DS-10-1536Inspection Number: INSP - 150497 Permit Number: DS -8 -10 -1536
Scheduled Inspection Date: March 29, 2011
Inspector: Bruhn, Norman
Owner: CARMONA, SERGIO
Job Address: 9402 NW 2 Court
Project: <NONE>
Miami Shores, FL 33150-
Contractor: HOME OWNER
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)751 -9697
Parcel Number 1131010150130
PAVE APPROACH RE4PALCE DRIVEWAY AND ACCESS
CONCRETE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
March 28, 2011
4.?•72q--,
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
For Inspections please call: (305)762 -4949
Page 2 of 11
1 ° 912 G State
Permit Fee $ 0 CCF $ CO/CC $
TraintnglEducation"Fee $ Technology Fee $
Radon $ DPBR $ Bond $
See Reverse side
Competency No.
Total Fee Now Due $
APPLICATION
BULL]
ss (where the work is being do
Miami Shores Village
PARCEL #
Historically Des
ctor's Company Name
tor's Address
Submittal Fee $
$
Scanning $
Double Fee $
Structural Review. $
w
iami Shores Village
wilding Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER.. (305) 762.4949
C
Certificate or Registration No. Certificate o
30 5 7671
hitect/Engineer's Name (if applicable) Phone #
alue of Work For this Permit $ 4 15 0 Square / Linear Footage Of Work: 350 .6 °
ype of Work: °Additions , [ Alteration New Repair/Replace
Q Demolition
Describe Work: Fits / PR0Ac R� ? L —Ac D New j Ae e .
BUILDT
PERIVIT
C 20
Permit Typ
Owner's Name (Fee Simple Titleholder)
Owner's Address '314 o l'\ IA)
City AM
Tenant/Lessee Name
Email G Pizm t.4
Job Addr
City
FOLIO /
Is Buildin
Contra
Contra
City
ialifier
State
ontact Phone
Bonding Conipaity"aName- (ifapplicable) •
..••DOOding.CeMpanY"aAddreSalli
•
NOTARYPUBLIC4,:.•
• •
..". • • • • •
.•
• •
MY • 7 •..
Engineer
Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
on tall has
lication is hereby made to -obtain a perinit to do the work and installations as indicated. I certify that no work or in s ati s
commenced, prior to the issuance of a permit and that all work will be petfonned to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit nuist be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and .AIR CO fsIDITIONERS, ETC....
OWNER'S AFFIDAVIT: 1 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, Me 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 P osted notice the
inspection will not be approved and a rei spection fee will be charged.
Signature .., - , ..... _„t„. Signature
.,0
0 er or A:, -rit Contractor
, Tile foregoing rumen was aclais)wledged before me this . The foregoing instrument was acknowledged before me this
, 20,1U
i\ , by e.--/ t..ii,v , i i.,, ,.. 4. - V „ ,,, ,
011.) 1.it-it (IN- , day of , 20 , by
, A o
who is per rfilly known to me or who has produced - )
i L who is personally known to me or who has prcidticeti
l
As identification and who did take an oath, as identification and who did take an oath.
NOTARY PUBLIC*
My Commission Expires:
1
‘s, -
- -
*******************it********1:** * 4 ****************** ******************b/e******* ************************
2
APPROVED - BY 7 Plans Examiner
Zoning
- Clerk checked
•
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: 5&»b C/1/2-M00 DATE: 2/2 2/10i /
ADDRESS: ` Uo 211/4)1) L% e M 571 47lr✓S 3,W1
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. 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
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 5L6,
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. G
Initial
Initial
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
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. 1, 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.
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.
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 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.
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.mvfloridalicense.com /dbpr /pro /cilbRndex.html
Initial
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:
6 )472 AJw c7,M 00g6 ,4 3'
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 5 7 L
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 Toss 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 a- day of `�`'�� , 20 41
CPMC IAGI who was personally known to me or who has
o/ .
Produced there Licen e or L V
WNER
Initial
Initial G
Initial 5 C 2
Initial �-
STATE OF (FLORIDA)
COUNTY OF (DADE)
wn
SWO' TO AND SUBSCRIBED before me this
ure
Revised on 5122/2009/ Revised on 6/12/09
SURVEY AFFIDAVIT
The undersigned Affiant,11 o CA2MOA does hereby attest that
(Property owner)
The attached survey, performed by U -) % T E C _ 5 Z'J y1 N4 ► 13G
(Name of surveyor's company)
For address: ° 402 P c-T
Affiant is personally known to me, produced �--
M iami Shores Viiiage
Building Department
Performed on 2/6. / 200 Z (date of survey) is an accurate representation of the
existing conditions and locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey Tess than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Further, Affia t say eth . ught
day of A 5�
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
5 --- ?6Ao CAi?t4.o4JA.
Property Owner Print Name
as identification����� O' 11►n,,,, ��� /' /
. _
1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) eA/OA/WA hereinafter referred to as the owner of
the following described property (address): 4 r/ Lk) Z e J ,,
MI 6 ijo? r:S _ 33 0
Legal Description Lot Block Subdivision
Folio #
Requests permission to install (describe work): S7 PLID Cz-ZticRe ' r're 7i
Within the public right of way of (address) ( 3 1 /02- NIA.) Z
Ajb c M S/t/2t5 33675
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of
way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any
and all liability, which may rise by virtue of permitting the installation of these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s)
to be removed and a lien being placed on the property and/or assessed against the Owner for all costs
incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land
and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until
such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this
SIG
2
ELI /ER n tf�: �?�' nce of:
4 40, 04
it ►�
day of &f) , 2014
gnature )
Charlie Crist
Govemor
Maria Carmona
9402 NW 2 Ct
Miami, FL 33150
RE: Contingency Letter
Application Document No: AP979175
Centrax Permit Number: 13 -SC- 1279481
OSTDS Number:
9402 NW 2 Ct
Miami, FL 33150
Lot: 5 Block: 2 Subdivision:
2. -This project entails : "STAMPED CONCRETE DRIVEWAY "
G/P
Enclosures
cc:
Sincerely,
Miami -Dade County Health Department
1725 NW 167 St, Opa Locker FL 33056
Phone: (305) 623 -3500 Fax: (305) 623 -3645
Ana M. Viamonte Ros, M.D., M.P.H.
State Surgeon General
September 23, 2010
1[1 IzoiT,R7
FEB : 2 2011
BY:--- ....... ---------
Dear Applicant:
This will acknowledge receipt of an application dated 09/20/2010 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
1. -There is no increase in sewage flow, change in characteristics compromising the integrity or
function of the system installation.
From a review of your completed application, it has been determined that your existing system is
adequate for the proposed use : " APPROVED ".
If you have any questions on this matter, please call our office at (305) 623 -3500.
r, Engineer Specialist II
Y%
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
Scale: Each block represents 10 feet and 1 inch = 40 feet.
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Notes:
Site Plan submitted by: %L i — t .1 r i IJVAAk. &'7Z ` g4
Plan Approved s� o Approved Date
By County Health Depart
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used)
(Stock Number. 5744-002- 4015 -6)
PART II - SITEPLAN
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ZONING DEPT
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SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
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LEGAL DESCRIPTION:Lot 5,Block 2,O MANORS,acco i 1, r .. the
Plat Book 41,Page 57 of the Public Records of Dade County,F1 "ida.
Plat thereof as recorded in
•••• GENERAL NOTES
• • 1) . IlMM11ERSHIP IS OOtI CT TO OPINION OF TITLE.
• • 2).Ex4 ItNATIOMOFTHEABSTRACTOFTITLEWILL HAVE TO BE MADE TO DETERMINE RECORDED
HVSTRUMENISS, IF Art, AFFECTING THIS PROPERTY. N/A DATUM.
• • 3) (2.22) DENOP>a34148SE ELEVATIONS REFERRED TO
4) :EQCATION AI41.13EIJTIFICATION OF UTILITIES ON AND /OR ADJACENT TO THE PROPERTY WERE NOT
• • 'SEC'U'RED AS6dC41•INFORMATION WAS NOT REQUESTED. X
5 TIIg I OPE 'WO 4 & HIN T}IE LIMITS OF FLOO I Z1 E
_ . , • . • - -,I • II 41 •, • • • 1 • 1 1 • lI P.._ i
1 I 1 O. N or i erican 1 e ompany, ergio armona an • ' aria aceres armona,
W T
1O' ; foal Ban - •r : i .1. ssigns DATE:February 06,2002
' APPLICAIBLE•ZONINGI, UNIDERGROUND. ZONING AND BUILDING SET BACKS . MUST BE CHECKED BY OWNER.
• ••• ii I RCHITgcc it R BUILt I B/FORE DESIGN OR CONSTRUCTION BEGINS ON THIS PROPERTY.
CER I' 1 ; :
1 HEREBY CERTIFY: That the attached Plan of Survey of the above described property is true
and correct to the best of my knowledge, information and belief, as recently surveyed and
platted under my direction, also that there. are not above - ground encroachments other than
those shown. This survey meets the minimum technical standards set forth by Florida
• Board of Land Surveyors to Chapter 61G17- 6,Florida A i • trative
pursuant
SURVEYING,INC. Code,Section 472- 027,Florida Statutes.- , ���_
L.B. No. 3333 -�����
147 ALHAMBRA CIRCLE No. 241 LAZARO D. ALONSO
CORAL GABLES, FLORIDA ,33134 PROFESSIONAL LAND SURVEYOR
Phone` (305) 4411 -9488 TIiIS IS A BOUNDARY SURVEY CERTIFICATE NO. 3590
STATE OF FLORIDA
NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYOR'S SEAL