DS-12-1107Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 174877
Permit Number: DS -6 -12 -1107
Scheduled Inspection Date: August 09, 2012
Inspector: Bruhn, Norman
Owner: DENNIS LEYVA, CLARK REYNOLDS
Job Address: 69 NE 102 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: fettmdatiprr
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060131680
Building Department Comments
PAVER DRIVEWAY
07/11/2012 - PENDING NOC
07/13/2012 - NOC SUBMITTED
Passed
Failed
Inspector Comments
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 08, 2012
For Inspections please call: (305)762 -4949
Page 5 of 27
111111 11111111111111111111111111111111111 1111
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SWAT TIME OF FIRST INSPECTION
PERMIT N O r . I ) I T A X FOLIO NO. I - 326 •'O 13 —j (p
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives totice that improvements wit be
property, and in accordance with Chapter 713, Florida Statutes, the
is provided in this Notice of Commencement,
CFN 2011.2R0494374
DR 1?k 28187 Ps 0613; f 1ps )
RECORDED 07/13/2012 13 :10: et _t
HARVEY RUVItir CLERK OF COURT
MIAMI -DADE C:OUHTYr FLORIDA
LAST PAGE
STATE OF FLOR C C A OF DADE
HERESY C ERnF fine is . e , ,„ crwaiMe
vrigira' f i is #rio ' of
By
)(Le* gescriAtiort9 dot /bPertY and ~address: 0 qi /V 7_, 70,2\ Space above reserved for o of recording office
ADescription of improvement: "b , 2, j U-Q idiot
Owners) name'and address: .wC , v v ' p
Interest in property: (t) .he/2
Name and address of fee simple titleholder. /14 '`/ /elc - )Qe Of ft a i c j
14.
Go yctor' e, addr an n um ,;_, ,
5. Surety: (Payment 4nd required by owner from contractor, If any)
Name, address and phone number
Amount of bond $
6. Lender's' name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(I)(a)7., .Florida Statutes,
Name, address and phone number.
vJ .
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section
713.13(1)(b), Florida. Statutes.
Name, address and phone number.
8. Expiration date of this Notice of Commencement
(the ekpiratIon date Is 1 year from the date of recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1; SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB'SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH VOUR LENDER OR AN ATTORNEY BEFORE, COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
ignature(s),of,�j, e s r • , s;
Prepared By • _
Print Name V AT/4GWf4
Title/Office '
STATE OF FLORIDA
orized Officer/Director/Partner/Manager
Prepared By
Print Name
Title/Office
COUNTY OF MIAMI -DADE
The foregoing Instniment was acknowledged before me this (/ day of .) ui ---`1
By C v '.G. �'�:/ ;? i ��r� .)
❑ Individually, or CI as for.\‘`‘‘„,t�;Ien. "ii,%
•❑ Personally known, or '' • roduced the following type of ident ation, • • • „o, i3' •% /.7� ms's
Signature of Notary Public: 0 .101x1 .7MIE +'
Print Name. / '''�i�i.
� • f • � U U (S --I I 0 U®
I .1C' _,t Ti EC • _ g 0 . D• =1r,rr � -.sf • !/e
Under' penalties of perjury,1 declare that I have read the'foregor� d: J0,f d` . $
that the facts stated in it are true, to the best of my knowledge artfi
Signatures) of Owner(e) or Owner(s)'s Authorized Officer /Director/PatiM�a gi who signed above:
By By
t23.01 42 PAGE9 3/10
cif 116_,CJJA-0—'
\9\\ 3-0V'
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
FBC 20
BUILDING Permit No. (D5 t fIC
PERMIT APPLICATION
Master Permit No.
Permit Type: BUILDING DING ROOFING
JOB ADDRESS: V' 9 'IL /d 2' .57.-ge°2477—
City: Miami Shores County: Miami Dade Zip: 3 3 / 3V
Folio/Parcel #: f! • V'(' 0 /?j' 1gia
Is the Building Historically Designated: Yes
NO
Flood Zone:
f
OWNER: Name (Fee Simple Titleholder): C. me g if eyile4IO5 Phone#30S g'/ j7
Address:
5 -7220'T
City: )41 ! a',I si?4).405 State:
Tenant/Lessee Name:
Email:
fL
zip: 33/3g
Phone#:
CONTRACTOR: Company Name:
Phone #:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer:
Certificate of Competency #:
Phone#:
dC
.)
Value of Work for this Permit: $ (/( Square/Linear Footage of Work:
New DRepair/Replace
Type of Work: DAddition
Descripd n of Work:
Alteration
7/7
ODemolition
Color thru tile:
******* **+ n* x:* * **********x:******* **** x*Fe *+x******* ** **** x******* **** *********+n**+n***
Submittal Fee -1 S ri,, Permit Fee $ /.j Q
Scanning Fee $ ` Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 1.15' MD
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 FT J CTRICAL 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 rove/ a ' einspec o ee will be charged.
Signature 3(
The fo
day o
wh . is I, rsonall kno to me or who has produced
h 1 �' s identification and who did take an oath.
0
NOTA
Sign:
Print:
My Commission Expires:
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:
APPROVED BY
G�P� b \ic stake o 23, 2p�5
'PU <, �yota� m Ex40 EE A2bbl on.
; My Co��'vsSV73 y oti�alNota�y P
Sign:
Print:
My Commission Expires:
*+ k************ ********** *********** *+k+k**+k+Nakss********N * **Nick****
141Z/ Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
liemi Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
O BUILDS D CLOSURE STATEMENT
NAME: �°� DATE: t /
Ss
ADDRESS: 6r i :
Do
oh I have son 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 understood the, following disclosure statement, which entitles me to work as my own contractor, !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).;Thebuilding 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 thatyou 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 bylaw. 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
contractor with certain restrictions even though I do not have a license. 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
Initial
1 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 nothing a licensed contractor to assume responsibility.,
3 1 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 tiled in his or her name instead of my own
name. 1 also understand that the contractor is required by law to be licensed in Florida and to Iist,.his or license i, mbers 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 o si tantially
improved d 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
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or
residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or
municipal ordinance.
7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that
erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may 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 wailfully acting as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. , J)
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 donee 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 850487.1395 or htto://www.mvfloridalicense.com/dbpdprokilb/inde .h
Initial/
11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that 1 am the party
legally and financially responsible for the proposed construction activity at the following address:
12. I agree to notify Miami' Shores Village immediately of any additions, deletions, or changes to any of the inform at 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 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 15 day of
By U01'L
who was personally known to me or who has
Produced ere License or
11 .6-9.0
OWNER
GIs identificatio
_ NQTARY
,, H n o,, CLAUDIA V. CUBII_LOS
a* —j \ Notary Public - State of Florida
• My Comm. Expires Sep 23, 2015
. o-, Commission # EE 128810
"' %° ..'. Bonded Through National Notary Assn.
SCOPE OF WORK
69 NE 102 STREET
MIAMI SHORES, FLORIDA
Anticipated work scheduled for July 2012
Project: Installation of pavers to provide a driveway from the house to the street,
which includes the swale area.
Work will involve:
1. Trenching indicated area 5 inches deep for installation of pavers and
concrete border.
2. Laying 21/2 inches of leveled sand in trenched area where bricks are to be
installed..
3. Installing bricks 21/2 thick x 4 wide x 7 1/2 long inch bricks on top of the
leveled sand.
4. Pouring concrete boundary 4 inches deep and 5 inches wide.
5. Pictures of bricks are included.
6. Locations indicated on survey.
MiamiShores �
Building Department
RECEIPT
PERMIT #:11)--S2 -° t 1 C5- -- DATE: (f)
C-k— 1e(_-- 12r-of NOLAD
o Contractor
,Owner
o Architect
1
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Picked up 2 sets of plans and (other)
Address: C162 (5
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Dep men continue rmitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE;
PERMIT CLERK INITIAL:
Permit No: 12 -1107
Job Name:
June 20, 2012
Miami Shores Village
Building Department
Building Critique Sheet
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
Page 1 of 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 762 -4859
1
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)755 -8972
Permit NO. DS -6 -12 -1107
Issue Date: Not Issued
Expires:NOt Issued
Folio Number:1132060131680
Owner's Name: CLARK REYNOLDS DENNIS LEYVA
Job Address: 69 102 Street
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 714
Total Job Valuation: $ 3,000.00
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/18/2012: Yes
Comments: FLARES CAN NOT EXCEED 2 FEET IN WIDTH