Loading...
RC-12-1924Inspection History Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Project: <NONE> Owner: Phone: Job Address: 102 NW 100 Street Miami Shores, FL 33138- Parcel: 1131010220370 Block: Lot: Scheduled Insp # 10/15/2012 INSP- 179982 10/15/2012 INSP- 179983 no mech work 10/15/2012 INSP- 179981 11/28/2012 I N S P- 179966 Not Ready. NB 01/10/2013 I N S P- 1799 64 NOT READY 11/15/2012 INSP-179972 Inspection Type Review Electrical Inspection Status APPROVED Review Mechanical APPROVED Review Building APPROVED Drywall DENIED Final DENIED Framing DENIED Inspector Date Completed Michael Devaney 10/15/2012 JanPierre Perez 10/15/2012 Norman Bruhn Norman Bruhn Norman Bruhn Jorge Rodriguez 10/18/2012 11/29/2012 1/10/2013 11/16/2012 NEED ELECTRIC AND PLUMBING REMOVE BALANCE OF CEILING TO INSPECT BEAMS REPAIRED. JR 10/15/2012 INSP- 179985 Review Plumbing APPROVED Rafael Hernandez 10/17/2012 11/28/2012 INSP- 181838 Framing APPROVED Norman Bruhn 11/29/2012 CREATED AS REINSPECTION FOR INSP- 181687. CREATED AS REINSPECTION FOR INSP- 179972. NEED ELECTRIC AND PLUMBING REMOVE BALANCE OF CEILING TO INSPECT BEAMS REPAIRED. JR 12/03/2012 INSP- 182201 Drywall DENIED Norman Bruhn 12/3/2012 CREATED AS REINSPECTION FOR INSP - 179966. Not Ready. NB 12/11/2012 INSP- 182337 Drywall APPROVED Norman Bruhn 12/12/2012 CREATED AS REINSPECTION FOR INSP- 182201. CREATED AS REINSPECTION FOR INSP- 179966. Not Ready. NB 02/25/2013 INSP- 184047 Final APPROVED Norman Bruhn 2/25/2013 CREATED AS REINSPECTION FOR INSP- 179964. NOT READY Monday, April 1, 2013 Page 1 of 2 PERMIT # -x--1 1 L- 1924 CONTRACTOR: Tkjfvt) Nu'' SUBMITTAL DATE: lot isi)2. ADDRESS: 102. I) \ 00S-7, NAME: YD(1V1 t V\, ` RESUBMITAL DATES: PROJECT TYPE: YtDian -(� J�VI,'`4JYC A ZONING I FIRE STRUCTURAL IMPACT FEES ELECTRICAL /9i 45)--67:76' (7- HRSIDERM ieL /ef? ry PLUMBING NOC MECHANICAL SAY BL ills Ot 0AF Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 184047 Permit Number: RC -10 -12 -1924 Scheduled Inspection Date: February 25, 2013 Inspector: Bruhn, Norman Owner: Job Address: 102 NW 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010220370 Building Department Comments BATHROOM REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 179964. NOT READY February 22, 2013 For Inspections please call: (305)762 -4949 Page 7 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 BUILDING PERMIT APPLICATION Permit Type: BUILDING_) I_ JOB ADDRESS: j 162 100 ST City: Miami Shores ITC 20 Permit No. 'W-11 2:- -. 1'14 Master Permit No. ROOFING County: Miami Dade Zip: 3 3/.5-0 Folio/Parcel #: Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): J 0 t'1 JAR.! ( Phone #: 3625 ` d`O 4 5/ Address: Aim City: State: Zip: Tenant/Lessee Name: Phone #: Email: CONTRACTOR 1Company Name: aavir Phone#: 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: $ i Type of Work: Addition ❑Alteration Description of Work: 2/ CE V1474 MY Square/Linear Footage of Work: 7 2 ci &_ ❑ , New Repair/Replace UDemolition t 4 - 7 4 I - M 7/ tE l 12 G t o r i 4 / 3 / # 0 6 t i Color thru tile: * * * * * ***** ** Aux:*** * **x:*****+x**** ****+x*** Fees**** x:xx: *****m********** ** * * ****+x**** * ****** Submittal Fee $ Permit Fee $ /fin" CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ L94 . �� f 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 The fore..' i tru ►' q�was aq h 1 ed fore me this day of t ; ' / / 20 j by V3 „ , ) j4 w o 'sjjpe sonally own to me or who has produced) �V '21 ' . ri ntification and who did take an oath. NOTA Y PUBLIC: NOTARY PUBLIC: 15 Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by dwho is personally known to me or who has produced as identification and who did take an oath. Sign: Print: My Commission Expires: a * * ** * * * * * * * * * * * * * * ** ** APPROVED BY Sign: Print: My Commission Expires: **************************** ****** *** **** **+x+x+x*** * **** ** /442;4l Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(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: ® u/91 ? -/ DATE: /6/45 ADDRESS: (69-, A/U. /b®St /116141 f CM 6-? / -F / 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;1 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. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or shed construction and is not hiring a licensed contractor to assume responsibility. td Opolte for the Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I ay 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. Initial 4. I understand that 1 may build or improve a one family or two- family residence or a farm outbuilding. l may al 'boil •r 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. Initial I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working residence. It is my responsibility to ensure that the persons whom I employ have the license required by law municipal ordinance. building or nd by county or Inftal 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. Initi 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor wh 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. 1 understand that my failure to follow these may subject to serious financial risk. Initial 1 �. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will s tall 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 t may contact the Florida Construction Industry Licensing Board at 850. 487.1395 or htto://www.mvfloridalicense.com/dbprforoicilbiindex.htrni Initial 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands th m the party legally and financially responsible for the proposed construction activity at the following address: 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 d of ha e 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 ency is required when the permit is issued. Was acknowledged before me this ' day of , 20 /2 Produced there License or who was personally known to me or who has 3•2t•1,W identification. •. 1 V' a < CLAUDIA V. CUBILLOS Notary Public - 1. State of Florida `_: * . pAy Camm. Expires Sep 23.2015 Commission # EE 128810 rort aQ: As. o-c h National Notary sn +;; off,;; °� Bonded Through NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 12---112-4 TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement 1111111 01111011 1111111111 I!11i 0111 1111 101 CFN 2012R0757902 OR Bk 28325 Fs 4117 °v (1es) RECORDED 1101/23/2012 15:17141 HARVEY RUVII'ls CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE � ( ` Space above reserved for use of recording office 1 Legal description of property and street/ ddrg s 191- 1`-t v11 169 t"Vl 1 .wt 1 Clitt7I5r 2 Description of improvement: I M110.A3M /?_ t UOO lr 3; Owner(s) name and address: v=lnterest in property: Name and address of fee simple titleholder: 4. ;Contractor's name, address and phone number. MIMM -, �Y 1.111') 4110,4t5 I, 330-0 5. Surety: (Payment bond required by owner from contactor, if any) Name, address and phone number 4- Amount of bond $ 6. Lender's name and address: o.. ,. 1 a#f4f 7. Persons within the State of Florida designated by C er upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 14/0-- 9. Expiration date of this Notice of Commencement: (the expiration. date Is 1 year from the date of recording unless a different date is spectiied) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. atule(skof Prepared By Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this ++ bt+ --t' ,FOYadividualy, or ❑ as for ❑ Personally known, or ❑ produced the following type of identification: Signature of Notary 'Wllis Print Wade: (SEAL) ? // 41f p4/..1c VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTE _ 8 ®Or� °4',2 Under penalties of perjury, I declare that I have read the foregoing and; ,n ' b�ft7�i, i that the facts stated in it are true, to the best of my knowledge and belief. ��i o,gdx�ip ; Signature(s) of Owner(s) or Owner(s)'s Authorized Officer / Director /Partner/Ma'r(g f *ne%1Ave: By By /brgw1Hint111,` d Officer/Director/Partner/Manager Prepared By Print Name Title/Office 3 day of n v` `-'. • "" ` 2' 123.01-52 PAGE 3 3/10 STATE OF FLORIDA COUNTY OF DADE I HEREBY CERTIFY Oils is a kw copy of the original Ned del of 1.• Lvol4917-"( - - r 134MA t,it viNtrOC u0AA SP/Ai-1iW2 pm Miami Shores Village APPROVED BY DATE ZONING DEPT BLDG DEPT 041 SUBJECT TO COMPLIANCE WITH ALL FEDERAL SLSTATE AND COI INTY RULES AND REGULATIONS Xlee r 49,797e_ 64—c,PG7- xeef7- tro r. rPrtvt1 RtbeieT1 ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER BATHROOM RECEPTACLE ON 20 AMP CKT INSULATED CONDUCTORS TO BE REPLACED. AND G.F.I PROTECTED LkcE E■TE 15,OCr -201) jOk n fir, ( cTIA f Pkop F-R_iy Ib f SS: 0). WA! /60 5 AFF) 446rn Slogs 5eoP Q, G�or2I : pE pL f cr ,Arai &,00p1 7 7L ', PL UY113i/l& foentn- s r /A/ii Y Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 --I z 1 Inspection Number: INSP- 186044 Permit Number: PL -10 -12 -1926 Scheduled Inspection Date: February 21, 2013 Inspector: Hernandez, Rafael Owner: Job Address: 102 NW 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010220370 Building Department Comments PLUMBING WORK FOR BATHROOM REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REI SPE ION FOR INSP- 179989. February 20, 2013 For Inspections please call: (305)762 -4949 Page 15 of 23 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: PLUMBING JOB ADDRESS: 0 Z /J " (, FBC 20 � Permit No. 17 1 l 2 Master Permit No. CAZ 10E4— City: Miami Shores County: Miami Dade Zip: .2 31 S) Folio/Parcel #: Is the Building Historically Designated: Yes NO V1 Flood Zone: OWNER: Name (Fee Simple Titleholder): J b 1-1-N) fit. j Phone #: ' 'O & O ? 31 Address: 0 VV1/E 4 A c City: State: Zip: Tenant/Lessee Name: Phone #: Email: CGOVVIC CONTRACTOR: Company Name: Phone #: 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: $ d"''V �,li Square/Linear Footage of Work: Type of Work: ❑Addres DAlteation ew epair/Replace •, s emolition Description of Work: � k)u)lo)y W Q yL TTO"{ b e Y 1, ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * ** * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ /( '- CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I 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 A1414IDAVIT: 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. The for • oinr ins Signature I Contractor + ++ ent was acknowledged be a me this 15 The foregoing instrument was acknowledged before me this day of , 20 _, by who is y - sonally oy o me or who has produced �' who is personally known to me or who has produced as identification and who did take an oath. 3.2i NOT ' Y PUBLIC: Sign: Print: My Commission Expires: identification and who did take an oath. APPROVED BY �� %9 f ®/1�� Plans Examiner Structural Review (Revised3 /12 /2012)(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) NOTARY PUBLIC: Sign: Print: My Commission Expires: Zoning Clerk 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: O f i• at) DATE: /0 7/11/1- ADDRESS: (01 (649 haw 1111,111% Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, FS 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 budding 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.CA and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with alt 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 contractor under ith certain prbestrictions even though I do exemption t have a license. l, as the owner of the ;pro�rly listed, may act as my own Initial, I understand that budding 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 t 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. Initial 4. I understand that l may build or improve a one family or two-family residence or a farm outbuilding. I may also bu it 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 iota, 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial ,I. • 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 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, 1 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, anozoning regulations. Initial° 1: I 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 htto:/I www. mvforidalicense .com/dboOrolcilbrndex.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 info have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who it 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 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 i ! day of .. , 20 By a-itr 000 who was personally known to me or who has Produced there License or :".\ VX. .o 5.2 • Z CaS identification. IP ii,i, 1 /- :a L.4 NOTARY CLAUDIA V. CUBILLOS State o1 Florida P�e,�.,� Notary Public fires 23. Sep . My Comm. Expires # EE 128810 aQ, Commission h National Notary Assn. �sr ,„00% Ynroug °�',o,,�., Bonded Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 1129 Inspection Number: INSP- 183864 Permit Number: EL -10 -12 -1925 Scheduled Inspection Date: February 21, 2013 Inspector: Devaney, Michael Owner: Job Address: 102 NW 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010220370 Building Department Comments MOVE EXISTING OUTLET IN BATHROOM. Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 183807. S. /D. in bedrooms. 5's-/& 7/ February 20, 2013 For Inspections please call: (305)762 -4949 Page 9 of 23 , Miami Shores Village Building Department 90050 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:- EleCtr1Cal JOB ADDRESS: l 0 2 IJ) IA) (Bo A. FBC 20 Permit No. ��^^i �j Master Permit No. -�../ 2,— 1 J ' 24 City: Miami Shores County: Miami Dade Zip: 17 3 i cb Folio/Parcel #: Is the Building Historically Designated: Yes NO X- Flood Zone: OWNER: Name (Fee Simple Titleholder): 00110 `J (1J Phone #: 5315-81 6 `7 ;; / Address: City: State: Zip: Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: 1 V ki)1kO(' - Phone #: 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: $ i Square/Linear Footage of Work: Type of Work: °Address °Alteration New DRepair/Replace °Demolition Description of Work: ft() fE- (lu C P% 6 V'/ rib ace-r. .,tw itrbils 2 / 7-f ****+xx *** ****** ** * * ** x**** *x: *x: ********* Fees***** x: ******** ************x :****** * ********** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ or 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 The foreg day of instru ,2 , y O onally known to me or who has produced 1 1(/ 03 who is pe Q2�• /SC Owner or Agent Signature Contractor e t was a wledged b ore �me this 15 The foregoing instrument was acknowledged before me this NOTA ' lf,PUBLIC: Sign: Print: cation and who did take an oath. day of , 20 _, by ho is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: CLAUbiA V. CUBILL' ` * << Notary Nuldlic - 9tatP o2 Florida •_ My Comm. Expires Sep 28810 015 3, moo= Commission # Assn. Bonded Through National Notary Sign: Print: My Commission Expires: ***s :*a::u ******a:***** * *,:* +x:x** ************* * * *** :*** ***x:******+x**m****e **** ******* ** ***** ********* **mix APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(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: It d Prg I 13 DATE:' /0/ /3—/ 2 ADDRESS: [ ©'L ti'sik bv;" /14.14 -61( 3 I✓( 13 )5O 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. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is respon'le 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 p'ect 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. Initial 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may ." 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. 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. 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. Initia 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who t not `'tenses 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 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. al pplicable 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.myforidalicense .com/dbor /oro /cilbliindex.html In' 1 1 . I am aware o f , and consent to; an owner- builder building permit applied for in my name and understands tha "'• m the party legally and financially responsible for the proposed construction activity at the following address: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info have provided on this disclosure. 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 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 15 day of 061- , 20 1 By /NO ank who was personally known to me or who has Produced there License or T 0 K` , QZ - 03'21.2,6$ventification. (13 NOTARY CI.AllDIA V. CUBillOS ,,owV'P�9 Public - State of FIoa015 o-� c. = MytComm. Expires Sep 23, Commission # EE 128810 Bonded Waugh National Notary Assn.