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DS-11-1222Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: 1 3 P- 161766 Permit Number: DS -7 -11 -1222 Inspection Date: Sep .ber 27, 2011 Inspector: Bruhn, N( an Owner: GRUNt I 'UGETTE Job Address: 90 P'A' ! eet Miami FL 331684319 Project: <NON! Contactor: I;C `IER Building Departmr Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360030080 !!!ments C'1' :CRETE Dr '.' ' INSTALLATION Passe led C ^ rrectioti Inspe,_ "i Fee 'ional In,; fee scheduled until Inspector Comments CG For Inspections please call: (305)762 -4949 Her 28, 20' Page 1 of 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 'errrrt Na Type Drive iiays/Side vaik Parcel Number Il t PROVED Expiration: 03/20/2012 Applicant 90 NW 110 Street Miami Shores, FL 33168 -4319 1121360030080 Block: Lot: HUGETTE GRUNDER 1 Owner information Address Phone Cell HUGETTE GRUNDER 90 NW 110 Street MIAMI SHORES FL 33168 -4319 Contractor(s) HOME OWNER Phone Cell Phone Valuation: Total Sq Feet: $ 1,650.00 480 1 Approved: Yes Comments: NOT MORE THAN 12 FEET WIDE AT PROPERTY LINE, 2 FOOT FLARES MAX Date Approved: 7/12/2011: Yes Date Denied: Type of Work: DRIVEWAY Bond Retum : Scanning: 3 Additional Info: CONCRETE Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $150.00 $9.00 $1.60 $166.70 Pay Date Pay Type Invoice # DS -7 -11 -41414 09/26/2011 Check #: 2679 07/08/2011 Check #: 2522 Amt Paid Amt Due $ 116.70 $ 50.00 $ 50.00 $ 0.00 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 26, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 26, 2011 1 c 6-i.\\1 —100(01, BUILDING PERMIT APPLICATION FBC 20 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 Permit No. 1:351)--)a,9„2_. Master Permit No. Permit Type: BUILDING ROOFING /I OWNER: Name (Fee Simple Titleholder): 9� �„tici�� —t J Phone #: ©S %�—g� 3 / Address: City: - a'Y� C State: 1- (' Zip: 3 l %_,g Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: c 0 (4) 1, l U City: Folio/Parcel #: Miami Shores County: Miami Dade Zip: /(=>� Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 14-c"-Yn e O(L vn Address: � O N ti) 1, 10 City: Qualifier Name: State Certification or Registration #: Contact Phone #: DESIGNER: Architect/Engineer: State: Phone #: (3 9 ) '?s —3' / 3/ ?Y "Z5-3 - Zip: 3 3 / (c4 Phone #: Certificate of Competency #: Email Address: Phone #: Value of Work for this Permit: $ ) 0'°" Square/Linear Footage of Work: Type of Work: Addition ❑Alteration ❑Demolition Description of Work: �Jl snS� _ ❑New ❑R- it eplace Permit Fee $ /.! 0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Submittal Fee $t00 TOTAL FEE NOW DUE $ (f2,--ko 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 : ed and a reinspection fee will be charged. Signature The for day o Signature Owner or Agent Contractor g instrument as ,20'tt ,b who is p - sonal Si ..I NOT Sign: Print: My Commission Expires: owledg before known to me or wh has produced this IAA 'fication and who did take an oath. UBLIC: *9eic4e:e9e9e9e4: kdede4e4e* k*d: oY Y*4: d: Y9:4e4r*x4r*k Y*:Y Y***k t**:t9e9e The foregoing instrument was acknowledged before me this day of , 20 _, by o is personally known to me or who has produced as identification and who did take an oath. - NOTARY PUBLIC: tz, 13F C� 1 r '�1�? Y'lrlt• My Commission Expires: APPROVED BY (Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) *************************** * ** * * * * *** * * ** *** * * * *** * * * * * * ** Plans Examiner Structural Review Clerk NAME: ADDRESS: EL 082011 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 ovh 9� � �-�-% DATE: 7 / / cD--e' 1 / O'tcc) itc 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 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 sub tantially 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 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. 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. 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. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Intemal 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 htto:// www. mvforidalicense .com /dbpr /prolcilbfindex..h 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 th 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 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 S day of ct- 1 , 20 1 1 By lc 14(--- who was personally known to me or who has Produced there License orTi OWNER Miami Shores Viiiage Building Department RECEIPT PERMIT #: ! 1 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 I, er are_ 4...44 ❑ Contractor Owner ❑ Architect Pi is of plans an Other) 4-47/4104it i4e€. NINN Inst Address: From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. 7— Acknowledged by: eVtiD PERMIT CLERK INITIAL— RESUBMITTED DATE: q 941. 14Dk PERMIT CLERK INITIAL: i& 1,4-1-re\c- Permit No: 11 -1222 Job Name: July 16, 2011 Miami Shores Village Building Department Building Critique Sheet 1) Plans must be approved by HRS for the septic system. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will doa complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 BOUNDARY SURVEY BY &Awn suravanrENG, 1840 NORTH PINE ISLAND ROAD PLANTATION, FLORIDA 33322 PHONE (954) 4734010 FAX (954) 473 -8020 CERTIFICATE OF AUTHORIZATION #LB7086 EMAIL; VEYINGQYAHOO.COM LEGAL DESCRIFTION: LOT 8, BLOCK 219 OF 'MIAMI SHORES EXTENSION° ACCORDING TO THE PLAT THEREOF A5 RECORDED IN PLAT BOOK 43 AT PAGE 40 OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIDA. NORTHWEST I 10th STREET 16 15 14 13 12 17 16 19 20 21 11 I0 9r8 7 22 23 24 25 26 NORTHWEST 109th STREET LOCATION SKETCH NOT TO SCALE 0 9011 1-1 22.2 -. ZONING DEPT BLDG DEPT SUBJECT TO COMP DANCE WITH ALL FEDERAL GHT POLE *ATE AND COUNTY RULES AND REGULATIONS POUND 1/2' IRON PIPE (NO ID) SET 1/2° IRON PIPE . ' • . . 629.7 ' W/ CAP L6#7086 • uoh irc\A 4" 4-1x1 t1 NOTES I) ELEVATIONS, IF SHOWN HEREON, ARE RELATIVE TO THE NATIONAL GEODETIC VERTICAL DATUM OF 1929. 2) UNDERGROUND IMFROVEMENT5- AND/OR UNDERGROUND ENCROACHMENTS NOT LOCATED OR SHOWN. 3) ANGLES SHOWN HEREON ARE BASED ON THE RECORD PLAT. 4) ROOF OVERHANG NOT LOCATED UNLESS OTHERWISE SHOWN. 5) THIS SURVEY 15 FOR PERMITTING PURPOSES ONLY. 6) REASONABLE EFFORTS WERE MADE REGARDING THE EXISTENCE AND LOCATION OF UNDERGROUND UTIUTIES. THIS FIRM, HOWEVER, DOES NOT ACCEPT RESPONSIBIUTY FOR THIS INFORMATION. BEFORE EXCAVATION, CONTACT THE APPROPRIATE UTILITY COMPANIES FOR FIELD VERIFICATION. 7) ALL BEARINGS/ANGLES AND DISTANCES SHOWN HEREON ARE BOTH MEASURED ON THE GROUND AND RECORD (AS PER PLAT) UNLESS OTHERWISE SHAWN. • THIS SjIMO 15 CERTIFIED EXCWSIVELY TO: • • • r1UGETTE GRADER • • • B 1 j FLORIDA. INC. •� ••� u I t ORIDA 12.32' • MI ••1111,.9) _ • ••••4D) • • •• • • ••• •• • • ••• • • A WIRES. RADE ELEVATION. • LAN r ►P, i Q11' �T ABSTRACTED • : • BY '+ " VC:NITS-OF -WAY AND /OR •EASEMERITStZF RECORD. TI3EREFORE. ONLY THOSE RK T5-0F -WAY AND EASEMENTS SHOWN ON THE REFERENCED PLAT ARE SHOWN. 0.22' 12.27' x x x� RO J to' flopi ami Dade Co tY HL. Rm LOT 8Bealth Depa i STORES EX'TE$SION'_ 0.50' J 6' WOOD FENCE x % X % X FOUND 1/2' IRON PIPE (NO ID) WATER METER WOOD POLE 0.40' FOUND 1/2' Ilk S PIPE (NO ID) CERTIFICATION: I HEREBY Ctkl IFY THAT THIS SKETCH OF SURVEY MEETS THE MINIMUM TECHNICAL STANDARDS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS IN CHAPTER 6 I G 17 -6, FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION 472.027, FLORIDA STATUTES. °NOT VALID WITHOUT THE SIGNATURE AND ORIGINAL RAISED SEAL OF DA PROFESSIONAL SUR OR AND MAPPER." PROFESSION 4, 4-j/" JAY KERI 51G SURVEYOR AND MAPPER NO. 572 I STATE OF FLORIDA FLOOD INFORMATION FLOOD ZONE: X (BASE FLOOD ELEV.: N/A COMMUNITY PANEL # 1 2065.2.0139 L BUILDING DIAGRAM WA 1 MAP DATE: 09 -1 1-09 LOWEST FLOOR ELEVATION : N/A ■GARAGE FLOOR ELEVATION : N/A °CLIENT: GRUNDER PROJECT NO.: 16469 SURVEY DATE: OCTOBER 7, 2010 90 NORTHWEST 114th STREET MIAMI SHORES, FL 33168 SCALE: 1' •20' FILE: BEAUTIFUL CONCRETE Rick Scott Govemor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General September 20, 2011 Huguette Grunder 90 NW 110 St Miami, FL 33168 RE: Contingency Letter Application Document No: API045078 Centrax Permit Number: 13 -SC- 1365381 OSTDS Number: 90 NW 110 St Miami, FL 33168 Lot:8 Block:219 Subdivision: Miami Shores Dear Applicant: This will acknowledge receipt of an application dated 08/22/2011 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced From a review of your completed application, it has been determined your existing system is adequate for the proposed use. Proposed concrete front driveway. There is not increase in sewage flow, change sewage characteristic, or any alteration that change the conditions under which the system was approved If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com