FW-13-1019Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 191195 Permit Number: FW -5 -13 -1019
Scheduled Inspection Date: March 10, 2014 Permit Type:
Inspector: Rodriguez, Jorge Inspection. Type: Final
Owner: HULL, KATHLEEN Work Classification: Wood Fence
Job Address: 9350 NE 9 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: OWNER
tsunamg uepartment comments
46' of wood fence north side
Phone Number
Parcel Number 1132060020040
INSPECTOR COMMENTS False
March 10, 2014 For Inspections please call: (305)762 -4949 Page 2 of 24
Inspector Comments
Passed��'
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 10, 2014 For Inspections please call: (305)762 -4949 Page 2 of 24
0 Miami Shores Village
Building Department
90050 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
Permit Type: BUILDING
FBC 20 /a /
Permit No. 14:Z( / —13
Master Permit No.
ROOFING
JOB ADDRESS:7n
City: Miami Shores County: Miami Dade Zip: 33139
Folio/Parcel #: -4P- I 1 - } 2. ®6- 001 -D®* ✓7
Is the Building Historically Designated: Yes
NO
Zone: K(
OWNER: Name (Fee Simple Titleholder): 6- AWZjmcE 6 Jy LL Phone#: 30 - -6TH -j 5W
Address: 2) 5.0 W C q-",- *V66 a i✓
City: i A ,�i 1 61-4-t kt State: zip :'3 3 13 8
Tenant/Lessee Name: d/ 9 / A- Phone#:
Email: 64 +t<- -so 1�5 �
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:
Value of Work for this Permit: $_ -1 D 9' Square/Linear Footage of Work:
Type of Welk: OAddition OAlteration ONew ORepair/Replace ODemolition
-� 4 fJ oR
Description of Work: S WoD ' � *' -9A- sl VE rf �'2 ®(�_`�Y,j' 1l7 c 74ACD
Color thru tile:
�C?
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ 0 1 J
Bonding Company's Name (if applicable) nN�
Bonding Company's Address
Ci `.y�.
s State
,y r�` �
Mortgage Lender's Name (if applicable) N
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and afreinspection fee will be charged.
Signature Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of _Ap i , 20 -03, by �WWCt 9 • H U11 ,
who i rsonally known tom or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: e
Print: A
My Commission Expires: Flre:
APPROVED BY
Contractor
The foregoing instrument was acknowledged before me this
day of .20 _, by ,
who is personally known to me or who has produced
as identification and who did take an oath.
Notary Public State of Florida
Barbara Asfendis
My CommMW DD898833
Fx1$ sires 07/13/2013
ss
BsIc $ a$ a $a$a$caja$a$a�e�Nik�kakkskak skHiakaknk=
-r-�Z/--7 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:
3 zoning
Clerk
Miami Shores Village
Building. Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
NAME: L&Z�4h"/W_7�- eek WE
ADDRESS: 1 Z) T�E cl A V e
Do hereby petition the village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, RS 489.103(7).
And I have read and understood the following disclosure statement, which entities 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 fot yourown use and
occupancy. It may not be built for sale or lease.-If you sell or lease a building you have built yourself withinrono year after the
construction Is complete, the law wilt presume thatyou 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 codes and zoning regulations.
Please read and Inftlal 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 ad as my own
contractor with certain restrictions even though I do not have a license.
i
Initl
2. 1 understand that building permits are not required to be signed by a property owner unless he or she Is responsible for the
corsbuctton and Is not hiring a licensed contractor to asume responsibuity.
In
3. 1 understand that as an owner builder, I am the responsible party of record on a pemnt I understand that I may protect myself
from potential Inandal risk by hiring a licensed contractor and having the permit filed in his or her narrne instead of my own
name. I also understand that the contractor is required by law to be ucarsed In Ftbrida and 6 list his or lioerse nu on
permits and contracts.
1
4. 1 understand that I may build or improve a one family or two-family residence or a fame outbuilding. I may also build or Improve
a commercial building if the cats do not succeed $75,000. The building or nWdennos must be for my use or oaxnpancy. it may
not be built or substantially improved for sale or Ise. If a building or residence that I have built or substantially Improved
myself is sold or teased within 1 year alter the construction Is complete, the law will presume that I built or su ly
Improved it for sale or lease, which violates the exemption.
Initial
5. 1 understand that as the owner - builder, I must provide direct orsite 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 aoerse required by law and by or
municipal ordinance.
Initial
I understand that it Is frequent practices of unlicensed persons to have the property owner obtain an owner - builder perrdt that
erroneously implies that the property owner �s providing his or her own labor and materials. I, an owner - builder, .mast lie: hell
We and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees" e+hile
working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as on
- bulkier and am aware of the limits of my insurance coverage for iryuries to workers on my properly.
Into
I understand that I may not delegate the responsibility for supervising work to be a licensed d 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 #w i must comply with lawn requirirtg the withholding of federal income tax and
soda] security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensatio r
the employee. I understand that my failure to Now these may subject to serious fmanclal risk.
Initial
1 agr96 that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable
laws and *uiremant that govem owner - builders as well as employers. I alto understand that'the
Construction must comply with all applicable laws, ordinances, building des, and zoning regulations.
Initial
10. 1 understand that I may obtain more irdormation 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 Industry Licensing Board at 850.487.1395 or J d .comtd r dl fin. dex l
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
ally and titian ally, respon si I for Vie proposed construction activity at the following address:
12. 1 pry notly Ifni shores pillage immediately of any additions, delegons, or changes to any of the knfornation that
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 Constr4uc Lion Industry Licensing Board and Department of Business and Professional Regulation may be unable to
asset you with any tnancial loss that you sustain as a result of contractor may be In civil court. It Is also Important for you to
understand that I 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
verifjfitg whether the contractor Is properly licensed and the stators 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 permiL A copy of the property owner's driver license, the
notarized signature of the property owner, or other type of verffication acceptable to the focal permitting agency Is required when
the permit Is Issued.
Was acknowledged before me this _day of 201
yy�� lI I ,, l y me or who h
By II�G/(`� V i �� who was personally known to as
Produced there License or .�
- .WWV
Ir1T�bV
CLAUDIA V. CUBILLOS
9 , Notary Public State of
_. My Comm Expires Sep Florida 23. 2015
Commission # EE 128810
Bonded Through National Notary Assn.
0.2'
LOTS,
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75.001 1
2'.
t9' �•
24.1'
1 & 2 STORY C.B.S. o
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75.00' '
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FIRST ADDITION
MARILYN HEIGHTS
According to the plat recorded in Plat Book 41, Page W. recar*d in Me
and >wrain8 u lic
records of Dade County, Florida; said land situate, lying,
Dade County, Florida.
FoIJNb /2ll.i-
160.00'
I.R. = iron rod
I.P. = Iron pipe
Asph = asphak
RP =radius
'T.4.
MIAMI
m SNORES
_.
Z:BAY
NORTH
BB Not to Scale
c h-, ` 1. N" Say Mae
R = radius /A� = central angle P.03. = point of beginning U/E = utility easement
L = arc length Gil. a fonter lne P.C. = point of curvature QB = bearing basis line
Esnd = easement Conc =concrete P.O.C. = point of commencement OIS = offset
T = ical P.1. = Int of intersection WPF = wood p rivacy, fence CLF = chain link fence
=-� John Renner CarlifiedT°:
(,t 1 S.E 4th Ave., Suite 211
Il Delray Beach, FL 33483 L AWRBNCE MILL AND KATHLEEN BULL
tip Phone 407- 243.4624 EANCBOSTON MORTGAGE CORPORATION
I
9350 N.E. 97H AVENUE
MIAMI SHORES, FLORIDA NO BELOW GROUND /NPROVEVENT. FOOTERS, FOUNDATIONS OR
UnUMB HAVE BEEN LOCATED OR SHOWN ON TW SURVEY.
Fax 243 -4869 Itle Suamma anNor Assigns
Was' Palm 735.7639
Wool Palm Fax 735-7841 SMITH & MATT. P A.
TotiFroe 1-800- 773.5531 ATTORNEY'81MXVi[SURANCEFUMINC
® Fax Free 1.800.954 -4408
I hereby certify that the *Sketch of Boundary Survey" shown
Flood Zone: X
LOT 3 4i
Chapter 21 HH-6, Florida Administrative Code pursuant to
Map No:12 S O 3 5 0011:61;=
W4
Section 472.027, Florida Statutes. Unless otherwise noted
elevations shown hereon are based on the National Geodetic
"q
Not valid unless
Vertical tu�D�M based on plat.
Scale: 1"=W
FoIJNb /2ll.i-
160.00'
I.R. = iron rod
I.P. = Iron pipe
Asph = asphak
RP =radius
'T.4.
MIAMI
m SNORES
_.
Z:BAY
NORTH
BB Not to Scale
c h-, ` 1. N" Say Mae
R = radius /A� = central angle P.03. = point of beginning U/E = utility easement
L = arc length Gil. a fonter lne P.C. = point of curvature QB = bearing basis line
Esnd = easement Conc =concrete P.O.C. = point of commencement OIS = offset
T = ical P.1. = Int of intersection WPF = wood p rivacy, fence CLF = chain link fence
=-� John Renner CarlifiedT°:
(,t 1 S.E 4th Ave., Suite 211
Il Delray Beach, FL 33483 L AWRBNCE MILL AND KATHLEEN BULL
tip Phone 407- 243.4624 EANCBOSTON MORTGAGE CORPORATION
I
9350 N.E. 97H AVENUE
MIAMI SHORES, FLORIDA NO BELOW GROUND /NPROVEVENT. FOOTERS, FOUNDATIONS OR
UnUMB HAVE BEEN LOCATED OR SHOWN ON TW SURVEY.
Fax 243 -4869 Itle Suamma anNor Assigns
Was' Palm 735.7639
Wool Palm Fax 735-7841 SMITH & MATT. P A.
TotiFroe 1-800- 773.5531 ATTORNEY'81MXVi[SURANCEFUMINC
® Fax Free 1.800.954 -4408
I hereby certify that the *Sketch of Boundary Survey" shown
Flood Zone: X
hereon meets the minimum technical standards set forth in
Chapter 21 HH-6, Florida Administrative Code pursuant to
Map No:12 S O 3 5 0011:61;=
Section 472.027, Florida Statutes. Unless otherwise noted
elevations shown hereon are based on the National Geodetic
Map Date: 11 - 4 - 8-1
Not valid unless
Vertical tu�D�M based on plat.
sealed whh embossed
surveyor's seal
Date: 'b' - t 0 - g u
�v ('/
Job No: S - ( $
Charles H. Palomba P.L.S. No. 6016
1 Revised:
v_
� SgORES Lr
OWNS nn�M
�x RIDI�
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
The undersigned Affiant, does hereby attest that
(Property owner)
The attached survey, performed by � 01N k eW f '-
-V'k (Name of surveyor's company)
For address: 5 0 WE q /1*Vvy �r-
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Performed on Ito (date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Further �Affi��th naught.
Property Owner Signature a Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this 024 day of ljqril -?®k .
Affiant is personally known to me, produced as identification.
Revised on 5/22@0091 Revised on 6/12/09