DS-12-479Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 176404 Permit Number: DS- 3- 12-479
Scheduled Inspection Date: July 30, 2012
Inspector: Rodriguez, Jorge
Owner: GRIMALDI, KARINA
Job Address: 1125 NE 91 Terrace
Miami Shores, FL
Project <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (786)285 -5527
Parcel Number 1132050010140
Building Department Comments
REMOVE OLD DRIVEWAY & REPALCE WITH A 4' X 4'
CONCRETE PAVER
Failed
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 171283. NO PERMIT ON SITE.
JR
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 27, 2012
For Inspections please call: (305)762 -4949
Page 27 of 37
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
Permit No. `DS 1 `Z -- 47
Master Permit No.
Permit Type: BUILDIN . ROOFING
JOB ADDRESS: `/ 9 L- qj Tar , -
City: Miami Shores County:
Folio/Parcel #: / % r javOc --/1 if —014/0
Miami Dade
Zip: .9.9 /9g)
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): k4 r / A1at CC j Id; Phone# :.i 552,11—
Address: IL a S M 2- '( let r
City: m i a ,NA, State: Zip: .373/
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name.
Address:
City: State: Zip:
Qualifier Name:
Phone #:
Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address: b`
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ � o 0 el Square/Linear:Footage of Work :'
UNew ORepair/Replace
Type of Work: DAddition ❑Alteration
Description of Work:
m
emolition
Submittal Fee Permit Fee $ /0611 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1, 1 3 ,
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City r 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 with occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap roved and a reinspection : will be charged.
/A
Signature
Signature
Owner or Agent Contractor
The foregoing i�istrument was acknowledged before me this .24•7 The foregoing instrument was acknowledged before me this
day of 104.4&, 20 by tezigt SClgj 41.3 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:
\��•`� f \weranrrr����i4
Sign: '-1111. � •. ��
Print: _ _ Q • ft. oo4% • =_
///,„ , Tn TE,OF``\`��
My Commission Expires:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY Plans Examiner (1) Z,t/I'? Zoning
Structural Review Clerk
(Revised 3 /12/2012XRtviged 07 /10 /07XRevised 06 /10/2009XRevised 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: y i &c . 6/ 1 4,411 /; DATE:
ADDRESS: 1/.2.5 N4 q'f
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 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 license numbers on
permits and contracts.
Initial
4. I understand that I may"buildor improve, atone family or two - family residence or a farm outbuilding. I may also build or improve
a commercidl building -fi the costs domot 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 or substantially
improved it for sale or lease, which violates the exemption ® e i" t s $
Initial
5. I understand that, as the owner- builder, I must provide direct, onsitesuperVisior¢ of the construction.
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.
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.
Initial
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide . • pplicable
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.
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.mvfloridaiicense.com/dbor /pro /cilb!ndex.html
Initial
11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am tfi
legally 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 information that 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 n 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
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 day of Jill a . , 20
By 16144.41-41-4. t24 J was personally known to me or who has
Produced there License or t p
R
as identification.
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shares Village
Building Department
SURVEY AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiant, � l x` 1 C 'U e c�.k,�oes hereby attest that
(Prope owner)
The attached survey, performed by l(
(Name of surveyor's company)
For address:
Performed oa l2 � 1 (date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures affect final inspe � ons as applicable to this or other permits.
Further, `i. nt sa
Pr.pe : Owner Signature Property Owner Print Name
SWO N TO AND SUBSCRIBED before me this 4lv 'day of IYlinON4 .
personal) known to me, ,�pnmr�rr,,,���
y 6e produced ,,jD as ide lai isms
.�. ommris
'` �1. ellin i
:"
ii f,P1.00ro
Affiant is
Revised on 5/22/2009/ Revised on 6/12/09
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This property described as:
Lots 16 and 17, Block 1,
WATERSEDGE,
according to the Plat
thereof, as recorded in
Plat Book 9, Page 141
of the Public Records of
Miami -Dade County, Florida.
Note: Underground encroachments
• and utilities, if any, not ..
located. Fdnce ownership by visual
means only, legal ownership not
determined.
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PROPERTY OF: Grimaldi, Karina 1125 N.E. 91st Terrace, Miami Shores, Florida
Not valid unl ess embossed
with Surveyors Seal
•
2'4 of You e/r.e17¢
A BGUNDARY
SURVEY
I hereby certify that the survey repre-
sented hereon mews the minimum
techn - standards sec torsi, by the
Boar - of land Surveyors .urwant to
Se • •. 471027,E &.St. There are
no _ • • achnnents. oc , ` !1f easeme
the r than
on the
Fla: Reg. • • . 4; No M1
33138
LANK ES and dARCIA, INC.
ENGINEERS - LAND SURVEYORS - LAND PLANNERS
L.B. #2098
Office address: 399 Alcarar Avenue, Loral Gables Florida 33134
FRANCESCO F. FAJARDO #4767
(3051645:7909 (954) 523 -8883
D TE � ' SCALE ,--.�i DR NJY
9 -15 -08 Recertified. Certified To. Name and Flood Information Revise
DRWG. NO
193 -2350
_23