DS-08-2010Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 100197 Permit Number: DS -11 -08 -2010
Scheduled Inspection Date: September 24, 2009
Inspector: Bruhn, Norman
Owner: CRUTCHFIELD, TIMOTHY
Job Address: 69 NE 99 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number 1132060131300
Building Department Comments
EXTENDING DRIVEWAY 12" SO THAT IT REACHES
STREET, AS NOW REQUIRED BY VILLAGE (APPROACH)
STOP ORDER ISSUED DUE TO BOUNCE CHECK
PENDING TO BE PAID.
Pass
>901>ocf..69
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Cnninmh•r 9R lnna
For Inspections please call: (305)762 -4949
Dann 1 of 17
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 1 Roofing
Owner's Name (Fee Simple Titleholder)
Owner's Address
Permit No.
Fi
orV 1 v 2
.
Master Permit No.
Phone # 4� 2_5-22
city /l ; ' A4 State et_ Zip 33 5r
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 6 I 1" t 7:
City Miami Shores Village County Miami -Dade Zip 33131
FOLIO / PARCEL #
Is Building Historically Designated YES NO &
Contractor's Company Name ikt 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) ✓1/ .4 Phone #
Value of Work For this Permit $ 10y
Type of Work:
Describe Work:
0
[Addition
ElAlteration
Square / Linear Footage Of Work: 12t9 if :II,.
❑New
/2/
❑ RepairlReplace ❑ Demolition
* * * * * * * * * * * * * * * * * * * * * * * * *:x**** * *** ** * ** Fees:** **** * *** * * *** * ***** :�x *:x*** *�x: * ** *** ** * ***
/69 Permit Fee $ CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Subniittit l e J •
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side --*
FS�*' - C O7 ! 11802
v._..i aa'vG -
13 Li _ 9 %.rf
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
Signature ' Signature
The for:,_oing
day of
who 'fpersonally known to me or who has
l"``' 1 VCAs identification and who did to an %ath.
c
..********************************44**
Owner or Agent
ent was acknow
NO IIA ' Y PUBLIC:
o ,
I1 I I
Sign: � _1
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 07/10/07)
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:
************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
Miami Shores Village
Building Department
•.. 10050 N.E.2nd Avenue
Miami Shores, to a 33138
Tel:T3 5)
Fax: (305) 756.8972
PermitN 'Y0%90 ( .
Job'Name
BUILDING CRITIQUE SHEET
•
".•) rill
:11
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
.1 a
Pennit NO. DS-11-08-2010i
elm
Issue Date: Not Issued
Work :41.wri, • on Re
Expires:Not Issued
Folio Number:1132060131300
Owner's Name: TIMOTHY CRUTCHFIELD
Job Address: 69 99 Street NE
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 0
Total Job Valuation: $ 1,000.00
Contractor(s) Phone Primary Contractor
••
••
••
••
••
••
••
HOME OWNER Yes ••
••
••
••
••
••
••
••
••
••
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 11/19/2008 : Yes
Comments:
VILLAGE OF MIAMI SHORES
—O�WNER BUILDER DISCLOSURE STATEMENT
�
NAME: (�!t'1 ����C z DATE: f/`
ADDRESS: 4/- 7� S � /`1 Nr7 �i �p z .3/3,�i
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
Myself.
Initial
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.
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 requited 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 NtOMW, 20 (Ar
who was personally known to me or who has
Produced there License or
OWNER
)1- lq-aola as identification.
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901.114
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JOB NO.: 95 -9 -222
DATE: July 19, 1995
L.a.!„.4rion/
to6.8c'67') (H)
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LEGAL DESCRIPTION:
Lots 19, 20 and 21 in Block 9 of AN AMENDED PLAT OF
MIAMI SHORES SECTION NO. 1, according to the Plat
:hereof as recorded in Plat Book 10 at Page 70 of
the Public Records of Dade County, Florida.
Property Street Address:
69 N.E. 99th. St.., Miami Shores,
Dade County, Florida.
This Survey is Certified to:
Timothy H. Crutchfield
Haley, Sinagra & Perez, P.A.
Attorney's Title Insurance Fund, Inc., and
Prime Mortgage Investors, Inc.
L>smmm
apeClaar
O/B.Off Set
rttc..Encroaat
CaVc.- concrete
. Line
-ry Line
of Way
Vocamentad Line
Lirk FOAM
N.Y.S..tist To Scala
W.F..Wendet Renee
A/C.Air (bdttfaner •
S.X.P..Set.j"isco Pipe
.S.11.60..Set trail and Disc
F.D.ILe antd trill Hole
P.X.P.-)i6 r Iran Pipe
F.14.&D..9Etmd Nall and Disc
F.W.•Found Hail.
N.G.V.D..Natimal: Geographical Vertical Datum
0.61.0.C..0mhead Utility Cables
u.E..tttilitS tit
PL..Planter
D.C.B.M..Dade Countr•bench Nark
L.F.EL. 7onart•Finer Elevation
C.B.S..concEete Block. Structure
P.C.P..Petwneat Control Point
P.R.M..Pereaceatt Reference ltnment •
(P):As per accorded Plat
(MIS
(C)=0:itputed
(L.0.1. As per legal. Description
P.C. Point of Curvatta+e
421- c...)/7 VG y
WOOD r -
SGr.4LE /rr� 24,1
*gtge-
• 1,701 l >rile • 40
lappgamarriumr
1 FLOOD INFORMATION: F(.00DZONE= X • FLOOD INSURANCE RATE MAP= 120652 -0093 J (3/2/1994).
Notes: l': -Not valid unlms Imprinted with an embossed Surveyor's Seal 2.- Elevations shown thus ' refer to N.G.V. Datum (1929)
3.= This is nj an
Surrey
4.Feire o p assumed ai coding to the position of • its •elerrents, (.enless otheniise noted I
5.North Arrow shown is as per Plat Book 10 at Page 70, Dade County Public Records.
v11ERfADY corn fY: That the attached PLAN OP SURVEY of the above described pm is tore and correct to the best of my lutowledge and
belief as tcccntly surveyed and platted under my direction; *an that thane are not above - iund encroachments other than those shown.
I further cent that•this survey meets the:Minimum Technical Standards set forth by the - Florida Board of Professional Land Surveyors pursuant to
ion •' 7, Ft • }Ida Statutes and Chapter 21 -HH1, Florida A ndnis rathrc
'flAR1fIErimf P.S.M.
Professional Surveyor and Ma
Registration No.2263
State, of Florida..;
Mailing Address: P.O.BOX 55 -7152, Miami, F1. 33255 -7152
A -1 LAND SURVEYING CO., Inc.
LAND PLANNERS, SURVEYORS
4811• H.W. 79 Ave. Suite 1 5, Miami, F1. 33166
PM. 305-7164696 17.X1 305- 669 -1189
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BY: ----- ------------
PERMIT #:1DS DX-DOD
Miami Shores Villa e
ZONING DEPT
BLDG DEPT
SUBJECT TO COMPUANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
STATE OF FLORIDA)
COUNTY OF DADE)
Ilteame Siotce4 ti
a14 Vowdwice
10050 NE 2nd Ave
Miami Shores, Fl 33138
Phone 305-795-2204; Fax 305-756-8972
www.miamishoresvillage.com
AFFIDAVIT
The undersigned Affiant, li,�, 6,„ 7� �f,�Z�� , does hereby attest that
(property ow)ier)
The attached survey, performed by 4 ( h44ye Au - 4 -2/'c
(n. e of surveyor's compan
for address:
performed on 7 (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, Affiant sayeth naught.
r
Property Owner Signature
Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this 1 day of N-10\)
Affiant is \4 personally known to me, produced
as identification.
�v ' �� Notary Public State of Florida
Yuswny Border
My Commission DD436629
Expires 06102 09