DS-12-372Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 172054 Permit Number: DS -3 -12 -372
Scheduled Inspection Date: April 23, 2012
Inspector: Bruhn, Norman
Owner: CEPERO, ROBERTO
Job Address: 50 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1131010200030
Building Department Comments
PAVER DRIVEWAY
Passe X;2f-/02—
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- 170662. Resod area and
remove debris. NB
April 20, 2012
For Inspections please call: (305)762 -4949
Page 20 of 33
BUILDING
PE ''` APPLICATION
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
RECEjV
MAR 0 2.2012
BY:
Permit No. is 2 i2— 312'
Master Permit No.
Permit Type UILDIN ROOFING p q q
OWNER: Name (Fee Simple Titleholder): C'1 O8 E. cilo e _ EJ° IVY- -C Phone #: 86 3` - 3
Address: 5 O AA (l S+
City: ?4o S orV 4 State: FL Zip: 33136
Tenant/Lessee Name: Phone #:
Email: C_ £9 . R-0 itA—c) P t', G ; 1 . f_cA-.
JOB ADDRESS: 50 N, L . o1 , S-1.
City: Miami Shores County: Miami Dade Zip: 39 1 3 8
Folio/Parcel #:
Is the Building Historically Designated: Yes NO %F Flood Zone: Ni 0
CONTRACTOR: Company Name: OW/lei— 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: $ Qr 0°0 Square/Linear Footage of Work: I 0 0 41 44
Type of Work: DAddition
DAlteration
New
° ❑Repair/Replace ❑Demolition
Description of Work: W i ct� i� 14 ,e. (n% c y f° I? r on i n n/�8 tr P pJI-1 Wml /
'PO gel 1104-4 Cre
°II�
bt Cat el I IC—
SP of
Submittal Fee $ ��2 Permit Fee $ CCF $ CO /CC $
in 0
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 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 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 - Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of jYlt4 , 20 IQ; by Petal 0 a ricao
who is p sonally known to r who has produced � who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
day of , 20 _, by
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: r �� �. i Sign:
.
Print:
My Commission Expires:
APPROVED BY
MIL"-
p Ex� E. Print: •
Co „o ?r-
/ 0,'• n = My Commission Expires:
•
/`, /'''��IiiiiiiA∎\ \Pllans Examiner F4) 3/7/12 Zoning
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
NAME: ZOG E OI1O C—VESA0 DATE: r a‘
ADDRESS: 50 IQ S3. )44'0,1.6 St ores )k.. 3323
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. 1 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 licensnumbers 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 substantially improved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I built o substantially
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 law and by county or
municipal ordinance.
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 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.
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
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.mvfioridalicense.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 am the party
legally and financially responsible for the proposed construction activity at the following address:
50 NE °11 S5.
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information at 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 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 't day of iYla2A1 , 20 1
B Ito 13t
who as personally known to me or who has
Produce re License or _ as
ict.e:� e 0 0660911/261'::// 21r
,
OWNER
NOT
NIC
+ �On #
%irrrn;rit����
1
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
Permit NO. DS -3 -12 -372
Expires: Not Issued
Folio Number:1131010200030
Owner's Name: ROBERTO CEPERO
Job Address: 50 91 Street
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 900
Total Job Valuation: $ 2,000.00
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 3/7/2012 : Yes
Comments: PLEASE NOTE CORRECTED DIMENSIONS ON PLANS
E1,(s
po��� kLS -o
EIaPi°2o�. l
Phone: (305) 552 -7504
Fax: (305) 229 -8068 Professional Land Surveyor & Mapper
G1
RA
c�
14317 S.W. 45th Terr.
Miami, Florida 33175
Property Address: 50 NE 9 / 5t Street, Mam(, FL. 33135
Legal Description:
1 DADE COUNTY. BM# L -24 ELEV.= 9.45' OF N.G.V.D. OF1929
LOT. The West 1/2 of Lot 5 * All of Lot 6 BLOCK. 9
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK
OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA.
/// /// / -// j NE 9 1st Street 's //// .
////l/t///// % _ ; s..: `a Drive (Plat) % ///
////://// , // 70' ,L !�/W / /
// / / / //
/ // / / , / 19' Asphalt P. /
SUBDIVISION. EL PORTAL SECTION 3
9 AT PAGE /45
SKETCH OF SURVEY
(Boundary Surrey)
////SCALE 1" = 20'
// /0
75.00' (R)
4
5'.5telewalk
ac. gr Lot
1/01.1'.
Alp
'b _
110/4 "rS
231.60'11?)*
FI
9.94'
10..s
min po.r,
I
I
I
9.67'
10.35'
18.40'
12.95
P
WI !I rlr�
BLOCK- 9
LOT- 7
12.20'
Conc.
4 51ab
12.20'
23.35'
ONE STORY
C.13.5.
Re5.# 50
F.P.E. = 14.25'
Gar. Elev.= / 1.24'
BLOCK- 9
LOT - 6 ' West 1/2
of Lot 5 pl
23.05'
/a54'
BLOCK- 9
Remainder of Lot 5
12.95'
23.05'
CD
0
m
t)
Steps
m
r�
C
co
ZIOZ 10 dVI
ZAIZL
50.00'
`90
1/2° 1.P.
BLOCK- 9
LOT- 24
4' C.L.P.
75.00' (le $ (M)
BLOCK- 9
LOT- 25
bah
BLOCK- 9
LOT- 26
O
U/
/2' LP.
BASED ON THE FLOOD INSURENCE RATE MAP OF THE FEDERAL EMERGENCY AGENCY
REVISED ON 9- / / -09 THE HEREIN DESCRIBED PROPERTY IS SITUADED WITHIN:
ZONE X BASE FLOOD ELEV. NIA COMMUNITY NUMBER: / 20652
PANEL NUMBER 0302 SUFFIX L
LEGAL. NOTES
THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP. EXAMINATION OF THE ABSTRACT OF TITLE
WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMF_NT6, IF ANY, AFFECTING THE PROPERTY.
THIS SURVEY IS SUBJECT TO DEDICATION, LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS
OF RECORDS. LEGAL DESCRIPTION PROVIDED BY CLIENT. THE UABIUTY OF THIS SURVEY 1S LIMITED TO
THE COST OF THE SURVEY. UNDERGROUND ENCROACHMENTS, IF ANY. ARE NOT SHOWN. THIS FIRM HAS
NOT ATTEMPTED TO LOCATE FOOTING AND/OR FOUNDATIONS AND/OR UNDERGROUND IMPROVEMENTS OF
ANY NATURE. IF SHOWN BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN. IF SHOWN ELEVATIONS
ARE REFERRED TO N.G.V.D. OF 1929 THE CLOSURE IN THE BOUNDARY SURVEY 18 ABOVE 1: 10000
DATE OF FIELD WORK: Aug. 3 /, 2010
REVISED ON: Feb. 23, 2012
THIS CERTIFIES THAT THIS SURVEY OF THE PROPERTY
DESCRIBED HERE ON WAS MADE UNDER MY SUPERVISION
AND THE SAME MEETS 7118 MINIMUM TECHNICAL
STANDARDS SET FORTH BY THE FLORIDA BOARD OF LAND
ARTURO R. TOIRAC P.S.M. 3102
NO VAUD WITHOUT THE SIGNATJRE AND THE ORIGINAL
EMBOSED SEAL OF A FLORIDA LICENSED SURVEYOR AND
MAPPER.
CERTIFIED TO:
Roberto Cepero
= CENTER LINE
P/L = PROPERTY LINE
= MONUMENT LINE
R/VN = RIGHT OF WAY
C.LF = CHAIN LINK FENCE
W.F. = WOODEN FENCE
LEGEND AND ABBREVIATIONS
FD. = FOUND IRON PIPE
O.H.L= OVERHEAD UTILITIES
(C) = CALCULATED
(R) = RECORD
(M) = MEASURED
CL = CLEAR
TYP.= TYPICAL
".= ELEVATION
R = RADIUS
A =ARC DISTANCE
C.B. = CATCH BASIN
B.C. = BLOCK CORNER
ENC. = ENCROACHMENT
C.B.S. = CONCRETE BLOCK STRUCTURE
CONC.= CONCRETE
0 = DIAMETER
D.M.E.= DRAINAGE MAINT. EASEMENT
I.F. = IRON FENCE
JOB No. / 20233
AC = AIR CONDONED UNIT
RES. = RESIDENCE
W.M. = WATER METER
U.E. = UTILITY EASEMENT
P.C.P.= PERMANENT CONTROL POINT
F.O.B.= POINT OF BEGINNING
„mi.„404.4/ov ,v0VA
0.
10.
70' TOTAL RIGHT OF WAY
ALABAMA DRIVE (PLAT)
NE 91st. STREET
19' ASPHALT PAVEMENT
. . .
9 00' ASPHALT PAVEMENT
' / 7 18.50' PARKWAY
NEW
PORCH FLOOR
(162.28sq.ft.)
LOT 7
BLOCK 9
9 . 9
75.00'
z
0
5' CONCRETE SIDEWALK
6
r)
7ROOF ITO BE
EMOVED
12.95' ■•.1
jillagerff
GARBAG
0 SHED
0.20' CL
12.20'
liCONC. SLAB
12.20'
PORCH
23.35'
ONE STORY
CBS # 50
LOT 6 & W1/2 LIOT 5
BLOCK 9
23...5'
9.67.
CONC. SI A13
0
9 r1 );j' 7-00'
9 . 5 4.
• --11
i
LOT 24
BLOCK 9
0
N)
4
METAL
ON CONC. S_AB
23.
18 80'
731 8'
.1
10.
10.4'
1 r-L1 900 GLS
STANK
CONIC. SLAB
4'C.LF.
75.00'
LOT 25
BLOCK 9
SITE PLAN
CO
1
1 OLD
_UT LINE
I i .
4 J
I,
I
I is)
Ic)
LOT 26
BLOCK 9
LOT REV AIN 5
BLOCK 9
IL i1LT BE ON
JOB TIME OF
INSPECTION
evision
' A
.”1
itt!tt,
Checked: M. LOPEZ
Dote: 11/01/10