PT-16-2068 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
nspection Number: INSP-264007 Permit Number: PT-7-16-2068
Inspection Date: December 07, 2017 Permit Type: Paint
Inspector: Naranjo, Ismael
Inspection Type: Final
Owner: TREVISA, SUSAN Work Classification: Addition/Alteration
Job Address: 100 NE 105 Street
Miami Shores, FL 33138-2033 Phone Number (305)992-3134
Parcel Number 1121360130690
Project: <NONE>
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Contractor: HOME OWNER
Building Department Comments
PAINT PERMIT FOR EXTERIOR Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
PassedE_(
I�
Failed El
cn
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
f
i
For Inspections please call: (305)762-4949
December 07, 2017 Pagel of 1
o�rA? Miami Shores Villa e c xV�D
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5 2016
1
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�
PAINT Master Permit No. K y7—
PERMIT APPLICATION Sub Permit No.
JOB ADDRESS: / C�Lp /CJ
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
OWNER: Name(Fee Simple Tiggtleholder): -5 !� f' �l�ti�S/-} Phone#:/�
Address: D D /w S V
City: �c� f� S D/�r!G State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �� / Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Value of Work for this Permit:$ Footage uare Linear a of Work:
/ / g
Description of Work: ,� tdl� �! l� � //1��/✓Yf�
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 ELECTRICAL,PLUMBING,SIGNS,WELLS, POOLS,FURNACES,BOILERS,
HEATERS,TANKS,AIR CONDiTiONERS,ETC.....
"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$2500,the applicant must promise in good faith that a
copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified
copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued.
In the absence of such posted notice,the inspection will not be approved and an inspection fee will be charged.
Permit Fee$ ��--++��D- CCF Fee$ O , h(� Notary$
V
Technology Fee$ . O O Training/Education Fee$ (�. 2b Double Fee$
TOTAL FEE NOW DUE$
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
DIRECTIONS: Please circle corresponding number to appropriate color sample.
Walls: 1 2 3 4 -o
Attach color sample with /+, o
Fascia: 1 2 3 4 E.
�
Drip edge: 1 2 /3 ) 4 U alks
G S 6 01 '
Soffit: (_]J 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4
Awnings: 1 2 3 4
2.
Chimney: /1 i7 3 4 TQ(3r � ,CAM
Doors&Jambso 2 3 4 &�mo e
r
Garage Doors: 1 Q 3 4
AAIl �jt`�1�
Railings: 1 2 3 4
3.
Fences: 1 2 3 4 /' t
All Brick: 1 L_2/ 3 4
Stucco Bands: 1 2 3 4
Other Stucco
Feature: 1 2 3 4 4• a`
Accessory Bldg: 1 2 3 4
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 n tion and*zoning.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of now 20-!Q by day of 20 by
i5'yn(n �L L.J i 5!� who is personally known to who is personally known to
me or who has produced�bj! S as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: A Sign:
Print: -A 12 L Li Print:
Seal: Seal:
,r• ANTHONY GALW►
Nohry Public•StW U iloridit
•° My Comm.ExOint Mir 7,2017 , L
APPROVED B '%j�F ,T Code Official
Historic Preservation Board
Miami
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S�oReM
lvtcs iami Shores Village
some� J
,,, � Building Department
10050 N.E.2nd Avenue
FtpMiami Shores, Florida 33138
OR
Tel: (305)795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: �U Slq4 / !//1S ,q— DATE: Z//
ADDRESS: ��� (B A9 6 S '
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 lew.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,may act as my own contractor with certain
restrictions even though I do not have a license.
Initgeshe
2. 1 understand that building permits are not required to be signed by a property owner unlesss responsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Init/nthat
3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I undI may protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name instwn name.I also understand'that the
contractor is required by law to be licensed in Florida and to list his or license numbers on perntracts.
_
Initial
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuil in 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 c panty. It may not be built or substantially
improved for sale or lease.If a building or residence that I have built or substantially improve yself' 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 leas hi s the exemption.
Initial
5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the constr ct' n.
Initial
6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise p working on my building or residence.It
is my responsibility to ensure that the persons whom I employ have the license required by la b county or municipal ordinance.
I iti
i'
4
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 f 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 contract r ho is not licenses to perform the
work being done.Any person working on my building who is not licensed must work under my dire s pervision and must be employed by
me,which means that I must comply with laws requiring the withholding of federal income tax and ial security contributions under the
Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employ I understan 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 w I 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 regulati
Initial
10. 1 understand that I may obtain more information regarding my obligations as an employer from the In rnal Revenue Service,the United States
Small Business Administration,and the Florida Department of Revenues.I also understand that I ma tact the lorida Construction Industry
Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbpr/pro/cilb/index.html
Initial
11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and underst ds that I a the party
legally and financially responsible for the proposed construction activity at the following address:
100 N F PO� S+
Initial
12. I agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any oft K
I have provided on
this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public.If you contract with a person wa license,the
Constr4uction Industry Licensing Board and Department of Business and Professional Regulation maybe uu with any financial
loss that you sustain as a result of contractor may be in civil court.It is also important for you to understaensed 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 t 20
By 15a n ALU SGZ who was personally known to me or who has
Produced there License or \i C txzx— as identification.
�'1'Notatry PsdiNc-,Si� :ot
OWNER NOT r4 Myr 7,2017'Florid>t
1;�N� ••.••; Commission tFA x79171