DS-13-2100Miami Shores Village
Building Department
1MM NY -2W Avemie, Miami Sham% Had& 33138
Tel: (305) 795MM Fax: (305) 756.8972
INSPECTION'S PRONE NUMBER: OW 762.4949
BUILDING
PERMIT APPLICATION
PenWt Te.
JOB ADDRESS:
BUILDING
3S
44
+, SEP 112013
P=..
Permit No. Z ICO
Master Patift No.
ROOFING
WyAw sJW . county+: Rpm 22n' _._.._._._
FOIiaJPa:
h the B+p It EvArkwly Dedpdwh Yes NO X Plood ZM:
OWNER: Name (Fee Simple Titleholder): ?_.�
Ate; 3SS}-
chr.__ nh.mw:, S�,.rea State: Fe pr.
TiramoVt�ssm; Nanm: .._�Pa
`�2�-Ee71Ar �4MCI ,lam
CONTRACTOR: Company Name• '� E
Afters:
Srate:
�Name�
State Cadladon or Registration#: Catiflcat of C�tmpatamy +�:.
WNIIMY. $ L.f J �•.
--Email Aft=-. D 1 X11
D.�_ ■ _■ ■ Monet.
Valve Of WOrk for fWs Permit: $ ®'
1jTC Worlu OAddidon OAlt ion allowp *ftplaoe ilD on
Dpfian Of WOTI� ..,.,..,5 \ 1`
v.� Aa
w+�.�rr■rim. �r..�+r ®j'�Maw
t�qi«�R#«tik•#i�Mr����iln1.�#�ktrnit#�i�ti��MWi���r1t41��M�M�k�t�ki��i�i�k1�#+Ir�CikMnk* •
%bad l Fee $ Permit Fee $ CCF$ co= $.
Sext�'ae $ Radoa Fee $ `DBrR 8 $
?40b"$ Tt ainin Q%cad= Fee $ - Tabadou Fee $
Double Fee $ Straetord Revkw $
TOTAL FEL NOW DUE $
V'*3oxdh:g Company's Nam (if applicable)
_t$"Company's Address
city stab ZIP
Mortgage Lendees Nam (if applicable)
Mortgage Lender's Address
_Stow zip,
AppHcadon is hereby made to obtain a permit to do the work and insuWans as irAcated I certify the no work or bmtdiation has
comamced prior to the issuance of a permit and that all work will be performed to mm the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WOW PLUMBING, SIGNS,
WELLS, POOLS, FURNA�l
MS� BqU..PRS, HEATERS, TANKS and AIR CONDMONIMS, ETC.....
. ,
OWNER'S AffWAVrr: I certify that all the foregoing information is ==ate and that all work will be done In compliance with an
applicable Imn mpbwg construction and zoning
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
DeROVEMENU, TO YOUR PROPERTY. IF YOU 6ftND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCENW.NT."
Notice to A;WU=N.- As a condition to the issuance of a bm7ftg permit with an estimated value exceeding $2500, the applicant =a
promise in good faith that a copy of the notice of commencement and consftdion lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a cert] copy of the recorded notice of commenconew 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
Wpecdon will not be approved and a reinspection fee will be charged.
OwworAscan Contractor
The, Instron W e4ged bOr me Will I The. Ibmsoing W=mt was aftowledged b*m me this
( J��a
f brAoin-4 )#owl
I
20 r day of
d" of by 20 _--, by
wbo' is kno to the ar who has vifia is'persotmlly known m use or who Inas
- It•12? .
-it 41& ( *21 if lu 45kindfieWilm and who did take ars ciA. u dentificifion and whb did to opdL
NOTAR-4 "LIC: NOTARY PMUQ '
Sign: Sign:
Notary pJbfic - S130of Florida
Print:
my commis "J
EE
Commission r My Com mission Exph":
........ Bonded Throvgh Nal.onal Notary Assn
SUveltmil Review
(RcviW 3/32012XPxdwd 07110V)0k%*W OVIOMMAUVWd 3/ISM
��21F
Mlaml Shores Village
Suiding Department
10050 N.E.2nd.Avenue
Miami Shores, Florida 33138
Tel (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: V aeL,, DATE: °)10113
ADDRESS: 10S
Do hereby petition the mage 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 unders(ood the following disclosure statement, which entity 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'mustbe lot yourown use and
occupancy. It may not he built for sale or lease_If you sell or lease 'a building you have built yourself within' one year after the
construction is, c ftlete, fti9w wll1paume that^you built lor-sale of lease, which We violation of this' extimption. 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 perm 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 fordnat employee, all as presdribed by law. Your construction must comply with all applicable laws, `ordinances,
buildings codes and zoning roguiations.
Please read and (nidal each paragraph.
1. 1 wWorstand that state law requires construction to be done by a Hoonsed contractor and have applied for an owner -builder
permit under an exemption from the law. The exemption specifies that I, as the ower of the property listed, may act as my own
contractor with certain restrictions even though I do not have a Ilcense.
lniflal_ ?-4tk
2. 1 understand that building permits are not required to be s1l;Ined by a property owner unless he or she Is rseporwlble for the
construction and is not hiring a loom contractor to assume responsibility.
Initial %
3. I understand that, an curet binder, i am the respotnsible party of mord on a pemdt i urldetstand that i may protect myself
from potetrtial financial risk .by hiring a ltotwed contractor and hauling the permit titecl fi � or tmr name instead of my own
name. I abo understand that the contractor k required by law to be Iicrerreed in Fbrida and to �t his or numbers on
permits and co *a*. lrnitial RRAtt�
4. 1 understand that 1 may build or iniprove a one family or two-family residence or a fans outbuilding. I may also build or improve
a commercial bolding if the cosi do not exosed $75,000. The building or residence must be folmy use or ncy. ft may
not be bolt or substantially improved for sale or lease. If a building or residence that I have built or subsfantialy Improved
myself Is sold or leased within 1 year after the construction is complete, the law will presume #0j bull or substantially
improved it for sale or lease, which violates the exemption.
. lrnitici
5. 1 understand that, as the Iur der, I must provide direct onsite supervision of the construction.
1niUal ��
6. 1 understand that I may not hire an unlicensed person to act as my co *Ww orto supenvbe perms working on my building or
residence. it Is my responsibility to ensure that the poisons whom I employ have the Boarnse required by law and by county or
municipal oMnanoe.
Inibsl ±��
7. 1 understand that it is frequent practices of unlicensed persons to have the properly owner obtain an owner -builder permit that
erroneo�ly implW that the property owner Is providing his or her own labor and materials. I, es an dw wr-Iwlldbrr.may be. heid
liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his of ern {—o hNe
working on my property. My homeowner's insurance may not provide coverage for those injuries. I em willfully acting as an
ownet builder and am aware of the limps of my insurance coverage for injuries to workers on my property.
Initml �1�
8. 1 understand that I may not delegate the responsibility for supervising work to be a libersaf contractor who Is not licenses to
perform the workbeing done. Any person n working on my buildhhg who not,lic$red must work under my direct supervision
and must be employed by me, which rri�afklfiat I must comply hs+ith laws *uiniig the withholding of federal Income tax and
social sem* 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 P Aur
I agree that, as the party legally and financially responsible for this proposed Construction adivity, I will abide by all applicable
lws and requiremand that govern owner4)uHders as was as employers. I also understand that'the
Construction mist comply with all applicable laws, ordlnances, building lode, ° and zoning regulations.
initial - ��t
10. 1 understand that i. may obtain more information regarding my obligations as an employer from the Internal Revenue saMce, the
United states Snag Business Administration, and the Florida Deperhnent of Revenues. I also understand that l may c onmct the
Florida Construction Industry Licensing .Board at 850.487.1395 or httol* w.mvfiorWdmnse.c omlobmbmJ-* rnimc.htmI
initial "A-
11. 1 am aware of, and consent to; an owner4wilder building permit applied for in my name and understands fiat I am the party
lega0y and tjnwndally responsible for the proposed construction activity at the following address:
Is% we AA
tnitml � �
12. 1 agree to notify Marl Shores Village immediately of any additions, deletions, or charges to any of the Information that i
have provided on ftvs disclosure.
initial k!L
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a
license, the Corstr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to
assist you withh any finendei loss that you sustain as a result of contractor may be int 614 court. it Is also Important for you to
understand that If an unlicensed contractor or employee of an individuel or firm Is injured while working bn your property, you may
be held liable for damages. B you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for
verifying Whether the contractor Is property 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 IssuiM the permit. A copy of the property ownaes driver license, the
notarized signature of the property owner, or other type of verification acceptable to the last pen .0% agency is required when
the permit Is issued.
was acknowledged before me this �� day of 201
gy C�� who was personally known to me or who has
Produced there License or d JOA + • 4"' as identrf'ication.
.� CUBI�L�s
State of fiotid;5
OWNERN�� , YUbFxPi�es $e �2g81O
MN m�ss1on * EE Notary Assn•
= Com National
®ondedThtough
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) Q 1 f`'(XS jb Q/1 �L' C_� (L�l F—t C Fe U ICXhereinafter referred to as the owner of
the following described property (address): 35,g lie ( oS A S T
R,l'ai S)n bas, FL 3313 R
Legal Description Lot Block Subdivision
Folio #
Requests permission to install (describe work):,GU cn wZr c� ` D� CzI^p
Within the public right of way of (address) ' C) 1 +"
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the dedicated right of
way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any
and all liability, which may rise by virtue of permitting the installation of these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the Item(s)
to be removed and a lien being placed on the property and/or assessed against the Owner for all costs
incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land
and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until
such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this / _� day of , 2013.
SIGNED, SEAL , A f��s6.11fqnnthe presence of:
b
2
(Owner's Signature)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nCOVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) V� l~ Q� (� �e_cl l i n He- f -'e Al Q- hereinafter referred to as the owner of
the following described property (address): 35$ i�%� 0SW1
I blah t 41.1)r2i- FL _33/_)8
Legal Description Lot Block Subdivision
Folio # f %
Requests permission to install (describe work):Jmucre-] d-riyewu an FI -s w al t
Within the public right of way of (address)
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the dedicated right of
way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any
and all liability, which may rise by virtue of permitting the installation of these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s)
to be removed and a lien being placed on the property and/or assessed against the Owner for all costs
incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land
and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until
such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this 1 -?411 day of Seb kw5nw--, 2013
&4 %
(Owner's Signature)
SIGN1, 41�E , A LI E th presenc
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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
RECEIPT
PERMIT* 1%5 �� DATE: 1 -3v -J3
&X,4'/(,a 14tr�:4-, a
,-I Crher
ctor
o Architect
Picked up 2 sets of plans and (other) �[
Address: 3-5�
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: 10 115) /-�
PERMIT CLERK INR
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
September 19, 2013
Permit No: DS 13-2100
Building Critique Review
1. PROVIDE DETAIL AND SPECIFICATIONS FOR THE PAVER DRIVEWAY.
PAVERS SHOULD BE SET OVER 2" OF COMPACTED LEVELING SAND, OVER 6"
COMPACTED LIMEROCK.
2. PROVIDE COVENANT FOR PAVER APPROACH.
Ismael Naranjo
Building Official
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.
SEP I iu13
_ N.E. 105th STREET r
i����.L® �1�� 75' R/WY'S iA91fI.�SEtDVCi��r
(18' ASPHALT) tbm Q� reU h.A SAd
o��-P10v a 4�1m,V
VV84
old C� 75.00'(R) �R. 8CO
93 ... ets 1l1
74.93'(M) 77.05' PnU)
_ • . s. ; �" "LK. ••. 77.17
F.I.P. 3/4' — — — — — "r- (25.00') 5.00')--
NO I.D. `'. •(50.00 ' FNO. D.H
l n x N
<
for I O W
IWmI \o z I, n
Ido LOT 7 I ul °D 1s.7 as ao
BLOCK 117 i 10.3' vl 29.0• _p m J
iP
UJ p o.2' 1a.e' I LOT 5
BLOCK 117 d
i
I V) z l e. (INCLUDED) I o = _ o z
0 r,..
N W M 10.6' N RESIDENCE M 'u U O
A 7C] #358 #358 14.4• � L CIR
SURVEY NOTES f
I c . F z
-ASPHALT DRIVE CROSSING THE l ,r .Z� 1 10.8' ( [,� 9.4' C f W W
NORTH SIDE OF LOT. ILL_ 29.4' " A/C
-PAVERS WALK CROSSING THE Y
NORTH SIDE OF LOT. I U' W t j
-THERE ARE FENCES NEAR THE Q O_
BOUNDARY OF THE PROPERTY. I m W 6. OPEN
PA 0
CO
C14 0.4• 11.0' 17.4•
�
O IQ
I W 0.7' I o
—L (25_00') 00 (25 —10
C,0-3 R ; F.I.P. 1/2 T
CORNER w 15; .A 75:0 LEY R�W NO 1.0. 9
TREE 9' ASPHALT
•( I I
I I I
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i I I
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PAGE 2 OF 2 PAGES
0 " N BOUNDARY SURVEY 00UNTIES 4y{•RS t F C C4 t
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� It0.28M ` SURVEYORS CERTIFICATESIHEREBYCERTJFYTNAT7HISBOUNOARYSURVEYIS A TRUE AND CORRECT REPRESENTATION OFA
SURVEYPREPAREDUNDERMYDIRECTION.$TAUOFNOTVAUDV47HO,rANAUME">�'TEDELECTRONI`SE��GALLFLORI
�y+tL O R t 9 P v SIGNATUREANDAUTNENTICATEDELtECJ�➢ and by CI de c eal
„ R v s gle+p assED SEAL AND sr = C{ McNeal, C = US
(� Y� 6250 N. MILITARY TRAIL, SUITE 102
Date: 2012.05.23 15:35:29 - WEST PALM BEACH, FL 33407
c:5�r---/'�'M c N e a I 04'00' PHONE (561) 840-4800
FACSIMILE (56(SIGNED) _ _ STATEWIDE PHONEi (800) 226.4807
CLYDE O. MCNEAL, PROFESSIONAL SURVEYOR AND MAPPER MM3 STATEWIDE FACSIMILE (800) 741-0576