PW-18-216 Inspection Worksheet
Miami Shores Village
3,
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-296179 Permit Number: PW-1-18-216
Scheduled Inspection Date: February 08, 2018 Permit Type: Public Works
Inspector: Miranda, Chris Inspection Type: Final Public Works
Owner: SHAER, STEVEN Work Classification: Public,Works
Job Address: 166 NW 93 Street
Miami Shores, FL 33138-
1 Phone Number (305)395-71711
Parcel Number 1131010330950
Project: <NONE>
Contractor: HOME OWNER
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Building Department Comments
REPLACE BROKEN SIDEWALK SECTIONS
Requirements
1)AII sections within the Driveway must be,6 inch thick
concrete.
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2)Use minimum 3000PSI concrete. k
3)Use clean sand to backfill when forms are removed.
- - -
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Inspector Comments
Passed21
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
February o7,2018 For Inspections please call: (305)762-4949 page 21 of 37
Permit NO. PW-1-1 -216
Miami Shores Village Permit Type:Public Works
10050 N.E.2nd Avenue NW Per,
it Worts Classification, Public Works
Miami Shores,FL 33138-0000
PermiuStatus:APPROVED
Phone: (305)795-2204
toravA ,
issue Date: 1/3012018 Expiration: 04/30/2018
Project Address Parcel Number Applicant
166 NW 93 Street 1131010330950
Miami Shores, FL 33138- Block: Lot: STEVEN SHAER
Owner Information Address Phone Cell
STEVEN SHAER 166 NW 93 Street (305)395-7171
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
HOME OWNER
Total Sq Feet: 25
Scanning:3 Available Inspections:
Inspection Type_:
Excavation ,
Review Public Works
Final Public Works
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Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.00
DBPR Fee InVOICe# PW-1-18-66254
$0.00 01/30/2018 Check#:542 $59.00 $50.00
DCA Fee $0.00
Education Surcharge $0.20 01/29/2018 Check#:525 $50.00 $0.00
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $109.00
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 Alertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a tonin F hermore, I authorize the above-named contractor to do the work stated.
January 30, 2018
4ruth6l1rized tig e.'-Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 30, 2018 1
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RECEIVED
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,► ` Miami Shores Village JAN 2 9 7018
Public Works Department n, ' r_
(305)795-2210 ���n`��1f' 41
Public works forms are available from the building department,10050 NE 2"d Ave., Miami Shores, FL 33138"' 111
PUBLIC WORKS PERMIT APPLICATION
Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property
Permit#: p v�
Name of Applicant(if utility see below): S<x{11 l k, _v
Owner off the following described property:
Legal Description: Lot Block Subdivision
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Folio#; �
Address: Lt/ S • BOS) B7_
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency#
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency#:
Requests pe mission to�ns all (describe work,attach separate page if necessary) in the adjoining right of
way: : J' �(Fl 7�n � Lpw
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Type of Work: V Paving ❑ Utility ❑ Sidewalk ❑P Electric',,', ❑ Irrigation "
❑ Landscape ❑ Antenna ❑ Other:
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DESIGNER:Architect/Engineer: (A
Address:
City:
Telephone: Email: I rnsR�n��wun•o7v�11•iroe, _�{'-.1i
Registration#: j
�4+4� •/RK1PMt.+!�.pir 4lW.lLli-n w:Nv:..:+�G�+�.,.e!ly
Value of Work for this Permit: $ 2"e06 Square/Lineal Footage of Work: JJ
***** Fees *****
Permit Fee$ 100.00
Notary$ Training/Education$0.20 Technology Fee$0.80 Scanning$
Bond$ (if required) Total Fee Now Due$
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A r.
Bonding Company's Name(if applicable):
Bonding Company's Address:
City: State: ZIP:
Applicatiorris,hereby made to obtain a public works permit to do the work in the right of way and
I
nstallations a's indi6t6d. 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, regulation construction in
this jurisdiction. I understand that separate,permits must be secured for
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with applicable laws regulating construction and specifically construction in the
— right-of-way::: ,
"WARNING TO APPLICANT:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value
exceeding$2,500,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 the
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 public works permit is issued. In the
absence of such posted notice,the inspection will not be approved and a reinspection will be charged.
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Signatur Signature
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Applnt or Authorized Agent Company/Utility Agent
The foregoing in'str'ument was acknowledged before The foregoing instrument was acknowledged before
me this day of 1 20 ,by me this day of 20 , by
who who
is persoIlyy��know me_or who has_produced is personally known to me or who has produced
UY 1llr as as
identification. identification.
NOT C NOTARY PUBLIC:
Sign. Si n:
•„3 Y” i MAHARAI K GONZALEZ
Print: = mYrOMMISSSIONAGG, g�j'in
SEAL: =a. & EXPIRES:November2,202(5EA
Bonded Thru Notary Public Underwriters
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****** **** *******************************
APPROVED BY: 24 I m Public Works Director, or Designee
2017-04-15
5H0 Miami Shores Village
� „ Building Department
10050 N.E.2nd Avenue
R Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME:
✓�� "!Q(r6 DATE:
ADDRESS:
, & 4' � V
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. w -�
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,may act as my own contractor with certain
restrictions even though I do not have a license.
Initi4/
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. j
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Initi�
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 thatthe
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
r)I:,;• coiistruction is complete,the law will presume that I built or substantially improved it for sale or lease,which violates the exemption.
Initia�
11. 5: I understand that,es the owner-builder,I must provide direct,onsite supervision of the construction.
In
+ Initial
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j X65 ;,I 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.
InitiY�Q• .r� t 4 A/ 4,
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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.
I Initial
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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. `
a
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
i 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.
Initi
i 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.myfloridalicense.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 f ancially responsible f proposed r7ruction activity at the following address:
Al
InitiaY 1
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
I 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 Z":' day of , 20
By C C� �� G l�r who was personally known to me or who has �-'�e •; '
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Produced th License as identification. 2 1
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STEtIEJ.SHAER -
INAKI SAt27ARBIT'OMA.ESQ. P.A.
OLD REPUBUC!DATION.AL T}TLE 4NSURANCE COMRANWATFS
LS'#Gi7t1
STATE OF
'Tyt LAPS
SEAL
Steven Shaer
166 GVW 93rdStreet
Miami Shores TG 33150
(305)810-9282 (Phone
April 24, 2017
My project is to replace 5 sections (rectagles) of sidewalk that were identified by code enforcement
as_beuig:def d6nt(crack-e Ekh-sectfon is 5."wide and between 5`End S'k'i bnT Wa wilt bieak.
apart the damaged sections.and haul off the waste and:..build a.sidewalk_consistent with.section.20-
1(y). of the Miami Shores building code:
Sidewalk/street standards. Sidewalks shall be constructed of 2,500 psi Portland cement
concrete and shall be a minimum of four inches in thickness except at driveways iv.1gre six-
inch thickness.is rerlulred The—sidewalk—may--be of unreinforWd:,�anctete ex pi_ ..'
driveways.where a six:by�six by,ten-wire mesh,shall beplaced in the cmiter of the si-inch •;
thick slab, with appropriate expansion joints every third section. A#1669W delAlous """
material shall.be.remo_ved.and.#fie.ground sy-nace..ro/%d prior to placemoiV Of coperete;...•:
0000 . .. 0000.
0..040 . ... 0000.
0000 .. . 0000..
Sincerely yours. •��
.
.
.0000.
toen Shaer
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