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BPP-14-2561 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 I Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 - FBC 20 BUILDING Master Permit No. - 14- D15 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �) \ CONTRACTOR DRAWINGS JOB ADDRESS: I �.I �✓v I a " (`-Q. l City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): C o (.1-0�'���,1'L Phone#: l U L-3 2 A I Addre s: �t City:-r=`0. bV1 Dc Q) State: Zip: -1 Tenant/Lessee Name: Phone#:* 1 9 Email:�°� '(� (-2, G L L®v+., CONTRACTOR:Company Name: L" vim 0( Phone#: Address: o.wA IX, CIX City: State: Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ `f9, 00 U CAS ,_,f Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration LV1 New ❑ Repair/Replace ❑ Demolition Description of Work: 1 N G -'QQ)(_ �;7f'' Specify color of color thru tile: I Submittal Fee$ Permit Fee$ �� CCF$ !I CO/CC$ ��• ( _ Scanning Fee$ 3 . o3 Radon Fee$ DBCP,R\$ 8 ,55 Notary$ S Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) 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 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 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Q day of 20 by day of 20 by iC-g e ,QkJsrho is personally known to who is personally known to me or who has produced ! –20'KP— `•i OE ' C as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: n Sign: Sign: Print: Print: Off Notary Public State o a Seal: ;� �; Sindia Alvarez Seal: +� r My Commission FF 159750 OF 0-1 Expires 09/0312016 APPROVED BY I"�[ "A` Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue �RID� Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 ��//�" OWNER BUILDER DISCLOSURE STATEMENT NAME-Q,,/e i', 'cc 001y let DATE: �JP G ZU lc/ ADDRESS: W 9, ; W ®�"`" 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 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. 1 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. Initia� 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. I 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.1 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. I 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 erisure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initials, �1 e r � 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. Initiate^�-C...� 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'/' 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 regulati'o1ns. Initiae" "\ 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 http://www.mvfloridalicense.com/dbpr/pro/cilb/index.html Initia l 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: Initial.'r 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. T InitialT�T 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 � day of 20 By Oi�15E_QLCKD who was personally known to me or who has Produced there License od �(� �Iy_�i as identification. ow Notary PuMle Stats of Plsrids Sandia Alvaroz OWNR NOTARY � � My Commission FP 139990 or Expires 09/03/2019 ORDERED BY: TRI DENS N - �7 .� 700 NE 90th Street Miami Shores,Florida 33138 305-351-0744 www.tridenttidellc.com PROPERTY ADDRESS: 21 NW 101ST ST MIAMI SHORES,FLORIDA 33150 SURVEY NUMBER: FL1304.2741 FIELD WORK DATE:4/25/2013 REVISION DATE(S):(REV.0 4/26/2013) R 1304.2741 BOUNDARYSURVEY MIAMI-DADECOUNTY LOT 3 LOT 2 LOT 1 BLK 2 BLK 2 BLK 2 9I 25.)/o o N 89°55'03"E 81.44'(M) g z 1NOFD S 0°16'55"E 81,68'(P) 1 T Fv / 25 .0' 0.1'OFF 25.0, I 0.3'0'F REMAINDER OF LOT 15 BLK 2 Le a� NOT INCLUDED �a I b w I "a SAO no o E.25'OF rq LOT 16 N P �� `-w LOT 151 BLK2 Awa o BLK 2 la'C.e.w. c it U I C-1 LOT 14 -oi p gam - > R=25.00(P&M) BLK 2 0 0 1 $o L= 39.27'(P)39.07(M) o o Nca. 25Z A/C co U � A= 90100100"(P)893206( )° ' "M Z ZE. f` I N45-00100-E,3536(P) io j 19.9' ON 1-1111 z N44 5944"E,35.21(M) ON UNE 106 1 STY. 19.9' RES#21 rn I � tv 2.0' / N /2.0' coo 10.1' 1 " 2 .5' N I 1ITIP NOFD / @ P.C. C �' rol Uo � oo 1/2"FIP 1/2"FIP G N o 25.0' NO ID 25.0' I @ NO ID t4 1/2"FIP S 90 00'00" 168'�P� 0 NO IDS 89°5448" 45' M `y S 89°54'48"W 24.90 0 NOTES: P�NsF Air LOT APPEARS TO BE SERVICED BY CITY WATER AND SEWER v p FENCE OWNERSHIP NOT DETERMINED l hereby certify that h Sketc"b3 Surve the hereon described property has been d and to the best of my knowledge and bel i to representation of a ao 0 15 30 survey that meets t' inimWRjWhni c andards set forth by the Florida Board O esSNF Lan rveyors as described in Chapter5J-17oftheiveCode. GRAPHIC SCALE (In Feet) > RONALD W.WALUNG 1 lACh = 30' ft State of Florida Professional Surveyor and Mapper Ucense No.6473 Use of This Survey for Purposes other than Intended,Without written Verification,will beat the User's Sole Risk and Without Uablllty to the Surveyor. Nothing hereon shall be Construed to Give ANY Rights or Benefits to Anyone Other than those Certified. FLOOD INFORMATION: POINTS OF INTEREST BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING NONE VISIBLE MUNICIPALITY OR WWW.FEMA.GOV,THE PROPERTY APPEARS TO BE LOCATED IN ZONE X.THIS PROPERTY WAS FOUND IN THE VILLAGES OF MIAMI SHORES,COMMUNITY NUMBER 120652,DATED 09/11/09. - � . � ' AFFILIATE CLIENT NUAT MBER:MS13-0055 DE: 4/26/2013 (, w J � � BUYER:FEDERICO G.GONZALEZ _lamC MEMBERS I, SELLER: GIANNY SANCHEZ CERTIFIED TO:FEDERICO G.GONZALEZ;TRIDENT TITLE LLC;OLD REPUBLIC;BANCO POPULAR NORT AMERICA www.exactaland.com Land Surveyors, Inc. P (305)668-6169• F(305)668.6325 ' This is page 1 of 2 and is not valid without all pages. LBa 7337 1222o Towne Lake Drive,Suite 55•Ft.Myers,FL 33913 REPORT OF SURVEY FL1304.2741 This is page 2 of 2 and is not valid without all pages. LEGAL DESCRIPTION: THE EAST 1/2 OF LOT 15 AND ALL OF LOT 16,BLOCK 2,NAVARRO,ACCORDING TO THE MAP OR PLAT THEREOF,AS RECORDED IN PLAT BOOK 12,PAGE(S)59,OF THE PUBLIC RECORDS OF MIAMI-DADE CONTY,FLORIDA. JOB SPECIFIC SURVEYOR NOTES: THE ASSUMED BEARING REFERENCE OF SOUTH 0 DEGREES 00 MINUTES 00 SECONDS EAST IS BASED ON THE EASTERLY RIGHT-OF-WAY LINE OF N MIAMI AVE,LOCATED WITHIN NAVARRO,ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 12,PAGE 59,OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY,FLORIDA. GENERAL SURVEYOR NOTES: 1. The Legal Description used to perform this survey was supplied by others.This survey does not determine or imply ownership. 2. This survey only shows improvements found above ground.Underground footings,utilities and encroachments are not located on this survey map. 3. If there is aseptic tank,or drain field shown on this survey,the location is approximate,and was determined by visual aboveground inspection only,and cannot be relied on for accuracy. 4. This survey is exclusively for the use of the parties to whom it is certified. 5. Additions or deletions to this survey map and report by otherthan the signing party or parties is prohibited without written consent of the signing party or parties. 6. Dimensions are in feet and decimals thereof. 7. Due to varying construction standards,house dimensions are approximate. 8. Any FEMA flood zone data contained on this survey is for informational purposes only.Research to obtain such data was performed at www.fema.gov. 9. All corners marked as set are at a minimum a Yz"diameter,18"iron rebar with a cap stamped LB#7337. 10.If you are reading this survey in an electronic format,the information contained on this document in only valid if this document is electronically signed as specified in Chapter 5.1-17.062(3)of the Florida Administrative Code.The Electronic Signature File related to this document is prominently displayed on the invoice forthis survey which is sent under separate cover.Manually signed and sealed logs of all survey signature files are kept in the office of the performing surveyor.If this document is in paperformat, it is not valid without the signature and original raised seal of a Florida Licensed Surveyor. 11.Unless otherwise noted,an examination of the abstract of title was NOT performed by the signing surveyor to determine which instruments,if any,are affecting this property. 12.The symbols reflected in the legend and on this survey may have been enlarged or reduced for clarity.The symbols have been plotted at the center of the field location,and may not represent the actual shape or size of the feature. 13.Points of Interest(POI's)are selected above-ground improvements which may be in conflict with boundary,building setback or easement lines, as defined by the parameters of this survey.There may be additional P01's which are not shown,not called-out as PON,or which are otherwise unknown to the surveyor.These POI's may not represent all items of interest to the viewer. 14.Utilities shown on the subject property may or may not indicate the existence of recorded or unrecorded utility easements. 15.The information contained on this survey has been performed exclusively,and is the sole responsibility,of Exacta Surveyors.Additional logo or references to third partyfirms are for informational purposes only. LEGEND: 5URVEYOR15 LEGEND BOUNDARYUNE AIC AIRCONDIT10NING D. IDDMMCA110N SEW. 5EM 13M BEARING RffHt2NGE INT. IRON ROD S.P. SQUARE.HO BUC BLOCK at IRON ROD 9/DH SLfi DRILL HOLE B.G. BLOCK CORNER IF IRON RPE SIRC SET IRON ROD 4 CAP STRUCTURE B.RL BUILDING RESTRICTION UNE L LENGM SN SCT NAIL 55W. BASEMENT LBO UCD=#-BU5INM 9114D SET NAIL DISC IYW DAY=WINDOW 150 UC;DW#-SUKVr= STY. STORY CONCRETE BLOCK WALL (C) CADCUTATFD M MEASURED S.T.L 5URVCY TIE UNE C CURVE N.R. NON RADIAL SV SUVER VALVE CHAIN-UNK m W_IRE FENCE CATV CABLE TV.RISER N.T.S. NOT TO SCALE SAN 50MAM WOOS FTNIX C.B. LONCLZEIE DLOM O.C.S. ON CONCRETE SLAB S.W. SEAWALL CHEM. CHIMNEY O.G. ON(ROUND TEL IMMICINE PAOUT S IRON PRICE C.L.P. CHAIN UK PO4CE O.H.L. 01 I= T.O.B. TOP OF BANK C.O. CLEAN OUT O.R.B. OFFICIAL RECORD BOOK TX TRANSFORMER IONIC. CONCRETE OH. OVERHANG Tyr. TYPICAL EDGE OF WATER C.V.G. COME VAUEY GUTTER QfA OVERALL W/C WITNE55 CORNER CA CENTER UNE CVS OFFSET WIP WATER FILTER WOOD CONCRETE 05 CONCRETE SLAB PKN PARKER-KAIDN NAIL W.P. WOODEN P01a CP COVERED PORGH PSM PRIXE9SIONALSURVEYOR WM WATER MCTPRIVALVE Box CSVW CONCRETE SIl7EWALIC AND MAPPER WV WATER VALVE BRICK m TILE COR CORNER PIS PROFESSIONAL LAND 5URVEYOR V.F. VINYL PENCE .ti (D) DE}D (P) PLAT DAY DRIVEWAY rX POOL EQUIPMENT WATER COVERED AREA D.P. DRAIN PSD RT PLANTER EUB EECfRIC UTIUTY am PP PINCHED PIPE ENCL ENCLOSURE P.B.ENPIAT BOOK T. ENTRANCE P.I. POINT OF INfCRSEGTON A.E. ANCHOR EA5EAEM w4wMARIE EO.P. EDGE OF PAVEMENT P.O.B. POINT OF BEGINNING C.M.E. CANAL MAINTNANCE®MT. CALL.o I CALCULATED POINT C.O.W. EDGE Of WATER P.O.C. POINT OF CO1vNIEIC:EM5U C.U.E. COUNTY LmuTY BMT. D CENTRAL ANGLE w DELTA fyL FENCE UNE P.T. POINT OF TANGENCY D.E. DRAINAGE PA9EMINT ♦ OCI IROL POINT PIP PENCE POST P.C. POINT OF CURVATURE I5MT. ME?AEM ■ CONCRETE MONUMENT (F) PIED P.C.L. POINT OF COMPOUND CURVATURE I.EUE.E. INGR 55,2GKt55 EDM f. CATCH BASIN P.P. FINISHED FLOOR MR.C. POINT OP REVERSE CURVATURE ERRE. IRRIGATION FA5EEMT ELEVATION EPL FLORIDA POWER 4 UGHT P.C.P. PERMANENT CONTROL POINT LAE. UMIIED ACCE55 F5MT. Y! FlRC FIYDRANI' I= POUND DRILL HOLE P.R.M. M. PERMANENT MICE MONUMENT LB.E. LANDSCAPE BUFFER E5MT. 0 MANHOLE FEPC FOUND IRON PIPE 4 CAP R RADIUS m RADIAL LM.E. LAKE OR LANDSCAPE PIRC FOUND IRON ROD 4 CAP (f0 RECORD MAINTENANCE EA50AENT is TREE FIR FOUND IRON ROD RFS. MWEMCE M.E MAINTOaNCE PA5CMPNT UTILITY OR LIGHT POLE PIT' POUND IRON PIPE RAV RIGHT OP WAY P.U.E. PUBUC UrUTY EA9EA W © wtu TCM TMD.CONCRETE MONUMENT (5) SURVEY R.O.E. ROOF OVOU ANG E51,!T. COMMON OWINMW FN FOUND NAIL 5.B.L SMACK UNE 5.W.E. 50EWAUC EA5EMET FN*D BUND NAIL 4 DISC 5.C.L SURVEY CLOSURE LINE 5.W.M.E.5TORM WATER W. FOUND 5CR. SCREEN MANAGEMENT E5MT. GAR. GARAGE SVDH SET DRILL HOLE I.U.E. TECHNOLOGICAL UTIUTY gMT. GM GAS METER SPP. SEPTIC TANK U.E. UTLIIY PA9E4EM ELECTRONIC SIGNATURE: PRINTING INSTRUCTIONS: OFFER VALID ONLY FOR: FEDERICO G.GONZALEZ In order to"Electronically Sign"all of the PDFs sent 1. While viewing the survey in Adobe Reader,select the by STARS,you must use a hash calculator.A free "Print"button under the"File"tab. online - - - - - --- -- -N calculator is available 2.Select a printer legal sized paper. r Sign survey 3.Under"Print Range",click select the"All"toggle. To Electronically I i Y Si 9 Y rveyPDF: 4.Underthe"Page Handling"section,select the number 1.Save the PDF onto your computer. 2.Usethe online tool at of copies that you would like to print. I POOL-FENCE •ADD IT ION, „i,I , , ;i,,, ,,,,,,,i„„,, .i,,,, _, ,,,, 5. Underthe"Page Scaling"selection drop down menu, to browse for the saved PDF on your computer. select"None.' 3.Select the Hash Method as SHA. 6. Uncheck the"Auto Rotate and Center"checkbox. O/O O ' 4.Click Submit 7.Check the"Choose Paper size by PDF"checkbox. Your PDF is electronically signed if all of the (UP TOg50q) characters in the SHA-11 code submitted by STARS 8. Click OK to print. ANY FUTURE matches the code which is produced by the hash TOPRINIINBLACK+YVHrrE: SURVEYING SERVICES calculator.If they match exactly,your PDF is 1. In the main print screen,choose"Properties". ION THIS PROPERTY electronically signed.If the codes do not match 2. Choose"Quality"from the options. I Offer voEd only for the buyer as listed on the exactly,your PDF is not authentic 3. Change from"Auto Color"or"Full Color"to first page of the survey. Total discount not to exceed$500. 'Gray Scale". - --- - - - ------j Exacta Land Surveyors,Inc. www.exactaland.com LB47337 P (305)668-6169• F(305)668.6325 12220 Towne Lake Drive,Suite 55•Ft.Myers,FL 33913