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RC-07-1204Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 176375 Permit Number: RC -6-07 -1204 Scheduled Inspection Date: July 26, 2012 Inspector: Rodriguez, Jorge Owner: HUMBLES, ALISON Job Address: 300 NW 112 Terrace Miami Shores, FL 33168 -3300 Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Garage Enclosure Phone Number (617)872 -6367 Parcel Number 1121360010260 Building Department Comments LEGALIZE GARAGE ENCLOSURE AND KITCHEN CABINETS PERMIT RENEWED ON 4/4/12 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 25, 2012 For Inspections please call: (305)762 -4949 Page 18 of 26 Miami Shores Village 11MIcn7IC 0 4 2.012 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. 16C,/ • Master Permit No. Permit Type: BUILDING ROOFING IL OWNER: Name (Fee Simple Titleholder): o' ///f2P-' 1'/Uh'1,,Ie,SS Phone #: 20 " 4 S -211®3 Address: - Z ! 4.7 /4• Sptzif)9 '*e /ct /?d_ City: g% Gt 2/I es G--o State: /91�J Zip: .2°E-7174 Tenant/Lessee Name: Phone #: Email: s'/Ufil bj2sG r irtgaliona►.U/IQ "22 JOB ADDRESS: _70 /Jw 1 / 1 /'i" "%e,4,2 a C E. City: Miami Shores County: Miami Dade Zip: 33r 6 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: " ; ' % `� '; 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: $ Square/Linear Footage of Work: " Type of Work: ❑Addition DAlteration DNew .DRepair. ' eplace Description of Work: DDemolition **** **** *****+ x**+ x**** *********+au::x******F ��,,**** *� **** a�********* a+ �x�:: �u� : ****x:�x+xx�x�x��xx: *�x+x*** Submittal Fee $ p Permit Fee $ Q �5 • W CCF $ CO /CC $ Scanning Fee $ 3 • C ) Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ A 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, BOIT.RRS, 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 Agent pc The for : oin: nstrume 1as a i= day. of 1 , 20 , by h . is personally o NOTARY PUBLIC: Sign: Print: My Commission Expires: wled ed befo Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: me or who has produced dentification and who did take an oath. * *** *** ** **** * *** ** ** *** APPROVED BY 00/ Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Sign: °Print: My Commission Expires: Zoning Clerk 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: 19.E HvA6 ce-d DATE: 1 -7W/z ADDRESS: 3» PIA/ it a ,ParseaCC 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 Alt 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. AP 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 or substantially improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner- builder, I miist provide direct, onsite supervision 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. Initial 7. 1 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. 1, 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. �f/ Initial " t 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, 1 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 he 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.mvfloridalicense.com /dbpr /pro /cilb /index.html Initial /' V 11. 1 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: 3 (20 tIL- //Z zi a 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 A 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 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 4fr‘ day of , 4O4 , 20 / 2 By /JDeti Produced there License or 00 who was personally known to me or who has Aity\ qui444 OWNER dentification. rtik :A1191114 NOTARY CLAUDIA V. CUBILLOS ,P,u`e'�c Notary Public - State of Florida •_ My COMM. Expires Sep 23.2015 Commission # EE 128810 o Bonded Through National Notary Assn. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 D'A LIDL4 Inspection Number: INSP - 171918 Permit Number: EL -6 -07 -1205 Scheduled Inspection Date: June 07, 2012 Inspector: Devaney, Michael Owner: HUMBLES, ALISON Job Address: 300 NW 112 Terrace Miami Shores, FL 33168 -3300 Project <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number (617)872 -6367 Parcel Number 1121360010260 Building Department Comments PERMIT RENEWED ON 4/4/12 �-'`1 "/ Passed 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- 52196. ADD RECEPTACLES IN KITCHEN , GARAGE ENCLOSURE AND LIVING ROOM. Service and hall panel not to code. Add smoke/ carbon monoxide detectors. )t/–' o '' June 06, 2012 For Inspections please call: (305)762 -4949 Page 8 of 24 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 II`'. 0 4 Zi,12 if-e Permit No. L v -9- —1 Z J S Master Permit No. E C t 9- -- 1 Permit Type: Electrical / / OWNER: Name (Fee Simple Titleholder): //J.2r✓ T`�M ��`f Phone #: .2 �`a ° 1�`� 5''Zll3 Address: 3�'� �� l/Z �" %��r?� C / /.7 / 5� 5pie Ae id ,ec( City: f Da242J��`.�'r)State: in Zip: 2. 0 8 -7 4 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 300 /V W //2 i» 41e, C-e. City: Miami Shores County: Miami Dade Zip: 3313 d? Folio/Parcel #: Is the Building Historically Designated: Yes L. CONTRACTOR: Company Name: Address: NO Flood Zone: nom Phone #: City: State: Zip: Qualifier Name: Phone #: T State Certification or Registration #: 'Certificate 9f Competency #: Contact Phone #: Email Address: d. 0. DESIGNER: Architect/Engineer: Phone#: $ Square/Linear Footage of Work: Value of Work for this Permit: Type of Work: Address Description of Work: OAlterati New ORepai p� ce J **** ** **+x************* * *** ******+ x**+ x�*** Fss�x�xx: x��x*********** * *�u**** *�x+x** ****** *�x�xx�x�+ * ** Submittal Fee $ Permit Fee $ J$ • CO (X Scanning Fee $ 01. 00 Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 64C0 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 At'FII)AVIT: 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 . pproved and a reinspection fee will be charged. Signature j;1 �/ Owner or Agent A The for oin instrument was arm' owled ed bef day of ■1; , 20 by Signature Contractor The foregoing instrument was acknowledged before me this ` lit %r/ day of ,20_,by wr, it is fr "o : y knolvAto me or who has produced (�,,��) l�Jl�l�]1' identification and who did take an oath. NOTARY P . LIC: ` • Sign:. Print: My Commission Expires: is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Prini: g a. • My Commission Expires: 2c# r Plans Examiriei '4` Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk 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 A 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 htto : / /www.mvfloridalicense.com /dbpr /pro /cilb/iindex.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 the party legally and financially responsible for the proposed construction activity at the following address: 3300 /✓W (1 z "' 172,t/Ca C.C' Initial A 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 AAA 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 retumed 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 day of , 20 /2 who was personally known to me or who has Produced there License or i41 identificafon. lr ATAPP '' �:° .>1„ �" ► B, �,'Q,.'� . : MY 01.? S s$4' 'vs poaty alike - $ t 2 te 0' t i COO. Eites S ep 2 d 1 5 oission a oag8 tp ;p 44F'Ho'; Bonded Sntouon National NaY assn • 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: 1��1 6/10,(0624 DATE: °I41 / 12- ADDRESS: 190 /IJIW Iall, Sk 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. 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, l 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 AM 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 or substantially improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as`ther owner- - builder, I must provide direct, onsite supervision 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. 4 Initial Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Owner's Name (Fee Simple Titleholder) ,#4J0".' Nu446 /es JUN 1 1 2007 Permit No. nn - %zO Master Permit No. ILC, 01' Owner's Address -POO /C/A/ 11 2-#4' - "'e cr- -c6- City 1794Z441 fiic„ceS Tenant/Lessee Name Phone# 6/7 rirt 9- State 2i DA Zip . 3i0, ci E -MAIL: 2LiJ 'i J- ,yeble.� a� rvt Job Address (where the work is being done) Slt/I'%e GLf 4,40Ve- City Miami Shores Village County Miami -Dade Phone # FOLIO / PARCEL # //-g/--.3 b- 00, — 01-60 Zip Is Building Historically Designated YES NO X Contractor's Company Name Contractor's Address Phone # City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # i't./421 1.✓o,t/c hid Value of Work For this Permit $ L Type of Work: Describe Work: do..� poilov f plc Square / Linear Footage Of Work: ❑Addition ❑Alterationew ❑ Repair/Replace El Demolition Z�( .- tee �i2tc4 -( 0o7L, % i� .tee s-Pc . , ,�� r isie x** xx***x*xx***** * ***x*xx**xx *•`••••••• • ' • s******** *****x x**xx* *xxxxxxx xxx******* ** ** Submittal Fee $ Permit Fee ' CCF $ (00 CO /CC Notary $ Training /Education Fee $ l 2,0 Scanning $ 3° Radon $ DPBR $ Zoning $ Technology Fee $ Z-50 Bond $ Code Enforcement $ Double Fee $ T r Structural Review. $ Total Fee Now Due $ I S, .55 See Reverse side 6e-- 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. 1 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 %el T Signature Agent The foregoing instrument was acknowledged before me this _A__ The foregoing instrument was acknowledged before me this day or 5, , 20 D', by P' n , 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: "' "��. Gilds Pereda NOTARY PUBLIC: omission #1:0273065 Contractor . �► /l /L m ExplrOS: OEC, 07, 2007 g Sig n ' %�dar '��, .. , . om Sign: Print: Oekti -'"L w Print: My Commission Expires: 12 -, 1, xxxxxxxxxxxxxxxxxxxxxxx xxxxxxxl xxxxxxxxxxxxxxxxxxxxxxxxxxac. i APPLICATION APPROVED BY: (Revised 02/08/06) My Commission Expires: vex xxxxx xxxxxxxxxxxxxxxxxxxxx x xx xx xxxxxxxxxxx Plans Examiner Engineer Zoning Permit Number: MC -6 -07 -1206 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 --- (2,c)L\ Inspection Number: INSP -52204 Inspection Date: April 04, 2012 Inspector: Perez, JanPierre Owner: HUMBLES, ALISON Job Address: 300 NW 112 Terrace Miami Shores, FL 33168 -3300 Project: <NONE> Contractor: HOME OWNER Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (617)872 -6367 Parcel Number 1121360010260 Building Department Comments KITCHEN CABINETS AND GARAGE CONVERTION LEGALIZATION PERMIT RENEWED ON 4/4/12 /4/ C ] 2- Passed Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until April 04, 2012 For Inspections please call: (305)762 -4949 Page 1 of 1 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 Type: MECHANICAL iMMEIEVI 04N12 I APR p1G 0 —12-0 6 Permit No. Master Permit No. OWNER: Name (Fee Simple Titleholder): 4// j7k.J �/,un'1be s Phone #: Address: -..� City: rl,�4-S State: 22/-27 /4f `7/ L S A . e c i;ij "e l r.Q Rct. a4,-J T 6-Dw4 • iY� p Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: L,9rn. ?11,fi .i /22-e i .41-hhel 3 c) /I/ 1-7 1/2'" �ee2 ace_ Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: NO Flood Zone: /; j ble f 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 $ Squai /LinearFootage of Work: Type of Work: UAddress ❑Alteration ❑New ❑Repair%C�e l � Description of Work: i4 W141 1'"'("` sd ❑Demolition ******** ** * **** **** ** ***** **** ** ** ***** Fees************* * ******* ** * ** * *** *** * **** ****** Submittal Fee $ Permit Fee $ /0e6 • Cl.) CCF $ CO /CC $ Scanning Fee $ 3. OD Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE$ �(J�`(11 / Bonding Conpaiiy'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 AlFI )AVIT: 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 The for day of who is ►_ I', NOTA ! Y PUBLIC: /-1 Vum-4/ Owner or Agent K oin a strument as a owledged befo�! m hi , 20 by only k, own Jo me or who has produced Sign: Print: My Commission Exp Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by o is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: • lentification and who did take an oath. * *** * **** * ************* APPROVED BY Sign: • Print: My Commission Expires: * * ** *+x******* * * **** x***** x:*********+x*********qua: * **** s Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk 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: Al i-lb ✓ Hv.6‘ef DATE: O 5e/o (f l i z ADDRESS: N'' //0 /'`' 17.c./e ! c2 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 "1 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 .'`ter` 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 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 or substantially improved it for sale or lease, which violates the exemption. 5. I understand t hat, as the'pwner- builder, I must provide direct, onsite supervision of the construction. Initial Initial ss`i' 1 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 „All 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 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.myfloridalicense.com/dbor/pro/cilbfindex.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 the party legally and financially responsible for the proposed construction activity at the following address:. 370 f41 Hz / 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 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 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 414- day of B y ' ' ' %U. 6 lei Produced there License or 20 (2- who was personally known to me or who has ' 4-� V6 �� "1p i CLAUDIA V. CUBILLOS a° `<- Notary Public - State of Florida • e My Comm. Expires Sep 23, 2015 ':',, Commission • EE 128810 �'�%PA* Bonded Through National Notary Assn. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 JUN 1 1 2007 Permit No. ` 0 ' 1 ZQQ Master Permit No. Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) f9 /%J-®/✓ NtI'rr 61e £ Phone # 61 - 54R - 6 9 ! f Owner's Address 800 AA/ `/,2 m eregfe4cc City J1/ n% cf"hofeS State ,00/C A Zip .316 t Tenant/Lessee Name Phone # E- MAIL: etarcel -A 6144 bk..' C 4-4.0a, , Ca rn Job Address (where the work is being done) ‘..1Pe"-e a 4.60 as I/42_ City Miami Shores Village County Miami -Dade FOLIO /PARCEL# %1/- 2,/ -36- 00i - ®2 (0o Zip Is Building Historically Designated YES NO .X Contractor's Company Naine amitur Phone Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # pluck hcot &Lim C/4-7/4-- p'ra,- /I i "46"t Value of Work For this Permit $ M ✓,4 Type of Work: ❑Addition ['Alteration Describe Work: 114 £ / j-e 4 C Square / Linear Footage Of Work: ❑ Repair/Replace / El Demolition f 00 C CQ C7-�4 dze47 e — **x xacx* xxxxxxxxxx* **xxxxxxxxxxxx*xxxxx Fees...*****.** xxxxxx**_xxxx'***...**x xx''c''a x* Submittal Fee $ Permit Fee $ I &O 1 DO CCF $ . (%O CO /CC Notary $ Scanning $ -CO Radon $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 101.0 •JI.J Pt iLfi';I a, Training /Education Fee $ c Technology Fee $ 2.r.S0 DPBR $ Zoning $ See Reverse side -* 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: 1 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 -_ The foregoiin� ' day of (1,412- , 20 07, by Pii Dr) who is personally known to me or who has produced Signature Agent Contractor instrument was acknowledged before me this /St- 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. tification and who did take an oath. Gilda Pereda aCommissidn #00273065 Sign: �+.'€ '01 Expires: DEC, 01 2007 Print: Or. My Commission Expires: ,�'`- xxxx wwwww wwaewwwwww xxw xxwxxxxxxxxx wwwxxxxxwwwwwwxxxxxx lek** *tr* c4e*r ut4: 9** tc **Ielc*w4caexdexa:dea'c3etiexxx xxtear**iexww*Icar***x 7/ NOTARY PUBLIC: Sign: 1 +�'°�+��;,;;•�`° WWW,AARONNOTARYcom Print: My Commission Expires: APPLICATION APPROVED BY: (Revised 02 /08/06) Plans Examiner Engineer Zoning Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 0 Job Name Date jt1/7 MECHANICAL CRITIQUE SHEET S r 1 JUN 1 1 2007 Miami Shores Village I I , . Building Department A1) ak. (,, f, ., . 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 • BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle) Building Owner's Name (Fee Simple Titleholder) 2O NAV !/ 2./ Tuts j-A ec 1" State ®re/ atA Zip Electrical cOI'51crW C)O1 12-04 Permit No. Master Permit No. Plumbing Mechanical Roofing ,44 rc,evi 71-keen4)/ r Phone # 6 /9. m34 9 ' 6 I � Owner's Address City /i fh/h Tenant/Lessee Name 23/4e- Phone # Job Address (where the work is being done) (.57afe a even, ✓e City Miami Shores Village County Miami -Dade FOLIO /PARCEL# / / 2 - / - 3 6 - 0 0 Is Building Historically Designated YES NO X Contractor's Company Name Contractor's Address ta%t/',ea Zip Phone # City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ o7 04c) - e> Type of Work: ❑Ad ition IDAlteration Describe Work: L -,!r /Z-e Square / Footage Of Work: 6 New ❑ Repair/Replace ❑ Demolition ij b * * * * * * * * * * * ** Submittal Fee $ Notary $ Training/Education Fee $ Scanning $ t — Radon $ DPBR $ 55 *** *** *� *** * * *** * ** * ** * ** ** Fees************** * * * * ** * ** * ** * * ** ** ** * ** * * * * * ** — Per�Git Fee $ Pc5j 4i^- CCF $ 1- 2-0 CO /CC a `tO Technology Fee $ G '(0 Zoning $ Bond $ Code Enforcement $ Structural Review. $ Double Fee $ Total Fee Now Due $ Z55 • S IUL 1 F) See Reverse side - C ' bLSZ 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 pe ated. I certify that_no work or installation has commenced prior to the issuance of a p dards of all laws regulating construction in this jurisdiction. I understa ORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, Alison Humbles, Ph.D. Senior Scientist OWNER'S AFFIDAVIT: I certify that al Research, Dept. of Respiratory Diseases e done in compliance with all applicable laws regulating construction and Medlmmune "WARNING TO OWNER: YOUR F 301 - 398 -5234y RESULT IN YOUR Fax: 301-398-8234 O OBTAIN FINANCING, PAYING TWICE FOR IMPROVE WITH YOUR LEND e-mail: humblesa @medimmune.com YOUR NOTICE OF COMMENCEMENT." NCEMENT." One Medimune Way, Gaithersburg, MD 20878 301- 398 -0000 Fax: 301 - 398 -9000 Notice to Applicant: As a condition to the issuance of a building permit wit an es z ding $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 r-"-t A- Signature Agent Contractor The foregoing instrument was acknowledged before me this 1 The foregoing instrument was acknowledged before me this day of �t e. , 20 [O, by ` &or1 — V4,v,,,\:1,t S , day of , 20 , by , who is personally known to me or who has produced as identification and who did take an oath. who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUB Sign Print: o� Gilds Pereda : �a ' Commission # DD273065 �p Expires; DEC. 07, 200 WvVJ ,AMONNOTARY.coi .1c1t, Qe -e4 . My Commission Expires: • -bI0 ? APPLICATION APPROVED BY: (Revised 02/08/06) NOTARY PUBLIC: Sign: Print: My Commission Expires: $ VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSU'RE STATEMENT NAME: Ak3,1 /ttio(Q.1 ADDRESS: So (0.71 r r- S3l6� Do hereby petition the Village of Miami Shores to-act as my own c.ontradtor pursuant to the laws of the State of Flo�r;da,. F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles the 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 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 underyour supervision and must be employed by you, which means that you trust 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 .411 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 i 1 Zt4 `r C • DATE: , l ® Initial Ali 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. 4. I understand that the building official alter or give advice on how to meet minimum.code. Initial and inspectors are not there to design, code - only if the structure meets the Initial Al-1 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 /4v` 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 companyor 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 M 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. /144 Was acknowledged before me this 1 day of JtAne- , 20 '01 By �\ � D r r V.Mn J\.e 5 who was personally known to me or who has Produced there License or as identification. G Ida Pereda ^amrnissi0n #DD273065 .OWNER NOTE Expires, DEC, 07, 2007 WWW,AARONNOTAAYQom DEVELOPMENT ORDER File Number: PZ07 -0222 - 01 Property Address: 300 NW 112th Terrace Applicant: Alison Humbles (Owner) Address: 300 NW 112th Terrace Miami Shores FL Agent: Patrick Duffy Address: 9718 NE 2nd Ave Miami Shores FL 33138 Whereas, the applicant Alison Humbles (Owner) has filed an application for site plan review before the Planning and Zoning Board on the above property. The applicant sought approval as follows: Site Plan Review, Sec. 600: Site plan approval — Garage Conversion. Whereas, a public hearing was held on February 22, 2007 and the Board, after having considered the application and after hearing testimony and reviewing the evidence entered, finds: 1. The application was made in a manner consistent with the requirements of the Land Development Code of Miami Shores Village. 2. The conditions on the property and the representations made at the hearing merit consideration and are consistent with the requirements of the Land Development Code. The Board requires that all further development of the property shall be performed in a manner consistent with the site plan, drawings, and the conditions agreed upon at the hearing: 1) Applicant to obtain all required building permits before beginning work and shall secure building permits for any work previously undertaken for which required building permits were not obtained. 2) Applicant to meet all applicable code provisions at the time of permitting. Page 1 of 2 3) A covenant in the form of a "Declaration of Use" assuring the property is used only for a single family purpose is recorded with the property. The completed "Declaration of Use" form and $25.00 fee for recording is to be submitted to the Planning Department within ten (10) days of this hearing date. 4) This zoning permit will lapse and become invalid unless the work for which it was approved is started within one (1) year of the signing of the development order by the board chair, or if the work authorized by it is suspended or abandoned for a period of at least one (1) year. Additionally, the applicant must, satisfy all applicable Miami Shores Village Codes, Miami -Dade County Codes, the applicable building and life safety codes required for development, and provide a copy of the development order to the Building Dept. The application with conditions was passed and adopted this 22nd day of February, 2007 by the Planning and Zoning Board as follows: Vice Chair Abramitis Yes Mr. Ulmer Absent Mr. Reese Yes Mr. Sastre Yes Chairman Fernandez Absent Date Vice Chairman, Planning and Zoning Board Page 2 of 2 MIAMI SHORES VILLAGE Page 1 of 1 PZ07- 0222 -01 Alison Humbles (Owners) Patrick Duffy (agent) 300 NW 112 St. Sec. 600: Site plan approval- Garage Conversion Mr. Dacquisto provided background information and summarized the information on the Staff Report. The Planning & Zoning staff recommended approval of the proposed site plan with the finding that it is consistent with the technical provisions of the code subject to compliance with listed conditions. Although the applicant had no questions for Mr. Dacquisto the Board did question him. The applicant's agent Mr. Duffy addressed the board. The Board did not question Mr. Duffy. Mr. Sastre moved to approve the application with the recommendations set forth by staff. Mr. Reese seconded the motion and the vote was unanimous in favor of the motion 3 -0. http:// www. miamishoresvillage. com/ VillageBoards /P &ZB /02- 22- 07P &ZMIN.htm 7/10/2007 vonamossimotimmossoso This property described as: Lot 10, Block 2, NEW MIAMI SHORES ESTATES, according to the Plat thereof, as recorded in Plat Book 51, Page 80 of the Public Records of Dade County ", Florida. Page 1 of 2 Notes Underground encroachments and utilities, if any, not located. • NUJ 1i2T14 1St 1074 7s' 1s1 11 z Q -1 24 z3 42 2 16 17 75' 75' 75' if IoZ' / cry al p04441AY %5 •lD CtitS t 24•111 • 4 .yo JeCI X 4. 0 IJGU III 'M T ' Lcxi°IJ P '44,10 1it.tso nA "9b.Ob'CP.3 • •4 1)tY° t� pAI�t�1r_ °.......� �/p �.- ...—. - -.. PROPERTY OI . Arts, Mureen; 300 N.W. 112th Terrace, Miami Shores, Not valid unless embossed A BOUNDARY SURVEY with Surveyors Seal. 1 hereby certify that the survey repre- sented hereon meets the minimum teehnicaLst ndards set f nh by the Boarrd of and Surveyo pursuant to Sedlo 72.027. Fla. S t tbs. There are no chmenu, easements ap ring on th P t, other than as hereto. Fla. Reg. L Surveyor No. ¢317 BEARINGS. IF ANY SHOWN, BASED ON LANNES and GggARClp55or3ri.ht.33168 L.B. NGINEERSB- LAND SURVEYORS - LAND PLANNERS •• ••4 Office address: 359 Alcazar Avenue, Coral Gables, Flo yda 33134 • • Mailing address: P.O. Box 561131, Miami, Florida•r56 • • (305) 666 -7909 • DRWG. f�0 1921-W66 • • ti I jU 11 2007 B • • • •• • •' • • • •• DATE jj SCALE DRAWN BY • • • p-27 -•9i lAsf.lj-' c..,4/4 • • • 12 -4 -9 Name" rev se • •• i • • •• 8 -07 -03 "Recertified ", Name and Certified T revised; Flopd Information •150581• and Zip Code added. p 4kP7" r 7 fjM 8847 • • • ••• • • • • • • • ••• • • • •• • ••• • • • • • • •• __._ • • • • ••• • • • • • • • •• •• • • 4100 • • • • • • • • • • • • • •• • ••• • • • • •• • • • • • • • • • • • • • • • • • • • •• •• FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. O.M.B. No. 3067 -0077 Expires December 31, 2005 BUILDING OWNER'S NAME _ALISON HUMBLES SECTION A - PROPERTY OWNER INFORMATION Forinsurance Com•an Use: BUILDING STREET ADDRESS (Including Apt., W. TERR. CITY SHORES 06 -1014 Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number Company NAIC Number STATE FLORIDA PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LET 10 2 PB 51, AT PAGE 80 BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use Comments area if necessary. IAL LATITUDE/LONGITUDE (OPTIONAL) (##'- ##'- ##.##° or##.4,I e) ZIP CODE 33 68 SECTION HORIZONTAL DATUM: II NAD 1927 I_._I NAD 1983 SOURCE: 1_1 GPS (Type): LI USGS Quad Map U Other: B FLOOD INSURANCE RATE MAP FIRM INFORMATION B7. NFIP COMMUNITY NAME & COMMUNITY NUMBER VILLAGE OF MIAMI SHORES 120652 B4. MAP AND PANEL ~NUMBER B2. COUNTY NAME MIAMI —DADE Bb. SUFFIX B6. FIRM INDEX DATE B7. FIRM PANEL EFFECTIVE/REVISED DATE 1202500090 J 7 17/95. 3 2 •4 B10. Indicate the source of the Base Flood Elevation (BFE data or base flood depth entered in B9. LI FIS Profile LI FIRM 1_I Community Determined LI Other (Describe): B11. Indicate the elevation datum used for the BFE In B9: IX I NGVD 1929 LI NAVD 1988 LI Other (Describe)• B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? L_I Yes IA I No Designation Date: B8. FLOOD ZONES X B3. STATE FLORIDA B9. BASE FLOOD ELEVATION(S) N/A SECTION C BUILDING ELEVATION INFORMATION SURVEY REQUIRED C1. Building elevations are based on: I_EConstruction Drawings LJBuilding Under Construction IXVIFinished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations — Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO Complete Items C3.a -1 below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum NP,V11 Conversion /Comments Elevation reference mark used BM Does the elevation reference mark used appear on the—FIRM? I J Yes I�I No Qa) Top of bottom floor (including basement or enclosure) 12.50 ft.(m) lab) Top of next higher floor N /,� ft.(m) c) Bottom of lowest horizontal structural member (V zones only) NIA ft.(m) .lad) Attached garage (top of slab) N /A_ ft.(m) De) Lowest elevation of machinery and /or equipment N/A ft servicing the building (Describe in a Comments area.) (m) ----Q f) Lowest adjacent (finished) grade (LAG) 11.65 ft.(m) g) Highest adjacent (finished) grade (HAG) 11,84 ft.(m) h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 I) Total area of all permanent openings (flood vents) in C3.h 0 sq. In. (sq. cm) o CI W • cu uz Li a E 0 z� N CI C U —I SECTION D SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification Is to be signed and sealed by a land surveyor, engineer, or architIct authprl2,gp i;y tavj tQ Bert fy elevation Information. I certify that the Information In Sections A, B, and C on this certificate rLpresedit$ r3ybett riZrts •fio Interpret the data available. 1 understand that any false statement may be punishable by fine or imprisvnn'ent uncler 1'8 IJ S.Code, Section 1001. CERTIFIER'S NAME ADIS N. NUNEZ TITLE REGISTERED LAND SURVEYOR ADDRESS 555 NORTH SIGNATURE LICENSE NUMBER 5924 • • '• '.` • COMPANY NAME •' : • • • BLANCO SURVEYORS • *INC,. • • ••• • • • • ••• •__s —•- • • d • • • •• • • •• • • • • •• • ZIP CODE 33141 FEMA Form 81 -31, January 2003 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these s aces co the corres •ondin 1 .190 BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. N.W. 112TH TERM. • CITY STATE ZIP CODE IAMI SHORES 33168 Information from Section A. For Insurance Corn an Use: Policy Number s SECTION D - SURVEYOR ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS Company NAIC Number CROWN OF ROAD ELEVATION: 11.42' ON CENTERLINE ON CENTER OF ROAD BM # N -769 LOCATOR # 3110 E. ELEV. 10.35' L. _1 Check here if attachments SECTION E BUILDING ELEVATION INFORMATION SURVEY NOT REQUIRED FOR ZONE AO AND ZONE A THOUT BFE For Zone AO and Zone A (without BFE), complete Items E1. through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Section C must be completed. El. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is l 1 I ft•(m) I 1 lin.(cm) j_I above or LJ below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6 -8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is I-1_I ft.(m) (_.jIin.(cm) above the highest adjacent grade. E4. The top of the platform of machinery and /or equipment servicing the building is j-1_I ft. (m) U_I in. (cm)1 I above or LI below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? U Yes j_ No j_,j Unknown. The local official must certify this information in Section G. SECTION F PROPERTY OWNER OR OWNER'S REPRESENTATIVE CERTIFICATION The property ...._ p p owner or owner's authorized representative who completes Sections A, B, (Items C3.h and C3.i only), and E for Zone A (without a FEMA - issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS SIGNATURE CITY STATE DATE ZIP'CODE SECTION G - COMMUNITY INFORMATION OPTIONAL The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. II The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 1 1A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3. _ The following information (Items G4 -G9) is provided for community floodplain management purposes. IG4. PERMIT NUMBER U Check here if attachments G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: j^j New Construction LJ Substantial Improvement G8. Elevation of as -bujlt floor (jnoludicng Iasement) of the building is: • ft.(m)Datum: G9. BFE or (in Zone AO);d$ptt of fliovding the iptilding site is: • ft.(m)Datum: LOCAL OFFICIAL'S NV,E f ' • ' • •' • • • • • TITLE COMMUNITY NAME ••• ••• • • SIGNATURE • • • • • • • • • •• • • • • • • • • • • • •• •• • • • • • ••• COMMENTS TELEPHONE DATE • • • • • • • • • • • • • • •• •• • • • •• •• • FEMA Form 81 -31, Janu ry 2003 • • _jFheck here if attachments REPLACES ALL PREVIOUS EDITIONS Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit MO. RC-6-07-1204 Issue Date: Not Issued Expires: of Issued Folio Number:1121360010260 Owner's Name: ALISON HUMBLES Job Address: 300 112 Terrace NW Miami Shores, FL 33168 -3300 Owner's Phone: Total Square Feet: (617)872 -6367 69 Total Job Valuation: $ 2,000.00 Contractor(s) Phone Primary Contractor HOME OWNER Yes ...... z.......,•............¢ a ..... ..................,.......<_ -a. z. ...a..... ..oz' �o .. ......z ....aa.3.dz3va..a <........a............a. z ........ Planning and Zoning Criteria and Comments Approved: Yes Comments: Date Approved: 7/10/2007 : Yes 11710 Old Georgetown Road Apt 1127, North Bethesda, MD 20852 Daytime Phone: 310- 398 -5234 Cell Phone: 617- 549 -6911 June 1a 2007 Re 300 NW 112th Terrace, Miami Shores, FL 33168 Dear Claudio, Firstly sincere apologies for not getting this information to you sooner, I wanted to hand this in to you personally but haven't had the opportunity to travel to Miami in the last 2 months. Further to our meeting to discuss the permits required to legalize the garage enclosure and kitchen remodeling (cabinets) to my house at 300 NW 112th Terrace, please find enclosed, as you requested, the following: 2 copies of Survey 2 copies of Elevation Certificate 2 Copies of Site Plans Building application to legalize garage enclosure and kitchen cabinets Electrical application to legalize existing electrical outlets in garage enclosure and kitchen Mechanical application to legalize existing AC drop in enclosed garage Owner Builder Disclosure Statement Original and 2 copies of hand drawn kitchen plan indicating existing electrical outlets 2 copies of site plan with electrical outlets as indicated in kitchen and enclosed garage space and also A/C drop indicated in enclosed garage. Please contact me at the above phone numbers should you require any further information, Best Wishes, Alison Humbles 1�T : 3oo )(-r/212 cjtryc - ,er7 1;4141 eiz • • • • • •• • • IE2.-77. 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