PT-09-1932 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
i nspection Number: INSP- 129933 Permit Number: PT -11 -09 -1932
Inspection Date: June 04, 2010 Permit Type: Paint
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: BENTON, THOMAS AND LAUREN Work Classification: Repair
Job Address: 230 NE 100 Street
Miami Shores, FL Phone Number (305)795 -2207
Parcel Number 113206013448
Project: <NONE>
Contractor: OWNER
Building Department Comments
Repair window sills and touch up paint.
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
June 04, 2010 Page 1 of 1
Miami Shores Village ;J
Building Department NOV 2 2
g p 009
100-5ON.F.2nd Avenue. Miami Shores, Florida 33138 BY:..... - -- - - - --
Tel: (305) 791.2204 Fax: (305) 756.8972
BUILDING Permit No. - 0 �,. f�
PERMIT APPLICATION Master Permit No.
Fs�
Permit Type: PAINT PERMIT
Owner's Name (Fee Simple Titleholder) —/ oA TEjil ��// Phone #
Owner's Address 0 3c ) ze/F 1061 - . - 51% CP+r+7
City �6Ae r State OFY Zip � � e "
Tenant /Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) J v A&E IC 20 SrAgeZ
City _ _ Miami Shores Village County Miami -Dade - zip —
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name _ 4OZZdA04 Phone #
Contractor's Address
City__ _ _ State Zip
Qualities Name Phone #
State Certificate or Registration No. Certificate of Competency No.
OWNER BUILDER: rJam Aloyt
Value of Work For this Permit $ � Type of Work: ❑ Addition / ❑ Alteration I ❑New /Repair/Replace
Describe Work: A 406,rrx •6U CC6 .27 �/ /iLA�err e�e� 1J�1 dGr�.C7
Application is hereby made to ottain a permit to do the work ,till installations ae indicated. I certify that no work or installation has commenced prior to the issuance ora permit
and that all weNk will be perforn'ted to meet the standards oral) laws t�gulatingconstruction in this jurisdiction. I understand that a separate pennit musCbe secured 161
E1.1- :CTRICAI. WORK. PLUMBINCi. SIONS. WELL POOLS. FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF (,OMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND 7 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.-
Notice to. I ppl ic•ant: .1s a condition to the issuance cal'o building pertnit with an eslintaled value exceeding $ 2300. 1he applicant mutt promise in goodl failh chat it cap} of the
notice gfcnnuni ncenrenl and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also. a ceriilied copy r)f1he recorded notice
of commenceinem nisi he posted of 1he job site,for the first inspection which occui s seven (7) days after the building permit is issued.. In the absence of such posted police. the
inspection will not he approved and a reinspection fee will be charged.
Permit Fee $ Ca�- -° CCF $ 0 Technology Fee: ,I
Training /Education Fee $ .J d Notary $ Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due $ F — . -
a
S� K Q v See Reverse side -�
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be tainted
Directions: Please circle corresponding number to appropriate color sample.
Walls.. 1 2 4 Attach color samples with name and
Fascia: I 2 3 4 number.
Drip Cap /Drip Edge: 1 2 ; 4
Soffit: 1 2 ; 4 t
Roof: 1 3 4
Plower Bins: 1 2 3 4
Shutters: 1 2 3 4
Awnings 1 2 3 4 2
Chimney: 1 2 3 4
Doors and Door Janis: 1 2 3 4
Garage Doors: 1 2 3 4
Railings: 1 2 3 4 3
Fences: l 2 3 4
All brick (simulated or re <Oular 1 2 3 4
Stucco Banding: 1 ? 3 4
Any other Stucco Features: l 2 3 4
4'
Accessory Buildings Other:
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.
Signature_ Signature
Owner or Agenf Contractor
The foregoing i st►ument was acknowledged h re me his �V The foregoing instrument was acknowledged before me this
dayof_k .20�by_ _ day of .20_,by
who is personally known ne or who has pix;ducc:d __ who is personally known to me or who has produced
As identification
and wh id take an oath. VD as identification and who did take an oath.
NOTARY P( IB �mSv C;3 NOTARY PUBLIC:
-
Sign: 1�� 3 �01� Sign:
Print: Print:
- - - --
My Commission Fxpires: y '•.,, , ,,•' g�1 P My Commission Expires:
APPLICATION APPROVED BY: �'�/ Plans Examiner
Preservation Board
Code Enl'orcement
(Revised 04 /24/0
.5t►o�!s Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DJSCLOSURE STATE NT
NAME: DATE: C
ADDRESS: _ CQQ I t'/ 1 � .
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 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- fargity residence. You may also build or improve a
commercial building at a frost 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.
7. I understand that state law requires construction to be done by a licensed contractor and hfive applied for an owner - builder
permit under an exemption from the law. The exemption specifies that 1, as the owner of the property listed, may act as my own
contractor with certain restrictions even though I do not have a license.
n 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 responsiti ty.
Initial
3. 1 understand that as an owner builder, I am the responsible party of record on a permit 1 understand that I may protect myself
from potential financial risk by hiring a licensed contractor acrd 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 — t'
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. t 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 We 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. /
initial ` r
5. l 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 by county or
municipal ordinance.
Initial �3
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.
Initi a
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 woridrxg 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.
Initial
9. 1 agree that, as the party Dally 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.
Initi a
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 httr:/ haww. myfloddalicense .comtdbor /pro/albfindex.html
Initia
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 a �ro construction activity at the following address:
Initial
12. 1 agree to notify Miami Shores Village immediately of any additions, deiations, or changes to any of the information that I
have provided on this disclosure.
Initia
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
ve*ng 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 o� 4 " A day of U� 20
By who w ag par nAly known to me or who has
Produced there License or as identification.
�4/ •.
OWNER RT �ff�-
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