DSC-12-1807Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 182093 Permit Number: DS -10 -12 -1807
Scheduled Inspection Date: November 29, 2012
Inspector: Bruhn, Norman
Owner: PONTON, RONALD
Job Address: 552 NW 112 Street
Miami Shores, FL 33168 -3318
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 3021360210640
Building Department Comments
NEW CONCRETE APPROACH INSTALLATION
Infractio Passed Comments
INSPECTOR COMMENTS
False
Puaetl/yJif
Gs(
Failed
Jy
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 179195. Grade and sod
disturbed areas. NB
November 28, 2012
For Inspections please call: (305)762 -4949
Page 16 of 25
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
BY: mv_.___._____0m_000�
loft l f� —fir rF C 20
BUI DING
Permit No. kib l a' -1
PERMIT APPLICATION Master Permit No.
Permit Type:
JOB ADDRESS:
BUILDING ROOFING
552
INs . NA.) . I 1 Z- ST
City: Miami Shores County: Miami Dade Zip: .5 3 k ‘dx Z.
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 3."' L CZ r4 C - e ®ca m Phone#: 3 0CC -IC\ '2 Z-`f
Address: 6 Z c 5 - A.)s • % ‘ ur
City: e % Arr. % 1-, CA r�3 State: l Ziip• 3 31 to
Tenant/Lessee Name: Phone* ' a) 3 • )) g
Email: 'se- A 1.4 2 C_ L'E. A 0 a c cs\ o c c., w-..
CONTRACTOR: Company Name:
Address:
City:
cure) ovvr
Phone #:
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: $ 1 100 i Square/Linear Footage of Work:
Type of Work: DAddition ❑Alteration "‘tiNnv ❑RepairlReplace 1
Description of Work: u l 3 if tn A, (VAC/ere)
❑Demolition
rr AA ll
Color thru tile: %
*, x, u, x, x***** x x, x, x, x ,x **** ***********a:+x*/n**** Fees********, x*, rx�****** * **,x *�r,x�x****+x** ** * *** * ****
Submittal Fee $ Permit Fee $ ifU cr► CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ IRO :10
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 properly 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 X
The fore
day of
01R
who is rso
Owner or Agent
nt�was ac
20Io`;by
wledged before this
51-
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.
NOTARY PUBLIC:
ally known to or who has produced
1 tification and who did take an oath.
NOTARY PUBLIC: ,
Sign:
Print:
My Commission Expires:
nu„
PU
at
1l
Dm V. CUSiLLOS
biic - State of23o�p15
fires Sep
o =,= , Commission . EE Notary Assn.
'■°‘s. Bootle
Sign:
Print:
My Commission Expires:
,*********************************** ****** * *** * *,*m** ***** ******* ** *****000* ** ****** *** ** ** * ***********o
APPROVED BY ��'2 �"L Plans Examiner ; / 4/),/2 Zoning
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
PERMIT # l) f 1 7S
CONTRACTOR: *MO AV/Y
SUBMITTAL DATE: 1 Q 1
J o -
ADDRESS: ±'2- W l ! P-S-f
NAME: O 196A∎ v kY
RESUBMITAL DATES:
PROJECT TYPE: ; / 11
aka /9' /72._° - a
ZONING
FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
BL
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: S- LA c DATE: ck \ `�
ADDRESS: 662— . ,44 t a
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. 1 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 fist 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 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.
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 1 employ have the license required by law and by county or
municipal ordinance.
Intial
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 requiting 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. l also understand that I may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or htta:// www. mvfloridalicense .com/dbprlpro /cilbfindex.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:
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 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
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 0 7 , 201
By aPli 2Q1I'I'\Jwho was personally known to me or who has
Produced there License or V `n A -1S- 9-07s identification.
L c.�
OWNER
i
Ai
CLAUDIA V. CUBILLOS
?ot �� -��; Notary Public - State of Florida
_ • My Comm. Expires Sep 23, 2015
+o`: Commission # EE 128810
%;° `� °e'•,, Bonded Through National Notary Assn.
B & B LAND SURVEYORS, INC.
11633 S.W. 58th Street
Cooper City, Florida 33330
Phone (954) 680 -4061
Licensed Business #6601
LEGAL DESCRIPTION:
LOT 5, BLOCK 4 OF "WEST SHORES ", ACCORDING TO THE PLAT THEREOF,
AS RECORDED IN PLAT BOOK 42, PAGE 18 OF THE PUBLIC RECORDS OF
MIAMI —DADE COUNTY, FLORIDA.
PROPERTY ADDRESS;
552 N.W. 112TH STREET
MIAMI, FLORIDA 33168
CERTIFIED TO:
1. RONAL6 V. PO
ii
A.G.
CONC.
N.T.S.
L.B.
FND.
CLF
WM
WDe.s.
PP
OHL
B
BRG
RLS
E' /W
C.P.
P.C.
DCR
A
T
PLS
A/C
r.v.o.
P.O.C.
BCR
0/S
R
FPL
CHO
CLR
PRM
N.
AVERAGE GRADE
CENTER UNE
RIGHT OF WAY
MEASURED
PLAT
PROPERTY UNE
CONCRETE
NOT TO SCALE
LICENSED BUSINESS
FOUND
CHAIN UNK FENCE
WATER METER
CONCRETE BLOCK
WOOD
POWER POLE
OVERHEAD UNE
ELECTRIC METER
BACK OF WALK
BEARING
REGISTERED LAND SU
EDGE OF PAVEMENT
EDGE OF WATER
COVERED PORCH
POINT OF CURVATUREL
FND. NAIL VTOD & DISC STONER & ASSOC
AT P.I.
l'.
274.00'
uuct
to3 lL
N.W. 112TH STREET
(19' ASPHALT ROAD)
sNouvinu
d QNV s3lnu A LN11OO UNY 31V15
-IVH3O33 T1VHLIM SONVdVIOO 011J3rff8
1d3C1 00113
1d3a JNINOZ
Lda G3AO ddV
a6eIIiA 90J0149 IweIIN
VAMIIIRTAI
DADE COUNTY RECORDS
ARC
DELTA
TANGENT
PROFESSIONAL LAND SURVEYOR
AIR CONDITIONING
PCI(T uF SZBiNNiUC
POINT OF COMMENCEMENT
BROWARD COUNTY RECORDS
OFFSET
RADIUS
FLORIDA POWER & LIGHT
CHORD
CLEAR
PERMANENT CONTROL POINT
N.W. 112TH STREET
1
2
3
4
5
6
7
8
9
0
20
19
18
BL
17
CK
16
4
15
14
13
12
11
Jz
i
§
N.W. 111TH STREET
LOCATION SKETCH
N.T.S.
LOT 4
32.1'`
FENCE
0.1' WEST
INACCESSIBLE
PROPERTY
CORNER
5' IRON
FENCE
10.5"
CE
0.0' WEST
ONE STORY
RESIDENCE
SHED ON
CONC.
4' CLF
CLF
ON UNE
x
x
WOOD
FRAME
SHED
WD
PP
x
58.00'
x x x x
R SET 1/2"
IRON ROD &
CAP, L.B. #6601
01'16
x
LOT
SET 1/2"
IRON ROD &
CAP, L.B. #6601
FLOOD INSURANCE NOTES:
COMMUNITY
PANEL
SUFFIX
DATE OF
FIRM ZONE
BASE FLOOD
NUMBER
NUMBER
FIRM INDEX
ELEVATION
120635
0090
J
7/17/95
X
^-
Lowest Finished Garage
Lowest
Floor Elevation "' Floor Elevation ^' Adjacent Grade
SURVEYOR'S NOTES:
Legal Description provided by client.
This survey was not abstracted by the undersigned for ownership,
easements, reservations, and /or rights —of —way of record.
Underground locations and /or underground encroachments, if any, are not
shown unless otherwise indicated.
Elevations are relative to National Geodetic Vertical Datum of 1929, and
shown thus: 19/ , and are based on ••• benchmarks.
Bearings based on • PLAT ANGLES MEASURED IN FIELD.
BENCHMARK:
Elevation
ti
DRAWN BY: EMB 1 CHECKED BY: GB 1 FIELD BK. PGS.
REVISIONS:
SCALE:
FILE NO
1"=20'
08 -023
THIS BOUNDARY SURVEY IS FOR TITLE AND MORTGAGE PURPOSES ONLY.
I CERTIFY THE ACCURACY AND COMPLETENESS OF THIS SURVEY FOR THE PURPOSE
INTENDED.
Dated this 18TH day of MARCH 20 08 A.D.
Gory L 1313 gumill
Professional Land Surveyor & Mapper
State of Florida Registration No. 5378
NOT VAUD WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED
SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER.