DS-12-125411
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 _ t 2- 9(o �-
Inspection Number: INSP- 175530 Permit Number: DS -7 -12 -1254
Scheduled Inspection Date: December 11, 2012
Inspector: Bruhn, Norman
Owner: Djordjevic, Mildred Johanny
Job Address: 10130 N MIAMI Avenue
Miami Shores, FL 33150-
Project: <NONE>
Contractor:
HOME OWNER
Building Department Comments
CEMENT SOME PARTS OF BACKYARD AS DESCRIBED
ON THE ATTACHED SURVEY
Permit Type: Driveways /Sidewalks/Slabs
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number
786 271 -7927
1131010210060
December 10, 2012
For Inspections please call: (305)762 -4949
Page 4 of 26
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 10, 2012
For Inspections please call: (305)762 -4949
Page 4 of 26
° Miami Shores Village
10050 N. E. 2nd Avenue
Miami Shores, FL 33138 -0000
' Phone: (305)795 -2204 Fax: (305)756-8972
Folio Number) 131010210060
Owner's Name: Mildred Johanny Djordjevic Owner's Phone: 786 271 -7927
Job Address: 10130 MIAMI Avenue Total Square Feet: 0
Miami Shores, FL 33150- Total Job Valuation: $ 1,000.00
Contractor(s) Phone Primary Contractor
HOME OWNER Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 5/25/2012
Comments: IDENTIFY LOCATION OF SECOND AWNING ON THE PLAN AND ITS AREA.
Miami Shores Village
10050 N.E. 2nd Avenue
ai
Miami Shores, FL 33138-0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number: 1131010210060
Owner's Name: Mildred Johanny Djordjevic Owner's Phone: 786 271 -7927
Job Address: 10130 MIAMI Avenue Total Square Feet: 0
Miami Shores, FL 33150- Total Job Valuation: $ 1,000.00
Contractor(s) Phone Primary Contractor
HOME OWNER Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/18/2012: Yes
Comments: IDENTIFY LOCATION OF SECOND AWNING ON THE PLAN AND ITS AREA.
6/18/12
NEW PLAN OK
f,.
Miami Shores Village
Cl
Buildin g Department
artment
�q 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
°mot Tel: (305) 795.2204 Fax: (305) 756.8972
` INSPECTION'S PHONE NUMBER: (305) 762.4949
C r �
_ BUIL ING Permit No.
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: Z I w &' / 4 oP *'.
MAY 252012
BY:- 0 A
FBC 20 CO
Master Permit NoAC_j a — 1 � S
ROOFING
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: .11
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple
NO Flood Zone:
3�?1.!r d
Address: ZO/ 30 &,Z44 141,4ml AU. v v
City: . ®/4M 1 State: I'S/ C, <C `/Q,4- Zip: 3_:�) l So
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: ��y` Phone #:
Address:
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer:
Certificate of Competency #:
Value of Work for this Permit: $ ��. UG Square/Linear Footage of Work•
/CJ6�,f
Type of Work: DAddition Alteration ONew ORepair/Replace ODemolition
Description of Work: 1415°4 16=f/
Color thru tile: d
Submittal Fee $ Qb. CYO Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Double Fee $ Q Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
caner or Agent Contractor
The foregoing instrument was acknowledged before me this 95 The foregoing instrument was acknowledged before me this
day of V1 "-� V , 20 t L by ti I aO S t AV DSCWZ (IN flay of , 20 _, by
who is personally known to me or who has produced t Q who is personally known to me or who has produced
NOT
Sign:
Print:
My C
As identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY / ���
Plans Examiner 4� Zoning
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3115/09)
NAME:
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
DATE: 12. OZ
ADDRESS:
351 !;O
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, FS 489.103(7).
And I have read and understood the following disclosure statement, which 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 m n
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 he
construction and is not hiring a licensed contractor to assume responsibility.
Initial
3. 1 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 o wn
name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licen nu 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 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 im ved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or s ally
improved it for sale or lease, which violates the exemption.
Initial
5. 1 understand that, as the owner - builder, I must provide direct, onsite supervision of the construction.
' Initial
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
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 w o 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 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. 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 contac e
Florida Construction Industry Licensing Board at 850.487.1395 or htt : //www.m oddalicense.com/db r/ ro /cilbfrndex.
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:
Initial
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informa 'on that I
have provided on this disclosure.
Initial
CAW
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 Z day of OTJ 20_
B JYM V 010d was personally known to me or who has
Al
Produced there License or r 2 entification.
i
OWNER
,,.'dv'o'�,•., CLAUDIA V. CUBiLLOS
=io` pf�ry Public - State of —1da
. My Comm. Expires Sep 23.2016
��:�° Comarissioa� 12SS1Assn.
n..na' Bonded ThroUQh
Permit No: 12 -965
Job Name:
September 18, 2012
Miami Shores Village
Building Department
Building Critique Sheet 3rd
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
1) The plans are designed under the wrong code and wrong wind loads.
Page 1 of 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305- 762 -4859
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 3313 8-0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number) 131010210060
Owner's Name: Mildred Johanny Djordjevic Owner's Phone: 786 271 -7927
Job Address: 10130 MIAMI Avenue Total Square Feet: 0
Miami Shores, FL 33150- Total Job valuation: $ 1,000.00
Contractor(s) Phone Primary Contractor
HOME OWNER Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 9/17/2012: Yes
Comments: IDENTIFY LOCATION OF SECOND AWNING ON THE PLAN AND ITS AREA.
6/18/12
NEW PLAN OK
9/17/12
NEW PLAN OK
Miami shores Y
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No: 12 -965
Job Name:
June 20, 2012 Page 1 of 1
Building Critique Sheet
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
2) The plans are designed under the wrong code. The correct code is the FBC 2010.
Stopped review 0 A, 0:5 /1 � 1 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 762 -4859
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No: 12 -966
Job Name:
August 9, 2012 Page 1 of 1
Building Critique Sheet 2nd
1) The slab permit is required first because this structure is attached to theuexisting Slab".
2) The HRS /DOH approval will be required on the slab permit.
Stopped review
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 762 -4859
Miami
Shores
Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tot: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: AC--k —.l 9(o3, DATE: _ / ca I t2-
o 7�ontracto r
c'bwner
❑ Architect
I
A.
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL: a0 ,
RESUBMITTED DATE:
PERMIT CLERK INITIAL: �
—0 \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 W
Permit No. D5 9 12 _ 12--5"A
Master Permit N
Permit Type: BUILDING ROOFING
JOB ADDRESS: 0 Q)46 ff
City:,, Miami Shores County: Miami Dade Zip: f
FoliolParceM-a3Z0102140
Is the Building Historically Designated: Yes Flood Zone:
/1
OWNER: Name (Fee Simple
Address:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: "" U Phone #:
Address:
City: State:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone#:
Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $
0
Square/Yinear Footage of Work:
Type of Work: OAddition
DAlterati%
ONew ORepair/Replace
ODemolitio4-.,
Description of Work:
Color thru tile: � `;LC -A
Submittal Fee $ 50, UJ Permit Fee $
Scanning Fee $ Radon Fee $
Notar $ Training/Education Fee $
Gub;Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $_
Technology Fee $
TOTAL FEE NOW DUE $ I
dC �1—
2-4
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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.
"WARMING 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
The fo
day oP
who is
NOT)
Sign: _
Print:
My Cc
=ntwas er or Agent Contractor
tru ackn wledge befo sM� foregoing instrument was acknowledged before me this
-120 44v- by 1 v, � f , 20 _, by ,
known to-we or who has produc o is personally known to me or who has produced
�, tification and who did take an oath. as identification and who did take an oath.
APPROVED BY 4�� ;&n- Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign.
Print:
My Commission Expires:
Zoning
Clerk
Miami Shores Village
Building Department
10050 N Und Avenue
Wrn Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
�� IW
NAME: ATE.
ADDlESS: '
And I have reads - h - — — - _
hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the "State of Ftgdda, RS 489.103(7).
and understood tho.foltowirig 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 75,00%.The butiding 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 Wilk presume that�you built for`sale or lease, which is a Ole f on 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 countyor 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 bylaw. Your construction must`comply with all' applicable laws, ordinances,
buildings codes and zoning regulations:
Please read and Initial each paragraph.
1. 1 understand that state law requires construction to done by a licensed contractor and.have applied for an owner - builder
permit under an exemption from the law: The eicem on specifies that 1, as the owner of the prgj Qhy listed, may act as my own
contractor with certain restrictions even though I do not have a license.
InitiaL,.��J�i~�
2. I understand that building permits arc not required to be signed by a property, owner unless he or she is responsible for the
construction and Is not hiring a ticensad ��ntractor to assume responsibility,
miff y —
3. 1 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 understah that the contractor is required by taw to be licensed In Florida and to list his or license n C on
Perm' and contracts. �M
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also bulldror improve
a commercial building N the costs do not exceed $75,000. The building or residence must tiefor 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 bull t,orpTfially
p which, the exemption. 411"/
improved it for sale or lease, w, ..Initial '
5. I understand that as the owner- builder, I must provide direct, onsite supervision of the construction.
Initial
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
1W
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 Igo 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 sub1ect to serious financial risk.
Initial
9. 1 agree that, as the party legally and financially responsible for this proposed construction activity,1 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. 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 l may contact the
Florida Construction lndustryl icensing Board at 850.487.1395 or hftp:/AvNw.mvfloridalicanse;oDm/dbor/Dro/Cilbfindex.html
Initial
- 1: 1 11. 1 am aware of, and consent to an owner- builder building permit applied for in my name and understands that I am thWerty
legally and financially responsible for the proposed construction activity at the following address:
I(>t3C,) W rAiA M\
Initial —W
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info*notve
have provided on this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who do
license, the Gonstr4uction 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 fine is injured while working on your'property, you may
be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for
verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and
returned to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when
the permit is issued.
Was acknowledged before me this day of l —,20 1 "2-
By N1 k l-G IKE D i, J c P. e' who was personally known to me or who has
Produced ere License or 1+Irr till as identification.
�.�� •tit p i r�; • �°/' /''. o �
03106/ 2016
.d
MIAIKIR _ NOTARY PUBLIC ; - TA
`��A .� EE 173059
LOW
Permit No: 12 -1254
Job Name:
August 9, 2012
Miami Shores Village
Building Department
Building Critique Sheet
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
2) Provide detail of construction on plans.
Page 1 of 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 762 -4859
Miami shores V
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: 1 �C� ' DATE:
1.
Contractor
Owner
Ei Architect
P'�ed`up 2 sets of plans and they i r ✓�i� �� r I
Address:
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE: q1 ) 01 ) °'
PERMIT CLERK INITIAL:
Miami
Shores
Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: 1) S I ? 12 Q4 DATE: -7 / (o / 2_
• Contractor
• Owner
• Architect
,/-' Picked
Address
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE: —i? — —/J—
PERMIT CLERK INITIAL: 011-e
SURVEY NUMBER: FL1011.1045
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PAUL M.vnalSurwE GRAPHIC SCALE (In Feet) N
State of Florida Professional Surveyor and Mapper
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y Use of This Survey for Purposes other than Intended, Without written verification, will be at the User's Sole Risk and Without Liability to the Surveyor.
Nothing hereon shall be Construed to Give ANY Ri' hts or Benefits to A ne Other than those Certified.
.81 11 -0 POINTS OF INTEREST: None Visible
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Miami -Dade County'Health Department
"125 NW 167. St; {?pa Lock
a, EL 33056 .
Phone: ('305) 6'23-3500 . pax: (305) 623-3645,-,'ht p: /fwvrw.M, ,'Flori.daERcom