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DS-11-658Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 164307 Permit Number: DS -4 -11 -658 Scheduled Inspection Date: November 21, 2011 Inspector: Bruhn, Norman Owner: HAILE, GREGORY & CHAE Job Address: 410 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132060140360 Building Department Comments REMOVE EXISTING ASPHALT ON DRIVEWAY AND INSTALL PAVER OVER SAND BASE. iNSTALLATION OF PAVER OVER EXISTING CONCRETE WALKWAY 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- 164189. CREATED AS REINSPECTION FOR INSP- 158394. CLEAN CONSTRUCTION DEBRIS AND HAVE PERMIT PAPER WORK AVAILABLE. NB 9/6/11 Remove debri and excess material NB November 18, 2011 For Inspections please call: (305)762 -4949 Page 16 of 47 Ffl9N5 I ( — Dak- 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 Type: BUILDING Th ROOF OWNER: Name (Fee Simple Tj 1 au -Hem lye Address: ) 0 M� I L irettq State: _..-- Zip: 3f13 f3 0 AUG? 3 2011 T�, Y Permit No. CUCIOS Master Permit No. 3o3---522 -a3 Phone #: -3 `S — -3i City: am i S4 t res Tenant/Lessee Name: Email: Phone #: JOB ADDRESS: " l I© OE 011-14A, City: Miami Shores County: Miami Dade Zip: '3313c. Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: City: Flood Zone: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition Description of Work: I UNew ❑Repair/Replace OIL A' • . Oek! ❑Demolition * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * *** * * * * * * * ** Submittal Fee $ "', Permit Fee $ 7.(% 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 even (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi ' io �� a app ov d d a einspection fee will be charged. Signature �' '��' �I 1' Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this p?3 The foregoing instrument was acknowledged before me this day of -- ,201/.by , day of ,20_,by who is persona y known to me or who has produced 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. My Commission Expires: APPROVED BY NOTARY PUBLIC: Sign: Print: My Commission Expires: * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * ** ** * * * * * * ** Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) :SNOISIA38 113NOIlIONOD all = J /tI )1008 lYld = 8'd 31VDS O110N = 'STN '39Vd = '9d SNOLLV1A3l/BBV ONV ON3937 1N3539d 1V35 03SSO9W3 03SIVN ONV 31WUVN951VN19190 S.90A3AN11S 31LL 1f10HLLM NOLL1niitW OflyA V ION SIX a au!U rrY ,00 DOT 0 f11 '0 7 _o. rn • • • • • • ••••• •• IIeM )18 alanuop ,b OZ'bE ,00'8 ,00'6 1003 ,00'SZ 30 83N1 ...a: ••• • • •• .. • • • • 1.. •• • • •�' •1 •• • • .!••• 00• :• i••4 :; •• • •. 01 • • .. • • • . • • MC • . ::% • .1 • • • • • •••• • ▪ •ssi. • . • :•••: • iii: • • • • , • Z rn ,0031 - Z'ST 0 add u�l „ puno d uo „51 puno3 add UOJI „ puno3 adld UO.�l „51 puno3 •• 0:1an1./oD OT'9T ,0£'b ivawaned lleydsy,TZ 1— 3'N ,SZ = „T :Glen S AHvaNnos\ SUBJECT TO COMPLIANCE WITH ALL FEDERAL 'ITATE AND COUNTY RULES AND REGULATIONS 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 10 /18/2011 Applicant 410 NE 94 Street Miami Shores, FL 33138- 1132060140360 Block: Lot: GREGORY & CHAE HAILE Owner Information Address Phone Cell GREGORY & CHAE HAILE 410 NE 94 Street MIAMI SHORES FL 33138 -2846 Contractor(s) HOME OWNER Phone CeII Phone Valuation: Total Sq Feet: $ 2,000.00 1000 1 Approved: Yes Comments: DRIVEWAY CAN NOT EXCEED 12 FEET IN WIDTH UNTIL IT CROSSES PROPERTY LINE AT WHIT Date Approved: 4/15/2011: Yes Date Denied: Type of Work: DRIVEWAY & WALKWAY Additional Info: PAVERS Bond Retum : Scanning: 2 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 $6.00 $1.60 $163.70 Pay Date Pay Type Invoice # DS -4-11 -40638 04/14/2011 Credit Card 04/21/2011 Credit Card Amt Paid Amt Due $ 50.00 $ 113.70 $ 113.70 $ 0.00 Available Inspections: Inspection Type: Final Sidewalk Landscaping 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. April 21, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date April 21, 2011 1 4 21) 1 Miami Shores Village Building Department J' ,? `�'] 77? APR 142011 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Bye ilia."........81.1.11.18". ppOO6° pe6Oa0 0,00 0 0 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. l., l Jl \� (C56 Master Permit No. Permit Type: BUILDING �1 OWNER: Name (Fee Simple Titleholder): bkoce Nr“ Phone #: 305 ! B23 — 9 $2'u Address: q i d P E ' Lt Sf eef" City: L Q.l�YI l S P3 +1--• Zip: 3313& 01 �'1d State: Tenant/Lessee Name: 1 Phone #: Email: Gin, Cle I14 4 4��'��YY�f�t,l C Oen JOB ADDRESS: y to N E g 41 S City: Miami Shores Folio/Parcel #: County: Miami Dade Zip: -.53/E) Is the Building Historically Designated: Yes NO ` Flood Zone: CONTRACTOR: Company Name: *MIsOW K.t-ir 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: $ 4si /�. Square/Linear Footage of Work: 1 �O0 Type of Work: ❑Address ❑Alteration Description of Work: ( Rio If m ` (re) New epair/Replace ❑Demolition it (0414, O over' 'A 6417 COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: d2/ ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * ** * * * * * ** * * * * ** * * * * * * * * * * * * *** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ Radon Fee $ Training/Education Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company'stAddress 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 oc rs s en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will n t be 'pproved j a e nspec,'on fee will be charged. Signature Signature Owner or Agent c / Contractor The fore � i i g in ment was acknow dged before me is/ 7 The foregoing instrument was acknowledged before me this day of /r 20 / 1 by CIq -e L. ! /-� , day of , 20 , by who is personally known to me or who has produced ,06 L- 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: Sign: P My Commission Expires: APPROVED BY • HARRISON (ommisslon# 0D773181 My comm. expires Apr. 7, 20121 Plans Examiner NOTARY PUBLIC: Sign: Print: My Commission Expires: !( Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10!2009)(Revised 3/15/09)(rev6/4/10) 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\ra-e \4A.l I e— DATE: L-11111 r ADDRESS: L410 E CY S-(• n i J eS '13 1 6 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 Cif 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. j� Initial t„rT f 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. n I 1 5. I understand that, as the owner - builder, I must provide direct, onsite supervisionpf the construction. Initial Initial (1) 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 a 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 06 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial l 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 c,t ` 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.myfloridalicense.com /dbpr /pro /cilb /index.html Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: t © `Nf- ®14 Str. Irnacyyx‘, yes (d 33) S Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for 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 owners driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this `T day of � , 20 arCiRce 166 who was personally known to me or who has Prod . ced there License or 1OIg24S zgentific tion. LL eo;oarit N.E. 94TH ST. a "Mail ante • 1—STORY C/W RESIDENCE 05. Ail \■.*1R )).:ffricI,v/r 911°,57: 1' OT 12 \ LOT 11 pp •••••1- p •-••••••••• O. 1.1"4016 4.44 we „J.-6y 0.4 de /49,0 • 24. 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