FW-12-1668Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 178204 Permit Number: FW -9 -12 -1668
Scheduled Inspection Date: September 24, 2012
Inspector: Bruhn, Norman
Owner: WATSON, LEONARD
Job Address: 165 NW 99 Street
Miami Shores, FL 33150 -1742
Project: <NONE>
Contractor: OWNER
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Iron/Ornamental
Phone Number
Parcel Number 1131010230390
Building Department Comments
NEW FENCE WROUGHT IRON AT WEST SIDE
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
September 21, 2012
For Inspections please call: (305)762 -4949
Page 17 of 31
PERMIT # Ftd / -14 fl
CONTRACTOR: 0 t®L
SUBMITTAL DATE: 6 7 a 6
ADDRESS: / S / we .)
NAME:
RESUBMITAL DATES:
PROJECT TYPE:
tit 00 7101 IT
ZONING
STRUCTURAL
ELECTRICAL
PLUMBING
MECHANICAL
FIRE
IMPACT FEES
HRSIDERM
NOC
BL
9-7a_
I�
City:
Tenant/Lessee Name:
Email:
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
Permit Type: BUILDING
JOB ADDRESS) 5 // 99
FBC�20iV
j`7
Permit No. LO -4L jag
Master Permit No.
ROOFING
City: Miami Shores County: Miami Dade Zip: 3 /.6' C
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name -(Fee imple Titleholder): eC o rd `� LA' rq � �CL±LP Phone #3O5 332 �5J7 j
Address: /✓ //� 99 ..S-)
State: Zip: 3( f6 c)
Phone #:
CONTRACTOR: Comp i y Name:
Addres
City:
/6atici-a-
Phone #:.a -333 -3
State:
Zip: /d <)
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 79O Square/Linear Footage of Work:
Type of Work: ❑Additio ❑ teration Clew • % - •air/Replace UDemolition
Des P
D of Work: / • jl�'
Color thru tile:
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * ** * * **
Submittal Fee $ TO Permit Fee $ /O CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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
� q
ti
-0914-94
s
Owner or Agent
The for . o u g i • . tru u' - nt was a owledgedbefore Ale
day of 1 Ii" 20JL.by
who
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of
,20_,by
to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
My Commission Expires:
APPROVED BY
"pi"
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
-` C%
o Plans Examiner G' fif)/ /1 Zoning
Structural Review Clerk
(Revised 5 /2 /2012XRevised 3/12/2012) )(Revised 06 /10 /2009XRevised 3 /15 /09XRevised 7/10/2007)
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
ce91.t -- DATE: 7G2r0/0
c1J 99 pi 'pia.. F7/56
ADDRESS:
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 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 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
! 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.
lnitiaL
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 -tty 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 umbers 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 s: stantially
improved ft 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.
Initial 54- "
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 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.
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 http : //www.mvforidalicense.com/dbor /pro /cilbrndex.h' I
Initial
11. I am awa .f, and consent to; an owner- builder building permit applied for in my name and understands that I am the party
legal) financially responsible for the proposed construction activity at the following address:
SOS .
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information th 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
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 day of
By &1(1/O((C' tairrcon who w
Produced there License or
ogfru-tat,oe (,,;gals:: vl •
OWNER
o me or who has
as identification.
„sl pU �,i� ' it CUBILLOS
e`(-% -Notary Public - State of Florida
My Comm. Expires Sep 23. 2015
" Commission # EE 128810
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A
SCALE: 1" = 20'
LEGEND
A/C UNIT
CENTER LINE
ELEVATION
PUMP
ABBREVIATIONS
NC = AIR CONDITIONER UNIT
CONC. = CONCRETE
0 = DIAMETER
F.F.EL. = FINISHED FLOOR ELEVATION
F.I.P. = FOUND IRON PIPE
H = HEIGHT
ID. = IDENTIFICATION
PG. = PAGE
P.B. = PLAT BOOK
I.IJ
a
N
z
50' PUBLIC RIGHT -OF -WAY
BLOCK
CORNER
Miami Shores Village
F.I.P.12"0
(NO ID.)
POWER
POLE
SUI JECTia PARK ADD§ITI ALL FEDERAL
STATE AND
D REGULATIPNJS
C C'ISY2#4�.�91'I C)
. .I
75.00'(R&M)
CJ
— x — x x x x x x
Y_t
LOT 11, BLO
"BONMAR PARK ADDITION"
P.B. 24, PG. 71
x—x
x x—x
x x x x x x—x—( —x
LOT 15, BLOCK 5
° - "BONMAR PARK ADDITION"
"r:dric; o P.B. 24, PG. 71
F.I.P.12"0
(NO ID.)
0'
5.0'
107.46' (R & M)
0,5'
r
s°'-
kill j
(/) gyp,,
F.I.P.12 "0 ~1
i (NO ID.) (NO ID.)
- -�� —F
150.0'
5' C.B.S
WALL
F.I.P.12"0
(NO ID.)
SHEET
1i1
PROPERTY ADDRESS:
165 NW 99th STREET MIAMI, FL 33150
DESCRIPTION:
THE WEST OF LOT 14 AND ALL OF LOT 15 BLOCK 5 OF "
BONMAR PARK ADDITION " ACCORDING TO THE PLAT THEREOF
AS RECORDED IN PLAT BOOK 24 AT PAGE 71 OF THE PUBLIC
RECORDS OF MIAMI -DADE COUNTY, FLORIDA.
FLOOD ZONE INFORMATION:
COMMUNITY NO. 120635
PANEL NO. 0302
SUFFIX: L
FIRM DATE: 09 -11 -2009
FLOOD ZONE: X
LEGAL DESCRIPTION WAS FURNISHED BY THE CLIENT.
LEGAL DESCRIPTION SUBJECT TO ANY DEDICATIONS,
LIMITATIONS, RESTRICTIONS, RESERVATIONS OR RECORDED
EASEMENTS.
THERE MAY BE LEGAL RESTRICTIONS ON THE SUBJECT
PROPERTY THAT ARE NOT SHOWN ON THE MAP OF SURVEY
THAT MAY BE FOUND IN THE PUBLIC RECORDS OF MIAMI -DADE
COUNTY, OR THE RECORDS OF ANY OTHER PUBLIC AND
PRIVATE ENTITIES AS THEIR JURISDICTIONS MAY. APPEAR.
THE MAP OF SURVEY IS INTENDED TO BE DISPLAYED AT THE
STATED GRAPHIC SCALE IN ENGLISH UNITS OF MEASUREMENT.
ATTENTION IS BROUGHT TO THE FACT THAT SAID DRAWING
MAY BE ALTERED IN SCALE BY THE REPRODUCTION PROCESS
THIS SURVEY WAS CONDUCTED FOR THE PURPOSE OF A
BOUNDARY SURVEY ONLY AND IS NOT INTENDED TO DELINEATE
THE REGULATORY JURISDICTION OF ANY FEDERAL, STATE,
REGIONAL OR LOCAL AGENCY BOARD, COMMISSION OR OTHER
ENTITY.
THE ELEVATIONS OF WELL- IDENTIFIED FEATURES AS DEPICTED
ON THIS SURVEY AND MAP WERE MEASURED TO AN ESTIMATED
VERTICAL POSITIONAL ACCURACY OF 1/10 FOOT FOR NATURAL
GROUND SURFACES AND 1/100 FOOT FOR HARDSCAPE
SURFACES, INCLUDING PAVEMENTS, CURBS AND OTHER
MAN -MADE FEATURES AS MAY EXIST.
REFERENCE BENCH MARK N-444 ELEVATION: 10.79 FEET
(N.G.V.D. 1929)
IF SHOWN ELEVATIONS ARE REFERRED TO N.G.V.D. OF 1929.
WELL- IDENTIFIED FEATURES AS DEPICTED ON THIS SURVEY
AND MAP WERE MEASURED TO AN ESTIMATED HORIZONTAL
POSITIONAL ACCURACY OF 1/10 FOOT UNLESS OTHERWISE
SHOWN.
THE SURVEYOR MAKES NO REPRESENTATION AS TO
OWNERSHIP, POSSESSION OR OCCUPATION OF THE SUBJECT
PROPERTY BY ANY ENTITY OR INDIVIDUAL
SUBSURFACE IMPROVEMENTS AND /OR ENCROACHMENTS
WITHIN, UPON, ACROSS, ABUTTING OR ADJACENT TO THE
SUBJECT PROPERTY WERE NOT LOCATED AND ARE NOT
SHOWN.
NOT VALID WITHOUT THE SIGNATURE AND ORIGINAL RAISED
SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER.
ADDITIONS AND DELETIONS TO THIS MAP OF SURVEY BY OTHER
THAN THE SIGNING PARTY ARE PROHIBITED WITHOUT THE
WRITTEN CONSENT OF THE SIGNING PARTY.
THIS MAP OF SURVEY HAS BEEN PREPARED FOR THE
EXCLUSIVE USE OF THE ENTITIES NAMED HEREIN AND THE
CERTIFICATION DOES NOT EXTEND TO ANY UNNAMED PARTY.
CERTIFY TO:
CHANTAL J. 8, LEONARD F. WATSON
SURVEYORS CERTIFICATION:
I HEREBY CERTIFY: THAT THIS "BOUNDARY SURVEY" AND THE
MAP OF SURVEY RESULTING THERE FROM WAS PERFORMED
UNDER MY DIRECTION AND IS TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE AND BELIEF.
360° SURVEYING AND MAPPING, LLC
FLORIDA CERTIFICA OF AUTHORIZATION NO. LB 6356
OSCAR E. B
REGISTERE
AND MAPP
STATE OF
- CiSIDO, P.L.S.
URVEYOR
NO. 5034
ORIDA.
360° SURVEYING AND MAPPING, LLC
Land Surveyors - Land Planners
2000 S.W. 83rd Court MIAMI, FLORIDA 33155
PHONE: (305) 265 -1002
ORIGINAL 02 -14 -2003
FIELD DATE
JOB NO. 0302 -0072A
REVISIONS:
02 -28 -2012
UP -DATE SURVEY