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PL-07-1441 t Inspection Worksheet yifz Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -55099 Permit Number: PL -7 -07 -1441 Scheduled Inspection Date: March 05, 2010 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: GROOM, JEFFREY Work Classification: Sprinkler System Job Address: 355 NE 93 Street Miami Shores, FL Phone Number Parcel Number 113206013629 Project: <NONE> Contractor: HOME OWNER Building Department Comments SPRINKLER SYSTEM INSTALLATION Inspector Comments Passed l Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections lease call: (305)762 -4949 March 04, 2010 p Page 9 of 9 , Yl III,' F A i I � ' I �{ 1 III C^ II 1 �M , I h ores V e � 0 I ic g T Lp_� ' aYt M 0 i I ,0050 N 2 ve n ge, Miami :_Shores, F :lo I 'da: 33138 I L. 4 , �1.,�(3�� �i�s ao4 fag: (305) 75618 P � I'$ NE ]i U*BFR: (30 702.4949 ' s a et. •I. B D q; ING; Permit �L-!V � II-- y I No. 9 � � P I M ILI �I se ( I �; 1V�ra �' Permit No.' � r I I i � I� ` , l •'� °., � {,� It �' a II - -' II I� Per 't Type: FL�JMB 1 I I t h I III ry , I - •'. �' I 'r I I is Name I (pee ; Smp <e Titloli� I m�Y1? hone O I r s Address ii 2 . Cxty r 'I' Zip J '' 11 I I I'I I I� � � I of • d I I ' Tr see N rne- Ph n # ' II I L L - � I 1 I I P III, I I I I t I I J I i V Job ` ddr ss (w a th� w rk � City,, Plfii ho V' , I 6 1 cy t3' `ami- a Zip «at , FQL 0 / PARCEL # IIII , I Is B ding $istorlcally Dpsip4ted O y Flood Zone Con ac for s Company' I ' Na sine Ph n e# Con tor'�s Ad ci I , b IIII I tY State I � Quali er Name 1 I I ' I "' p� ne # Stater ertif`l{ cate,Px N�.egistrotibn CY � I I- I I I�' � 1 �I'- er�iGate Of G. uGY Cott t Phone I, Email I' I I , I I II �I Arc tectiEn 'S Nam if a lx P; II jr ; �` ( �� hone # I �L. I' tiq ,,I i ,I j' �I: �., I � f�� Value of Work or this permit $ .I ,EJ Square / Lineir F otage Of Work: l ZC rk [)Additioniter�ti ' I I� []N8w Repair/Replace n m lition V. be 4ork• k; h I I I I I I I .I . w '�',� �tedr�a' rlkak4rde skai9e �� &�tr�%rlk�t �?4r'i�t� �W+ti�+e fir #a�edrsk71r�k4raYdr3e�'a3rieo@ �Ft�' artk' �k�tesY4rda9edrrkdnte ±Y�trdr�i &�k�Y4n�i skaY Sub • it Mal Fee $ I' k l I F C $ Cl h � !�I�� lll�k � �` I � II• I II al ,II Nota $ � ' lEdue . l ee Teehuology Fee $ I { r Scan � I I I $ Ra o '' n $ PB g R B � I $ B ond I I I I , 11 I, I I I D Fee I p4 $ I- I I � oat Ir'I tl 'I I p I F r E '6. I nd+ '.II t I� I �F Stru al'�tevie' . I 14 I I t� Iw$ I , � , I Total fee Now Due $ ��II I I ,I See I { n3 IS I everse side N � I Bonding Company's Name (if applicable) Bonding Company's Address City State Zip i Mortgage Lender's Name (if applicable) Mortgage Lender's Address i 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 I 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..... OWNER'S AFFIDAVIT: jI 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." 1W otice 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 k 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 P. inspection will not be appro�ed an re nspection fee will be charged. Signatur Signature U. 0 Armr gent 2 Contractor T"he foregoing instrument was acknowledged before me this J The foregoing instrument was acknowledged before me this day of L **""' 2 0 �� by r.���dor+ -`% 1-vtcc 1 day of , 20 by who is personally known to me or who has roduced �� D who is personally known to me or who has produced p P Y _ P As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: r I e17 Sign: � _ / pi, •. G Sign: = Cl • �! 0 : m Print: — 9 1 Print: M Commission Expires: i�4 @j�� �� r Y p � �, .• 16� /C'. • My Commission Expires: 0RIDP Oil APPROVED BY Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10 /2009) 1111 � , hores Vi��a e ,- B Depart ant 1 10050' r Ri2nd Av ue, Miami Shor�s,'PI rit)a 33138 Tel: (305) 7. ,2204 Fats: (305) 756,$972 ' I� it :kuI0l 3� �f "g�" Permit 0: ' P,P RMIT Pi 'LIC +�A o. i IO Master: Permit FCC 200 a Permit Type;. I>ltiml<1il �I Oyvner's Name (Fee Si m ple TitlehdldePj r /" ®v j Phone # �✓ C9�IVner's, Address ' ! G"' --'► City Stat Zip e 'an tlLes see N anl e. Phone 4 Jo Addr ess ( where r o thew k' i is l n done li i being C i i res V i e Coun Miami -Aade Zip 3$ i ( % PAltCEL N �r ls'�3u'tldin g Y Historicall !Desi nated YES . g O x , I Contractor's Company dame ell Phone # C4 i tra , ��n c fors A City State zip j Qu'41ifie' Name i'hc�ne # State Certificate or ri egistration No. Certificate of I`ompetency N� o. E- {k1Ail1: A itegtJEngineer� one (if '' N i, . ap licab'ie) Phone # , For f Work Fa is��JE'e rm it � o'l ue o �th � $ Square ! Linear � y►otage Of Work: T of Work: k• rr, Sl A di a on New P Lion Alt i I y e� � e ❑ R airJRe lace D molition i D"cribe Work. � Y`I �" vo Su�bmittal� Fee $ �� Perin it Fee $ i Nmtary $ � Training /Education Fee $ ''eehuology >Fe� $ ij Sc nnitx'g $ , [td I $ �_ DPBR $ Zouittg $ Bopd $ Code Eni forcerneak $ 'Double F $ Sfuctu�ral Revt . w. $ To t Now ee Due Q� r I " n !,, I See iReverie side 'fir 1 1, nn i V I II- 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. l understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: [ 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 r Signatur Signature . Owne or gen / Contractor The foregoing instrument was acknowledged before me this `�✓ The foregoing instrument was acknowledged before me this day of J , 20 ® by T t 2ev0 ' 7 day of , 20 _, by who is p o produced me or who has ' p � �'• J4 who is personally known to me or who has produced C0¢ ( -'S [ As identification and who did take an oath. • as identification and who did take an oath. NOTARY PUBLIC NOTARY PUBLIC: 01 A ROBERT BUTLER, JR. Sign: a� Notary Public, State of R 2009 Sign: Print: � 6 a {—� No.DD394765 Print: My Commission Expires: My Commission Expires: steYxdede de dedrrerx &deardr�drae de nFxa4de tYde do eY deY de aY `ode dr xeY xaY de x+exaYxa: de e #+k dedr de de�e4xde uorenYW�eYxeY drxxde � &xaeaYx>ti Y dcrx'eYaYuYeYxxaYtu9rueY de && APPLICATION APPROVED B � Plans Examiner Engineer Zoning (Revised 02/08/06) . • • • 0 0 0 : 0 ON tv,ann \/i AP PROVE D B �DATE ` Y £ r all ZONING D =:PT P BLDG DEPT SUBJECT TO COMP I CE TH ALL FEDERAL V STATE AND COUNTY RULES AND REGULATIONS` JUL 10 2 007 a a - -- - - - • 1 1 � t �.. :::»»::>::»::>::>::»»:<:::>::>:: > :: > :: > :: > :: > :: >:<::::: >:: » :: >: >. >. = . , 9,,- M iami Shores Village 10050 N E. 2nd Avenu Mi ' Shores, o res F L 33138 - h 0000 ::;: : >:::: >: :: : >: ::« :. � ::: >:: :: >: »: ::: >: ::: >:: : >:: ::: >: >:>:»»>::>::>::>::»::»::;;>;::>::>::>::>::>::>-:>::>::»::»::;.:>:::>::>:>::«::>»;_::>:;:;::;::;::;: : >:; ::«: >:;::: » >::;.; >:::: >:::� tom .: >;:::::: >:::: >:: ice ............................ s. Phone: 305 7 - 95 2204 :<: >:::........ «::;: >.....:: >:« «...... Expiration: 011091200 Project Address Parcel Number Applicant . .................... ..... ......... --- - - - - -- - ----- --- ................ .............: 355 NE 93 Street 1132060136290 JEFFREY GROOM Miami Shores Village, FL Block: Lot: .....ONTgr, {pforati4n ............ ._ ............... Address. ..,. ................. Phone ........ ......... ......... .....Cell JEFFREY GROOM 355 NE 93 ST MIAMI FL 33138 -2854 ••,•:: "......... Aaa•.a•.a.. K3Y4......... ........: �....: ...... ..... .... ..... a•.aaaaaaa .. ..... ...... .. ...... .. ........................................................ ............................... Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 HOME OWNER Total Sq Feet: 0 Type of Work: PLUMBING Available Inspections: Type of Piping: SPRINKLER SYSTEM Inspection Type Additional Info: Final Bond Return Underground Sprinkler Classification: Residential Fees Due Amount Total Amt Paid Amt Due CCF$1.80 ................ ,.......... Education Surcharge $0.60 $ 0.00 $ 0.00 $ 0.04 Permit Fee - Additions/Alterations $170.00 _a......--- ,- ,.......... Scanning Fee $3.00 Payment Type: Technology Fee $4.25 Total: $179.65 DAID JUL 17 P 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 17, 2007 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Tuesday, July 17, 2007 1 Minim hores Village Bud d 10050 N.E2nd Av ue, Miami Shores, Florida 33138 tL 1 Q 207 Tel: 0 (3 5) 7 .2204 Fax: (305) ?56a8S�2 B I • � . � Y v'' I �i 1 UV I D �. PST I l __II Permi� 1No. I I� RMIT PLICATION r Merit ivo.. F)3C 200 Pr�i''Tye• ZUEIl 1 I O ' ner Name (Fee W ( Simple Titlehdlder) G Phone # 1 �-�� -ors �syg Owner's Address] tJ y City ',c.r�� c Stag 1�1 � zip I� T' hant/Lessee Name one # E- YIA[L: �. Job Address (wherelthe'work is being done) City Miarni Shores Viiiaae Coun Miami -Dade Zip FOLIO,,,/ PAR EL# r � Is'6uiiding Historically`Designated YES NO I � l IQ tractor's Comp y fame il'' ' i 'hd�'ne # tag lyz Co ' tractor's Addre Ci" ' P State �I I , n QL � li&i Nat ji " 'none St te Certifi or R g' ` tration No. Certificate of Competency No. -we (. 1� I. A� hltee' �" N d9ri r e (ifappiit�le) hone # j� 4 . 5 It V� t lus of VVo it For th'Permi $ Square / Liedr cn2tage Of Work• II T f o Work: �Addition O Alt ion � �` El Repair! place Demolition Docrilip Work: ii *!I t** * *Fees Su6mittal Fee $ Pemtnit Fes $ CCF $ CO /Cd Notary s T 0 c gl o i in E n atiort ee s ' $ Technology Fee $. S nning $ r Roden DPBR $ Zonin g $ Bond $' Qande Enforcement $ Double .Poe $ j S�•'luctukal Review $ ---+ Total #eoNow Due $ I See Reverse side]' —� IG I 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. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the•pers s whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a tion fee will be charged. Signature Signature — 0 ner or t Contractor The foregoing instrument was acknowledged before me this The foregoing in was acknowledged before me this day of , 20 _, by day of , 20 _, by who is personally known to me or who has produced who is personally known to me or who has produced ' As i % tion a" .ke an oath. as identificatior��d} J�o did "o NOTARY PUBLIC: * * MYCLIMMI8810 #0D 47 NOTARY PUBLIC: * * MYCOMMtSSI0N4DD425947 w WIRES; June, a, EXPIRES. June 7 2009 �� �Y �k11 � ''F °"�� Bonded Thrn Budget►,, �rvlces Sign: Sign: Print: ✓/ Print: My Commission Expires: �'� My Commission Expires: YxeY$e�dr�xeY &4e da oYde ak &akeY oY 3e oY Y'b4 aY3e do &xde� oe 4e eY' otx• +Yude a4xxx (� aYxeY 9:+tPe+e e4xek &xYxeYae at dexxde 9ca6+49: #dex &x4e Y tt tYx &atxxY•ke: aY aYa'-ot aYxa& &aYrY Yrxdr xic a4 APPLICATION APPROVED BY / Plans Examiner Engineer Zoning (Revised 02/08/06) 1 VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: J 6 c - OO VV) DATE: C� ADDRESS: 355 N F— 93 SF 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 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 hold title to the above property and I am planning on doing this construction Initi 2. I understand that as an owner - builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application Initi qg��_ 3. :I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initi��V 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code –% only if the structure meets the minimum code. Initia 5. I understand that as an owner- builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate ~ any contract disputes. Initia 6.. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company-or person. Initi 7. I understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initi 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my - property with out first obtaining the proper permits by licensed contractors. Initi Was acknowledged before me this day of ` " 20 y� � B J - 1 r`� c- who was pem - arown to me or who has Produced there License or �� ��•�c rS C:� ,S-( as identification. r R'� NOTARY ��+ a ROBERT BUTLER, JR. Notary Pubfio, State of Florida RAY comm. expires Apr. 19, 2009 No. DD394765