DS-11-1730Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 164680
Permit Number: DS -9 -11 -1730
Inspection Date: October 31, 2011
Inspector: Bruhn, Norman
Owner: FARRAR, MICHAEL & ELAINE
Job Address: 776 NE 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks/Slabs
Inspection Type.
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060141870
Building Department Comments
REMOVE EXISTING PAVERS AROUND POOL AND
REPLACE WITH NEW TRAVERTINE PAVERS OVER
EXACT SAME LAYOUT
Passed
Inspector Comments
4.4.... t r I
inzr74(
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
For Inspections please call: (305)762 -4949
October 31, 2011
Page 1 of 1
43(511—M
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
---� OWNER: Name (Fee Simple Titleholder):
Address: -7 —7 (12 N L- q 5 fit
City: Mu v1, 5 h ®i-€s
OOFING
c% e t .
State: �L
SEP 2 2011
Permit No. 136 1)—
Master Permit No.
lfo e #:
Zip:
Tenant/Lessee Name: Phone #:
Email: rQ a, r\ CL Y) S o-n Q 176 6 • C t /V1
L
ADDRESS: C.D / C (454-14--
City: Miami Shores CountPig- Miami Dade Zip: 3 '3 1 3 O
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name:lav O Or' Phone #:
Address:
City: iarh State: f L Zip:
'1
Qualifier Name: Phone #:
State Certification or Registration #:
Certificate of Competency #:
Contact Phone#: 11 << Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ "1 c 1 % ' v v Square/Linear Foo ge of Work: 4 Z S-0
Type of Work: Addition DAlteration ONew P{dRepair/Replace ODemolition
Description of Work: Re MOW.- Lk iJ -1-111, fi -3 R lot,^4 f e r yk L-
k (-1-14 AL_ i 4(41/4,- 44.4,t
******** *** * * * * * * * * * * * * * * * * * * * * * * * * ** ** Fees************* * * * * * * * * * ** * * * * * * * * ** * * * * ** * * **
Submittal Fee $ Permit Fee $
/T1.) 4.41 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 in ,. c zo hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be app ved and a reinspectipn fee will be charged.
Signature X ' .i
Owner Agent Contractor
The for : oin_ instrument was ac owledged before • ; this' • The foregoing instrument was acknowledged before me this
day of , 20 1 1 , by iL -A _ • n , day of , 20 , by
who is •�n ly�o�own` me or who I produced RE who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
NOT ' Y PUBLIC:
Sign:
Print:
entification and who did take an oath.
My Commission Expires:
d ts1 dub '\71
c to
Sign:
Print:
My Commission Expires:
****************************** ***********************************************
Plans Examiner j Zoning
APPROVED BY
Structural Review Clerk
(Revised 07 /10 /07XRevised 06 /l0/2009XRevised 3/15/09)
1 111111 1111111111 11111111111111111111 1111 1111
NOTICE OF COMMENCEMENT
A EC'ORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO 1991.--.
1 iCTAX FOUO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
C:iF"N 2011R0662034 2011
OR Bk 27846 P9 0028i (fps)
RECORDED 10/03/2011 13:09:39
HARVEY RUVIW, CLERK OF COURT
MIIAMI -DADE COUNTY, FLORIDA
LAST PAGE
r pace above reserved for use of recording ofi
1. Legal description of property and street/address: ' N e al J
2. Description of improvement: ,I --C- 10 1 a C ? ct,v,t. v 5
3. Owner(s) name and address: 'N A P g a r \ c. - - s a
Interest in property: - 0110-4001.1%-,
Name and address of fee simple titleholder
4. Co
ctor's name, ad
-I? S
~7 7 t.P it! r Pi 6 5-4
Irn1()y --, Share% ,3i3t
arld Aone number.
5. Surety: (Payment bond required by owner from contrac or, if any) t 6 356, —0 cg 0 (e
Name, address and phone number.
Amount of bond $
6. Lender's name and address:
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,
ify
Name, address and phone number.RgRy
8. In addition to himself, Owners designates the following pe
713.13(1)(b), Florida Statutes.
Name, address and phone number.
�. �j,.:.a: ucr•'. -� _ ov
r
Awl
HARVEY
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 INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR R ORDING YOU�OTiCE OF COMMENCEMENT
4/144up„
At �b�"-
Sig a ur f Owner(s) or Owner(s)' Authorized Officer/Director/Partner/Manager
Prepared By Prepared By
Print Name Print Name
Title/Office Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI -D E
The
By
❑ Individual or ❑ as
Personally known, or
ged before me this 0l:1 day of
P
for
producedthe fol owing type of identificati
Signature of Notary Public:
Print Name:
(SEAL)
0
A . ermilawriarnr
111
Under p = es of perjury, I declare that I have read the foregoing and
that the facts s ed in it are true, to the best of my knowledge and belief.
Signatu
By
or Owner( s
uthorize Officer/Director/Partner/Manag who
By
lain V. Cubilios
Commission pp �# D�D717923
bOjAv«S/ Expiry: SER 23, 2011
106i1) TEM KIFLANTieltdO tA,I C.
rove:
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
Folio Number:1132060141870
Owner's Name: MICHAEL & ELAINE FARRAR
Job Address: 776 95 Street
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 1250
Total Job Valuation: $ 7,168.00
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 9/26/2011: Yes
Comments:
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: 1 '- \4scr DATE: C
ADDRESS: C LE 15 s 4- 1 a I Y3 FL
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). 3 \ 3'
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.CA 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.
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 Iice U umbers 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 substa Ily i proved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I bui or rlt tantialiy
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 my building or
residence. It is my responsibility to ensure that the persons whom I employ have the license required by Ian county or
municipal ordinance. p
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 willfytiylt g 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
socidl 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
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.
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 htto:// www. mvfloridalicense .com/dbor /urokilb/ f .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:
Initi
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the inform
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 contractors 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 G day of
By
Pro
, 20 11
who was personally known to me or who has
License or
Ti
ll «YtO'e
ntiflcatio
.
•
/7 6ZWOW
4NER
OTARY PUBLIC STAW 0'R i A
Claudia V. Cubillos
E r ion*D1)717923
, ,` pi : SEP. 23, 2011
TTr MIANTic arsmnee Ca, INC.
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiantl an ila ages hereby attest that
(Property owner) 1 ��
The attached survey, performed by b V a r v yo 1;1
(N n f sutveyor company)
For address: 1 (y1 l Q; 1 reS 1
t
0� date of survey) is an accurate representation of the existing conditions and
Performed on y) ' p 9
locations of all struc ures o the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Further, Affiant say eth naught.
&aa n SOY)
Property Owner Signature nn nn Pro • - Owne ' 'nt Name
SWORN TO AND SUBSCRIBED before me this did. day of / a.)
Affiant is personally known to me, produced Kara 1
Revised on 5/22/2009/ Revised on 6/12109
identification. .
NOTARY Pt)PU ATE 0711.0%u:1-
Claudia V. Cubillos
�_ commission
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d Expires: 5P. 3, 2
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