:1
a m m a s o M.F. =Metal Fence
m o c o. w M.H. = Manhole
m I� = Monument Line
tC L m'• C L .rJ N
MON. =Monument
m m c w mN/A = Not Applicable
E o m a' m �' o N/D = Nail & Disc
aZaF-tq<5PF- 0E
NTS = Not to Scale
O/S = Offset
c
O.U.L. =Overhead utility Lines
E OH = Overhang
t o P - Plat
PB = Plat Book
$ Q w PC = Point of curvature
$
c io c E P.C.C. = Point of Compound
w c ;- Curvature
8 g o PCP = Permanent Control Point
o $ c PG = Page
1 c a P.I. = Point of Intersection
E m R = Property Line
PL = Planter
2 � io a o � P.O.B. = Point of Beginning
g
a a P.O.C.= Point of Commencement
m o -S 2 P.P. = Power Pole
° E m o P.R.M.= Permanent Reference
o c m fS � m xo Monument
B a Z m °'°' P.R.C. - Point of Reverse
v m : Curvature
° m v a o 'o PT = Point of Tangency
R = Radius
3 $ $ o m E
RIR = Railroad
t x 5 m m 49 m o 9 PSM = Professional Surveyor
m m B $ -. io € '$ ° Mapper
$ e e o m RAN = Right -of -Way
0 W O c v E SWK =Sidewalk
m *1 9 Sec. = Section
i3 m - o 0 3 (7YP) =Typical
m m aE�r�co T =Tangent
e m o m `_° 2 m U.E. = Utility Easement
c H H W W s W.F. = Wood Fence
8 :$ c 8 0 c€ v,g Ei c W.M. = Water Meter
W.V. = Water Valve
m y 8 m m� v v et =Denotes Spot
°e' $ 16 io � / Elevations Taken
Zm Z civet
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"=25' F.C. 13-19957