DS-16-2076 3
Miami Shores Village #8l??tlt 7 j� "'N"AP ya
�► 10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
127 Expiration: 01I 2017
Project Address Parcel Number Applicant
1058 NE 98 Street 1132050180330
PETER EPSTEIN
Miami Shores, FL 33138-2506 Block: Lot:
Owner Information Address Phone Cell
PETER EPSTEIN 1058 NE 98 Street
MIAMI SHORES FL 33138-2506
Contractor(s) Phone Cell Phone $ 7,000.00
HOME OWNER Valuation:
Total Sq Feet: 1200
Approved:In Review Available Inspections:
Comments:
Date Approved::In Review LInspection Type:
Date Denied:Type of Work:REPLACEMENT OF EXISTING DRIVEWAY Additional Info: nning
Bond Retum: Classification:Residential lding
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# DS-7-16-60725
CCF $4.20 07/27/2016 Credit Card $629.70 $50.00
DBPR Fee $2.25
DCA Fee $2.25 07/25/2016 Credit Card $50.00 $0.00
Education Surcharge $1.40 Bond#:3167
Notary Fee $5.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $679.70
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction=ytllerm re,I authorize the above-named contractor to do the work stated.
July 27,2016
Authorized Signature:Owder / Applicant / Contractor / Agent Date
Building Department Copy
July 27,2016 1
1� Miami Shores Village
A �
�,N Building DepartmentJUL 2 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 7BY.-
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20H Sol
BUILDING Master Permit Nd-
PERMIT
oPERMIT APPLICATION Sub Permit No.
UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
��QQ CONTRACTOR DRAWINGS
!�
JOB ADDRESS: ® � � 6+
^ i
City: Miami Shores County: Miami Dade Zip: 33130
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): —?E 11� Phone#: Za6 -U` - 0 7,4-3
Address:
City: t-�I R-N-L State: ��- Zip: 3 7a/,3 CP
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: C2w r\\,(- Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip-
Value of Work for this Permit:$ 45w® Square/Linear Footage of Work: Zac&
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: f r Jo- l ,
Specify color of�color thru tile:
Submittal Fee$CJ�-° `2 Permit Fee$ 1'3) CK
CCF$ CO/CC$
Scanning Fee$ C� Radon Fee$ ;Z ° 3-' c D�BPR$ Z)" Notary$ ` P�
Technology Fee$ G - Co Training/Education Fee$ 1 ' �1 d Double Fee
Structural Reviews$ Bond$ ®` W
TOTAL FEE NOW DUE$ - -90
(Revised02/24/2014) 62— 9 > _�O
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 r ' spection fee will be charged.
Signatur Signature
OWNER o AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2 1i day of 20 ,by day of ,20 by
V,e�'er f10L'avCl in who is pryersonally known to ,who is personally known to
me or who has produced C`��r tai CcQ Y\3 Q as me or who has produced as
identification and who did take an th. identification and who did take an oath.
NOTARY BLI NOTARY PUBLIC:
Sign: Sign:
1
Print: Print:
„.v
4
Seal: 3�..��Yi'Y% Y YPRIEro
MY COMMISSION 9 FF 214031 Seal:
i she. BondedTnro MUuyPMarch 25,2019
Pubic UrelBnwrlt¢B
AAPPROVED BY Plans Examiner AZoning
Structural Review Clerk
(Revised02/24/2014)
7
T
r
Miami Shores Village
,,, on Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305) 756.8972
OWNER BUILDER D,ISfCLOSURE STATEMENT
NAME: Z / n7r-f/'® DATE:
ADDRESS: e F-e —
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.
nitial3. 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— 2-e
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-
6.
nitial6. 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-,byy�county 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.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.
Initialpe
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 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_
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/dbr)r/pro/cilb/index.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:
Initial eg
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 U 1 20 16
By pe+T r f}W CAt d Y-\ who was personally known to me or who has
Pr there se or iv,-e` L I, C identification.
L •,y v,,,,, YMADY PRIETO
N R N Y MY(X)A�I+IISSM#FF 214031
EXPIRES:March 25,2019
v�,%lf;h4'P'. awded Thru Nctmy Public undewitem
i
Miami shores Village
KEEN Building Department
10050 N.E.2nd Avenue
baa.. Miami Shores, Florida 33138
lORIDA Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant, �" &P.3 7N,does hereby attest that
(Propertyowner)
The attached survey, performed by
(Name of surveyor's company)
For address: / 06-9 Al E- 2 9"- '6+ ,
Performed on (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 may affectfikal inspections as applicable to this or other permits.
urther
Property Owner Si6nature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this ay of v
Affiant is personally known tome,—°L-produced-Dr; ation.
�,,y�•.,, ypimy PRIETO
1A MY CANIMIssION i 2 21403181 otary
Revised on 5/22/2009/Revised on 6/12/09 ,• = EXPIRES'M Pubrx�� �
9°"dedThro t Y
•
Mls don: RING Scaft
To protect,pronate&irrprooe the health Gmernor
people through integrated
state,
all a in Florida conTw*efforts. 1 tColests PNIlp,MD,MPH
HEALTH°D1 & State Surgeon General and Secretary
Vh&m:To be the Hea gest MAD in the Nation
July 20, 2016
Peter Epstein
1058 NE 98 Street
Miami, FL 33138
••
•'•"' RE: Modification to a;Single Family Residence-No Bedroom Addition
::so*: Applicatton Dd$;tuneQt Number: AP1244836
,• Centfax Permi¢NL•mlier: 13-SC-1690137
•••••• 1148ACQ8 Stregj•••
.. . .
•••�•• Mia.9V F4 3313$...,..
• • Lo%l0 Alock:ISO&SLbdivision: Rev PI Miami Shores Sec 8
•••••• Dew s%pplicant,••••••
• •
• • ••• • ••
0:0090
This.vgDtknowledge receipt of a floor plan and site plan on 06/20/2016 for the use of the existing
onsite sewage treatment and disposal system located on the above referenced property. No
Objection: replacing existing driveway. Driveway is not on top of septic system. Issued by E. Omisca
on 07/20/2016.
This office has reviewed and verified the floor plan and site plan you submitted,for the proposed
remodeling addition or modification to your single-family home. Based on the information you provided,
the Health Department concludes that the proposed remodeling addition or modification is not adding a
bedroom and that it does not appear to cover any part of the existing system or encroach on the
required setback or unobstructed area. No existing system inspection or evaluation and assessment,
or modification, replacement, or upgrade authorization is required.
Because an inspection or evaluation of the existing septic system was not conducted,the Department
cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use.
You may request a voluntary inspection and assessment of your system from a licensed septic tank
contractor or plumber, or a person certified under section 381.0101, Florida Statutes.
If you have any questions, please call our office at(305)623-3500.
Sincerely,
�� &p' ®V�.uoi�
Edande Omisca
Engineering Specialist II
Department of Health in Dade County
in Dade County• •,Florida TWITTER:HealthyFLA
PHONE: (305)623-3500 FACEBOOK:FI-DepartmentofHealth
YOUTUBE:fldoh
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c � ` This Property Described As:
- ! Lot 16 , Block 180 , REVISED PLAT OF
TRACTS 178B, 178C, 179A, 179B, 180A AND
NJ OF 180C OF REVISED PLAT OF MIAMI
SHORES , SECTION 8 , AS RECORDED IN 'PLAT
BOOK 31 , PAGE 41 OF THE PUBLIC RECORDS
OF MIAMI—DADE COUNTY, FLORIDA.
NO OBJECTION `t
Florida Health Miami-Dade CountyO.S }
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P �(:�p �° .-1� Date: "1� I
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'/o•os Lowest Adjacent Grade: `�( 4
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PROPERTYOF: Epstein, Peter, 1058 N.E. 98th Street, Miami Shores , Florida 33138
NOT VALID WITs�H(AN TM %2N JUI0 AWP,, • • ~
LICENSEDTHE NAL SURi7r*OR ANOMPINER:0 ` 0• •
A BOUNDAR' SURVEY ti
. • • • • • I It certify that the eurvey represented LANNES AND GARCIA, INC: A
•• ••• •• • • hereon masts the minimum technical
h
standards got forth by ilio Board of Land L.B. #2098
Surveyors In chapter 61G17.6 Florida
41 0 . ••• AIIm'Vittiptive Code pursuant to Section Surveyors-Mappers-Land Planners Co
• • • • • •� 47:9.067 lata.Statutes. There are no to.
••i i • •.• • • 1'hantc Oertaps, easements appearl.:P an BEALE SMITH, PSM #5238 OI
of �• ••� ••• yyPiayolherthan aashown hereloFRANCISCO F. FAJARDO #4767
Office Address:359 Alcazar Ave,Coral Gables,FL 33134 I
f
(305)666-7909 (954)523-8663 °1
• i 000 i i • �BA1ht./J :' C�Ym<�I y FIELD DATE. SCALE DRAWN BY DRAWING NO
••• •• •• ••• ••• •FL.PREF.SURVEYOR AND MAPPER NO. r���anc`�,tJ..�,':. ( //M�Q' 7C� 146974
5•-21--03 "Recertified" , Name and Certified To re•vised .�f rt. i 149322