PW-11-442Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
ei -310
Inspection Number: INSP - 157159 Permit Number: PW- 3- 11-442
Scheduled Inspection Date: June 07, 2011
Inspector: Bruhn, Norman
Owner: LOUZADO, LYLLIAM
Job Address: 33 NW 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Public Works
Inspection Type: Final
Work Classification: Public Works
Phone Number
Parcel Number 1131010330150
Building Department Comments
TRENCH IN ALLEY FOR UNDERGROUND SERVICE
Inspector Comments
PasseJ�' (121,�
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
June 06, 2011
For Inspections please call: (305)762 -4949
Page 2 of 11
ROVTin
14010 2.01
Miami Shores Village
Public Works Department
10050 N.E. 2nd Avenue, Miami Shores, Florida 33138 ^�
Tel: (305) 795.2204 Fax: (305) 756.8972 J 1 1 G /
Public Works 0,Sl(i%Perm t iNo E L- 2 - (310
Permit Application
FBC 2004 ( %
Permit Type: Public worm WATER Phone 0: •� `J - �l g '� -J6- 8
owners Name (Fee Simple Tttleholder) 2 d Z 1
r Owners Address 3 3 ti l6,1 I .
city If; H i 0 iZ F S state. . 1G ZIP 33/6 .a
Tenantlessee Neale.
Job Address (where the work is being done)
City
Miami Shores Village
33 iz-)&-) 9 (' 971-
County
Phalle 0:
Is Building Historic* Designated: YES
opo-)Fk, Rf C4 6 rcc%
Contractors Comparry Name
Contractors Address
City
Zo U 6(-;
!Aland Dade
NO . uz
zip 73 I-6
3s
nip H1 664(s
Phone 0:
30c:76-6-59-88
State
Archited/Engineers Name Of applicable) Phone B:
$ Value of Work For this Pemdt
Type of Worts
Describe Work:
Zip 33 / 'D
LInea Footage Of work:
for
Bonding Company's Name Cif applicable)
Bonding.Companys Address N/A
City State
Mortgage Lender's Name (if applicable) N/A
Mortgage Lenders Address
City State
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 permft and that all work will be performed to meet the standards of all laws regulating constgdion in
this jurisdiction. I understand that a separate permft 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 this Issuance of a Public Works permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and cor sb ,ctlon lien haw broohwe will be delivered to the person whose
property Is subject to attachment. Also, a certified copy of the reowded notice of commencement must be posted at the Job site for the list
Inspedfbn which occurs seven (n days after life building permit is issued In the absence of such posted notice, the inspection will not be
approval and a refnspecition fee will be charged
Signature Signature
Owner or Agent Contractor
The foregoing Instrument was admowtedged before me this l The foregoing instrument was adcnowledged before me this
day of , 2011., by, `L Loolakci day of , 20_, by
who is personally known to me or who has produced _D Who is personally know to me or has produced
ow i I it rho
as identification aq( \`%6Qhkqty 6tjth. as identification and who did take an oath.
NOTARY PUBLI NOTARY PUBLIC:
a0'
Sign:. � Sign:
Print: ?10?/90//0 Print
My Commission Expires: , q ' d'
My Commission Expires:
APPLICATION APPROVED BY: :r
11/17/2005
Public Works Director or
his designee.
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: 2 i c(/dd / a �-0. ?Ad3 DATE: �((t l a J 1'
ADDRESS: 3 3 5 a- 1-0 A 1-17 o 4 s TL 3 3 5 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 my own
contractor with certain restrictions even though I do not have a license.
Initial R
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.
Initial
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 numbers on
permits and contracts. Q /
Initial ' C�
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 built or substantially
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 L
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 k. <-
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 govern 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 http: / /www.myfloridalicense.com /dbpr /pro /cilb /index.html
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 a- ` �'
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I
have provided on this disclosure.
Initial ` L
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 contractors 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 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
By (Lqe�j
Produced there License or
day of RA. , 20 I l
who was personally known to me or who has
d ty > 4 C(0
OWNER
as identification.
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Miami Shores VIIlage
APPRQ
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ZONING • EPT
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FEDERAL
BLDG DEPT
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SUBJECT TO COMPLIANCE WITH ALL
STATE AND COUNTY RULES AND REGULATIONS
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