FW-12-380Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 173171 Permit Number: FW -3 -12 -380
Scheduled Inspection Date: September 12, 2012
Inspector: Bruhn, Norman
Owner: DIAZ, RAFAEL
Job Address: 9618 N MIAMI Avenue
Miami Shores, FL
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number 305 -310 -7876
Parcel Number 1131010330310
Building Department Comments
WOOD FENCE INSTALLATION ON THE NORTH SIDE OF
THE PROPERTY
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP- 170710. Fence may nmot
/ exceed 5'.
Provide Pr permit for walkway at north side. NB
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
September 11, 2012
For Inspections please call: (305)762 -4949
Page 5 of 31
September 10t , 2012
To Miami Shores Village Department,
FarCEr
SP102012 I
-40 1.9-3
I Rafael G Diaz, would like to ask for an extension on my permit
Number FW -3 -12 -380 for the fence while the paper work for the
walkway permit is processing with Miami Dade County. This will allow
me to take care of all permits at once. Sorry, for the delay and any
inconvenience But unfortunately I've had medical circumstances to
take of with my father. Thank you in advance for assistance with this
matter.
Sincerely Yours
Rafael G Diaz
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 67
Permit No.TW j V9
Master Permit No.
Permit Type: BUELDING ROOFING
(
OWNER: Name (Fee Simple Titleholder): + m X /'l Z Phone #: 3°6- 3 1 0 7 8 7 6
Address: 9(1C3 /ld . 447 r ,4ye,
City: PM '' 4 fit) S 1-i o %' G 5 State: f l k3 Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: CI CP 1 g /) v W1 r A tM 1- 4 V C.
City: Miami Shores County: Miami Dade Zip: 3 3 P t
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
/ 0UM e I
CONTRACTOR: Company Name: [--i C3 0'x'1/ C' r'- <3/'', Phone #:
Address:
City: State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
®d,v :... �H�er
Value of Work for this Permit: $ L1 Square/LInear Footage of Work: 2.
Type of Work: ❑Addition
Description of Work:
°Alteration
°New
°Repair/Replace
°Demolition
* *********+ x* *+x*********** * *******a **' ** ees** ** **** ******* ***** ***** **********+x+x*****
etc►
Submittal Fee $ Permit Fee $ 4,0
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 6/ I
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 inspe _ ' n which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will t b: ap±' oved and a reinspection fee will be charged.'
Signatur
Owner or Agent
g in trumen was a� ' 0 1 = � befo e e i
i l 20, by . i /
s t ersonally kno to me or who has produced OA
The f oreg
day o
who
I0 o
NO
s identification and w
did take an oath.
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _, by
ho is personally known to me or who has produced
as identification and who did take an oath.
Sign:
Print:
My Commission Expires:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
********************************************** ***** *** ****** * ** * **** ** ******* * ** **x* ***** ***** * *****'x** **
Plans Examiner 3 f 7 /2 Zoning
APPROVED BY
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: (R RAFIelat, 1.1 411, DATE: 3-5- 1Z,
ADDRESS: 961% AL, MIA Ail 1q 1% 07 , 144 :En fr g G �✓
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 a my own
contractor with certain restrictions even though I do not have a license.
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 li e 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 .� s stantially
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.
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 46
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.
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 l(lb
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 govern 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 h •: /lwww.m oridalicense .com/dbsr /,ro /cilbfinde
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:
cite le A Tin °' e® 'u IZ-'S)lo eS
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information •t 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
retumed to the local permitting agency responsible for issuing the permit. A copy of the property owners driver license, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when
the permit is issued.
Was acknowledged before me this 3
Prod there License orr
1
■ _
,r •
WNER
who was personally known to me or who has
)2,Z S 4'L2..0)'as ide icatio
P 6f; • d •. MY GIAU°VA v Gue "r
t_°S
Notary State l
otV1
Gomin, Exp; eSep 21.2p
5
commisso N# EE. 1`
BonAP `btonflb at oa'°a t Assn
... .�.
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiant, l 1 A FR 6"1.. 14TY z., , does hereby attest that
(Property owner)
The attached survey, performed by CA (T 4 %3 E- A 1U =N,.S P L- CTI O,u $ 5 o r v E Y 6
(Name of surveyor's company)
For address: q (o IS NI In1 r g G, Yvt '5 II, pt E S
Performed on 110 'O &'(date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may vio - - zoning or building code regulations. The Affiant further understands that the existence of any such
st ay affect fin, inspections as applicable to this or other permits.
F t.
5,/1ir .�i
ti--
,, r_
1 •perry caner Signature `� Pro. -rty Queer Print Name
-WORN TO AND SUBSCRIBED before me this t./ day of 1 1
Affiant is personally known to me, produced 1 i���iL!. Was identification
es
tither,
lant sa
2AFJ4GL. Or
Revised on 5/22/2009/ Revised on 6/12/09
CLAUDIA v. CUBILLOS
A Notary Public - State of Florida
,1 ? My Comm. Expires Sep 23.2015
o.*, �; �o; Commission # EE 128810
''•g,, Bonded Through National Notary Assn.
tary
1
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit NO. FW -3 -12 -380
Peimit Type Fet elaH
ut
*pa caod Fence
issue date Not Issued Expires :Not Issued
Folio Number:1131010330310
Owner's Name: RAFAEL DIAZ
Job Address: 9618 MIAMI Avenue
Miami Shores, FL
Owner's Phone: 305 - 310 -7876
Total Square Feet: 26
Total Job Valuation: $ 400.00
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 3/7/2012: Yes
Comments:
BOUNDARY SURVEY
SCALE:1 "=20'
LEGEND:
NGVD =NAB C VERTICAL DATUM
NID =NAIL ar
T.S -NOT ScALE
/aQ -NUM u
O. -
D.>:&
PL
P.C.C.
P.C. -,
P.T. -POIN
P.O.0 =POW
i i i
P R.G ; REG�I CURVA7
P.P. =FOYER POLE
P.C.P. - PERMANENT CONTROL POINT
P.& - -PLAT BOOK .
PC. =PAGE
PW - PARKWAY
P.rLA/. =PERMANENT REFERENCE MONUMENT
S S/R4c)4P
gig, DISTANCE
=RAILROAD 5 8
R/R► -RIGHT- OF-WAY
RADIUS
- RANI.'
- warm
-STORY
- SIDEWALK
=SET IRON PIPE
-SET IRON ROD
- TANGENT
-UTTUN SEAIEIVT
- UTILITY POLE
-WATER METER
=INTERIOR ANLYi HOUSE
=POKER POLE
ROE:
SEC
STY.
DAC
SLR
T
Typ.
U.P.
W.M.
aH..
Ac
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BLOC►
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a&8
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2(0 FeGT woo IOENcd, LOAat
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bo boor( 2G su .UaS LAlC.1.4
2 -y.4 Co
(D-
EAST 130 00' (R & M)
LEGAL DESCRIPTION:
S 20' LOT 2 & LOT 3 BLK: 130, MIAMI SHORES, SECTION 6,
ACCORDING TO THE PLAT THEREOF AS RECORDED
IN PLAT BOOK 10, PAGE 39, OF THE PUBLIC_
RECORDS OF MIAMI DADE COUNTY, FLORIDA
PROPERTY ADDRESS:
9618 N. MIAMI AVE. MIAMI SHORES, FL 33150.
CERTIFIED TO:
RAFAEL G. DIAZ.
TITLE COMPANY OF AMERICA.
ATTORNEYS TITLE INSURANCE FUND.
-AIR CONDITIONER' PAD 21
=ASPHALT
-CCU N
- COAICRE7E BLOCK STRUCTURE
- CHAIN LINK FENCE
=CO NC E.
-E vA
-FIRE HYDRANT
- FOUND NW PIPE
=FIELD
...FOUND ROD
- F7MSTN FLOOR ELEVATION
=FOUND
=UNDER CONS RUCTKW
FT. =FEET
C -FOUND BLOCK CORNER
F.N.D. -FOUND NAIL & DISC
F.aH. -FOUND DRILL HOLE
F.N. -FOUND NAIL
GAS& EL - GARAGE ELEVATION
W.P. LIGHT POLE POLE
L) - p/R�EyDT WRE
(69)
=BASIS OF BEARINGS
-WATER URINE
—C =UTILITY POLE ARCHLY.
- CONCRETE
!F =CHAIN. LINK FENCE;
h
FIP
C 5 2Gv?
® -CATCH BASH
`D-1 =UT/UTY POLE
y-79- -84700 FENCE
yrd -FIRE HYDRANT
- ELEVATIONC.C& WALL
- SANITARY SEVER MAN -HOLE
-TILE
- ASPHALT
-GRASS
..........
Glina
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horns VillaarP.
APPR01,FD
'ON NG DEPT
BLDG DEPT
DATE
SUBJECT 110 GCrvIPI JAAICE WI fH A
`rn.T6'7lCli rrya L SF1i 1 �i
1 HEREBY CERT7F1: THAT THE BOUNDARY SURVEY CAF THE ABOVE DESCRIBED PROPERTY IS TRUE
AND CORRECT 70 THE BEST OF Mr KNOKLEDGE AND BELIEF. AS RECENTLY SURVEYED UNDER MY
DIRECTION. IT IS ALSO MY PROFESSQNAL OPd1ION THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL
STANDARDS SET FC/VH BY THE FLORIDA 80.RD OF PROFESSIONAL. SI?VEYCHS AND MAPPERS AV
CHAPTER 61 0-17 -6 OF THE FLORIDA ADM!MSTRATIVE CODE PURSUANT 70 SECTION 472-027 OF THE
FLORIDA STATUTES
rZ_
NOE AGU
PROFESSIONAL N No )'OR & MAPPER
STATE OF FLORIDA
THE SURVEY SHORN HEREON IS NOT VALID KITHOUT THE SIGNATURE AND
OR/GNAL RAISED SEAL OF A FLORIDA SURVEYOR AND MAPPER
ij / /41
SURVEYORS NOTES:
1-OWNERSHIP IS SUBJECT TO OPINION OF 77TLE
2- EXAMINA7ION OF THE ABSTRACT OF 77TLE WILL
HAVE TO BE MADE TO Dt itKMINE RECORDED
INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY
3 -NO UNDERGROUND IMPROVEMENTS WERE LOCATED
4- ELEVATIONS ARE REFERRED TO NATIONAL GEODETIC
VERTICAL DATUM OF 1929 (UNLESS ASSUMED).
5 -THERE MAY BE ADD/71ONAL RESTRICTIONS NOT SHOWN
IN THIS SURVEY THAT MAY BE FOUND IN THE COUNTY
PUBLIC RECORDS
6 -LEGAL DESCRIPTJON PROVIDED BY CLIENT
7- UNLESS OTHERWISE NOTED RECORDED AND MEASURED
DATA ARE IN SUBSTANTIAL AGREEMENTS
8- BEFORE ANY CONSTRUCTION THE SET BACKS
MUST BE CHECKED
9 -FLOOD ZONE X BASE - PANE
10- DATE OF FIELD WORK 10 -06 -03
T-
0093
CARIBBEAN INSPECTIONS & SURVEYS
CARIBBEAN N A CONSULTING INC I LB7234
7911 N.W 72nd AVE., SUITE 105 MEDLEY, FLORIDA 33166
JOB # A -9618
DRAWN BY: J.M J REV: N.A.
EASTCOAST OPERATIONS
MIMI DADE /MONROE HBO WARD
(305) 889 -1100 (954) 435 -0220
FAX (905) 889 -2900 FAX (954) 438 -7272
PALM BEACH MARTIN /ST. LUCIE /INDIAN RIVER
FAX (6 1) 741-4259 FAX (772) 398-5
6532
COLLIER /LEE (239) 5409 59 � /FAT I (, 39) 549 -5811
TOLL FREE STATE WIDE 1- 866 - 261 -CBIC
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1