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RC-12-857Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 179215 Permit Number: RC -5 -12 -857 Inspection Date: October 04, 2012 Inspector: Bruhn, Norman Owner: THOMAS, ALBERT Job Address: 1453 NE 104 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1122320320080 Building Department Comments REPLACE KITCHEN CABINETS Infractio Passed Comments INSPECTOR COMMENTS False Passed /- Inspector Comments CREATED AS REINSPECTION FOR INSP- 179178. �r /bL Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 October 04, 2012 Page 1 of 1 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 No. 1 r� L gs - Master Permit No. BUILDING PERMIT APPLICATION FBC 20 I 0 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): 144A4 4 G ELY ' L , Address: A L15% (`\ T .•jam it c3- R - -r City: 1 l 1' 1 S N oaf S State: f t o Phone#: `30 5("cC 611 ) Tenant/Lessee Name: 1' ( et) 3) c 1 /Z Email: Zip: Phone #: JOB ADDRESS: 41 G" D �T4 ' IAN M 1 2-t S City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: Flood Zone: 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: $:.. ' Square/Linear Footage of Work: Type of Work: Addition /' A `� a on ❑New or • epair/Replace ❑Demolition Description of Work: * * ** x******** *a::+x***** ** * *** *** * *+x*** *Fees******************************************** pa Submittal Fee $ 50 - g 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 $ 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, BOTT.RRS, 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. r&I 6 Signature �� — Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 4,01- , 20 !R, by ti &-- AllgUl owJ 1(1/ day of , 20 _, by who is personally known to me or who has produced /" 1. /.7 who is personally known to me or who has produced As identification and who ditd et/an oath. as identification and who did take an oath. ` NOTARY PUBLIC: ,' d 4l aO y,,,'% NOTARY PUBLIC: Sign: H r9�d' �o Sign: Print: % a`> d �'�A® d`O / -4" 3 Print: My Commission Expires: My Commission Expires: tlillllll ****************************** ' kds********************************************** **** *************************** APPROVED BY 41# •/'� /U �� Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. e — 2232. `0 3 Z-00 To STATE OF FLORIDA: COUNTY OF MIAMI -DADE: STATE OF I HERESY CER ./10941 io THE UNDERSIGNED hereby gives notice that improvements wIl be made td4 property, and h accordance with Chapter 713, Florida Statutes, the following a f i is provided in this Notice of Commencement. By 1 1111111111111111 11111 1111111111 11111 1111 1111 CFN 2012R0363766 OR ek 28120 P9 3238f (l-p9 ) RECORDED 05/22/2012 14:03:04 HARVEY RUVIN, CLERK OF COURT f1IAl1I -DADE COUNTYr FLORIDA LAST PAGE OF tivil tlrix isyrsy gj to A D o's. CLERK, of Ciro eed Cow, Cam ;OP r ' Y D.C. Space above reserved for use of recording office 1. Legal description of property and street/address: /153 /OE /04 z sf fl J,e i r S.Plag fc FL I S 2. Description of improvement: 3. Owner(s) name and address: �C 6 E we-4 * 4) ez /zo&) S Interest In property: 0 LO Name and address of fee simple titleholder: 4. Contractor's name, address and phone number P{Qocr 1 n r,(e-r oAi 'pc u1i I'L - Si' t4 Miq i 33t6R _ 3nE oo 5"l1 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lenders name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents maybe 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 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of ruing unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARECONSIDERED 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 WORE-COMMENCING WORK. OR RECORDING YOUR NOTICE OF-COMMENCEMENT Signature(s) of Prepared By Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE �,/ The foregoing instrument was acknowledged before me this d'Y' By Y r- (2,t u Individually, or 1D as for 1i Personally known, or Rproduced the following type of identification: Signature of Notary Public: Print Name: • s) og /r Owne lam,/ s)' Authorized Officer/Director/Partner/Manager Prepared By Print Name Title/Office day of 2t t_ (SEAL) .• °ea. "cs' Y - VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES 'o o Untler penalties of perjury; I declare that I have read the foregoing and 'a' � � �� ''� z that the facts stated in it are true, to the best of my knowledge and belief. si �,o °� izr Signature(s) f !�• .- s) or Owner )'s.Authorized Officer /Director /Partne MaG by igri tabov By . / '1 By ��.olPrbf►ntnnt.0\� 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: k /--). i3cJS a-- DATE: 4/2h7/? - ADDRESS: /i5---3 CIE ( 4 sT 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 IA kki 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 numbers on permits and contracts. Initial U� 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. 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. Initial Initial 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. Initial ‘fJ 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 - \ "O 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 /dbpr /pro /cilbfindex.html Initial � vO 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 AA 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information tt at 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 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 H'nv'( , 20 19 By 'k t (A-1 C1-° A' ' w of was personally known to me or who has 1 ��u1uiu +.n Produced there License or as identific0 p\1l01� `'o,, o�'o 'acs' OWN R r • ' p q, .tea � //° Siu$t):' Avt‘ W''` Miami Shores Village APPROVED ZONING DEPT BLDG DEPT BY DATE TYPE LOCATION MOUNTING GENERAL ELECTRIC M.L0 DREI. — .11111 wer NAME 200 A INTERIOR 8US RATING 200 A RECESS VOLTAGE 120/240 V. 60 Hz KVA W CON— DINT TRIP REOA 4 OKT NO. CK1 NO. (S— at TRIP CON CLOT ME KVA EXIST. COST. EXIST. 2/60 A.H.0 1 2 DRYER 2/40 EXIST. EXIST. EXIST. 3 EXIST. EXIST. EXIST. 2/30 WATER HEATER 5 6 POOL PUMP 1/20 EXIST. EXIST EXIST 7 8 PO6L PUMP 1/20 COST. EXIST. EXIST. EXIST. EXIST. EXIST. 2/80 RANGE 9 10 OARAGE 1/20 EXIST 5)05 EXIST. 11 12 GARAGE 1/20 EXIST. EXIST. EXIST. EXIST. DST. EXIST. 1/20 MICROWAVE 13 14 GAS 1/30 EXIST. EXIST. EXISF. EXS7. ENOST. EXIST. 1/20 IRON 15 16 DISHWASHER 1/20 EXIST. EXIST. EXIST. EXIST. EXIST. EXIST. 1/20 UP STAIR BATHROOM 17 18 WASHER 1/20 EXIST. EXIST. EAST. EXIST. oast ET08T 1/20 S.E BED BATHROOM 19 20 KITCHEN APPLIANCE 1/15 EXIST. COST. EXIST. EXIST. EXIST. EXIST. 1m HALL BATH HEATER 21 22 IGTOEN APPLIANCE 1/ 0 EXIST. EXIST. EXIST. EXIST. EXIST. EXIST. 1/15 UP STAIR BATHROOM. 23 24 DISPOSAL 1/15 EXIST. EXIST. EXIST. EXIST. MST. EXIST. 1/15 8.E BATIHROCL 28 28 UP STAIR HRID (1 1/15 EXIST. EXIST. EMT. EXIST. EXIST. 0057 • 1/15 N.E BEDROOM. 27 28 UP STAN BATHROOM 1/15 EXIST. EXIST. EXIST. EXIST. EXIST. EXIST. 1/15 SE BEDROOM. 29 30 OWNING 1 /15 EXIST. EXIST. EXIST. COST. EXIST. EXIST. 1/15 RECPT. & 1.75 ass BATHROOM 31 32 LIVING ROOK 1/15 0087. EXIST. EXIST. oast EXIST EXIST 2/20 POOL HEATER. 33 34 OUSTER E. BEDROOM 1/15 07057. EXIST. 0081. 35 35 REFRIGERATOR 1/15 EXIST. CAST. EXIST. EXIST. EXIST. DINT 1/15 HOOD 37 35 SPARE SPAPE 39 40 SPARE r--- -- CONNECTED LOAD: EXISTING DEMAND LOAD: EXISTING NOTE t11E DAI E70SiRre LOAD R____M1= fEEDER(S): EXISTING SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS SCOPE OF WORK 1. NEW KITCHEN CABINTES. 2. REPLACE THE EXISTING RECEPTACLES. 3. REPLACE THE DISHWASHER RECEPTACLE. 4. REPLACE THE REFRIGERATOR RECEPTACLE. B. REPLACE THE DISPOSAL RECEPTACLE. 6. PLUMBING REINSTALL KITCHEN SINK, DISPOSAL AND DISHWASHER. ADD SMOKE/CARBON MONOXIDE DETECTORS. WELYCZKOWSKI'S RESIDENCE 1453 NE 104 STREET MIAMI SHORES 33158AND ALL CLOTH AND RUBBER G /C , ��� KITCHEN REMODELING INSULATED CONDUCTORS TO BE REPLACED. e0 1 All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. MARIA WELYCZLOWSKE 4 -18-12 TECH OLOGiiS This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 4/1812012 Printed: 4/19/2012 All Drawing #: 1 C -3a C-13 Gttl- lf C -20 eat tete o m 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition �s' TECHNo ools - Designed: 4/18/2012 Printed: 4/19/2012 MARIA WELYCZLOWSKE 4-18-12 J Drawing #: 1 c -22 i il ,c9fc5pc,"Pf A 61MT G24 .-2O NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.E I PROTECTED RECEPTACLE PUT WW RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. Note: This drawing is an artistic interpretiIOnOf the general Wawa= of the design. It is not meant to be an exact rendition. TECH Old 5 Designed: 4/18/2012 Printed: 4/19/2012 MARL& WELYCZLOWSKE 4-18-12 I Ali I Drawing #: 1 0 NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F..I PROTECTED RECEPTACLE, PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. Note: This drawing is an artistic ' interpretation of the general appearance of the design. It is not meant to be an exact rendition. s`J C NodooP s J Designed: 4118/2012 Printed: 4/19/2012 MARIA WELYCZLOWSKE 4 -18-12 A11 Drawing #: 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. .c — k TftNN0 61ES Designed: 4/18/2012 ]hinted' 4119/2012 MARIA WELYCZLOWSKE 4 -18-12 Drawing #: 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. TECNTJoibG1ES Designed: 4/18/201 Printed: 4/19/2012 MARIA WELYCZLOWSKE 4 -18-12 Drawing #: 1 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 FBC20[0 Permit Type: MECHANICAL REcovE ocr 01 2O1Z Permit No. C-- Yi 1 Master Permit No. 2 — OWNER: Name (Fee Simple Titleholder):JO 6' iik ilka. cz Phone#:'9- .0-606 (./ Address iS3 /J E /0 Y 57 e City: r a 1 t Siweek ST/4#& State: zip: 3 31 Tenant/Lessee Name: Phone#: Email: 7- IA/0y czzieetAk,Kte om 'RAJ ' JOB ADDRESS: 1 'f.33 /0ei' 57. City: Miami Shores County: Miami Dade Zip: 3 / Folio/Parcel #: ir' 2--2 ® 32_ 00190 Is the Building Historically Designated: Yes NO nO Flood Zone: 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: $1Dc ' Square/Linear Footage of Work: Type of Work: °Address ❑Alteration °New epair/Replace °Demolition Description of Work: 01- 1; }�►9' -�° 1 **** ** * * * ** **** x **** *** ****** * * **** ***F ***a ** *****+x*** **r * * *** * **** * * * ** * * ** * *** Submittal Fee $ Permit Fee $ 16,00D CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ fa' 4 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 a p p r o v e d and a reinsp on fie will be charged. Signature Signature Owne gent Contractor The fi going instrument was acknowledged before me this 01 The foregoing instrument was acknowledged before me this day of /O , 20 /2., by r!1 1E.0 o W ay of , 20 _, by who is personally known to me or who has produced rt—,1 0 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. `�����I11 I I11Nt /lt ��i .`��.\N Sif V�ar �. 1106120 6 NOTARY PUBLIC: Sign: Print: My Commission Expires: 3 comm,5Sio0I: v E�113059 s,.gT�,OF. �'0 NOTARY PUBLIC: Sign: Print: My Commission Expires: ************ * * * * * * * * * * * * * * * * * * * * **I** * *�a� **** x�**> i<+ r<***** �x**« �x*********w x�*** *�x *a�+><�r+x **** * * *** *+xa *** * *** * *�x+><+x� *** APPROVED BY t Y 412._ Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Structural Review 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: ' e DATE: i f r G ADDRESS: /'1S3 t Jt JPt ( 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, m act a , 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 sh j'. res onsibl 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 may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of y own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or li «; e n 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 Aso 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 subst. tially i proved myself is sold or leased within 1 year after the construction is complete, the law will presume that I bu' antially 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 wor'f!g on my b ilding or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law;; d by .unty or municipal ordinance. 4 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 willfull a i 4 as an Initial I owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. o Initial 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 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;, mpensation 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 a all app icable 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. I also understand that ay con act the Florida Construction Industry Licensing Board at 850.487.1395 or http : //wuwv.mvforidalicense.com/dbor /pro /cilb/i j x.h Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands th legally and financially responsible for the proposed construction activity at the following address: party 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. isns/ Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who d %es 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 retumed 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 DI day of t , 20 I By 56{4626—. Wrk-ekz k.o ) who was personally known to me or who has Produced there License or as identification. \,tlulliilllllli� s.o' 2016 ERj � NOTAI$' NOl�R�6I �►' — r PUBLIC `j':; Commission # �'•• ;EE 17305 . •' • ' /9�F �F F L�14�oP�``` ��Jtllttl111N�I�� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176356 Permit Number: PL -5 -12 -858 Scheduled Inspection Date: September 26, 2012 Inspector: Hernandez, Rafael Owner: THOMAS, ALBERT Job Address: 1453 NE 104 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ALL ABOUT CONSTRUCTION INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122320320080 Phone: (305)300 -5174 Building Department Comments REPLACE DISHWASHER AND SINK DISPOSAL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTI • N FOR INSP- 173557. FBC P1002. AMASTER TRAP SEAL R, UIRED AT SINK FOR FINAL.OZZIE September 25, 2012 For Inspections please call: (305)762 -4949 Page 16 of 41 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 FBC 20 RECEIVED MAY 14 2012 BY:, • Permit No. Master Permit No. 2 Permit Type: PLUMBING OWNER: Name (Fee Simple Titlehold�� IC4/` /4r � d � ��� Sl Phone#: 5»S `6012_ Address: /`x'55 ./0 03 City: fMM1/4 l �� State: FZ-- Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: #53 7-/-1--'2 `Sl City: Miami Shores County: Miami Dade Zip: ,,F3/-g Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: 4/l CONTRACTOR: Company Name: Phone #: Address: W.6.5 KGGtr' /2-7 S7 4, City: A! 171 '4'A' (4 / State: Z- Zip: 33 I 00 Qualifier Name: R09-"40 AJ (..)/ L.C. 71.1 Phone #: 3 os - Z' '/. 93 0 7 State Certification or Registration #: eFC. /4-2e 2 37 Certificate of Competency #: Contact Phone #: 31' DO' 5 / 7 Email Address: " J a.Ct h'tOt f �P.i %s 07,1/114 1'1 �° DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ., a ,- 1 Square/Linear Footage of Work: UNew ,`2 1.epair/Replace ODemolition Type of Work: ❑Address OAlteration Description of Work: - '� '' 5/(,e -ae, . "-c e..4- 7 )jt L q + x*****u:****a:*** ******* * *** * *** * **** ***Fees*** x ***** ** * * ** ***** *** ******* *****x:*+xa:**** Submittal Fee $ Permit Fee $ /6 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 41Z/4-62.-1— Owner or Agent The foregoing instrument was acknowledged before me this 6( The fore day of '2 tit-, 20 l2- , by I`"'" .' t t d� IAJAYCZ- qay of —L_ who is personally known to me or who has produced As identification and MI? did take an oath. ott •Jeta..... NOTARY PUBLIC: Sign: Print: My Commission Expires: , o @ �6� linnn0 Contractor g instrument was ackn , 2011-, by 5 who is personal ` yknown to me on oduc V`1 . i`1410 -�(as identification APPROVED BY (U,1 47 ! 4' -i Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOT P Sign: Print: ps � kil ' NA COTO dhlinak r ° °° ugh ,s1.°� °p4��°� t BLi ate � ‘4,09,4 MARIA EL A COTO My Commission Expires, $ 1 Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. ( COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTORS TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: NIA. ab ou-1- Go 0 5-4 p.uc ko 3 so c. - BUSINESS ADDRESS: 464' N Lt) (a 4/1 ST • CITY N e Q.4I, Iq t Rr» 1 STATE L ZIP CODE 5 ( BUSINESS PHONE: ( ' J O ) 6 8 1 86k>7 FAX NUMBER (3oS 6 g I 23 617 CELL PHONE ( 34S) 2'9 $ 936 i QUALIFIER'S NAME: P.A1 -1CN Gui cL£.nl QUALIFIER'S LIC NUMBER: G4SOT 72.0- 33 - 206 -p E -MAIL ADDRESS (IF APPLICABLE): T'94cfh rrue —r @. be-tLsoo-Fh . Created on 311910B BY MLDV 1 RV 3126419 MLDV CERTIFICATE OF LIABILITY INSURANCE 5%2!2012' THIS CERTIFICATE 18 I$$UED AS A NATTER OF INFORMATION LNO D CONFERS NO RIGHTS UUPON THE CERTIFICATE HOLDER, T14111 CERTIFICATE D001 NOT AFRUMWELY OR NEGATWR1.Y ANEW, EXTEND OR ALTER THE COVERAGE Ammo 8Y me POLICIES BELOW. TIN CERTIFICATE OF INSURANCE OMB NOT CONSTITUTE A CONTRACT BBTW8*N THE ISSUING INSURER" AUTI4CRIEEO REPRESSITATIVE OR PRDDUC3 . AND TIN CERTIRICATE NOLMMA IMPORTANT: 1NAr a tllcsts holdrr Is an ADDTfIONA INSURED, Um polle ) oust be sndomaf. If SURROOATION WAtv1O, IRENE to dts Isms sad SOINGEses stMO policy, urn pour may moults an enderuntrnt. A Mammal on Me $Sl*IEals doss not mire Wits M tar partly ats hold r In Ile* of sue $$do s PROMMOR NSW LAW INSURANCE 103094th Ave Himlesh, FL 33010 INSER1+0 ALL ABOUT CONSTRUCTION INC 455 NW 127T9 STREET NORTE MIANZ, FL 33268 (305) 298 -9307 COVERAGES 305 887 -0711 a newla vimslluraace @acl . aam (303) 084 -2411 nw Hams mums* A : ASCENDANT I11T8t1AANCE IYBUREEI8 : INSURER C: i3!uREiR 0: INSURER E • INSURER : • THIS IS TO CERTIFY THAT INDICATED. N0T%MTNSTANDING CERTIFICATE MAY BE ISSUED EXCLUSIOIIISAND CONDrrtONS THE POLICIES OP INSURANCE UNTIED BELOW HAVE BEEN a3VEI) TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY RECUMBENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO AU. THE TERMS, OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. -fin TYPE OP INSURANCE ¶ .gryp POLICY tansER LEE GENERAL tJlE9I IiV" COMMBROIAL GENERAL UABILRY E] OCCUR GL37660 -0 07/02 /1107 /og /T,2 EACH • ..N , Nca • 1,000,0 8 .' ' ■ ^ ^�,,° ,__ . • 100,000 S I CLAar$.MADE , WO E*P l*yy en. eenonl • 5 , 000 s x,000,000 • 1,000,000 500.00 DZDUCTISLL PER8n1,0,LajavlrtusV PROPERTY DANA= GENERAL AfP3RE0AT6 L AGGREGATE U LET APPLIES PEER: POLICY n n LOC .jit PRoDuCTS- COtoicPA9$ • i , 000 , 000 a �, AUTOMOLE uALY ANYAUTO ALL OWNED AUT09 MEWLED ALTOS WIRED AUTOS NON•OYIft1E0 AUTOS COMM E NGLEBT (Er *MEM) 1 — EOM INJURY (Per WREN • _, BODILY INJURY (Par nano s PROPERTY MANAGE tlowwieident) a • • ___- UMBRELLA LIAR EXCESS LUIS OCCUR MABIIB -EAADE — !AM, OCCURRENCE $ ¢OQRE:LiH►TE $ DEDUCTIBLE RENDITION $ a — woitans N ise Ec E� ANY PRCRbE aiNPARMER f jUTPM OPP $UR anae!R entwoIDP t�Myam�A,dw1 a M'l IPTtON Mx NIA 1J 1 Ion- E.L. EACk AOOIOIJYf a NI EL MASS - EA ninon! 0 8 L DeenaE-PoUMiy Lei • +__I ^ DESCRIPTION OF OPERATIONS f LOCATIONS, VBH1CLEI (Aam¢fi ACORD 101, Addidanei RIfmgw &Mehl , If truer Mole N MM+$) FLUBBING WOAIC WITBZN BUILDINGS LLBCTSTC WORK WITHIN BUILDINGS .DER *CAM $R0AE8 VILLAGE BUILDING DEPARTMENT 10050 NS 2nd AVE MAW SNORES, FLA 33138 305- 683, -8367 FAR SHOULD ANY OF 714E ABOVE DEMISED POLICES BE CANCELLED BEFORE TINE EXPIRATION DATE THEREOF, NOTIE WIU 0E 7.1ELIV3R3D Iu ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED . ,,IpTAIE ACORD26(200W03) •d O IOe8.2009 ACORD C O R P O R A T IO A I . A B rights rearved The ACORD name and logo are reglsared mtts of ACORD • KH4 13t'2I3S}fl dH WdOS :C 2102 20 ReW MIAMI-DADE GOItNTY 2011 LOCAL BUSINESS TAX RECEIPT 2012 TAX COLLECTOR 1st FLOOR MIAMI, FL 33130 FIRS1+CLASS U.S. POSTAGE PAID MIAMI, FL. PERMIT NO. 231 MIAMI -DADS COUNTY - STATE OF FLORIDA 140 W FLAGLER ST EXPIRES SEPT. 30, 2012. MUST BE DISPLAYED AT PLACE OF BUSINESS PUI3SUANTTO COUNTY CODE CHAPTER 8A - ART. 9 & 10 665289-6 THIS IS NOT A BILL - DO NOT PAY RENEWAL. BUSINESS NAME 1 LOCATION RECEIPT NO.. 692388-3 ALL ABOUT CONSTRUCTION INC STATE# EC13004474 465 NW 127 ST 33168 NORTH MIAMI' OWNER ALL ABOUT CONSTRUCTION INC Sec. Type of Business 196 SPEC ELECTRICAL CONTRACTOR THIS tB ONLY A LOCAL BUSINESS -TAX RECEIPT. IT DOES. NOT PERMIT- THE HOLDER -TO VIOLATE -ANY'; EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR . CITIES. NOR DOES IT EXEMPT:. THE HOLDER FROM ANY OTHER PERMIT -.... OR LICENSE REQUIRED BY LAW. THIS IS NOT. A CERTIFICATION OP THE: HOLDERS. C:UALI ICA-.. PAYMENT RECEIVED • EMI AA ECOUNTT TAX 08/0212011 60030000045 000045.00 SEE OTHER SIDE I WORKER /S` 1 DO NOT FORWARD ALL ABOUT CONSTRUCTION INC LUZMARY GORDON HERNANDEZ PRES 465-NW 127 ST N MIAMI FL 33168 II tilt rti1L111i111III till I tiff T111LPHPI lit JllSW MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOE MIAMI, FL 33130 2011 LOCAL. BUSINESS TAX RECEIPT 1 2012.. MIAMI- DADE`COUNTY - STATE OF FLORIDA EXPIRES SEPT. 300 2012 - MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 "& 10 THIS 1S NOT A BILL - DO NOT PAY FIRS7':CLASS U.S. POSTAGE PAID . MIAMI, FL PERMIT NO. 231:= 665296 -1 RENEWAL BUSINESS NAME I LOCATION RECEIPT NO. 692396-6 .: ALL ABOLIT CONSTRUCTION INC STATE# CFC1428237 465 NW 127 ST 33168 NORTH ;MIAMI OWNER ALL ABOUT CONSTRUCTION INC Sec. Type Df Business 196 PLUMBING CONTRACTOR THIS IS ONLY A LOCAL SUSDNEIS TAX:RECEIP . IT - -. DOES NOT :PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF. THE COUNTY OR CITIES. -NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR.... LICENSE. REQUIRED BY LAW. THIS IS NOT A CERIIRCATION:OF HOLDER'S OUALIFICA- PAYMENT RECEIVED MIAM1•DADE mum TAX COLLECTOR 08/02/2011 60030000049 000045.00 ii$F (ITI4FR SIIW WORKER /S 1 DO NOT FORWARD ALL ABOUT CONSTRUCTION INC 465 NW 127 ST MIAMI FL 33168 III J) lf iIII11111I III 11 r11111111IJJIIIJi71 ,Ii111lIIIIIIJII 1I PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DMSION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW EFFECTIVE 07/08/2010 EXPIRATION DATE: 07/07/2012 PERSON: RAMON GUILLEN FEIN: 811815059 BUSINESS NAME AND ADDRESS: ALL ABOUT CONSTRUCTION INC 465 N W 127TH STREET MIAMI, FL 33168 SCOPE OF BUSINESS OR TRADE 1- PLUMBING CONTRACTOR 2- ROOFING CONTRACTOR 3- ELECTRICAL CONTRACTOR IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election 1- under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(121, F.S., Certificates of election to be H exempt. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (8501 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -89721 Inspection Number: INSP - 176291 Permit Number: EL -5 -12 -859 Scheduled Inspection Date: September 27, 2012 Inspector: Devaney, Michael Owner: THOMAS, ALBERT Job Address: 1453 NE 104 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ALL ABOUT CONSTRUCTION INC Perthit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1122320320080 Phone: (305)300 -5174 Building Department Comments REPLACE 6 GFI AND LIGHT FIXTURES 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 IOP- 176127. All covered up ,no rough inspection. Add smoke carbon and rioxide detectors. ;.1 September 26, 2012 For Inspections please call: (305)762 -4949 Page 8 of 43 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 RECEIVED MAY 14 2O1Z BUILDING Permit No. EU 2 "` 2 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): ,To%�z� ( / - °1 Address: ( 3 /OE / ''s% City: /U% / '% S� /� � ? & State: Zip: 3 5/ 3 Tenant/Lessee Name: Phone#: Email: f `f c ( `J- acl)k 9// 'tee(, 056'21 JOB ADDRESS: /4'53 � lc Jam/ City: Miami Shores County: Miami Dade Zip: 551-2:'° Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: All ,4bout Cbn5fi-vc-4o4 die. CONTRACTOR: Company Name: Address: -105 Al kr ' % 27 7f `/per' ' Phone #: City: A/© ii - M ia'27 i State: 1-- Zip: .?5/(06 Qualifier Name: XCarr)0/7 Grr /' //-€11 Phone #: 305.. 2g8r)4 q O7 State Certification or Registration #: EC /3 00 24 7 Certificate of Competency #: Contact Phone #: C. 300, / 7'1 Email Address: iy' 70ma 71 ,mil &aZL % • i7ef DESIGNER: Architect/Engineer: v Phone#: Value of Work for this Permit: $ 6Y- Square/Linear Footage of Work: DAlteration New ARepair/Replace ODemolition Type of Work: OAddress Description of Work: +x*** * *************** ** **** *** *** ***** Fees* *****+ x*: x****: xx: ******** ************* ** *x:**** Submittal Fee $ • , Permit Fee $ /.-C-0 ''° F, CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ V C ICS 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 MR 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. Owner or Agent D The foregoing instrument was acknowledged before me this 74 day of AD r1�' , 20 !!j-, by 9-1 AQA (AK-C. `IL Ca who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: „tNn1►l►ut,,���. yd -17,-;:f o `a ' .;L zCvl� Signature The fore of Contractor strument was acknow ged b 201 by ally lin• to me or who has produced tt,as identification and who did take an oath. W in r f r i n n s Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOTAR Sign: Print: MARIA E�_ COTO Ii My Commission Expires: (3 Zoning Clerk