RC-11-190Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 155649 Permit Number: RC -2 -11 -190
Scheduled Inspection Date: February 06, 2012
Inspector: Bruhn, Norman
Owner: LONGMAN, JOHN
Job Address: 333 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Residential Construction
Inspection Type: Final Building
Work Classification: Alteration
Phone Number -
Parcel Parcel Number 1132060136370
Building Department Comments
REMOVE DRYWALL AND INSTALL R30 INSULATING R30
INSULATION AND REINSTALL DRYWALL
Passe .
Failed
Inspector Comments
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 03, 2012
For Inspections please call: (305)762 -4949
Page 2 of 16
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SiTE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO 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.
111111111111111111111111111111111111111111111
CFN 2011RO110366
OR ek 27591 Pa 0622; Ups)
RECORDED 02/17/2011 13:04:27
HARVEY RUVIN, CLERK OF COURT
f1IAf1I -DARE COUNTY, FLORIDA
LAST PAGE
Space above reserved for use of recording office
f;. Legal description of property and street/address: 3 33 .JE
° ', Description of Improvement:
Owner(s) name and address:
Interest in property:
,,Name and address of fee simple titleholder.
`'4 Contractor's name, address and phone number ef�G� Ff 3^ .s�j^f V "Ai n
5. Surety (Payment bond required by owner from contractor, H an
Name, address and phone number:
Amount of bond $
6. Lender's name and address:
y/4-
7. Persons within the State of Florida designated by Owner , pon whom notices or other documents may be served as provided by
Section 713.13(1X47., Florida Statutes,
Name, address and phone number.
8. In additlon to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number. ae/ .
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 I z D TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR N2000 -< OF COMMENCEMENT.
• ,ter, or • oriz
pf
l'repared By
Print Name
[rector/Partner /Manager
Prepared By
Tine/Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The for instrumjt was acknowledged before me this
By i✓ ,O4 q4
❑ lndividually, or Li as for
UPersonally known, or a produced the following type of identification:
Signature of Notary Public:
Print Name:
Print Name
Title/Office
day of
t_3
(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.
Signature(s) of Owner(s) or Owner(s)'s Authorized Officer /Director/Partner /Manager who signed above:
By By
n s :.#. f (
(fxp�re . d►
foe
'ruitiiutre 91‘
123.01.8E PAGE 3 3/10
STATE OF FLORIDA, COUNTY OF DADE
• HEREBY CERT/FYThat this is a`tr a opy of the
,ng/nal filed in this office on l diary of
eB , A D 20
WITNESS '
1ARVE �' i
gy r_,l
nd and Official Seal.
LERK, of Circuit a
County Courts
D.C.
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
RM.clEgVairl
BY:..
Permit No. f---C-j` 1 ` v
Master Permit No.
Permit Type: BUILDING % -7
OWNER: Name (Fee Simple Titleholder): .J �ln/ i o '-' 44,4 -' Phone #:_D_ 7— 7
Address:
City:
r4v.,J f, 4-y
Tenant/Lessee Name:
Email:
dEQ
State: p(
Zip: 3-?/27
Phone #:
JOB ADDRESS: J 2 3 q),
City: Miami Shores County:
Miami Dade
Zip: 3 z/27
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: In,L/ ✓✓ iL✓� tti (� �/'f�� Phone #: Address: 2_,?,? 3,33 /iJ 2 4
City:
/11'- ! 4 Ai R. 1 4- do1Z!J State: / "
Zip /Jf
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #:
DESIGNER: Architect/Engineer: Phone #:
Email Address:
r' Value of Work for this Permit: $
Type of Work: ❑Address
c< Description of Work:
✓i`�'�iL2 P Square/Linear Footage of Work:
New ❑Repair/Replace ❑Demolition
gs
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
********* + * * * ** ***** * ** ** * * * * * * * * * * * * * *F ************* * * ** ** * * *** * * * * * * *** * * * *** ** * **
/�
Submittal Fee $ i. O� Permit Fee $ l S `-' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 4 I '10
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
we/tr. r
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 properly 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 wh• occurs seven days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a' +r' ed and s - nspe on fee will be charged.
e , Signature Signature
\\ /
gent Contractor
The foregoing in ment was acknowledged before me this 1 The foregoing instrument was acknowledged before me this
day of F 64 , 20 ti , bySb+4 Pap141.1 , day of , 20 _, by
who is personally known to me or who has produced (L. ID 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:
Print:
4s,
My Commission Expires:
NOTARY PUBLIC
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
**** * * *de*B:4e****k** **oYa4e4e4*** *%******** 4rde: YY:% MA A* eYx 4e4cFe****** k: Y9e9: oYoYk9****k eY4: 4r4r* 9r*** �Y�Y4e4e* oYOYoY ****de9:9:4:9rx4r4:4ro'roY**
APPROVED BY �j' //� Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/I0)
NAME:
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
.rJ ,/ DATE: ,Pu,6 y/ Z P9 //
ADDRESS: 333
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 is responsfor 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 thatit"may protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead o my own
name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licensers 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 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
myself is sold or leased substantially within improved 1 year oafter the construction building fete, the law will built or
I built or i � roved
Y P presume Y
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 work'
residence. It is my responsibility to ensure that the persons whom I employ have the license required b
municipal ordinance.
Initial
on m' •uilding or
and by county 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 ay;r, an
owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
Initia
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor wh not licenses to
perform the work being done. Any person working on my building who is not licensed must work under ./ 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 compens - -n 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' ' 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.myforidalicense.com/dbor /pro /cilb/iindex.h
Initial
11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I
legally and financially responsible for the proposed construction activity at the following address:
4TH SPI�`e j
Initia
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info ation that I
have provided on this disclosure. lJ�
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 11 day of 9 , 20 t
By who was personally known to me or who has
Produced t - cense or as identification.
-OWNER
1 IE.
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FEB
Building Sketch °lain
Borrower
Pro Address 333 NE 92ND ST
kilAhl SHORES
Lender Wells Fame Bank, NA/Rels
JOHN LONGMAN
C MIAMI Stale
S)ores Viiiage
ti
,11■10•MNIMONNIIIMO
SUI3,1FCT TO COMI'l IANCE WITH ALL FEDFFIAL
STATE AND COtJN UY HtJI FS AND FTGUI ATIONS
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