DS-07-2497Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP -70029 Permit Number: DS -12 -07 -2497
Scheduled Inspection Date: July 07, 2011
Inspector: Rodriguez, Jorge
Owner: LUNA, LUISA FERNANDA
Job Address: 10090 N MIAMI Avenue
Miami Shores, FL
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
Phone Number (305)757 -3133
Parcel Number 1131010210090
Building Department Comments
pavers walkway at the side of the house
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 06, 2011
For Inspections please call: (305)762 -4949
Page 18 of 18
Miami Shores Village
Building Department Jut
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 NoD Si2 " ZH
Master Permit No.
Permit Type: BUILDING // ROOFIN�rG
OWNER: Name (Fee Simple Titleholder): (J/ 4 �• i �'Q Phone #: 005 Z / 33
Address: 0 C1) Ito a J--.1 ; i G
via %�� State: ��/�- Zip: �faS
Tenant/Lessee Name: _ l Phone#:
Email:
VOA / ,y� / JQD%? 76 G �Y G / i ✓M/ .�—
/if JOB ADDRESS: 1 0 . ii\ L 130111
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: 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:
Type of Work: ❑Addition ❑Alteration ❑Newer ❑Repair/Replace ❑Demolition
Description of Work: yCLR i T CZ `~-' , ___
************** * * ******** *************** Fees **** * * * *** ** * *** :**** * * * * * * * *** * * * * * * * * * **
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ VCO
•
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 n t be approved and a reinpection fee will be charged.
Signatur Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of -610, 20 U ,1)77.3.-"4. , day of , 20 _, by
who is personally known to me or who has produced Cut, who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: ! ;\`u �� m = Sign:
Print: _ `z % :_- ` Print:
`SS'A.' o My Commission Expires:
s
Ce Cc' \' . C" Y P
i
y ...
r l,4 ..
*************** x�****** * * *****�xx�****m�a***4�:44404M** x***** ******* ************ ****** u: ***** **** ** **** * * *****a:****
My Commission Expires:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
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):
Electrical
Permit No. S 1 l441-1
Master Permit No.
Plumbing Mechanical Roofing
Owner's Name (Fee Simple e olderZ `A _. Phone #
Owner's Address �'- .. -.�✓ -? = /77,
estate Zip
Tenant/Lessee Name
Phone #
Job Address (where the work is being done)
City Miami Shores Villa • e
FOLIO / PARCEL #
o bo .c) /n! frevt4 1 A-GO—
County Miami -Dade
Zip
Is Building Historically Designated YES NO
Contractor's - Company Name
Contractor's Address
Phone #
City
Qualifier Name
State
Zip
Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ eX®�® Square / Linear Footage Of Work:
Type of Work:
Describe Work:
DAddition
['Alteration New ❑ R air/Replace ❑ Demolition
?--- &JA'Z a$7 �e a
* * * * * * * * * * * * * * *** **: *** * * * * * * * *** * *� * ** Fees* * ** * * *** * * * * * * * * * * * * *** * * * * * * *: * *** * * * * * * **
Submittal Fee $ Permit Fee $ /t 0 �/' • CCF $ ®• �J CO /CC
Notary $ Training/Education Fee $ ®' X Technology Fee $ L (O
Scanning $ '00 Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ DEC 2 0 200r�Total Fee Now Due $ 111
AV 4647
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 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
Si ature } " °�,' Si afore
gn Sign
Owner or-Agent
The fore • oing instrument was acknowledged before me this L.5 The foregoing instrument was acknowledged before me this
day o , 20 by E S®i , day of , 20 _, by
who is personally known to me or who has produced . who is personally known to me or who has produced
126'0(01 ' 0054 identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Contractor
NOTARY PUBLIC:
Sign: —am& / i .� i ' A C11 fe3'6 ' Sign:
IV if WIMPY •i' 00 Ski a'
Print: m ,, '. • e� off° Print:
My Commission Expires: �,,,, C)o4�S My Commission Expires:
** * ************+e*:Y**********4e**** ***** �ii Ft **** * ***** :*** **** * ** *****ic******+ r* ***** ******atr***** *********
3'
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)758-8972
Pennit NO. DS-12-07-2497
Issue Date: Not Issued
Expires:Not Issued
Folio Number:1131010210090
Owner's Name: LUISA FERNANDA LUNA
Job Address:
Owner's Phone: (305)757-3133
10090 MIAMI Avenue N Total Square Feet: 10
:.•
Miami Shores Village, FL
Total Job Valuation: $ 1,000.00
Contractor(s) Phone Primary Contractor '
.1,...
HOME OWNER Yes
....
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 12/14/2007 : Yes
Comments:
cs1-294t
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: ,/ �79 DATE:
0
ADDRESS:
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
Initial 4
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
Initialr��
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 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 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 ' 3 day of
By ()Asa Cuice,G
Produced there License or
Initial
001
who was personally known to me or who has
14S'Q 01 OS-09as identification.
STATE OF FLORIDA)
COUNTY OF DADE)
'1 /tutu Voted fi& 9e
MO 7, overmear
10050 NE 2nd Ave
Miami Shores, Fl 33138
Phone 305-795-2204; Fax 305 - 756 -8972
www.miamishoresvillage.com
AFFIDAVIT
p*Z41
The undersigned A f fi a n t , C-'/C-W, does hereby attest that
(property owner)
The attached survey, performed by
�, � '� (namo.of surveyor's company)
for address: p:� - ' .
performed on (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 saye, naught.
7
Property Owner Signature Property Owner Print Name
_12Cli
SWORN TO AND SUBSCRIBED before me this 13 day of
Affiant is personally known to me, produced a g
V4.i 4 ice
ie
"fGCL,14E"0 ol-OS- $Identtfication.
Notary
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