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FW-13-528Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 189157 Permit Number: FW -3 -13 -528 Scheduled Inspection Date: April 15, 2013 Inspector: Bruhn, Norman Owner: BERGNES TRS, ADRIANA DIAZ Job Address: 101 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Fence/Wall Inspection Type: Final Work Classification: Wood Fence Phone Number Parcel Number 1132060131790 Building Department Comments ADDING 2 FOOT WOOD FENCE TO EXISTING 3'HIGH CONCRETE FENCE 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- 187574. NEED SELF LOCKING GATES April 12, 2013 For Inspections please call: (305)762 -4949 Page 23 of 38 PE IT# CO RACTOR:) ``-� -- SUB ITTAL DATE: 3 NAME: RZ - 36-(2- ZS RESUBMITAL DATES: FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING MECHANICAL 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: ( 0 lye T 20 FBC 20 ID Permit No. Master Permit No. ROOFING City: Miami Shores County: Miami Dade ' Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: 0 a (Fee Simple � ui t i ikik V I �`, 2- 4 a r_ f Phone #: 74 - _5 3 OWNER: Name ee Sim le Titleholder ) Address: (©1 !v e 10-2_ STT i City: 1 k kilrt/i,10 a e 5 State: —C3 Zip: C3 3 Tenant/Lessee Name: p f . (J Phone #: Email: , l t1 �1 \':- 'bli j( o si) I (°D kl ccLl.,:o . C -0-w-1 CONTRACTOR: Company Name: Address: City: St Qualifier Name: Phone #: Zip: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 3 ©( Square/Linear Footage of Work: Type of Work: *Addition ❑Alteration UNew ❑Repair/Replace UDemolition Description of Work: C` C) fJ c, 2- Vo4 t COO CD V--eCA- - €- r S -. 3 c(t.P f - o Color thru tile: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * **** Fee *********** * * * * * * * * * * * * * *** * * * * * ** * * * * * * ** Submittal Fee $ �t-s'� Permit Fee $ Mc" Cogi CCF $ CO /CC $ Scanning Fee $ 1Y Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ a y Bonding Company's Name (if applicable) Bonding Company's Address City State ` Zip Mortgage Lender's Name (if applicable) j� I 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 issu ce 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, FURNACE , BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I c rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating cons ction 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 YO r NOTICE OF COMMENCEMENT." Notice to Applicant: As a con 'ition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a cdpy 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 Signature Owner o Agent V _ Contractor The foregoing instrument was or before me this The foregoing instrument was acknowledged before me this day 01).4201 , 245 , by ''"SIAi Llt- A cPtoc. 136e6,14Pktly of , 20 , by who is personally known to me or who has produced () who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: As ident NOTARY PUBLIC: Sign: Print: My Commission Expires: fication and who did take an oath. * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY * Sign: Print: My Commission Expires: ************************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** P-fir5 Plans Examiner 1I) 770/(3 Zoning Structural Review Clerk (Revised 5/2 /2012XRevised 3/12/2012) )(Revised 06 /10 /2009)(Revised 3 /15 /09XRevised 7/10/2007) 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: , ' { A' ',� V'' \/-9 DATE: I 13 ADDRESS: 10 p 51- u n ki ( �' 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; 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. 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 AI) el5 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 numberon 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 of substantial 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 ;;tun municipal ordinance. Initial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain erroneously implies that the property owner is providing his or her own labor and materials. I, as an liable and subjected to serious financial risk for any injuries sustained by an unlicensed person working on my property. My homeowner's insurance may not provide coverage for those injuries owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my pro n owner - builder permit that wner-builder, may be held or his or employees while I am willfully acting as an rty Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contract r 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 o 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 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 regulation 10. I understand that I may obtain more information regarding my obligations as an employer from the Inte United States Small Business Administration, and the Florida Department of Revenues. I also underst Florida Construction Industry Licensing Board at 850.487.1395 or h / /www.m oridalicense.com/db , r/ ill abide by all applicable Initial al Revenue Service, the nd that I may contact the ro /cilbrnd:. 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: ( ®l & Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatio 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 v license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regu assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also understand that, if an unlicensed contractor or employee of an individual or firm is injured while working be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, verifying whether the contractor is properly licensed and the status of the contractors workers compens Before a building permit can be issued, this disclosure statement must be completed and signed by the returned to the local permitting agency responsible for issuing the permit. A copy of the property owners notarized signature of the property owner, or other type of verification acceptable to the local permitting the permit is issued. ho does not have a (ration may be unable to rnportant for you to n your property, you may ou will be responsible for tion coverage. roperty owner and driver license, the gency is required when Was acknowledged before me this kS day of .MASZ-C-t-1, 20 1 By Zit :0 tk 622/ -04h) was personally known to me or ho has Produced there License or OWNER • 285 ALHAMBRA CIRCLE - SUITE 404 CORAL GAMES, FLA. 33134 THOMAS 'J. KELLY, INC. SURVEY NO.9Z•109 9A0 t 1309)444 -7692 XD: 1309) 441 -66491 LAND "SURVEYOR SHEET �, oF-A- 763 SKETCH OF SURVEY SCALE: 16= Z'(Jl ....... . A.1.6-.1.'. _ :.: ( f . A !PAK* op.) �r—. m!•_ ° 10R6* (h) • . =rte• •, -Z.8N (&( fM 1 i X11 pc � ao, oa 4 ,� �,Nt4,) I y a� • PL. 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