RC-09-281Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
nspection Number: I NSP- 129724
Permit Number: RC -2 -09 -281
Inspection Date: November 19, 2009
Inspector: Bruhn, Norman
Owner: PALMER, ANN
Job Address: 920 NE 99 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060143401
Building Department Comments
REPAIR LEAK IN INT. OVERHEAD AND RETILE LOWER
SHOER IN THE BATHROOM DOWNSTAIRS.
Passed �'�9,
y
Inspector Comments
CREATED AS REINSPECTION FOR INSP - 107343. No Access NB
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
For Inspections please call: (305)762 -4949
November 19, 2009
Page 1 of 1
311,,AcA Miami Shores Village IIMEETIE1
Building Department It FEB 2 6 2009
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 BY: ° ° ° ° ° ° °°°ee °eeeeeeem
BUILDING
PERMIT APPLICATION
FBC 2004
Permit No.F.C/( 9
Master Permit No.
Permit Type (circle): Building_,,, Roofing
Owner's Name (Fee Simple Titleholder) pk ".4& .. Phone # 3 5 'N3 - -Cl2 (#'
Owner's Address i , X4 2 ‘i'''i .5 —ra
City ki i ii`Ali ,S' ! )8'�,2S State p--1...A— Zip ;..
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
'Ja "'` AAA rm —C`�T
City Miami Shores Village County Miami -Dade Zip 3 313
FOLIO / PARCEL #
Is Building Historically Designated YES NO IQ
Contractor's Company Name 6U (AL -- Phone # `_�L%,S 7ci 3
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: ['Addition ['Alteration ['New • ❑ Repair/Replace ❑ Demolition
Describe Work: ` d�� :` kZ� Cz
// (4-11-117/2--t-
FEB2 6 p ** * * * *** ** ** * *** *>i *** ** ****** * * * * **/ Flees************* * *** * ***** * * **** * * * * *** *** * * * **
Submittal Fee $ 5'0. O Permit Fee $ AVO' CCF $ 1 '(r F F0fCC
Notary $ ' (D Training/Education Fee $ 0'irC) Technology Fee $
Scanning $ 6 ' OL) Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $'l •5a,
See Reverse side -*
Zoning $
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 CONDmONERS, 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
The foreg
day of
Owner or Agent
'ng instrument was ackn lee ged be VI) re
2Q()9, b t ALLA
own to me or who has produced
identification and who did take an oath.
Sign:
Print:
My Commission Expires:
$'1* t�.24k, naee�� e6a
Signature
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:
******* ********************** k sae�a� pi-*************************************** **** ***************************
-/or4�
APPLICATION APPROVED BY:
(Revised 07/10/07)
Plans Examiner
Engineer
Zoning
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: b 1 P L7 � 61-L. DATE: X 01
ADDRESS: Asa::
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 exoeption.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 sate or lease, which is a violrition 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.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
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
p ermit.
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)
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 '1"P
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 `f
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
440
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 go day of
Initial
, cog
Bydle'Vad PaJ Paiber who was p Y ersonall known to me or who has
Produced there License or -0 a 516 -6
("17Az6C)
OWNER
identification.
Feb 25 09 09:52a Mary Ann Cole / r1 =ab- 13.1
DURABLE POWER OF ATTORNEY
Known all men by these presents that 4-NW �- A �-- (patiekit)
dons appoint KEG k6_ 6. t'Nt,- LerL (appointee) , true and lavf l
attorney for him /h and in his/her name, place and. stead, giving and
granting unto V'c4A_ 15, t M (appointee) , full power and
authority to do and perform any and all acts as are necessary in- managing
his /her personal life and business matters, as he /she might or could do if
pe son�all n presseat, hereby ratifying and confirming all that
` tt elv„ (patient) shall lawfully do or cause to be done
by virtue hereof.
THIS POWER INCLUDES THE AUTHORITY TO MAKE HEALTH CARE TREATMENT
DECISIONS, INCLUDING 'THE POWER TO REUSE TREATON'r, OR BEHALF OF THE
PRINCIPAL AND THE POWER TO OBTAIN OR DIRECT'DELXVERY OF MEDICAL RECORDS.
This durable poorer of attorney is nondelegable and shall not be affected
by disability of the principal except as provided by statute. It is valid
until the principal. dies, revokes the power or is adjudged by a court as
being incompetent. In the event a petition to determine competency or
appoint a guardian for the principal has bean filed, the durable power of
attorney shall be suspended until the petition is dismissed cr withdrawn or
the principal adjudged competent, at which time the power is reinstated. If
the principal is adjudged- incompetent, the power is automatically revoked and
a guardian is appointed for the principal.
of flIN WITNESS WHEREOF, I have hereunto set my hand and seal the (9,Q, day
eg , 39o2ail fL e 1'
cpg E ATURE
Signed, sealed and delivered in the presence of the undersigned
witnesses_ We further attest that the named principal, being unable to.sign
his/her name, affixed his /her mark hereto stating that he /she intended the
same to serve as his /her signature, /37gc1 68RJ1nth iri RAW
11- 1 k.V4 ir1 i, FL. 33011
JiggSINES. SIGN$TURE j'
r cN ���� ! of
SWORN TO, SUBSCRIBED, AND ACKNOWLEDGED
A*� C. Pjjrsier' and sworn to
by J . Uttar
WITNESS ADDRESS
12419 V1ek C�^1Pr.T�`1PA
l'ivatoN
WITNESS ADDRESS
and
witnesses, this tulcil. day of flGi49f
F.S. ?09.0$ as amended Ch. 90.232
1183
CON
before me by the declarant,
and subscribed before me
not t
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NO CLIC
M Commission Expires: ./4,0501
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SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
9-7-01Z8I
Inspection Number: INSP- 107353 Permit Number: PL -2 -09 -282
Scheduled Inspection Date: November 10, 2009
Inspector: Levrock, James
Owner: PALMER, ANN
Job Address: 920 NE 99 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060143401
Building Department Comments
REPAIR LEAK IN TUB OVERHEAD AND RE TILE
SHOWER
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
November 09, 2009
For Inspections please call: (305)762 -4949
Page 1 of 29
Miami Shores Village FECIEUVR
Building Department 2 s 2009
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY v�
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder)
Owner's Address qa &f' /G sr-
City ll'iA rt, .'t Z- State
Tenant/Lessee Name
E -MAIL:
Permit No. 01 0(71—
Master Permit No.120 n9 -2rs
Phone #
Zip
Phone #
in,pa( wn R.,6to w ®- . Cam, •
Job Address (where the work is being done) q)-6 /q- Sr
City Miami Shores Village
S ---tq 3 --� ,1,1 ,,,
3-3/3V
FOLIO / PARCEL #
Is Building Historically Designated
Contractor's Company Name
Contractor's Address
City
Qualifier Name
YES
County Miami -Dade
- -CttP 3to1
NO K1
NY-0 eViL„
Zip . (3 /3 y
Phone # 'N3L-q4
State
Zip
Phone #
State Certificate or Registration No. Certificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
b
Phone #
Square / Linear Footage Of Work:
Type of Work: ['Addition ❑Alteration ��� / ['New ► Repair /Replace El
�J
Describe Work:
x4rerir********** r************************ Fees *****u**nY***************** ************ ****
Submittal Fee $
Notary $ 5'
Scanning ADO
Permit Fee $
Training /Education Fee $ ®•
Radon $
Bond $ Code Enforcement $
Structural Review. $
DPBR $
CCF $ 040 CO /CC
Technology Fee $ 4'SO
Zoning $
Double Fee $
Total Fee Now Due $
� �w
See Reverse side —>
Bonding Company's Name (if applicable)
Bonding Company s Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. l 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: 1 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
Owner or Agent
The for-.: Ling instrument was ackn p 1- i ged be ys re
day of ti At, 20 ?, b 11 Ai Itlk r
who is personally k own to me or who has produced
10.
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of 20 b
, Y
who is personally known to me or who has produced
identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
xxxxxnYzxxx*4zst***wxxxxxww*
Sign:
Print:
My Commission Expires:
X*xxx xxx xx xx*x xxlCxx xxx*wwwww.xxxx* x xxxxx Y.xxxxxx*'Y.xxxx x x *xxxxx
APPLICATION APPROVED BY:
(Revised 02/08/06)
/Plans Examiner
Engineer
Zoning