DS-08-1410Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 08/04/2008
Inspector: Rodriguez, Jorge
Owner: VUKOVIC, VLADIMIR AND JANET
Job Address: 284 102 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 1132060134710
Lot:
Building Department Comments
AFTER THE FACT DRIVEWAY PERMIT. CUT AND
BRING IT SIDES CONCRETE DRIVEWAY AND
UP TO OF
® ® ®�
Passed
Inspector Comments
CC s ®t;; 4, � �
//al
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Friday, August 1, 2008
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
BUILDING
PERMIT APPLICATION
FBC 2004
Permit No. O O 14) 0
Master Permit No.
Permit Type (circle): Buildin Roofing �% p
Owner's Name (Fee Simple Titleholder) ,+ 1/ /Giles / !'Y7 / Y'` Y U�UV /C. Phone # 305 1?/ -608.'2_
Owner's Address 2 R4 Al&,, d 0 2) Si-reel-
City �/1 d $hPe. State b/ Zip 3 31 .3F
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 284 7)E-. /62 S7ee
City Miami Shores Villa g e County Miami -Dade Zip
33/3S-
FOLIO / PARCEL #
// °3206" 013-47/0
Is Building Historically Designated YES NO L
Contractor's Company Name Oritint A_/ LU / / O 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 #
Value of Work For this Permit $ ! j no -�
x /3 ,bra veid
Square / Linear Footage Of Work: Peri? 67/at'
/ilegal pen >11-
Type of Work: ['Addition ['Alteration [Kew ► Repair/Replace 11 Demoliti n
Describe Work: i'�j7 L r f. ,A !�- •' It
�l ailPIS . MEI NI r A Lam.
* *** * ** * * * * * * * ** * ** *a *** * * * * * ** Fees** * * * **** x** ** * * *** x** ** * * * ** * *** * *** * * * * ***
Submittal Fee $ Permit Fee $ , / i • CCF $ CO /CC
Notary $ Training/Education Fee $ _ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
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 AF 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 $2500, the applicant must
—wrwse prup"r " -/a , ,,f;. ._ „z;_42;r ,,, 1rs, ,ere n'Te.nc-e y pn �nas,tguetfp li�ej law brochure will be delivered to the person
P!. / v... 14G14LGff t( llFGi l4 Yi l: !✓I/JYtiµ 14y LL(,G, (,C s
for the first inspec'On which occurs even _(7) day/ -a huilding permit _is issued: ha the absence
inspection veil t be approved and a inspection fee will be charged spa pfd notice, the
l�
Owir or Agent
trument as , ,.4'owledgedbefore
by
known to me or who has produced
entiftcation and who did take an oath.
Signature
Contractor
The foregoing instrument was acknowledged before me this
j Clay of , 20 , by
who is personally known to me or who iias produced
as identification and who did take an oath.
NOTARY PUBLIC:
NOTARY.
Si
Print:
My Commission Expires:
- MY MMISSIbN # OD 430503
EXPIRES. June 17, unssroltsts
*********** * ******* * * **
Sign:
Print:
My Commission Expires:
*****.p * ** vas*** *** * *** ** * * ** * * * *4 * *********** *** * ***
* * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
(Revised 07 /10/07)
Plans Examiner
Engineer
Zoning
7 .'ickrsi S4r4 *etia9e
R e,teost
10050 NE 2nd Ave
Miami Shores, Fl 33138
Phone 305-795-2204; Fax 305-756-8972
www.miamishoresvillage.com
HOLD HARMLESS
PROPER OCATED AT: IO S+r ( ®1 e s'
As GbJ$J4'' Iicense contractor of subject property,
DATE:
7/4/)/1)?
Permit number
Issued to
lG
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 attomey's fee)
resulting from missed inspection of the above mention permit. I furthermore assume responsibility for the
correction, if required, of work performed under the above permit.
Type of inspection missed .-11-1 uti
(Prime Contractor - qualifier)
State of Florida
County of Dade:
c dew
lk_A
(Print Name)
g ^
1� LA I IA. r r.
U Ot&
The undersigned, being the first duly sworn, deposes and says that he /she is the contractor for the above
property mentioned.
Sworn to and subscribed before me this
Notary Public, Sate of Florida at Lar
e
day o T
P, KE ARY DI
s MY COMMISSION 4 DD 400505
4.t EXPIF ES; June 17, POOg
Bonded 11i i Nardry PUblic UnddrwHi®rs
g"6'.'m..._ i .'C" J .k —)— b F,.
VILLAGE OF MIAMI SHORES
I / OWNER BUILDER DISCLOSURE STATEMENT
I/
NAME: 0:00/101/r. ULtkaIle, DATE: 7/3 a / ?"
ADDRESS: 2g4 NE /02 57 -vee7L- m, Q/77' Jhne5
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 co i ction
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. Inac ' e
permits for a period of over 180 days will become null and void (exp ed)
and a new permit will be required to be issued for reinstatement f 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 ode.
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 t design,
alter or give advice on how to meet code — only if the structure eets 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.
Initia
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 an 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 elude
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 of aining
the proper permits by licensed contractors.
Initial
Was acknowledged before me this 3 0 day of July , 20 OF(
By Viodim 1 - Vo kova who was personally known to me or who has
Produced there icense or
CU
as identification.
`PG. . Lori C. Norris
• Lcmmassion= DD344463
�xpces� .AUG. 05, 2008
r a N.Aa RONNOTARY.com
OWNER NOTARY
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit MO. DS -7 -08 -1410
WS
Issue Date: Not Issued
Expires: of Issued
Folio Number:1132060134710
Owner's Name: VLADIMIR AND JANET VUKOVIC
Job Address:
Owner's Phone:
284 102 Street NE Total Square Feet: 156
Miami Shores, FL 33138-
Total Job Valuation: $ 1,000.00
Contractor(s)
Phone
Primary Contractor
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 7/30/2008 : Yes
Comments:
NE 102 STREET
20.00' ASPHALT PAVEMENT
Property Address:
284 N.E. 102 STREET
MIAMI,FLORIDA:33138
• CCRIicti.:491,Va • t•ignis••• r Mt,
r n r..PC4 317 ,44
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Notes:
NO NOTES
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