RC-08-103Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP -72365 Permit Number: RC -1 -08 -103
Scheduled Inspection Date: July 24, 2012
Inspector: Bruhn, Norman
Owner: LANE, CULLEN & CRYSTAL
Job Address: 1200 NE 91 Terrace
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Kitchen Cabinets
Phone Number (305)498 -9822
Parcel Number 1132050010490
Building Department Comments
New kitchen
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 23, 2012
For Inspections please call: (305)762 -4949
Page 25 of 25
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
Permit No.
Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: \--2-00 (^E, q1 &1- }evi.
City: Miami Shores + County: Miami Dade Zip: 331 3 K
Folio/Parcel #: t\ ° 3yr� 5 — 601 — 0 4d10
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder):
Address: 17 0 i.)- T
City: tiv\ 4cVUIt S k-k
Phone #: 3) 335 -98x3
State: t'
Zip: 35t 3'
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: 4 - - 0 1 W tiuJ l\e4=-, Phone #: 6 / ?.bS r 9.?
Address: lie.- t\e_,
City: State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #:
DESIGNER: Architect/Engineer: Phone #:
Email Address:
Value of Work for this Permit: $ !'R
Type of Work: Addition UAlteration
Description of Work: 1 J W3
Square/Linear Footage of Work: i 2-
ONew URepair/Replace UDemolition
Color thru tile:
**** ********** ****: x***** **** * ****** ****Fees*********** :*:x******* * ** : **x : ******m:xu:*******
Submittal Fee $ Permit Fee $ 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 CONDmONERS, 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first in ction whi occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wi, npt b, , ed d a 'insp;, Lion fee will be charged.
Signature
The for
day of U0
who is pe
NOTAR P IC:
Owner or A ent
instrument was
, 201 %!by
efore
Signature
Contractor
Th . egoing instrument was acknowledged before me this
ay of ,20_,by
s personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
own to e or who has produced
entification and who did take an oath.
Sign:
Print:
My Commission Expire
000 �
?$ '
mites
S e p o 1 2
d,
a
COMOSSloN A
xx*xaxxx*xx x�xxxx ma Bonded Zh rouh Nati a9 sa
Assn.
m
xxxx xxxxuxxaxxxaxxxxx* a*axxxx**** x* axa*****x**x **** *xxaxd*aaax*****
Sign:
Print:
My Commission Expires:
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
'Ws -q4s -014Z-
Inspection Worksheet
Miami Shores Village
KG
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 05/30/2008
Inspector: Devaney, Michael
Owner: LANE, CULLEN & CRISTAL
Job Address: 1200 91 Terrace NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: PULSAR ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
bu.
Block:
Phone Number (305)498 -9822
Parcel Number 1132050010490
Lot:
Phone: (954)394 -5827
Building Department Comments
KITCHEN REPAIR 6 PLUGS AND 1 WALL OVEN.
JUN 0 3 2000
Passed
Inspector Comments
>
kae7 628
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Thursday, May 29, 2008
Page 1 of 2
Inspection Date: 01/30/2008
Inspector: Grande, Claudio
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Owner: LANE, CULLEN & CRISTAL
Job Address: 1200 91 Terrace NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Residential Construction
Inspection Type: Drywall
Work Classification: Kitchen Cabinets
Block:
Phone Number (305)498 -9822
Parcel Number 1132050010490
Lot:
Building Department Comments
New kitchen
D
el 0
IN
C
0(
Inspector Comments
CC
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid ..
Tuesday, January 29, 2008
Page 1 of 2
AFFIDAVIT OF HOMEOWNER
1200 NE 91ST TERRACE
MIAMI SHORES, FL 33138
RE: PERMIT PROCESS NO. RC 08 -103
STATE OF FLORIDA )
SS:
MIAMI -DADE COUNTY )
ECEi
JAN 2,21 II
�.r�rrays�
BEFORE ME, THE UNDERSIGNED AUTHORITY, PERSONALLY APPEARED,
CULLEN J. LANE OF 103 NW 103RD ST., MIAMI SHORES, FL 33150 WHO
AFTER BEING DULY SWORN UNDER OATH, DEPOSES AND SAYS THAT:
1. Presently I reside at 103 NW 103rd Street Miami Shores,
FL 33150.
2. On October 5, 2007 I purchased the property located at
1200 NE 91st Terrace, Miami Shores, Fl 33138.
3. Upon completion of the cabinet /appliance(s) (Permit
Process No. RC 08 -103) installation at 1200 NE 91st Terr, Miami
Shores, FL 33138 I intend to make 1200 NE 91st Street, Miami
Shores, FL 33138 my domicile /primary residence /homestead.
4. I DO NOT in end to rent /lease the residence located at
1200 NE 91st Terrace, '' Mi. Shores, FL 33138.
DATE
24TH DAY
SHORES MIAMI -DADE COUNTY, FLORIDA, THIS
008
SWORN TO AND SUBSCRIBED BEFORE ME THIS L+ DAY OF T4?
2008, BY CULLEN J. LANE WHO PRODUCED IDENTIFICATION AND O DI
TAKE AN OATH.
MY COMMISSION EXPIRES:
MONICA USSETH DIAZ
MY COMMISSION # DD 483995
r EXPIRES: October 20, 2009
4eto Bond4d Tin NOSY PubliCUndeM1Vriters
S ATE OF FLORIDA
asmv...mem
4"1
Ac21. &,-;i:umnur
pk,
11141,514W 1:1-Ar .w.sonenua-
111111 i mum, o
iitiainurnInfirmi aliammATAW.g!f minimum tif ti
' kir
I a I
• -„:0 • ■••••:;:•4 •i
in effect to repair /rebuild the damaged property, delays in
repairs due to conflict created by multiple corporations with a
claim to insurance proceeds thereby being unable to distribute
those funds, other damages to be determine.
WHEREFORE, Plaintiff, SECTION FOUR, demands judgment for
actual and compensatory damages against the Defendant, LOOMIS plus
taxable costs, prejudgment interest, and further demands trial by
jury of all issues so triable.
CULLEN J LANE, ESQ. P.A. 12/07
IOTA TRUST ACCOUNT
PO BOX 530232
MIAMI, FL 33153 -0232
305 - 758 -1153
ORDER THE
FE Paul Gast & Annette Gast, His Spouse
Bank of America 1004
ACH Rif 063100277
• 63 -4/630 FL
1348
1/9/2008
Three Thousand One Hundred Eighty -Three and 33/100"'*""
DOLLARS
MEMO
Net proceeds of Settlement/File No. 4475
CULLEN J LANE, ESQ. P.A.
11'00100411' I:0E, 300004?': 8980L33 L2926"
Paul Gast & Annette Gast, His Spouse
IOTA TJtUST ACCOUNT
1/9/2008
1004
3,183.33
IOTA Trust Account Ban Net proceeds of Settlement/File No. 4475 3,183.330
CULLEN J LANE, ESQ. P.A. IOTA TRUST ACCOUNT
Paul Gast & Annette Gast, His Spouse 1/9/2008
IOTA Trust Account Ban Net proceeds of Settlement/File No 4475
I1111111111111I N 39119
1004
3,183.33
3,183.330
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cottc,ttatteLt.
BUILDING
APPLICATION
FBC 2004 JAN 1 7 ENT'D
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type (circle): Buildi B o�
Owner's Name (Fee Simple Titleholder) C v ,' � ' -e°' Phone #
Owner's Address D/ #4, /0 fr'/
City r d ,` 5 6uZa',7'' state 4
Permit No. 8— l
Master Permit No.
2 e_
Zip L /L®0
Tenant/Lessee Name Phone #
Job Address (where the work is being done) / 2 0 0 Nin f e s¢ et`--
City Miami Shores Village County Miami -Dade Zip 5 if LP
FOLIO /PARCEL# /d° 7 0 5 - 007 — OY /./9
Is Building Historically Designated YES NO
Contractor's Company Name DIi a 1,1,-e T
Phone # 3 d � 4, '® g 2- z-
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
t, 6,„ ea L,. J -J
Value of Work For this Permit $ /0 Square / Linear Footage Of Work:
Type of Work: DAddition
Describe Work: t 6ti 14. a'
Alteration i��1Tew is Repair/Replace 0 Demolition
CeYl d 9b/cE Pie l fr ld '7 f9. )1
* ** :**** :***** **. x*a: ** **************** *F * * * *** ** **** * *** n**** ** *********************
Submittal Fee $ ja Permit Fee $ 30 D CCF $ e .co CO /CC
Notary $ 5,0D Training/Education Fee $ 9-00 Technology Fee $ 1 'SO
Scanning $ (0'00 Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ & 2 r • 50
See Reverse side -*
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if appl'c le� v
Oc
Mortgage Lender's'Address ( )thc, C
City kt ta-N 14 State f Zip 7 01 C1 7 � Z
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
promise in good faith that a copy p
whose property is sub' t to att
for the first inspect,
inspection will no
Signature
the iss,.F e of a building permit with an estimated value exceeding $2500, the applicant must
the no 'e of commencement and construction lien law brochure will be delivered to the person
o, a certified copy of the recorded notice of commencement must be posted at the job site
n (7) days after the building permit is issued. In the absence of such posted notice, the
nspection fee will be charged.
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this /7 The foregoing instrument was acknowledged before me this
day of , 20 t , by day of , 20 _, by
who is personally known to me or who has produced 1T f/� Yi2i9'/31fC who is personally known to me or who has produced
110I D As identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as identification and who did take an oath.
Sign:
Print:
Sign:
Print:
My Commission Expires: .9 ,M,
My Commission Expires:
APPLICATION APPROVED BY: f os Plans Examiner
Engineer
Zoning
(Revised 07 /10/07)
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Permit No. V 114
STATE OF TLe
COUNTY OF
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-e ,r( J (41 ire 4 )f ?f
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ax Folio No.
NOTICE OF COMMENCEMENT
THE UNDERSIGNED hereby gives notice that improvement 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.
1. Description of property: (legal description of property, an street address if available)
3Lo�-- J/ -041 it, (90 f / "' Tor M.f
7 3131
Tcir Ai; ,v; s
3 3(,��
2. GeneralIdes on of improve: ehty g
3. Owner information l i t" 1-4,4e, 7. 649 A'I 7/it
a. Name and address: t�iJ ` /
b. Interest in property: T yf .1 jam,
c. Name and address of Tee simple tffleholder (if other than owner):
4. Contractor.
a. Name and address:
b. Phone number.
5. Surety
a. Name and address:
b. Amount of bond $
c. Phone number.
4 ;c
GOV11 01119 ��?1�
i17 ti w j ) aka Ski kit
6. Lender
a. Name and address:
b. Phone number.
4 ce4f0 eqo I? 3 5
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713 3(1 a)7., Florida Statutes: >
a. Name and address: f 1{ „ 4.0 11 t , Z" £! `f/ J iiY
b. Phone number. J�
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section
7.13.13(1)(b), Florida Statutes:
a. Name and address:
b. Phone number.
9. Expiration date of 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
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER HAPT
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FO PRO
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POS !; ON
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMEN
RATION OF THE NOTICE OF
713, PART I, SECTION 713.13,
E,TS TO YOUR PROPERTY. A
SITE BEFORE THE FIRST
ER OR AN ATTORNEY BEFORE
Signature • er •f er's Authorized Officer/Director
Partner/Manager
Signatory's Title/Office
Thecftwina irtss t t n w s acknowledged before me this day of nih
r (name of person) as d j i
authority, afr
ly, ....g. officer, trustee, attorney in fact) for
behalf of whom Instrument was executed).
d8 (year) by
(typo of
(name of party on
Signet
Print, ype, or Stem
Commission Number •
e of Florida
stoned Name of Notary Public
Personally Known _ or Produced Identifica
Verification Pursuant to Section 92.525. Florida Statutes
Under penalties of perjury, 1 declare that I have read the foregoing and th
knowledge and belief.
t of my
Signet
bove
LK.
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
t e% � � ,' • DATE:
ADDRESS: / 2 4'I c /J4 11
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 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 hold title to the above property and I am planning on doing this construction
Initial
2. I understand that as an owner - builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
Initial
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 62-
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
C�
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
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
Was acknowledged before me this day of y-,A°Cc
20 Of
By C A c 7 L.4ie who was personally known to me or who has
Produced there Li e6 or f?, -- 7rei'S Lt 71/SO as identification.
OWNER