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RC-09-968Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 116525 Scheduled Inspection Date: September 29, 2009 Inspector: Bruhn, Norman Owner: BLACK, BRIAN Job Address: 1294 NE 96 Street Miami Shores, FL Permit Number: RC -6 -09 -968 Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number (678)986 -2032 Parcel Number 1132060143840 Building Department Comments REPAIR OF DAMAGED CEILING DUE TO WATER LEAKING OF ROOF. Passed �� f,017 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments •)nne For Inspections please call: (305)762 -4949 D•s..e A ..F 97 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY' • Complete items 1, 2, and 3. Also complete item 4 If Restricted Delivery Is desired. © Print your name and address on the reverse so that we can retum the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. ,111 Z t Article Addressed to: 1p16CCSG A o, h1(G [64th B. Received • (Printer!"Naine) D. Is del l very, address e?Wfrom item 1? ❑ Yes If YES, en ) € ter livery address below: 0 No 2. Article Number (fiansfer from service label) 3. Service lypa`. ▪ Certified Mail 0 Express Mali O Registered 0 Return Receipt for Merchandise O Insured Mail 0 C.O.D. 4. Restricted Delivery? (Exba Fee) 7009 1410 0000 6994 7025 0 Yes PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE 1 Hill First -Class Dail Postage & Fees Paid LISPS Permit No. G -10 • Sender. Please print your name, address, and ZIP +4 in this box • (Al2-1-\)11.- la-9 (( Ne 96 rh fkOulkk Sko V-c) 9-)i 3g IatII tt1it tit iIt, JIt111111t it lt1 111111tltt111i,ltttlt_tltuJi11 AUG 122 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. gG (A ` Y Master Permit No. BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle):. Building Roofing Owner's Name (Fee Simple Titleholder) y des �/e r� jne% Phone # 017 Z Owner's Address / i� ort e City M j4Y!?/ .,Shp rQ$ State Tenant/Lessee Name Phone # FL Zip 33/38 Job Address (where the work is being done) ).- 1,4 1\1E/ ate City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # NO Is Building Historically Designated YES Contractor's Company Name Ow- Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addif n ['Alteration Describe Work: Gt !L YI� Cn Avr DNew ❑ Repair/Replace ❑ Demolition OJT ° **************** * * * * ** * *******:x********Fee *** *�::x�x**** *�x�x�x�x� ** * *�x�x** **�x *•x�xa� ****a:****** Submittal Fee $ Permit Fee $ *7 CCF $ C(71C'iT Notary $ Training/Education Fee $ Technology Fee $ 1 ng/Ed gY Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ +CO 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re pection fee will be charged. Signature Owner o A = nt Signature Contractor The foregoing instrument was acknowledged before me this /4 The foregoing instrument was acknowledged before me this day of ' y , day of , 20 , by who is ly known to me or who has produced V$ 7/7 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 44 20 d 9, by via v Mo.. 777667 Oh.S 67 As identification and who did take an oath. NOTAIIY PUBLIC: Sign: Print My Commission Expires: 1 • + k*d= ****+ k✓ F***riaekrk**+k+kak***=k***ik **4=s Sign: Print: My Commission Expires: B k�Y Y **** *:k:k***sk k+k*d:ek*ek*********.* **! k*B: **# ********+k***$*************** APPLICATION APPROVED BY: (Revised 07 /10/07) Plans Examiner Engineer Zoning CMEWEinl It AUG 12 2009 J VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT BY: .m..m ..oemo NAME: YVe4 1/e CO a DATE: ADDRESS: j q y- NA- 4 - ,S i R.ti �''i - /Ye Pte) e-t h /Its. \rC. 33/3 ' 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; 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 It contractor. It is your responsibility to make sure the people employed by you My •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.LC.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 Myself. Initial y✓ 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. •Inactive permits for a period of over 180 days will become null and void (expired) and a new permit will be required. to be issued for reinstatement of the permit., 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. 4. L 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 7 5. 1 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 4n attorney. The department will not mitigate any contract disputes. Initial r✓ 6. I understand that if T compensate any person or company for work performed they are requited to halve 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. 1 tial . V 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 j. 8. 1 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 [ R Ii itial day of 20 01 BY r veU who who was personally known to me or who has Produced there License or he ) 1\Jp v "I w i.Pik of ►v'�v r identification. NOTARY 1"011`, L C-STATEOF ItID Cb,�a °D7 23 :�,,. "A`LT<.:a3•m� t1, 23,261 Waged sow ti►ayte '& emeeteat 10050 NE 2nd Ave Miami Shores, Fl 33138 Phone 305. 795.2204; Fax 305-756-8972 www.miamishoresvillage.com HOLD HARMLESS DATE: rd? PROPERTY LOCATED AT: / Z„ 9 /- i' i 9 (6 r.S /7%9 /-)); r_s'h e_,s 33 ! 3 V oq -467 As legal owner of subject property, I request the cancellation of permit number issued to for the following reason: Date of last inspection: I (Y) ` / I hereby apply as owner - builder, or authorize (new contractor) V eJj V -e v v7 to apply for such permits as necessary to construct or complete the construction on subject property. I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or expense (including attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I am requesting cancellation. • (Owner's `ignature) (Prime Contractor -Only if subcontractor holds permit or if change of qualifier) y v e� (Print Name) (Print Name) State of Florida County of Dade: The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the above property. Sworn to and subscribed before me this day of Notary Public, Sate of Florida at Large �dn ja-SL-- 40 a_ fr-le-Lc aJe, e?Lz-k-, s2,4,u2,0-e 4a2 7lJ-z<-&ec,e7 cz(2,--6-J !�I?L/z, v6/7 Gin -c�� ✓4 G/oY .e° Pe-fc/L-Log, N^ y Im JUN 3 0 2009 JD BY: y/e-s Pici4 s- QYn" cot-%' June 30, 2009 Pisces General Contractor Inc. 2221 North East 164 Street North Miami Beach, Florida 33160 la JUL 2 8 2009 ,J BY:- - mmmev This is written to inform you that your permit No. RC -6-09 -968 has been cancelled. Therefore, you are no longer on the job located at 1294 North East 96 Street Miami Shores, Florida 33138. A Change of contractor is on file at Miami Shores Village Building Department. Regards, Yves Verna (owner) 54,-9" DAMAGED CEILING TO BE REPAIRED DINING ROOM LIVING ROOM DAMAGED CEILING TO BE REPAIRED FOYER Lu THROOM BEDROOM 3 DAMAGED CEILING TO BE REPAIRED • • • • • •• • • • • • • • •• • • • • RS ELOOR DAMAGED CEILING TO BE REPAIRED 25-7" BALCONY Y1� 1- MASTER BEDROOM DAMAGED CEILING TO BE REPAIRED ti BATHROOM BALCONY WALKING CLOSED 5-7" BALCONY SFCO\D ELOOP • • • • •••• • • . • •• • •••• • • • • • •• • • • • • •••• • • • • • • •••• • •••• • • • • •• •• •••• • •••• • • • • • • • • •••• • • • • •••• • • • • • •• • • •• • • • • • •••• 11111111111111111111111 1111111111111111111111 CFN 200980441.099 NOTICE OF COMMENCEMENT OR Bk 26907 Fs 40221: (1 ) A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION HARVEY VIINI CLERK OF HARtIEY S:U4'INp CLERK OF COURT MIAMI-DADE COUriTYr FLORIDA PERMIT NO. I"1CO ' 9 TAX FOLIO NO. //-3206'04 3gi� LAST PAGE 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 / addr t2 6 Sr /7 n/ R 33/3S 2. Description of improvement: 31,ITe Rr'R & Odd 3. Owner(s) name and address: // r Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address:-,--, CAS' Z 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: 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 date is 1 year from the date of recording unless a different date is specified) M. >/vt-s Sign =ture of Owner Print Owner's Name Sworn to and subscribed before me this 0 8 Notary Public: Print Notary's Name: My commission expires: Prepared by 0 Be i1),Ib Y14 day of ^ e , 20 09 . BONDED THRU ATLANTIC BONDING CO., Md. NOTARY PUBLIC-STATE OF FLORIDA • ° "' ',',- Milena Paparani Commission #DD685086 .,,, ,,,,.•' Expires: JUNE 13, 2011 BONDED THRU ATLANTIC BONDING CO., nic. Address: LZ-Z-( ka /6i S7 x#320 ,P r 3/6Z' 3TATE OF FLORIDA, COUNTY OF DADE HEREBY CERTIFY that this is a tr e rdy of the )ri,gwataged in this off■ce on da of NITNESS 'IARVE By , AD 20 and and Official Seal. VIN, CLERK, o Circuit xd ounty Courts D.C. 06- 07 -'09 02:28 FFOM- T -775 P003/005 F -882 ,ICO 1- 96 ECEIVE JUN 1 0 2009 Power of Attorney for Rnances. Limited Power.)--- aci‘t /NJ r. G Pirirr y vz5 ✓el ►Jr _J of Lc„ r(6,,1wr i.,,. to ,►ct fv, my place for thc purposes of 1 appoint ,rs This power of attorney takes effect or /r e7 t- or until �-� t ti • and shall continue until terminated in writing , whichever comes first. I grant my attorney -in -fact full authority to act in any manner both proper and necessary to the exercise of the forego- ing powers, and 1 ratify erv'ery act that my attorney -in -fact may lawfully perform in exercising those powers. agree that any third party who receives a copy of 'this document may act under it. Revocation of the power of attor- ney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against thc third party because of reliance on this power of attorney, Signed: This r;] day of State o /1, f ew - ' vt 1 - Co , ty Signature: T., Principal Social Security number. d 4 + - 7 733 Witnesses On the date written above, the principal declared to me that this instrument is his or her financial power of attorney and that he or she willingly executed it as a free and voluntay act, The principal signed Ibis instrument In my pres- ence. Witness 1 t itss slate, Zip Code Witness 2 SiEnatule ?nnted sate Street Address liy, felt, Zip Code WAWOWftmeraAftm6009 wwWld9@toaanl 06- 07 -'09 02 :28 FROM- Certificate of Acknowledgment of Notary Public State of x/ .e..) T -_75 P004/005 F -882 201- ECEIVED JU ;1 0 2009 1C,06/ q6 On t before me, , el notary public, personall 4 J`2"Ild} , who proved to me via the baste of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowl edged to me that he/she/they executed the an in his/her/their authorized capacity(iea), rind thot by his/hex/their signature(s) otx the instrument the person4s), or the entity upon behalf of which the persont(s) acted, i the +instn* c t.1 certify under PEN,ASZY OF PERJURY weer the laws of the State of P.4ten £P? /C. that the foregoing is true and sx . Witness my o ?;, cial seal. Signature JEAN o', BERNARD (Seal) Notary Public, Slate of New VOA No. 244779741 tmisa i i+ed In Kings Cpuniy .,..�' expires MNION;VW7 (-°4"1 Acknowledgment et Attorney -Fact By accepting or acting under the appoindm a t, the attorney -inn -fact assumes totes fiduciary and other legal responsibili- ties and liabilities of an agent, Name ofAttomey -in -Facts Signature ofAttorney -in Fact: Miami Shores Village Building Department >0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit Noll.,® " 76 PERMIT APPLICATION Mgr `Ntlf Master Permit No. FBC 2004 34'33 3/A1333E11, Permit Type (circle): Building 'VP-5 Roofing Owner's Name (Fee Supple Titleholder) \k r M O Ownerr''�s Address � 2C1 y e O (o S1 City 1 I t cum 1 StI10141 State -' 10 n'd A • Tenant/Lessee Name Zip Phone# �'�S f� - CM2 33►3`d Phone # Job Address (where the work is being done) t City Miami Shores Village County FOLIO / PARCEL # 1J (0 ST Miami -Dade Zip 3 3 i5 Is Building Historically Designated YES NO Contractor's Company Name l Ce& Qn P V wk.-tro t,TJr Phone # V30.S�33S mh912 Contractor's Address 2.2 2/ We I (p ST (* 320 city jf oRr14 MI M i' c�a e 4-C N state El zip '3'3)160 Qualifier Name iD 1Ln 1 o `t-b $ u- . tors Phone # ( 5' State Certificate or Regisllation No. (C,C 1 S 0 I 6 S 4cti. fr, erti ic ate of Competency No. ?� a Architect/Engineer's Name (if applicable) t Phone # Value of Work For this Permit $m �o Square / Linear Footage Of Work: G 00 s I Type of Work: ❑Addition ❑Alteration ['New ❑ Repair/Replace -� ❑ Demolition Describe Work:' 1 ,, pOZA \b t �} -d4 02-4 I ( uQ. G�kT�o'k e k� /fig CU 63 * *, rya**** *** ** *** * ** *** * ***** * *** *a***** Feee ss************* ** * * * *** * * * * * * ** ** **** * * *** ** ** eP Su ittal Fee $ Permit Fee $ /� / 4 J 0 CCF $ 3' /kcal m-- Training/Education Fee $ 1' 0,n, �0 Technology Fee $ t :) Notary $ Scanning $ (./i• Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ 99 Structural Review. $ Total Fee Now Due $ ) 54.1° See Reverse side -4 GENERAL CONTRACTOR N. C 5 Roberto Toth (.) 9 Maces General Contractor, Inc. Roofing & General Contractor Licenced & Insured 0 0 Roofing - Repairs Tiles - Shingles - Flat roof Free Estimates 2221 Ne 164 St #320 North Miami Beech, R 33150 Phone (305) 335-7812 Fax (305) 948-5164 E-mail rctb2@yahoo.com • 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 l' ' — Contractor The foregoing instrument was acknowledged before me this pa The foregoing instrument was acknowledged before me this r8 dayof ,2099, by Lev £ ((te ��C n(�L,r�rd�y.of� ,200 j, byA er'rej fa 11,1 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: Print: 1 � 4.--k°- NOTARY My Commission Expires: Milena Paparoni u #DD685086 Expires: I M " ON " D C BONDING CO., INC. BONDED THRU ATLANTIC BONDING ca, INC. BONDED MU ATLANTIC APPLICATION APPROVED BY: NOTARY PUBLIC: Sign: ,r Print: ,4 /7E - , -r a: s „�.0FRLORIDA My Commission Ex i ile,ia Faparani Commission # DD 685086 - 41900st *ta i i424 011 * ** • (Revised 07/10/07) RECEIVED JUN .1 0 2009 s• Plans Examiner Engineer Zoning Iraq _q68 (tof 2)