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DS-11-1137Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 161266 Permit Number: DS -6 -11 -1137 Scheduled Inspection Date: July 25, 2011 Inspector: Bruhn, Norman Owner: MARIN, MARLENE Job Address: 1040 NE 105 Street MIAMI SHORES, FL 33138 -2106 Project: <NONE> Contractor: HOME OWNER Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122320280050 Building Department Comments RESURFACE DRIVEWAY PasseV12 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 22, 2011 For Inspections please call: (305)762 -4949 Page 12 of 28 Miami Shores Village Building Department JUL 2 2011 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. 361 1 1 1 3 Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): M4 f I�h f i '� Phone #: 7S 6— 3 2 6 _ S. vv Address: (O((() vt /01— S r City: K 4 ' i State: 0.- Zip: 3 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: (0(ye U / U S City: Miami Shores County: Miami Dade Zip: 7 ( -3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: u� v FCL 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 UNew n ❑Repair/Replace ❑Demolition Description of W:. k• r4!; 1 , ; I > c �a P C. (. 1' YI�I �. �� s,.....t.' :.s� "N$ �` :�'- .?�`+`�..•dd�`7'" ".A�?'n� �. o a .. .. car !O e�!'a e * * * ** * ** +***** ** ********* * *********** Fees*** x�******** �xu��n�x�x* a��u+ x�a* a+ ****+��x�x�x�:a��x�x **** *�x+�:x 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 $ 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. Owner or Agent The foregoing instrument was acknowledged befo e me this day of �� , 20� by fl k'W /ACA lam' ri2-40, who • er n to me or who has produced As identification and NOTARY PUBLIC: Sign: Print: My Commission Expires: ,, ° ° °iiiiiel a��\���\\\` 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: * * * * * * * * ***:x***** **** x*****: x+ x*m+ x****+ xx:***** ********* * ***** **u:********* **** ******* APPROVED BY 74927—//-* Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ning Clerk M LOCATION MAP (N.T.S.) 1 1 -rte' Li Y ; / '* f ;,rte i 76 r 1 i �. 7 PROPERTY ADDRESS: LEr.,A, DESCRIPTION according to the at Page 58, of the FOR: MARLENE MARIN. -1 AMEEMAIEW M(ASUREDWAY (R) RECORD (Cek.) CALCULATED FIP FWJMD IRON PIPE FRB FOUND RE —BAR FD /H FOUND DRILL HOLE F N. FOUND NAIL F N &_ D FOUND NAR d DISC CONCRETE FLOCK & STUCCO C/B r<P) EN C C.L.F W.F CONC C.P. FAH MM 8/9 w.P L P C.P PI P PT TYPICAL CENTER LINE MONUMENT LINE PROPERTY LINE CLEAR ENCROACH CHAIN LINK FENCE WOOD FENCE CONCRETE CONCRETE POLE FRE HYDRANT MAN HOLE WATER METER wOOD POLE UGHT POLE PERMANENT CONTROL PONT POINT OF INTERSECTION POINT OF COMMENCE POINT OF TANGENCY 1040 N.E. 105th Street, Miami Shores, Florida 33138. Lot 5, Block 1, "MIAMI SHORES ESTATES", plat thereof, as recorded in Plat Book 45, Public Records of Dade County, Florida. CERTIFY TO: MARLENE MARIN. STEVEN A. GREENSPAN, P.A. --- ATTORNEY'S TITLE INSURANCE FUND. REPUBLIC CONSUMER LENDING GROUP INC., its successors and /or assigns, as their interest may appear. SURVEYOR'S NOTES 11 This survey was conducted for the purpose of a'Boundary Survey' only and Is not Intended to delineate the regulatory jurisdiction of any federal. state. regional or local agency, board, commission or other entity 2) The accuracy obtained by measurements and calculations on this survey, meets and exceeds the Minimum Technical Standards require" .a. its for a Suburban area (1 foot in 7,500 feet) as specified in Chapter 61017 -6, Florida Administrative Code 3) This Survey does not reflect or determine ownership 4) Legal descnpton subject to any dedications, (imitations, restrictions reservations or easements of record. 5) Examination of the Abstract Of Title will have to be made to determine recorded instruments, if any affecting the property. search of Public Records not performed by this OI5Ce. 6) No effort was made by this ounce to locate any underground utilities and%or strictures within or abutting the subject property. 8) This survey has been prepared for the exclusive use of the entitles named hereon only and the certifications hereon do not extend to any unnamed parties 9) Utility facilities within Utility Easements not noted as violations. 10) Driveways or portions thereof within Roadways not noted as 'notations or encroachments. 11) Foundations and/or footings underneath the ground surface that may Cross beyond the boundary Ones of the herein described parcel are not shown. 12) All Iron Pipes or Reber found and shown on the sketch of survey have no caps unless otherwise stated. 13) Fence ownership determine by visual means onty (If any). Legal ownership not determined 141 No search of records was made by this firm beside the record plat, therefore we do not Imply or accept responsibility for any Easement. Dedication or Limitation for ♦vr4Oh information was not furnished. 15) Contact the appropriate authorities prior to any design work on the hereon} - described parcel for Building end Zoning information 16) Professional Land Surveyor and Mapper in responsible charge: Rolando Orsz LS 4312. State of Florida 17) This survey is not valid without the signature and the raised seal of a Florida Licensed Land Surveyor and Mapper. 1 hereby certify to the above named firm and/or persons that the Sketch of Survey ot6he described property is true and correct to the best of my knowledge and belief as recently surveyed and plated under my erection; also that meets the Minimum Technical Standards set in Chapter 610176, Fonda Administrative Code. pursuant to Section 472 027 Florida Statutes. PRA/ A8) BY, GROUP. QNTER INC. Le 4507 LAND SURVEYING - LAND KAMM 9350 S.W. 22nd TERRACE AMC FLORIDA 33165 (305) 220 -0073 BY: .... •.. ORTIZ L5 4312 PROFESSIONAL LAND SURVEYOR 6 MAPPER. STATE OF FLORIDA. • SKETCH OF SURVE a. 4/4 2 F rfri oil) UTILIT-f iivar.46.4.1 1)511--1)3-1-po- Molifitsave ..11111L 9.00' caj (,) - SUBJECT TO COMPUANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS r-AS Gi4J\nc:4L 40-k.( p-/Lm) WcP OA. ay su (vey Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax (305)756 -8972 Expires:6 /30 /2011 Folio Number:1122320280050 Owner's Name: MARLENE MARIN Job Address: 1040 105 Street MIAMI SHORES, FL 33138 -2106 Owner's Phone: Total Square Feet: 1720 Total Job Valuation: $ 1,500.00 Contractor(s) HOME OWNER Phone Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 7/20/2011: Yes Comments: OVERLAY TO EXISTING DRIVEWAY ORIGINALLY BUILT IN THE 50'S 7 -20 -11 NEW PLANS OK 12 FT WIDE DRIVEWAY PARIsj° 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 OWNER: Name (Fee Simple Titleholder): Address:I / lO ST ROOFING City:t(iQmf 5 r Tenant/Lessee Name: Email: JUN 202011 Permit No. DS I 1 Master Permit No. n Phone #: '� -3��� J OO State: f l JOB ADDRESS: O'f (D NI 6 (c)(-) ST zip: 3`313 ir Phone #: City: Miami Shores County: Miami Dade Folio/Parcel #: Zip: 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: Types Qf Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace XL Description of Work: ❑Demolition * * * * * * * * * * ** * * ** * *** * *** **** **** ** * ** Fees**************** * * ** * * * ** *** * * ************** Submittal Fee $ ' 0 Permit Fee $ ! 06... O6 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 31 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. nature Owner or Agent The foregoing instrument was acknowledged before me this day of 3 ,20 IA,by r aiLts; who is personally known to me or who has produced l As identification and whg� ®i f.� h S \tea ®1A ....... NOTARY PUBLIC: Sign: Print: My Commission Expires: seq. �\� �� - -i�� ej B A\\S // / /inillllll\- 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: ik***H<< k*s k**i k*** *nk****d :+kds***Na+k*ihik* kek**sk **d:********* yak #**XaH:Na*****k *Nk*** k*sk**H ** €41 APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(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: Hq r I e.41E, � v 7 n DATE: ADDRESS: J nC O `C" J T 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 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 W 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. 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 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. Initi� 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 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.mvforidalicense.com /dbpr /pro /cilb/iindex.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 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 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 veritying 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 �t day of '- , 20 By -' N who was personally known to me or who has Produced there License or (� ,as llettt !dato(9 ----71-7'tt OW ER / i1liiiill<<lo Descr P4-c bi-- Ss A0.1e‘c,-+E w-ck-\n Gs JUN 2 , 2011 wit114-11 Levy-‘'N O LP 5,1 1144.t. k i4 futict.1-- (2,/ (De44,-,1 IsuRIFCT TO COMPLIANCE WITH ALL FEDERAL S 1 ATF AND COUNTY RULES AND REGULATIONS Ut kpedy k ctck Awg Miami Shores Village APPROVED ZONING DEPT BLDG DEPT BY -C— 6 SKETCH OF '; SURVEY -,c kirlu :f critlw5.4, EVISION CHED r, kl i! ,, kl . it'_•-e-;,1 , . vier I -Ai; - . C PY . • • .V7e tor,•‘• vo 7-1 •-• .1 .3"9 Toict( -c A gr -1 10 io-f-