DS-10-1324Miami Shores Village
Building Department it JUL 1 9 nano
1 0050 N:E.2nd Avenue, Miami Shores, Florida 33138
Tel (305) 7952204 Fax: (305) 756.8972 B Y: _
INSPECTION'S PHONE NUMBER: (305) 7614949
BUILDING Permit No V 5) 0 • 1329
PERMIT APPLICATION Master Permit No
FBC 20
PernSt TYPe: PUIL,DING RQQFING
Owner's Name (fee Simple. Titleholder) 3 8)i► w J i 1'Ysa e/ d rtb , "ehone #
Owner's Address; : ( lcAr V ) .: ' o
City Kw TY) t .
4' i'le: . 'State.'
:. 'Zip;' ° 1,50
Value of Work For this Permit $ 4 6 P.30
Type of Work: []Addition :''. OAiteration
Describe Work
1A rte_.
Square / Linear Footage Of Work:
New Repair/Replace
1os) 40
See Reverse side -a
Demolition
Tenant Lessee Name ..._~"' Phone #
Email Cb+
Job Address (where the work is being done)
City Miami' Shores 'Village : County Miami -Dad Zip
FOLIO / PARCEL # . .
Is Building Historically Designated -_ YES NO Flood Zone
Contractor's Company Name t r 1 .. Phone #
1Z'1 � h
�,��
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No Certificate of Competency No
Contact Phone E-mail
Architect/Engineer's Name (if applicable) Phone #
* * ** * * * * *. ** * * * * **** *******************F ** * * * * * ** * * * *** * * ** * * ** a * * * ** ***
est.)
Submittal Fee $ Permit Fee $ CCU' $ CO /CC $
Notary $ :.:Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ ` Bond $
Double Fee $ Violation date:
Structural Review; $
Total Fee Now Due $ ' 0 le .
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 :tlie. 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. PAVING 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."
Clerk checked
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 reenspection fee will be charged.
Signature - Signature
Owner or Agent . Contractor
The foregoing instrument was acknowledged before me this iq The foregoing instrument was acknowledged before nie this
day of )Ll' , 2010 , byt� $ ? 5 , , day of ' , 20 by
who is personally known to me or who has produced F_ 1 0 who is personally known to me or who has produced
As identification and vwl girl take an oath: as identification and who did take an oath.
00, NOTARY PUBLIC: ,.\` SL`d1S. '' NOTARY PUBLIC:
Sign: ;. � 5�. � p -. Sign:
7 ..... t s k . Z ; 1
. e 1 4‘,`:"4 r _ Print:
My Commission Expires: ,• . ...s• 'A My Commission Expires:
1,94 Ur, i i it iti►o
* * * * * * ** *******.*** * ** ****** ** * * ** * **k ** *. **** * * ** ** *** * *** * * *** *******************************************
(Revised 07 /1 06/10/2009)
76.
Plans Examiner
Engineer
STATE OF (FLORIDA)
COUNTY OF (DADE)
Revised on 5/22/2009/ Revised on 6/12/09
SURVEY AFFIDAVIT
The undersigned Affiant, \J 'Ut.d Q( yL , does hereby attest that
F ' (Property owner)
The attached survey, performed by ' 1 r— e Cillideyi i 1 fl a:
(Name of surveyor's company)
For address: 1 k t\f\I UQ ,
Performed on 1 l b ='' (date of survey) is an accurate representation of the
existing conditions and locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey Tess than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Further, ffi say eth naught.
Prope f er Signature �
SWORN TO AND SUBSCRIBED before me this F p 1 day of
Affiant is personally known to me,
M iami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
)1y1 ensyl,.t_de-ctketk‘
Property Owner Print Name
as identific lion! a w
106 tifil;•
Nct� ndAlvin
OZ/90/E0
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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 acting as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
8. I 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 I must comply with laws requiring the withholding of federal income tax and
social security contributions under the Federal Insurance Contributions Act (FICA) and rrrust provide workers compensation 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 by all applicable
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 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 http : / /www.mytloridalicense.com /dbpr /pro /cilb /index.html
11. I 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:
16614w t66
have provided on this disclosure.
Was acknowledged before me this
Produced there License or rD
t9
day of 3 , 20 1
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12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I
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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 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
retumed to the local permitting agency responsible for issuing the permit. A copy of the property owners 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.
By ,I} NNI (5ericri1�Vi' - who was personally known to me or who has
4.\ -
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5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction.
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
J V OWNER BUILDER DISCLOSURE STATEMENT
NAME: e J DATE: Z (olezvo
ADDRESS: Q Dip W7) q• cc„,,„ S1' 5it, FL:310s-zi
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;) 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. I 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 as my own
contractor with certain restrictions even though I do not have a license.
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2. I 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.
3. I 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 licens- mbers on
permits and contracts.
4. I 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 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.
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6. I 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.
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• • • • • • •
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.H....CHORD
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number:1131010230360
Owner's Name: JOHNNY JEROME JORDAN
Job Address: 166 100 Street
Miami Shores, FL 33150-
Owner's Phone:
Total Square Feet: 329
Total Job Valuation: $ 2,000.00
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
1
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 7/20/2010 : Yes
Comments:
Inspection Number: INSP- 148926 Permit Number: DS -7 -10 -1324
Scheduled Inspection Date: August 09, 2010
Inspector: Bruhn, Norman
Owner: JORDAN, JOHNNY JEROME
Job Address: 166 NW 100 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
REPLACE DRIVEWAY AND ADD APPROACH WITH
CONCRETE
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
August 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: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1131010230360
Page 17 of 32