DS-12-176Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 169501 Permit Number: DS -2 -12 -176
Scheduled Inspection Date: March 20, 2012
Inspector: Bruhn, Norman
Owner: SOLARI, ANGEL
Job Address: 9701 NE 4 Avenue
Miami Shores, FL 33138 -2481
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060170240
Building Department Comments
CONCRETE SLAB, WIRE MESH 6" DEPTH
Inspector Comments
Passe
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 19, 2012
For Inspections please call: (305)762 -4949
Page 3 of 15
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
311 (e/ 112.7-‘1104C/1
INSPECTION'S PHONE NUMBER: (305) 762.4949
IL ING Permit No
FEB 01�us
BY:
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): ,4 t, ( 5 4
Address: 70 V6 4ve
City: A4 d0:.nt ,J State: lc' (
Tenant/Lessee Name:
Master Permit No.
Phone #: 3C:t- 33,- /n3„1
Zip: 3 a3( 3)
Phone #: r f
Email: CbsYKV'ill, 11 5�LA G,' MTc r (A244
JOB ADDRESS:
7(;) 1 !t C c( ®4-1
City: Miami Shores County: Miami Dade
Zip: 33 / 3
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: froter f �/ C/(sv 1 f! Phone #:
Address:
City: State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
�o�o,
Value of Work for this Permit: $ Square/Linear Footage of Work: c(! i y e f
Type of Work: ❑Addition
cription -of-W
❑Alteration
❑New URepair/Replace
❑Demolition
* * ** * * * * * * * * *** * *** * * *** * * * * * * *** * ** Fees * **** * * ** * *** ** x**** *x::x ****a:***** *** * * *** * **
Submittal Fee $ 0 0 Permit Fee $ /° dc)-c) 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, 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 o s seve ) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a# .' ' ed and a reinspect sn fee will be charged.
The fo,
day of
who is personally known to me or who
as produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
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:
Print:
My Commission Expires:
* ** * ** * ** * * **' * * ** * * ** ** ************************ ***************** ** * * *********** * *** **** *** * **** :*
APPROVED BY `f" 4.` ' Plans Examiner
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 7
NAME: f�f ( )gl -) DATE: 2/(/ /,
�f 7J( .�� ✓� Yes
ADDRESS:
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 iponsible 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 m• protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name ;'f tead 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 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 als' Build or improve
a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or .ccupancy. It may
not be built or substantially improved for sale or lease. If a building or residence that I have built or substanti • improved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I bui '.'u • ntially
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
Initia
,1.1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or
resldeinoe; It is my responsibility to ensure that the persons whom I employ have the license required by law a % county or
,..municipal ordinance.,4.
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 willfully acting as an
owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
Initial
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is ''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
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abid
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
all applicable
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.myfioridalicense.com/dbor /pro /cilbfindex h I
Initial /71
11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that
legally and financially responsible for the proposed construction activity at the following address:
Initial
the party
1
r
Initial /1,
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who d . 4 not have 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 contractors 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 t day of �' CAO , 20 _O I 2-
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.
By ' cIY%%Jtb who was personally known to me or who has
Produced t License or
OWNER
as identification.
FLORIDA DEPARTMENT OF
HE
Rick Scott
Governor
H. Frank Farmer, Jr., M.D., Ph.D.
State Surgeon General
February 21, 2012
(Statewide Septic Connections, Inc)
PO Box 3865
Hollywood, FL 33083
RE: Contingency Letter
Application Document No:AP1062206
Centrax Permit Number: 13-SC- 1393637
OSTDS Number.
9701 NE4Ave
Miami, FL 33138
Lot:10 Block:87 Subdivision: Miami Shores Sec 4
Dear Applicant:
This will acknowledge receipt of an application dated 02/16/2012 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
From a review of your completed application, it has been determined that your existing system
is adequate for the proposed use (concrete slab).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Sincerely,
Joseph.' "iv - , Engineer Specialist II
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com
7IEFTATE Or FLORIDA
DEPARTMENT OF HEALTH
APPLICA-T11:?N; FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
. . Permit Application Number
PART il ' SITE PLAN-
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County Health Department
ALL CHANG ESMUST BE APPROVED BY THE COUNTY.HEALTH DEPARTMENT .
0H4015, t plepleses HRSI-1.1 Farm ON which mal be used)
Wade Number: 5744-1202-40t54)
Page 2 of 3
APPROVED
ZONIN 2L ME' 4
tor 1 1. A
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Si A7 I: ANA; ;11,10 REGULATIONS
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AUAAN SNORES. FLI:0000 33136
CERTIFIED TO, - - -
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NOTES,
LEON. DESONAITON PROWERD 8T MOO.
ONNOLATION Of Rif WORK, Of Ref TM Mu NAVE
TO EIE Au= TO OCIOMEL PEO3NDED argoweAONs p ANY
A1VECT ires PROPERTY.
ThC IM05 S0 OVN4 OLEOS v61 ,TINCIED
EASEMeort Olt CYDER ZION=
ENCUNIVOLANCES NOT SRPAYPI Ow The PMT
THE moose or io stem. rox Tor USE OEITAWING
TITIE INISIDANCE AND SWANONG
ARO WOULD .Cr ea Low FOR Met C09.5011X110.
POLAVOING, DESIGN 011 ANTE/Mt PQRPOSE um=
Trz antrrm, CONSOR 01' INONALLA %WONG 0A55flS.
UNDEROROOND MOONS OP 'carnal fOUNEATIONS OR OMR
IMPROVONONS WERE ROT LOCUM
ONLY YONNE AND move GaMite INC2O+CistENT5 =AM
WALL TIES ARE TN! Mr Or the RAU.
race owner r HOT OrREMPED
BEARINGS READIER= TO UNE MOM PO114
OCRIRORRY WRY& MEMO A ORAYPIG Al5AR GRAPt0C
afFIRESENrAnON Or RSE SOO& *am reRremao Di
THE MO. rano ea Mom AT A SPORN 50E! PAO= WI
TO *CME
NO ESORMORION moo 0011410241Crf C00015t0 was* waren.
1107 7444.0 LAWS SEW MN 775 575741465 SURVOCIES CAOCEDEO SPA
01015575145 SNOW Are FLAT 010 741455560 URIESP) onlosvoto SNOW
ELEVATIONS 11 ShOwN USW WON 0600 I arg waft Welty:1W
ICTW.
Was Es A DOWOART SIOWET MESS ommorie NOTED
7155 4055050 %IWO rya SUN MMUS) ?OA tiCIRSM uSE
ME Dames H0117102:00 077 CECTIRCATONS DO 0101er/TNO To my
Oman" r45069
MIAMI-DADE DOUMTY HEALTH DEPARTMerr
PERMIT #: _tafiefa, 2 C
02/06/2012 15:11 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES
1 1001
TRANSMISSION OK
TX /RX NO
RECIPIENT ADDRESS
DESTINATION ID
ST. TIME
TIME USE
PAGES SENT
RESULT
* ** TX REPORT * **
* * * * * * * * * * * * * * * * * * * **
2206
93053706677
02/06 15:11
00'32
1
OK
Permit No: 12 -176
Job Name:
February 2, 2012
Miami Shores Vwage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
Building Critique Sheet
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 762 -4859
c6 ?)1c
Permit No: 12 -176
Job Name:
February 2, 2012
Miami Shores Vivage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Building Critique Sheet
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
Page 1 of 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 762 -4859
IVI iami Shores Y
Building Department
RECEIPT
PERMIT #: D f DATE:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
'LA„.
o Contractor
erit.Qwner
o Architect
Picked up 2 sets of plans and (other) it,�
Address: ati, 0 Lt
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
I2