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RC-11-936Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163640 Permit Number: RC -5 -11 -936 Scheduled Inspection Date: August 23, 2011 Inspector: Bruhn, Norman Owner: OLASO, NORA Job Address: 9826 N MIAMI Avenue Miami Shores, FL Project: <NONE> Contractor: MARMAN CONSTRUCTION Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010330010 Phone: (786)210 -7691 Building Department Comments REPAIR BATHROOM, REMODELING FIXTURES Passed �� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 162606. CREATED AS REINSPECTION FOR INSP- 162468. NEED FINAL INSPECTION. FOR ELECTRICAL AND PLUMBING. JR August 22, 2011 For Inspections please call: (305)762 -4949 Page 25 of 29 ink 1 pf,r(Asax- 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 L.7711 757-Y MAY 2 `:71 2011 , BY: Permit Nd C 11 1 ............... Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): oak. ?• 0 1-A50 Address: GA '824 Xi (/S-3Al 44 City: )-lc ,&)k( 'i:, & lO' - S State: Tenant/Lessee Name: Phone #: Phone #: '% S 6 62S -0286 Zip: S 3 S o Email: JOB ADDRESS: c B Z6 D.3 • l A t A-4 re City: Miami Shores County: Miami Dade Zip: -Sl SC) Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Phone#: Address: 'a5=34'33 J.J L3 • G C'"1" City: ac A)A \ State: A- Zip: 1 S Qualifier Name: (zyt,asAA i``a Phone #: `?�G 2.110 "76a?1 State Certification or Registration #: Cam•- -E 1 S ai', 35 \ Certificate of Competency #: Contact Phone #: r7L► ' ..2 Ja q 6e1 Email Address: tA DESIGNER: Architect/Engineer: Phone #: 2co `769 I Value of Work for this Permit: $ ®a Square/Linear Footage of Work: Type of Work: Addition ErAlteration New ORepair/Replace ODemolition Description of Work: c)-i% 1.0 z%.t i *a~2 •t�, 0) Q.0 k Submittal Fee $ �lj Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ * Fees * * * * * * * **�* ** ** * * * * * * * * * ** * * * * * * * * * * * * * * * * * * ** e�I?CF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ "Vl 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 a. proved and a re'. ' on fee will be charged. Signatu Owner or Agent c� The foregoing instrument was acknowledged before me this 11 Contractor e The foregoing instrument was acknowled 4QC' edd bbefore me this �V.) day of AC 1 , 20 `� , by N OYZA- °LJ ' , day of i`.'1�(e , 20 i (, by '1 iC !+ who is personally known to me or who has produced 'PL I D who is personally known to me or who has produced -(D As identification and who did take an oath. as identific. on and who did take an oath. NOTARY PUBLIC: \\,��`'� �'�0,/,/ NOTARY PUBLIC: # uois Sign: Print: : ' ; My Commission Expires: APPROVED BY UNI9OIEO '% SandX'?•'�a iS is0a�\ Si • 2i rr. • n• Print: My Commission Expires: 3110114 J YLQN ZLOZ/soIEO Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) OP ID: AM ACCAREY 01.......--- CERTIFICATE OF LIABILITY INSURANCE I DATE (MWDDIYYM 05/18111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY 114E POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSLIING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(lee) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certMcate holder In lieu of such endonsementisi. PRODUCER 954-731-558S W.F Roemer Insurance Agency William F. Dowd 954431-8438 P.O. Box 110869 Fort Lauderdale, FL 33319 Jonathan F. Rentes CONTACT NAME: PELIL.0„e, I FAX Nt* ADDRESS: eltculicm - MARk1A-1 CUSTOMER .. ik INSURES(S)AFFORDING COVERAGE NAM* INSURED Merman Construction, Inc. 18833 NW 84 Court Hialeah, FL 33015 wsuRER A : Mid-Continent Casualty Co 23418 INSURER B : 04GL000811700 INSUREFt C: 01/24112 WIRRER 0: $ 1,000, 000 INSURER E : DpRICrasr?&ENTED ) INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING MY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR LTR TYPE OF INSURANCE ADM INSR SUBRI WVD POLICY PABABER AgtifEFlyi POLIConal mlonrilEXP LOUTS A GOMM. LIAMILITY CONMERCIAL GENERAL uceury OCCUR 04GL000811700 01/24111 01/24112 EACH OCCURRENCE $ 1,000, 000 X DpRICrasr?&ENTED ) 8 100,000 I CLAIMS-MADE X MED EXP (Any one person) $ EXCLUDED PERSONAL & ADV NJURY $ 1,000,000 GENERAL AGGREGATE 0 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: POLICY I-7 ,Pira ri LOC FRODUCTS - COMP/OP AG d $ 1,000,000 —1 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS FIRED AUTOS NON-OWNED AUTOS 0401000811700 01124111 01124112 COMBINED SINGLE MUT (Ea sadden() $ 1,000,000 — BODILY t4JJRY (Perperson) $ BODILY NARY (Per accident) $ PROPERTY DAMAGE (Perm:Merit) $ X X $ UMBRELLA LIAB EXCESS UAEL OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE 8 DEDUCTIBLE RETENTION 4 $ IS WORKERS CCSIPENSATION A1DESPLOYESSUA0fljTY ANY.PROPRETORIPARTNEMIDECUTIVE OFRCERNEMBER EXLUDED? (Mandatory In 1411) If yes. describe urxIer DESCRPTION OF OPERATIONS 'i'lN N IA 1 WC STATU- I IOTh- I TORY Lmen-s i I ER E.L. EACH ACCII:ENT $ EL DISEASE- EA EMPLOYEE $ below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHCLES (Aftath ACORD101, Additional Remarks Schedule, If men space la required) M IAMIS2 Village of Mitsui Shores 10050 NE 2 Issa SIMMI Shores, FL 33139 1 SHOILD ANY OF NE AIME DESCRIBED POLICIES BE CAMMLED WORE 116 EXPIRATION DATE THEREOF, NOTICE WSJ. BE DEARS= IN ACCORDANCE WIlli THE POLICY PROVISIOM AUIWORIZED REPRESENTATIVE -,---6itz...e..4,-.-.. ACORD 25 (2009109) 1999-2009 ACORD CORPORATION. All rights rose The ACORD name and logo are registered marks of ACORD NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA COUNTY OF MIAMI -DADE: TAX FOLIO NO. THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 111111111111111111111111111111111 111111111111 CFN 201 1L R034241L 2 OR 8k 27700 Ps 0962i (fps' RECORDED 05/25/2011 12:40:03 HARVEY RUVII4, CLERK OF COURT 1'IIAMI -DACE COUNT 'r FLORIDA LAST PACE 1. Legal description of property and street/address: ct S2-6 - ).'&. t )s*v 2. Description of improvement: P. Esi ( i - 3. Owner(s) name and address: cR "' c. i+7 . C � i a V �. (� } a < S 7 I? ga Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: -( 4-9---. (' P� 'T 2iz C.7rt Z 0 c,L) 4- cam- f►r 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: y 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording different ` -te is specified Signature of Owner 2/S. Print Owner's Sworn to and subscribed before me this 1 day`44, -M /1/11, , 201k Notary Public Print Notary's 'Name My commission expires: 123.01 -52 PAGE 4 8/02 Prepared by l<? Address: k- 2,0Ea--3`1 ADD SMOKE/CARBON MONOXIDE DETECTORS ANY AND ALL CLOTH AND RUBBER INSULATE CONDUCTORS TO BE REPLACED. p/lr, Vaka..; LOCATION MAP SCALE 1/4' BATH ELECTRICAL PLAN SCALE 1/4' r-tr CONTRACTOR SRAM REUSE EXISTING BATHROOM RECEPTACLE AND um= mans BATHROOM RECEPTACLE ON 20 AMP CK1 AND G.E1 PROTECTED BATH LOCATION PLAN SCALE 1/4' EXIST. AND tr Civ BATH WATER SUPPLY PLAN SCALE 1/4- - BATH ELECTRICAL PLAN SCALE 1/4' EXIST. SANITARY MN UNE -t) CO EX BATH PLUMBING SANITARY PLAN SCALE : 1/e - SCOPE OF WORK REMODEL EXISTING BATHROOM. ALL cceracnous ARE EXISTING. ONLY FIXTURES NELL RE REPLACED. CHANCE DOMING LAYOUT FOR samooK, Dam mans *LL BE USED. NOT SIGNIFICANT LOAD CHANGE. ROOM FINISH SCHEDULE ROOM BASE !FLOOR MAUS REMARKS 1 I ill i;iiill NEW BATH /NE a) J BATH PLUMBING SANITARY PLAN SCALE : 1/e - SCOPE OF WORK REMODEL EXISTING BATHROOM. ALL cceracnous ARE EXISTING. ONLY FIXTURES NELL RE REPLACED. CHANCE DOMING LAYOUT FOR samooK, Dam mans *LL BE USED. NOT SIGNIFICANT LOAD CHANGE. ROOM FINISH SCHEDULE ROOM BASE !FLOOR MAUS REMARKS 1 I ill i;iiill NEW BATH a) , MASH LEGEND 1. MATOi EXISTING FINISH_ 4 101, - ., - 'M • . PANT TO %CHOSEN BY 017/c 3. fr-1 " 9t-C TP'FFIr,... ( 1T j3L MAY 2 2011 B -0,4 • • EMU SHORES VILLAGE 1 ECTRV • • 7}- I Ain ( B ATE. A 6§7 izkitg‘YANCE W111--- ST D C7,n'NA4TJ!RNAFi._, Fk. Nd3RA7-0-1.ASO RESIDENCE 9826 N MIAMI AVE MIAMI FL, 33150 jp,k1101\1:1, OF 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 1-9* Inspection Number: INSP- 162730 Permit Number: EL -5 -11 -937 Scheduled Inspection Date: August 04, 2011 Inspector: Devaney, Michael Owner: OLASO, NORA Job Address: 9826 N MIAMI Avenue Miami Shores, FL Project: <NONE> Contractor: MARMAN CONSTRUCTION Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010330010 Phone: (786)210 -7691 Building Department Comments BATH REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 03, 2011 For Inspections please call: (305)762 -4949 Page 16 of 24 Walgreen. Co. 106 Wilmot Drive MS #1630 Deerfield, IL 60015 Re: Siror M ,t4 I 4/26/201i Co. Letter of Authorization — HVAC Rooftop Unit Retrofit Remodels This letter is written to orize Mr. Charles Jason Kujula from AES Mechanical Group, Ltd, to conduct the itting process for the HVAC rooftop unit retrofits remodels occurring at Walgreen store locations within your municipality's jurisdiction. Walgteen Co. hereby allows Mr. Kujula to secure the permits for these locations and commence work per the construction documents submitted under your review. AES Mechanical Group, Ltd., is located at 2171 AL HWY n9 S. Tallassee, AL. If you should have any questions, please feel free to contact the undersigned at (847) 315- 2364. Regards, itten Vaigreens Co. Constriction Project Engineer 847-315-2364 OFFICIAL SEAL INGRID M HOFF N NOTAFIY PLIMIC -STATE OF ILLINOIS MY COMMISSION EXP RES't 2 Walgreen C�, 106 Wilmot Road • Deerfietd, 11. 60015 www.walgreens:corn Miami Shores Q?�r 'a 71/ r,h,,� • 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 MAY 2 3 2011 Permit No. �--� ® Jam - Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): k3 02- 4- ®I. 1 - Phone #: '756 c2 (32-86 Address: X 8 2 L) 5-JO AW A—ME City: »"-' -V-4k State: -� Zip: ‘'S Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 'a 24 l,-) • k44.101/4 fir= City: Miami Shores County: Miami Dade Zip: -M3lS Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: Ci sRat ., I1—DSet---- CONTRACTOR: Company Name: 4 ,n-,- ° 6' Phone #: a Address: 4-.10 64 •-r` 7g a4Q2SLP.\ City: State: L Zip: 1 Qualifier Name: Pe Phone#: State Certification or Registration #: p- 6 ) • c S l Certificate of Competency #: Contact Phone #: 913 6 Z- V, '76°f\ Email Address: Y1/19- ''(COQ %4 t L Q E e Comet DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ GC) Square/Linear Footage of Work: Type of Work: ❑Address °Alteration UNew Ef kep air/Rep 1 a c e °Demolition Description of Work: Q`,, .r eiLl rye` ("AAA A Q (kA-cS (\ , rep **** x** *********** : ********** ** * **** *** Fees:** ****** x** ** * *** *** * ** :** *****x:******+x**** Submittal Fee $ S- ° ?4, i rD Permit Fee $ /fir" e? 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 a►proved and a reinspection fee will be charged. Signature ` Signature Owner or Agent The foregoing instrument was acknowledged before me this day of nA"( ,20 t(, by NU2t C S The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced ID who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: \‘��w'it11 rtttt/.. ,o1 f , \z-0.N '�•��' °° °O'er• ��o Sign: ) % �� _ � , ,'` = Print: ,��0 \�� My Commission Expires: & /a /1,1s * * * * * * * * * *'liV* * x******************************* * ***** * * * ************* **** * **** /2- �-.t t YPlans Examiner Zoning NOTARY PUBLIC: Sign: Print: My Commission Expires: Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) • Miami Shores Village Ming Depart 50 1N E 2rid Aver IF Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT DAT ADDRESS: —1d kr/7/ 147/7 4006 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 1 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 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. 1 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. 1 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial Initial 4/4,49 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 0601d 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that errtirteousfy� lri t s ihattheeroperfy owner is providing hr or her, town labor and tetfais I, s an owner buider mey be held stad �uiitAGtect saerurus financial ria for alit r ur s:s# acne " as a t bused person r his or erttploq swbk wbr tig:on try property `ivly'tiomeownera insurance may notprovide cosrarage,for those injures, "[:am wrlifulf acting as an owner- builder and am aware of file limits of my insurance coverage for' injuries to workers on my property. Initial /4„, 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'contribitionss under the Federal Insurance Contributions Act (FICA) an, must provide workers compensation for the empioyee;:1 under dn# that my failure to follow-these may ubject to;serrous 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 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 Y 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 /cilbfindex.html Initial ap 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 M 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 4/0 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 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 day of , 20 By --arbp was personally known to me or who has Produced there License or as identification. OWNER NOTARY Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 160076 Scheduled Inspection Date: August 05, 2011 Inspector: Hernandez, Rafael Owner: OLASO, NORA Job Address: 9826 N MIAMI Avenue Miami Shores, FL Permit Number: PL -5 -11 -938 Project: <NONE> Contractor: HOME OWNER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330010 Building Department Comments BATHROOM REMODEL Passed r4 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 04, 2011 For Inspections please call: (305)762 -4949 Page 2 of 12 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. R.,1 - Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): ®12 A- O( O Phone #:7'8 6 C-,2S Address: S �6(��l(U City: \A\ )1 &k2- . State: C__ Zip: 3 3lS Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: ctcf32. \)1., ` •- City: Miami Shores County: Miami Dade Zip: °S-S \5 '® Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Phone #: e.: 1 Address: ( <f)k City: iA \ _ State: t--- Zip :..-L.--& C3 l S Qualifier Name: Phone #: ' 6S 1 State Certification or Registration #: Certificate of Competency #: Contact Phone #: %"tea 21z9"r7& \ Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address OAlteration ❑New QRepair/Replace ODemolition Description of Work: 2a`1 y trl Y PAA4 t `),<V-c, Y ******** ***** * * * * *** *** ******** *** ***** Fees************* ** **** * * * * ******* * * ** ** * ******* Submittal Fee $ Sa 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 $ I n9. in 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. Signatu Owner or Agent I The foregoing instrument was acknowledged before me this day of '�‘ , 20 �k, by i\10e -4- 0J 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: say �'.`' •.�' ... Ica ************ ****:x*+x******* ** *:x**** * * ** * * *s<******** :* ************** ** **** ** *+x***:****:x************ *** APPROVED BY °� 1/ Plans Examiner Zoning Signature C tractor The foregoi g 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: (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Structural Review Clerk Miami Shores Village I in D artme;ft E2nd Avenue sari Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT ADDRESS: 4fr. ‘ ,W � '0/771/*1/ !y am 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 C:7 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. /� 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. 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 1 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 matenais.1,. as an owner - wilder; may be held fable aed subjected to serious :financial risk for any utilities sustained by an unlicensed person 'Or 'tits ,br employees while, corking on my property: My homeowner's insurance may not provide coverage for those injuries. Iam wilfully acting as an wiener- 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 Py �..g soolal 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 tasertousfinancial 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. 119 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.mvtloridalicense.com /dbor /pro /cilbfindex.hhttml Initial l '2 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 Dally and financially responsible for the proposed construction activity at the following address: Initial - z) 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 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. re me this 19 day of H. A,. , 20 (. I who was personally known to me or who has Produced there License or C1S OWNER as identification. NOTARY