RC-19-491Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: RC-03-19-491
P� ( K Permit Type: Building (Residential)
i-n-ni U
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date: 04/02/2019 1 Expiration: 09/30/2019
Location Address Parcel Number
1321 NE 103RD ST, Miami Shores, FL 33138 1132050300120
Contacts
ADRIA I SILVERMAN Owner
1321 NE 103 ST, MAMI SHORES, FL 33138
Other:3055420908
HOME OWNER Contractor
HOME OWNER
Description: BATHROOM REMODEL 3 BATHROOMS TO REPLACE Valuation: $ 21,070.00 Inspection Requests:
RC-1-18-160 3#l5.762-4949
Total Sq Feet: 0.00
Fees Amount
50% Renewal Fee $316.05
Total: $316.05
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$316.05
Credit Card
04/02/2019 $266.05
Credit Card
03/06/2019 $50.00
Amount Due:
$0.00
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 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. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner ! Applicant / Contractor / Agent Date
April 02, 2019 Page 2 of 2
Miami Shores Village RECEIVED
Building Department artment MAR 06 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
f� I Tel: (305) 795-2204 Fax: (305) 756-8972
,✓ l INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20��1 f
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
10B ADDRESS: 13� L 1 03 �� -C-*V
City: Miami Shores County: Miami Dade Zip: 3 3 (3 8
Folio/Parcel#: I 1 -1 LP-5-0 3 OD I QLV Is the Building Historically Designated: Yes NO ✓�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SG191 V k4f i 6- Ve4-rY1CVK\ Phone#: -30
Address: 03 St-"-e.C�t r
city: jV-1;� U State: Zip:lv)
Tenant/Lessee Name: Phone#:
Email: a -A <<Q S ( �JPr /1'l aln r-n OlA ^ 6'6- h
CONTRACTOR: Company Name: t(Y\P &VJPhone#:
Address:
City: State:
Zip:
Qualifier Name:
Phone#:
State Certification or Registration #:
Certificate of�Co/mppetency #:
DESIGNER: Architect/Engineer:(QC-Q &J!�A-rz
1 5 �I ^ZE8 'a S-� 0
A/r 1_ 5-l6i�y�S `(-`-Cii
Address: k � �.3 (`� Lp(� f�
�PAhone#:
City: �--Gutic�CC �t-l�,t- State: fi, Zip: 3 331
Value of Work for this Permit: $
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: �o �ip
❑ New /`❑ Repair/Replace ❑ Demolition
10 ((V1y
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 $ L 6 O
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
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 fee will be charged.
Signature OS X e Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was a1cknowledged before me this The foregoing instrument was acknowledged before me this
day of 1 / pp yy l 20 I , by day of 20 , by
PAY i In I' Q�' i U Cwh imp 1onally known to , who is personally known to
me or who has produced r::� � f �c me or who has produced as
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
7-e
r�***APPROVED BY **• Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: _ ' Ck\ CL S � 1.4,ff 0✓i^f DATE: Q 3 — O% f I Q
ADDRESS: 1 .3 a- I aG 1 03 rd STr e & , cy� I a r�-,l s: DdL-S ( f=t, _3:� (3 9
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. 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
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.
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 con acts.
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 substantially improved it for sale or lease, which violates the exemption.
Initial
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 or municipal ordinance.
Initial
.-
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 -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 responsibi!lty 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 http://www.myfloridalicense.com/dbpr/pro/cilb/index.htmi
Initia
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:
,� S e�
initial
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
this disclosure.
Ini al
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(0 day of WOr( 20 1 Q
By I\ I Vi �y�r -who was personally known to me or who has
Produced ther License or
OWNER
as identification.
NOTARY
�SNo b Miami Shores Village
Building Department
10050 NE 2 Ave
Miami Shores FL 33138
�oRlOt'
v Permit No. RC-03-19-491
Type: Building (Residential)
Wo*cfass: Addition/Atterati'V roved on
rov
Issue Date: 4/2/2019 Expires: 09/30/2019
INSPECTION REQUESTS: (306)762.4949 or log on at https:Hbldg.msvfl.gov/energov—prod/selfservice
Requests must be received by 3:30pm
WORK IS ALLOWED: MONDAY THROUGH FRIDAY, 8:OOAM - 7:OOPM
SATURDAY 8:OOAM - 6:OOPM.
NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS
BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY .
NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED . PLANS ARE
READILY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND
EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR
EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION .
POST ON SITE
1132050300120
Owner's Name: ADRIA I SILVERMAN Owner's Phone:,(305)542-0908
Job Address: 1321 NE 103RD ST Total Square Feet: 0
Miami Shores, FL 33138 dotal Job Valuation: $ 21,070.00
Contractor(s) Phone Address
HOME OWNER
Description: BATHROOM REMODEL 3 BATHROOMS TO REPLACE RC-1-18A60
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
Page 1 of 1
INSPECTION RECORD
STRUCTURAL
INSPECTION
DATE
INSP
Foundation
Stemwall
Slab
Columns (1st Lift)
Columns (2nd Lift)
Tie Beam
Truss/Rafters
Roof Sheathing
Bucks
Interior Framing
Insulation
Ceiling Grid
Drywall
Firewall
Wire Lath
Pool Steel
Pool Deck
Final Pool
Final Fence
Screen Enclosure
Driveway
Driveway Base
Tin Cap
In -Progress
Roof Installation
Roofing Final
Shutters Attachment
Final Shutters
Rails and Guardrails
ADA compliance
• DOCUMENTS
Soil Bearing Cert
Soil Treatment Cert
Floor Elevation Survey
Reinf Unit Mas Cert
Insulation Certificate
Spot Survey
Final Survey
Truss Certification
STRUCTURAL COMMENTS
WINDOWSDOORS
INSPECTION DATE INSP
Attachment
PUBLIC WORKS
INSPECTION DATE INSP
Excavation
ELECTRICAL
INSPECTION DATE INSP
Temporary Pole
30 Day Temporary
Pool Bonding
Pool Deck Bonding
Pool Wet Niche
Underground
Footer Ground
Slab
Wall Rough
Ceiling Rough
Rough
Telephone Rough
Telephone Final
TV Rough
TV Final
Cable Rough
Cable Final
Intercom Rough
Intercom Final
Alarm Rough
Alarm Final
Fire Alarm Rough
Fire Alarm Final
Service Work With
ELECTRICAL COMMENTS
INSPECTION JDATE INSP
Final Sprinkler
Final Alarm
INSPECTION I DATE I INSP
Rough
Water Service _
2"d Rough
Top Out
Fire Sprinklers
Septic Tank
Sewer Hook-up
Roof Drains
Gas
LP Tank
Well
Lawn Sprinklers
Main Drain
Pool Piping
Backflow Preventor
Interceptor
Catch Basins
Condensate Drains
HRS Final
PLUMBING COMMENTS
INSPECTION DATE INSP
Underground Pipe
Rough
Ventilation Rough
Hood Rough
Pressure Test
Final Hood
Final Ventilation
Final Pool Heat r
Final Vacuum I NU
MECHANICAL COMMENTS
hc- Ji�'/
`o- J I --�— A a8 1 /A.V)40A/-,)A Ch f I I r i. t