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DS-11-1192Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 164713 Permit Number: DS -7 -11 -1192 Scheduled Inspection Date: October 05, 2011 Inspector: Bruhn, Norman Owner: QUINONEZ, SANDRA Job Address: 188 NW 104 Street Miami Shores, FL 33150- Project: <NONE> Contractor: HOME OWNER Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360131500 Building Department Comments 16 X 16 SLAB IN BARCKYARD Passed Failed Inspector Comments CREATED AS REINSPECTION FOR INSP- 161579. Not Ready. NB Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 04, 2011 For Inspections please call: (305)762 -4949 Page 29 of 49 1 i Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 01/25/2012 Applicant 188 NW 104 Street Miami Shores, FL 33150- 1121360131500 Block: Lot: SANDRA QUINONEZ Owner Information Address Phone CeII SANDRA QUINONEZ 188 NW 104 Street MIAMI SHORES FL 33150 -1240 Contractor(s) HOME OWNER Phone Cell Phone Valuation: Total Sq Feet: $ 850.00 256 1 Approved: Yes Comments: Date Approved: 7/5/2011: Yes Date Denied: Type of Work: 16 X 16 SLAB Bond Retum : Scanning: 2 Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $6.00 $0.80 $162.10 Pay Date Pay Type Invoice # DS -7 -11 -41347 07/05/2011 Check #: 4700 $ 50.00 $ 112.10 09/21/2011 Check #: 4712 $ 112.10 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Final Foundation In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. September 21, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 21, 2011 1 1✓'"_fr.-15icQ 41,cikt Q214\ -cw5lur) Miami Shores Village Building Department 10050 N.E2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 'JUL 0 RECD, Permit No. D5' ' I 1 9 2 Master Permit No. Permit Type: BUILDING ROOFING �� e OWNER: Name (Fee Simple Titleholder): ' " riagW tZ GP �-f' `-Y Phone#: Address: La S I®4 ' State: Zip: lJ� Tenant/Lessee Nanie: _ Phone* Email: --4--Q0‘ v N° id0e _ j T LLNAO , C V JOB ADDRESS: Lc) 8 voio (Di S 6 City: Miami Shores County: Miami Dade Zip: I� Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Phonett: Address: City: State: Tap: Qualifier Name: Phone State Certification or Registration #: Certificate of Competency 4t: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit $ 850 r Sjiare/LInear Footage of Work: Type of Work: OAddition ❑Alteration Description of Work: ew ORepair/Replace ODemolition iG t , J \7c)..c.K 'fa/tct, . car ** w*** * ** ****ss ****a*«*aIMM*s *Feq * * *was*ssawss*a,**,r**w4.1,** *gas *14**+ * + : **e+ Submittal Fee $5i) ° C ` ) Permit Fee $ ZJ Scanning Fee $ Radon Fee $ DBPR $ CCF $ CO/CC $ Beni $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review TOTAL ME NOW DUE $ 1 k q l 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 net 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 , hment Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which ��curs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved '1,1!'>. — ' ction fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this frj d a y of SUL - 20 _LL, by ( x-1)t(.e_; 0)mr 6.r_ who is personally known to me or who has produced A— ° `, As identification and who did take an oath. NOTARY PUBLIC:`G Sign: Print My Commission Expires: APPROVED BY Zgie :F . ✓0- 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: st#4}#41111 I�4tt� ;:fie**** *********** ********* ** o **************** *** I******** �� Plans Examiner 7( Zoning St rocmral Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15104) 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: C-"<"-C3 I.c V N. ` DATE: - / ®C° ( 20 L ) ADDRESS: \ )0 CO (4 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 respons construction and is not hiring a licensed contractor to assume responsibility. Initial G 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may pro '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 Iicen mbers on permits and contracts. for the Initial 4. I understand that I may build or improve a one family or two - family residence or a farm outbuilding. I may also bu: 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 substantiall 'mproved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built . .tan ally 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. Initial Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working o residence. It is my responsibility to ensure that the persons whom I employ have the license required by law an municipal ordinance. building or ounty or 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. 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not I'y ses 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 com• j lion for the employee. I understand that my failure to follow these may subject to serious financial risk. �1,+ Initial V'� r 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by al 1. P licable 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 co tact the Florida Construction Industry Licensing Board at 850.487.1395 or http: /lwww. myfloridalicense .com /dbpr /pro /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 p 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 informati 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 h 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 __day of kt` , 20 By F1 1cA, c_a) ' - - - ho was personally known to me or who has Produced there `tense or C2(- 4 as identification. ��t� `0 mn' mien's E Xf • cn �•�. ® ®,:.`B'✓��`/ •mac ,,tLORIO'\r' �11rtnin110\ Miami Shores Viiiage Building Department RECEIPT PERMIT #: psi DATE: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ❑ Contractor Owner ❑ Architect Picked up 2 sets of plans and (other) 1-0 A-1 e---& Address: tee Qr1/4a-D (Or* SA- t-Ai &V■Al- 4 \12n -0-- From the building department on this date in order to have corrections done to plans And /or get County stamps. I und: stand that the plans need to be brought back to Miami Shores Village Building Departme\b._ continue permitting process. Acknowledged •.r PERMIT CLERK INITIAL: _Q__.cak RESUBMITTED DATE: PERMIT CLERK INITIAL: 1 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 Permit NO. DS -7 -11 -1192 Issue Date: Not Issued Folio Number:1121360131500 Owner's Name: SANDRA QUINONEZ Job Address: 188 104 Street Miami Shores, FL 33150- Owner's Phone: Total Square Feet: 256 Total Job Valuation: $ 850.00 Contractor(s) HOME OWNER Phone Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Comments: Date Approved: 7/5/2011: Yes APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: Francisco G Quiroz STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT [g] Existing System [ ] Abandonment [ ] Holding Tank [ ] Temporary APP DOC #1M31041661 PERMIT #:13-SC-1359818 DATE PAID 07/15/2011 FEE PAID: 70.00 RECEIPT #:13 -PID- 1671104 [ ] Innovative [ ] AGENT: Francisco G Quiroz MAILING ADDRESS: 188 NW 104 St Miami, FL 33150 TELEPHONE: 1 (786) 200 -0423 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. LOT: 11 BLOCK: 12 SUBDIVISION: Miami Shores PROPERTY ID #: 11- 2136- 013 -1500 PROPERTY SIZE: 0.21 PLATTED: 01/01/1949 ZONING: I/M OR EQUIVALENT: ACRES WATER SUPPLY: [ ]PRIVATE [X]<= 2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? PROPERTY ADDRESS: 188 NW 104 St Miami, FL 33150 [ Y 4-71 DISTANCE TO SEWER: [ Y "I r [ ] >2000GPD FT DIRECTIONS TO PROPERTY: I 95 to Nw 103 St East to Nw 2 nd Ave to Nw 104 St E to Address BUILDING INFORMATION: Type of Establishment [x] RESIDENTIAL [ ] COMMERCIAL No. of Bedrooms [ ] Floor /Equipment Drains [ ] Other (Specify) SIGNATURE: Building # Persons Area Ft Served 3 1300 Total Design Flow For This Unit 6 300 A P11( IED- MINM -DADS COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E- 6.001, FAC v 1.0.0 AP1041661 EID1359818 DATE: 07/15/2011 Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Additional Notes and Comments: County Notes Fields: County Process #: APP DOC #: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: API041661 13- SC- 1359818 07/15/2011 70.00 13 -PID- 1671104 County Permit #: Storage Box #: Zone: Permit Type: County Status: General Comments: This perm granted to inst - . ncrete slab only. Does not have any impact on the existing OSTDS. Pedro Os Engi = =r II v 1.0.0 A21041661 mule tT rn DEPARIVOrt pop, 101011 ptiatart EID1359818 • SKE I CH OF SUPVEYSCALE:1'=20' • 00 1 /°ave/72e72/ REVISIONS: N° 040655 CC LU O CC 0 V' O O' CU N LU Z Z O EVISED IS UPDATED CAD F I LE: t 0 x 0 J W L�. LL 0 w I- 4 0 OU 1 NONEZ. co (J) DECEMBER D,S Miami Shores Village BY DATE APPROVED ZONING DEPT , ` 7/ BLDG DEPT I ''*\\ StIR,JF(;T TO COMP, -LANCE WITH ALL FEDERAL 1A1I AND COUN JY RULES AND REGULATIONS CITY