FW-16-892 Miami Shores Village -Z,
Building Department APR 01 016
10050 N.E.2nd Avenue,Miami Shores, Florida 33138 nv
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
F�BC 20 1k—I 3161
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
2SOUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: G o. Lc f�� / St'
Citv: Miami Shores County: Miami Dade Zip: 3
Folio/Parcel#: Is the Building Historically Designated:Yes NO_Lll�
Occupancy Type: Load: Construction Type: /2 Flood Zone: BFE: n FFE:
OWNER: Name(Fee Simple Titleholder): I CP�r Phone#: ®S�, / J 9'0 2-3 S^
Address: S11-
City: l94 !�'L 0 r-e 5 State: Zip: �731 3k
Tenant/Lessee Name: Phone#:
Email: ✓UrLke-coa- cC)- i4o
L �� vim►
CONTRACTOR:Company Name: [ �_t t3eA-, l rowi&e r Phone#:
Address: S,&_i,*Lc_ eN_� A)6o Ue—
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
o®
Value of Work for this Permit:$ &00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration / ❑ New ❑ Repair/Replace /❑ Demolition
Description of Work: fe KC t. °���r T�do� ® '� weS S/ e �y � jR�ciS-�
—21 Et3
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ )O d 03 CCF$ 0- 60 CO/CC$ �
Scanning Fee$ Radon Fee$ DBPR$ Notary$.
Technology Fee$6 • E)C*) Training/Education Fee$b, rD_0 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
pwm
�s*4Wtom yMiami Shores Village e T F'nC /Wall
10050 N.E.2nd Avenue NE
Work Classification.-Wood Fili 8
... An
Miami Shores,FL 33138-0000
Phone: (305)7952204 'li $U�:'A �RVE ��.
issu t�:41612016,, Expiration: 10/03/2016
Project Address Parcel Number Applicant
1015 NE 97 Street 1132050170120
Miami Shores, FL 33138-2555 Block: Lot: ROBERT BAILEY
Owner Information Address Phone Cell
ROBERT BAILEY 1015 NE 97 Street
MIAMI SHORES FL 33138-2555
Contractor(s) Phone Cell Phone Valuation: $ 400.00
HOME OWNER
Total Sq Feet: 95
Approved: Available Inspections:
Comments:
Inspection Type:
Date Approved:: Final
Date Denied: Foundation
Type of Construction:Wood Fence Additional Info: Review Planning
Classification:Residential Scanning: 1 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# FW-4-16-59265
$2.00 04/01/2016 Cash $50.00 $63.60
DCA Fee $2.00
Education Surcharge $0.20 04/06/2016 Credit Card $63.60 $0.00
Notary Fee $5.00
Permit Fee-Wire&Wood $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $113.60
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
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify th I the foregoing info on is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fut e, I a rize t o amed contractor to do the work stated.
April 06, 2016
Authorize Signature:Owner / roov� Contractor / Agent Date
Building Departme
April 06, 2016 1
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 AGE CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1
day
22of��Aea"-- 20 I(7 , by day of .20 ,by
1311 1r -' ,who is personally known to who is personally known to
me or who has produced f:2-�L� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUB` Q,�
` \Np\yp1��0 / NOTARY PUBLIC:
Sign:
'Sign:
Sign:
oi
,
Print: -�i t Print:
PO Seal: •.s//�/•(.�/eyW� ` :mac) Seal:
W
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
r
p �
5�!Os Miami Shores Village
.,, an Building Department
10050 N.E.2nd Avenue
RmAy Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: VOL 4 I\t— le�&,. ►4 le DATE: �/ 2-®f
ADDRESS: L®/S—/VE 27
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
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 cc7onntr cts,
Initial I/`9 '
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 1
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
j
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 compensation for the employee.I understand that my failure to follow
these may subject to serious financial risk.
Initial
—46
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-46
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.htmi
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:
Initial 1�6
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 ` day of ,LP(IZA - , 20 1 4'
By R n I who was personally known to mpoWlFKW1) S
`SON by
gF 0QS'�
Produced there License or i7:04W2 ,�m• Ic tiqbX
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Miami Shores Village
Cl : R=25•St) 0000
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n APPROVED By DATE
•�•••• A=49.20' ZONING DEPT
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'••.•• •••• SLIR.IFCT TO COMPLIANCE WITH ALL FEDERAL
09• • • • • STATF AND COUNTY RULES AND REGULATIONS
:4:60:
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Fences Good Side Out. The vertical and horizontal
• • ' T 4 130ang members of a fence shall face the °
•••••• error Of the Int on ul� �
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and the fin�she�I : I hich the fence is located
•:'• I ,I,.P s "II face fila uG'jpinii�g
lot or any abutting riUht.ef.wQ
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NOTE: BUILDING SETBACK LINES (B.S.L.) SHOWN HEREON =ALE '=201 SKETCH NO.: 06-2969
ARE PER DAVE WITH THE CITY OF MIAMI SHORES
PLANNING AND ZONING DEPARTMENT 0 305-759-2207. DRAWN BY: K.W. SIDE 2 OF 2
THIS INFORMATION IS NOT GUARANTEED AND SHOULD BE VERIFIED.
IN.NELL rtS UR VES INC. g...:.
2151 WEST A LtSBORO BLVD.,SUITE 206 ' •••• •
n DEERFIELD BEACH,FLORIDA 33442 •• 1115 WES�'4FFH STREET 9
(954){18494(' -FAX(954)418=4941 ••6 s JiOUSTd AINAAS 77MOo•:•
CERTIFICATE NO.:LB6857 •4'1$)$80-0808 4W713)8Q2-1221,
SURVEY ADDRESS: CERTIFY TO. •••' •••• 60000
•,6666
69.06. 6666 666.6
IQ15 N.E.97TH STREET 1.ROBERT BAILEY *0 00• • 11000 •
MIAMI SHORES,FLORIDA 33138 2... :60:0: • g 9
3.
4. 0 :.0.:9 9.99..
FLOOD ZONE&ELEVATIONS:
. . .0000.
FLOOD ZONE:X/AE •• • •••• 9 9
BASE FLOOD ELEVATION:8' 0600
CONTROL PANEL NO.:120652-0093-J
DATE OF FIRM INDEX:07/17/95 POTENTIAL ENCROACHMENTS:
1.ONE STORY C.B.S.RESIDENCE IN VIOLATION OF 25 FOOT BUILDING SETBACK
LOWEST FLOOR ELEVATION:11.61' LINE ALONG THE SOUTHERLY PORTION OF THE SUBJECT PROPERTY.
GARAGE FLOOR ELEVATION:N/A
REFERENCE BENCHMARK.
R,ES.#1260 N.E.97TH STREET,
FINISH FLOOR ELEV.=8.33'
LEGAL DESCRIPTION:
LOT 12,BLOCK 180 OF"MIANU SHORES VILLAGE",ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 43,AT PAGE 51
OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY,FLORIDA.
LEGEND&ABBREVIATIONS:
A —ARC ESMT. =EASEMENT P.B. =PLAT BOOK
A/C =AIR CONDITIONER ELEV. =ELEVATION P.C. —POINT OF CURVATURE
A.E. =ANCHOR EASEMENT E.M. =ELECTRIC METER Pl —POINT OF INTERSECTION
ASPH.. =ASPHALT FND. =FOUND P.R.C. =POINT OF REVERSE CURVE
B.M. =BENCHMARK F.P.&L. =FLORIDA POWER&LIGHT P.T. =POINT OF TANGENCY
B.C.R. —BROWARD COUNTY RECORDS I.P. =IRON PIPE P.O.B. =POINT OF BEGINNING
C.B.S. =CONCRETE BLOCK STRUCTURE I.R. =IRON ROD P.O.C. =POINT OF COMMENCEMENT
CHATT. =CHATTAHOOCHEE L.B. =LICENSED BUSINESS P.P. =POWER POLE
CONC. =CONCRETE L.P. =LIGHT POLE R —RADIUS
G.L.F. =CHAIN LINK FENCE M.H. =MANHOLE RES. =RESIDENCE
C.L.P. =CONCRETE LIGHT POLE (NI) =MEASURED R/W =RIGHT-OF-WAY
(C) =CALCULATED MAINT. =MAINTENANCE T =TANGENT
C.B. =CHORD BEARING NO. =NUMBER (TYP.) =TYPICAL
C.R. =CABLE RISER N.G.V.D.=NATIONAL GEODETIC VERTICAL DATUM U.E. =UTILITY EASEMENT
(D) =DEED O.H. =OVERHANG W.F. =WOOD FENCE
D.B. =DEED BOOK O.R.B. =OFFICIAL RECORDS BOOK W.M. =WATER METER
D.C.R. =DADE COUNTY RECORDS O/S =OFFSET L =DELTA OR CENTRAL ANGLE
D.E. =DRAINAGE EASEMENT (P) =PLAT E =CENTERLINE
ENCH. =ENCROACHING P.B.C.R. =PALM BEACH COUNTY RECORDS =ELEVATION
GENERAL NOTES: CERTIFICATION:
1.TYPE OF SURVEY:BOUNDARY THIS IS TO CERTIFY THAT I HAVE RECENTLY SURVEYED THE
2.THE PROPERTY SHOWN HEREON WAS NOT ABSTRACTED FOR PROPERTY DESCRIBED IN THE FOREGOING TITLE CAPTION AND
OWNERSHIP,RIGHTS-OF-WAY,EASEMENTS OR OTHER HAVE SET OR FOUND MONUMENTS AS INDICATED ON THIS
MATTERS OF RECORD BY PMNELL SURVEY,INC. SKETCH AND THAT SAID ABOVE GROUND SURVEY AND SKETCH
3.UNLESS OTHERWISE NOTED,FIELD NSA qU RFMFNTS ARE IN ARE ACCURATE AND CORvECT TO THE BEST OF MY KNOWLEDGE
AGREEMENT WITH RECORD MEASUREMENTS. AND BELIEF.I FURTHER CERTIFY THAT THIS SURVEY MEETS
4.THIS SURVEY IS NOT VALID WITHOUT THE SIGNATURE AND MINIMUM TECHNICAL STANDARDS UNDER RULE 61G17-6,
THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED FLORIDA ADMINISTRATIVE CODE,ADOPTED BY THE FLORIDA
SURVEYOR AND MAPPER STATE BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS.
5.ELEVATIONS SHOWN HEREON(IF ANY)ARE BASED ON THE
NATIONAL GEODETIC VERTICAL DATUM OF 1929,UNLESS
OTHERWISE NOTED.
6.UNDERGROUND]MPROVEMIIQTS AND UTII.ITIES ARE NOT
LOCATED. y
7.BEARINGS SHOWN HEREON(IF ANY),ARE REFERENCED TO
THE BEARING SYSTEM USED ON THE SUBDIVISION AS JASON H PINNELL
REFERENCED IN THE ABOVE LEGAL DESCRIPTION. PROFESSIONAL SURVEYOR&MAPPER
8.FENCE OWNERSHIP IS NOT DETERNENED. g., ° LICENSE NO.5734,STATE OF FLORIDA
F S TCH NO.:06-2969
DATE OF SURVEY:09/14/06,'.CHECKED BY:Y.T.
ADD BUILDING SETBACK LINES 11/26/08 FIELD BOOK/PAGE:243/64
UPDATE SURVEY(08-1715 11/14/08 S.A
REVISIONS DATE CHK'D BY SIDE 1 OF 2