DS-11-2097Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 166594 Permit Number: DS -11 -11 -2097
Scheduled Inspection Date: May 29, 2012
Inspector. Bruhn, Norman
Owner: BRUCE, VICTOR
Job Address: 370 NE 101 Street
Miami Shores, FL 33138 -2425
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks/Slabs
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1132060135270
Building Department Comments
NEW CONCRETE WALKWAY & DRIVEWAY ON THE
FRONT OF THE HOUSE
Inspector Comments
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 25, 2012
For Inspections please call: (305)762 -4949
Page 2 of 30
Nteil nog a
BUILDING
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: BUILDING ROOFING 2 r�
OWNER: Name (Fee Simple Titleholder): �� .0 t('hone #: . ✓t 0 ` Jo3o
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
NOV 1 0 2011 NJ
BY:
permit No.tJ)- M
Address:
City: Mt S- s State: H Zip: 3-713
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: S
•
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address:
wrAmmor
NO Flood Zone:
C n
Phone #:
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:
Type of Work: DAddition
D cripti o1 Work:
ItACI
TYQ01— 111(
$ /ad," d
Square/Linear Footage of Work: •
DAlteration
C New ORepair/Replace DDemolition
Submittal Fee $ Permit Fee $ 1(9000 CCF $ - 0/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ 11.0
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 AI 1DAVIT: 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the firs inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection ill not be approved . einspection fee will be charged.
Signature �� Signature
Ownv or A_ =•nt 1 Contractor
The forego in trument1was a owwl ged b fo me �thgi -s� t C The foregoing instrument was acknowledged before me this
day of ° �k , 20, 1 , by 1 l/�I V Y PX r), day of , 20 _, by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
�••: Print:
Print: . ,�, +,+fit:
My Expires: 1ssl� (�W
M Commission Ex ices: My Commission Expires:
��g6Z d S$aale sd Rte1oN e ° °�l
�`p2 \46911:741:1111:41711:11°1144
o e1�1S " d pnd1'J
�x x�.x+x.x x�+x+r+x+x+x+x+x *� �x +xx� It11 �3: ...•.. , >• A �x �:* ********, xx�x�x�+ r�x�x�x� : *+x+x�•�x�x *�x�x�:�xx�� *** ***** �xx��x�x�x� :�x *�►tk *x��x+x�x�x******
APPROVED BY d Y �1� Plans Examiner
/7 7 /Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
lommum
at flov 1 0 2011
Building De
9 Department
p
�: „Ve ............. .. 10050 N.E.2nd Avenue
Miami Shores Village
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
V / COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) �( f FAA-(E.
hereinafter referred to as the owner of
the following described property (address): 51O NO 1(1:".1) - �Tn
kt ANA 1 q)(W5
Legal Description Lot 33Liw Blo q+ Subdivision
1
Folio #
Requests permission to install (describe work): TAZTVaktiVI
Within the public right of way of (address)
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of
way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owr e s failure tq'do so,
such expense shall be paid by the Owner or shall constit e a Iiein,against the,above des r bed property
1
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any
and all liability, which may rise by virtue of permitting the installation of these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s)
to be removed and a lien being placed on the property and /or assessed against the Owner for all costs
incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land
and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until
such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village (or his fully authorized representative).
Signature
Own r or Ag nt
The foregoing instrument was acknowledged before me this 10 day of NH, 20 I , by \l C/6
who ispersonally known to me or who has produced As identification and who did take
an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
,,,,,�,,,,, CLAUDIA V. CUBILLOS
6`"a;' Notary Public - State of Florida
My Comm. Expires Sep 23.2018
�� e;= Commission # EE 128810
°% „o r ; :�` Bonded Through National Notary Assn.
2
lovimy35
faou 1 0 ?opt
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
DATE: 1 1 1 1 D ((
NAME: \s/1(try /U(5
ADDRESS: 1O 41F
ado
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 responsiblb for the
construction and is not hiring a licensed contractor to assume responsibility.
Initi
3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may prote 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 orfcensan
permits and contracts.
Initia
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 improv
myself is sold or leased within 1 year after the construction is complete, the law will presume that I uilt or
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.
Initia
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my builiding 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.
201118U3 V ALCIUA 4Zt
e.. FOE .sS erR RVge3 unmet aM '•,
058Si 33 ft duicai;cii»t,5
aed gseWA ?rranI 1 naur,, t
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 illfully acting as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
Initi
iy�
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licens; o
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 co • ns- ion for
the employee. I understand that my failure to follow these may subject to serious financial risk.
Initial
10,
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by/all applicgble
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 ay nt t the
Florida Construction Industry Licensing Board at 850.487.1395 or http : //www.myfloridalicense.com /dbor /pro /cilb/iir 1ex.h ill
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
Dally and financially responsible for the proposed construction activity at the following address:
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info
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 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
retumed 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 GO 1U day of MOVa4 20 (1
By vICAe{
Produced there License or
who was personally known to me or who has
as identification.
OW
NOTARY
6° CONC. SLAB
Wt6x641.12.9x14.9
W.W.F. ON WELL
COMPACTED FILL,
TYP. BOTH DRIVEWAYS
..-•
c5.•
20'± Pavement
centeriine
1 01 st Street::;..
*
TOTAL
20'± Parkway
4
425:0Found
0'
Drill Hole
Found Y211 Pipe
No Identification
(0.2' Offset South
West 25'
LOT 4
o I
of g
O. .
IJ
0)
cn
One Story Residence
370 N.E. 101st Street
Finish Floor Elev.=+13.24'
0
L.1
0.10'
BOUNDARY SURVEY
20
Found
Drill Hole
Found 12" Pipe
No Identification
(0.2' Offset
0.60'
0
10
GRAPHIC SCALE
20
40
( IN FEET )
1 inch = 20 ft.
1)FLOOD ZONE X PANEL NO. 12088C0302 L
COMMUNITY NO. 120652 DATE OF MAP: 9-11-09
South) 2)11E1E MAY BE ADDITIONAL RESTRICTIONS THAT ARE NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE
PUBLIC RECORDS OF THIS COUNTY
3)E(AMNA1ION OF ABSTRACT OF TITLE IVILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF An
AFFECTING PROPERTY
4) DOS CER1IFICA1ON IS ONLY FOR THE LANDS AS DECREED, IT IS NOT A CERTIFICATION OF Ira& ZONING,
EASEMENTS, OR FREEEDOM OF ENCUMBRANCES. ABSTRACT NOT REVIEWED
5)LOCATION AND IDENIIRCATION OF (J11.111LIES, IF ANY ARE SHOWN IN ACCORDANCE WITH RECORDED PLAT
6)OWNERSHIP IS SUBJECT TO CHUN OF TITLE
7)TYPE OF SURVEY BOUNDARY SURVEY
8)THE HERON CAPTIONED PROPERTY WAS SURVEYED AND DESCRIBED BASED ON 11E SHOWN LEGAL DESCRIPTION:
PROVIDED BY CUENT
9)SURVEY MAP AND REPORT OR THE COPIES THEREOF ARE NOT VAUD AND FOR REFERENCE ONLY, UNLESS SIGNED
AND SEALED WITH THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER
10)ThilS PLAN OF SURVEY, HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE MITES NAMED HEREON. THE
CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTIES
11)UNDERGROUND UTILITIES ARE NOT DIMMED HEREON, CONTACT THE APPROPRIATE AUTHORITY PRIOR 1D ANY
DESIGN WORK OR CONSTRUCTION ON THE PROPERTY HEREIN DESCRIBED. SURVEYOR SHALL BE NOTIFIED AS TO ANY
DEVIA10N FROM UTIU1ES SHOWN HEREON.
12)THE SURVEYOR OF RECORD DOES NOT DETERMINE OWNERSHIP OF FENCES. MEASUREMENTS SHOWN HEREON
DEPICT PHYSICAL LOCATION OF FENCE
13)ACCURACY: THE EXPECTED USE OF LAND AS CLASSIFIED IN 111E MINIMUM TECHNICAL STANDARDS (61G17—FAC), LS
*SURBURBAN'. THE IIMMUM RELA11VE DISTANCE ACCURACY FOR THE TYPE OF BOUNDARY SURVEY IS 1 FOOT IN
7500 FEET. THE ACCURACY OBTAINED BY MEASUREMENT AND CALCULATION OF A CLOSED GEOMETRIC FIGURE
WAS FOUND TO EXCEED THIS REQUIREMENT
14)114 SOME INSTANCES GRAPHIC REPRESENTATIONS HAVE BEEN EXAGGERATED TO MORE CLEARLY ILLUSTRATE
RELATIONSHIPS BETWEEN PHYSICAL IMPROVEMENTS AND/OR LOT UNES. IN ALL CASES, DIMENSIONS SHOWN SHALL
CONTROL THE LOCATION OF THE DAPROMENTS OM SCALED POSITIONS.
15)40 ATTEMPT HAS BEEN MADE 10 LOCATE ANY FOUNDATION BENEATH THE SURFACE OF TIE GROUND.
16)CONTACT THE APPROPRIATE AUTHORITY PRIOR 10 ANY DESIGN WORK ON THE HEREIN DESCRIBED PARCEL FOR
BUILDING AND ZONING INFORMATION.
17) ADDMONS OR DELE1ONS 10 SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS
PROHIBITED WITHOUT WRITTEN CONSENT OF THE SIGNING PARTY OR PARTIES
80
0)
LOT 2
8
1,2
" GATE 0.35'
t■i■t
(1) ■I-g, 11 —i
„_ „
L —
•• n-
LJ
N 90'00'00"
15 ALLEY ..:• •••••-::• •-••.:•••"''' U it y
Asphalt
Pole
LOT 21
LOT 22
-7- LOT 23
IF ELEVATIONS ARE SHOWN, THEY ARE BASED ON A CLOSED LEVEL LOOP USING THIRD ORDER
PROCEDURE AND ARE RELA1IVE TO THE NATIONAL GEODETIC VERTICAL DATUM OF 1929.
0.0 DENOTES EXISTING ELEVATION
ELEVATION REFERS TO THE NATIONAL GEODETIC VERTICAL DATUM OF MEAN SEA LEVEL OF 1929
BINCHMARK: N-397—R ELEVA1ON: +10.12'
LOCATOR ROC: 3100
BEARINGS HEREON ARE REFERRED TO AN ASSUMED VALUE OF N 90 00'00.E FOR THE SOUTH RIGHT OF WAY LINE
OF NE 101 STREET
ROM SURVEY DATE: 9-10-10
DRAVING DATE: 9-13-10
SCALE 1' = 20' DRAWN BY: M.A.B.
Flit SKETCH DRAWING ND. 10-0503
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4........,.1.., 1.. km.,.z.l.) 1 klailt.,1-.1. I i:l....., .2,1 t.I .: ' i" l !": Ti-rj
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LOCATION SKETCH
NOT TO SCALE
LEGAL DESCRIPTION: Lot 3 and the East 25 feet of Lot 4, Block 39, AN AHMED PLAT OF MIAMI SHORES
SECTION NO. 1, according to the Plat thereof, as recorded in Plat Book 10 at Page 70 of the Public Records of
Dade County, Florida, now known as Miami—Dade County, Florida.
SURVEY FOR VICTOR BRUCE AND MARCELA BRUCE
370 NE 101 STREET
MIAMI SHORES, FLORIDA 33138
I HEREBY CERTIFY: That the SKETCH OF SURVEY of the above captioned property was
supervision and/or direction, to the best of my knowledge and belief. This survey m
Technlcal Standards set forth by the Flaida Board of Land Surveyors in Chapter 5J—
Pursuant to Section 472.027, Florida Statutes.
DELTA SURVEYORS, INC.
13052 SW 133RD COURT
MIAMI, FLORIDA 33186
CERTIFICATE OF AUTHORIZATION
L.B. NO. 3386
STATE OF FLORIDA
305-253-0909
FAX: 305-253-0933
---
PROFESSIONAL * F:NPaAEZSURVE32; AND MAPPER
STATE OF FLORIDA
'DELTA SURVEYORS INC. 13052 S.W. 133rd COURT MIAMI, FL 33186 (305)253-0909 DELTAPAEZ@AOLCOM
SEAL
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION, PPE9MI . t
Permit Application Number ' ; . +' $ ;
»••»--««-«- •- ««« «•«»«-- » « »•- »- «•- ««•• - - »- -PART 11- SITE PLAN —
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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Site Plan submitted by
Plan Approved
SIGNATURE
Not Approved
E
Date`s
By County Public Unit
ALL CHANGES MUST BE A . VED BY THE COUNTY PUBLIC HEALTH UNIT
HRS-H Form 4016, Feb 85 {Metes previous editions Web may not lsfuse,*
(Stock Number: 5744- 002 - 4016.8) Page 2 of 3