FW-10-1217Project Address
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Contractor(s)
HOME OWNER
Phone
Cell Phone
Fees Due
CCF
Education Surcharge
Permit Fee - Wire 8 Wood
Scanning Fee
Technology Fee
Total:
Amount
$0.80
$0.20
$100.00
$3.00
$0.80
$104.60
Building Department Copy
Address
Authorized Signature: Owner / Applicant / Contractor / Agent
Parcel Number
9717 NE 1 Avenue
Miami Shores, FL
1132060132420
Block: Lot:
HORNEMAN TR
1
Phone
Approved: Yes
Comments:
Date Approved: 7/6/2010 : Yes
Date Denied:
Type of Construction: Wire Fence
Classification: Residential
Additional Info: fence
Scanning: 1
Pay Date Pay Type
Invoice # FW -7 -10 -38353
07/13/2010 Credit Card
07/02/2010 Credit Card
Amt Paid Amt Due
$ 54.60 $ 50.00
$ 50.00 $ 0.00
Applicant
July 13, 2010
Date
Cell
HORNEMAN TR
57750 RIVERCREST Drive
ELKHART IN 46516
1
Available Inspections:
Inspection Type:
Final
Foundation
1
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.
July 13, 2010 1
..c
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING• ROOVING
Owner's Name (Fee Simple Titleholder) L r't refA (O QS
Owner's Address cm t Ill 9 I , sr MC
City vAtkvAl 5�.(7S. Staff
Job Address (where the work is being done) 9. `t 1 11
City Miami Shores Vil1a�e . County
Mimi Shores Village
Building Department
1 0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel (305) 795.2204 Fax: (305):.756, 8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. f "i0 1 Z. `
Master Permit No
Phone # . - 30Skf=t4 Q
zip 311'6
Tenant/Lessee Name Phone #
Email
&J . k Ail L
MianmDade Zip :.. ` • Y "3 - �
FOLIO / PARCEL #
Is Building Historically Designated YES___ � _ NO Flood Zone
OladractirsisinpanyNam U u., ik.) e Phone #
Contractor's Address
City State Zip
Qualifier Naive
.. ,. Phone. #
State Certificate or Registration No Certificate of Competency. No
Contact Phone
Architect/Engineer's Name.. (i f applicable)
i t
Phone #
V . 00
,. :�'�� :.. ::.. Square / Linear Footage Of Worlc. `:
Type of Work: OAddition . DAlteration ONew Repair/Replace
[] Demolition
Describe Work. fi,,a e AC ott ssploco c t o.) 6 t
.. * ** * * * * ** ** * * ****** ********************F afar :@ **** *** ******************* ***** **
Submittal. Fee $ "W Permit Fee $ . 4.54-1- �. (t- '
��C� CCF $ 0 cUICC $
Notary $ Training/Education Fee $ P..7-. Technology Fee $ . ` :
Scanning $ . CO Radon $ DPBR $ Bond $
Double Fee $ . Violation date:
Structural Review, S- Total Fee Now Due $ e5 4 (61
See Reverse side a
Signature
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 ELECTRICAL WORK, PLUMBINO, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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
applicablolaws 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.
Sign:
Print:
My Commission Expires:
*3!'. *** ****** Cif' 1.(* ***** *7t" J( *** *7C***T7f *******7t'7(******
Zoning
AZ,
�►' /te , :•eat
The foregoing instrument was acknowledged before me this v<
:day ,. 2O 1>y CAL • 1 C
who is personally known to me or who has produced L j )
Asidentif cation and who did take an oath.
NOTARY PUBLIC:
nunii,,,
sign: ••� • -,
3 d
Print: / ,� � .• •
My Commission Expires: = cn c �'�dp ,�
V .• 1/4 • ��,f • ar
-. esyp i :. ,1.
.'***** F.****. ************* *******iQ'ii'A"l* YC7[' 'k�l 10 4,] .T"�t'11** A.
/c) 4 4 Plans l Examiner
APPROVED BY
(Revised 07f10/07)(Revised 06/10/2009)
Engineer
Signature ;
Contractor
The foregoing: instrument was acknowledged before me. this .:
day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oa
NOTARY PUBLIC:
5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction.
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: C9 YU(oCo S DATE: r ° \ ' 1
ADDRESS: C A C I 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 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 C A
2. I 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 C. VIA
3. I 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 C- '
4. I 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 L' '
Initial C. �/vl. b
6. 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.
Initial e_vk‘ acv
7. 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 N
8. I 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 LOA- .("`
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable
laws and requirement that govem 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 (- yti CP
10. I 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.myforidalicense.com /dbpr /pro /cilbfindex.html
Initial _ M '4o
11. I 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:
Initial .... Vt-t.
12. I 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.
Initial V t^-
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 contractors workers compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and
retumed 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 Nit , 201
By who was personally known to me or who has
Produced there License or
as identification.
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number:1132060132420
Owner's Name: CARL PENDLETON
Job Address: 9717 1 Avenue
Miami Shores, FL
Owner's Phone:
Total Square Feet:
Total Job Valuation:
50
$ 800.00
Planning and Zoning Criteria and Comments
Approved: Yes
Comments:
Date Approved: 7/6/2010 : Yes
•75:97,'(P)
18.80
r.Ii[' 2.70'
23.40' laao
t•liC9 41
ASPHALT 1±---x —x
DRIVEWAY
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• Propertyt�tdress:
• 9917 N.Ee1 • AVE .JE,
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MIAMI SS1OR FLORIDA 33138
SIGNED
•
MIGUEL ESPINO*.:
STATE OF FLORIDA'
• • • 1 BVAYE :UA'9_^.ffTIFitT!J�1 I lE E' CETTIF- -nAT TH - ::5 0SuNCLAh ::n EVEr S A TFJE Ann
• • CC•RAECT REPRESENT, CAI OF A 3J8vE FRE JUDEA MT EIREC'I0WI THd EOMPLE$ - �
• • • • THE MN A1'JM TE..Hl.CAL ST AADARDS AZ SE TSA-n 8• TnE STATE OF FLOR:JA SOAAD I*'
PROFE3SIE LAYD SUFE,T,55k§ it 8'31' 8 rif:Q DA ACMINISTRATNE CODE gLA: }J.iKf
TO 472 0'_' , LOR DA Si/Wit:
I
FOR THE FIRM
P..SM NO 5101
O
N
N. E. 98th STREET
20' ASPHALT PAVEMENT
22' PARKWAY
75.913'(P)(M)
10' ASPHALT ALLEY -1
Notes:
NO NOTES
MIGUEL ESPINOSA LAND
SURVEYING, INC.
10665 SW 190 Street
Suite 3110
MIAMI, FL 33157
PHONE:(305) 740 -3319
FAX #:(305) 669 -3190 LB # 6463
Accepted By
Survey: A -15327
0
0
ui
5' ,COTIC: WALK
F.I.P.1 2
PAGE 1 OF 3
f
Inspection Number: INSP- 147809 Permit Number: FW -7 -10 -1217
Scheduled Inspection Date: July 15, 2010
Inspector: Bruhn, Norman
Owner: PENDLETON, CARL
Job Address: 9717 NE 1 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
repalce missing chain link 4 ft high
Passed
Failed
Correction
Needed
Re- Inspection
Fee
July 14, 2010
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspector Comments
(7i
For Inspections please call: (305)762 -4949
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wire Fence
Phone Number
Parcel Number 1132060132420
Page 16 of 21