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RC-12-2426Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 194213 Permit Number: RC -12 -12 -2426 Scheduled Inspection Date: July 09, 2013 Inspector: Bruhn, Norman Owner: ADKINS, RANDAL Job Address: 90 NE 105 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ARCO CONSTRUCTION Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1121360120010 Phone: 305 - 892 -6507 Building Department Comments REPLACE FLOOR JOIST IN BATHROOM. NEW TILES IN WALLS AND SHOWERS H.O. told me an unlicensed contractor is performing work. Provide a licensed contractor prior to any further work. Permit placed on hold. CHANGE OF CONTRACTOR MADE ON 3/5/13 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- 193701. NOT READY. MUST PASS ELECTRICAL. JR July 08, 2013 For Inspections please call: (305)762 -4949 Page 18 of 31 f { # 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: 6/ 0,, %®. FBC 20 1..m Permit No. rr�� Master Permit No.��. ^Oti ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO - Flood Zone: OWNER: Name (Fee Simple Titleholder): 7i'JL4L 41‘4/S Phone #: 605 -7s7 - 950 Address: Qj 0 dl) E / 0 g—i City: j474hr6" C Tenant/Lessee Name: Phone #: Email: r oc bti 5 State: PC Zip: ?3i3 CONTRACTOR: Company Name: I,'! 0[ a < C i Phone #: 5- g�a 6 S Co 7— Address: )2cPq /0y C,�r. City: K a State: Zip: i Qualifier Name: z_eS caseY1 , . State Certification or Registration #: c / !3 5,16 _3 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Phone #: Value of Work for. this Permit: $ oatf.2 r Square/Linear Footage of Work: Type of Work: ❑Addition UAlteration UNew Repair/Replace ODemolition Descr��iptti/ion of Work: /� �, ,,� & d cle ¢� 0 �es —z' e q: J eke. tho C 44 c ( - ' -fTr2— Color thru tile: ***** * ********** * * ** ** ** * * *** ***** ** *err eS* * * * ** * ** r* r* ** ** * ** *** * ** * **** **** *** **** ** Submittal Fee $ Permit Fee $ �4) 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 Owner or Agent The foregoing instrument was acknowledged before me this 2 ? The forego day of cid , 20/3, by1?A' �1\f day of who is personally known to me or who has produced D As identification and who did take an oath. NOTARY PUBLIC: Si !Cr Sign: r Print: - /j �`�r %' golly My Commission Expires: APPROVED BY ntractor trument was cknowledg d before I,ne thi by me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission E State of ori� Notary Public 2015 .` a • • 23. o`:` Commission 5 EE 128810 9r/j, F f' Bonded Through National Notary Assn. Plans Examiner Zoning Structural Review Clerk (Revised 5 /2 /2012XRevised 3/12/2012) )(Revised 06 /10 /2009XRevised 3 /15 /09XRevised 7/10/2007) a' v IVI iami Shores VUlage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. CA 2 - Owners Name (Fee Simple Title Holder): gvve4 ( •Ods Phone #: 'S - 2S7 5 Z3 Owner's Address: lc /Lie /v l City: Job Address (Of where work is being done): City: Miami Shores State : Zip Code: ?3 /.'t % Air /v C State: Florida Zip Code: 3 3/3 Contractor's Company Name: MC0 (4/ ea17/..CiV. cot39 Phone #: 6 SP Address: /2_91 A45. ifo51 ° City: e`,_ State: Qualifier's Name : P ,P..--4- Lic. Number: C6-.C. Zip Code: 1 Architect/ Engineer of Reco Address: City: Phone #: Describe Work: jS.v�° Zip Code: I hereby certify that the work has been abandoned and/or the contractor /architect is unable or unwilling to complete the contract. l hold the Building Official and the Miami Shores harmless for all legal involvement. Signature, l� Signatur tier or Agent Contractor or The foregoing instrument was aknowledged before me The = oing trument was this Iday of ,20 lby (1 Sthis ,QY ,Q 8 day of r r 4a Who is personally k nown to me or who has produced 1'� ^ Notary Public: Sign: Seal: as indentification. ,'49 / e v1I1111111e1 ged before me whossaffie or who has produced oao% I uti3' wjgptification. `‘` ca` \Vote 1 Notary Public: Sign: Seal: 0 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: JOB ADDRESS: (i Ale /v� €- FBC20 (� Permit No. Master Permit No. - C12- 7 Li ROOFING City: Miami Shores County: Miami Dade Folio/Parcel #: // 2- - ®l Z - t9O/ 0 Is the Building Historically Designated: Yes NO Flood Zone: i4) Zip: 3 j OWNER: Name (Fee Simple Titleholder): �+f,✓l / of �'�� Phone #: Address: 9D Ale /US City: 111,`474-; -g 1i -5 State: P( Tenant/Lessee Name: Phone#: P.C1 Wei Zip: Email: irliefL 5 '21( CONTRACTOR: Company Name: i,--'-42— Phone #: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: 1/4— Value of Work for this Permit: $ G Square/Linear Footage of Work: q2 "P. ?//7 Type of Work: DAdditio / DA1t tion ONew XRepair/Replace ODemolitioonn Description of Work: )t f /4ke- 11 ° `S P L) A 401. t 7;Ve5 Color thru tile: ?A ******* ******** ********* ******** *******Fees****a��xa�** *** *** * * * * * ** ** * ***+x�x+xx�+x�x+xa� ****** Submittal Fee $ ' L�7 Permit Fee $ �1i 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, BOIT.F,RS, 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 Owner or Agent Signature Contractor The foregoing instrument was acknowledged before me this 2 ( The foregoing instrument was acknowledged before me this day of C , 20 by day 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 idjylike an oath. as identification and who did take an oath. NOTARY PUBLIC: ,00‘ �� ° °0'�., NOTARY PUBLIC: mod= Sign: Print: My Commission Expires: Ili im \ \'` Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * ** * * St* * ** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *** * * * tic * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY /J 2 7:/L 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: ✓4 ll v-s" DA`fE° / ° 7(-/2- ADDRESS: Pe 1416 /) f �` , G � 33 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 entities 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 1, 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, !nit' 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: 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 im p roved ft 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 /414 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 municpal ordinance. Intial /441-' 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 f w 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 govern owner - builders as well as employers. I also understand that the 6onstruction must comply with all applicable laws, ordinances, building codes, and zoning regulations. /4/' Initial 10. I understand that 1 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 Revenue& l also understand that i; may contact the Florida Construction Industry . Licensing Board at 850487.1395 or htto://www.myfloridalicense.com/dborforokilb/index.html html Initial i 4� tm 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 rail—. 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. �� Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It Is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and 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 rcQ , 20 1 By ► ocaciN who was personally known to me or who has Produced there License or OWNER pidentif 99tion. yea• ....• .s.: - • Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 193844 Permit Number: EL -12 -12 -2428 Scheduled Inspection Date: July 01, 2013 Inspector: Devaney, Michael Owner: ADKINS, RANDAL Job Address: 90 NE 105 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1121360120010 Building Department Comments UPGRADE ELECTRIC FOR BATHROOM Infractio Passed Comments INSPECTOR COMMENTS False Passed 7 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- 193700. Not ready. ieviy June 28, 2013 For Inspections please call: (305)762 -4949 Page 18 of 32 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: Electrical JOB ADDRESS: 9(.2 AIE c FBC 201 Permit No. C 1 G5b Sao Master Permit No. City: Miami Shores County: Folio/Parcel #: / / ^ 2. / 3 1 ° 012_- 0010 Miami Dade Zip: .75/3r- Is the Building Historically Designated: Yes % N00% /L Flood Zone: OWNER: Name (Fee Simple Titleholder): `1 L ��1✓S Phone#: 3 0 5-- 7s 4s 23 Address: 5 0 ))e. / C9 s— City: '5 ' i v r `' s State: F1— Zip: .?3 /3 f2' Tenant/Lessee Name: Phone #: 3 C''- 7(? g$'-2-s' Email: A( 4/4- '.' C 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: $ 7e) Square/Linear Footage of Work: % 7 -,'T'T ' c_ /i't_ Type of Work: Address ❑Alteration, ❑pNew Repair/Replace O ODemolition Description of Work- /' <'l�e- 'Ln he-Al- L fi4'"- 15.9-41X rook.- = Ciotale, J € r: AL c,,, se- ox 40 I1 LL � Qjrti4 .< 4 A **************************************1F s ******,**** a: x�* �x�xu�**** �x�x�x�x ****x:a�a� *�x�xa��x�x*** z .7.5 , .rA—,7 Submittal Fee $ Permit Fee $ 71,--•§2-'4°‘? 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. Signature Owner or Agent Contractor The fore oing instrument was acknowledged before me this 2-\ The foregoing instrument was acknowledged before me this day of LC- , 20t 2. , by r'2- \() , day of , 20 _, by who is personally known to me or who has produced - t i-- 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. NOTARY PUBLIC: .tot 11 1 1 1 I I1►►I q�t/i /, .. 4-: Sign: .+ice _ / o �o Sign: — Nor ' <o 4:k.. .o�j•`- Print: = c x k G a> u' - Print: 6 o � . `� My Commission Expires: * *** * * * * * * ** * * * * ** * * ** * * * * * * * ** � �� � � ** * n 2o /a APPROVED BY yr'y/L A /%� °i- 4— Plans Examiner Zoning NOTARY PUBLIC: My Commission Expires: 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 - UILDER DISCLOSU ° E STATEMEN r j NAME: t DATE; % ° 11 ° f ADDRESS: 7 14% /(-25-2°' _ : &.ef r 3 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). Ypei And I have read and understood the following disclosure statement, which entities me to work as my own contractor; ) further understand that f 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). Thetuilding must be for your own use and occupancy. It may not 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 forthatemployee, all as prescribed bylaw. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1, I understand that state law requires construction to be done by a licensed contractor and have applied for an owner- builder permit under an exemption from the law. The exemption specifies that 1, as the owner of the property list ed, 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 ds responsible for the constriction and is not hiring alicensed contractor to assume responsibility. 3 I understand that, as an owner. builder, I am the responsible party of record on a permit I understand that 1 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. l also; understand that the contractor is required by law to be licensed'in Florida and to list his or lice +u. bers 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. 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 i� 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 bylaw and by county or municipal ordinance. Infial a . 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 limfts 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____ v 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 �=� C�/r 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 htto://www.mvfloridalicense.com/dborforo/cilb/index.html 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: Initial ��i° 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 /al— 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 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 , 20 . r By VANDAU ADCA r4 who was personally known to me or who has Produced there License or l I CD ,,,ride )ification. ,``S�\� era , i�i�',''i '/,, S TAT ti. %Jo \ OWNER Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 1 VI° Inspection Number: INSP- 183410 Permit Number: PL -12 -12 -2427 Scheduled Inspection Date: June 19, 2013 Inspector: Hernandez, Rafael Owner: ADKINS, RANDAL Job Address: 90 NE 105 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 1121360120010 Building Department Comments FIX BROKEN PIPIES REPLACE FIXTURES BATH REMODEL Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 19, 2013 For Inspections please call: (305)762 -4949 Page 3 of 38 PERMIT # CONTRACTOR: ( ►. ;` SUBMITTAL DATE: 2- . ( 1°2., ADDRESS: 9 NAME: te--1 �I RESUBMITAL DATES: PROJECT- TYRE: y FIRE STRUCTURAL a./ ELECTRICAL, IMPACT FEES HRS/DERM �LG PLUMBING NOG MECHANICAL j 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 FBC 20 tO BUILDING Permit No. ep L -9`- 9 21 PERMIT APPLICATION Master Permit No. Permit Type: PLUMBING JOB ADDRESS: f () A)1 /67 S City: Miami Shores County: Miami Dade Folio/Parcel #: it/ - x-13 6- (9 f L° 0010 Ls the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ,d% k /s,�s Phone #: ,? eS 257- s 13 Address: 90 1.))- / 0 r 5i Zip: 3.313. City: j 4 .'4 State: FL Zip: 3 /, Tenant/Lessee Name: Phone#: 3o s-- 2S7 l� Email: r4IL"f %/f l' Y oo 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: $ 2‘,061 Square/Linear Footage of Work: "�' 4 ✓�lt� Type of Work: °Address °Alteration °New tepair/Replace °Demolition Description of Work: F%K / t L / ' 1 /7AS 4jeti°k g t ®n ° + x*** ******** *********+xa *** * **+x+x ******** Fees ******** * **** *** ***** *****+x***** * * *** ****** Submittal Fee $ Permit Fee $ /5-r) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE$ \ 10v� �) 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 FLECTRICAL 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 Owner or Agent The foregoing instrument was acknowledged before me this ZJ day of C, , 20by_N ), who is personally known to me or who has produced R 1� As identification andA{}A } fl take an oath. NOTARY PUBLIC: k cc. �O q� ``�Gi ®C43a L • N Sign: Print: My Commission Expires: ** *******x:*******axe ******* APPROVED BY cr> "— • fin►111110r``�. Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: + x**** ***** **+ x**** ******+ x+ x****+ x********** **x:****, x****+ x***** ******** *************** 12'' 2-C -C - `-Plans Examiner Zoning Structural Review Clerk (Revised3 /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 BUI DER DISCLOSURE STATEMENT NAME: t'4� d 4-CJhd S DATE: /I "e `" 12 ADDRESS: 2d l Dc i' .tot ;5 1i 3 3 l ?� 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 built for sale or lease. If you sell or lease a building you have built yourself withirt one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption, You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed bylaw. Your construction must 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. inidal,. I understand that building permits are not required to be signed by ,Er property owner unless he or she is responsible for the construction and is not hiring a: licensed contractor to assume responsibility. 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.) 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 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 p 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_��' rte! 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. Intiali' 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 ��Y/r 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues.) also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or httu:// www. mvfloridalicense .com/dbortnro /albfndex.html Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that l am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying : whether the contractor is properly licensed and the status of the 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 egt day of , 20 1' By a--9)C-1 •' who was personally known to me or who has Produced there License or as identification. OWNER "ow ,,,,S1T1A�}10�. Panel Schedule Jc/ -1 90 l)-- 1054- General Information Panel ID Panel Location Fed From 1 t3ree 1.e 4-e ti Breaker Details r: Main Breaker 1 1 Go Amps i Main Lugs Only J (� Fed -thru Lugs Phase Type: (i Single Phi (' Three Phase Planning Department Voltage Type 120 / 240 'r` -277/ 480 r 120 /208 Brkr Pole Wire (AWG) Pipe Size VA Voltage Description Ckt Ckt Description Voltage VA � +�� Pipe Size Wire Size (AWG) Pole Brkr 20 / Z Ili.) 1/i /1� �! 120 /240 ) L�t�; to_ Sj �4u pk�k� 1 2 1 a -E-e,� -1�� -- 120 � 1' tr 1 ,3 z., Leo sv Z„ r� 1 '1 t i 120/240 ®Ue,� 4 3 4 ,9e.t • ch}� e.. f.14,; 120 240 �2f: t ` 6o So % Aix 120/240 Gae,a.1.00-e C: !`C•. -r' 5 6 L.4 &A,490r, Z0 la-5 120/240 tiro 1/L t' / L / ZO q0 Z_ L/Z " 120/240 '. r W�c+' Of t r' �' 7 9 8 10 al at- tJ JI )1 i9' Awte (;illy u- 01e 0,4,iti'. 120/240 120/240 54< 5,41 //2 n 1 /L" /0 /D '2-' 30 30 �0 8 IA ,, 9.6k 120/240 cliGi�61- C4 C tc.-; •4- 20 / 1 2 /rfa 120/240 11 12 /';o; iQotav, (9flci'1 H4- 11 leg 14- V1l1041 64-i'itr0t9q. �.it�},.�'.actid. 120 /zoo �y rd fl i2 / 2-" ZJ Z O ! j 2 1f I/L !� 120/240 t A;(zr � L; �1f L I t C 1 - _r1 5 t4OSQt� 13 14 120/240 2z) / 1 2_ //Z 1' /ga 120/240 {'tt 0,4-1,4- - kei•r: i; ?, /,,,0 15 16 120/240 Z 0 ZD / / Z. / tv 120/ 240 t a 17 18 120/240 20 2 Z .i t / 2 11 1 z ) D 120 /240 kJ:" 12004.2.o,��k fa- k- ,41 ; ,. ,.. (9.Aiti -/ c41 19 21 20 22 1 rtGle".";t 11iit'F ".4.- >ar`.. l � t tit ll(k5�IJPs 001-14,1% iti- '�' 120/240 120/240 1�'(7 t /)zIr / �. ( 2(/ 120/240 120/240 23 24 120/240 25 26 1201240 B - -; r 2efr .., 27 28 120/240 - - - i', /,7 -Tnii P ini 204_ - 0 ; Villan, PO' 00 120/2 29 30 120/240 ,FP i Y rn, -o-L e ,33 3 2 ; 120/240 s r ON'1r.iG DFP .r 120/2 _ 33 34, " f �' ■ " 1201240 DC3 C %' _� P III /,/ / %� 1 174/01-/-43 'pp : : 5/ �6 / 120 /240 UL' EGT 1 0 C( P,I "I. 'j ICE l4/240 I - r)��. l 37 ' 38 120/240 TA I r FJ` v Li_ .fJi�a i ! n' ,L�`�;1fdL� 12pr2ao F1(-■ il_J1�1'`1G�h,j`; J { � - 120/240 120/240i2 120 /240 Notes 1) All Electrical Works Shall Be Done In Accordance With The Approved Drawings, The National Electrical Code And Current Local Electricity Laws And Regulations. Any Deviation From The Approved Drawings Shall First Be Approved By The Electrical Inspectorate, 2) All Electrical Works Is To Be Done In A Neat And Acceptable Manner. 3) Provide 4 -Wire Branch Orcuits For All Dryers, Ranges And Cook Tops. 4) All Switches / Receptacles Located In Bath Rooms To Have Ground Fault Protection. 5) No Mini Breakers Are To Be Installed 6) Provide Light And Receptacle In Attic For Servicing Equipment. Questions or comments about this form? Contact darren.enns @gov.ky Print Form Rx.i&14- 9 D )116` 1 OS- c 4c1 )6,4eci (Jo al ow'4-1Q' 1-S C zdki I 2 qoo So �,., 3 I Z is SO o 5. 1 z �lv 14�io 9 °l • 6 20 Aryl 1 1 2‘100 Zv4410 13 2-goo Zvr 1c Z q00 2ohy 24 oO Z &47O 1 �1 Z Woo ©rfwo k e ! L K �.� 304~10 /0 `1.1\,- , / 2_ Z go 0 2 0,,y J L/ 2ciAio / , 2,01664p 20 2-4oc; ='ce 0 VC-0 �09 J.4-:O�e:-- Otc1i (A-'2c1 Aaster 1-k Sw; },k 1-..1k4 1 -1.4- c l ose i- 1,, f) Ash I6ed,00.1 /0,4-/e4- Owe. .�.� -ie�- r Fe. f ,s ict4-1- 41 %ire' R0 2owfIe'tj I .— L C�. ;.1 RdoM, L J-i F� Ock<e tc)4° e, lrer cie,JJ : c4-f J c '-c = �- G e L0J-L* 1 L..el k7— c ; v5 eook, 1 ottA.14.4 -) ok...4 64irk t YX.V. 104,4-1,4- 1 4 N - 1 1 1C. +eL-4.i i� IFS t( Ycr U L C 4- i 0„ -lets )6¢c too w- 1 0=44 44-. z0 174 +44-64,, 111 EK vvi Ai( S6K. - 1--Zgo 12o0 Grt �So 4 ►4,k. at I� 1,..1A -4-er 14¢)-et- 4 -0 f_. �- Z `'! 13e,I,aa..,, . reGeOl'Ac Co I4-;Owe, Chi he Aqle 6/4 ALA tik+-5.0 , /mn29te..- Cres,. f&. ie., 4--for/A9,-sk 4.4. 9 - i- /O f 0 /1 - 20✓., rc"/'I; cIe 14,0) ) mkc-773kkrJOw NceeQE -tile 10on 1U recern ?Ore It 1.' 11,+- a: r 5 'oo,._ w 5.c1e r-ece., -(40 le . 1 ec1r, C 4 l R; Se `7 o VU' 1 c`3S c B -a G, �+ pe_ e(1ae 1 e ;A:N ; ti � �►+� ',c (/ t461' s9. ✓,,,� 00A, 114461-tr 69.1 Doh ►v k14 t1 a.+kl fEG 21 2012 Jti.f` 0 W 0 w LL J T w U 0 0 IL) Lt 1 J 1 huh ►kc��Cr�7 : ,J S R 33/.3r refk: 1j 4-100 r J0 :44- BAS r, RECEPTACLE ON 20 AMP GK G.EI PROTECTED �I9P1 I Uu SMOKE/CARBON MONOXIDE DETECTOR ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. \c\d% ( Miami Shores 'iIIage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 December 3, 2012 Permit No: EL12 -2428 f2 —Lf2 Electrical Critique — Michael Devaney 1) Need panel schedule, riser diagram and load calculation. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings.