PL-09-2120 n /
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 132362 Permit Number: PL -12 -09 -2120
Scheduled Inspection Date: January 28, 2010 Permit Type: Plumbing - Residential
Inspector: Levrock, James
Inspection Type: Final
Owner: JESKE, CRAIG Work Classification: Addition /Alteration
Job Address: 116 NE 97 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 113206013256
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
MAIN WATER PIPE REPLACEMENT
Inspector Comments
Passed EET�
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 27, 2010 For Inspections please call: (305)762 -4949 Page 10 of 27
,s k I'3e
s Low, Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000 iii f
a Phone: (305)795 -2204 IN r a _» a Yi P' `IfE�
�QR i s ' � �y 4 r3
ti s Expiration: 07/2712010
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Project Address Parcel Number Applicant
116 97 Street 1132060132560
Miami Shores, FL 33138- Block: Lot CRAIG JESKE
Owner Information Address Phone Cell
CRAIG JESKE 116 97 Street
MIAMI SHORES FL 33138 -
Contractor(s) Phone Cell Phone $1,000.00
HOME OWNER Valuation:
Total Sq Feet: 0
Type of Work: PLUMBING For Inspections please call:
Type of Piping: MAIN WATER PIPE (305)762 -4949
Additional Info: Available Inspections:
Bond Return : Inspection Type:
Classification: Residential Top Out
Re Pipe
Main Drain
Heater
Water Service
Water Main
Lavatory
Final
Underground
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $0.60 PL -12 -09 -36724 $ 154.59 $ 154.59
Education Surcharge $0.20 $ �'��
Permit Fee - Additions/Alterations $149.99
Scanning Fee $3.00
Technology Fee $0.80
Total: $154.59
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated
January 21, 2010
Authorized Signature: Owner / Applicant / Contractor ! Agent Date
Building Department Copy
January 21, 2010 1
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INSp1;�CT °S'�'l NUMB :130 762,4949
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Application is hereby made to 'obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the i issuance of a permi d that all work will be
omm s an performed to meet the standards of all laws regulating
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construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
INVELLS, POOL$, 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.
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"`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 goo, 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.
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Signature Signature
Owner or Agent Contractor
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The for oing ins eY�byl was a owledged before e this The foregoing instrument was acknowledged before me this
J da of
day of 20
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who i sonally known to me or who has roduced 1 who is personally known to me or who has produced
(� • - denrification and who did take an oath. as identification and who did take an oath.
N T' UBLIC: - NOTARY PUBLIC:
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Print: Print:
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My Commission Expire : C r�' o�' My Commission Expires:
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(Revised 07 /10 /07)(Revised 06/10/2009)
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.sus Miami Shores Village
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Building Department
10050 N.E.2nd Avenue
@io R Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: _ DATE:
ADDRESS:
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 (hat 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 fora 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 $25,000.01 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 We 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.
Initra(�
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 li bens on
permits and contracts. / se
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 substan' ty improved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I b s ally
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 b county or
municipal ordinance.
Initial v
7. 1 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. cl�
Initial
8. 1 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 1 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 corn nsation for
the employee. I understand that my failure to follow these may subject to serious financial risk.
Initial
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.
Initial ✓J
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 hh _ptt :/ Awww. mvWdalicense .comtdbnr /Dm /Cilbrii -'/
Initial l
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:
Initial
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info I
have provided on this disclosure.
Initial
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 property 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 51 jday of �2 0
By NOW who was personally known to me or who has
Produced there License or
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• (- as iden ' cation.
OWNER NOTARY
� , OF F%n`�RIDA
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NOTP XBIJC T ' "
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