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DEMO-10-1788Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 152111 Scheduled Inspection Date: June 30, 2011 Inspector: Bruhn, Norman Owner: RODRIGUEZ, GUSTAVO Job Address: 560 NW 113 Street Miami Shores, FL 33168- Permit Number: DEMO -10 -10 -1788 Project: <NONE> Contractor: HOME OWNER Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 3021360210830 Building Department Comments DEMOLITION OF SHED IN THE BACK YARD. Passed e sJ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 29, 2011 For Inspections please call: (305)762 -4949 Page 3of24 1-61151i 0 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING/AIM-24/7P '' OWNER: Name (Fee Simple Titleholder): &l,' -S 142€9 12/ (.0 // Z Phone #: ���� docF '=11 Address: S'1O O i.1 fi;il /13 S City: ,A1/4.141, ' ahkr,F"S State: -/-->"— Zip: Tenant/Lessee Name: /4/ Email: JOB ADDRESS: Sr--( 0 _LU} //_' % City: Miami Shores County: Miami Dade Zip: . / Folio/Parcel #: /'% ,91 .3 cp., - 0,2 - 3 Is the Building Historically Designated: Yes NO j( Flood Zone: ACT 0 8 1010 pi Master Permit No. Phone#: CONTRACTOR: Company Name: C 7,47/ Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ /0047 Square/Linear Footage of Work: 02 S Type of Work: OAddress OAlteration ONew ORep '/Replace Demolition Description of Work: Ile »i 7 /, 3 a- L2 1= /k )%/d COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: N/ * * * * * * * * **** * * * ***+x** **** ** **** * ***** ** Fees**** ***** ** ***** * ******* * ************* ** * **** Submittal Fee $j ' 0 Permit Fee $ j©C) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ U (;) N . ( 0 Bonding Company's Name (if applicable) )4// 4- Company's Address City State Zip Mortgage Lender's Name (if applicable) Al 94 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 approv nd a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoingiinstrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of «L $ , 20 , by (Z,1& 1410) PeA)ff , day of , 20 b —, by who is personally known to me or who has produced FL ®L who is personally known to me or who has produced A.--1).04' 04'7 0As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: ,+ + +i i u,l NOTARY PUBLIC: Aria Sign: f' 46,;....":0 Sign • 0 Print: _ M :°ova,- ,o y al = Print: ., My Commission Expires: • *** **,x **** **** * ************x *** * ***, 14: 41goo kwA*:\ 2****** x�w �x+ sa�m x��a**** x��x�xx: �x�x**** �x�xa�a��e* �x� :s+** **x�a�** **�x�x** **�x** **a My Commission Expires: APPROVED BY �d Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) NAME: Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT 9 L /4.1/47 RiOD 2 ! (,Q a fe 2- DATE: ADDRESS: ° -v(t& S //3 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 new form states 75,000). 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 understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as mown contractor with certain restrictions even though I do not have a license. Initial v' 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for he construction and is not hiring a licensed contractor to assume responsibility. Initial t 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licepsp nu m}r on permits and contracts. Initial 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I buil .a sub ar 'ally improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acts an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htto://vvww.myfloridalicense.com/dbortro/cilb/inde ml . Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: ?re 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informal th have provided on this disclosure. Initial CC Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owners driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this •1 day of , 20 ACM By `A 4k) who was personally known to me or who has Produced there License or -I 0 (Z 3 62' , ` S identification. NOTARYSP:11:C/1/ �,�•. Commission %�� DD765901 /NZ.���. OF . �0lZ4li0— 7AL0 Permit No: 10- / 7g)? Job Name / /pi> , 2010 Miami Shores Vivage Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 b 16 /`0 - t)(Y4sJO Permit No: Job Name /0- IY 10- M , 2010 Miami Shores Village Building Department Building Critique She 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 rli I j' 11 - a- IROMM, OCT 0 .0.■■••••• .1••■•■•• • • .4 • "z, • ''.F.,,', • '" • •;#19 • • •Lil. • • • • • • • • • • • W"ev•o io rl • • • • • • • • • , • ca • • • • • • • • • • • • • • • /at' • Miami Shores Village APPROVED BY DATE ZONING DEPT BLDG DEPT st113.11- CT TO COMPLIANCE WITH ALL FEDERAL S 1 ATE AND COUNTY RULES D REG ,TIONS ..A1.142 /12) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ()--Alsc8 Inspection Number: INSP - 153848 Scheduled Inspection Date: December 06, 2010 Inspector: Devaney, Michael Owner: RODRIGUEZ, GUSTAVO Job Address: 560 NW 113 Street Miami Shores, FL 33168- Permit Number: DEMO -10 -10 -1789 Project: <NONE> Contractor: HOME OWNER Permit Type: Demolition Inspection Type: Miscellaneous Work Classification: Electric Phone Number Parcel Number 3021360210830 Building Department Comments DEMOLITION FOF A SHED IN THE BACK YARD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments DEMOLITION OF ELECTRICAL IN SHED December 03, 2010 For Inspections please call: (305)762 -4949 Page 18 of 25 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 FfgopMc. Permit Type: Owner's Name (Fee Simple Titleholder) G O 3 kg!. (06/ P2, Phone # Owner's Address Z---.7(.2 a i City JAW,' S e�o,?_C, State PL__ Tenant/Lessee Name iour082010 Permit No. ELI Master Permit No. Email ri/ /4 Zip 33/ Phone # Job Address (where the work is being done) ,U, iA), /13 ,spa City Miami Shores Villa l e FOLIO / PARCEL # 1f „?/31g Is Building Historically Designated YES County Miami -Dade Zip 3:3/ 0,2-/ 0S-30 ) Contractor's Company Name Contractor's Address City Qualifier Name NO CL tsC Flood Zone Phone # State Zip Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone Architect/Engineer's Name (if applicable) E -mail Phone # Value of Work For this Permit $ /000 Type of Work: ❑Addition ❑Alteration Describe Work: .DOin. // y1J a1 £7 c Square / Linear Footage Of Work: ❑New 02S-(7 ❑ Repair/Replace Demolition Me 41Cil 70/d * * * * * * *, ****** * *** ** ****** ** * * * * * * * * *Feesx * *** * * * * * *** * ** rat**** * * * * * * * *** **** * * *** * ** Submittal Fee Serer -_ Permit Fee $ CCF $ CO /CC $ Notary $ Scanning $ Radon $ Double Fee $ Training/Education Fee $ DPBR $ Violation date: Technology Fee $ Bond $ Structural Review. $ Total Fee Now Due $ 4i -cgo See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip /y!A- 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 indicateI k or installation has commenced prior to the issuance of a permit and that all work will be performed to mrar ry 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 oved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before /me this day of 0 ;1- , 20 /O , by ria4,1,04) /r` dy-fe§ vii , � \\IVV1111 `I // who is personally known to me or who has bluced it //i, L 0Ie:VA-AV -(cti'f(0%-a As identification iid r di a l . `� � NOTARY PUBLIC: _ ~ ® ' °' <aeV> — N m. -...■ ............,7 _47.4.. 4s, 1.----: .•*V ...§:* Sign: Print: My Commission Expires: CI)_ 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. APPROVED BY ! f /fit`- cif' / Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) NOTARY PUBLIC: Sign: Print: My Commission Expires: Zoning Clerk checked Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �- - //OWNER BUILDER DISCLOSURE STATEMENT NAME: 6�US )(4-& '.0©1? (fug 2 DATE: 902 /// ADDRESS: 0 �u% //3 S`j" 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 new form states 75,000). 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 understand that state law requires construction to be done by a licensed contractor and have applied for an owner- builder permit under an exemption from the law. The exemption specifies that 1, as the owner of the property listed, may act as rrpy-swn contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license nu on permits and contracts. Initial 4. I understand that 1 may build or improve a one family or two- family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that 1 have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or su ntially improved it for sale or lease, which violates the exemption. /1� Initial (� 5. I understand that, as the owner-builder, 1 must provide direct, onsite supervision of the construction. 6. I understand that 1 may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom 1 employ have the license required by law and by county or municipal ordinance. Initial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial ✓'°' 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htto://www.mvfloridalicense.com/dbpdpro/cilb/index Initial 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informa • that I have provided on this disclosure. S _ Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of 62 , 20 By who was personally known to me or who has Produced .,: re License or OWNE .,10 APbbe - C FL 0 R\0P \ \�`���` ���/1111111111 \ \ \\\ Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 152409 Permit Number: DEMO -10 -10 -1841 Scheduled Inspection Date: May 25, 2011 Inspector: Perez, JanPierre Owner: RODRIGUEZ, GUSTAVO Job Address: 560 NW 113 Street Miami Shores, FL 33168- Project: <NONE> Contractor: AIR & HEAT UNLIMITED CORP Permit Type: Demolition Inspection Type: Final Work Classification: Mechanical Phone Number Parcel Number 3021360210830 Phone: (305)557 -9333 Building Department Comments REMOVAL OF OLD AC UNIT Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CL May 24, 2011 For Inspections please call: (305)762 -4949 Page 1 of 22 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. Li eA /P /0 /P Master Permit No. Q &U L7 — / 0 — /P— ,Jfs) Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): (IIA t' �� v_.6 '2 / 42 U Phone #: % Ce 02 OR" PS 1 / Address: , L' J W° //3 s/ City: —All 0 v►) / State: Zip: 3 3 / Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: ,v' W /l 3 s j° City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: // _ a /3 (G' ° 0 / ' ?-3 c7 Is the Building Historically Designated: Yes NO Flood Zone: i CONTRACTOR: Company Name:.-` IL k $ { �- 1,X,(1 L_1) C'_cx ' • Address: 9 MS Y Pk.. City: Cxl@ State: Qualifier Name: 1\-(4a Y� (Zu- State Certification or Registration #: e A 18 (5 Z Contact Phone #:t 9in) Email Address: DESIGNER: Architect/Engineer: Phone #: Zip: t 2 Phone#: <- Certificate of Competency #: Phone #: Value of Work for this Permit: $ /0 �o `, Square/Linear Footage of Work: Type of Work: DAddress OAlteratio Description of Work: /-1Q vVt ®// 1014 New DRepair/Replace Atbemolition * * * *** **** ***** * ****** **** * ** *** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ * * * *; *LL ** **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ . W 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 A}E B)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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will no be appr . ed an a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this 'T day of '/ ,20 /J, by 62/44S /41/12 PM/e /w‘? who i ersonally known NOTARY Sign: Print: Signature "°�` Contractor The foregoing instrument was acknowledged before me this itch day of 1,� �� , 20 JD , byt e` � COL) 6 me or who has produced who is personally known to me or who has produced As identification and who did take an oath. •■■ t:r My Comm. Expires Jul 28, 2013 P `" :';„� ;;tP��' Commission # DD 877164 My Commission ......... xx�vi APPROVED BY s Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOT Sign: Print: as identification and who did take_ . oath. 9 LIQ$EIDI 5, CARRILLO MY CQMMI55ION # D0955157 MP' 3 J.- n ary 25, 1 My Commission Expires: o\ jz6 ly Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Y%* Inspection Number: INSP - 152113 Scheduled Inspection Date: May 24, 2011 Inspector: Hernandez, Rafael Owner: RODRIGUEZ, GUSTAVO Job Address: 560 NW 113 Street Miami Shores, FL 33168- Permit Number: DEMO -10 -10 -1790 Project: <NONE> Contractor: HOME OWNER Permit Type: Demolition Inspection Type: Final Work Classification: Plumbing Phone Number Parcel Number 3021360210830 Building Department Comments DEMOLITION OF A SHED IN BACK YARD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments May 23, 2011 For Inspections please call: (305)762 -4949 Page 2of21 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. pkilen,0 ' ° ~ mO Master Permit No. BUILDING PERMIT APPLICATION FBC 20 TtLUMR14 Permit Type! OWNER: Name (Fee Simple Titleholder): Gi' -34114-4/ -3 ha is /(x'1' �' 1 Phone #: 7c G2 4'217.5' 'I Address: (0- 0 ,A) City: ,_.) / 4.4A ' G%1 d l.' State: P-e-- Zip: 3 "1 Tenant/Lessee Name: Mid Phone #: Email: JOB ADDRESS: ST 0 a-4 41-A /) City: Miami Shores County: Miami Dade Zip: 33 / Folio/Parcel #: 1/ (9/3 3 ('‘,7 afr / ®e 3'-) paznwn OCT 0 s Soto Pi) BY :.. Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: C.N C-J2-• 1Lb( -€__ Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ � Square/Linear Footage of Work: v ' Type of Work: ❑Address °Alteration UNew °Repair/Replace r{ � . emolition Description of Work: IYti J/j )Id 0 I-- G4 2 Ai -� d i ^�� D PAC /2 /� /d *********** **************************Fees******************************************** �xxxxa********* x**** *xxxx****xxxxx **** * *** Submittal Fee $ S '0 Permit Fee $ /4'11 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 5 KiGAD Bonding Company's Name (if applicable) Bonding Company's Address City State Zip ///4 Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip %N /4 Application is hereby made to obtain a permit to do the work and installations as indicattd. I i that no ., 116 or installation has commenced prior to the issuance of a permit and that all work will be performed Mall laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for EA FETRIcAEL. ORI£ ? JMBING, 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 gppoved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of OL+ ,2o / 1) , by Gtb /,4lk•J �1tJ/Jd? t t t1 , who is personally known to me or who has produced 5 1y }}}l111ry � �% -3 t G. Y //4* /� As identificati wUho d fi e an oath. NOTARY PUBLIC: cn Sign: ' 2 f cr, y: c Print: My Commission Expires: •....... • • ••:• "1111111111I1° \ 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: ** *** ******* * *** ** ** ***** ** * ** *** **** ** ************************************ * *** * * ** *** * *** * ** * *** *** ** * *** r�� APPROVED BY 0 rn Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06110 /2009)(Revised 3/15/09) Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 � / OWNER BUILDER DISCLOSURE STATEMENT NAME: 6 as i`Ak Rabk /Coto 2 DATE: id —Nec2 ADDRESS: S 7 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 new form states 75,000). 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 understand that state law requires construction to be done by a licensed contractor and have applied for an owner- builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initi 2. I understand that building permits are not required to be signed by a property owner unless he or she is respon e for the construction and is not hiring a licensed contractor to assume responsibility. Initi 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or li : •,,,, +-rs on permits and contracts. Initial 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I byilt or s sta tally improved it for sale or lease, which violates the exemption. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initia Initia po 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and byrtounty or municipal ordinance. Initi 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. CU' Initial 1 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http: //www.myfloridalicense.com /dbpr /pro /cilb/iindex.h 1 Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatio have provided on this disclosure. /i a Initial Ce Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 1 day of \ Z , 20 la By who was personally known to me or who has Produced there License or as identfcyg,nr,i1/4/ '.co G .006S-we, F '%�'�zaRIDP 0- "rr1111 n ll,q����