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RC-11-1479Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 164970 Permit Number: RC -8 -11 -1479 Scheduled Inspection Date: October 04, 2011 Inspector: Bruhn, Norman Owner: DEFEDE, JAMES Job Address: 10650 NE 11 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1122320280670 Building Department Comments REMOVE & REPLACE TILE Inspector Comments Passed -s Failed 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 18 of 26 1 111111 11111 11111 11111 1111111111 11111 1111 1 111 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION I` PERMIT NO. 1C.A l —1(117°1 TAX FOLIO NO. 1 2N9-.3 202 3'- 6-7� STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made gC -tc property, and in accordance with Chapter 713, Florida Statutes, th is provided in this Notice of Commencement. 031 egal description of property and street/address: =1= 1 2011 1 80589613 OR Bk 27817 Ps 3635; (.1 Ps RECORDED 09/07/2011 16:05 :16 HARVEY RUV'INv CLERK OF COURT MIAMI-CDADE COUNTY? FLORIDA LAST PAGE z DOA 8 we coyD, y et ttzc gt wrive IoC5c #JE )11 Ave ce.l mtanyi Shnlvs , f'L-' 33 ).?4i escription of improvement: VCv'KN z {e 13AllArcoyeN 0.0 Space above reserved for use of recording office wner(s) name and address: erest in property: 0 W new Name and address of fee simple titleholder: Contractor's name, address and phone number: 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: e/'.. _Jun- ►P toi5b ,Nc f%t x}1/8. newt S 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTIO I. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK R R,J I OUR NOT E OF COMMENCEMENT. (s) f P ner(s) or nerds' A horized Officer /Director /Partner /Manager Prepared By 4ni 1 ^ Prepared By Print Name if.'-rtIC e �2 Print Name Title/Office OW A Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowle ged before me this day of By D. et..e {� ❑ Individually, or ❑ as Personally known, or roduced the following type of identification: Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. for ZJO ( I Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner /Manager who signed above: By By 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. I l h1 1 Master Permit No. Permit Typ : BUILDING OWNER: Name (Fe ' s e itleholder): Nl es F Phone#305- 093 14799 Address: ,/ 0 a NE / Pr, Awe_ � "' 1/S' �3 City: Y°ar\ ` a deTh A o .re S State: p: Tenant/Lessee Nam • ton e Email: e GO Phone #: JOB ADDRESS: I 06 o /U C / City: Miami Shores County: AvaiL.0 e. Miami Dade Folio/Parcel #: `/ c33 0 a "' 0670 Zip: 33 3 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 0'11/431"" " 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: $ / a 00 0 Square/Linear Footage of Work: Type of Work: ❑Addition DAlteration ONew 'Repair/Replace' '` ODemolition Description of Work: re..(r _ k ` i 1e.. . i YvT t ** *+ x*****+ x**** ****** ** *******+x**** *** ** Fees* ****+ x** ********** ***+ x+ x+ xx :*+x******+x+x**** *+x*** Submittal Fee $ (0' CO Permit Fee $ /& 0 CCF $ CO /CC $ ox iv Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ (o / 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 subj , t to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspecti' which occuy seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not appr ved a reinspecti c fee will be charged. Signature 8 (d 11 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of A✓S , 20 1 1, by -3e4N 3 0-e Fea� who is personally known to me or who has produced P r -e e S who is personally known to me or who has produced L-e 1n As identification and wh.'.id take an . th. as identification and who did take an oath. x I� NOTARY PUBLIC: NOTARY PUBLIC: The foregoing instrument was acknowledged before me this , day of , 20 _, by Sign: Print: 6� e My Commission Expires: ��1,L `) 201 5 A-"-- MELISSA R. LAX Notary Public, Stale of Florida Commission# EE 107488 •mm.e res une '15 Sign: Print: My Commission Expires: ********************** *+ x+ x+ u* **+ xm+ x***** ******** **x: ****************** ****m *********** ****** x+ *+ x**+xu:***a: ********* APPROVED BY 4:r.:7-l. -i/ Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk 3 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: Jain DATE: g ADDRESS: / (366° N e I ("P Ave- r M 1 "1 l 5 ' Ft- 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 -bu -r permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may ac „� y o contractor with certain restrictions even though I do not have a license. r� Initial _.M 2. I understand that building permits are not required to be signed by a property owner unless he or sh= respons e for the Initial construction and is not hiring a licensed contractor to assume responsibility. r 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 -rs on from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name inste of m own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or lice . 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 m.' 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 subs ally improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I b 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. Initi Initia 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on m building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law ar y.unty 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 em ., ees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willful, cti . as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial Ii1 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who not li -nses 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 inco . tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers co , -ns; 'on 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 abi 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. 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 ..ntact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.mvforidalicense.com /dbor /pro /cilbliinder• Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I .m the party Initial Alf 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info at4,1 have provided on this disclosure. legally and financially responsible for the proposed construction activity at the following address: Initial a Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who do not ha e a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation ay 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 By Produced ther_,License or %? day of 4)S/ , 20 11 who was personally known to me or who has wur', 1bds'''' %,, as identification. te' �� \S • \� • .4\ NOTARY ° ° ° °B"° Na J er. c? \\ \' CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. O. Copy of the Coact must be attached) PROPERTY OWNER: \Oile S c, H1C1 ADDRESS: /065-b O V t 116 PERMIT # FOLIO NUMBER: FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CON1'RACT) sotgoo TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPAL STR ; t' URE (attac¢3ppraisal): OWNERS SIGNAT PLANREVIEWER. PLAN REVIEWER SIGNATURE: 000 DATE: g !toil Created on June 2009 DATE: 9472—/( SUBSTANTIAL IMPROVEMENT / DAMAGE LIST (NOTE: THIS LIST IS INTENDED FOR GUIDANCE ONLY, AND IS NOT ALL INCLUSIVE) ITEMS TO BE INCLUDED ALL STRUCTUAL ELEMENTS, INCLUDING Foundations including; Spread footing, Continuous footing, isolated footing, piles and pile caps Slabs including; Monolithic, floating, elevated Walls including; Exterior walls, Bearing walls, Shear walls Beams, Tie Beams, Columns and Posts Wood decking, Floor and Roof Sheathing Trusses, Joist Windows /Doors ALL BUILDING ELEMENTS, INCLUDING Interior Partitions, Walls, Columns Drywall, Ceilings, Built in Furniture, Cabinets, Vanities All Fixtures Flooring, Tile, Carpet, Stone, Linoleum, ect. All Finishes including Drywall, Paint, Stucco Plaster, Paneling, Tile, Marble, and Moldings Roofing Material ALL HARDWARE ALL UTILITY and SERVICE EQUIPMENT HVAC Electrical System and Equipment Plumbing System and Equipment Security System and Equipment Central Vacuum System Plumbing Fixtures Lighting Fixtures and Ceiling Fans Water Systems including Softeners /Filtration Created on June 2009 ALSO: All Labor and other Costs associated with Demolition, Removing, Replacing, Installing Building or Altering Building Components Construction Management / Supervision Overhead and Profit Equivalent cost for: Donated Materials Volunteer Labor (including owners and friends) Any Improvements Beyond Pre - damaged Condition, including; Utility Upgrades Code Upgrades ITEMS TO BE EXCLUDED Plans and Specifications Survey Costs Elevation Certificate Costs Permit fees Debris Removal Items not considered to be REAL Property Rugs, Furniture, Refrigerator, Appliances not Built -in Outside Improvements, Including; Landscaping Sidewalks Patios Fences Yard lights Sheds Gazebos Irrigation Pool Property Information Map My Home Miami -Dade County, Florida is `da *e. o Property Information Map Aerial Photography - 2009 0 28 ft This map was created on 8/12/2011 12:01:02 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. Page 1 of 1 MI MI DADS' Summary Details: Folio No.: 11 -2232- 028 -0670 Property: 10650 NE 11 AVE Mailing Address: JAMES DEFEDE 10650 NE 11 AVE MIAMI SHORES FL 33138 -2121 Property Information: Primary Zone: 1000 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 2/2 Floors: 1 Living Units: 1 Adj Sq Footage: 1,783 Lot Size: 9,750 SQ FT Year Built: 1950 Legal Description: MIAMI SHORES ESTATES PB 47 -58 LOT 17 BLK 4 LOT SIZE 75.000 X 130 OR 19062- 1667 03 2000 1 OR 19062 -1667 0300 00 Assessment Information: Year: 2010 2009 Land Value: $58,443 $132,066 Building Value: $117,779 $148,536 Market Value: $176,222 $280,602 Assessed Value: $164,866 $160,532 Exemption Information: MINIMIIM 2010 2009 Homestead: $25,000 $25,000 nd Homestead: YES YES Taxable Value Information: Year: 2010 2009 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $50,000/ $114,866 $50,000/ $110,532 County: $50,000/ $114,866 $50,000/ $110,532 City: $50,000/ $114,866 $50,000/ $110,532 School Board: $25,000/ $139,866 $25,000/ $135,532 Sale Information: Sale Date: 3/2000 Sale Amount: $155,000 Sale O /R: 19062-1667 Sales Qualification Description: Sales which are qualified View Additional Sales http: / /gisims2 .miamidade.gov /myhome /printmap. asp? mapurl = http: / /gisims2.miamidade.go... 8/12/2011 ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. Miami Shores Village APPROVED BY DATE ZONING DEPT st 111,1FCT TO COMPLIANCE WITH ALL FEDERAL T ATF AND COUNTY RUr AND REGULATIONS �dk Y � """ern AUG1 2011 Bbec, ...... 6 ifr 6ATHROOM RECEPTACLE ON 20 AMP CKT AND C.FJ PROTECTED C t v- 9-s t-toc‘ I o 6 57) N e l rt the Q-e-%0 r\ RCV To( Laz,115 )J' 3ATNROOM RECEPTACLE ON 20 AMP CKT AND G.EI PROTECTED tfl)Q ,lam t, p .T) r T ,,, n -1L.:t5e,.—C3 6-\ II:\ _C'- --; p ; ,........ 4 ) --r-) r z1 ct Z,N°e E. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \ ,019 Inspection Number: INSP- 163249 Permit Number: PL -8 -11 -1480 Scheduled Inspection Date: October 03, 2011 Inspector: Hernandez, Rafael Owner: DEFEDE, JAMES Job Address: 10650 NE 11 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122320280670 Building Department Comments REPLACE TOILET SINK & SHOWERS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 30, 2011 For Inspections please call: (305)762 -4949 Page 8 of 29 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: PLUMBING OWNER: Name p (Fee Simple Titleholder): „Jaenes e Ft "e- Address: / C) 0 )1141 Permit No. PL 1 ( Y 45)f Master Permit No. Phone#: 3 913 4179? City: in t a do 4 £ OleS, State: P L Tenant/Lessee Name: e., Email: ni e e ezei. Go ,,e1 Zip: 33 I3e Phone #: JOB ADDRESS: if °� Q Ate- l l AV- City: Miami Shores County: Folio/Parcel #: j J t9pZ.39 m 03,9 — 067 Is the Building Historically Designated: Yes CONTRACTOR: Company Name: D t-LIVIVU Address: City: State: Zip: Miami Dade Zip: 33 )36 NO Flood Zone: Phone#: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $®C Square/LinearFootage of Work: Type of Work: °Address °Alteration Lt New ARepair/Replace °Demolition J Description of Work: re ?ic ce V 1 d ie1 K + ivw ***************************************Fees*** * * * * * * * * * * ** Submittal Fee $ c�-� Permit Fee $ O CCF $ * * * * * * * * * * * * * * * * * * * * * * * * * ** CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ 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, BOIT.FRS, 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 ch occurs se (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be , p 9 ro'e and a , spection fee w'll be charged. Signature e ti • wner or Agent / �J The foregoin l instrument was acknowledged before me this i O` day of V l''N, 20 , by ') CA BS fKast, Aat who is personally known to me or who has produced p L Lt h As identification and who di s take an . t th. NOTARY PUBLIC: Sign: F t L fl - Print: K.Q. - \e '514. �. l,�✓� My Commission Expires: "1-O '2'`5/ 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: --MELISSA R. t nt: Notary Public, State of Commission# EE 1 My comm. expires June 28, 2015 o mission Expires: ******** ********* *+x**+x***+x*** **a *** * **** * * ** * ** x*• ******** ******** ***** *** ******* *************** ******* ** 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 J NAME: R m bC Fecie DATE: G ADDRESS: /°666 ,� E / Ave- I /11 I( 540. cm L 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 -b ' der permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act .s my own contractor with certain restrictions even though I do not have a license. Initial AT 2. I understand that building permits are not required to be signed by a property owner unless he or she nsible 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 tha' I ma protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name i / ad of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or Ii'�,g' bers on permits and contracts. Initi 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 substan': ly improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I buil • su;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. Initia Initi 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons wo ing on residence. It is my responsibility to ensure that the persons whom I employ have the license required by law a municipal ordinance. Initi building or ty or 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 ng 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 `s 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 inco • tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers co tion for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial /I 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will a de 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. 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 ay contact the Florida Construction Industry Licensing Board at 850.487.1395 or http : //www.mvfloridalicense.com /dbpr /pro /cilbfi . 1 Initi 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands t legally and financially responsible for the proposed construction activity at the following address: party Initia 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information 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 retumed 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 l Z day of By ry tL, DE,r6iDc who was personally known to me or who has Produced there Licenser -- t7 as identification. OWNER • Orr c5Z. p�.951i'' Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INS P- 164969 Permit Number: EL -8 -11 -1481 Scheduled Inspection Date: October 03, 2011 Inspector: Devaney, Michael Owner: DEFEDE, JAMES Job Address: 10650 NE 11 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1122320280670 Building Department Comments REPLACE GFI OUTLET & FIXTURE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 30, 2011 For Inspections please call: (305)762 -4949 Page 22 of 29 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 RECEIVED AUG 112011 BY: Permit No. 11— t lr0 Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Jcrce6 be 1Fed a Phone: 306 g 93 ? 79? Address: / 6' dv C 1 ° A \2 City: irnlam l 6 p's State: FL Tenant/Lessee Name: .S2a/ Email: d � Q Cei Zip: 33f 3Q) Phone #: JOB ADDRESS: 10 6. O ,J )111 Avet4 ve City: Miami Shores County: Miami Dade Folio/Parcel #: ) f °° c2c9 39 -OA " 06 7 Is the Building Historically Designated: Yes CONTRACTOR: Company Name: d 1n1aJ Zip: 33 138 NO Flood Zone: 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: $ 3o a Type of Work: °Address °Alteration Description of Work: f f l a c & F t` Square/Linear Footage of Work: UNew epair/Replace co ICf — °Demolition *************+ x*+ x**** *******************Fees*********** *****x:***** *******+ *******+x:x***** Submittal Fee $ O,- Permit Fee $ /V "P VI CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ COO /JO 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 subjec to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspec ti. hich occurs en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not ' / pprov and, einspection fee mill be c arged. /a 11 Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of AU 5, , 20 I , by 344.1 ®-C t - - , day of , 20 _, by who is personally known to me or who has produced » » i ver.S who is personally known to me or who has produced c--; 1.1.-A ye.. As identification and who di take an oath.% as identification and who did take an oath. NOTARY PUBLIC: MELISSA R. LAX n Comnissloot X107 $ / My comm. expires �28, My Commission Expires: (.0/2 `�. ! t 5 ifirrommission Expires: NOTARY PUBLIC: **** **** **** * *** * *** s; ,:r:,::,;:T.:. **m*:x**** * *** **** ***x: ********* *******x:***** ******:xx *** *** * * **** x************** ,� (� /y #'4 'fans Examiner Zoning APPROVED BY Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 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: ✓4a Rote_ DATE: S ADDRESS: JO49 ifOC 1 r AV-e-/ M tam; 3k, - 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 a/- y 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 i construction and is not hiring a licensed contractor to assume responsibility. Initial e for the 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 instea of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or lice bens on permits and contracts. Initial 4 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 substan', improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built ' 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 Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on rhy building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law an y 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 emplo ees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully, f 'ng 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 not licerises 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 comensation 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 abi • e 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 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.mvfloridalicense.com /dbpr /pro /cilbTnd ;�',,�• I Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that 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 informa 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. Was acknowledged before me this 1 day of Arc, , 20 /r who was personally known to me or who has Produced t, re Licens or °PC CD Z ,' "1,, `✓il,r ' \\ '' +re38i nm