FW-14-2577 Alta
Miami Shores Village y
10050 N.E.2nd Avenue NE g _ •• ''
� Tli�c�r'kCtasstfi�a#rt�n. a e,
^' Miami Shores,FL 33138-0000
PermitStatux
Phone: (305)795-2204
816124. Expiration: 12/05/2015
Project Address Parcel Number Applicant
166 NE 98 Street 1132060132330
Miami Shores, FL 33138- Block: Lot: TODD LEONI
Owner Information Address Phone Cell
TODD LEONI 165 NE 98 Street
MIAMI SHORES FL 33138-
PO BOX 381703
MIAMI FL 33238-
Contractor(s) Phone Cell Phone
Valuation: $ 1,000.00
HOME OWNER
Total Sq Feet: 65
Approved: Available Inspections:
Comments: Inspection Type:
Date Approved:
Final
Date Denied:
Foundation
Type of Construction:Wood Fence Additional Info:PLACE WOODEN FENCE ON BACK Review Planning
Classification:Residential Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# FW-71-14-53690
DBPR Fee $2.00 11/24/2014 Cash $50.00 $69.60
DCA Fee $2.00
Education Surcharge $0.20 06/08/2015 Credit Card $69.60 $0.00
Notary Fee $5.00
Permit Fee-Wire&Wood $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $119.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
L B
required for ELECTRICAL, UM ING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I rtify that alGheoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. u hermor Ihe above-named contractor to do the work stated.
June 08, 2015
Authorized Sign t re:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 08,2015 1
CNBV 24 2014
Miami Shares Village BYo
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20 0O
BUILDING Master Permit No.ev 'Sj7
PERMIT APPLICATION Sub Permit No.
ro�BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION XTENSION ❑RENEWAL
[]PLUMBING E] MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 165 N E 98th St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Lot 23 & E 1/2 of Lot 22, Block 17 Is the Building Historically Designated:Yes NO x
Occupancy Type: Res Load: Construction Type: Flood Zone: x BFE: n/a FFE:
OWNER:Name(Fee Simple Titleholder);Todd Leon! Phone#:305-300-4192
Address:165 NE 98th St
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Alison Baker& David Massey Phone#:
Email: alison_p_baker@yahoo.com
CONTRACTOR:Company Name: n/a ®w Pwl ze— Phone#:
Address:
City: State.• Zip:
Qualifier Name: Phone#:
Staff Certification or Registration#: Certificate of Competency M
DESIGNER:Architect/Engineer: n/a Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$1000 Square/Linear Footage of Work: 65'linear
Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition
Description of Work: place wooden fence on back of property, inside of existing chain link fence
Specify color of color thru file:
Submittal Fee$ 2 Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Training/Education Fee Double Fee
Technato Fee$ $ $
I;Y
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ °
(RevisedO2/24/2014)
s
'i
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$1500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is subject to a tochment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whicIf occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be Tjalnst.
fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing Instrume t w s acknowledged before me this The foregoing Instrument was acknowledged before me this
day of 20 by day of P20 by
wh ' personally know o who is personally known to
me or who has produced as me or who has produced as
3
identification and who did take an oath. identification and who did take an oath.
OTARY PUBLI NOTARY PUBLIC:
2
Sign Sign:
Print: ,:4r. . Print:
Seal: Seal:
ail
APPROVED BY Plans Examiner �H C�Zonln
g
i
Structural Review Clerk
(Revised02/24/2014)
w
Miami Shores Village
all Building Department
10050 N.E.2nd Avenue
R� Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant, F' " )06M ,does hereby attest that
(Property owner)
The attached survey,performed by 06,12� �—,%J C
/ (Name of surveyor's company)
For address: +� tj C CIS C/-1-
Performed on 0 (date of survey)is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to Issue a building permit for the property
without first providing a survey less than seven(7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures
m affect final Inspections as applicable to this or other permits.
Further,Affi t say r
Property Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this '9 day of
Affiant is rsonally known tom , roduced as identification.
ANDREW VOXEL
MY COMMISSION 0 M130M
EMM:NOW*003,2015 Notary
1 ABY n Nobly Dlt OM AIM Co.
Rev6W on 50M/Revised on W120
I�
Ste.° Miami Shores Village
nu wn
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204.
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT / //
NAME: �� f� "v' J DATE: �( �Z� b y
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 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.
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�C,,-
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 hich violates the exemption.
Initial
5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. f ,
Initialy
6. I understand that I may not hire an unlicen§ed 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 coynty or municipal ordinance.
Initial(V
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 acting as an owner-builder and am aware of the limits of my insurance
coverage for injuries to workers on my property. ,�
Initial_ (-I-
8.
./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_ ! ��
9. 1 agree that,as the parry 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.
v
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 http://www.myforidalicense.com/dbpr/pro/cilb/index.htmi
Initial ' I
11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that IIaam the party
legally and financially responsible for the proposed construction activity at the following address: / '
Initial 1 y
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. I
(/
Initial 1 v
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 U111 20
By B Zle?1222 who was personally known to me or who has
Produced there License or as identification.
I
IJP Public State of Florida
OWNER OTA jr��rtfl8 M FetlGlano
My C-6ri rnlnelon FF 082753
E(Oft8 X1 11121201
11 212 0 1 8
Fences Good Side Out, The veQioal and horizontal
-- supporting members of a Woo shall face the
R.UVW-1 TV interior of the plot on AM tho fence Is located
NOV �8�4
and the finished side shall face the adjoining
let or an ab_wttin rl ht=cf-way,
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N. E. 98th STREET
Accepted By:
Property Address: 165 N.E.98 STREET NOTES:NO NOTES
MIAMI SHORES,FL 33138
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SIGNED FOR YH!POW MKM I,FL 33167
PHONE:(306)740.3318
bow' P.SAL No.6101 FAX:(305)869-3190
NOT MXIONRROOT 81Y WWANDAVDEMWWT6D tMTRO"SM AMMON
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Property Address: Viral Notes:
1The Lope!Description used to perform f*survey was supplied by others.
itsN.E. survey does not detamfte cr is not to Imply ownarshlp.
MIAMI SHORES,FL 33938 2. This mom only shows above ground improvements. Underground
utioties,footings,or onaoachrae its are not located an ft survey map,
3. It there is a septic tank,wen,or drain geld on this suture His location of
Flood Information! 14
darns was sham to us by others and the Wonnattal was not vw Med.
a. EEamtrre6on or the abstract of ttk colo have to be meds to determine
recorded insvumems,if any,arfed this property.The lands sham herein weft
Community Number: 120852 not abslracaed for easement or oftriscorded encumbrances not sheen on
Panel Number. 1208600302 the plat.
6. Wall gas ate done to the face of the wao.
Sttffig: L 6. Fence ownsrafdp Is not determined.
Date of Frio Index: 9/11/2008 7• aearinga referenced to one noted S.A.
8. Dimensions sham are planed and measures units*otnemise snow.
Flood Zona: X 9. No identification found on property comers unless noted.
Base Flood Elevation: NIA 10. Not vasa unless sealed Wth the signing surveyors embossed*eat.
11. Aoundary survey means a drawing aftwer glephic(epre*entallm Of Ule
Date of Feld Work: 4/3/2014 survey work pedmmed in the field,could be dram at a shown scale and/or not
Dale of Completion: 4/10/2014 toy
12. Elevagms g shoam are based upon NCiVD 1tt20 Carless outenvisa noted.
13. Tlda Is a BOUNDARY SURVEY unless ottterwiso noted.
14. This survey is exdueive fur the use of the parties to whom it is certiffed.
The cefugcadons do rot mdend to any unnamed par w.
Legal Description:
LOT 23&THE EAST 1/2 OF LOT 22,BLOCK 17,OF SUBDIVISION MIAMI SHORES SECTION NO.I.,ACCORDING TO
THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10,PAGE 70.OF THE PUBLIC RECORDS OF MIAMI-DADE
COUNTY,FLORIDA
MOM ra:73MD MR,TRUITE W57 mo;
ER NTI� NG INSTRUCTIONS: ASHLEY TITLE COMPANY;OLD REPUBLIC NATIONAL TITLE
While viewitlg the survey in any Acrobat Reader, INSURANCE COMPANY;;.Its'successors and/or assigns as their
select the File Drop-down and select"Print" Interest may appear. i $
Select a color printer,K available.or at least one with I
8.6"k 14°paper. ! i
Select ALL for Print Range,and the#of copies you
would like to print out, ease py ave oro y repaf8 on urposes only:
Under the"Page Scaling"please make sure you have E do*srmt aeanaror byreasoa r ex r
Any 69N&easements6A*rests*r�ta+s fimmay cast byrossmofaraftway,me
selected'None.° WapLvfigfAcr*atownanthasraveypreper*tlDy MGUPLEca MSA MedI
Do not check the"AutoRotate and Center"button. a0/(M14 beannp Job it 4AZUZ
Check the"Choose Paper size by PDF"checkbox. c NO NOIES
Click OK to Print
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M.E.Land Services, Inc. j
10666 SW 190TH Street,Suite 3110 MIAMI,Ft.33167 s'
PHONE:(306)740-3319 FAX#:(305)659.3190 LS#6483 } r
WWW.MELANDSERVICES.COM
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