DS-07-1292Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 07/03/2007
Inspector: Grande, Claudio
Owner: , owner /occupant
Job Address: 890 100 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number
Parcel Number 1132060340010
Lot:
Building Department Comments
Tuesday, July 3, 2007
Page 1 of 2
JUL 0 3 2007?
rity
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Tuesday, July 3, 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
ocol C.
BUILDING Jcws
PERMIT APPLICATION
FBC 2004
Permit Type (circle)
momnvEci
BY:
Permit No.D -1 - ag2-
Master Permit No.
Electrical Plumbing Mechanical Roofing
309 7 2`-3.548
Owner's Name (Fee Simple
Owner's Address
City / 5 't p5 State
Tenant/Lessee Name
Phone #
zip 3 3 t 38
Job Address (where the work is being done
City Miami Shores Village
FOLIO / PARCEL # - l
Is Building Historically Designated YES
Phone #
d 9d n1CX00 5f-.
County Miami -Dade Zip .?.31 3
Contractor's Company Name a
Contractor's Address
City
Qualifier Name
NO
OCR1.>e
Phone #
State Zip
Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ dZS7dt
Type of Work: ❑Addition
Describe Work: 5
6t e.
❑Alteration
Phone #
Square / Linear Footage Of Work: /g0 FO s..
24ew
❑ Repair/Replace
Submittal Fee $
Notary $ Training/Education Fee $
Scanning $ A Radon $
** ** ** * * ***** ** ** * ** ****
Permit Fee $
* ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Bond $ Code Enforcement $
Structural Review. $
DPBR $
CCF $
CO /CC
Technology Fee $
Double Fee $
$
Total Fee Now Due $
ACS'
See Reverse side --*
Q1 M27PAID
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 Alt FII)AVIT: 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
r
Signature
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of der , 2007, by 34 / _`a e a day of , 20 _ , by ,
who is personally known to me or who has produced ,fif iclif who is personally known to me or who has produced
60 r I r rt. _As identification and who did take an oath. — - - -- . n and who did take an oath.
NOTARY PUBLIC:
Sign: o
Print: e /4• a e f e
My Commission Expires: qq
** * *** ** ** ** **** * * * * *, ter ** *****4* * , *,x * *x * ** ** *, * ** * ** * ** ** ** *** * ** * ** rat * *, * * *** **** ** * * * * *, *** * * * * * * * **
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Pennit NO. DS-6-07-1292
kits
Atter-
Issue Date: Not Issued
Expires:Not Issued
Folio Number:1132060340010
Owner's Name: owner/occupant
Job Address: 890 100 Street NE
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 180
Total Job Valuation: $ 2,800.00
Contra ctor(s) Phone Primary Contractor
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/20/2007 : Yes
Comments:
ITOMEWrg
JUN 2 0 210
FIR 1/2" NO 1
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B L O C
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BLDG DEPT
SUBJECT TO COMPLIANCE
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FIRM ZONE
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BY: w�.Q,
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P.G. BATTLE, PSM N0. 5753
COMMUNITY NO.
120652
PANEL NO.
93
SUFFIX
J
DATE OF FIRM INDEX
7 -17 -95
FIELD DATE: 10-12-00
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..STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,
attached survey, performed by
AFFU)AVIT••
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:=3—CmAit, ra , does hereby attest that the
(property o»mer)
t
h net E LICrVC ( G �
(name of surveyor's company)
performed on IJ, / 2- d , is an accurate representation of the existing conditions and
{ to of s ey)
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.
" rresg4
Sft/eS
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this / f ay of L/%Je
Affiant is personally known to me, . t4roducecl _ /, ;� ` �, ��, _ as identification.
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VILLAGE OF MIAMI SHORES
• •.. • • • • • •..• • • • • • • .. •
. . .. . . . . . . . .
OWNER BTUILDERDISGT�x sT, ;T1 ENr
• • ... . • •
•
NAME: ��A,, 5 b
....DATE: •.•�0 •'� 9 �'' •
• ADDRESS:
�' /UtT 7(() •.•• •...�.•
•• •
Do hereby petition the Village of Miami Shores to-aet as my own contradtor pursuant to the laws
of the State of Flox;da,. F.S 489.103(7). And I have.read and understood the following disclosure
statement, which entitles me'.to work as mx own contractor; I further understand 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 commiercial building at a cost of $25,000.00 or less. The building must be
for your-own use and occupancy. It tn-ay 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 npt licensed must work underyour supervision and must
be employed by you, which means that you trust 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 understa'fid that as ari owner - builder t must abide by all zoning ordinances and
building;relationd % n effect at.the time of permit application
Initial r
3. :T 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
alter or give advice on how to meet
minimum -code.
and inspectors are not there to design,
code —. only if the structure meets the
Initial
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5:001 utulerst i ,that as' a1 river- builder, . that any contractor disputes with sub -
econiaetars;and•mysgli;niu.t be handled in a civil court with the advice of an
attdrney. Thellepartment will not mitigate any contract disputes.
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6. I•tindtfs&1 that ff. 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 uiilicensed Eompanyor person.
Initial
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 T 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 Llectrical,
Plumbing, Heating, Air & Roof work on my•proper y with out first obtaining
the proper permits by licensed eontraators.
Was acknowledged before me this
day of , 20 0 01
BY -TA -- /V/ -S e. ,42/ who was personally known to me or who has
Produced there. License or 4-- P4' . as identification.
•
NOTATtY
ei/l a e ,C4-,-1 / (413
iiy J-7