DS-13-1049 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-191412 Permit Number: DS-5-13-1049
Scheduled Inspection Date: December 24,2013 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: LUBIN, PATRICK&LAREMISE Work Classification: Addition/Alteration
Job Address:11121 NW 6 Avenue
Miami Shores, FL 33168-3311 Phone Number
Parcel Number 1121360210600
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
INSTALLATION OF CONCRETE APPROACHES IN FRONT Infractio Passed Comments
OF TWO EXISTING DRIVEWAYS TO LEGALIZE INSPECTOR COMMENTS False
ENFORCEMENT ORDER
Inspector Comments
Passed
rJ l>i
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
December 23,2013 For Inspections please call: (305)762-4949 Page 5 of 21
a
. 4 Miami Shores Village
Y 1 3 2013
. -� -
�, Building Department
�a�000mo®�®�Bpooaoo�o
l� 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 No U-1049
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: 1 112( ( l W 6 �
City: Miami Shores County: Miami Dade Zip: 1 ��
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): c�'��C�� y 1 Phone# C%cl) r
Address: ` J 615rJ1r__
City: m iris I S�a<Q S State: �" Zip: 3� ' 6
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: � '��f� 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 s Permit:$ Square/Linear Footage of Work: (,3-bo r
of Work: ®Addition DAlteration ONew ORe air/Re lace emolition
Type P P
Description of Work: Q V e-
Color thru tile: �
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
d .,Bonding Company's Name(if applicable) r
Bonding Company's Address
City State Tap
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
f or the first inspection which occurs seven (7) d ay s after the building P ermit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature A Signature
Owner or Agent Contractor
The foregoin meE,,s ac ledged efo e The foregoing instrument was acknowledged before me this
or who has produceEl. ho is personally known to me or who has produced
�' as identification and who di an oath
enhfication and who did take d take
NO RY P LIC: " ' S eye a�2`�`ILI) NOTARY PUBLIC:
se4 ��0
e 2 5
c 1 s
Sign: Sign:
Print: }• - °mt��p Print:
My Commissi n Expires: ��;4,E�F;;' My Commission Expires:
/ 1-7
APPROVED BY Plans Examiner ! f—/13 Zoning
Structural Review Clerk
(Revised 3/12(2012)(Revised 07/10/07XRevised 06/10/2009)(Revised 3/15/09)
Miami Shores Village
Building Department
K
10050 NZ.2nd Avenue
Miami Shoras, Florida 33138
Tel: (305) 795.2204
Fax: (305)756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: ?A�r t c. K DATE: 1
ADDRESS: I \ 1 1 ► i a ► 331 L
Do hereby petition the Village of Mfaint 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'cotnplets,.t1folaw wiil:presume thabyou built for sale or lease,which Is-a violation of this exemption.You may not hire
an unlicensed person as a contractor.It is your responsibility to make sure the people employed by you have licenses required by state
law and by county or municipal licensing ordinances.Any person working on your building who is not licensed must work under your
supervision and must be employed by you,which means that you must deduct F.I.CA and with-holdings tax and provide workers'
compensation for that employee,all as prescribed by law.Your construction must comply with all applicable laws,ordinances,
buildings odes 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 Oft,may ad as my own
contractor with certain restrictions even though I do not have a license.
Initial �L .
2. 1 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. I
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 fist his or license numbers on
permits and contracts.
Initial L
4. 1 understand that I may build or Improve a one family or two family residence or a farm outbuilding.I may also bul d or improve
a commercial buiiding 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 tease. If a building or residence that I have built or substantially improved
myself Is sold or leased within 1 year after the con*ucUm Is complete,the law will presume that I built or substantially
Improved it for sale or lease,which violates the exemption. Initial p
5. 1 understand that as the owner-builder,I must provide direct onske supervision of the construction.
Initial Q L
6. 1 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. 1 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
Gable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees'Ob{
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 limb of my insurance coverage for injuries to workers on my property. ,p
Initial 9
8. 1 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 me=that I must comply with laws requilithg the withholding of federal income tax and
soda]securly contnbutions 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. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all applicable
laws and requirement that govern owner-builders as well as employers.I also understand that'lle
Construction must comply with all applicable laws,ordinances,building codes, -and zoning regulations. t
initial .;� l•
10. 1 understand that I may obtain more Infometion regarding my obligations as an employer from the Internal Revenue Service,the
United States Small Business Administration,and the Floride Department of Revenues.I also understand that I may contact the
Florida Construction Industry licensing Board at 850.487.1395 or,httDJ/www.mvfloridel icerse.coMdbortrolcilblindexAml
Initial 1
11. 1 am aware of,and consent to,an owner-buckler 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:
Inmel L
12. 1 agree to notify Miami Shores pillage immediately of any additions,deletions,or changes to any of the Information that I
have provided on the disclosure.
Initial 1P 1,
Licensed contractors are regulated by laws designed to protect the public.If you contrect with a person who does not have a
license,the Com Nuction 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 elso 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
venfyirg whether the contractor Is property 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 properly owner's driver license,the
n oWted signature of the property owner,or other type of vedfirtation acceptable to the local permitting agency Is required when
the permit Is Issued.
Was acknowledged before me this day of ��� .20�
By 20 1 )C,, . -L-= who was personally known to me or who has
den' tion.
AV4
OWNER NOTMIA V.CUDNotaryAssn.
ry
` ? Notary Public -Stat
•, - My Comm Expires S
s; ac` Commission#EE
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MAP OF SURVEY
11121 & 11125 N* 6TH AVE.
MIAMI . FL 33168
NW 112TH ST . (50 ' R/W) (P)
5 30 7S
y 'aM1+ ASPHALT ROAD
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ARC: 39.24' a 4' CLF ALONG
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LOT 19
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� BLOCK 4
13LDG DEPT
SUBJECT TO COMPLIANCE WITH ALL FEDERAL WEST SHORES
STATE AND r01INTY RULES AND REGULATIONS
PB 42/18
AS—BUILT SURVEY FLOOD ZONE. X
PREPARED BY: LAWRENCE E. POWERS LS # 5505 FEMA FIRM.MAP # 12086CO139L
1235 FARRAGUT DR N ST. PETERSBURG, FL 33710 DATED SEPT. 11 , 2009
P: 727-537-9895 E: SURVEYINGSTPET.E®GMAIL.COM PANEL # 0139 SUFFIX L
DATE: MARCH 5, 2013 PROJECT #: 111256 COMMUNITY # 120635 PAGE 2 OF 2
COPYR I GH.T 2013
LAWRENCE E 'POWERS MAP OF SURVEY
TYPE OF SURVEY: AS-BUILT
PREPARED FOR: PATRICK LUBIN, LAREMISE LUBIN SUBJECT ADDRESS. LEGAL DESCRIPTION SUPPLIED:
CERTIFIED TO:
A) PATRICK LUBIN, LAREMISE LUBIN 11121 & 11125 4 6TH AVE. LOT 1, BLOCK 4, WEST SHORES, AS
B) PER MAP OR PLAT OF RECORD IN
C) V141 , FL 33168 PLAT BOOK 42 AT PAGE 18 OF
THE PUBLIC RECORDS OF MIAMI-
DADE COUNTY, FLORIDA.
PROJECT #: 111256 LAT: 25 052'38. 1" N LONG: 80 012'29.3" W
FIELD SURVEYED: MARCH 6, 2013 YEAR BUILT: 1959
DATE DRAWN: MARCH 11, 2013 SUBD. PLAT DATE: 1940
DATE SIGNED: MARCH 12, 2013 FOLIO #: 11-2136-021-0600
LOT SIZE: 10,034.6 +/- SOFT
LAND USE: MULTIFAMILY 2 LIVING UNITS
SECTION: 36 T52S R41E
GENERAL NOTES:
ADDITIONS OR DELETIONS TO THIS SURVEY MAP OR REPORT OTHER THAN LEGEND:
THE SIGNING PARTY IS PROHIBITED WITHOUT WRITTEN CONSENT OF THE
SIGNING PARTY PER FLORIDA STATUTES RULE 61G17-6.003(2)(E). (FM) FIELD MEASURES
(D) DEED
RE-USE OF THIS SURVEY FOR PURPOSES OTHER THAN WHICH IT WAS INTENDED (P) PLAT
WITHOUT WRITTEN CONSENT FROM THE ENTITY IN WHICH IT WAS PREPARED (R/W) RIGHT-OF-WAY
FOR, WILL BE AT THE RE-USERS SOLE RISK AND WITHOUT LIABILITY TO (NR) NON RADIAL LINE
THE SIGNING SURVEYORS OR ITS FIRM. (IP) IRON PIPE
(1/R) IRON ROD
NOTHING HEREIN SHALL BE CONSTRUED TO GIVE ANY RIGHTS OR BENEFITS (CM) CONCRETE MONUMENT
TO ANYONE OTHER THAN THOSE WHOM THE SURVEY WAS PREPARED FOR. -E- ELECTRIC LINE
(4.53) DENOTES ELEVATION
THIS MAP CONSIST OF 2 SHEETS. WHEN MULTIPLE SHEETS COMPRISE THE -T- TELEPHONE LINE
-X- FENCE
PLAT OR MAP OF SURVEY NO SINGLE SHEET SHALL BE CONSIDERED FULL AND (FH) FIRE HYDRANT
COMPLETE WITHOUT THE OTHER/S.
ENO ENCROACHMENT
(WV) WATER VAVLE
LANDS SHOWN HEREON WERE NOT ABSTRACTED BY THIS SURVEYOR FOR (WM) WATER METER
EASEMENTS AND/OR RIGHTS OF WAY OF RECORD.
(CLF) CHAIN LINK FENCE
" SECONDS SYMBOL
THIS SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES (WPP) WOOD POWER POLE
NAMED HEREON, THE CERTIFICATION SHOWN HEREON DOES NOT EXTEND TO (CPP) CONCRETE POWER POLE
ANY UNNAMED PARTY. FP&L FLORIDA POWER& LIGHT
ESM'T EASEMENT
THIS IS AN ABOVE GROUND SURVEY AND LOCATIONS ARE LIMITED TO VISIBLE MINUTE SYMBOL
IMPROVEMENTS ONLY. NO IMPROVEMENTS HAVE BEEN LOCATED EXCEPT AS ° DEGREES SYMBOL
SHOWN. THERE MAY BE ADDITIONAL ABOVE GROUND AND/OR UNDERGROUND W WEST
UTILITIES / IMPROVEMENTS NOT SHOWN ON THIS SURVEY. <- GUY ANCHOR
E EAST
NO ABSTRACT OF TITLE, TITLE COMMITMENT, NOR RESULTS OF TITLE S SOUTH
SEARCHES WERE FURNISHED TO THIS SURVEYOR. THERE MAY EXIST OTHER BLDG BUILDING
DOCUMENTS OF RECORD THAT WOULD AFFECT THIS PARCEL. N NORTH
(FD) FOUND
MEASUREMENTS SHOWN HEREON ARE IN U.S. SURVEY FEET AND DECIMALS 0 SET IRON ROD
THEREOF. 0 FOUND IRON ROD
❑ SET CONCRETE MONUMENT
m FOUND CONCRETE MONUMENT
THE EXISTING MONUMENTATION AS SHOWN HEREON HAS BEEN HELD TO DEFINE (PC) POINT OF CURVATURE
THE PLAT AND RECORD BOUNDARY TITLE DESCRIPTIONS. SAID MONUMENTATION (PT) POINT OF TANGENCY
HAS BEEN DETERMINED TO BE THE BEST ACCEPTABLE EVIDENCE OF THE
DEEDING INTENT OF THOSE AREAS INVOLVED. SAID EXISTING MONUMENTATION A 1 INCH IRON PIPE OR
MAY OR MAY NOT HARMONIZE WITH STANDARD SECTIONALIZED LANDS LINES, 5/8 INCH REBAR WITH A
OTHER RECORD PLAT BOUNDARIES OR LIMITS AND OTHER FEE TITLE PLASTIC CAP LABELED LS
DESCRIPTIONS ADJACENT TO THE AREA SHOWN HEREON. 5505 IS SET WHERE SET IS
INDICATED ON THIS PLAT.
THERE MAY BE ADDITIONAL RESTRICTIONS AND/OR OTHER MATTERS THAT ARE
NOT SHOWN ON THIS PLAT OF SURVEY THAT MAY BE FOUND IN THE PUBLIC
RECORDS OF THIS COUNTY.
THE TERM CERTIFIED AS USED ON THIS PLAT, IS UNDERSTOOD TO BE THE
PROFESSIONAL OPINION OF THIS SURVEYOR WHICH IS FORMULATED ON HIS
BEST KNOWLEDGE AND INFORMATION, AND AS SUCH, IT DOES NOT CONSTITUTE
A GUARANTEE OR WARRANTY, EITHER EXPRESSED OR IMPLIED. THE SURVEY
DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LIABILITY INSURANCE.
I THE UNDERSIGNED HEREBY CERTIFY, THIS PLAT TO BE
A TRUE REPRESENTATION OF A FIELD SURVEY MADE
LAWRENCE E • POWERS OR EXCEEDS DIRECTION SUPERVISION
EXCEE STHE MINIMUM N II MUMTECHNI CAL STANDARDS
1235 FARRAGUT DR N. FOR RECORD SURVEYS IN THE STATE OF FLORIDA AS PER
CHAPTER 61 7-6.005(2), FLORIDA ADMINISTRATIVE
ST. PETERSBURG, FL 33710 CODE. SUB CT TO ALL NOTES SHOWN HEREON.
®
P: 727-537-9895 NOT VALID
WITHOUT
E: SURVEYINGSTPETE@GMAIL.COM EMBOSSED SEAL
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