RC-08-1355Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Scheduled Inspection Date: June 09, 2009
Inspector: Bruhn, Norman
Owner: GROSSWALD, DANIEL
Job Address: 301 NE 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060135610
Building Department Comments
Passed adfAr4"
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
1CL \o1; "yV1310\1
\m( i
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. 40 (-1335
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle):
Roofing
cc cg7;7'
JUL 2 3 2 ?08
B Y L' ----
Owner's Name (Fee Simple Titleholder)
Owner's Address 3 0 ( �`:
City i� State —f�
s
Zip 33/3
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 0. 0 1
City Miami Shores Village County
FOLIO / PARCEL # t 13 cZ b 6 C 3 5 6/ 0
Is Building Historically Designated YES NO (�
5T
Miami -Dade Zip 3 3 1 3
Contractor's Company Name
41, I M -o 14)4--e---r,
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 #
Square / Linear Footage Of Work: 3 5 5 s
Value of Work For this Permit $ 4'0
Type of Work: DAddition DAlteration
Describe Work: lit; C a-6.e. -4,10
❑New
-F-
/Replace
D Demolition
* * * * * * * * * * * * * * * * * * * * * *,�x�x
Submittal Fee $ Permit Fee $ /`
Notary $ S'130 Training/Education Fee $
Scanning $ CO '0D Radon $
Bond $
* * * * * *Fw**:x************* ** ** *�x, **** *** *�x:x�:�x *�x�x�x *� ***
•
CCF $ 1.OV CO /CC
0 40 Technology Fee $ 3 r t S
DPBR $ Zoning $
Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ ! &1' LJ
See Reverse side —*
a-fru-sr- (-Dr/11440g
2- E,A, .
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 a • ova y a reins ection fee will be charged.
SiSignature /'
gn A � _ Signature
Owner or Agent Contractor
The for _oi ig nstrument ackn wledg:• b5 •re me ' s ■ The foregoing instrument was acknowledged before me this
�
day o i -: L , 201,1 D ,, by ‘ •f I �L I\k i LI day of , 20 _, by
h is person. ly kno n to me or who has produced WV_ who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
N I TARP PUBLIC:
Sign:
Print:
identification and who did take an oatI
v
etp
y.. `.5v�,�sQc� Sign:
a4�G Print:
My Commission Expires:
��' My Commission Expires:
1
*************************************U* ** ** x****** : * * ** ******* ** ** *********: w** ** *** * *** * **:x ***********
APPLICATION APPROVED BY:
(Revised 07/10/07)
Plans Examiner
Engineer
Zoning
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Oft
Inspection Date: December 09, 2008
Inspector: Devaney, Michael
Owner: GROSSWALD, DANIEL
Job Address: 301 98 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: PARDIME ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number
Parcel Number 1132060135610
Lot:
Building Department Comments
CC
Passed 2
Inspector Comments
52-
��
Failed
Correction's
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Monday, December 8, 2008
Page 1 of 1
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
�' ' 777
tlF�
y
JUL 2 3 2M8
BY: %--- - --
Permit No. E1 1 XO
Master Permit No. pc W 15s
S
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder) /Zit, ��i®714t- S -e ��e_ Phone #
Owner's Address .5.-0 1 / l G ' r ST
City IIl414/ 0 (a State P1'
Tenant/Lessee Name /IZ E -MAIL: l V l (It 144 V 5014/1. C-)Al
Job Address (where the work is being done) .o 1 'j e_ CL g S-4
zip 33/3
Phone # 5'2 &2C6
City Miami Shores Village County Miami -Dade
FOLIO /PARCEL# 1130-06l35610
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City
Qualifier Name
Zip 33/3
4/4' E1�C li°l�% Phone # C-44- a cat)
State Zip
_ •' ; ?�
Phone #
State Certificate or Registra ion °k.t: Certificate of Competency No. bUstliA43j7
E -MAIL: ,‘„SS fF► t
Architect/Engineer's Name (if applicable)
Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: ['Addition
Describe Work:
['Alteration
❑New ❑ Repair /Replace ['Demolition
e
\AKS.Mg
* x****** * ** * * *xx * * * * * *xxx * * *x *x * * * *x * ** Fees********** xxxxx * * * * *x * * * * * * * *x *xx * * ** *x * * ***
Submittal Fee $
Notary $ S'
Scanning $ 3
Permit Fee $
Training /Education Fee $
0-2-C)
Radon $ DPBR $
Bond $ Code Enforcement $
CCF $ U lUV CO /CC
Technology Fee $ V'1S
Zoning $
Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side -4
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. l 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 Signatu
Owner or Agent
The foregoing instrument was acknowledged before me this
day of ,20,by
who is personally known to me or who has produced who is person. lly known to me or who h.: produced
As identification and who did take an oath identification and who did take a
ti ti
NOTARY PUBLIC: NOTA Y PUBLIC:
Sign: Sign:
Print: - Print:
My Commission Expires: My Commission Expires:
:xxxxxxx xx is xxx at x x**** x xxxdc xxxx9cx *xxx
*,c, wXxxxxx *** xxxxxxxxxxxxxx *xxxxxxxxxw xxxxx** ***** **x*x* x x x x xx w 'sac*
APPLICATION APPROVED BY:
(Revised 02/08/06)
'‘,'ePlans Examiner
Engineer
Zoning
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
4:6--e4 NAME: �' DATE: 112' 3 `0;5
ADDRESS:30I A(& e 7( ,t ,emu- �l� I�-4 3313 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 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 c� tion
Myself.
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 reinstatem` of the
permit.
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. 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.
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.
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.
Q92,14—
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, 9ould 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
who was personally known to me or who has
Produced there License or T-
Qk,' nes-0 ! 0 -c2S •o2�i % identification.
o�4\ -tip
.
Me *
NOTARY o�,,,,,;s��
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