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RC-10-1560BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING (- OWNER: Name (Fee Simple Titleholder): /� )eVr Pho : � ��� j ���" 9a(- ?9 - ?63Z(Fic3 Zip: / 3/M C F—LL Address: /1/ / � /j /1/ 6 ( /00 a City: / T'/ (/ .c7;49,etif Tenant/Lessee N e: Email: / d �� dl'!d • CJ V JOB ADDRESS: /7/20 / /©c9 04 City: Miami Shores County: Miami Dade FolioIParcel #: Is the Building Historically Designated: Yes CONTRACTOR Company Name: /7/01ec (24!/ Phone#: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: rr Phone#: 6L. o oc Value of Work for this Permit: $ Type of Work: UAddress DAlteration Description of Work: 45 :€61(4. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (30S) 7614949 State: Phone#: 406 o 201(1 ��-� -.�^ B Y: ' Permit No. nn,�.. r Master Permit No. PC 10 66 Zip: 9 3/ 3, NO Flood Zone: Square/Linear Footage of Work: DNew pair/Replace ODemolition A _ 4/ ��-9, -� " �y 1 / / 2 / ®te COLOR TIIROUGH ROOF TILE IS REQUIRED acknowledged by: N N NN NN NN W W N N N N NNW WN WN N N N N N N NN N N N N N NN N N Nfj W W N N N N N N W W N N N N N N N W W W W NN N N N N N N NW NN N NN WNN W N NWN Submittal Fee $SO Permit Fee $ Q CCF $ rID Scanning Fee $ r Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ CO/CC $ Bond $ 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, 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 person whose property is subject to aft- chment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whi _ "occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap o ed a re's will be charged. Sign: Print: Signature Signature Contractor The forego 'trument was acknowledged before me this v`"" The foregoing instrument was acknowledged before me this day of n it 20 Al by Dr/43 P47 ^^ , day of , 20 by , who is per »finally known to me or who has produced (-4•11) who is personally known to me or who has produced as identification and who did take an oath. As identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: APPROVED BY er or Agent 0%11 U 4N ►►►/n \`` 1dl S ' ®.. ! . _ . ''moo . •�1 '' _ '. ,Q.ea) (Revised 0710 07)(Rewised 0610 2009)(Revised 3 15 09)nw6 4 10) NOTARY PUBLIC: Sign: Print: My Commission Expires: 141414 1414141414141414 *it 14141414141414141414 1414141414141414 *sit 141414 sit* II* 141414141414141414 14141414 *It 141414141414141414141414141414141414**it** 14141414141414141414tt****1414141414141414141414 Plans Examiner Zoning Structural Review Clerk 1 Inspection Number: INSP - 151160 Permit Number: RC -8 -10 -1560 Scheduled Inspection Date: October 07, 2010 Inspector: Bruhn, Norman Owner: BTESH, JOSE Job Address: 1180 NE 100 Street Project: <NONE> Miami Shores, FL 33138- Contractor: HOME OWNER Building Department Comments October 06, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Drywall Screw Work Classification: Alteration Phone Number Parcel Number 1132050190390 BATHROOM AND KITCHEN REMODELING. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 150643. not ready d L Page 15 of 31 4. Contract is name and address: / 9 . ./-41.1f7e.fey 1 �5. Surety: (Payment bond requir h and address:_ Amount of bond $ I�+.I ine' .' tnyherdend (Vold azsg. 6. Lender's name and address: • 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a) ., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Notice as provided in Section 713.13(1)(b), Florida 3t Name and address: 9. Expiration dat different date ' s• • /,� igna - ✓of O ' Print Own = �. 01-1p4-6 Z`rC - iu, S NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that Improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: 3 3 /3, 2. Description of improvement: 3. Owner(s) name and address: C9-"tet,f` 4-96)/g/t Interest in property: a/x Name and address of fee simple titleholder. Notary Public Print Notary's Name My commission expires: 123.01 -52 PAGE 4 8102 TAX FOLIO NO. tice, of Commence //1' z t� m 44 icier ?I A TE OF FLORtr A )time f . * EAT* y owner from contractor, t P 1 2s ®t d t2 111111111111111111111111111111111111111111111 CFN 2010R0592924 OR etc 27406 Ps 2272; lips) RECORDED 09/01/2010 12:09 :49 HARVEY RUVIN? CLERK OF COURT IMIAIII -DADE COUNTY? FLORIDA LAST PAGE ef e expiration date is 1 year from the date of recording unless a , 2 01.. Prepared by 1 C/IA \*V.R. Address* y ✓' 1 f t M iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILD R DISCLOSURE STATEMENT DATE:O, A0/0 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. 1 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 • m own contractor with certain restrictions even though I do not have a license. 5. I understand that, as the owner - builder, I must provide direct, onsfte supervision of the construction. Initial / 2. I understand that building permits are not required to be signed by a property owner unless he or she is ponsib . for the construction and is not hiring a licensed contractor to assume responsibility. 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that 1 r ° pr.tect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her nam - instead of own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license : :,. on permits and contracts. Initial Initial / 4. I understand that I may build or improve a one family or two - family residence or a fame outbuilding. I may a o b ild or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use .r 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 tially improved it for sale or lease, which violates the exemption. Initial I nitiate � 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons wo,' g on my bui residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and b municipal ordinance. Initial 9 or or 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 acti n % an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �/ Initial /: 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who i o 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 compens -tio 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 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. 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal ' evenue 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 htto : / /www.myfloridalicense.com /dbpr /pro /cilbfindex. 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I a legally and financially responsible for the proposed construction activity at the following address: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info have provided on this disclosure. Initial ./ /t. Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does t 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 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 3o day of , 20 1 By Thni PqokSl�', -k. Produced the i • -for Initial Initial: Initial Initial who was personally known to me or who has q.: cv0 as identification. 1111111 // CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER: ,0/L1 °aJ O /d- 4 €/7r? - PERMIT # ADDRESS: FOLIO NUMBER: /4 /;' 7a, fi o /per , . 77 BASE FLOOD ELEVATION: FREEBOARD: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS :4' St 7o ( (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): v� VALUE OF PRINCIPAL STRUCTU - ach appraisal): y 6 LS OWNERS SIGNATUR PLAN REVIEWER: 11 -12 -08 / FLOOD ZONE: EAST OF FL.CCCL: DATE: PLAN REVIEWER SIGNATURE: DATE: Primary Zone: 1400 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/2 Floors: 1 Living Units: 1 Adj Sq Footage: 2,382 Lot Size: 10,909.92 SO FT Year Built: 1951 550,000/ $289,655 5 53 42 MIAMI SHORES City: SEC 8 REV PB 43 -67 Legal LOT 3 BLK 178 LOT Description: SIZE IRREGULAR OR School Board: 19770 -0394 06 2001 1 $25,000/ $305,726 OR 19770 -0394 0601 00 Year: 2010 2009 1180 NE 100 ST Applied Applied Taxing Authority: Exemption / Taxable Exemption/ Taxable 1180 NE 100 ST MIAMI Value: Value: Regional: $50,000/ $289,655 $50,000/ $280,726 County: 550,000/ $289,655 $50,000/ $280,726 City: $50,000/ $50,000/ $289,655 $280,726 School Board: $25,000/ $314,655 $25,000/ $305,726 Folio No.: 11- 3205- 019 -0390 Property: 1180 NE 100 ST Mailing JOSE E BTESH &W Address: SUZANNE YES 1180 NE 100 ST MIAMI SHORE FL 33138 -2602 Year: 2010 2009 Homestead: $25,000 525,000 2nd Homestead: YES YES ,MiamijDade My Home My Home n i ami' ade. ov Show Me: Property Information Search By: Select Item - Text only Property Appraiser Tax Estimator IV Property Appraiser Tax Comparison IM Portability S.O.H. Calculator Summary Details: Propert y Information: Assessment Information: Market Value: 2010 $131 986 $339 655 2009 Exemption Information: Taxable Value Information: Sale Information: lc., In nn.,.. Ic innn i ACTIVE TOOL: SELECT Aerial Photography - 2009 My Home I Property Information 1 Property Taxes I My Neighborhood! Property Appraiser Home 1 Using Our Site 1 Phone Directory 1 Privacy 1 Disclaimer Web Site © 2002 Miami -Dade County. All rights reserved. 0 113 ft If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Page 1 of 2 Legend Property Boundary Selected N Property ,"° Street "0 Highway Miami -Dade County Water http: / /gisims2.miamidade .goy /MyHome /propmap.asp 8/30/2010 .. • • •.•. • • • • • • • • • •••• •• •• • • • • • • • • • • • • • •° • • • •• •• • • •••• • • PRPRCVED ZONING DEPT BLDG DEPT • � "SllS'JECT i O CCMPLIANCE WITH ALLfFEUERAL SLAT. 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