PT-16-541 Inspection Worksheet
z. Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-294971 Permit Number: PT-2-16-541
Scheduled Inspection Date: March 09,2018 Permit Type: Paint
Inspector: Naranjo, Ismael Inspection Type: Final
Owner: DITOMMASO,TOM Work Classification: New
Job Address:295 NE 104 Street
j Miami Shores, FL 33138-2006 Phone Number
Parcel Number 1121360130620
Project: <NONE>
I
Contractor: HOME OWNER
,
Building Department Comments
PAINT WALLS AND DOORS OF HOUSE Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
PassedElCREATED AS REINSPECTION FOR INSP-253723. Not ready
I5,--
Failed � G�
Correction ❑
Needed
r
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
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March 08,2018 For Inspections please call: (305)762-4949 Page 4 of 36
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-253723 Permit Number: PT-2-16-541
Scheduled Inspection Date: February 06, 2017 Permit Type: Paint
Inspector: Naranjo, Ismael Inspection Type: Final
Owner: DITOMMASO,TOM Work Classification: New
Job Address:295 NE 104 Street
Miami Shores, FL 33138-2006 Phone Number
Parcel Number 1121360130620
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT WALLS AND DOORS OF HOUSE 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.
February 03,2017 For Inspections please call: (305)762-4949 Page 4 of 48
Permit NO, PT-2-16-541
Miami Shores Village Permit Type: Paint
tri 10050 N.E.2nd Avenue NE Work Classification:New
.• � Miami Shores,FL 33138-0000 Pen I't
Permit Status:APPROVED
Phone: (305)795-2204
F�ORIDp'
issue Date:2129/2016 Expiration: 08/27/2016
Project Address Parcel Number Applicant
295 NE 104 Street 1121360130620
Miami Shores, FL 33138-2006 Block: Lot: TOM DITOMMASO
Owner Information Address Phone Cell
TOM DITOMMASO 295 NE 104 Street
MIAMI SHORES FL 33138-2006
295 NE 104 Street
MIAMI SHORES FL 33138-2006
l
Contractor(s) Phone Cell Phone Valuation: =1,200.00HOME OWNER
Total Sq Fee
Type of Work:Exterior Available Inspections:
Color: Inspection Type:
Additional Info:PAINT WALLS AND DOORS OF HOUSE Final
Classification:Residential
Color:_Approved Code Comments:
Color:_Approved_ Color:_Denied
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Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
Invoice# PT-2-16-58845
Education Surcharge $0.40
Notary Fee $5.00 02/29/2016 Credit Card $68.20 $0.00
Permit Fee $60.00
Technology Fee $1.60
Total: $68.20
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In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT* I certify, at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z g. Futh ore,I authorize the above-named contractor to do the work stated.
February 29, 2016
Authorlized Signature: wner Applicant / Contractor / Agent Date
Building Department Copy
February 29, 2016 1
Miami Shores Village
Building Department FBY:
WRI ►
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 9 201 , 0
Tel: (305)795-2204 Fax:(305)756-8972 '1
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201
PAINT Master Permit No.
J ��
PERMIT APPLICATION Sub Permit No.
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: /
Folio/Parcel#: Is the Building Historically Designated:Yes NO /�
OWNER: Name(Fee Simple Titleholder): ` �`\`\� �.1Y� tY1 C) Phone#: �1 �)� /�` 10
,
SD
Address: _a�s Ml� sem`,`C 2 2
City: �i 1 ,1 Al S \�C S State: Zip: 7 J
Tenant/Lessee YName: Phone#:
Email:
CONTRACTOR:Company Name: �tjmp, 0l,✓3a,0,r Phone#: r
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#: `
Value of Work for this Permit:$ `tom Square/Linear Footage of Work: 1 v V
Description of Work: 0�.. �_ =�(`�Q � 'C _ �a-> 0�
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$2500,the applicant must promise in good faith that a
copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified
copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued.
In the absence of such posted notice,the inspection will not be approved and an inspection fee will be charged.
. d
Permit Fee$ CCF Fee$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$ /
TOTAL FEE NOW DUE$
t PAINT COLOR APPROVAL AND AGREEMENT
t 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: (in 2 3 4
Attach color sample with name and number
Fascia: 1 2 3 4
Drip edge: 1 2 3 4
1
Soffit: 1 2 3 4
Flower Bins: WIP, 2 3 4
1 Shutters: N I 1 2 3 4 1s
Awnings: IJ) 1 2 3 4 moonshine OC-56
2.
Chimney: V)IN 1 a 2 3 _-4
Doors&Jambs: 1 2 3 4
Garage Doors: 1 2 3j 4
Railings: WIr 1 2 3 4
Fences: �I Pc 1 2 3 4
O
All Brick: 1� 2 3 4
Stucco Bands:Wl 2 3 4 is
Other Stuccopp� OC-64
Feature: oj` 2 3 4 4 Ewhide
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 regul ng construction and zoning.
Signature Signature
1
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20J by day of 20 by
a Y n,cx I Cjy�yyna sonall k1 n�own._t0 who is personally known to
me or who has produced 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:
e
Sign: —z _ Sign:
Print: +/QV'IWAnt:
Seal: r`'!1"•"� MARIAASSUNTAFE.RRARO Seal:
MV COMMISSION k FF 082444
1� 'a EXPIRES:February 13,?.018
80ndsd hru r!n!a,,PuLk Urderwrilew
APPROVED BY: -7—/2, ? I f , Code Official
Historic Preservation Board
AN
4 SNORes
�nC.193Z y,� Miami Shores Village
fill Building Department
-� 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
F� 10
ORNA
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: �� DATE:
ADDRESS: C N 42 If 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 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,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. t
Initial
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 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 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 su t tially
improved it for sale or lease,which violates the exemption.
Initial
i
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 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.
Initial
i
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T 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.
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. 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 htt ://www.m ohdalicense.com/db r/ ro/cilbriindex.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:
�9S �I s�
Initial
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the inform
ati a 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 �- , 20
By Um(�,S i (Orh��S who was personally known tome or who has
Produced t re License or aK, q,,Mft
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