DGT-10-1170Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
115 NW 109 Street
Miami Shores, FL 33168 -4316
1121360030230
Block: Lot:
JADE DAVIS
1
JADE DAVIS
115 NW 109 Street
MIAMI SHORES FL 33168-
Contractor(s)
HOME OWNER
Phone
Cell Phone
Approved: Yes
Comments:
Date Approved: 6/29/2010: Yes
Date Denied:
Type Const: Wood Deck
Classification: Residential
Scanning: 1_
Additional Info:
Scanning: 1
Fees Due
CCF
Education Surcharge
Permit Fee - Deck (wood)
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$150.00
$9.00
$0.80
$160.60
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Pay Date Pay Type
Invoice # DGT -6 -10 -38276
06/25/2010 Check #: 2681
07/16/2010 Check #: 2685
Amt Paid Amt Due
$ 50.00 $ 110.60
$ 110.60 $ 0.00
Valuation:
Total Sq Feet:
$ 1,000.00
100
1
Applicant
Available Inspections:
Inspection Type:
Final
Foundation
Framing in Progress
1
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.
July 16, 2010
Date
July 16, 2010 1
A
Inspection Number: INSP - 146951
Scheduled Inspection Date: September 09, 2010
Inspector: Bruhn, Norman
Owner: DAVIS, JADE
Job Address: 115 NW 109 Street
Miami Shores, FL 33168 -4316
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
new wood deck on the side of the house
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 08, 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 Number: DGT -6 -10 -1170
Permit Type: Decks /Gazebos/Trellises
Inspection Type: Final
Work Classification: Deck - Wood
Phone Number
Parcel Number 1121360030230
Page 5 of 31
1
0 .r
BUILDIN
PERMIT APPLICATION
FBC 20
Miami Shores Village
Building Department
0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
§ CME W
JUN 4 tea
13Y:
P e r m i t No l01110
Master Permit No.
Permit Type' BUILDING
Owner's Name (Fee Simple Titleholder) T lJ.\A S Phone # an � - '' 1 ` .
Owner' Addre 1
ss . 1 ; .
City iC1. State
Tenant q e Name Phone #
Email 1Q(Jt -Ylr i'�VC.I�/1'J- Q;QJ�''INI
.Joh Address (where the work is being done)
City Miami Shores Vil
FOLIO/ PARCEL # U
Is Building Historically Designated YES
Contractor's Compare Name
Contractor's Address
City
Value of Work For this Permit $.
Type of Work: °Addition
Describe Work: Nirt.6
Submittal Fee $; !�
Notary $.:. ..
Scanning ;CA'
***. * *: * * * * * * * * * *** * * * * ** * **
Radon $
Permit Fee $
County Miami- bade.. _ Zi
W 3 -' oa
NO
State
DPBR $
e &1cpg'
Flood Zone.
a nVIO/C Phone #
Zip
Qualifier Name Phone #
State Certificate or Registration No Certificate of Competency No.
Contact Phone
: Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Worki
DAlteration New 0 Repair/R.eplace 0' Demolition
42) a° CC'F $ 4 0 CO/CC $.
Training/Education Fee $ G `. Technology Fee $
Bond $
"�- �ea;�ie-FSea Violation date:
Structural Review. $ Total Fee Now Due $ ) 10 00
See Reverse side -
Bonding Company's Name (if applicable)
Bonding Company's 's Address
p
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....,
Signature
APPROVED 13Y
UBLIC:
3C*]'f%f******ia**it** **JA'*i$ *** A
dayo
who . personally known to me or who has produced
' 1 ' identification and who did take an oath.
(Revised 07 /10107xttevised 06/10 /200o)
Engineer
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."
*: , k********* * * ** * * * * * * ***************** **** * *,F *7r
Plans Examiner
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
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 wil t be appr ved and a reinspection fee will be charged.
Signature
Contractor
The foregoinginstru nent`was acknowledged before me this
ACY of ,'20 , by
who is personally known to Me or who has produced
as identification and who did take an oath.
40.% NOTARY PUBLIC:
gi p. +°
•
Sign:
Print
My Commission Expires:
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: DATE: (.0 '�y11�
ADDRESS: 11 ` � �v L3 /D q � hates, l(
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 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.
2. 1 understand that building permits are not required to be signed by a property owner unless he or she is
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 may protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed in his or her n•' : instead of my own
name. 1 also understand that the contractor is required by law to be licensed in Florida and to list his instead
numbers on
permits and contracts.
5. 1 understand that, as the owner- builder, I must provide direct, onsite supervision of the construction.
Initial
ponsible for the
Initial
4. I understand that 1 may build or improve a one family or two- family residence or a farm outbuilding. 1 may al 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 .. bstantially improved
myself is sold or leased within 1 year after the construction is complete, the law will presume that It or substantially
improved it for sale or lease, which violates the exemption.
Initial
In�tia ,■�
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.
Initi
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 prope
l
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is e t 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 wor, ompensation 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 ' 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.myforidalicense.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 . m the party
legally and financially responsible for the proposed construction activity at the following address:
Initial
Initial
Initia
Initi
1,( ' °",) 1 0 l ` 1Chv1 ( Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the in
have provided on this disclosure.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does of have a
license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to
assist you with any financial Toss 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 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{ day of AA/ J , 2011
BOOde1 v A .rr►1 . n La r+. J Oattho
as personally known to me or who has
Produced there License orl ` .2Q) (O5)i ROI ?as identification.
,il
�� OWNER
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
Owner's Name: JADE DAVIS
Job Address: 115 109 Street
Miami Shores, FL 33168 -4316
Owner's Phone:
Total Square Feet:
Total Job Valuation:
100
$ 1,000.00
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
1
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/29/2010 : Yes
Comments:
Issue Date: Not Issued
Folio Number:1121360030230
4,5
9.80'
13.40
2.40'
-
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21.90' •
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•
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: •75.00' M R ..........
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OnP
Property Address:
115 N.W. 109 STREET,
MIAMI SHORES FLORIDA 33168
'(M)(R) + '` 5' Qe L:N () 04.32' M R ( )
75.00 o
A:'^ Slwolk :'
12' Gross Parkway c
10' Asphalt
13' Median Grass
N.W. 909th Street
!HEREBY C& TIPV1WLT1V13.130UNDARY SURYEYG9 ATRUE AND
COW...CT REPRENVOCrION OFA SWIM PREMED =St WYOIRCCTWN.TH•COMPUEE WITH
T H E WHOIUTATEOIQHCAL r � . -.; AS =FORM BY THE STATE OFFLORHMBOARDCe
PROFESSIONAL LANDS ... +.�•,., `iT. .?r <'_0t0474 FLCAIDA ADMIMSTRATIVE COOEPURcuANT
TO 42.727, FLORIDA ST
P.S.M. NO. 5101
N0f •ALpWI1151081 , 1 &MEWS 68,11.01¢ MIMI= CISI WIMCNNMAIBD MSORI IC SULAA66R
7N76 MAP 6101iO DWIRICU TN6&DW01R®MnVRCINSW.RATIC0.58AL 09 SLIM= RIALYSICP
MOLIMPPR
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Notes:
NO NOTES
(NOD)
m
.15'
MIGUEL ESPINOSA LAND
SURVEYING, INC.
10665 SW 190 Street
Suite 3110
MIAMI, FL 33157
PHONE:(305) 740 -3319
FAX #:(305) 669 -3190 LB # 6463
Accepted By
PI
Survey: A -12050
scale: 1"/20'
a er
PAGE 1 OF 2
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Certified To:
JADE M. DAVIS,
TITLE GUARANTY OF SOUTH FLORIDA, INC.,
OLD REPUBLIC NATIONAL TITLE INSURANCE
WELLS FARGO BANK, N.A.
Its'successors and/or assi gns as their interest ma A eaT
Y Appear
GENE! N� OT • • J
1) LEGAL DESCRIPTION PROVIDED BY OTHERS. • I
2) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE • • 1
RECORDED INSTRUMENTS, IF ANY, AFFECT THIS PROPERTY.
3) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENT OR OTHER • •
RECORDED ENCUMBERANCES NOT SHOWN ON THE PLAT.
4) THE PURPOSE OF THIS SURVEY IS FOR USE 174 OOTAININOTITLE INSURANCE AND •
FINANCING ANO SHOULD NOT HE USED FOR CONSTRUCTION, PE'RIWTRNG. DESIGN, •
OR ANY OTHER PURPOSE WITHOUT THE WRITTEN CONSENT OF MIGUEL ESPINOSA • •
•
5) UNDERGROUND PORTIONS OF FOOTINGS, FOUNDATIONS OR OTHER IMPROVEMENTS •
WERE NOT LOCATED.
S) ONLY VISIBLE AND ABOVE GROUND ENCROACHMENTS LOCATED. •
7) WALL TIES ARE TO THE FACE OF THE WALL •
8 8 ) FEN WN N
OE 1 OTDETER6IN N ED. •
10) BOUNDARY SURVEY MIEANSADRAWING AND/OR GRAPHIC REPRESENTATION OFTHE
SURVEY WORK PERFORMED IN THE FIELD, COULD BE DRAWN AT A 51-107,94 SCALE
AND1OR NOT TO SCALE
11) NO IDENTIFICATION FOUND ON PROPERTY CORNERS UNLESS NOTED.
12) NOT VALID UNLESS SEALED WITH THE SIGNING SURVEYORS EMBOSSED SEAL
13) DRAENSIONS SHOW ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN.
14) ELEVATIONS IF SHOWN ARE BASED UPON N.G.V.D. 1929 UNLESS OTHERWISE NOTED.
15) THIS ISA90UNDARYSURVYUNLESS OTHERWISE NOTED.
16) THIS BOUNDARY SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE
ENTRIES NAMED HEREON, 1110 CERTIFICATIONS 00 NOT EXTEND TO ANY UNNAMED
PARTIES.
Community Number:
Panel Number:0139
Suffix: L
Date of Firm Index:09 /11/2009
Flood Zone: X
Base Flood Elevation:
Date of Field Work: 12/5/2009
Date of Completion: 12/15/2009
Legal Description: LOT 23,BLOCK 219,OF MIAMI SHORES EXTENSION
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 43,PAGE 40,
OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA.
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SIGNED L - FQR THE FIRM
Property Address:
115 N.W. 109 STREET,
MIAMI SHORES FLORIDA 33168
MIGUEL ESPINOSA LAND
SURVEYING, INC.
10665 SW 190TH Street
Suite 3110
MIAMI, FL 33157
PHONE:(305) 740 -3319
FAX #:(305)669 -3190
LB # 6463
--1TE-
Accepted By
MTGUELESPI ,• '., '
STATE OP FL* ,•... ,,ys�A ^a, " P.S.ALNO. 5101
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Survey: A -12050
PAGE 2 OF 2
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