RC-10-1471Scheduled Inspection Date: February 28, 2011
Inspector: Bruhn, Norman
Owner: MENDEL TRS, ERVIN
Job Address: 10317 N MIAMI Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
February 28, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 150129 Permit Number: RC -8 -10 -1471
For Inspections please call: (305)762 -4949
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Kitchen Cabinets
Phone Number
Parcel Number 1121360130920
KITCHEN REMODEL. CONVERTION OF A WALL INTO
BAR
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 5 of 33
80Lt /0
6110 -U-w_iS
BUILDING
PERMIT APPLICATION
FBC 20
Contractor's Company Name ��✓Lr �- o w �, r�
Architect/Engineer's Name (if applicable)
/O € ‹.3
Value of Work For this Permit $
Type of Work DAddition alteration
Describe Work: e / ;,, ✓1 °
r e .
* * * * * * * * * * * * * * ** * **
•
Submittal Fee $-00' Permit Fee $
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
Permit Type: BUILDING ROOFING
Owner's Name (Fee Simple Titleholder) C- s'o (. e ( "' ° hone #
Owner's Address I v 3 l N• /'- v
City . -' .t ' ,$&. r &s State r d z3 (s v
Tenant/Lessee Name Phone #
Email \ c e C q
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
GtL l p
Training /Education Fee $
Permit No.
Master Permit No.
AUG 1 6 2010
04411
205- 6/2.fc5e
— o>_- 3 .5 - 76f
Flood Zone
Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No Certificate of Competency No
Contact Phone E -mail
Square / Linear Footage Of Work:
DNS' 0 Repair/Replace
Phone #
rO,
***************: r*** F r**** * * * * * * * * * * * * * * * * * * * ** ** * ** * * * **
f6e, CCF $
CO /CC $
Notary ,$
Scanning $ Radon $ DPDR $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Otte $ fl 1 tl .
o Demolition
dt y9 R e"
Technology Fee $
Bond $
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 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
The fore oing in trument
was
day of , 20
who i perso
NOT ' Y , UBLIC
Sign
Print:
My Commission Expires:
APPROVED BY
Owner or Agent
(Revised 07!10 /07)(Revised 06/10/2009)
owl ge before me this
to me or who had produced
s identification and who did take an oath.
Plans Examiner
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _ , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Zoning
Engineer Clerk checked
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOUO 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.
Space above reserved for use of recording office
1. Legal description of property and street/address: 1 123 / 7 N• ' ti j fie.. ' r+^; .14., Ps c L
33 l S v'
2. Description of improvement: V- fc 7- re—Pie/ ("4"" 1 0A-4 4 €-' '1; �-+�
r e l� - 04, eJ y U
4'7(C, Q
3. Owner(s) name and address: C .-:.r i- ( -0,2ez - to 3
Interest in property: 17ugt,- 'i
Name and address of fee simple titleholder. So- e a
4. Contractor's name, address and phone number. ...f k
i`>< 65 ;s.�- e V C t5 - 7
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number. Ai//t
Amount of bond $
6. Lender's name and address: dl// 4d-
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, address and phone number.
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number:
9. Expiration date of this Notice of Commencement:
(the expiration date is 1 year from the date of recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENC
OR RECORDING YSUR NOTICE O COMMENCEMENT.
Signature(s) of :' n er(s ' A
Prepared By
Print Name
Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
ed Officer/Director/Partner/Manager
Prepared By
r ' — " " 2 Print Name
Title /Office
The foregoing instrument was acknowledged before me this day
By
❑ Individually, or ❑ as for
❑ Personally known, or ❑ produced the following type of identification:
Signature of Notary Public:
Print Name:
(SEAL)
VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in it are true, t• the best of my knowledge and belief.
Signature(
By
123.01 -52 PAGE 3 3/10
By
Authorized Officer/Director/Partner /Manager who
1111111111111111111111 111111111111111 11111111
CFtit 201 OR061 1 34-6
OR Bk 27415 Ps 0749; (19s)
RECORDED 119 /09,,2010 12 :3B:40
HARVEY RUV'INr CLERK OF COURT
MIAMI -CDADE COUNTY? FLORIDA
LAST F'AGE
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
r OWNER BUILDER DISCLOSURE STATEMENT
Ci w r'l O t� f 6
NAME: P 'DATE: / (
ADDRESS: 1‘23 1 N ; 4-e
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 haveapplied 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.
Initial
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 n bers 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 . uild 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.
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.
Was acknowledged before me this RP day of
Produced there License or
1
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 acti as an
owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. _`
Initial (�
NER
L
Initial
Initial a
who was personally known to me or who has
as identification.
NOTARY
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.
Initial �I
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 Intemal 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 htto: / /www.myfloridalicense.com /dbpr /pro /cilb/iindex.html
Initial
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
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 contractors 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.
PERMIT
. y -4 -___I
Shores Village
Miami
APPROVED
BY
DATE
ZONING DEPT
BLDG DEPT
�� 1 '9�l CI
�� %�.J
WITH ALL FEDERAL
RULES AND REGULATIONS
SUBJECT TO CCMPUANCE
STATE AND CCUN'iY
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Designed: 5/27/2010
Printed: 6/4/2010
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Designed: 5/27/2010
Printed: 6/4/2010
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Designed: 5/27/2010
Printed: 6/4/2010
LOPEZ, ANDREA AND CHRIS original design 11 Drawine #: 1
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drawing is an •
artistic
interpretation of
the general
ppearance of
the design. Tt is
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ANDREA AND CHRIS original design 1
A1xib 61mensions5 /27/2010
epenci 6/4/2010
Cannot save DIB 1
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Designed: 5/27/2010
Printed: 6/4/2010
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All dimensions _size designations given are
subject to verification on job site and
adjustment to fit job c4y$itipns.
LOPEZ, AND1%. AND CHRIS original design 1
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20 201 This is an original design and must not be
TECHNOLOGIES released or copied unless applicable fee
•
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Designed: 5/27/2010
Printed: 6/4/2010
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subject to verification on site and
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20'
TECHNOLOGIES
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This is an original design and must not be
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Designed: 5/27/2010
Printed: 6/4/2010
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All dimensions _size designations given are
subject to verification on job site and
adjustment to fit job conditions.
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TECHNOLOGIES
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This is an original design and must not be
Pe o rco o pied 1J ss jpplirgble fee
iiis teen paid oryob •rdes placmtl. 0.
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Designed: 5/27/2010
Printed: 6/4/2010
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All dimensions .size designations given are
subject to verification on job site and
adjustment to fit j b conditions.
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TECHNOLOGIES •
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This is an original design and must not be
releas or copiej1 >gltisssitpplirpble fee
bas been padaraiob irde •plac tl.
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Designed: 5/27/2010
Printed: 6/4/2010
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Designed: 5/27/2010
Printed: 6/4/2010
LOPEZ, r OPEZ. ANDREA AND CHRIS flncifiu1 i1e i 11 1 1 Tlroaar:n.+ A. 1
REVISIONS:
Fd. v.H N.E. 104th STREET
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Bearing, if any, shown based on N/A
'f ms property described as:
Lot 12, at,c::Lc North One Half (N Y2) of Lot 13, Block 123,
AMENDED ?LAT OF SECTION 5 OF MIAMI SHORES„
according to the Plat thereof
as recordea in Piat Book 10, Page 47,
of the Public Records of Miami -Dade County, Florida.
(reference) N/A
FLOOD ZONE COMM. No.
X 120652
F.I.R.M.DATE F.I.R.M.INDEX
09/11/09 09/11/09
to
LOT 11
BLOCK 123
REMAINDER
OF LOT 13
BLOCK 123
PANEL No.
0302
BASE ELEV.
+ N/A N.G.V.D.
130.00'(M)(P)
130.00'(M)(P)
LOT 14
BLOCK 123
CERTil+•1LD TO:
Christopher Lopez and Andrea Lopez
MetLife Home Loans, a Division of MetLife Bank, N.A.
its successors and/or assigns, ATIMA
Concorde Land Title Services, Inc.
First American Title Insurance Company
10317 North Miami Avenue, Miami Shores, FL 33150
SUFFIX:
L
ELEVATION NOTE: (IF APPLICABLE)
L.F.EIev.= N/A (lowest habitable floor elevation).
Elevation shown hereon refer to N.G.V.D. 1929.
Lowest adjacent grade elevation= N/A
BM. N/A Elev.= N/A
Garage Elev.= _ N/A Erp.= N/A
Not valid unless
it bears the
signature and the
original raised seal
of Florida licensed
Surveyor and
Mapper.
/,P .:: 1 :
N4!L
LOT 9
BLOCK 123
LOT 15
BLOCK 123
NOTE:
No platted easements in these Tots
No visible encroachments
THIS SURVEY DECLARATION 1S MADE ON THE FIELD
DATE INDICATED, TO THE OWNERS) LISTED. IS IS MOT•
TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR: •
. SUBSEQUENT OWNERS." •. • • •
BOUNDARY SURVEY.
1 HEREBY CERTIFY: that this survey meets the
minimum technical standards as set forth by the •
FLORIDA BO SS L SURVEYORS.
AND MAPPE - S in c • er 61G17 Florida Administrative
Code, pursua 1 / 27 Florida Statutes. •
• _ E Iii •
o Sectro� .0
VES 05/21/10
P'OFESS ON SURVEYOR AND
MAPPER No. 4327. State of Florida.
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s °
:61 Eli 9
o
kill 0
IR
• zg m 14� 8 . 0
al 7 0'. 1 ' :s •
5
LEGEND
A =Arc
ASPH = Asphalt
BM = Bench Mark
BRG = Bearing
CB = Catch basin
CBS = Concrete Block Structure
CH = Chord
Ghana= Chattahoochee
= Center Une
CLF = Chain Link Fence '
CL = Clear
CONC.= Concrete
D = Delta
0 = Diameter
DH = Drill Hole
DME = Drainage & Maintenance
Easement
= Electric Box
= Encroachment
= Finish Floor
= Fire Hydrant
E.B.
Enc.
F.F.
F.H.
F.I.R. = Found Iron Reber
FPL = Florida Power & Light
F.I.P. = Found Iron Pipe
FD. = Found
L.P. = Ught Pole
M = Measured
M.F. = Metal Fence
M.H. = Manhole
= Monument Line
MON. = Monument
N/A = Not Applicable
N/D = Nail & Disc
NTS = Not to Scale
O/S = Offset
O.U.L. = Overhead Utility Lines
OH = Overhang
P = Plat
PB = Plat Book
PC = Point of Curvature
P.C.C. = Point of Compound
Curvature
PCP = Permanent Control Point
PG = Page
P.I. = Point of Intersection
E = Property Une
PL = Planter
P.O.B.= Point of Beginning
P.O.C.= Point of Commencement
P.P. = Power Pole
P.R.M. = Permanent Reference
Monument
P.R.C.= °'+I ^t of Reverse
Curv6 ure
PT = Pah d of Tangec,cv
R = Radius
R/R ,2dhroad
PSM = Professional Surveyor
Mapper
RNV = Right of-Way
SWW' = S•drrwalk
Sec.. = Section
cry`)
T = Tacagent
UJlity Easeme, t
W F Wolf Fence
W M. - = V.ate, Meter
W.V. -= Water valve
4.7 D F ^
lotes Spot
Elevations Elevations Taken
Alvarez, Aiguesvives and Associates, Inc.
• Surveyor$, Mapptrratd Land Planners
6Jp1 1 a th'Arer.ue #04, Miami, FL 33173
' Pho% 385.385.x385 Fax 305.385.0623
305.298.2706 / L.B. No. 6867
Date;.
:05/410/$1:0:
••• • • •
brawn by:
D.G.
Drwg. No.
10 -18055
Inspection Number: INSP - 156127
Scheduled Inspection Date: February 23, 2011
Inspector: Devaney, Michael
Owner: MENDEL TRS, ERVIN
Job Address: 10317 N MIAMI Avenue
Project: <NONE>
February 22, 2011
Miami Shores, FL 33138-
Contractor: HOME OWNER
Building Department Comments
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: EL -8 -10 -1472
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1121360130920
ELECTRICAL WORK FOR KITCHEN REMODEL
Passed
Eri
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 21 of 29
Inspection Number: INSP - 156127
Scheduled Inspection Date: February 24, 2011
Inspector: Devaney, Michael
Owner: MENDEL TRS, ERVIN
Job Address: 10317 N MIAMI Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
ELECTRICAL WORK FOR KITCHEN REMODEL
February 23, 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: EL -8 -10 -1472
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1121360130920
Page 14 of 17
BUILDING
PERMIT A
FBC 20
Permit Type: EL CTRICAL 11
Owner's Name (Fee Simple Titleholder) < S t'/� ^��� Phone #
/ JCS
Owner's Address
City 1 i sel isr re State � -
Tenant/Lessee Name
Email V4-2 e
PLICATION
tiv/ 4
e f' J
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Architect/Engineer's Name (if applicable)
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
� v3( /V. Ai..;
w� —
County
Name
® , o
State
NO
Miami -Dade
Permit No.
Master Permit No.
Z i p 33 ( d
Phone # 3 O 3 i s Y 6
Contractor's Compan
Contractor's Address
City Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Phone #
Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: DAddition DAlteration ['New
Describe Work: &-lec-fii'' 'c c.l
paTEWSD
AUG 1 6 2010
p is . 6 (3• ef
Zip
Flood Zone
❑ Repair/Replace ❑ Demolition
r /
******** * ** * * * ** * * * * * * * * * *** * * * * * * * * * ** Fees* * * * * * * * * * * * ** * *** * * * **** * * * * * * * * * * * * *** * **
Submittal Fee $ Permit Fee $ /:3 "' ' CCF $ CO /CC $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 1 O '
See Reverse side -+
F
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 anspection fee will be charged.
Signature Signature
The for
day of
who is
NOT
Sign:
Print:
0
Y PUBLIC:
elli
My Commission Expires:
* * * ** * * * * * * * * ** * ** *
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
to me or who has pr
As identification and who did take an oath.
1�t'
01 ' i Sign:
y �,hh °° .01c,
rint:
c o .• y Commission Expires:
/6' Plans Examiner
Engineer
Contractor
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Zoning
Clerk checked
OWNER BUILDER DISCLOSURE STATEMENT
NAME: C- '114,/,' r�� [ o,��pe DATE: 3 fo ( (
/ 0 3 [ /CZ % u- e.
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.
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
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 pymbers 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 gr su ntially
improved it for sale or lease, which violates the exemption.
Initial
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.
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 actjpg as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
Initial
Initial
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 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.mvforidalicense.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:
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information th ,
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 noffrave 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 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 °t ✓' day of
tVe •
Produced there License or T
NER
who was personally known to me or who has
a'aG . s i.entification.
NOTARY
Inspection Number: INSP - 150506
Scheduled Inspection Date: February 23, 2011
Inspector: Hernandez, Rafael
Owner: MENDEL TRS, ERVIN
Job Address: 10317 N MIAMI Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
replacing sink
February 22, 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: PL -8 -10 -1537
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360130920
Page 4 of 29
Is Building Historically Designated YES
Contractor's Company Name � .
Contractor's Address
City State
Qualifier Name
Value of Work For this Permit $ •
Submittal Fee $
Notary $
Scanning $
Double Fee $
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 No
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) G "' °�' 4 ` ' ` 'fr z- Phone # 3 ° `
Owner's Address 1 J 7 t 7 Al
City .via/ -wz% "e-.I State Zip 3 l
Tenant/Lessee Name Phone # 0 • 3k/ 6 7
Email V- 4 4ae e - 4-r Q y w ; ( -
Job Address (where the work is being done) " 0 2 t z- ). /4(A—, .(--‘-,4
City Miami Shores Village County Miami -Dade Zip 3 a t s C)
FOLIO / PARCEL #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect /Engineer's Name (if applicable) Phone #
Type of Work: ❑Addition ❑Alteration ['New ❑ Repair/Replace ['Demolition
Describe Work: .S.`
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $
U
Training /Education Fee $
Radon $ DPBR $
NO Flood Zone
Phone #
Zip
Phone #
Square / Linear Footage Of Work:
CCF $ CO /CC $
Technology Fee $
Bond $
Violation date:
Structural Review. $ Total Fee Now Due $ 155 * D g
See Reverse side -->
AUG 2 6 2010
Bonding Company's Name (if applicable)
Bonding Company's Address
City
it 4,a1Viortfaeer's Nre (iappl able)
'" Mortgage Lenle e" Ad
City
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 or Agent Contractor
The foregoing instrument was acknowledged before me this 2 R y The foregoing instrument was acknowledged before me this
day of , 20 t v, by C, --t2.1 S To P . . Loa day of , 20 , by
who is personally known to me or who has produced 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.
NOTARY PUBLIC:
NOTARY PUBLIC:
State
State
Zip
Signature
Zip
\\ \o oniliii
Sign: - n
Print: _ _� r n d
G:l.�o i yh • J _
My Commission Expires: a> .. q t : LL
... ''•••....... \ < C ,
*********************** * * * * * *I/ #�yf91t1# ***********************************•* * * * * **** * * * * * * * * * * * * ** * * * * * ** **
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
Sign:
Print:
My Commission Expires:
4P/ ' Tans Examiner Zoning
Engineer Clerk checked
NAME:
ADDRESS:
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
f °s04 "1" 6742- " z DATE: g 2 r
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 °I
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.
5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction.
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
c
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.
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 CO
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.mvfioridalicense.com /dbor /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 1 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 th at 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 contractors 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 2T day of A-3- , 20 1 v
By who was personally known to me or who has
Produced there License or
OWNER NOTARY
Initial
Initial
as identification.
Initial a-
Initial C/4