DS-13-2608 Miami Shores Village I Z' „._,�,.�_
4 '
Building Department INGV�L0-b
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: 305 795.2204 Fax: 305 756.8972
�. INSPECTION'S PHONE NUMBER:(3057 762.4949
FBC 20 LO
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.9 51 3
Permit Type: BUILDING ROOFING
JOB ADDRESS: 273 �W g2nd &Yeei,
City: Miami Shores County: Miami Dade Zip: 3 _f�(�
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone: /V a —
OWNER:Name(Fee Simple Titleholder): V//._2 r.f 7:44 .3 Phone#: :LQ6 ,376 2q57
Address: 2 2 3 AI AI !2 Z 2
City: ,'ed z f! saglyce S State: FL Zip: 3,115 V
Tenant1essee Name: Phone#:
Email:
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:$ Square/Linear Footage of Work: C-7 S700 s�e,
Type of Work: ❑Addition alteration ONew ❑Repair/Replace ODemolition
Description of Work: Zag ve r e !v► r,Z
Color thru file:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ 0 L yy��
TOTAL FEE NOW DUE$ 6V
•
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 no proved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this Q The foregoing instrument was acknowledged before me this
day of ,20 a,by LkA Oc--V day of ,20_,by ,
who is personally known to me or who has produced ��1 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: ��+++���' �ru NOTARY PUBLIC:
r
Sign: Sign:
Print: Print:
ASS ya
My Commission Expires: My Commission Expires:
TAT
APPROVED BY `r ���� Plans Examiner Zoning
Structural Review Clerk
(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
o ,
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: lG6/�r?e• ��n Ia S DATE: f L-Z:�'Ly
ADDRESS: 27.7 IV h) q;? 5iZ;
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,RS 489103(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 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.
Initial.
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,
Initi al
3. 1 understand that as an owner builder,I am the responsible party of record on a permit I understand that I maayy protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name Nod 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
4 ti permits and contracts.
Initial
4. 1 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. 1 understand that,as the owner-builder,I must provide direct,onske supervision of the construction.
Initisia I—;�r�
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
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. 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 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. 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 the
Construction must comply with all applicable laws,ordinances,building odes, and zoning regulations.
Initial
10. 1 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:INwwu.mvfloddalicense.comldbar/pro/CilbMdex.htrnl
Initial
11. 1 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:
273 IYU) go 9""
Initial
12. 1 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 gwner 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 requiroel when
the permit is issued.
Was acknowledged before me this day of„4,w�20 13'
By W I t-C—t `70-OAKS who.was personally known tome or who has •
Produced there License or as identification.
ra
OWNER tea: ' Q�`° '
ON
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,,t:�t8all41ss�1t�
r. ,,"
Rick Scott
Mission: z Governor
To protect,promote&improve the health
of all people in Florida through integrated
state,county&community efforts. John H.Armstrong, MD,FAGS
HEALTHState Surgeon General&Secretary
Vision:To be the Healthiest State in the Nation
October 30, 2013
William Tubbs
273 NW 92 Street
Miami, FL 33150
RE: Modification to a Single Family Residence - No Bedroom Addition
Application Document Number: AP1124269
Centrax Permit Number: 13-SC-1501997
273 NW 92 Street
Miami, FL 33150
Lot: 15 Block: 14 Subdivision:
Dear Applicant,
This will acknowledge receipt of a floor plan and site plan on 10/23/2013 for the use of the existing
onsite sewage treatment and disposal system located on the above referenced property. Proposed
pavers terrace at the back yard
This office has reviewed and verified the floor plan and site plan you submitted, for the proposed
remodeling addition or modification to your single-family home. Based on the information you
provided, the Health Department concludes that the proposed remodeling addition or modification is
not adding a bedroom and that it does not appear to cover any part of the existing system or
encroach on the required setback or unobstructed area. No existing system inspection or evaluation
and assessment, or modification, replacement, or upgrade authorization is required.
Because an inspection or evaluation of the existing septic system was not conducted, the Department
cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use.
You may request a voluntary inspection and assessment of your system from a licensed septic tank
contractor or plumber, or a person certified under section 381.0101, Florida Statutes.
If you have any questions, please call our office at (305) 623-3500.
Sincer
Car s
Engi ee III
Depart ment of Health in Dade County
Florida Department of Health www.FloridasHealth.com
in Dade County• •,Florida TWITTER:HealthyFLA
PHONE: (305)623-3500 FACEBOOK:FLDepartmentofHealth
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Florida Health Miami-Dade County ��i��i °�®��� �° °9�n�
O.S.T.D.S. & Well Pro ram J�
9 ���®VE® BY DATE
Application No.: 1
Date: o f"J r4I nl 12 DEPT
.Si nature
9 BLDG DEPT
Accepted By: SUBJECT TO COMPLIANCE WITH ALL FEDERAL
roperty Address: 273 N.W. 92 STREET NOT �/Nt)PNOTPSNTY RULES AND REGULATIONS
MIAMI SHORES, FL 33150 'DS
i
RESENTATIONOFASU 1 RE`YD' RMY DIRECTION.THIS COMPLIES W ITH THE MINIMUM C - MIGUEL ESPINOSA LAND SURVEYING, INC.
ECHNICAL STANDARDS,AS FORTH BY THE TE OF-FLORIDA BOARD OF PROFESSIONAL LAND
RVEYORS IN CHAPTER � 17-S.4F�I O-C)A ATDMINI THE CODE PURSUANT 70 472.027,FLORtbA STATUTES. 1 O66J SW 190TH Street I
Suite 3110
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-204045 Permit Number: DS-11-13-2608
Scheduled Inspection Date: December 26,2013 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: TUBBS,WILLIAM AND VICTORIA Work Classification: Addition/Alteration
Job Address:273 NW 92 Street
Miami Shores, FL 33150-
Phone Number (786)376-2959
Parcel Number 1131010331150
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Infractio Passed Comments
LAY PAVERS IN BACKYARD INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
December 26,2013 For Inspections please call: (305)762-4949 Page 11 of 19