DS-07-1454Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Numbe
IN,
P -55
22
Pe
t Number
a'
-7-07-1454
Inspection Date: 07/30/2007
Inspector: Grande, Claudio
Owner: RENES, CECILIA
Job Address: 705 94 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
eis•Work Classification: Addition /Alteration
Block:
Phone Number (786)587 -0701
Parcel Number 1132060141960
Lot:
Building Department Comments
Friday, July 27, 2007
Page 2 of 2
1
Passed t
""
Inspector Comments
my
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Friday, July 27, 2007
Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7952204 Fax: (305) 756.8972
BUILDING C"l1 }�1
PERMIT APPLICATION
FBC 2004
Permit Type (circle):
1
JUL 1 2007 L
Y:_G,�m
Permit No. OS Olt [
Master, Permit No.
Bid_ alibi' ihkeheoppievelio Roofing
Owner's Name (Fee Simple Titleholder) lMJA- ■ C •
Owner's Address ti_
City IAA-kW, < State _ • Zip '31f-3.50
Tenant/Lessee Name___— l Phone # --
Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name reCilLIA. VOISS CCU )
Contractor's Address SAM •
City State Zip
Qualifier Name Phone -#
State Certificate or Registration No. Certificate of Competency No.
Phone '# ! " (
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work:
Describe Work:
❑Addition
Phone #
1-000
DAlteration
Square / Linear Footage Of Work:
❑ Re pair/Replace ❑ Demolition
***************************************Fees****************
Permit Fee $
Notary $ ' OD Training/Education Fee $ 040
Scanning $ ���//'''lm Radon $ DPBR $
Bond $ 'WO CO Code Enforcement $ Double Fee $
Total Fee Now Due $ 12- ' JUL 1 7 4',
See Reverse side
Submittal Fee $
�ff yy * * * * * * * * * * * * *, * * **
CCF $'''' bli CO /CC
Technology Fee $ Jj ' 12- •
Zoning $
Structural Review. $
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 ss'parate permit must b8 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 Appl . nt: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in go d fai that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose proper f s eject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first 1 j ect n which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection wil .. t b approved and a reinspection fee will be charged
Signature i Signature
wner or Agent Contractor
The fore instrume i t was acknowl ed before me this it The forego _ instrument was acknowledged before me this
day of 2001, by I Ct , day of 20 , by ,
who • perso' . ly kno me or who has produced q,,p who is personally kno to me or who has produced
identification and who did t ip.0 as iden cation and who did take an oath.
NOTARY PUB 0ti '4���5',
* oo,0: NOTARY PUBLIC:
Sign:
Print
My Commission xpires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Sign:
Print
My Commission Expires:
�1
Plans Examiner
Engineer
Zoning
Jul 05 07 04:59p
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PROFESSIONAL SURVEYOR AND MAPPER
12230&W.131etAvenue, Suits 201
M1au1d, Florida 33188
Tel: ( 251-9006 Pax (305)261-6057
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VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: l& CL PIA .cS DATE:
ADDRESS:
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 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 hold title to the above property and I am planning on doing this construction
Initial G
2. I understand that as an owner- builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
Initial CC-12-
3. .I have an understanding of the 2004 FBC & FRC and understand that this
department and its inspectors are there to help enforce and interpret the code.
There is a copy of the code in this office for review.
Initial C '-V-- .
4. I understand that the building official and inspectors are not there to design,
alter or give advice ors how toy meet code —. only if the structure meets the
minimum code.
Initial CC^Z _
5. I understand that as an owner - builder, that any contractor disputes with sub-
contractors and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate'any contract disputes.
Initial
6. I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company or person.
Initial C-C�
7. I understand that if any person gets injured on my construction project—they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Initial
8. I understand that under state and local laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my property with out first obtaining
the proper permits by licensed contractors.
Was acknowledged before me this f2, day of
B,,Cec,tli a ePAs
Initial
20 al
who was personally known to me or who has
as identification.
n lir i x. n
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit NO. DS-7-07-1454
Issue Date: Not Issued
Expires:Not issued
Folio Number:1132060141960
Owners Name: JAIME & ANA MALCZYK Owners Phone:
Job Address: 705 94 Street NE Total Square Feet: 816
Miami Shores, FL 33138-
Total Job Valuation: $ 2,000.00
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Contra ctor(s) Phone Primary Contractor ••
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 7/13/2007 : Yes
Comments: