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RF-13-147r _� ► Miami Shores Village Building Department JAN 2 s 209 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 CQI� Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 c '�::) BUILDING Permit No. I `3 — I PERMIT APPLICATION Master Permit No. f�--_1 r` `� �Y2- Permit Type: BUILDING ROOFING JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Phone#,7' Address: City: �'llA `S� State: Zi Zip: >13 6 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ :3 Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 14.E Cv ( ( ( ti w�T t'�'c�,t' A' -"j C Color thru tile: **��****�**��*��*��,��**�*������**Fees*****�*��**�*�������**��*��������**�*����*** Submittal F Permit Fee $ S CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ ` 4 Bonding Company's Name (if applicable) C Bonding Company's Address City State Zip 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 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 oc rs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved nd a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this "L -1P The foregoing instrument was acknowledged before me this day of , 20 �, by day of , 20 _, by , who is erersonally known me or who has produced �`-'� P who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY NOTARY PUBLIC: Sign: Print: My Commission Expires: DAMAYiVEGA M`,' COMMISSION # EE 066066 EXPIRES: April 1, 2015 Plans Examiner Zoning Structural Review Clerk (Revised 5/2/2012)(Revised 9/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) T r t In accordanceNthMA�reguJadon costs of al improvements must�>�e nib costs' of`'any' proposed imp ovein&N include demolition, raw and finished which are to be included as 4611 ",those exclu must be attached) PROPERTY OWNER: mi Shores Village )y food Damage Prpvent on ,c O�dman e the, The costs of any impfovexnents in the past 12 months and the shown on the worksheet. The . cost of improvements ` iriust „s (include those donated), labor (including volunteer an self - gement, and overhead and profit. A list'of.items the costs of ded is attached for your reference. (A Copy of the Contract vr ADDRESS: ' L V) 4' FOLIO NUMBER: FLOOD ZONE:. BASE FLOOD EUVATION FREEBOARD: EAST OF FL.CCCL: _ COST OF PAST IMPROVEMENTS (12MONTHS):1� c COST OF PROPOSED IMPROVEMENTS:, Uu (ATTACWCOPY OF;CONTRA.CT) t> TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): �...: VALUE OF PRINCIPAL STRUCTURE (attach appraisal): 1 OWNERS SIGNATURE: DATE: PLANREVIEWER• ` PLAN REVIEWER SIGNATURE: DATE: SUBSTANTIAL (NOTE: THIS LIST IS t ALL INCLUSIVE) eievated V1lalls'rk9luOin'm Exterior walls, Besting 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 with pagement I Supervision refit Equivalent cost for: Donated Materials Volunteer Labor Qncludirto° owners and friends) Any Improvements Beyond Pre -;damaged Condition, including; Utility Upgrades Code Upgrades ITEMS TO BE E� QpED , Plans and Specifications Survey. Elevation Certificate Costs } Permit fees De6dif Rd noval - Items not cohs de'red'to'be'REAL Progertv Rugs, Furniture, Refrigerator, Appliances not Built-: in � Oufside T,n,iprovehients; Cncluding Landscaping Sidewalks t Patios Fences Yard lights Sheds Gazebos Irrigation Pool Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 MIAMI SHORES VILLAGE NOTICE TO BUILDING DEPARTMENT OF EMPLOYMENT AS SPECIAL INSPECTOR UNDER THE FLORIDA BUILDING CODE 40 KAiIZaG i- f)- v v NerL- i (We) have been retained by A Ater P–L- _ru F &'r 34uG to perform special inspector services under the Florida Building Code at the I5Sn kic 101� s r. AAW sµaassproject on the below listed structures as of I 12N i 3 (date). I am a registered architect or professional engineer licensed in the State of Florida. PROCESS NUMBERS: Zt 1212 2yn ❑ SPECIAL INSPECTOR FOR PILING, FBC 1822.1.20 (R4404.6.1.20) ❑ SPECIAL INSPECTOR FOR TRUSSES >35' LONG OR 6' HIGH 2319.17.2.4.2 (R4409.6.17.2.4.2) ❑ SPECIAL INSPECTOR FOR REINFORCED MASONRY, FBC 2122.4 (R4407.5.4) ® SPECIAL INSPECTOR FOR STEEL CONNECTIONS, FBC 2218.2 (R4408.5.2) (,a cD f ❑ SPECIAL INSPECTOR FOR SOIL COMPACTION, FBC 1820.3.1(R4404.4.3.1) ❑ SPECIAL INSPECTOR FOR PRECAST UNITS & ATTACHMENTS, FBC 1927.12 (R4405.9,12) ❑ SPECIAL INSPECTOR FOR Note: Only the marked boxes apply. The following individual(s) employed by this firm or me are authorized representatives to perform inspection 1. ALMA --Io CA IZDUh1X 2. A "LieL ALVA42E' 2 3. 4. *Special Inspectors utilizing authorized representatives shall insure the authorized representative is qualified by education or licensure to perform the duties assigned by the Special Inspector. The qualifications shall include licensure as a professional engineer or architect; graduation from an engineering education program in civil or structural engineering; graduation from an architectural education program; successful completion of the NCEES Fundamental Examination; or registration as building inspector or general contractor. 1, (we) will notify Miami Shores Village Building Department of any changes regarding authorized personnel performing inspection services. I, (we) understand that a Special Inspector inspection log for each building must be displayed in a convenient location on the site for reference by the Miami Shores Village Building Department Inspector. All mandatory inspections, as required by the Florida Building Code, must be performed by the County. The Village building inspections must be called for on all mandatory inspections. Inspections performed by the Special Inspector hired by the Owner are in addition to the mandatory inspections performed by the Department. Further, upon completion of the work under each Building Permit I will submit to the Building Inspector at the time of final inspection the completed inspection log form and a sealed statement indicating that, to the best of my knowledge, belief and professional judgment those portions of the project outlined above meet the intent of the Florida Building Code and are in substanf accordance with the approved plans. Signed and Sealed Engineer/Architect Name A Lw -12--[b C.Aric.:�cNa, i� Lc�aNa. , 1`I I3Y tMn Address W 3,S� Sv-► 211a ��` pito PA14, ; -FL . DATE: I Phone No. 37S- 2S(s — Created on 6/1012009 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: le -t, DATE: ADDRESS: 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 1 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 -orlease 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 l do not have a license. L/ 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 (t/„l// 3. 1 understand that, as an owner builder, I am the responsible party of record on 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 numb rs on permits and contracts. Initial 4. l understand that I may build or improve a one family or two-family residence or a farm outbuilding, l 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 occ/im y not be built or substantially improved for sale or lease. If a building or residence that I have built or substand myself is sold or leased within 1 year after the construction is complete, the law will presume that I bu't oy 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 �Az 6. 1 understand that l may not hire an unlicensed person to act as my contractor or to supervise persons working on my buildin residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by co or municipal ordinance. Initial 7. 1 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 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 with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensate n for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I 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 l 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 co act the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.myfloddalicense.com/dbDr/prof lindex.htrfil Initial I 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 infortion 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. 2 Was acknowledged before me this day of , 20 By who was personally known to me or who has Produced there License or OWNER as identification. NOTARY APR -28-2009 11:53 From: A►c - CERTIFICATE THIS CERTIFICATE IS ISSUED AS A MATTER OF WOI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATI BELOW. THIS CERTIFICATE OF INSURANCE DOES N REPRESENTATIVE OR PRODUCE=R. AND THE CERTIMA IMPORTANT-. H the cotellGate lwldet in an ADDITIONAL t+ teems and eondldom of the "ICY, osRRtn potldes mafllr Gwff ats holdo! In lieu M each ondoewra"W. The Solution Insurance SVCS INC 10656 SW 72 SV"I. Suite 7 Miami, FL 33173 Addedy DervelopmOrIt Inc 8255 W. Sunrise Blvd, Suite 11g ftntallon. FL. 33322 INDICATED NOrMTHSTANDING ANY REMIREMENT. TERM a CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE JNSUPY EXCLUSIONS AMC) CONDITIONS OF SUCH POLICIES. LNrrS SHOD AWL SM ML sR TYLE Ola tllBtIRANCE c!!P1AL I.uuse " GL OU012 COMMERCIAL G£sMRAL LIAWLITY CLAIMS 1IAD� a OCCUR - - OWL, AGGREGA7{ UMIT APPLIES PER I X POLX:Y X Io' X Loc AUTORIOMLZ LtAMNIN ANY AUTO ALL 0W4ED AUTO$ { SCHROULED AUTOS Il y_ WRED AUTOS NON.OwNED AUTOS --...i UNDRE" LAB exix SU" CLUMS.IVAM DEDuCnBLE - To:13057568972 Pa9e:1,'1 IF LIABILITY INSURANCE, I " off, RTION ONLY AND CONFERS NO MGM UPON THE CERTIFICATE HOLDER. THIS LY AMl1END, EXTEND OR ALTER THE COVERAGE AFFORDED By THE POLICIES CONSTITUTE A CONTRACT BETWEEN THE ISSUING INBURER(S), AUTHORIZED HOLDER. JM. the poiicy(" must be atld6nied. it SUSROGA:fioN IS WANED, subject to the Vft an ondonwmmnt. A stftnWnt on this cwtiflceta does not con1w "t" to " AkDEMPLCYER3'LMOLITY YIN 106-603n I ANY ArtOPR1ETOR�vARTNERrF�SECUnVE OFfi1CEWMfiM96RGXCLUDED? Y NIA ION OF OP@1A11bN$ f UWATIOna f wwo"" ACOM tot, Carpeertry. Masonry, Paln*V I"ISION NUMOM. BELOW HAVE BEEN ISSUED TO THE INSURED CONDITION OF ANY CONTRACT OR OTHER CE AFFORDED BY THE POLICIES DEWRI6 I MAY HAVE BEEN REDUCED BY PAID C 0811812012 108/ 1812013 INS 3elwdul' if 08M 0013 nar ") ED NAMEp ABOVE POR THE POLICY PERIOD ED CLAIMS. DOCUMENT VIIITFI RESPECT TO VftGH THIS IiEREIN !s SUBJECT TO ALL THE TERMS. _ Laws EAOH OCCURWENCF M>:DEJW one s 50.000 PERSONAL6AMIWIJRY _ � GENERAL AGGREGATE 5 � 1 ��DO, PROMJQTS - COA IP/OA AGG s t (1n0-Qnn s cOMINNED SINGLE LII41T : EES apadnf#) BOpLY lWuRY {Por wsf" T •• •—_ _ BOWLY IWURY (pw atrkum PROPERTY MMAC,E S (Fame deM EACH OCCURRENCE E AGGREGATE s E L. "CH AC"DENT E E L DISEASE - EA F-MpLoyr;g S E L. DISEASE • P4LICY JJMIT f idtOYlD ANY ME A9! WMF=W P BE c Cry of Miami Shores, Building Dept. �T= VILL RE DtLrtvjm IN 100SO PIE 2 Avenue Miami Shores, FL. 33138 Aunlosazo �► ® iDOS ACORD C RATION. ACORD 25 (200el09) The ACORD dome 4aW logo are reaM and f"fks Of ACORD KM TIC vlJTtt TME All Tights seservw- NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. jt 3 2 D S'O 31 10 STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be property, and in accordance with Chapter 713, Florida Statutes, the 1 is provided in this Notice of Commencement. 1. L 1 descri tion of property and street / address: I HEREBY CERTIFY orf tW fill #1 OR 8k 28425 P9 1397; QP9) RECORDED 01/02/2013 12:06:15 HARVEY RUVINP CLERK OF COURT MIAMI—GALE COUNTYe FLORIDA LAST PAGE COUNTY OF LAM Ihte k s o/ tabs � = d ly of �... _ _A020 ;Wee ;Lcr c,9(;'TAY"01- Courts i ormatton O.C. aN i0t'if r<5 f s 69i? e Ll .- 2. Description of ir�provent: 3. Owners nam and ad9ress: i4f fC e'N- Interest in property: Name and address of fee simple titleholder. 4. Contractor' name nd addreM AAA oA M W (, 92 6 U) , 'A L&. AAt ,7f %? J I `�t , 5. Surety: (Payment bond required by owner from contractor, if any) Nameand Address: 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 and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienoes Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of Owner Print Owner's Name _tPrepared by Swom to and subscribed before me this 1W Notary Public: Print Notary's N My commission MY COMMISSION # EE 066066 EXPIRES: April 1, 2015 Bonded Thru Notary Public Underwriters day of D -Cc r \ p0 1 '�- . . Address: Existing Premanufactun Existing Tie Beam Alberto Cardona, P.E. �k11�-s--{111 --� ht,lAltAA t SHORES VILLAGE APPROVED BY DATE 20NiNG S`i RUCTU RAL ELECTRICAL_ PLUMBING MECHANICAL Bi..DG. SUdIECT TO COMPLIANCE WITH ALL I LOERNL. �TATE AND; COUNTY RULES AND REGULAiltJ�tS rU5$ TRUSS STRAP DETAIL PROJECT: 1550 NE 103rd St., Miami Shores Lic. No. 11138 1 TYPB I Building NO. SME NTS PROJECT No. 121070 SNE' 1 OF 1