RC-10-1254Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 159546 Permit Number: RC -7 -10 -1254
Scheduled Inspection Date: July 30, 2012
Inspector: Bruhn, Norman
Owner: PUFF, MARTIN
Job Address: 1208 NE 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (786)553 -7400
Parcel Number 1132050090360
Building Department Comments
BATHROOM REMODEL, CONVERTION OF TUB TO
SHOWER
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- 148180. Work covered. Missed
inspections. NB
July 27, 2012
For Inspections please call: (305)762 -4949
Page 1 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
'IZET7----0
JUL 1 3 252
BY; ®eaomovoeevoao
FBC 20c.\
Permit No. e C i
Master Permit No.
Permit Type: BUILDING ROOFING
/2 P Cf% �
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: Z ?/. Jc
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO /
Flood Zone: %C
OWNER: Name (Fee Simple Titleholder): r
- 4 i Phone#: 7r6 c(37...? F a®
Address: /2C4 ir..). 9e
City: 77. 2.■ ®, rh State: Zip: ?'2'/W
Tenant/Lessee Name: Phone#:
Fmsiii:
CONTRACTOR: Company Name: � ()OAo{ Phone#:
Address:
City:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: °Addition °Alteration ONew CIRepdr/ to lace °Demolition
Description of Work:
Color thru tile:
*+ >s*********a+x*a *** * *********** x***+ ***F ************ ***,x** ****** *** * **** ******* ** **
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDrrIONERS, -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 ' e will be charged
Signa Signature
• I�r Agent Contractor
The fo ::.o'' g instrume • was ackn . y ledg ppfore , ' i fl(a The foregoing instrument was acknowledged before me this
day o a R_ by [ (f ,u` J � � , day of , 20 , by
wh is personal] kn to who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
or who has produced
As identification and who did take an oath.
NOTARY ' LIC:
Sign:
Print:
My Commission Expires:
—vow
:iUDS
C Aa State o1
,
a
MY Comm. i 3.20
5
Commission # E1288
'..�� � °`` .F Bonded Though National MIA Assn
Sign:
Print:
My Commission Expires:
**N* ************* ********* * • ******* **** ************* ************** Rik***** **** * *************** **** *******
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Arienis Silvera
From: puffm @bellsouth.net
Sent: Wednesday, November 02, 2011 3:55 PM
To: Norman Bruhn
Cc: Arlenis Silvera
Subject: Permit Number RC -7 -10 -1254
1208 NE 98th Street
Miami Shores, FL 33138
Dear Mr. Bruhn,
Regarding above mentioned permit, I kindly ask you to extend it for 30 days. Also, I would highly appreciate if we could
meet when you are back in the office to discuss options to conclude and close this permit.
Thank you very much for your consideration and best regards,
Martin Puff
1
1 /p -s)iz
Miami Shores Village ZOTOW� JUL 0 9 'too
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
.....
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ROOFING
Owner's Name (Fee Simple Titleholder) /7, '7/ /
Owner's Address /2087
City /7/4/7/ S-fineES State Zip � L57?
Permit No. "/ 115A.'
Master Permit No.
Phone #
i rZ
Tenant/Lessee Name Phone #
Ernail
/2 4 7eA _fc5, , rye,/
Job Address (where the work is being done) /20f 1(/ ,V14 J ?e_.
City Miami Shores Village County Miami -Dade Zip '"�/
FOLIO / PARCEL #
Is Building Historically Designated YES Flood Zone
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 2 Zoo, o o Square / Linear Footage Of Work: OA- rzt s
Type of Work: °Addition
d °Alteratv io n r2>QNew Repaair/Replce Q Demolition
Describe Work: �o// Q ricn o /, rep4.t 4416 G4// 7/7
Submittal Fee $ 50 Permit Fee $ CCF $ 1 • CO /CC $
Notary $ ,. y
Scanning $ • C J
Training cation Fee $ �-12.1
Radon $ c0 2_ DPBR $ V 52
Technology Fee $ a -40
Bond $
Double-Fee $ Violation date: p
Structural Review. $ Total Fee Now Due '$ 11'-t-'1-
See Reverse side -a
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State zip
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. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDI'T'IONERS, 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
r or Agent
The foregoing ins nt was acknowl ged be
day of ,20Laby “ Y(1 r
who is - rsona known to me or who has roduced�%
Y P
entification and who did take an oath,
NOT ' YI;IC:
Sign;
Print: I
My Commission Expires:
Signature
Contractor
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.
;fit•
re 4
7 /r/915 Plans Examiner Zoning
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)
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: !l/ 77sV DATE: 77e//0
ADDRESS: /2 'F ieho aseatpli %% 'E ff% t"/
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; 1 further
understand that 1 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.
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 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.
Initial
7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that
erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner- builder, may be held
liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while
working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
Initial
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to
perform the work being done. Any person working on my building who is not licensed must work under my direct supervision
and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and
social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for
the employee. I understand that my failure to follow these may subject to serious financial risk.
Initial dm2
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 /dbpr /pro /cilb /index.html
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:
/24r 144, /74e °JA
Initial e,eier
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.
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 8 day of
By 1\4O■1\jhY1
, 20 /
who was personally known to me or who has
Produced there License orT Q() 025'O (0'2_4.99,0 10 as identification.
NOTARY
NOT ABS PUBLIC Ckadia 7 P'o",i: li t`�6 3
CifileraiSePTA
ail'. 23, NIA
BONDED rRU l A 171N, ICBONDLicCO.INC,
HUD -1
A. Settlement Statement (HUD -1)
OMB Approval No. 2502 -0265
B. Type of Loan
O 1. FHA
Q 4. V.A.
O 2. RHS
O 5. Conv. Ins.
• 3. Conv. Unins.
6. File Number
10-48
ID:
7. Loan Number
7116333761
8. Mortg. Ins. Case Num.
C. NOTE:This form is fumished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items
marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. NAME OF BORROWER:
Address of Borrower:
E. NAME OF SELLER:
Address of Seller:
Martin Puff and Veronica Arcila, husband and wife
295 NE 95 Street, Miami Shores, Florida 33138
Theodore R. Donahue and Margaret Donahue, husband and wife
130 Oak Hollow, Floresville, Texas 78114
F. NAME OF LENDER: Coldwell Banker Home Loans
Address of Lender: One Mortgage Way, Mount Laurel, New Jersey 08054 -5954
G. PROPERTY LOCATION: 1208 NE 98 Street, Miami Shores, Florida 33138
H. SETTLEMENT AGENT: Christopher P. Kelley, P.A.
Place of Settlement: 11098 Biscayne Boulevard, Suite No. 205, Miami, Florida 33161
1. SETTLEMENT DATE: 6/15/10 DISBURSEMENT DATE: 6/15/10
Phone: 305 -893 -6004
J. Summary of borrower's transaction
K. Summary seller's transaction
377,000.00
100. Gross amount due from borrower:
101. Contract sales price
-(
377,000.00
400. Gross amount due to seller:
401. Contract sales price
102. Personal property
402. Personal property
103. Settlement charges to borrower (Line 1400)
10,890.58
403.
104.
404.
105.
405.
Adjustments for items paid by seller in advance:
106. City/town taxes
Adjustments for items paid by seller in advance:
406. City /town taxes
107. County taxes
407. County taxes
108. Assessments
408. Assessments
109. Waste - Miami Shores from 06/15/10 to 06/30/10
32.99
409. Waste - Miami Shores from 06/15/10 to 06/30/10
32.99
110.
410.
111.
411.
112.
412.
120. Gross amount due from borrower:
387,923.57
420. Gross amount due to seller:
377,032.99
200. Amounts paid or in behalf of borrower:
500. Reductions in amount due to seller:
201. Deposit or eamest money
11,000.00
501. Excess deposit (see instructions)
202. Principal amount of new loan(s)
301,600.00
502. Settlement charges to seller (line 1400)
32,823.50
203. Existing loan(s) taken subject to
503. Existing loan(s) taken subject to
204. Principal amount of second mortgage
504. Payoff of first mortgage loan
205.
505. Payoff of second mortgage loan
206.
506.
207.
507.
208. Principal amt of mortgage held by seller
508. Principal amt of mortgage held by seller
209.
509. Water escrow
250.00
209a.
509a.
Adjustments for items unpaid by seller:
210. City/town taxes
Adjustments for items unpaid by seller:
510. City/town taxes
211. County taxes from 01/01/10 to 06/15/10
1,066.96
511. County taxes from 01/01/10 to 06/15/10
1,066.96
212. Assessments
512. Assessments
213.
513.
214.
514.
215.
515.
216.
516.
217.
517.
218.
518.
219.
519.
220. Total paid by/for borrower:
313,666.96
620. Total reductions In amount due seller:
34,140.46
300. Cash at settlement from /to borrower:
301. Gross amount due from borrower (line 120)
387,923.57
600. Cash at settlement to /from seller:
601. Gross amount due to seller (line 420)
377,032.99
302. Less amount paid by/for the borrower (line 220)
(313,666.96)
602. Less total reductions in amount due seller (line 520)
(34,140.46)
303. Cash ( ✓ From ❑ To ) Borrower.
74,256.61
342,892.53
603. Cash ( ✓ To ❑ From ) Seller
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This
agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No
confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the
settlement process.
Borrowlnitial
(Seller's Initial(s):
DoubleTime®
HUD -1
U.S. Department of Housing and Urban Development
Page 2
L. Settlement charges
'
Paid from
Seller's
Funds at
Settlement
700. Total Real Estate Broker Fees $22,915.00
Paid from
Borrower's
Division of commission (line 700) as follows:
Funds at
701. $ 11,310.00 to Majestic Properties Design District
Settlement
702. $ 11,605.00 to Cold Bnkr Res RE (incl Broker $295 Commission)
703. Commission paid at settlement
295.00
22,620.00
704.
705. to
800. Items Payable in Connection with Loan
801. Our origination charge $600.00 (from GFE #1)
802. Your credit or charge (points) for the specific interest rate chosen ($754.00) (from GFE #2)
803. Your adjusted origination charges to Co[dwell Banker Home Loans (from GFE A)
- 154.00
804. Appraisal fee to STARS (from GFE #3)
415.00
805. Credit report to CBC Innovis, Inc. (from GFE #3)
10.43
806. Scoring Fee to FHLMC FNMA
15.95
807. to
808. to
809. to
810. to
811. to
812. to
813. to
900. Items Required by Lender to Be Paid in Advance
901. Daily interest charges from 06/15/10 to 06/30/10 a $42.94 /day (from GFE #10)
687.04
902. Mortgage insurance premium for months to (from GFE #3)
903. Homeowner's insurance premium 1 years to Royal Palm Insurance (from GFE #11)
1,819.86
904. Flood insurance premium for years to
905. Windstorm insurance premium 1 years to Citizens Property Insurance Corporation
2,658.00
1000. Reserves Deposited with Lender
1001. Initial deposit for your escrow account (from GFE #9)
1002. Homeowner's insurance months @ per month
1003. Mortgage insurance months @ per month
1004. Property taxes months @ per month
1005. Flood insurance months @ per month
1006. months @ per month
1007. months @ per month
1008. months @ per month
1009. Aggregate accounting adjustment
1100. Title Charges
1101. Title services and lender's title insurance (from GFE #4)
943.50
1102. Settlement or closing fee to Christopher P. Kelley, P.A. $695.00
1103. Owner's title insurance to Old Republic Nat. Title /Christopher P. Kelley (from GFE #5)
OPM- 1960.00
1,960.00
1104. Lender's title insurance to Old Republic Nat. Title /Christopher P. Kelley $248.50
MPF- 25.00;8.1 -25; F9- 198.50
1105. Lender's title policy limit $301,600.00
1106. Owner's title policy limit $377,000.00
1107. Agent's portion of the total title insurance premium $1,545.95 to Christopher P. Kelley, P.A.
1108. Underwriter's portion of the total title insurance premium $662.55 to Old Republic National Title Insurance Comp
1109. Abstract or title search to Christopher P. Kelley, P.A.
250.00
1110. Attorney's Fees to John J Heam, Esquire
800.00
1111. to
1112. Pre - computer Search to Attomeys' Title Insurance Fur
40.00
1113. Lien Search to Lightning Lien Letters
158.00
1200. Government Recording and Transfer Charges
1201. Govemment recording charges (from GFE #7)
181.50
1202. Deed $18.50 Mortgage(s) $163.00 Releases $0.00 $181.50
1203. Transfer taxes (from GFE #8)
1,658.80
1204. City/County tax/stamps Deed $0.00 Mortgage(s) $603.20
1205. State tax/stamps Deed $2,262.00 Mortgage(s) $1,055.60
2,262.00
1206. Record Continuous Marriage Affidavit to Clerk of Court Miami -Dade County
18.50
1207.
1208.
1300. Additional Settlement Charges
1301. Required services that you can shop for (from GFE #6)
399.50
1302. Tax Service Fee to STARS $85.00
1303. Flood Certification Fee to STARS $19.50
1304. to
1305. Survey to Nova Surveyors $295.00
1306. A/C Replacement to C & R Air Conditioning Co
6,610.00
1307. Miami Shores Re- Occupancy to Enrique Garcia (reimbursemen
65.00
1308. to
1309.
1400. Total Settlement Charges
( Enter on lines 103, Section J and 502, Section K)
10,890.58
32,823.50
* POC (B) = Paid outside of dosing by borrower
* POC (S) = Paid outside of dosing by seller
Borrower's Initial(s):
Seller's Initial(s):
r Y V
DoubleTime®
#J'4' ?7/
ril�i ill rY
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
254
Inspection Number: INSP- 148072 Permit Number: PL -7 -10 -1245
Scheduled Inspection Date: May 06, 2011
Inspector: Hernandez, Rafael
Owner: PUFF, MARTIN
Job Address: 1208 NE 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (786)553 -7400
Parcel Number 1132050090360
Building Department Comments
replace pipe system around the house.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
May 05, 2011
For Inspections please call: (305)762 -4949
Page 2 of 10
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) 7624949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
JUL 0 8 2010
Permit No. 10 Qi24
3
Master Permit No.
/r'' 30s - Ra2. 362K.
OWNER: Name (Fee Simple Titleholder): I �f '( 1- Phone#: �1v 1!J ✓ 5Y3
VINILI ..1 Oi. ✓./
Address:
City: i F-U .S4►2e
State: __EL Tap: 33 133g
Tenant/Lessee Name: Phone:
PUrM Y�a,L S uu7n-t. Nei
Email:
JOB ADDRESS: 1 ��C, 1 O S G��
City: Miami Shores
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
County:
Miami Dade
CONTRACTOR: Company Name:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER Architect/Engineer: Phone#:
Flood Zone:
Phone#:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: °Address °Alteration °New DRepair/Replace °Demolition
Description of Work:
******** *** ********** * *** * ***** **** **** Fees************* ********* * * * *s******* ****** * * **
Submittal Fee $ Permit Fee $ a
Scanning Fee $ x•00 Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ 'a° COICC $
DBPR $ 0 52 2 Bond $
Technology Fee $ 1- WO
TOTAL FEE NOW DUE $ cZa • L4
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. W 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
pronnise 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 roved and a reinspection fee will be charged
Signature ,4- Signature
or Agent
trument was acknowledged before me this
2010, by
known to me
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 , by
who has produced\ _,) who is personally known to me or who has prat
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: ��, 1 ps� Sign:
4 'co -�. Print
Print
My Commission Expires:
,F,,Q; t;
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: ON-11 i2Gi T \J D (I( t �l
ADDRESS: 1901 NE LSI M) NJ s)I0 1215SP 4L 33)3D
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 V ik
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 ,sstantially
improved it for sale or lease, which violates the exemption.
Initial
5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction.
Initial V i
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 V f\
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 V
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 \J Pi
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 V
10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the
United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.mvfioridalicense.comldbpr /pro /cilb /index.htmll
Initial V PI-
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:
pug r '16 cit S7 AA.MIL s , 33133
Initial V
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information tha
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 property 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
BY�YJ�'�.tC,Q Aic\c
Produce.; ere License or
OWNER
, 2010
who was personally known to me or who has
as identification.
NOTARY �,,.
v 1431\11' ,�-. r���J pal
F; la 120„ 0,
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 148204
Permit Number: EL -7 -10 -1255
Scheduled Inspection Date: April 05, 2011
Inspector: Devaney, Michael
Owner: PUFF, MARTIN
Job Address: 1208 NE 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (786)553 -7400
Parcel Number 1132050090360
Building Department Comments
ELECTRICAL WORK FOR BATHROOM REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
April 04, 2011
For Inspections please call: (305)762 -4949
Page 3 of 20
Miami Shores Village Izalmw
Building Department Au" g. ?YN
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795.2204 Fax: (305) 756.8972 �Y' ° ° ° ° „ °,,,,.
INSPECTION'S PHONE NUMBER: (305). 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No. E-1 t 0! 1 Z•
Master Permit No.(J 10- -a521—
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) /47/17- /A) �j�.�PC Phone # ,'., T ?4oc
Owner's Address /26, ,Q . Ar 6
City 17/4-"/ J/'€'L State Zip �� /�
Tenant/Lessee Name Phone #
Email ,off lieeb c ri
Job Address (where the work is being done) /220., c?Cfp
City Miami Shores Village County Miami-Dade Zip ' /3Q
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City
Qualifier Name
Phone #
Flood Zone iiOc
State Zip
Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable)
Phone #
Value of Work For this Permit $ Oa—) '(x
Type of Work: DAddition ['Alteration
Square / Linear Footage Of Work:
ONew 17t Repair/Replace 0 Demolition
Describe Work: olet 46� 1 ®mss/ txlet, i `4 �o✓J� Jac
Submittal Fee $ ” 50 00 Permit Fee $
CCF 0
CO /CC $
Notary $ Training/Education Fee $ Technology Fee $ 0
Scanning $ ,5' co Radon $ 0 • uc ✓ 1- DPBR $ 0 52- Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 10'(04.
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: 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 re- inspection fee will be charged.
_%
Signature „!_�.i /j/
Owner • gent
The foregoing instrument was ackn wlec4ged befo s
day of ,20 /a, by N O\
personally known to me or who has produced
s identification and who did take an oath.
Signature
Contractor
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.
NO ARPUBLIC: NOTARY PUBLIC:
t,'1. ID i %gti1 •
,e.
My Commission Expires:
* * * * * * * * * * * * * * * * * * * **
Sign:
Print:
My Commission Expires:
************************************************ ************** ************* ****
APPROVED BY -_ ., / '2 J iY /Plans Examiner Zoning
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)
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: /7/ %7/) / DATE: ,7 /;j /l®
ADDRESS: 126f ,ij 'M c -et 'c1,vr c 7_ ci ?'hi.�P
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 c-' e
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 that, as the owner- builder, I must provide direct, onsite supervision of the construction.
Initial
Initial 0022
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or
residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or
municipal ordinance.
Initial
7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner- builder permit that
erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held
liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while
working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
InitiaL.4. '
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 "4,7'
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 htte://www.mvfloridalicense.com/dber/pro/cilb/index.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:
r.. L
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 contractors workers compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and
returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when
the permit is issued.
Was acknowledged before me this 9' day of
B ry k A1A, (9()F who was ersonall known to me or who has
Y personally
Produced there License orf \ __} 02-3-0 0(0-24 O1Oas identification.
NOTARY
4 !1!973
s :� 23, 2011
k ,
BONDED
T'3 ATLANTIC BONS