FW-12-382Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170721 Permit Number: FW -3 -12 -382
Scheduled Inspection Date: September 04, 2012
Inspector: Bruhn, Norman
Owner: Djordjevic, Mildred Johanny
Job Address: 10130 N MIAMI Avenue
Miami Shores, FL 33150-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number 786 271 -7927
Parcel Number 1131010210060
Building Department Comments
WOOD FENCE IN FRONT OF CHAIN LINK WOOD FENCE
WITH GATE SELF LATCHING & SELF CLOSING.
Inspector Comments
Passe
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 31, 2012
For Inspections please call: (305)762 -4949
Page 6 of 29
riVy,f,44-1
U ING
PERMIT APPLICATION
FBC 20
Permit Type $UILDINF.T) ROOFING
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
Permit Noi U 12—.—t
Master Permit No.
OWNER: Name (Fee Simple Titleh der): I r I lOgr . I '
2 ((�S c �� 2-4
Address: (0 I eB 0
City: L b
Tenant/Lessee Name:
Email:
State:
Phone#: �
Zip: g (_,S=4D
Phone#:
JOB ADDRESS: CO( B6 (L) rn i k
City: Miami Shores County: Miami Dade
Zip: 1S-0
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
NO Flood Zone:
hone #:
C‘)U01A
Address:
City: State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ C Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration w ❑Repan eplaee ❑Demolition
Description of Work: tk) U( J II r6\ (--\-),F
m ***+ x**********+ x**+ s *+xs:******** ********* Fees **** ***** ********+ x********** * ***+s***********
Submittal Fee $ Permit Fee $ A9 0 ° a
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ ,) (n0
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 reinspection fee will be charged.
Signature
Owner or Agent Contractor
The fore ing ingru2 b
en�as ac
day D
ged ref' ; me thi I The foregoing instrument was acknowledged before me this
CIA P A ,20_,by
f �1
NNW 1/ w ' is personally known to me or who has produced
W I� identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
who is rson 1 known to me or who has produc
Sign:
Print:
My Commission
Sign:
Print:
My Commission Expires:
******************* * ***** *****,********************************* **** *******, * *****w* ** ** *w* **** * *** * *******
APPROVED BY �J i /c1.0 Plans Examiner Z
a er \ �/1/ Zoning
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: /1 QDII , e DATE: 12/0////
�1
ADDRESS: /0/ 3O 11-14 / /4-/1/ i4v. HI4i'tf - 1i14Er5 1 5150
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.
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: rs 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 a so 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•L tially
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.
';t= :.414 ..._,_.
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
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abi 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 may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or http : //www.mvfloridalicense.com/dbor /pro /cilb/iindex.h
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:
(o/ ju /t ki *14/
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 oes ave 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 day of , 20 1)
By5fatIlaV JOYdf V who was personally known to me or who has
Produced there License or 1--) 40#61) i d s dentification.
NITi'
o„����,,,,, CLAUDIA V. CUBILLOS
aao 0 ; Notary Public - State of Florida
My Comm. Expires Sep 23, 2015
NPc Commission # EE 128810
•f,,, „,a• Boned Through National Notary Assn.
Ordered By:
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— Serving all of Florida—
PROPERTY ADDRESS: 10130 N. MIAMI AVENUE, MIAMI SHORES, Florida 33150
FIELD WORK DATE: 11/21/2010
FL 1011.1045
BOUNDARY SURVEY
MIAMI -DADE DOLINTY
SURVEY NUMBER: FL1011.1045
REVISION DATE(S): (rev.0 11/222010)
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PAUL M. VALENTINE
State of Florida Professional Surveyor and
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STATE ANLr r„(IJN i f r1ULES Ai'JD Pr-7GIII ■7r77'_S q
Use of This Survey for Purposes other than Intended, Without Written Verification, will be at the User's Sole Risk and Without Liability to the Surveyor.
Nothin hereon shall be Construed to Give ANY Ri • hts or Benefits to An . ne Other than those Certified.
POINTS OF INTEREST: None Visible
F: \02 Departments106 Safeguards \05 Wood Fence MPS \SKU 5179 - Wood fence MPS (2007 FBC).DWG
02/09/2012 - 10:49am
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NOTE: 4' -0" O.C. MAX FOR 6' HEIGHT
5' -0" O.C. MAX FOR 5' HEIGHT
6' -0" O.C. MAX FOR 4' HEIGHT
4 X 4 PT POST II■ 4 X 4 PT POST
2 X 4 PT RAILS 2X4PTRAILS
1 X 6 PT PICKET 1 X 6 PT PICKETS
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GENERAL NOTES
1. ALL WORK HAS BEEN DESIGNED AND SHALL BE CONSTRUCTED IN ACCORDANCE WITH
THE 2007 FLORIDA BUILDING CODE & ASCE 7 -05. FENCE DESIGNED TO AND GATE TO
REMAIN OPEN & SECURED WHEN SUSTAINED WINDS EXCEED 75MPH (90MPH 3 SEC
GUST) IN EXPOSURE 'C GATE AND FENCE HEIGHT NOT TO EXCEED 6' -2" ABOVE GRADE.
2. ALL LUMBER SHALL BE A MINUMUM OF PRESSURE TREATED #2 SYP OR BETTER WITH A
MINIMUM FIBER STRESS OF 1100PSI IN BENDING.
3. MAXIMUM POST SPACING OF FENCE ACTING ON GATE = 8'
4. ALL FASTENERS SHALL BE CORROSION RESISTANT.
5. ALL WELDING SHALL CONFORM TO AISC STEEL CONSTRUCTION MANUAL 13TH EDITION
AS VERIFIED AND INSPECTED BY BUILDING OFFICIAL.
6. ALL CONCRETE AND EPDXY TO REACH A MINIMUM COMPRESSIVE STRENGTH OF 3000
PSI IN 7 DAYS. ALL CONCRETE SHALL CONTAIN MINIMUM 0.1% FIBERMESH CONTENT
PER CUBIC YARD.
7. SURROUNDING SOIL TO BE COMPACTED TO 98% OPTIMUM DENSITY 2500 PSF MIN.
8. ENGINEER SEAL AFFIXED HERETO VALIDATES STRUCTURAL DESIGN OF FENCESYSTEM
AS SHOWN ONLY. USE OF THIS SPECIFICATION BY CONTRACTOR, et al. INDEMNIFIES
AND SAVES HARMLESS THIS ENGINEER FOR ALL COSTS AND DAMAGES INCLUDING
LEGAL FEES AND APPELLATE FEES RESULTING FROM MATERIAL FABRICATION, SYSTEM
ERECTION, AND CONSTRUCTION PRACTICES BEYOND THAT WHICH IS CALLED FOR BY
LOCAL, STATE, AND FEDERAL CODES AND FROM DEVIATIONS OF THIS PLAN.
9. ENGINEERING EXPRESS HAS NOT VISITED THIS JOBSITE. INFORMATION CONTAINED
HEREIN IS BASED ON CONTRACTOR- SUPPLIED DATA AND MEASUREMENTS.
ENGINEERING EXPRESS SHALL NOT BE HELD RESPONSBILE OR LIABLE IN ANY WAY FOR
ERRONEOUS OR INACCURATE DATA OR MEASUREMENTS. DIMENSIONS ARE SHOWN TO
ILLUSTRATE DESIGN FORCES AND OTHER DESIGN CRITERIA. THEY MAY VARY SLIGHTLY,
BUT MUST REMAIN WITHIN THE LIMITATIONS SPECIFIED HEREIN. WORK SHALL BE
FIELD VERIFIED BY OTHERS PRIOR TO CONSTRUCTION. ENGINEERING EXPRESS SHALL
BE NOTIFIED AND GIVEN AN OPPORTUNITY TO RE- EVALUATE OUR WORK UPON
DISCOVERY OF ANY INACCURATE INFORMATION PRIOR TO MODIFICATION OF EXISTING
FIELD CONDITIONS AND FABRICATION AND INSTALLATION OF MATERIALS.
10. EXCEPT AS EXPRESSLY PROVIDED HEREIN, NO ADDITIONAL CERTIFICATIONS OR
AFFIRMATIONS ARE INTENDED.
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