DS-14-966Miami Shores Village
1 w�A , J
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
114 BUILDING ❑ ELECTRIC ❑ ROOFING
RECEIVED
MAY 12 2014
FBC 20
Master Permit No. L� �
Sub Permit No. 5111 Ll Q jo " r
❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS -CHANGE OF ❑ CANCELLATION E]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 6 L jan KI L -J 574 4 Ore- °
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SQ]L<</ L �"s Phone#: 4 ZM '���3
City: hm'f" y State: Zip: ��1_4 42
Tenant/Lessee Name: „%%-1 �_ �,e / US Phone#:L-���
Email:
CONTRACTOR: Company Name: Q /`� ���- Phone#:
Address:
City: State:
Qualifier Name:
State Certification or Registration #:
Certificate of Competency M
DESIGNER: Architect/Engineer: Phone#:.
Address: City: State: Zip:
Value of Work for this Permit: $ t Square/Linear Footage of Work:- �2�
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
of Work: P ; P (AJ(k V k
P) L.l�e (_ —
iM flxt 1 .
Specify color of color thru tile:
Submittal Fee $50' Permit Fee $ CCF $ CO/CC7 9—
$
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Double Fee $
Bond $
TOTAL FEE NOW DUE $hl )o
I(�
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
Zi
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC ... .k
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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
12- day of Imo• rA-'-C , 2014 • by
S >J1 C'tFil1fL%.S, who is personally known to
me or who has produced r -L' t7�) as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to
me or who has produced
identification and who did take an oath.
b% �,,�� NOTARY PUBLIC:
O Sign:
Z,7_ Print:
Seal: ••••• Seal:
as
APPROVED BY Plans Examiner � Zoning
Structural Review Clerk
(Revised02/24/2014)
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: S C—ADATE: f
ADDRESS: Z l ` (-)® /t 1Al
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 entities 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 as my own
contractor with certain restrictions even though I do not have a license. c,
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 I 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 or substantially
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.
Initial� C-
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 v
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.
Initial
I 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 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. 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 htto://www.myfoNdalicense.comtdbor/aro/Cilbriindex.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:
(QUO tow 5 -hoL,
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 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.
Was acknowledged before me this 112- day of n , 201_
who was personally known to me
Produced there License or ICS
OWNER
s
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5582 N.W. 71A STREET, SUITE 202
MIAMI• FLORIDA 33128
TELEPHONE; (305) 220-3171
FAX: (305) 554.7822
itrars
LAND SURVEYORS
BOUNDARY SURVEY Scare l° =
SURVEY NO. / �7-f
SHEET NO. ` OF - -f
o� MAY 12
014
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7o F
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.11 I
o5fliami Shores'V Bgage
A
D
DATE
L DEPT
.`;U(3e - T TO COMPLIANCE WITH ALL FEDERAL
SIATE ND COUNTY RULES AND REGULATIONS
VsILf
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5582 N.W. 7th STREET, SUITE 202
MIAMI, FLORIDA 33128
Jahn 6$u���fIr�3ur.
SURVEY No.
TELEPHONE: (3D5)220.3171 ,,��jj ,G`jJ.�•
FAX: (305)554.7822
DRAWN BY: LAND SURVEYORS SHEET NO.—
Survey of Lot: 11 Block: 4
Subdivision: WEST SHORES
According to the Plat thereof as recorded in the Plat Book No. 42
at Page No. 18 of the public records of MIAMI-DADE County, Florida.
Property Address: 11100 NW 5 AVE, MIAMI, FL 33168
For: SONY CHERRELUS Date: 05/19/1998
&;il.
111-011
LOCATION SKETCH Scale 1°= HT*i
15111
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ea /9 /B /7_ /16 /.f /3 /2
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tL— .11 • Q _�O'Qa,�..'a•.�._.r%_ ._. fir. ..
A . ARC.
F.N.D.. FOUND NAIL & DISK
P.R.C. = POINT OF REVERSE
A/C = AIR CONDITIONER PAD.
FR, - FRAME.
CURVE.
A. E. = ANCHOR EASEMENT.
.76 • �
.
A/R = ALUMINUM ROOF.
• ,J14.
4
CORNER.
A/S = ALUMINUM SHED.
INSURANCE PROGRAM.
P.B. . PLAT BOOK.
ASPH. = ASPHALT.
F.N. - FOUND NAIL.
PG.. PAGE.
B.C. - BLOCK CORNER.
H.. HIGH (HEIGHT).
PWY . PARKWAY.
'aw•rn�
far C i/.fss ,
PRM a PERMANENT REFERENCE
ea /9 /B /7_ /16 /.f /3 /2
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tL— .11 • Q _�O'Qa,�..'a•.�._.r%_ ._. fir. ..
A . ARC.
F.N.D.. FOUND NAIL & DISK
P.R.C. = POINT OF REVERSE
A/C = AIR CONDITIONER PAD.
FR, - FRAME.
CURVE.
A. E. = ANCHOR EASEMENT.
Fr. - FEET.
PROP. COR. - PROPERTY
A/R = ALUMINUM ROOF.
FNIP.. FEDERAL NATIONAL
CORNER.
A/S = ALUMINUM SHED.
INSURANCE PROGRAM.
P.B. . PLAT BOOK.
ASPH. = ASPHALT.
F.N. - FOUND NAIL.
PG.. PAGE.
B.C. - BLOCK CORNER.
H.. HIGH (HEIGHT).
PWY . PARKWAY.
BLDG. = BUILDING.
IN. & EG.. INGRESS AND EGRESS
PRM a PERMANENT REFERENCE
B.M. =BENCH MARK.
EASEMENT.
MONUMENT.
B.O.B. - BASIS OF BEARINGS.
L.P. - LIGHT POLE.
P.L.S. - PROFESSIONAL LAND
C. - CALCULATED.
L.F.E. - LOWEST FLOOR
SURVEYOR.
C.B. =CATCH BASIN.
ELEVATION.
R. =RECORDED DISTANCE.
C.S.S. = CONCRETE BLOCK
L.M.E. • LAKE MAINTENANCE
RR. - RAILROAD.
STRUCTURE.
EASEMENT.
RES.. RESIDENCE.
CBW - CONCRETE BLOCK WALL.
' • MINUTES.
R/W. - RIGHT-OF-WAY.
CH. = CHORD DISTANCE.
M. - MEASURED DISTANCE.
RAD, - RADIUS OR RADIAL.
CH. B. = CHORD BEARING.
MON.. MONUMENT.
R.P. - RADIUS POINT.
CL. - CLEAR.
M/H = MANHOLE
RGE. - RANGE.
C.L.F.. CHAIN LINK FENCE.
M/L. = MONUMENT LINE.
SEC. - SECTION.
C.M.E.. CANAL MAINTENANCE
N.A.P. = NOT A PART OF.
STY. - STORY.
EASEMENT.NGVD.
NATIONAL GEODETIC
SWK. - SIDEWALK.
CONC. - CONCRETE.
VERTICAL DATUM.
S.I.P.. SET IRON PIPE L.B. #8044
C.P. - CONIC. PORCH.
N. - NORTH.
S.. SOUTH.
C.S. - CONCRETE SLAB.
I N.T.S.. NOT TO SCALE.
S.N.D. -SET NAIL & DISK L.B.88044.
D.E.. DRAINAGE EASEMENT
It • NO.. NUMBER.
SP. - SCREENED PORCH.
D.M.E. = DRAINAGE MAINTENANCE
O/S.. OFFSET.
". SECONDS.
EASEMENT.
OH. - OVERHEAD.
T. - TANGENT.
DRIVE. • DRIVEWAY.
O.H.L.= OVERHEAD UTILITY LINES
TWP. - TOWNSHIP.
o - DEGREES.
OVH. - OVERHANG.
U.E.. UTILITY EASEMENT.
E. - EAST.
O.R.B. - OFFICIAL RECORD BOOK.
UTIL.. UTILITY.
E.T.P. - ELECTRIC TRANSFORMER
PVMT.. PAVEMENT.
U.P.. UTILITY POLE:
PAD,
PL. - PLANTER.
W.M. - WATER METER.
ELEV. - ELEVATION.
P/L. - PROPERTY LINE.
W,F.. WOOD FENCE.
ENCR. - ENCROACHMENT.
P.C.C. - POINT OF COMPOUND
W.S. - WOOD SHED.
F.H. - FIRE HYDRANT.
CURVE.
A - CENTRAL ANGLE.
F.I.P. - FOUND IRON PIPE.
P.C. - POINT OF CURVE.
W. . WEST.
F.I.R. - FOUND IRON ROD.
PT. - POINT OF TANGENCY.
= CENTER LINE.
F.F.E. • FINISHED FLOOR
POC. . POINT OF COMMENCEMENT
ELEVATION.
POB.. POINT OF BEGINNING.
= ANGLE.
WOOD FENCE.
CHAIN LINK FENCE.
C.B.S. WALL (C.B.W.)
0.00 X EXISTING ELEVATIONS.
0 PROPOSED ELEVATIONS
SURVEYORS'S NOTES: 1). IF SHOWN, ¢EARINGS ARE
REFERRED TO AN ASSUMED MERIDIAN, BY SAID PLAT
IN THE DESCRIPTION OF THE PROPERTY. IF NOT,
THEN BEARINGS ARE REFERRED TO COUNTY
TOWNSHIP MAPS.
2). IF SHOWN. ELEVATIONS ARE REFERRED TO
B.M.# ELEV. _
OF N.G.V.D. OF 1929.
3). THIS IS A SPECIFIC PURPOSE SURVEY
4). THE CLOSURE IN THE BOUNDARY SURVEY IS
ABOVE 1:7500 FT.
I HEREBY CERTIFY: THAT THIS "BOUNDARY SURVEY'
OF THE PROPERTY DESCRIBED HEREON, AS
RECENTLY SURVEYED AND DRAWN UNDER MY
SUPERVISION, COMPLIES WITH THE MINIMUM
TECHNICAL STANDARDS AS SET FORTH BY
THE FLORIDA BOARD OF PROFESSIONAL LAND
SURVEYORS IN CHAPTER S1G17.8, FLORIDA
ADMINISTRATIVE CODE PURSUANT
TO 472.027, FLORIDA STATUTES.
BY: 4/� QQ
Q MARRA (DATE OF FIELD WORK). 2�9lJ
PRO SS 0 AL LAND SURVEYOR NO. 2y 3¢
LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY (SURVEY): STATE OF FLORIDA. (VALID COPIES OF THIS SURVEY WILL
EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED BEAR THE EMBOSSED SEAL OF THE ATTESTING LAND
INSTRUMENTS. IF ANY. AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT TO DEDICATIONS, SURVEYOR).
LIMITATIONS. RESTRICTIONS. RESERVATIONS OR EASEMENTS OF RECORD. LEGAL DESCRIPTIONS
PROVIDED BY CLIENT OR ATTESTING TITLE COMPANY.
BOUNDARY SURVEY MEANS A DRAWING AND/OR A GRAPHIC REPRESENTATION OF THE SURVEY WORK
PERFORMED IN THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND/OR NOT TO SCALE.
THE LIABILITY OF THE SURVEY IS LIMITED TO THE COST OF THE SURVEY. REVISED ON_____ __•__ _____._______
THE TERMENCROACHMENT' MEANS VISIBLE AND ABOVE GROUND ENCROACHMENTS.
ARCHITECTS SHALL VERIFY ZONING REGULATIONS, RESTRICTIONS AND SETBACKS AND THEY WILL REVISEDON__^
BE RESPONSIBLE OF SUBMITTING PLOT PLANS WITH THE CORRECT INFORMATION FOR THEIR
APPROVAL FOR AUTHORIZATION TO AUTHORITIES IN A NEW CONSTRUCTION, UNLESS OTHERWISE
NOTED, THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTINGS AND/OR FOUNDATIONS.
FENCE OWNERSHIP NOT DETERLONED.
THIS PLAN OF SURVEY, HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMED
HEREON, THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY:
THE FNIP FLOOD MAPS HAVE DESIGNATED THE HEREIN DESCRIBED LAND TO BE
Situated in Zone: X Community/Panel/Suffix: 120635-0090-J
Date of Firm: 03/02/1994 Base Flood Elevation:
Certified to: SONY CHERRELUS AND LOUCENOR MAJOR
ATTORNEYS' TITLE INSURANCE FUND, INC.
JAMES LOREN, ESQUIRE
TROPICAL TITLE INC.
DMR FINANCIAL SERVICES, INC. ITS SUCCESSORS AND/OR ASSIGNS,
ATIMA
W
N
SEAL