PL-12-762Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 172902 Permit Number: PL -4 -12 -762
Scheduled Inspection Date: August 06, 2012
Inspector: Hernandez, Rafael
Owner: DAVITAN, GEORGE
Job Address: 85 NW 102 Street
Miami Shores, FL
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number
Parcel Number 1131010180080
Building Department Comments
NEW SPRINKLER SYSTEM INSTALLATION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
August 03, 2012
For Inspections please call: (305)762 -4949
Page 13 of 61
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
mmcmEwmr-
gt I�
APR 3 0,2912 �J
B Y:
Permit No. r 12.----Kop,
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): Gi D / J 1417i / /�/'/ Phone #:305 ,2t2h �4
Address: gS—
City: N/A-A/ / $,4f f V/LI 4State: /, . Zip: 33/S O
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 35- %I/k/ /02_ 5 a
City: Miami Shores County: Miami Dade Zip: 3 3/ 50
Folio/Parcel #: // � 3/D /- ° doge
Is the Building Historically Designated: Yes NO Flood Zone:
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#:
Phone #:
Value of Work for this Permit: $ 7SY). ®® ° ; g$guare/Lipear Footage of Work:
Type of Work: °Address °Alteration
Description of Work: _ PR/4/fr2Asie_<
ew :;
DRepair/Replace
S00 3_F
°Demolition
***************************************F * **F * * ** x*+ x****+ x** *+ x****** **********************
Submittal Fee $ Permit Fee $ /S—C3---- CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ t+ •
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) /1/®/V
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 CONDPTIONERS, 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 't be approve !_�nd a reinspection fee will be charged.
Signature! Signature
Owner or Agent Contractor
The fore going ins ment was acknowledged before me this Z9 The foregoing instrument was acknowledged before me this
day o , 20 le b ' - r aeri,guday of , 20 _, by
/ /
who has produced _ who is personally known to me or who has produced
L As ideritif atyn_AnKLw]2p didiak an oath.. • as identification and who did take an oath.
NOTARY PUBLIC:
.`i Y P4e«�'. MUHAMMAD MOINUDDIN
4, 01.
s. Notary Public - State of Florida
�1 a, My Comm. Expires Jul 6, 2015
Sign: %'�'� /•s ���; "�' `Commission • EE 109561 Sign:
s
Print:��� � �-A Print:
My Commission Expires: d.(jl S My Commission Expires:
NOTARY PUBLIC:
**** x *,xa:,x,x*s,+x+s+x**** *** ** *** x*** ** ******** ** ** say***************,************** * ****** *****,x******* *** **** ***
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
NAME:
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
i�7 ATE: 4A/2_
ADDRESS: Sc r /it) /,0 2
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 wn
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 wild 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 i ..roved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I built orAo., o .ntially
improved it for sale or lease, which violates the exemption. /
Initial Alr
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 Jaw and j1 unty 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. 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 ting 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 compe sation 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.
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 ma contact the
Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.myforidalicense.com /dbor /pro /cilb /ind .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
Dally and financially responsible for the proposed construction activity at the following address:
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information
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
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 30 day of
By ((ROT) ( 2t\i l Fin B V ut �/ who wa
,20 )9
me or who has
Produced there License or _ gas identifica 'on.
rWNER
P, ,, CLAUDIA V. MAWS �( c''s Notary Public - State of Florida
4 My Comm. Expires Sep 23, 2015
%; ; °:�` Bonded Through National Notary Assn. Commission # EE
NOTARY
LlgoetttelJ'e.tN
1------------Northwest 103rd Street------
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PROPERTY ADDRESS:
85 Northwest 102nd Street
Miami Shores, Florida 33150
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Northwest 102nd Street---------r1
SURVEYOR NOTES
#1 Lands Shown Hereon were not abstracted for
Easement and/or Right of Way Records. The
Easement / Right of Way that are shown on
survey are as per plat of record unless otherwise noted.
#2 Benchmark: Miami -Dade County Public Works Dep.
BM Loc. 3100; Name: N -567; Elev. +10.54'
#3 Bearings as Shown hereon are Based upon
Northwest 103rd Street, N90 °00'00 "E
#4 Please See Abbreviations
#5 Survey is incomplete Without Sheet 2 of 2
#6 Drawn By: A. Torres Date: 12 -16 -2009
#7 Complete Field Survey Date: 12 -15 -2009
#8 Disc No 2009, Station Sunning Scion
#9 Last Revised:
810 Legal Description Furnished by client.
#1 1 This Certification is only for the lands as described
It is not a certification of Title, Zoning, Easements,
or Freedom of Encumbrances. ABSTRACT NOT
REVIEWED.
#12 There may be additional Restrictions not shown on
this survey that may be found in the Public Records
of Miami -Dade County, examination of ABSTRACT -
OF TITLE will have to be made to determine record
instruments, if any affecting this property.
#13 ACCURACY:The expected use of the land, as classified
in the Minimum Technical Standard (61017- 6FAC), is
"Residential ". The Minimum relative distance accuracy
for this type of boundary survey is 1 foot in 10,000 feet
The accuracy obtained by measurement and calculation
of a closed geometric figure was found to exceed this
requirement
#14 Foundations and/or footings that may cross beyond the
boundary lines of the parcel herein described are not
shown hereon.
#I5 Not Valid without one signature and the original raised
seal of a Florida Licensed Surveyor and Mapper.
Additions or deletions to Survey maps or reports by
other than the signing party or parties is prohibited
without written consent of the signing party or parties.
#16 Contact the appropriate authority prior to any design
work on information.
#17 Underground utilities are not depicted hereon, contact
the appropriate authority prior to any design work or
construction on the property herein described.
Surveyor shall be notified as to any deviation from
utilities shown hereon.
#18 Ownership Subject to OPINION OF TITLE.
JOB # 09 -646
DATE 12 -16 -2009
PB 12 -59
ABBREVIATIONS
A -ARC DISTANCE
AVE. - AVENUE
ASPH - ASPHALT
A/C =AIR CONDmoNER
BLDG - BUU.DINO
B. COR. -BLOCK CORNER
C.B. -CATCH BASIN
CLF .CHAIN LINK PENCE
CONC.- CONCRETE
COL -.COLUMN
C.U.P. - CONCRETE UTILITY POLE
C.L.P. - CONCRETEUGHTPOLE
CBS ..CONCRETE BLOCK
CMl.-- CANALL MAINTENANCE
EASEMENT
D - DntGCfONN
D/W - DRIVEWAY
D.M.E. - DRAINAGE&. MAINTENANCE
EASEMENT
ENC. - ENCROACHMENT
E.T.P.-ELECTRIC TRANSFORMER PAD
F.P.L - FLORIDA POWER AND LIGHT
F.H. -FIRE HYDRANT
F.I.P. -FOUND IRON PIPE
F.R. - FINISH FLOOR
F.D.H.-FOUND DRILL HOLE
F.R. -FOUND RaBAR
FN -ROUND DISC
FIN -FOUND NAIL
OF -IRON FENCE
L - LENGTH
L.P. -LIGHT POLE
MEAS.- MEASURED
M.H. -MAN HOLE
N.O.V.D - NATIONAL GEODETIC
VERTICAL DATUM
N.T.S. -NOT TO SCALE
O.E. - OVERHEAD ELECTRIC LINE
0/t. -ON LINE
P.C.P.-PERMANENT CONTROL POINT
A.C. -POINT OF CURVATURE
R - RADIUS
RES - RESIDENCE
SDWLK - SIDEWALK
T - TANGENT
U.E. - UTILITY EASEMENT
W/F -W00D PENCE
W.V. -WATER VALVE
W.U.P. -WOOD UTILITY POLE
-- �� ----- IRON FENCE
.CHAIN LINK FENCE
-M`— WOOD FENCE
-CBs WALL
- OVERHEAD ELEC.
- CENTER LINE
- EASEMENT
RILIEL - DENOTES ELEVATIONS
..BUILDING
- DISTANCE
.. - --_.
AFA
Company, In
ELEVATION INFORMATION
National Flood Insurance Program
FEMA Elev. Reference to NGVD 1929
Comm Panel 120652
Panel # 0302
Find Zone: "X"
Date of Firm: 039 -11 -2009
Base Flood Elev. N/A
F.Floor Elev. 11.50'
Garage Elev. N/A
Suffix:
Elev. Reference to NVGD 1929
CERTIFIED ONLY TO:
Hmayak Intoyan
LEGAL DESCRIPTION:
Lot 17 and the West 15.00' feet of Lot 18, Block 1
of: "NAVARRO" according to the Plat Thereof
as Recorded in Plat Book 12, Page 59 of the .
Public Records of Miami -Dade County, Florida.
L 811
Pro fessional
Surveyors & Mappers LB 7498
13050 SM. 133rd Court
Miami Florida, 33186
Ph. # (305) 234 -0588
Fax # (305) 234 -0423
This certifies that the survey of the property
described hereon was made under my super-
vision & that the survey meets the minimum
technical standards set forth by the Florida
Board of Professional Land Surveyors &
Mappers in Chapter 6IG17 -6 of Florida
Administrative Code, pursum to Section
472.027, Florida Statutes.
& That the Sketch huraon is a true and
accurate representation thereof to the best
of my knowledge and Belief, subject to notes
and notations shown hereon.
/11164...APINO*'
Armaada F. Alvaro;
ofess 'nalSurveyor & Mapper # 5326
Stale•ofFlorida
Not !Valid unless Signed & Stamped with EmbassedSeal
.4
.....................
Boundary Survey
25.00
S8739'56'W_
N901'00'00'E
70.00
1
CBS Wall
f
SI hi Cot 2
Y2' FIP
No Id
o.e•
g
Y2' FIP
No Id
0.e.
— 4' CLF
NI
0 1.15'
x CL''
West 15.00' le
_Da 1 /15.001
,_,_
22.21'
.......... ......
'25.05
8
25.05
22 08'
.... ........ • ••••••
L -39.12
R -25.00
D-8939'56"
Tan -24.54V-
F/N
•
Conc..
,Walk
onc.
Stripe
1.43'
CLF
A
• :9
•
• :. :F�nt : :::,:�",,, ..,,.", : rv�aoaro�• ."...... ; 94:s 5, • ... ,. ;. ;..... ;. ...:. •;. ;..... • •
.'.$0r. Dedicated 'R /W'Al •F'er•'P912 -59' Midmi-Dacte'Couniy, : FIorkta:•' ........... ............................. •
1/2" FIP
No Id
W/V
0
FiN N (700'00'E
1705' Parkway
45.15' ® W/M
Y' FIP
No Id
w
g$
'16:00 "•Aeptaalt•'t'avernent 4 , , . , .. , , ,
llki ::iiy
was# id •re::......... ;.r. •�•, •.
L
Survey or Notes•
Survey is Incomplete without sheet 1 of 2
Scale of Drawing 1 =20'
Drawn By: A. Torres Date: 12 -16 -2009
Completed Field Survey Date: 12 -15 -2009
A FA A. nnii sr, A 11111 rns...
13(-3( LL2k/
The sketch hereon is a true and
Accurate representation thereof to the best
of my knowledge and belief, Subject to notes
and Notations shown hereon.