FW-10-797Inspection Number: INSP- 142688 Permit Number: FW -5 -10 -797
Scheduled Inspection Date: June 15, 2010
Inspector: Bruhn, Norman
Owner: VAN DER VENN, JAMES & CLARISA
Job Address: 161 NW 105 Street
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
replace wirefence gate on the side of the house with 5 feet
tall wooden fence gate supported by 4x4 spaced no more
than 4 ft and closer at gate opening
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
June 14, 2010
Miami Shores, FL 33150-
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: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number
Parcel Number 1121360080110
Page 7 of 25
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
1 61 NW 105 Street
Miami Shores, FL 33150-
1121360080110
Block: Lot:
JAMES & CLARISA VAN DER VE
Owner Information
161 NW 105 Street
MIAMI SHORES FL 33150-
Contractor(s)
HOME OWNER
Phone
Cell Phone
Approved: Yes
Comments:
Date Approved: 5/10/2010 : Yes
Date Denied:
Type of Construction: Wood Fence
Classification: Residential
Additional Info: 5 feet high
Fees Due
CCF
Education Surcharge
Permit Fee - Wire & Wood
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$100.00
$3.00
$0.80
$104.60
Address
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Permit
Permit NO. FW -5 -10 -797
Permit Type: Fence/Wall
Work Classification: Wood Fence
Permit Status: APPROVED
Issue Date: 5/13/2010 Expiration: 11/09/2010
Parcel Number
Phone
Pay Date
Invoice #
05/06/2010
05/14/2010
Pay Type
FW -5 -10 -37822
Credit Card
Cash
Amt Paid Amt Due
$ 50.00 $ 54.60
$ 54.60 $ 0.00
Applicant
Available Inspections:
Inspection Type:
Final
Foundation
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.
May 14, 2010
Date
Cell
May 14, 2010 1
L-v-t
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ROOFING c�.
Owner's Name (Fee Simple Titleholder) 1 l w.. Vet .4 C6 -e'.r le-e- r t Phone # .3 Cl S 35a - 2.. 4 41
Owner's Address 1, ( M W . fi
City ( t ati, ,Sko (es
Tenant/Lessee Name
Email d" Uc,..< 44.42.e d ( LO d CaS . !►( - t'f
Job Address (where the work is being done) ( 1 I`( c•) lo .64
City Miami Shores Village County Miami -Dade Zip $ 3 /.S
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name . .�- (,- f
Contractor's Address
City State
Qualifier Name
State Certificate or Registration No. Certificate of Competency No.
Contact Phone
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ {" 10•. CO
Type of Work: ❑Addition ['Alteration ['New g Repair/Replace ❑ Demolition
Describe Work: RAN?. - kr<re- F-44.44-e. ! vice.f - t.. w l4- t.. . ' ci.ALM (' tcrlc.t- /S d
S ' cr.-} -e- d- (Q Y)C s r C..e d r (c'
a1C a (e- csp-..K ( .14...
Submittal Fee $
Notary $
Scanning $
Double Fee $
Structural Review. $
******* * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** F * * * *r * * * *** * * * * * * * * * * * * * * * * **** * * **
Radon $
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: (305) 762.4949
State it i_ zip 33 / 5'O
Permit Fee $
Training/Education Fee $
E -mail
Violation date:
Square / Linear Footage Of Work: 10
400 CCF$O
DPBR $
Master Permit No.
Phone #
Phone #
paisscsD
MA'fd`d
Permit No. y 1V o
Flood Zone 14 8
Zip
Phone #
Total Fee Now Due $
CO /CC $
Technology Fee $ c WO
Bond $
10400
See Reverse side -
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 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.
Signature
Sign:
Print:
My Commission Expires:
APPROVED BY
Owner or Agent Contractor
The foreg.i g instrumen�t knowledged b ,fore e this The foregoing instrument was acknowledged before me this
day of ' , 20 � V, bW\ WS P day of , 20 , by
who ' ersonally�kno to me or who has producedt/ who is personally known to me or who has produced
I' I I 'IS . UU M ias identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
(Revised 07 /10 /07)(Revised 06/10/2009)
n 9 NOTARY PUBLIC:
Sign:
17.1.°`• 0. Print:
* ** * * ** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** * * * * * * ** ** * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** * * * * *,* ** * * **
- !J
Plans Examiner
Engineer
Signature
My Commission Expires:
C
Zoning
Clerk checked
Planning and Zoning Criteria
Owner's Name: JAMES & CLARISA VAN DER VENN
Job Address: 161 105 Street
Miami Shores, FL 33150-
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax (305)756 -8972
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 5/10/2010 : Yes
Comments:
Issue Date: Not Issued
Permit NO. FW -5 -10 -797
Owner's Phone:
Total Square Feet:
Total Job Valuation:
Expires:Not Issued
Folio Number:1121360080110
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
1
0
$ 1,000.00
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: S UG o✓ U.ee DATE: T f 7/ 1 O
ADDRESS: 1C( KW 1o. <" s( - c,w,, .5hcAr F 33 k4
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. 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.
Initial v
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.
Initial L
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 license numbers on
permits and contracts.
Infiaty
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.
5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction.
Initial
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.
Initial'
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.
OWNER
Initial�� (/'
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 amply 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.
V
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.
Initial
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. myfloridalicense .com/dbor /pro/cilbRndex.html
Initials ' v
11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that l am the party
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 information that 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 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 1 day of � , 201.0
131JCZQZ, 6yd9Akeik.„, who was personally known to me or who has
Produced there License or 1 1 35- 4'1S a01 b as identification.
64 ' a Li
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£GAL DESCRIPTIOH:Lot 11,Block 204,DUNNING'S MIAMI SHORES EMISSION N. 4,according to the
)tat thereof as recorded in Plat Book 48,Page 20 of the Public Records of Miami Dade County,
Florida.-
GENERAL NOTES
1) OWNERSHIP IS SUBJECT TO OPINION OF 11TLE.
2) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, W ANY, AFFECTING
THIS PROPERTY.
3) (2.22) DENOTES THOSE ELEVATIONS REFERRED TO N/A DATUM.
4) LOCATION AND IDENTIFICATION OF UTILfI1ES ON AND/OR ADJACENT TO THE PROPERTY WERE NOT SECURED AS SUCH
INFORMATION WAS NOT REQUESTED.
5) THIS PROPERTY IS WHIM THE LIMITS OF THE FLOOD ZONE X
6) NO UNDERGROUND LOCATIQNS WERE DONE BY THis COMPANY.
:ERTIkI'IED TO:HOme Title Agency, Inc., Fidelity National Title Insurance
:omp.,Home Financing Center,Inc.,
James and Clarissa Vanderveen
SURVEYING, INC • •
L.B. NO.3333
6187 NW 167 STET,
MIAMI, FLORIDA 31016 •••
308/512 -4940 • •• • •
APPLICABLE ZONING, UNDERGROUND, ZONING AND BUILDING SET BACKS, MUST BE- CHECKED BY OWNER,
ARCHITECT OR BUILDER BEFORE DESIGN OR CONSTRUCTION BEGINS ON THIS PROPERTY.
• •
• • • •
• '
• •
• • • • •
• • •••
•
• •
•• • •
• • •• • • •
•
NIS IS A BOUNDARY SURVEY
NOT liAtiN3SISILtESS SqALED WITH AN EMBOSSED SURVEYOR'S SEAL
• • • • • •
••
•• •••
•
SCALE 1 °= t
DATE:
DEcember 17,2008
l HEREBY CERTIFY: That the attached Plan of Survey of the above described property true
and oaf to the best of my knowledge, Eton and bend, as recently surveyed and platted
• • • • Loder my direction, also that there are not above-ground encroachments other than those shown.
• This survey meets the minimum technical standards set forth by the Florida Board of land Surveyors
•
• • Arrant to Chapter SlGlY.6, Floes AtIntigadrative Code, Section 472-027, Florida Stables.
• • • • •
•
D. Alonso
anal Land Surveyor
Certificate No. 3590
State of Florida