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FW-15-462v BUILDING PERMIT APPLICATION Miami Shores Village 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 ❑ ELECTRIC ❑ ROOFING °�.Y MAR 0 3 2015 i '01 Master Permit No.,R&) 4-E— _ Sub Permit No. ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL r-] PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION E] SHOP nl CONTRACTOR DRAWINGS JOB ADDRESS:at 3 IVC 1 r 0 1 S+ree Com: Miami Shores County: Miami Dade Zip: 3 31-38 • Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction` Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):`(A i cc3 0 '-?C) ( Phone#: 3DS " 6 0 CO - ® 8 SD Address: a.53 1) E i o i S+ r e Lel City: Y 1" 1 lOLM I SfOf f c-�, State: U C- Zip: 33 ),38 , Tenant/Lessee Name: nn I)/fl Phone#: Email: 7ZA iv u z e 00ry-) CONTRACTOR: Company Name: v (j/�� L U' �i {' i� I Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: I City: State: Zip: Value of Work for this Permit: $�o®) Square/Linear Footage of Work:'® Fee__� Type of Work: 5�. Addition ' �" ❑i Alteration ❑ New ❑ Rgeppair/Replace` ❑ Demolition 1 Description of Work: -E17 - +a 1 [0A(_(5 n OF `��J0 w b o� I i n c'e, `� C) We 5'h s I Cti e 4 wr d: I Q e c+E "rik c � g ® .Ifl re) r" ,i o i 'P the l- 9 C"'_ _C� 11 11111+11 I nc K C. Specify color of color thru tile: /� tsar Submittal Fee $ Permit Fee $ (26GID' w CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ n r1 TOTAL FEE NOW DUE 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 Zip r 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..... 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 inspe h occurs seven (7) after the building permit is issued. In the absence of such posted notice, the inspection will qdt be appro ed and a reinsp tion fee ill be charged. Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of M 20 , by who is personally known to me or who has produced pZ 2 /J // as identification and who did take an oath. NOTARY PUBLIC: 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. NOTARY PUBLIC: as APPROVED BY (J Plans Examiner ( U� Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 OWNER BUILDER DISCLOSURE STATEMENT NAME. C CDC DATE: , ADDRESS: E io Tel: (305) 795.2204 Fax: (305) 756.8972 kores 33138i Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, KS 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.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. Initial —ja2 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 00 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 um 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 o bstaftly 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 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 P 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 a ' g n 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 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 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 odes, and zoning regulations. Initial . -.klfi 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 h :/Amm.m oddalicense.com/db r/ ro/cilbfiindex. I 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 nstruction activity at the following address: Initial_W 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information at 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 qday of d , 20 1 By,0i(O/dO 1901- who was personally known tome or who has there Licensor � 20as identification. 4 �� � ., <:7� — OWNER N err au® r® °; u} opv�° Notary Public Stets of Florida Joanna M Feliciano My Commission FF 082753 Expires ()111212018 Pdered By: We need to take every,opportmity possible to thankour amazing clients ibrtheirsupport.- ThankYbull! By: Address: 253 N.E. 101 STREET NOTES: NO NOTES MIAMI SHORES, FL 33138 1 SWERr.AMR09 = as U10mcnowam C0mPLmSVmHnm Mmomm M.E. Land Services, Inc. V%6qTA=MMXS. wcmnmm Of FIGISDABOARD OF PRCFESSKMLLAND YORS Of CODE PURSUANT TO 4MOV, FL(UUDA STATUTE& 10665 SW 190TH STREET SUITE 3110 SIGN' MIAMI, FL 33157 FOR THE FIRM PHONE: (305) 740-3319 MG I Trm P.S.K No. 5101 FAX: (305) 669-3190 LEW.6463 MAR 0 3 2015 z A�F Cd %1 V) _ NQ 4 P ,_,o 10' ASPHALT ALLEY q 100.00ygm I C & .0 1% .4 C z -&gr -j Z -41 ac TNM LLJ wc 2L55 Lu RIE OD 0 RESIDENCE 1253 t50 01 w o Z 3 Lu oar z 0 .7mo S.Ar (L 0 _j -1 6-1 4 < ren n uJ F"UX .M 22.5' PARKWAY 0 0000 0000 • 00090:• sees 20, r ASPHALT PAVEMEN :0909: N.E. 101st STREET 00 sees** •9• 9 • 690 :• •609• tooso By: Address: 253 N.E. 101 STREET NOTES: NO NOTES MIAMI SHORES, FL 33138 1 SWERr.AMR09 = as U10mcnowam C0mPLmSVmHnm Mmomm M.E. Land Services, Inc. V%6qTA=MMXS. wcmnmm Of FIGISDABOARD OF PRCFESSKMLLAND YORS Of CODE PURSUANT TO 4MOV, FL(UUDA STATUTE& 10665 SW 190TH STREET SUITE 3110 SIGN' MIAMI, FL 33157 FOR THE FIRM PHONE: (305) 740-3319 MG I Trm P.S.K No. 5101 FAX: (305) 669-3190 LEW.6463 Survey:A-48340 Client File #: Page 1 of 2 Not valid without all pages. V) z TNM LLJ Lu OD 0 Z 3 Lu [L z 0 (L 0 _j -1 6-1 < CD uJ Survey:A-48340 Client File #: Page 1 of 2 Not valid without all pages. + Surveyor's Legend PROPERLY UNE STRUCTURE TO FOUND DON PIPE / D.R. DEARIND REFERENCE TEL TELEPHONE FACILM ¢� Cue. am WALL PRN AS NOTED ON PLAT A CENTRAL ANGLE OR DELTA U.P. UTILITY POLE —X—X— CHNN-UNX FENCE OR WIRE FENCE LB/ LICENSE / - BUSINESS R RADIUS OR RADIAL E.U.D. ELECTRIC UTILITY DOR --V~� WOODTIERCE LW LICENSE / - SURVEYOR RAO. RADIAL TIE SEP. SEPTIC TANK —o--o-- IRON FENCE CALC CALCULATED POINT N.R. NON RADIAL O.F. OA/OP1rELD ---- EASEMENT SET SET PIN TYP. TYPICAL A/C AIA CONDITIONER — - — CENTER UNE ♦ CONTROL POW LR. IRON ROD S/YV SIDEWALK ® WOOD DECK ■ CONCRETE MONUMENT I.P. IRON PIPE am DRIVEWAY BENCHMARK Hh0 W& Q DSK SOS SCREEN O CONCRETE EILY ELEVATION PK NAIL PAR ER-ITALON NAIL BAR GARAGE ® ASPHALT P.T. POW OF TANGENCY D.N. GRILL HOLE ENOL ENCLOSURE P.C. POW OF CURVATURE ® WELL N.TS. NOT TO SCALE BRICK / TILE PRW PERMANENT REFERENCE MONUMENT ® FIRE HYDRANT Fd. FDOUSUM FLOOR P.C.C. POW OF COMPOUND CURVATURE 0 M.H. MANHOLE T.O.& TOP OF RANK PRC. POINT OF REVERSE CURVCURVATUREOR4 EDGE OF WATER OVERHEAD ONES E.O.W. ,.•"'••-•----- APPROXIMATE EDGE OF WATER P.O.& POW OF BEWWWO TX TRANSFORMER EA.P EDGE OF PAVEMENT P.O.C. POINT Or COMMENCEMENT CATV CABLE TV RISEN C.V.G. CONCRETE VALLEY GUTTER ® COVERED AREA P.C.P. PERMANENT CONTROL POINT W.M. WATER METER BSL BUILDING SETBACK LINE 1:1 TREE M FIELD MEASURED P/E POOL EBSPYENT STA. SURVEY TE LOU POWER POLE P PLATTED MEASUREMENT CONC. CONCRETE SLAB CL. CENTER LINE ® CATCH BASIN 0 DEED [AIG EASEMENT R/W RSHT-CFWAY C.U.E. COUNTY UTR.RY EASEMENT C CALCULATED D.E. DRAINAGE EASEMENT PALE. PUBLIC UTILITY EASEMENT LL/E.E. INGIEW / EGRESS EASEMENT 1.9 LAKE OR LANDSCAPE MAIHT. ESML LSE. LANDSCAPE BUFFER EASEMENT C.M.E. CANAL MMNYRNANCE EASEMENT LIZ UTILITY EASEMENT SO.L ROOT OVERHA Ni EASEMENT LAE. LIMITED ACCESS FASOUM A.E. ANCHOR EASEMENT Property Address: General Notes: 1. The Legal Description used to perform this survey was supplied by others. This survey does not determine or Is not to imply ownership. 253 N.E. 101 STREET E 2. This survey only shows above ground Improvements. Underground MIAMI SHORES, 33138 LLIiIttles, footings, or encroachments are not located on this survey map. 3. If there Is a septic tank, well, or drain field on this survey, the location of such items was shown to us by others and the Information was not verified. Flood Information: 4. Examination of the abstract of title wig have to be made to determine recorded instruments, if any, effect this property. The lands shown herein were Community Number 120652 not abstracted for easement or other recorded ancumbrances not shown an Panel Number 12086CO302 The plat. 5. Wag ties are done to the feLU3 of the wag. Suffix: L 6. Fence ownership is not determined. 7. Bearings referenced to line noted B.R. Date of Firm Index: 9/11/2009 8. Dimensions shown are platted and measured unless otherwise shown. Flood Zone: X 9. No identification found on properly comers unless noted. 10. Not valid unless sealed with the signing surveyors embossed seal Base Flood Elevation: N/A 11. Boundary survey means a drawing and/or graphic representation of the Datppf Field Work: 5/1/2014 1 survey work performed in the field, could be drawn at a shown scale and/or not • • Date T Com I tion• 5/2/2014 AP P lr to scale. 12 Elevations it shown are based upon NGVD 1929 unless otherwise rioted. • e e e e • • • • • • 13. This is a BOUNDARY SURVEY unless otherwise noted. • • • 14. This survey is exclusive for the use of the parties to whom it is cedgied. 64,69 i The certifications do not extend to any unnamed parties. • • • : • • • • 1.e89l Descriptio::. „ • LOT$417 ANDB18 BLOCK 35, OF SUBDIVISION AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1,, ACCORDING • • • TO AHE PIAN tFE'f2E'OF AS RECORDED IN PLAT BOOK 10, PAGE 70, OF THE PUBLIC RECORDS OF MIAMI-DADE • • • • • LC1[%TY, FLQRIM-. • .PRINTING INSTAW111ONS: TITLE SERVICES, LLC; FIRST AMERICAN TITLE INSURANCE 0000 COMPANY; BANK OF AMERICA, NA.; . Its'successors and/or assigns While viewing the survey in any Acrobat Reader, "Print" as their interest may appear. select the File Drop-down and select Select a color printer, if available, or at least one with 8.5"x 14" paper. Select ALL for Print Range, and the # of copies you ease dBFy a ow or Po cy mepara on Purposes only: would like to print out. his Paity cbmoOtIn99 _89a"st toss OrOFMB ebyreas0ofMer OM179ercepum Under the "Page Scaling" please make sure you have "None." any dgtns, easements, interests orcialms which may exist by nmm of, or reflected by, the selected fdlov&g facts shown on the surrey pmpwad by WGUEL ESPINOSA dated Do not check the "AutoRotate and Center" button. osrmM14 bearing Job # A4a340 : Check the "Choose Paper size by PDF"checkbox. a) NO NOTES Click OK to Print. b) c) M.E. Land Services, Inc. 10665 SW 190TH Street, Suite 3110 MIAMI, FL 33157 PHONE:(305) 740-3319 FAX #:(305) 669-3190 LB # 6463 WMAELANDSERVICES.COM SurvevA-48340 Client File #: Page 2 of 2 Not valid without all pages.