BP-05-916 F
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-198859 Permit Number: BP2005-916
Scheduled Inspection Date: September 11,2013 Permit Type: Imported Permit
Inspector: Naranjo, Ismael
Inspection Type: Final Building
Owner: KETELHOHN,GEORG Work Classification: <NONE>
Job Address:185 NW 107 Street
Miami Shores, FL 33168- Phone Number
Parcel Number 1121360100090
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT EXTERIOR OF HOUSE Infractio Passed comments
INSPECTOR COMMENTS False
PERMIT RENEWED 8/5/13
In pector Comment
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
1
September 10,2013 For Inspections please call: (305)762-4949 Page 20 of 28
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-198859 Permit Number: BP2005-916
Scheduled Inspection Date: September 11,2013 Permit Type: Imported Permit
Inspector: Naranjo, Ismael Inspection Type: Final Building
Owner: KETELHOHN, GEORG Work Classification: <NONE>
Job Address: 185 NW 107 Street
Miami Shores, FL 33168- Phone Number
Parcel Number 1121360100090
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT EXTERIOR OF HOUSE Infractio Passed Comments
INSPECTOR COMMENTS False
PERMIT RENEWED 8/5/13
-ifis'pector Comments
Passed
(J
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 10,2013 For Inspections please call: (305)7624949 Page 20 of 28
1
Miami Shores Village
Buildin g 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 No.
PERMIT APPLICATION Master Permit No P
FBC 20
Permit Type:PAINT
i / I
OWNER:Name(Fee Simple Titleholder): �C Phone#:
City:- � 1 e�L, ►: 'S State:_ FL
Tenant/Lessee Name: Phone#:
Email: ic
JOB ADDRESS: V SIYT -
City: Miami Shores County: Miami Dade
Folio/Parcel#:
Is the Building Historically Designated:^Yes NO VZ Flood Zone: r
CONTRACTOR:Company Name:
ion a�1f Phone#:
Address:
City: State zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
Value of Work for this Permit:$ U C) Square/Linear Footage of Work:
Description of Work: pn,,
J� - r �' '
G'�° �� v Duct—s;\ 1-1 --3)
Application is hereby made to obtain a perms to d e work and instalons gas in 'cat . Pcerpfy that no York or ms anon has coWnenced 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.....
"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. Asa condition to the issuance of a building permit with an estimated value exceeding$2510,the applicant must promise in good faith that a copy of
the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the
recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. In the absence of
such posted notice,the inspection will not be approved and an inspection fee will be charged
Permit Fee$ CCF$ Notary$ Training/Education Fee$
Technology Fee$ Double Fee$ TOTAL FEE NOW DUE$
t
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
DIRECTIONS:Please circle corresponding number to appropriate color sample.
greenmount silk
Walls: �� 2 3 4
Fascia: 1
y 3 4 Attach color sample with name and i...�.a.,.
Drip edge: 1 3 4 -}— I
Soffit: 1 3 4 1d'l'�'tn ►ry�G�n I S, C _3
_�2��
Roof: 1 t 2 9 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2. 3 4 2 V )„ tt�
Awnings: 1 2 3 4
Chimney: 1 2 33 4
Doors&Jambs:1 2 l3 0 4 white
Garage Doors: 1 2 3 4
Railings: 1 9Z 3 4 Y Y
Fences: 1 2 3 4
Ali Brick: 1 2 3 4
Stucco Bands: 1 2 3 4
Other Stucco 4
Feature: 1 2 3 4
Accessory Bldg: l 2 3 4
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.
Signature: Signature:
Owner or Agent Contractor
The fo oing i trument�was ac wled ed before e s " The foregoing instrument was acknowledged before me this
day of ,20 Q,by 'lay of ,20_,by ,
w►os p ,onall k o to me or who has produced who is personally known to me or who has produced
V entification and who did take an oath. as identification and who did take an oath.
NOTAR P LIC: NOTARY PUBLIC:
I I U f2
Sign: CVAUD ' Sign:
Print,. a \ Notary u Iic State of Florida
Print:
Commission#EE 128810
My Co sibs My Commission Expires:
"������� S•Bonded Through National Notary Assn.
APPROVED BY: Code Official
Preservation Board
� •° Miami Shores Village
Building Department
10050 N.E.2nd.Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
!OWNER BUILD R DISCLOSURE STATEMENT
NAME: if\ -DATE:—,
ADDRESS: tr
��� S�v�� 33 16,E
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State.of Florida,KS 489.103(7)
And I have read and unders(ood the.following disciosu statemer4;which entrtles 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
commercialr building at a cost of$25;000.00 or less(The new form states 75,000).The building'mustbe for yourown use and
occupancy.It may not b6built for sale or leaserlf yocrsell orleae'a building you`have built yourself within on#'year after the
construction Is,td rmplete.the lawwilt presume that�you built forsale of lease;which is`a Wolatlon of this 6k6tription.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 FICA and with-holdings tax and provide workers'
compensation for that e-nildyee,all as pr 6bed'by law.Your construction must comply with all applicabie laws,ordinanc es,
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 G IC
2. 1 understand that building permits are not required to be signed by a property owner unless he or she Is responsible for the
construtsiorl and is not hiring a licensed contractor to assume responsibility.
loot
3. 1 understand that,as an calmer builder,I am tit responsible party of record on a permit.I understand that I may protect myself
from potential financial risk by hirinng a licensed contractor and having the permit tiled in his.or her name instead of my oar
name.I also understand that the contractor Is required by law to be licensed In Fbrida and to list his or license numbers on
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 costa do not exceed$75,01M.The building or residence must tie for iry use or occupancy.It may
not be built or substantially improved for sale or lease.N 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 win presume that I built or substantially
Improved it for sale or lease,which violates the exemption. I�
Initial
5. 1 understand that,as the owner-builder,I must provide direct,onske supervision of time construction.
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 person whom I employ have the license required by law and by county or
municipal ordinance. ]/
Initial i�
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 properly owner is providing his or her own labor and materials.I,as an owner-builders mamba Held
liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employ�"ees�i he
working on my property.My homeowner's insurance may not provide average 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_baing done.Any person working on my building who is not licensed must work under my direct supervision
and must be employed by me,whlch`m6afit that I must amply adth laws r—eiti irig 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 two may subject to serious financial risk GK-'
Initial
9. I agree that,as the party legally and financially responsible for this proposed construction activity,I will abide by all applicable
taws and requirement that govern ownet-builders as well as employers.I also understand that'the
construction must ic amply with all applicable laws,ordinances,building codes, °and zoning regulations.
Initial-.
10. 1 understand that I may obtain more information regarding my obligations as an employer from the Intemal 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 httpJMw.mvfioddelicense.com/dborbddIbAndox.html
lnlfial
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:
Inlfial C@
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the Information that 1 `
have provided on this disclosure.
lnlfial
Licensed contractors are regulated by laws design to protect the public.If you contract with a person who does not have a
license,the Corstr4uction Industry Ucensing 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 cM 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 property licensed and the status of the contractor's workers compensation average.
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 hued.
Was acknowledged before me this day of �/ vs 20 3
By �b`r �l �"` who was personally known to me or who has
Produced there License or as identification.
OWNER NOTARY
Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel. (305)795 2204 kax (3Q )756.8972
BUILDING Permit No. 9 /-6
PERMIT APPLICATION'�� �
Master Permit No.
FBC 2001 ---- ®-®_�
Permit Type(circle): ` uilding
p Electrical IN bing Mechanic
al Roofing
Owner's Name(Fee Sim p le Titleholder G F_ Y ��el Phone# �4 7(�
Owner's ddress
City State L— Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done) t OD S A "" ° 10-4 S-�Y6CT
City Miami Shores Villace County Miami-Dade" Zip
Is Building Historically Designated YES NO
I.) P,�.R.Y
Contractor's Company Name Phone#
p Y s—
Contractor's Address
City State Zip
Qualifier
r
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit Q Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition ]
Describe Work: „ O !'1 v Y �Y o r �'l G J �r 1 I c3
W k 1
Submittal Fee$ 4 Permit Fee$ (,0- ✓ CCF$ 0. 60 CO/CC
Notary$ d Training/Education Fee's ®- Technology Fee$ �(
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$_ °3D .
(Continued on opposite side)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) ' y
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 afer the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspecti fee will be charged.
Signature Signature
Owner or Agent Contragtor
The foregoing instrument was acknowledged before me this- The foregoing instrument was acknowledged before me this
day of 200y,by U ay of 20 by ,
who i sonally kn to me or who r has duced who is
P personally known to me or who has produced
identification and who did take an oath, as identification and who did take an oath.
NOTARY PUB IC• argas NOTARY PUBLIC:
`,,,�,a,,,
Sign: __ Co ission`DD231984 Sign:
Exp ires: u 7
Print: ' nondedThru Print:
My Commissi Expires: F Atlantic Bonding o., ne.
p My Commission Expires:
APPLICATION APPROVED BY: c.e �''Y 0 J Plans Examiner
Engineer
Zoning
chc 05/13/03
Miami Shores Village
r Paint Color Approval and Agreement
Date �' °
Phone
Owner s Name
Owner s Address
City Y►1cf`�CS State- Zip
Job Address
where the work is being done)
City Miami Shores Village County Miami-Dade Zip
NO
' _�—
]s Building Historically Designated YES
Contractor's Company Name(if applicable)
Phone#
All elements on the site mush be listed and indicate the color to be painted
Walls
V, Yl1'YtO.SvV C
Fascia
Drip Cap/drip Edge
Soffit `` +� � S►I
Roof i ► rT C 3'
Flower bins t Attac 'Jamples
Shutters 1 Vl`( W.ch Numbers
Awnings \,A;
Chimney
Doors and door jams
Garage doors
Railings tJ
Fences
z
Decorative metal + YY'By()
All brick(simulated or regular) YO
Stucco banding Ro 10
Any other stucco features
Accessory Buildings
Other
information is accurate and that all work will be done in compliance with all
OWNER'S AFFIDAVIT: I certify that all the foregoing
construction and zoning.applicable laws re g g
Date � �J
Signature
er or Agent
n
APPLICATION APPROVER BY:
Date
� . cnc 6118103
fs..::. Oficia
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
P
OWNER BUILDER DISCLOSURE .STATEMENT
I lJ e C� being the legal property owner, for the property
S�Located at: O S t L! A-0 ,
Legally described as-
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 ,end I have read and understand the following disclosure
Statement, which entitles me to'work as my own contractor, I further understand that I as the owner
rriust appear in person to complete all applications.
DISCLOSURE STATEMENT
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that 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 or a farm out-building. "You may also build or improve a
commercial building at a cost of$25,000.00 or less.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 completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption.You may not hire an unlicensed person as your contractor.It is your responsibility to make sure
that 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 Icensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with-holding tax and
provide workers' compensation for that employee, all as prescn'bed by law. Your construction must comply
with all applicable laws,ordinances,building codes and zoning regulations.
Proof of ownership provided( ) YN, initial of reviewing clerk.Tlie foregoing instrument
4,
Was acknowledged before me this day of Uhf 20
By who is personally known to me or who has
Produced as identification and who did take an oath.
Notary
Yr
Owner
Miami Shores Building Permit Villa g e
10050 NE 2nd Avenue
Phone: 305-795-2204 Permit Number: BP2005-916 ' "`
Printed:6/2312005 Page 1 of 1
Applicant: RACHEL GASH
Owner: GASH RACHEL
JOB ADDRESS: 185 NW 107 ST
Contractor Contractor's Address:
Local Phone:
Parcel# 1121360100090 Legal Description: DUNNINGS MIAMI SHORES EXT 6 PB 51-31 LOT 9 BLK 212
Fees: Description Amount
FEE2005-8650 Building Fee $60.00 Total Fees: $67.30
FEE2005-8651 CCF $0.60 Total Receipts: $0.00
FEE2005-8652 Notary Fee $5.00
FEE2005-8653 Training and Education Fee $0.20
FEE2005-8654 Technology Fee $1.50
Total Fees: $67.30
Permit Status: APPROVED Permit Expiration: 12/17/2005 Construction Value: $800.00
Work: PAINT EXTERIOR OF HOUSE
. JUG 2 3 PAID
c-rc -r- I o4
Signed: (INSPECTOR)
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 responisibility for
all work
done by either myself,my agent,servants or employes.
Signed: (Contractor or Builder) BY: