RC-07-475Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP -42681 Permit Number: RC- 3- 07-475
Scheduled Inspection Date: April 16, 2012
Inspector: Bruhn, Norman
Owner: SIMEON, JOSEPHINE
Job Address: 375 NW 111 Street
Miami Shores, FL 33168 -3303
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Kitchen Cabinets
Phone Number
Parcel Number 1121360010760
Building Department Comments
REPAIR OF KITCHEN CABINETS
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
(1(
April 13, 2012
For Inspections please call: (305)762 -4949
Page 36 of 36
Miami Shores Village
Building Department
RECEIVED
MAR I92012
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
UIL ING Permit No. 2o--7
PERMIT APPLICATION Master Permit No.
FBC 20 O
Permit Type: BUILDING ROOFING
' OWNER: Name Fee Sim leTitleh.lder): cc`d JL ®g .e-f + 19 At
Address: '7 G'`� / ' C
City: State: feitc:■■
Tenant/Lessee Name:
mail:
Phone 46 646 Sit2
Phone #:
JOB ADDRESS: , • T2 r/E--N.CA 111
City: o L 1(.,y Miami Shores
Folio/Parcel #:
County: .0 O--Miami Dade Zip: 3 3 Z 61
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: —1/14/LE—a-/
Address: 1/LJ L t• l ,'/
City: State:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Phone #: j
- 5-X, 02,6
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑Re air/Reppllace ❑ IDemolition
Description of Work: (L L LA �__ 3 92t 1 1�..0 C7 ` 5
**** ** ***** ********************u:m****** Fees**** **+ x******** ***** * **** ****:x*x:*****m******
Submittal Fee $ Permit Fee $ 1
Scanning Fee $ 3 • 0.D Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 153
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 seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
—..w0111111011,1 glw„
Owner or Agen
The foregoing instrument was acknowledged before me this l9 The foregoing instrument was acknowledged before me this
MOOday of
in 20 I y —Suteti 36 ,
Signature
Contractor
,/ day of , 20 _, by
1
who is personally known to me or who has produced .A p who is personally known to me or who has produced
As identification and who did to oath. as identification and who did take an oath.
`\``���111 �I�A���/'�., NOTARY PUBLIC:
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NOTARY PUBLIC:
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Print:
My Commission Expires:
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Print:
My Commission Expires:
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APPROVED BY
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
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RAI '115Z
BUILDING MAR 0 9 2007
FBC2004 BY:n� '
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel• (305) 795.2204 Fax: (305) 756.8972
PERMIT APPLICATION
Permit Type (circle):
MAR 0 9 2007_
BY: --
LI Permit No. RC. —" , /
Master Permit No.
Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleho er) JU L- 14 0 ii .....S6/4-k1 Phone # 3 Q -75 ^
Owner's Address
City ill t P1 J State
Tenant/Lessee Name
Job Address (where the work is being done)
City /C/ ° Miami Shores Village
FOLIO / PARCEL #
Zip 3316,8
Phone # o ` ,. <75-V- - 6 72/
75-eNL.() L ri
County I
iami -Dade
Zip 33 ra,C
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
0,)„.„(
Phone #
City State
Qualifier Name
State Certificate or Registration No.
Zip
Phone #
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work:
Describe Work:
Certificate of Competency No.
❑Addition ❑Alteration
Phone #
Square / Linear Footage Of Work:
QNew
Repair/Replace ❑ Demolition
* * * * * * * * * * * * ** *,.* * ** * * * ** * * * * * * ** Fees * * * ** * * * * * * * *** * * * * * * * * * * * * * * * * * * * * *** * * * *,r
Submittal Fee $ Pe Permit Fee $ � � CCF $ 1.23 CO /CC
Notary $ Training/Education Fee $ (40 Technology Fee $
Scanning $ 61 00 Radon $
DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 104 •
See Reverse side —>
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City
State
Zip 3 G ‘,
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 seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Age
The foregoing instrument was acknowledged before me this
day of (11 ,200 -2 , by 4\.
who is personally known to me or w
-tom`' As identification
NOTARY PUBLIC:
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:
My Commission Expires:71 0,14") 1
APPLICATION APPROVED BY:
(Revised 02/08/06)
My Commission Expires:
Plans Examiner
Engineer
Zoning
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: .14.4 • DATE: 03 41,- -20
ADDRESS: 3 5 AL ti // /41 a 9 3.409
Do hereby petition the Village of Miami Shores to act as my own contradtor 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 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 npt licensed must work underyour 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 hold title to the above property and I am planning on doing this construction
Initial Ir
2. I understand that as ari owner - builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
Initial
_j,/
3. :I have an understanding of the 2004 FBC & FRC and understand that this
department and its inspectors are there to help enforce and interpret the code.
There is a copy of the code in this office for review.
Initial
4. I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code —. only if the structure meets the
minimum code.
Initial ��
5. I understand that as an owner- builder, that any contractor disputes with sub-
contractors and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate any contract disputes.
Initial ,5
6.- I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If-for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company-or person.
Initial
7. I understand that if any person gets injured on my construction project-they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Initial j�
8. I understand that under state and local laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my property with out first obtaining
the proper permits by licensed contractors.
Initial Xi—
Was acknowledged before me this % day of (1)r 20 0
Produced there License or
who was personally known to me or who has
as identification.
SANDRA M. ..`'
Notary Public . BRYANT
= • � 4 State of Florida
; My Commission Expires Mar 27, 2010
F oa, Commission # DO 533629
" "� Bonded By National Notary Assn.
Miami Shores Village
Building Department
-:030tORE.2hd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No.
Job Name
Date
BUILDING CRITIQUE SHEET
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01 (,)/74,t7... / 5 /2/cap?) Ajp
Reviewer:
Claudio Grande C.B.O
305-795-2204 Ext 1430
owine0 -t-cc )L crIA-kc
P■ed ccJopc Eewe gA
3112,101