DS-17-1526Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-284014 Permit Number: DS -6-17-1526
Scheduled Inspection Date: October 26, 2017
Inspector: Riveron, Alexis
Owner. CIO SASHA BERDEGUER, ROBERT
eeo�un
Job Address: 671 NE 105 Street
Miami Shores, FL 33138-2053
Project <NONE>
Contractor: RM & ASSOCIATES CONSULTING INC
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1122310120100
Phone: (786)348-3903
Building Department Comments
REMOVAL OF ASPHALT DRIVEWAY REPLACEMENT
WITH 4'X8' MARBLE PAVERS
REPLACED DS16-137
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
October 25, 2017
For Inspections please call: (305)762-4949
Page 5 of 27
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
201....
oniAlte
APPROVED
Expiration: 1 06/2017
Applicant
671 NE 105 Street
Miami Shores, FL 33138-2053
1122310120100
Block: Lot:
ROBERT MORENO C/O SASHA E
Owner Information
Address
Phone
CeII
ROBERT MORENO CIO SASHA
1 NE 2 Avenue
MIAMI FL 33132-
1 NE 2 Avenue
MIAMI FL 33132-
Contractor(s) Phone CeII Phone
RM & ASSOCIATES CONSULTING INC (786)348-3903
Valuation:
Total Sq Feet:
$ 6,000.00
2200
Approved: In Review
Comments:
Date Approved:: in Review
Date Denied:
Type of Work: REMOVAL OF ASPHALT DRIVEWAY REPL
Bond Return :
Scanning: 3
Additional Info:
Classification: Residential
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$3.60
$3.00
$3.00
$1.20
$5.00
$200.00
$9.00
$4.80
$229.60
Pay Date Pay Type
Invoice # DS -6-17-64256
06/09/2017 Credit Card
Amt Paid Amt Due
$ 229.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
Review Planning
Review Building
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 AF
construction a
IT: I certify that all the forego
Fut t ern1ore, autf oriz th
formation is accurate and that all work will be done in compliance with all applicable laws regulating
ve-named contractor to do the work stated.
June 09, 2017
Authorlized Signe re: Owner / Apicjant / Contractor / Agent
Building Department Copy
Date
June 09, 2017
1
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
Master Permit No.
Sub Permit No.
RECEIVED
JUN 0 8 tllp
CLJkl--Q
FBC 0 ‘-'•
-/6-33Y0
-DS \-- ` 52o
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
6' 9 / /Os s /-ec"t
City: Miami Shores
Folio/Parcel#:
Occupancy Type:
County: Miami Dade
Zip:
3>/3f .
Is the Building Historically Designated: Yes NO
Load:
OWNER: Name (Fee Simple Titleholder):
Address: /676) S e4v
City: /'YID„.rl1
Construction Type:
ko i« 7 /1% O /Lc // o
Flood Zone:
/O << S / Y7 S
State: `L
BFE: FFE:
Phone#:
- 3 9' - 32o3
Zip: 3 -S/86.
Tenant/Lessee Name: Phone#:
Email: /'/77 °/Q/f °
/ if
Alai/. ram
CONTRACTOR: Company Name:
Address: /'/ J S w /05/ S I g c/9f
City: /?i</ini State: FG
Qualifier Name: R° 4Q,_ / /�'1 ° °�'r
State Certification or Registration #: C G C 15 a % Y /
DESIGNER: Architect/Engineer:
Address: City:
/P'M SsoceafaJ
/e'o Phone#:
3os" - 5a2/
zip: 3 3 / 6,
Phone#: 7 m” 3 V. 3 9° 3
Certificate of Competency #:
Phone#:
State: Zip:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑
fo K /a
Description of Work:
p ��lec/ /
Alteration
a-e.,ea
On sCkedIf #4.7
Square/Linear Footage of Work:
❑ New
If
OO s�
)2(Repair/Replace ❑ Demolition
eRSt ®n
Q
Specify color of color thru tile: 0
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $ Bond $
DBPR $ Notary $
Training/Education Fee $ Double Fee $
TOTAL FEE NOW DUE $ — •
j�r
(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 ee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of � �, p ,22p00 9 , by
er *0 �L�`-tflll..ewho p ?dna y kno to
me or who has produced M Co 5 b -
9 3.3 - 8 as
identification and who did take an oath.
NOTAR PUBLIC:
Sign:
Print:
Seal:
a. ' MY COMMISSION # GG 044602
��: �""" *= EXPIRES: November2, 2020
1."-4,Ffebtto• Bonded Thru Notary Public Underwriters
Signature
CONTRACTOR
The foregoing instrument was acknowledged -fore me this
CO day of 1 , 20 ('�j by
p®be,rk �' ,� I�erson�alltyTcn'ow�n C)
Q_ g3 a "
'e bhoiias produced
identification and who
NOTARY PUBLI9
Sign:
Pa t
"Seal:
d take an oath.
**********************************************************************************************************
APPROVED BY
(Revised02/24/2014)
VI Plans Examiner
Structural Review
Zoning
Clerk
IVliami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLED THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENT
Signature:
Owner
State of Florida
County of Miami -Dade �^,
The foregoing was acknowledge before me this �'t day of
By aNDIGItY40 TeA sl—Ah^'ois
�Tt(Q 5 `• 33 J SU - I i ntifica�tion.
Notary:
SEAL:
,20 ��
known to me or has produced
j1 • I
MAHARAI K. GONZALEZ
•• MY COMMISSION # GG 044802
'* EXPIRES: November 2, 2020
'rF rp Bonded Thru Notary Public Underwriters
/el AZ
f2tR-io/ei
aid gAr
'd
9q 9 /7
,A M � ( A
0
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ke-
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Of Fly Qhne Th S d r)cy so b SCri bid be ori
O n- Cfr, v -e) Pmv l(
rir - -�� O Pro duct, d rb
este* 's MAHARAIK. doN Z
MY COMMISSION # GG 044802
�QS�
EXPIRES: N Nby Public
U.2020 _ _� S3-
-
:q,E Bonded Thru Notary {'ubOc U�erordters 3 8( I m
OT SuBDIVIDED
,OLF 1...;(:)0t-)
70.00' N7.33549E-
17 NJ
• *()
• Of),
1Y90
00.0 ,
0 "ic
NO REVIEW REQUIRED
Florida Health Miami -Dade County
Program
Application ho.:
Date: 1-1 1—
signature
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Notes:
1. Underground utilities, footings, and/or underground encroachments are not located on this survey map.
2. No instruments of record reflecting easements, right of way, and or ownership were furnished to this
surveyor except as shown.
3. Elevations and vertical data, if shown are refenad to N.G.V.D. 1929.
4. Unless otherwise noted record and measured data are In substantial agreement.
8. The Street Right -of -Way abutting this property are physically open unless otherwise noted.
205.
\\„0
(24-
)
2.
VP' Ii I I A
1`07.
I
L.-.. 6 4 •.:t, • IIAID
..
Miami Shcres
Wage ,
APPRO\tED
BY DATE
ZONING DEPT
(7, DEPT
41101,
, ' j. : • , . si) i.. !
.. .. .... .
s 1_15,1ECT 1 0 CC;NIPLIP Psi CE WITH ALL FEDERALSC
Property Address: •
M. , ( -1- 1 ,IV, V .-/I .1 •,-,Q Amn la 7r4f II ATunniC
a I gamma ..••••••••••••Adtto. ••••• almitaa•alt..• aft At a. --- -----------a, 1.•••••• a Soo •••t..•..1 -------1..
r•Asefitwwl Too •
1.tc
• • • t fr)
es•••••• • 1• ,
•
• •
E:10=30'
1 NE 105 STREET
lam! Shores, fL 33138
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
OA,
CETVED
JAN 19 2016
FBC20/yam
taster Permit No.
015 1/3- 13.7 -
Sub Permit No.
ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
EI PLUMBING ❑ MECHANICAL ElPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C NTRACTOR DRAWINGS
JOB ADDRESS: 6 9- I / ®S sh?,?_
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Occupancy Type:
Load:
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): D `1"L" " e��® Phone#(9"6') ? ei i - 3 703
Address: / 4/6'? 9 S /6"( S / A' c/91
City: i,4.0 / State: 0' Zip: 3 3 / Y 6 .
Tenant/Lessee Name: Phone#:
Email: rine re/,® 0- /14 eSS'ac. resen
CONTRACTOR: Company Name: Ov`6-r7-_- 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: $ / 0/ 000. o ® Square/Linear Footage of Work: / �LEV,.
,i
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ u al�
YP��
Description of Work: •` e 4.7 0 i, a-/ ® A.SQXel- If Ci/of-1 4-.e44i
c/7le) CC /rd €,1 / Gr/, /11 'y ' x 1 ify2 09 2 tue. p ct. Fi ell
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
9
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 { i .- 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 ce i 1 • copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days aft- the building permit is issued. in the absence of such posted notice, the
inspection wi a approved and a reinspection fee dill b - charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
`( day of —3'dis,".1 , 20 (s by
4?_i Li O "b , who is personally known to
me or who has produced C' — 1--Z_.-
identification and who did take an oath.
O1ARY PUBuO ,� �G. 'ft faiiii��iiii�i//i
r G 1 �� o .,�i
Sign: Q �Pii �:i."�4 '.... = Sign:
4' $, o� •v=
Print: ‘`S.%‘,;`'�c\ Print:
Seal:• .. •', Seal:
//1 STAS . .`�
sir,Nint o•
•********+R****►**+k************M********************+k*******iii*********MSF******************** ************ *
as
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20 , by
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
s
NAME: i
OWNER BUILDER DISCLOSURE STATEMENT
O/Lc.t_ c9 . DATE: / o®/ / S
,#'t 02
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ADDRESS:
G 9-/ ,t.: /as --
g /,t.ec ,
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. I 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, map a as my own, contractor with certain
restrictions even though I do not have a license.
Initial
2. I understand that building permits are not required to be signed by a property owner unless - - 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 ins - • 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 permi
Initial
act
4. I understand that I may build or improve a one family or two-family residence or a farm outbuildi g. 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 improv . If 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 ease, ' 'ch iolat s the exemption.
Initial
5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the constru
Initial
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise ons working on my building or residence. It
is my responsibility to ensure that the persons whom I employ have the license required by law a `d b un or unicipal ordinance.
Initial
•
7. I 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 -b : , • am .ware of the limits of my insurance
coverage for injuries to workers on my property.
Initial
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contror 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 : • : ee. I understand t' :t 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 activi
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 regul
I will abide by all applicable laws and
Initial
10. I 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
Initial
11. I am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am he party
legally and financially responsible for the proposed construction activity at the following address:
6 i/ k -S (0 S s
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to a T the info at' • n that I have provided on
this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public. If you contract with a per on 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 1' day of < ��- na- , 20
By V--t_.)S liVior
who was personally known tq\tmte'bi'WI has
i#e giflefliji
•
. o G'' •
_Produced there License or
�,
NOTAkiii"'i i11100