DS-07-235Inspection Worksheet
Miami Shores Village '
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 04/25/2007
Inspector: Grande, Claudio
Owner: ROBERTS, SANDRA
Job Address: 271 95 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
Block:
Phone Number
Parcel Number 1132060133950
Lot:
CONCRETE DRIVEWAY
APR 2 5 2007
Passed 69,‘ (1/7.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 39620.
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Tuesday, April 24, 2007
Page 1 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle
• Building
Permit No.
Master Permit No.
FEB rgamawma
la 0 9 2007 All
B Y: --- 115? ......
D37Z35'
Electrical Plumbing Mechanical
Roofing
Owner's Name (Fee Supple odder) 541-JD - (j ■F7 Phone # 305-
`Z D 3 - 3
Owner's Address
City 9 /frrv) t' //?S State Zip
Tenant/Lessee Name
Phone #
Job Address (where the work is being done) C7' iv i:a. 95' /7Z-C:17-1---
7C- -C:1 —/
City Miami Shores Village County Miami -Dade Zip 33
FOLIO / PARCEL #
Is Building Historically Designated YES NO
/4141t2 024 Or
Contractor's Company Name
Contractor's Address
State �' —L Zip
Phone #
3c3S°
Qualifier Name ,�; ' J Ll C
Phone # �`;� 3 _3
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $s=) '
top
—
Square / Linear Footage Of Work:
Type of Work: ❑Additio ❑Alteration. ['New ► 4r Repair/Replace ❑ Demolition
Describe Work: C t D(2-1° I/ ( C C.) 717
***************************************F ******************************** * * * * * ** * **
Submittal Fee $ Permit Fee $
Notary $ 5 -
Scanning $ (o — Radon $
Bond $ 3
Training/Education Fee $ LO 0
DPBR $
CCF $ t -6 0 coicc
Technology Fee $ 5 . ' .
Zoning $
Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ c>'r 1
See Reverse side -+
G3
8 PMD
Bonding Company's Name (if applicable)
Bonding Compaii's Address
City State Zip
Mortgage Le der's4Narne (if applicable)
Mortgage) entjeti'3 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 AFN'IDAVIT: 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 Ls issued. In the absence of such posted notice, the
inspection will not be a roved qi d a reinspection fee will be charged.
Signature ( Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 9 The foregoing instrument was acknowledged before me this
day of (tf b , 20 S k, by . 14 (y4 '7S , day of , 20 , by
who icpersoially kno 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:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * **
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
/ % Zoning
• • ••• • • • • ••
•• •• • • • • • •. •• •
• • ••• • • •
• • • • • • • • • • •
• • ••• • • • • • •••
• 16CaU7dskeY favEX•
• • • •••
• • • • • • • • • • • • • • •
•
•• • •• •• • • •
• • • • • • • • •
• ••• • •• • •
._ • •- • •. ::. ; •.
. . •• • • • •
• •/
.. •_•._
%f
COTS
jam- —2' Q. •
6.5 Xo. A9
'as/c/a, 44.94.2_)'
2.0 "--Ei"
Legend:
rk — Centerline
Res — Residence
Fd — Found
Conc — Concrete
CIr — Clear
R/W — Right of way
Clf — Chain link fence
Ms Measured
Encr — Encroachment
Note: Lands shown hereon were not abstracted
for easements and / or right -of- ways of record.
Legal description provided by client
/<-
Elevations base j on
PCBM # Aj A / Bearings if shown are based
Bev. — , NGV Datum on assumed me 'tiha�n/�aandd[
1929 Ala_ oe Qr ___ _ •
pic?
)i<4, 4/o cP, g-So
............
•
• •
•
.. ..
•••• • •......
•
• .. ▪ • ••
• • • .... ...
•••• •••• •
.. ▪ •
• • • • ....
. ......1 ....
• ••••• • • • • • ••• • • •
•••• • ••• • • • •
• ...... ••••
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: /4)6 6 4 4 /4)6 / DATE: °2/ /® ?—
ADDRESS: c Z E j S — /1"€1 X97 / /7DY
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
2. I understand that as ari owner- builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
'✓'
Initial
• 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
4. I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code –. only if the structure meets the
minimum code.
Initial
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
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
day of
Initial
, 20
By 341() a/24 (2.0D
bEra
o was personally known to me or who has
Produced there License or
as identification.
,. MO
••• _ MY COMMISSION # DD 403995
* ' EXPIRES., October 20 2009
'Q�
'%3,''�` Bonded 'Nu Natal, Public Undetwdters
Miami SIjorej (/i��ccc�e
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (30.51795-2207
Fax: (305)756 -8972
/�PPROOti-ctt
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
/ T2)L)V V
WHEREAS, NT , LQ inafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio #:
Lot Block Subdivision
Tax Folio R:
requests permission to install:
?ffAsphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other y(
within the public road right of way of ( / 9 `J 9� ; lam(
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running withthe land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this d
Fe6 z00
SIGNED. SEALED AND DELIVERED in the presence of:
` MY COMMISSION # DD 83995
EXPIRE$: Octpber20, 2009
dionuu Navy Public underwa
STATE OF FLORIDA)
COUNTY OF DADE)
Sieees
Skid efuvriareut
10050 NE 2nd Ave
Miami Shores, Fl 33138
Phone 305-795-2204; Fax 305-756-8972
www.miamishoresvillage.com
AFFIDAVIT
The undersigned Affiant, 5 'tJ 3 *does hereby attest that
(pr ert owner)
The attached survey, performed by Lf C-(CL.S r C--
i ame of surveyor's company)
for address: N
performed on cp1 0®F (date of survey) is an accurate representation of the
existing conditions and locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a
building permit for the property without first providing a survey less than six (6) months
old. The Affiant, as property owner, further agrees to remove or obtain permits for any
structures which now may exist on the property which are not permitted or which may
violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other
permits.
Further, • ant s}; eth naught.
roperty Owner Signature
5413OL 6.,68 -/3
Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this day of re
Affiant is s ersonally kno to me, produced
as identifica
PREPARED BY:
DECLARATION OF USE
KNOW ALL MEN BY THESE PRESENTS:
WHEREAS, the undersigned ' - je.z T is /are the fee simple owner(s)
of the following described property ( "Property") situated and being in Miami Shores Village, Florida:
Lot(s) Block of (Subdivision),
according to the plat thereof, as recorded in the Plat Book Page of the Public Records of
Miami -Dade County, Florida, (address) and
WHEREAS, the undersigned owner(s) have sought certain development approval from Miami Shores and are
providing this document in consideration thereof and to induce the Village to grant same:
NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which is acknowledged,
the undersigned do(es) hereby declare and agree:
1. That the Property will not be used in violation of any ordinance of Miami Shores Village or Miami -Dade
County now in effect or hereinafter enacted.
2. That the property will be used for a single family residence only.
3. That he /she will not convey or cause to be conveyed the title to the above property without requiring the
successor in title to abide by all terms and conditions set forth herein.
FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant
concerning the use, enjoyment and title to the above Property and shall constitute a covenant running with the land and
shall be binding upon the undersigned, his /her successors and assigns and may only be released by Miami Shores
Village, or its successors, in accordance with the codes, rules and regulations of said Village then in effect.
IN
on this
I. TNESS WH OF he undersigned has /have caused
A' day of , 200v
WITNESS(ES)
OWNERS:
hand(s) and seal(s) to be affixed hereto
Signature Signature
and Print and Print
Signature Signature
and Print and Print
STATE OF FLORIDA )
COUNTY OF MIAMI -DADE )
I HEREBY CERTIFY that on this day personally appeared before me
who iCpersonally kno to me or has produced (type of identification) as
identific—alton e she acknowledge that he /she executed the foregoing, freely and voluntarily, for purposes therein
expressed.
SWORN TO AND SUBSCRIBED before me on this
My commission expires:
l day of
re4 , 200e)?.
MONICA LISSETH DIAZ
-,01 MY COMMISSION # DD 483995
! EXPIRES:October20, 2009
0bndotl 7hru Notary Public underwriters