PT-17-1478 i
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-283631 Permit Number: PT-6-17-1478
Scheduled Inspection Date: September 20,2017 Permit Type: Paint
Inspector: Naranjo, Ismael Inspection Type: Final
Owner: SELZER,ALEXANDRA Work Classification: Addition/Alteration
Job Address:271 NE 101 Street
Miami Shores, FL 33138- Phone Number (305)600-7182
Parcel Number 1132060134810
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed d4
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 20,2017 For Inspections please call: (305)762-4949 Page 3 of 22
Miami Shores Village Rs v` Z
l`1N'0 2'201?"
Building Department J
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949 0
BUILDING Permit No: '1 T
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type:PAINT ��,(�")
OWNER:Name(Fee Simple Titleholder : Phone#:� 'r— " --7 I 9�D—
Address: l I D
City: Q mI State: I / Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS:
City: +Miami Shores County: Miami Dade Zip:l
Folio/Parcel#: __,�Oup — ()1-2) — 10)
Is the Building Historically Designated: Yes O Flood Zone-
CONTRACTOR:Company Name: Aft�jrw
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
Value of Work for t e it:$ 1OJD• Square/Linear Footage of Work:
Description of Work: l ► J�C(� '
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 WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS,
HEATERS,TANKS and 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$2500,the applicant must promise in good faith that a copy of
the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the
recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. /n the absence of
such posted notice,the inspection will not be approved and an inspection fee will be charged.
Permit Fee$ CCF$ Notary$ Training/Education Fee$
Technology Fee$ Double Fee$ TOTAL FEE NOW DUE$ 6SSE . !�
-J�A,t-i>
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to beaiu nted
DIRECTIONS: Please circle corresponding number to appropriate color sample.
Walls: 2 3 4
Fascia: 3 4
Attach color sample with name and number
� 1 �
Drip edge: 1 2 3 4
� 1.
Soffit: 1 / 2 1 3 4
Roof: 1 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 Q2 1 3 4
2.
Awnings: 1 2 3 4
Chimney: 1 2 3 4
Doors&Jambs:l 2 3 4
Garage Doors: 1 2 3 4
Railings: 1 2 3 4 3.
Fences: 1 2 3 4
All Brick: 1 2 3 4
Stucco Bands: 1 2 3 4
Other Stucco 4.
Feature: 1 2 3 4
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 construction and zoning.
Signature: Signature:
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foorre�goioing instrument was acknowledged before me this
day of I�Ci 20 a by- �� Q h&rG S�}1�b1"r ,20_,b
UVJ Y
1 G who is personally 1kno0 to me or who has produced SU 2( — who is personally known to me or who has produced
CAAs identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: T I L I«WSX_.- NOTARY PUBLIC:
Sign: Sign:
•••rAr �'•.,• MAHARAI K.GONZALEZ
Print: u�a SGIGN 0 GG 944692 Print:
M Commission Expires: ; �_ EXPIRES:November 2,2020
Y P My Commission Expires:
Bonded Thru Notary Public Underwriters
APPROVED BY: Code Official
Preservation Board
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PPU7-09u ULTRA PURE WHITE°
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Lit Miami Shores Village
I
m,,, pss.M - Building Department
10050 N.E.2nd Avenue
rtoR � Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
�OWNER BUILDER DISCLOSURE STATEMENT
NAME: DATE:
L" �VIG- DATE: I [
ADDRESS:
1
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
I 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 courity 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 complyFwith'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
t
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.
r
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 tracts.
Initial
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4. 1 uriderstand 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 10
S. I understand that,as the owner-builder,l 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 aDunty or municipal ordinance.
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