RC-10-1060Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 145823 Permit Number: RC -6 -10 -1060
Scheduled Inspection Date: September 16, 2010
Inspector: Bruhn, Norman
Owner: STOBS, BETH ANN
Job Address: 9031 NE 4 Avenue Road
Miami Shores, FL
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number (786)236 -1198
Parcel Number 1132060460160
Building Department Comments
REMOVE EXISTING KITCHEN CABINETS AND INSTALL
NEW CABINETS
Passed yy
Failed
9,k41
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 15, 2010
For Inspections please call: (305)762 -4949
Page 4 of 23
1
Protect Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795 -2204
Parcel Number
Applicant
z
9031 NE 4 Avenue Road
Miami Shores, FL
1132060460160
Block: Lot:
BETH ANN STOBS
Owner Information
Address
Phone
Cell
BETH ANN STOBS
9031 NE 4 AVE RD
MIAMI SHORES FL 33138 -3183
(786)236 -1198
i
Contractor(s)
HOME OWNER
Phone
Cell Phone
Valuation:
Total Sq Feet:
$ 6,000.00
130
1
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Construction: KITCHEN REMODEL
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted:
Certificate Date:
Bond Return :
Occupancy:
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Fees Due
CCF
DBPR Surcharge
Education Surcharge
Permit Fee
Radon Surcharge
Scanning Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Total:
Amount
$3.60
$0.65
$1.20
$180.00
$0.65
$6.00
$50.00
($50.00)
$4.80
$196.90
Pay Date Pay Type
Invoice # RC -6 -10 -38159
06/30/2010 Credit Card
06/10/2010 Cash
Amt Paid Amt Due
$ 146.90 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final PE Certification
Shutter Final
Window Door Attachment
Tie Beam
Slab
Termite Letter
Framing
Insulation
Drywall Screw
Shutter Attachment
Window and Door Buck
Ceiling Grid
Fill Cells Columns
Declaration of Use
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
June 30, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 30, 2010
1
(t)A9c1\
Miami Shores Village To rm w,
Buildin g Department
artment
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 BY:
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit T BUILDING ' OOFING
Permit No. VCI O l C:Pb
Master Permit No.
Owner's Name (Fee Simple Titleholder) Beth Ann Stobs Phone # 786- 236 -1198
Owner's Address 9031 NE 4th Ave Rd
City Miami Shores State FL Zip 33138
Tenant/Lessee Name Phone #
Email bag tobs @stops . coin
Job Address (where the work is being done) 9031 NE 4th- Ave . Rd.
City Miami Shores Village County Miami -Dade Zip 33138
FOLIO / PARCEL # 11- 3206 - 046 -0160
Is Building Historically Designated YES NO XX Flood Zone No
Contractor's Company Name eg ne Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable) OJ JA Phone #
N ICI.`.
Value of Work For this Permit $ 6000.00
Type of Work: DAddition u Alteration
Square / Linear Footage Of Work: 130 sq. ft.
Describe Work: Remove existing kitchen cabii ;ets &, insta4 new ca1x fal s
❑ Demolition
**** * * ** ** * ** ** *** * ** * * **** ** ** * * **
** *Fees * * * * **
Submittal Fee $50 • Permit Fee $ /CO*243 CCF $ 0 { J CO /CC $
`PPsi S�
Notary $ Training/Education Fee $ 1 '9'0 Technology Fee $ 4.10
Scanning $(yCj(J Radon $ 0- DPBR $ O'COE Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ (21(.0'
****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
See Reverse side -+
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 Li
day of ) , 20 E 0, by hAt i\ s4
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
MILDRED Y. GOMEZ
Contractor
The foregoing instrument was acknowledged before me this l7
day of cS■A — , 2010 , by J J2 C( } 701.3
who is personally known to me or who has produced fie
as identification and who did take an oath.
My Commission Expires:
APPROVED BY
NOTARY PUBLIC ;00111;11d ®i,,,e�
,Mi g,;; 1 i ,
Sign:
Print:
8Bd A8ViON
My Commission
- Z• aZ a0�0
• ,unnn►►
Plans Examiner Zoning
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO.
TAX FOLIO NO. 11- 3206- 046 -0160
STATE OF FLORIDA
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
111111111111111111111111111111111111111111111
CFN 201080352933
OR £k 27297 Ps 2574; Pips;
RECORDED 05/26/2010 10:14:47
HARVEY Rl1VIi4 CLERK OF COURT
MIAMI -DACE COUNTY? FLORIDA
LAST PAGE
1. Legal description of property and street/address:.Shthres vi 11 as Cnnria. R1 rig A' Unit
9031 Undiv 1/88% Int In common elements Clerks Files 74R- 185949 &
74R- 263202
2. Description of improvement: Remnvp px; sting Kit-r•hen nabinets & appliances and install
new cabinets & appliances
3. Owner(s) name and address: Beth Ann Stobs 9031 NE 4th Ave. Rd. Miami Shores ,FL
Interest in property: 100%
Name and address of fee simple titleholder:
4. Contractor's name and address: Beth Ann Stobs (owner /builder)
9031 NE 4th Ave Rd, Miami Shores, FL 33138
5. Surety: (Payment bond required by owner from contractor, if any 1111
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be
provided by Section 713.13(1)(a)7., Florida Statutes,
Name and address: Donald W. Stobs, Jr
9505 NE 5th Avenue, Miami Shores, FL 33138
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice
in Section 713.13(1)(b), Florida Statutes.
Name and address:. Carol Stobs, 580 NE 92nd St Miami Shores, FL 33138
sell
as
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different dynte; c ed)
Sig re of Owner
Name��
Print Owner's
Sworn to and subscribed before me this
Notary Public
Print Notary's Name
My commission expires:
123.01 -52 PAGE 4 8/02
4 Y p *, MILDRED Y. GOMEZ
4f+'i
? Notary Public •State of Florida
s My Comm. Expires Aug 24, 2013
q ''•. off:' Commission # DD 916836
Prepared by A V S
Address:
5460 NE-eta -.
Corikt:x".V.S. SkrNCreS PL.
3-5V5
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: Rpth Ann Stahl
DATE: 5/75/2010
ADDRESS: 9031 NE 4th Avenue Road, Miami Shores, FL
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 ?;AYS
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 0.5
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
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.
Initial `;'-`
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 ('" ° ""
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. I also understand that I may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or htto : / /www.mvfloridalicense.com /dbpr /pro /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:
9031 NE 4th Ave. Rd
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 A5 day of 5-011 6 , 20 .10
By 15e An S-to b6
who was personally_ known to me or who has
Produced there License or as identification.
0 \��
� el ON • 0\\ \ate
11/111,1 r100
°"* ''`•. MELISSA RAMIREZ 0
E . +� ° Notary Public - State et Florida
z0.1 car My Comm. Expires Aug 24.2013
Voo,,,vot7 Commission # DO 917941
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Miami Shores Village
APPROVED
BY DATE
ZONING DEPT
BLDG DEPT
SUBJECT i O CCMPIJANCE WITH ALL FEDERAL
^STATE AND CLUN iY RULES AND REGULATIONS
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JUN 1 2010
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33:"
Morelm , Kitchen and Bathe, Inc.
All dimensions and size designations
given are subject to verification on
job site and adjustment to frtjob
conditions. This is an original design
and must not be released or copied unless
applicable fee has bean paid or job
Designed 5/14/2010
Printed: 6/1/2010
MUNOZ.kit
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C Momlm> r Kitchens t Esth , inc.
All dimensions and size designations
given are subject to verification on
job site and adjustment to fit job
conditioner This is an original design
and mast not be releaeod or copied unless
applicable fee has been paid or job
MUNOZ.kit
Deeignad: 5/14/2010
Printed: 6/1/2010
113rawing #: 1 j Seale : 0 3/8" = 1'
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® Moralmmr Kitchens and Baths, Imo.
All dimensions and size designations
given are subject to verification on
job site and adjustment to fit job
oomlitioo . This is an original design
and mast not ba misused or copied unless
applicable fee has been paid =job
MUNOZ.leit I All
Designed: 5 /14/2010
Printed: 6/1/2010
1 Drawing #: 1
Will Call Tri County Couriors
C/o Title Guaranty of S Fl.
4430 Weston Rd •
Davie Fl. 33331
THIS
iNirmumma PREPAREDBYANDRETURNTO:
Title Guaranty of South Florida Inc.
4430 Weston Road
Davie , F%. 33331
Property Appellees Patel Idenlification (Folio) Numbers: 1132060460160
1 111111 01111110 1111 111111111 11111 1111 1111
CFN 2010R0371899
OR Bk 27306 Pas 1269 - 12711 Gass)
RECORDED 06/03/2010 14/06121
DEED DOC TAX 730.00
HARVEY RUVIN, CLERK OF COURT
HIAHI -DAOE COUNTY, FLORIDA
Space Anne 'lids Lbw For Recording Dem
THIS WARRANTY DEED, medethe 6th day ofM y,2010 by DANIEL VELMLLA, a single man and JAMIE
VELILLA end CLARA W VELD LA, husband end wife whom post oiace address is 9031 NE 4 AVE RD,?sIIAKI
SHORES, PL33138herein called the graters, to SETH ANN STORE, whose post office address is 9031 NE 4 AVE
RD, MIAMI SHORES, P2,33138„ hereinafter relied the Grantee:
=dimming* toien tame ea -8 mere 9xaAedt all tepanuer to this inamasent mid the hairg legal
a ml anignsofftelkidroak mu hits auseassort andass(Viaeir
WI T N E S SE T He That the gowns, for sad in conddentionofdm sum ofTEN AND 00/1008 (51000) Dollars end
other valuable 000aid , receipt whe eofis hereby acknowledged, hereby grants, bargains, sells, aliens, remises,
releases, c o n v e y s zed coa> S unto the grantee ep that certain Inml situate in bIIAMid1ADE County, State ofPlorlda, viz.:
Unit No. 9031 of SHORES VH.LAS, a Condominium, according to The Declarastbut of Comlominfam
recorded to O.R. Book 87S1,Page 1715, and all exhibits and amendments thereof, Public Records oMiami-
Dade Canty, Florida.
Subject to easements, restrictions and reservation; of record and taxes for the year 2010 and thereafter.
TOGETHER, with all dhe teinellientS, hesedite urns and appurtenances thereto to bolo tar is anywise wing.
TO HAVE AND TO HOLD, tho same in flee simple forever.
AND, the gondola bezeby covenant with said grates thethe grantors are lawfdly seined of said land in &e simple; data
the wanton have good hs tand la dbl authority to sell amt convey said lased, and hereby watrasmthe title to said kind and
will defend the same agah t*e lawful *inn *fall persona whomsoever; and that said>and ht free *fan encumbrances,
except taxes accruing absented to December 31, 2009.
IN WPPN S WHEREOF, the said grant rs bave sdgoed and seated these presents the day and year first above written.
1 eWa Tel 0 -209
Book27306 /Page1269 CFN #20100371899 Page 1 of 3
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 145843 Permit Number: PL -6 -10 -1062
Scheduled Inspection Date: September 15, 2010
Inspector: Hernandez, Rafael
Owner: STOBS, BETH ANN
Job Address: 9031 NE 4 Avenue Road
Miami Shores, FL
Project: <NONE>
Contractor:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (786)236 -1198
Parcel Number 1132060460160
Building Department Comments
REPLACE SINK, DISPOSAL, REFRIDGERATOR
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 14, 2010
For Inspections please call: (305)762 -4949
Page 5 of 19
1
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
9031 NE 4 Avenue Road
Miami Shores, FL
1132060460160
Block: Lot:
BETH ANN STOBS
Owner Information
Address
Phone
Cell
BETH ANN STOBS
9031 NE 4 AVE RD
MIAMI SHORES FL 33138 -3183
(786)236 -1198
Contractor(s)
HOME OWNER
Phone
Cell Phone
Type of Work: REPLACE SINK, DISPOSAL, REFRIDGERAT
Type of Piping: PLUMBING
Additional Info: KITCHEN REMODEL
Bond Retum :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Surcharge
Education Surcharge
Permit Fee - Additions/Alterations
Radon Surcharge
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$0.65
$0.20
$150.00
$0.65
$3.00
$0.80
$155.90
Pay Date Pay Type
Invoice # PL -6 -10 -38161
06/30/2010 Credit Card
06/10/2010 Cash
Amt Paid Amt Due
$ 105.90 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Re Pipe
Main Drain
Heater
Water Service
Final
Water Main
Lavatory
Underground
-,
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
June 30, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 30, 2010
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
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) Beth Ann Stobs Phone # 786- 236 -1198
LCttL., nil ' ! 5'9 7
JUN 0 9 201(i y
BY:
No. P I O ~ )O( L
Master Permit No. ,10-- 10(40
Owner's Address 9031 NF. 4th Ave. Road
City Miami Shores
Tenant/Lessee Name
State FL
Zip 33138
Phone #
Email bastobs @stobs.com
Job Address (where the work is being done) 9031 NE 4th Ave: Road
City Miami Shores Village County Miami -Dade Zip 33138
FOLIO / PARCEL # 11- 3206- 046 -0160
Is Building Historically Designated YES
Contractor's Company Name Owner /Builder
Contractor's Address
NO XX Flood Zone No
Phone #
City State
Qualifier Name
Zip
Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone
Architect/Engineer's Name (if applicable)
E -mail
Phone #
Value of Work For this Permit $ 200.00
Type of Work: ❑Addition
Square / Linear Footage Of Work: — 130
❑Alteration ❑New )J Repair/Replace ❑ Demolition
Describe Work: Replace sink, disposal, Refridgerator (no dishwasher)
**** x* *, * * * * * * * *x * * * * * ** * * *** * * * * * * ** *Fees*
Submittal Fee $ • ��
Permit Fee $
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
/0c)-- CCF $ (a0 CO /CC $
Notary $ Training ducation Fee $ O
Scanning $ Radon $ O �U� DPBR $
Double Fee $ Violation date:
Technology Fee $
Bond $
0.0
Structural Review. $ Total Fee Now Due $ IOS'10
See Reverse side -
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 AFFIDAVIIjt: 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
CONCEM*NT 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 k 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 wiich 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 Lk
day of J� , 20 10, by ∎-b \
who is personally known to mor who has produced
cetrzioNc.A As, identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY
Notary Public -
4 My Comm. Expires Aug 24. 2013
°' Commission # D0 916836
Signature
Contractor
The foregoing instrument was acknowledged before me this 'P
day of SLR (..__ , 20\13, by i. 1 3.7C
who is personally known to me or who has produced
as identification and. who did take an oath.
���N uUhry
NOTARY PUBLIC: ���` \\ \014 d0 ���'",
;`���.A ®• • 106S9LO0
uo!ssiww •
(Revised 07 /10 /07)(Revised 06/10/2009)
Sign:
Print:
nO11901£0
My Commission Expir4: ay i d ...?
efilus
Zoning
Clerk checked
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: Beth Ann Stobs DATE: 6/4/10
ADDRESS: 9031 NE 4th Ave Rd,/Miami Shores, FL 33138
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.
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
ktip
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.
Initial
5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction.
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.
Initial `
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 e
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
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. I also understand that I may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.mvfloridalicense.com /dbpr /pro /cilb /index.html
Intal
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:
goad N LIA „AJe_ C2,
Initial t-” -)1f
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
retumed 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 LI day of ��� , 20 % 0
By iAM\ c)
Produced there License or
who was personally known to me for who has
uuuu,
voNo
,////////:/111111\,000 � c9i\\`�
as identification.
MILDRED Y. GOMEZ
3 s Notary Public - State of Florida
. = My Comm. Expires Aug 24.2013
••.,., n. o` Commission # DD 916836
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
1v
Inspection Number: INSP- 151241
Permit Number: EL -6 -10 -1061
Scheduled Inspection Date: September 15, 2010
Inspector: Devaney, Michael
Owner: STOBS, BETH ANN
Job Address: 9031 NE 4 Avenue Road
Miami Shores, FL
Project: <NONE>
Contractor: AGC ELECTRIC, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (786)236 -1198
Parcel Number 1132060460160
Building Department Comments
KITCHEN REMODELING 8LIGHT FIXTURES 3 DIMMERS
SWITHCES, 1 SINGLE SWITCH, 2 GFI RECEPTACLES, 4
DUPLEX RECEPTACLES, 1 GARBAGE DISPOSAL
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
September 14, 2010
For Inspections please call: (305)762 -4949
Page 18 of 19
1
Protect Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
9031 NE 4 Avenue Road
Miami Shores, FL
1132060460160
Block: Lot:
BETH ANN STOBS
Owner Information
Address
Phone
CeII
BETH ANN STOBS
9031 NE 4 AVE RD
MIAMI SHORES FL 33138 -3183
(786)236 -1198
Contractor(s)
AGC ELECTRIC, INC
Phone
Cell Phone
Valuation:
Total Sq Feet:
$ 935.00
130
1
Type of Work: KITCHEN REMODEL
Additional Info: ELECTRICAL
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Surcharge
Education Surcharge
Permit Fee - Additions/Alterations
Radon Surcharge
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$0.65
$0.20
$225.00
$0.65
$3.00
$0.80
$230.90
Pay Date Pay Type
Invoice # EL -6 -10 -38160
06/30/2010 Credit Card
06/10/2010 Cash
Amt Paid Amt Due
$ 180.90 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: 1 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. Futhermore, I authorize the above -named contractor to do the work stated.
June 30, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 30, 2010 1
Miami Shores Village
� Ev7 , h
Building Department Jury 4w, a
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 '
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 BY: ••••
BUILDING
PERMIT APPLICATION
FBC 20
Permit No. F- L 10 f 0 (Ye'�
Master Permit No I 0 —1(3e2C)
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) Beth Ann Stobs Phone # 786 -236 -1198
Owner's Address 9031 NE 4th Ave Road
City Miami Shores State F1 Zip 33138
Tenant/LesseeName Phone #
Email bastobs @stobs.com
Job Address (where the work is being done) 9031 NE 4th Ave Road
City Miami Shores Village
FOLIO / PARCEL # 11- 3206- 046 -0160
Is Building Historically Designated YES
County Miami -Dade
Zip 33138
Contractor's Company Name A G
NO XX
Contractor's Address a ez =lot s'Q
Flood Zone Nn
Phone # 5623 v 2 2 %Cs
City V.® State S N-
Qualifier Name h T . v vw•�-
State Certificate or Registration No. E C C 00 o '1
Contact Phone it%tom, %* 0 b le v wv
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Work: r.\Tc.V.+.M.
a.s Q• Sa.
Zip 3'%1:40‘
Phone # l °
Certificate of Competency No.
E -mail °'°J a ale r c ✓l
Phone #
413S• °°
Alteration
V�►o 41. Via. c
G FEZ
Square / Linear Footage Of Work: L
:New ❑ Repair/Replace ❑ Demolition
�fi l•s i -% ter -t i 1 _tas J 9
********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *'* Fees****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ c�V.W Permit Fee $ 2 2-5747e) 3 f,U'Sj CCF $ O' WO CO /CC $
Notary $ Training/Education Fee $ 0•20 Technology Fee $ 0480
Scanning $3'00 Radon $ 0.CaS- DPBR $a• JS Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 1 go' C� 4O
See Reverse side —.
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 . osted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In t4 e absence posted notice, the
inspection will not be approved and a re- inspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this LA
day of -)C. ,20ta,by e AM \ �,
who is personally known to meor who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign.
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * **
APPROVED BY
Notary Public - State of Florida
S. '= My Comm. Wires Aug 24, 2013
*rap „p Commission DD 916836
Signature
The foregoing ins
day of t J
[Lr
ontractor
as acknowledged before me this?
Gur ct:r),
20 It , by
who is personally known to me
as iden
ho has produced
and who did take an oath.
Sig
Print:
My Commie' ion Expires:
****************************************** **** *** ** * ** ** * * *** * * ** * * *** *** t****
je.44-ialans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Zoning
Clerk checked