DEMO-16-2979 MIZk R 3�
Miami Shores VillageW., PeIT#1 1�riractll�n
10050 N.E.2nd Avenue NE I/1/oIt*0CBitort
Miami Shores,FL 33138-0000
Phone: (305)795-2204
r t q Pert /its
aR * 00"",
Expiration: 05/02017
Project Address Parcel Number Applicant
123 NE 97 Street 1132060132440
Miami Shores, FL 33138-2332 Block: Lot: JUAN R. DEL RIO
Owner Information Address Phone Celt
JUAN R.DEL RIO 123 NE 97 Street
MIAMI SHORES FL 33138-2332
123 NE 97 Street
MIAMI SHORES FL 33138-2332
Contractor(s) Phone Cell Phone Valuation: $ 215.00
HOME OWNER
.. _.w. . ..:..... _._.__.... _.m._„n__. Total Sq Feet: 176
Type of Demo:Building Available Inspections:
Additional Info:CAR PORT DEMOLITION Inspection Type:
Classification:Residential Final
Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# DEMO-11-16-61866
DBPR Fee $2.00 11/01/2016 Credit Card $50.00 $64.60
DCA Fee $2.00
Education Surcharge $0.20 11/02/2016 Credit Card $64.60 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
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 certifyApt at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio nd zory'ng. Fut e,I auth 'ze above-named contractor to do the work stated.
November 02, 2016
Authorized Signat-dPardwner / Applicant / Contractor / Agent Date
Building Department Copy
November 02,2016 1
4
v 1 CEIV D
Miami Shores Village NOV 012016
Building Department BY:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 �
BUILDING Master Permit No. �LmQ %I — b—Z 1 * I
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
ACONTRACTOR DRAWINGS
,
JOB ADDRESS: /V
City: Miami Shores �,�
County: Miami Dade Zip: L3�
Folio/Parcel#: -,3906 — 013—dL L1`,o Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): � V aAJ �'� / Phone#:K3 01 ,y V-0? 0
Address: l' I:
City: lrI Q m/ 0/,Ys State: �` �� Zip: 34)1.3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Ott)A)- Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration M Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 09 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteratio liw` ❑ New ❑ Repair/Replace CA Demolition
Description of Work: ue d 17 J
rue
Specify color of color thru tile:
Submittal Fee$ Q% Permit Fee$ tW-LO CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ s
(Revised02/24/2014)
ti
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
—6&OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day C&
dV'e MiCr2 r 20 Lb ,by day of 20 by
lXa�n ���D trek wh its personally known to who is personally known to
me or who has produced �C��Pe Y l 1 C�eng-c as me or who has produced as
identification and who did take an o identification and who did take an oath.
NOTARY P U NOTARY PUBLIC:
Sign Sign:
Print: p Print:
ziY ei YANADY PRIETO
Seal: = �= NIYCOMMISSION#FF214031 Seal:
=m EXPIRES:March 25,2019
Bonded Thru Wt"Public Undenxrlters
�x�**rix**r�**�*�***�•��x**�xws�e�**pix x�*x�* *�*®wx��x**�*��*+kx��r**x�***�x**��r�r***mx�s�***��x�x�*a�**��x****aux*�***a�*+k**x�*�x�
�K
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
stns Miami Shores Village
pm Building Department
10050 N.E.2nd Avenue
Ri Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
OWNER BUILDER DISCLOSURE STATEMENT
/ f
NAME: iq k• di + 4" DATE:
ADDRESS:�d► ' A/9 j'7��-5 tr't le �!►'�P a r�s. I �
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 entities 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 under nd 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 outbuil . elmay 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 s d 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,w h 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 roqg on my building or residence.It
is my responsibility to ensure that the persons whom I employ have the license required bylaw and by co n 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.1,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
9. I agree that,as the party legally and financially responsible for this proposed Construction activity,I wil 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 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/cilbAndex.html
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:
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the in rmation 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 Sk day of 110"v-etmb-er , 20
By r )UCkn 9CSSY---zk1do 64k R;o who was personally known to me or who has
Produced there License or as Iden ati
4r MY COMMISSION WY rF 214031
EXPIRES:March 25,2019
Bonded Thru Notery Public Undenwitem
-CrWNER N
129 N.*..et 97th;
8Y DATE
ZOMNS DEP
BLDG DEPT
S UBJECT 10 CG, ,IPI.IV`1`ICE W1 r1 ALL F E AL 10
STa,TE ANL)UU.11Y
_ _t Te PROPERTY FRONT VIEW
CERTIFIED TO: FLOOD INFORMATION:
JUAN ROSBALDO DEL RIO Community Number: VILLAGE OF MIAMI SHORES
FIDELITY NATIONAL TITLE INSURANCE COMPANY 120652
COLUMBUS CAPITAL LENDER LLC Panel Number: 12086CO302L
ITS'SUCCESSORS AND/OR ASSIGNS AS THEIR Suffix: L
INTEREST MAY APPEAR. Date of Firm Index: 9/11/2009
Flood Zone: X
Base Flood Elevation: N/A
Date of Survey: 8/16/2016
LEGAL DESCRIPTION: LOT 17, LESS THE WEST 6.7 FEET THEREOF,AND ALL OF LOT 18, BLOCK 18,AN
AMENDED PLAT OF MIAMI SHORES SECTION NO. 1,ACCORDING TO THE MAP OR PLAT THEREOF,AS RECORDED
IN PLAT BOOK 10, PAGE 70, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
PROPERTY LINE Surveyor's Legend ;•••;•
STRUCTURE
CONK.BLOCK WALL Esq 4.TREE L.M.E. LAKE or LANDSCAPE MAINT.ESMT. ••ENT• EA Iwi •
••• •
X— CNNN—LWK or FENCE i P.P. POWER POLE R.O.E. �OVERP.P.
EASEMENT •• • 000••
PUMPLAE. LANDSCAPE BUFFERTESMT. ••
WOOD FENCE ®C.e. CATCH BASIN PL PLANTER OR PROPERTY LINE ••G • LIMITED ACCESS EASEMEN? •
C.U.E. COUNTY UTILITY ESMT. I.D. I�ITIFICATOXV •$�,• TEI.FPt -F�CUIES ;*see;
o- �— Di01d FENCE LE./EE. INGRESS/EGRESS lA/T• B.C. BLOCK CORNER • U_.FT. • UTDIZY •
U.E. UTILITY EASEMENT •IL" ELEC7fW@ FAM BOX •••••
— ——— EASEMENT FPD).OR F FOUND IRON PIPE/ BA BEARING REFERENCE SFP71C TANK • •
CENTER UNE PMI AS NOTED ON PLAT CENTRAL ANGLE or DELTA SEP.••S P•. • •••••
LBO LASE _BUSI
NESS R RECORD OR RADIUS fIIA�I��'y A1
LSB LICENSE B-SURVEYOR RAD. RADIAL •• • e A ••••••
® WAD DECK CALL CALKXlLAlEO POINT ICR. NON
SET SET MONUME14T TRP. TYPICAL RADIAL ;•SOLIKW*• SCR E N • ••
CONCRETE ♦ COMROL POINT LR. IRON ROI) • @ ; SCREEN • ••••••
■ CONCRETE MONUMENT I.P. IRON PIPE
ELEV ELEVATION N&D NAD'&DISK • •• • •
:. ASPHALT P.T. POINT OF TANGENCY PK NAD. PARKER-KALON NAE. • 6, • NOT SCALE ••••••
rf�� P.C. POINT OF CURVATURE D.H. DRILL HOEWEL •i F. • FlNT41t�1F7 i • •
T.O.B. TOP40F BANK
AN HOLE E/P OR E.O.P. EOPAVEMENT
BRICK/TILE P.R.M. PERMANENT REFERENCE MONUMENT W FOE HYDRANT E.O.W. EDGE&'•WA"
P.C.C. POINT OF COMPOUND CURVATURE M
PRC. POINT OF REVERSE CURVATURE O M.N. MAN
WATER QHL OVERHEAD LINES C.V.D. CONCRETE
E VALLEY LITTER
P.O.B. POINT OF BEGINNM TX TRANSFORMER B.S.L. BUILDING SETBACK UNE
P.O.C. PMT OF COMMENCEMENT CATV CABLE TV.RISER S.T.L. SURVEY TIE LINE
APPROXBAAIE EDGE WATER PM.C.P. PERMAN CONTROL POINT W.M. WATER METER FIELD MEASURED P/E POOL EQUIPMENT Rq CENTER 1 WAY
P PLATTED MEASURMENT CCNC CONCRETE SLAB R.O.E. PUBLIC UTILITY EASEMENT
® COVERED AREA D D® C.M.E. CANAL MAINTENANCE EASEMENT
C CALCULATED AZ ANCHOR EASEMENT
GENERAL NOTES: , !)
1) LEGAL DESCRIPTION PROVIDED BY OTHERS. j
2) EXAMINATION OF THE ABSTRACT OF TITLE IMLL HAVE TO BE MADE TO
DETERMINE RECORDED INSTRUMENTS,IF ANY,AFFECTING PROPERTY.
3) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENT OR —
OTHER RECORDED ENCUMBERANCES NOT SHOWN ON THE PLAT.
4) THE PURPOSE OF THIS SURVEY IS FOR USE IN OBTAINING TITLE INSURANCE
AND FINANCING AND SHOULD NOT BE USED FOR CONSTRUCTION,PERMITTING PepeHmft
DESIGN,OR ANY OTHER PURPOSE WITHOUT THE WRITTEN CONSENT OF Printing to Scale: 5a+M I c ❑col.
ONLINE LAND SURVEYORS INC.
5) UNDERGROUND PORTIONS OF FOOTINGS,FOUNDA77ONS OR 077-IER 1, Sefect'None'lrom Page Scaling T
IMPROVEMENTSWERENOTLOCATED. 2, Deselect Auto-Rotate and Center` @MW&Aamfe&mTCmW
6) ONLY VISIBLE AND ABOVE GROUND ENCROACHMENTS LOCATED. 3. SelectChoose paper source by
7) FENCE OWNERSHIP NOT DETERMINED. @07 by PDF pwft
8) WALL TIES ARE TO THE FACE OF 774E WALL. PDF page size"
U.—t..PBPB 9FC n'hCl h-edetl
9) BEARINGS ARE BASE ON AN ASSUMED MERIDIAN.
10) BOUNDARY SURVEYMEANS A DRAWING AND/OR GRAPHIC REPRESENTATION
OF THE SURVEY WORK PERFORMED IN THE FIELD,COULD BE DRAWN ATA IELD WORK 811512016
SHOWN SCALE AND/OR NOT TO SCALE.
11) NO IDENTIFICATION FOUND ON PROPERTY CORNERS UNLESS NOTED. �WN BY. V P
12) NOT VALID UNLESS SEALED IMTH THE SIGNING SURVEYORS EMBOSSED OR 4�ptt vl C F
ELECTONIC SEAL. NECKED BY: M.E
13) DIMENSIONS SHOWN ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN.
14) ELEVATIONS IF SHOWN ARE BASED UPON N.G.V.D.1928 UNLESS OTHERWISE
NOTED. lNAL REVISION: 0811612016 II,. s101
16) THIS IS A BOUNDARY SURVEY UNLESS OTHERWISE NOTED.
16) THIS BOUNDARY SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF OMPLETED: 811612016
THE ENTITIES NAMED HEREON,THE CERTIFICATIONS DO NOT EXTEND TO A �s coRt Dp e
UNNAMED PARTIES �, 1"=20' s�°fit sulrAtYDR
VENCOD I i'II 0-28105 904
15271 NW 60 AVE,Suite 206
Miami Lakes,91 33014
-0123
Phone:(305)910-0123
SURVEYORS,INC. Fax:(305)675-0999
www.OnlineLandSurveyors.Com
Survey Date:8/16/2016 Survey Code:0-2810 Page 2 of 2 Not valid without all pages.
LOT 13 LOT 12 j LOT 11 LOT 10
BLOCK 18 BLOCK 18 BLOCK 18 BLOCK 18
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F.LP. 1/2� 11.50' o• rq F.I.P. 1/2" —
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COMMON WALL �' LOT 18 LOT 18
a LOCK 18 BLOCK 18 N
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1 inch = 20' ft. 50 r- CONC 9°70' n
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REMAINDER OF "0•83c 4
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LOT 17 0 11.50' Q�' ONE STORY O BLOCK 18
BLOCK 18 p I RESIDENCE 0.70 Q
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:::......—..:.'.................'....-.-......-----------
::::::::.::::::::::::::::::::::::::':'::::::::::.:::::::::::: N.E. 9'7th STREET...:::::.::•:::. :::::::::::: :::::::::::::::::::::::::
.................'.......................................................'....'............................
...........................................................................................................
INT O NTEREST:
ONC DRIVE CROSSES LOT LIN�E..•� /� �/SURVEY
a+r®`�Cv
MAP OF BOUNDAR 1 SU i/G i 1 HEOF A SURVEY
THAT THIS BOUNDARY SURVEY'1S A TRUE
AND CORRECT REPRESENTATION OF A SURVEY PREPARED UNDER MY DIRECTION-THIS
COMPLIES WITH THE M1Nl STANDARDS,AS SET FORTH BY THE STATE OF
FLORIDA BOARD OF SIONAL S S AND MAPPER IN CHAPTER 5.I-17.051,FLORIDA
Prgmrty Address: ADMINISTRATIVECo UANT TO SE 472027,FLORIDA STATUTES.
123 NE 97 ST RSIF 1
` e
MIAMI SHORES, FL 33138
No. 5101
®® STATE 0 �4
l®O ■eLand �l^ FCORI O.P. QQ
SIGNED `�'S. � FOR THE FIRM
MIGUEL ESPWO sup P.S.M.No.5101
SURVEYORS,INC. STATE OF FLORIDA
15271 NW 60 AVE,Suite 206 NOT VALID WITHOUT AN AUTHENTIC ELECTRONIC SIGNATURE AND AUTHENTICATED
Miami Lakes,FL 33014 ELECTRONIC SEAL AND/OR THIS MAP IS NOT VALID WITHOUT THE SIGNATURE AND ORIGINAL
RAISED SEAL OF A LICENSE SURVEYOR AND MAPPER.
wwwr.OnfineLandSurveyors.Com
Survey Date:8/16/2016 Survey Code:0-28105 Page 1 of 2 Not valid without all pages.