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RC-10-1603Inspection Number: INSP - 155388 Permit Number: RC -9 -10 -1603 Scheduled Inspection Date: February 01, 2011 Inspector: Bruhn, Norman Owner: ROVINSKIY, DENNIS Job Address: 65 NE 106 Street Miami Shores, FL 33138 -2034 Project: <NONE> Contractor: HOME OWNER Building Department Comments REPALCE KITCHEN CABINETS AND COUNTER TOPS KITCHEN REMODEL. Failed Correction Needed Re- Inspection Fee January 31, 2011 No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments nl it34 -1(0044- C,L mclo-- KOOS' cu Uoll For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (786)382 -9647 Parcel Number 1121360060300 Page 14 of 15 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 2 C 10 ' FOLIO 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: 6S i v& (t fig - -ems` 14-14'0444,', Pi (- 35/3 2. Description of improvement: 1�� 1 vta, -, c+ oCcif 3. Owner(s) name and address: DENTS Ro Vi . /1( S (c 1 � Owl e Yki i 64 & S N E /o(( h St 5144o-re Ft 3 3 1 3 Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: Da a5 1204. ; 4i S ii.-411 444 A / -w 6 S N I o6 . SY r eka: ...' SL�-.e r -rL 3 /3 g 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 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)7., Florida Statutes, Name and address: iV/ 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration different dat ecified) /4 of cane Signature r Print Owner's Name 1./1/I S \\\ Sworn to and subscribed befOkAINEI \ 31v Notary Public✓ Print Notary's Name My commission expires: 123.01 -52 PAGE 4 8/02 AI- 11 111111111 111111 1111111111 111111 111111111 111 .I- 11 11 1 1 1 1111 CF N 2010R.061.2343 OR Bk 27415 F's 3163; (1as ) RECORDED 09/09/2010 15:54:56 HARVEY RUVI4dr CLERX. OF COURT i'IIAi1I —C+ADE COUNTYr FLORIDA LAST PAGE date is 1 year from the date of recording unless a Prepared by id( Ue/ ,441'0) ,2010 pp Address: 1V t- 04 }N 4, Oli SL o Ff. '/313$ 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 3 IP " SEPu BY: BUILDING Permit No.PNCIC PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOFING Owner's Name (Fee Simple Titleholder) De /Ll S NNB C £' Phone # 1 - 38 _ :' Owner's Address (; S N6 ) d 6 rhi 59" City ro i 04"4 £1 ✓e S State /L Zip 3 3 / 5 Tenant/Lessee Name Phone # Email of (LO v1 /I'.S tt Y ( y 12- h 62o, C49'14-1 Job Address (where the work is being done) 6,s /1/6 lc* h-, it- 8 City Miami Shores Village County Miami -Dade Zip 33 / 3 FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name W jet- (c'i►/ Phone # Contractor's Address City Qualifier Name Phone # State Certificate or Registration No Certificate of Competency No. Contact Phone State it Zip Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ - "' - w , Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace n �� ID Demolition Describe Work: l .12'I &..C.L.. Ls iCit✓ .4t L'LI ' h GL� cQ e Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ ******** ** ** * * ** * * *** * ** * * ** * * * * * * ** * ** F ees * * * * * * ** ** * ****** * * * ** Submittal Fee $ Permit Fee CCF $ CO /CC $ Technology Fee $ Bond $ Double Fee $ Violation dater Structural Review. $ Total Fee Now Due $ See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address t � City State Zip - Mortgage Lender's Nance (if applicable) Mortgage Lender's Address C1ty Mate Application is hereby Inade 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 13c performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be seenred for ELECTRICAL WORK, f LUIvIBIN(, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC,.... OWINNERWS AFFIDAVIT: I certify that all the foregoing information is acute and that all work will be done in compliance with all applicable laws regulating construction and zoning, "WARNING TO OWNER: YOUR : FAILUICE TO RECORD A. NOTICE OF COMMENCEMENT MAY RESULT IN OUR 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 budding 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 fob site for the first inspection which occurs seven a) days a 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 Owner or Agent Contractor The foregoing instrument was acknowledged before me. this. O J The foregoing instrument was acknowledged before me this day of , 20 , by tU�' � _ rl l t day of ,.20 a by who is personally known to me or who has produced a. 1) who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Signature As identification and who did take an oath. .... E Sign: . .. a pe j Print: My Commission Expires: *************************k***** ;k:4dr** **::*** ci- d• :1' : 3k.q} *% :* ******* ****1,** •ic*jc•kA********!: *** * ***?Fk:F*****:F **** **J,;4 Plans Banuner APPROVED BY IRe∎used U7 1 O'07)(Revise(.1 Ci 10/2009) ( 11 Dijlt OF • . Engineer Zip Si: gn Print My Commission Expires Clerk checked OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE: T / 17 ADDRESS: 6 5 NE /N1)-1 S?` 04-i .4.,' n9w2 f, r-L 33 /3 g 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. 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 license numbers on permits and contracts. nn Initial D 1L 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. (� /, Initial 'J l� 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 Initial DfZ- Initial 0 2 Initial D 1 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 ID n 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. Initial DP__ 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 must 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.mvfloridalicense.com /dbpr /pro /cilb/iindex.html Initial 0 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: 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 K 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 By TX te.il S Initial day of 4 A. , 20 1D \I t %45yZ1'' who was personally known to me or who has Produced there License or as identific #ion. \`\\ 01%1 uu,,, ` ' ar o � 1 ; yy� . O � , - j V 6 SI WW1" C' III Initial OR Initial Og J Inspection Number: INSP- 151004 Permit Number: PL -9 -10 -1604 Scheduled Inspection Date: January 28, 2011 Inspector: Hernandez, Rafael Owner: ROVINSKIY, DENNIS Job Address: 65 NE 106 Street Miami Shores, FL 33138 -2034 Project: <NONE> Contractor: HOME OWNER Building Department Comments REPLACE KITCHEN SINK INTO EXSITING PLUMBING Passed Failed Correction Needed Re- Inspection Fee January 27, 2011 No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments For Inspections please call: (305)762 -4949 gy p \US Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)382 -9647 Parcel Number 1121360060300 Page 2 of 9 Contractor's Company Name Contractor's Address 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING //'�� Owner's Name (Fee Simple Titleholder) /'GI S I(,CIV1 /V> Phone # 76 — J j 2 - 96 7 Owner's Address ,1 NC /06 City thi cl 44,+' State (`7 Tenant/Lessee Name Email d Phone # Job Address (where the work is being done) l0 S NC /06 Q (5 Permit No. 1 1-- _ 11 ' ' 4 ^C 9 Master Permit No. 1 1( C Zip 3 3 /38 City Miami Shores Village County Miami -Dade Zip 33 /3 8 FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone O w Phone # ' LP 0 8 E� 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 # Value of Work For this Permit $ (00, 00 Square / Linear Footage Of Work: 70 Type of Work: ❑Addition ❑Alteration ❑New ) Repair /Replace ❑ Demolition Describe Work: r fi Q..Q.C.- fc/ kk. i t f?)-=_-cj p ******** * * * ** * * * * * * ** * * * ** * * * * * * * * * * *x* F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ I e7 CCF $ CO /CC $ Notary $ Training /Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 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 Owner 6r Agent Contractor The foregoing instrument was acknowledged before me this `` The foregoing instrument was acknowledged before me this day of (t , 201C , by iavr� �� +� 1C,17day of , 20 , by who is personally known to me or who has produced As identification 6/el4ta ,an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) Signature who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Plans Examiner Sign: Print: My Commission Expires: Zoning Engineer Clerk checked M iami 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: i4 :S . 56..-i y DATE: 7/77/ 0 ADDRESS: S NE /e6 Ovictr ti' d2E)'! e ,t" 'j i3 8 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 tease, 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 1 do not have a license. Initial D 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 " 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. Initial 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 1 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 J 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial DR_ 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 t/� 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. 1, 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. Initial DP 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 must 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 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. 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 /dbpr /pro /cilb /index.html Initial P� 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: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I Initial have provided on this disclosure. 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 day of `"� , 20 1(.; By` > ' f \it r . 'i f.N -1 t who was personally known to me or who has Produced there License or Initial Initial Da- Initial �� Inspection Number: INSP-151006 Scheduled Inspection Date: January 27, 2011 Inspector: Perez, Jan Pierre Owner: ROVINSKIY, DENNIS Job Address: 65 NE 106 Street Miami Shores, FL 33138-2034 Project: <NONE> Contractor: HOME OWNER Building Department Comments January 26, 2011 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 Number: MC-9-10-1605 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Kitchen Hood Phone Number (786)382-9647 Parcel Number 1121360060300 INSTALL EXTERNAL EXHAUST FAN ABOVE STOVE Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. Inspector Comments Page 6 of 29 Miami Shores Village BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL 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 Owner's Name (Fee Simple Titleholder) DC/4 3 acQc IV £,� Phone # 7e-6 38 2 96 4 7 Owner's Address �,, f!4 c E 106 9', ii-- City Ow i c' .w 4 Gw-re-I State Zip 33/33 Tenant/Lessee Name Phone # Email rot/ t NS1C / e y12-4 & Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name OW k.2� Contractor's Address Architect /Engineer's Name (if applicable) Value of Work For this Permit $ 2-04. 04.3 Notary $ Scanning $ Double Fee $ Structural Review. $ C N6" County Miami -Dade Zip 3 /3 g NO E -mail Master Permit No. HC. ( " - : /46 04 d7- Phone # Phone # Square / Linear Footage Of Work: ' iCVZWE SEP082010 BY: Flood Zone Permit No. rr C 10 - (lf .- City State Qualifier Name State Certificate or Registration No. Certificate of Competency No. Contact Phone Zip Phone # Type of Work: ❑Addition ❑Alteration ['Ne / w ❑ Repair/Replace 11] Demolition " Describe Work: 111 r 0 c 2 - 1-LeJ € /LOWS . a4�ve, 5 6+^t� fe._ ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ************** * *: * * * ** * *** * * * * * * * * * * * * * * * *** \ et) Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Violation date: ��� .�� ' Total Fee Now Due $ See Reverse side Training /Education Fee $ Technology Fee $ Radon $ DPBR $ 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 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 NOTARY PUBLIC: Owner of Agent Contractor The foregoing instrument was acknowledged before me this U The foregoing instrument was acknowledged before me this day of , 20 IC) by , M Nwk i ?' , day of , 20 , by who is personally known to me or who has produced 1`L') D 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. APPROVED BY s wkwil Sign: ■\ ` / / Sign: Print: \1l Print: My Commission Expires: ,, l \t °'`C : :-.-• My Commission Expires: i'i, (1' U ,. ' . r � ' „;:. ......................„„ b 8 cit F�: d:**********: t:Y�F**** * **** *:F:F�F****:F**** * * ** **** * ** ** ** *aF�Fk*** ** 111 A Lf 1 s Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) Signature NOTARY PUBLIC: OWNER BUILDER DISCLOSURE STATEMENT NAME: L 7& S ` Jt-ffl y DATE: / l L0 ADDRESS: 6 S 4/E (CC 5r ( 'a i -f G Z 3 (3 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; 1 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, 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 license numbers on permits and contracts. Initial 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. Initial Jl 5. I understand that, as the owner-builder, 1 must provide direct, onsite supervision of the construction. M iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Initial Ott Initial 0 Initial D 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 0 R 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. yy�� Initial ©r& 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 must 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 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. 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 /dbpr /pro /cilblindex.html Initial 11. l 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: 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, ;1 �j Initial {� 1� 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 j day of f , 20 l' Produced there License or OWNER Initial D Initial �l\ who was personally known to me or who has Initial OP_ Scheduled Inspection Date: January 26, 2011 Inspector: Devaney, Michael Owner: ROVINSKIY, DENNIS Job Address: 65 NE 106 Street Project: <NONE> Contractor: JULIO ELECTRIC CORP Building Department Comments January 25, 2011 Miami Shores, FL 33138 -2034 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 155268 Permit Number: EL -9 -10 -1671 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (786)382 -9647 Parcel Number 1121360060300 Phone: 786/346 -7597 1 EXHAUST LITE, GFI, 2 PENDAENT LITES 2 REPALCE EXISTING GFI. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ,...._____/ 77 Page 17 of 18 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Owner's Name (Fee Simple Titleholder) /t/IS 2014 t Phone # �� - 3e 2- !6 9 7 Owner's Address 6 5 N E 106 174 St City r' l 1 S14.0-r23 State f Zip 33/3 Tenant /Lessee �Name E -MAIL: GL RovI NS /c ye. Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name /( Contractor' Address /�70 9-04' Sr City Qualifier Name State PE „,s,„ State Certifi at or Registration No. E .;,�I t(?tlL'c`t'I1rGC'i iZSC/ 4..,.. >. Architect /Engineer's Name (if applicable) Value of Work For this Permit $ Type of. Work: ['Addition Describe Work: (K I S 1C. * * * * * * * * * * * * * * * ** ['Alteration hest L Submittal Fee $ a ) Permit Fee $ Notary $ ` Training /Education Fee $ Scanning $ Radon $ Bond $ Code Enforcement $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Y M-t con/ County Miami -Dade NO Z [New DPBR $ Master Permit No. R C -1- /0 - 1603 Phone # Phone# .32/7 Zip - 7 / 7 j `1 -7J Phone # Certificate of Competency No. 0 E 000 5 Phone # Square / Linear Footage Of Work: Repair /Replace 1 e *r.xrxx * *xxr.xxxx F * * **wwvcxxx *a•. *xr. xr. xx war * * *ww ** *a' w************ CCF $ See Reverse side —> Permit No. ELI° t(1-51 1 Zip 3 Sa° L3 3tfG -7f f7 CO /CC El Demolition Technology Fee $ Zoning $ Double Fee $ Structural Review. $ Total Fee Now Due $ 10 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 1 The foregoing instrument was acknowle before me this 00 day of , 20 /0 , by r n r 5 J�QVi h5 �ci y day of_.s�2 � . ,..,,,__ _. , 20 /� , by, 4 61 t ' lint t' who is personally known to me or who has produced cict f2•-• who is personally known -to me or who has produced 774.E L,` R i Si 1 7 7 $Ott 6S I As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: veraw (Revised 02/08/06) (407) 398 -015 APPLICATION APPROVED BY/ ,,, D AVID ENCARNACION „ *= MY COMMISSION # DD757599 S February 11, 2012 noridallotaryBervice.com as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: /S'1 / Plans Examiner Engineer Zoning DAVID ENCARNACION : *_ MY COMMISSION # "! ; DD75759 2012 FIRES February 11 900(15N0)aq e • ?id My My Commission Expires: My Commission Expires: • ....XxX..YXXXX.. Y.XY.YXYY*****:: a':): i' C>;*********'************ *YYYXYYT'Yi:'* *** *****'******** ci :********* *****YY*XX %********* 1 1111 IKEA Home Planner Printout ) HT 5 wi c ( 4 ) k lex L 'IA xtztlt ) 0 5 4 or- -er c.zur Page 5 of 8 kitchen 1 - 3D View 0000-0079-4907 All measurement in inches http://kitchenplanner.ikea.com/us/UI/Pages/PrintoutsNPUISummaryPrintout.htm 8/14/2010 CERTIFICATE OF LIABILITY INSURANCE PRODUCER Blanco Bice Associated Inc. 1460 E 4th Ave. Hialeah, FL 33010 Phase (30624 INSURED Julio Electric Corp. 1290 rte 208 St North Nam', FL 33179 - (7863467587 Fax (3-6218 TINS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CODERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER TIE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFF ORDIN G COVERAGE pusuRER A: NATIONAL INS.CORP. INsunEnB: AEQUICAP INS INSURER C: INSURER D: INSURER E: DATE (MMI0DVYY) 09/13/10 RAC # THE POLICES OF ROMANCE USTEI$14AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY ANT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. ThE INSURANCE AFFORDED BY THE POUCES DES CREED HEREIN IS SUBJECT TO ALL THE TENS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIETS SHOWN MAY HAVE BEEN REDUCED BY PAIN CLAIMS. ttisR At1D9. TYNE OF INSURANCE 1111_2018 GENERAL LWMLRY Q cOMERCIAL GENERAL LIAIALITY ❑❑ MANS MADE p OCCUR GENT. AGGREGATE LMT APPLES PER: ❑ POUCY ❑ PROJECT ❑ LOC COVERAGES B AUTOMOBILE' ABILITY ❑ ANY AUTO D ALL OWNED AUTOS B 0 ❑ SCHEDULED AUTOS ❑ FEED AUTOS D NON OWNED AUTOS 0 GARAGE LIABILITY ❑ ❑ ANY AUTO 0 T EXCN S / UMBREJA UAB(L.ITY ❑ OCCUR ❑ CLAD MADE OTHER ❑ DEDUCTIBLE D RETENTION $ CERTIFICATE HOLDER ACORD 21 1) C� POUCY ISOMER 002384 WORKERS OCKAPENSATION AND EN vAN WC - 07079162 aPLOY UMW/ ANY PRO TORIPARTNER1EXECUTNE OFFICER / WEBER EXCLUDED? (Mandatory In NH) SPECJAL � below MIAMI SHORES VILLAGE BUILDING DEPARMENT 10050 NE 2ND AV MIAMI SHORES FL 33138 POIJCY EFFECTIVE PC UCY EXPIRATION DATE (10 YYY)DATE (IYI YYYV) 09/04/2010 09/09/2010 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES 1 EXCLUSIONS ADS BY 84DORSEMENT / SPECIAL PROVISIONS CANCELLATION 09/04/2011 09/09/2011 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS tII1TEN NOTICE TO THE CERTIFICATE HO>.DER NAMED TO THE LEFT, BUT FAILLRE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF16NY KIND UPCMI TIE INSURER, ITS AGENTS OR REPRESENTATIVES. A( ATIVE MARIA ALMOLDA EACH OCCURRENCE PREMSES (Ea occurrence) MED EXP (Any one parson) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/DP AGO CQMBINED SINGLE LMT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE E.L. EACH ACCIDENT LIMITS EA ACC AGG Z ovY ❑ OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POUCY LINT 1,000,000 50,000 5,000 1,000,000 1,000,000 1,000,000 100,000 500,000 100,000 01988- -2009 ACORD CORPORATION. Ali rights reserved. 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