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
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Bonding Company's Name (if applicable)
Bonding Company's Address
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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:
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Sign: � _ / pi, •. G Sign:
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Print: — 9 1 Print:
M Commission Expires: i�4 @j�� �� r
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0RIDP
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APPROVED BY Plans Examiner Zoning
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10 /2009)
1111 � , hores
Vi��a e
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B Depart ant
1 10050' r Ri2nd Av ue, Miami Shor�s,'PI rit)a 33138
Tel: (305) 7. ,2204 Fats: (305) 756,$972
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Sc nnitx'g $ , [td I $ �_ DPBR $ Zouittg $
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Bonding Company's Name (if applicable)
Bonding Company's Address
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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:
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APPLICATION APPROVED B � Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
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AP PROVE D B �DATE ` Y £ r all
ZONING D =:PT
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SUBJECT TO COMP I CE TH ALL FEDERAL V
STATE AND COUNTY RULES AND REGULATIONS` JUL 10 2 007
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M iami Shores Village
10050 N
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Mi ' Shores, o res F
L 33138
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ice ............................
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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
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Owner's Address] tJ y
City ',c.r�� c Stag 1�1 � zip
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T'
hant/Lessee Name
one #
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Job Address (wherelthe'work is being done)
City Miarni Shores Viiiaae Coun Miami -Dade Zip
FOLIO,,,/ PAR EL#
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Is'6uiiding Historically`Designated YES NO
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Co ' tractor's Addre
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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
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WIRES; June, a, EXPIRES. June 7 2009
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Sign:
Sign:
Print: ✓/
Print:
My Commission Expires: �'� My Commission Expires:
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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