DS-14-1082Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 213079
Permit Number:
DS -5 -14 -1082
Scheduled Inspection Date: June 19, 2014
Inspector: Rodriguez, Jorge
Owner: PAUL, PIERRE
Job Address: 11250 NW 6 Avenue
Miami Shores, FL 33168-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number
1121360210330
Building Department Comments
CONCRETE DRIVEWAY
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
June 18, 2014
For Inspections please call: (305)762 -4949
Page 20 of 39
PERMIT # I5 t `� " tI
CONTRACTOR:
SUBMITTAL DATE: 5 I i�
ADDRESS: �' t4 L (0 �L
NAME:
RESUBMITAL DATES:
PROTECT TYPE: I N WrL
STRUCTURAL
FIRE
IMPACT FEES
ELECTRICAL
HRS /DERM
PLUMBING
MECHANICAL
BUILDING
PERMIT APPLICATION
Pi
UILDING ❑ E
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795 -2204 Fax: (305) 756 -8972
INSPECTION LINE PHONE NUMBER: (305) 762 -4949
ECTRIC ❑ ROOFING
1RECEIVED
MAY 2 7 2014
FBC 20 t
Master Permit No. U S) �i " ) 0a-Z
Sub Permit Noq
❑ REVISION ❑ EXTENSION ❑ RENEWAL
E] PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF
!. Gm
CONTRACTOR
JOB ADDRESS: /I ? N IA) Aenue
City: Miami S
Folio /Parcel
Occupancy Type:
ores
County:
❑ CANCELLATION ❑ SHOP
DRAWINGS
Miami Dade Zip:
Load:
OWNER: Name (Fee Simile Titleholder):
Address: M_., 0 Al
City:
Construction Type:
19,1 41(-5
Tenant /Lessee Name:
Email:
is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
PL
State: /6(
Phone#:3 5`' - 4
Zip: 33 [ i '
Phone#:
CONTRACTOR: Company
Address:
Name:
/U/g 0/AV10-2_
Phone#:
City:
Qualifier Name:
State: Zip:
Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect /Engineer: Phone#:
Address: City: State: Zip•
Value of Work for this P rmit ,S-0° ' - `� Square /Linear Footage of Work MI-1c,,
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair /Replace ❑ Demolition
Description of Work: (PpP 1 r 7 r1 V' U l ee,,bil a zd h
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02 /24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE$ )1S.?
CCF $ CO /CC $
DBPR $ Notary $
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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
inspecti will not be • roved and a reinspection fee will be charged.
Signature ,ra
Signature
OWNER or AGENT.. CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
. 9- ► day of ITN PrAi , 20 I '( , by day of , 20 , by
7) (z-2 i'?A ■--- , who is personally known to , who is personally known to
me or who has produced i't--k D as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBUC:
Sign:
Print:
Seal:
01,11111111 „/Il
0,0161, 4010r;
NOTARY PUBUC:
Sign:
Print:
Seal:
** * * #*
APPROVED BY (J%/'s Examiner "I° Zoning
Structural Review Clerk
(Revised02 /24/2014)
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
ME: fl i erre Pt DATE
ADDRESS: PR SD AN m Ye ' 2 1 i S4/"6'
Do hereby pet bon 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).
And I have re 5d and understood the following disclosure statement, which entitles me to work as my own contractor, I further
understand thSt 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. h, 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
1.
2.
3.
4.
and initial each paragraph.
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, maact as my own
contractor with certain restrictions even though I do not have a license.
Initial
I 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.
Initial d 0
I understand that as an owner builder,_1 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 o
name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license
permits and contracts.
Initial
I 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 substantia improv
myself is sold or leased within 1 year after the construction is complete, the law will presume that I built 'r. u' ,tant-'y
improved it for sale or lease, which violates the exemption.
Initial
I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction.
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 license required by Id by,C`)ty or
municipal ordinance. IL''
Initial
7. I 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. I 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. I 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.
10. I 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 htth : //uwuw.mvfloridalicense.com/dbor /pro /cilb ' :.h+
Initial
11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party
Dally and financially responsible for the proposed construction activity at the following address:
Initial 1 a
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info
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 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 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 gl day of fl A'X , 20 I L{
By 1arl- - ?NA-- who was personally known to me or who has
Produced there License or CI, 1\9 as ;den f wafip,p „,
Ar/�''s,
/ ate\` 4 ... �-• . , -
▪ sip
s
''''''/;('‘,°:. 1, , I r D A r f � « � � � ‘.��`\``
0 LIND "4.19 1 S .`:
SCALE :1 20'
NGVO
N/D
N. T.S.
0 /So
ofi
Q.R.B.
PL.
P.C.C.
P. C
P. T
P.O.C.
P.O.B.
P.R.C.
P.P.
P,GP
P.B.
PG
Pyy
P.R.M.
P.L.S
(R)
R.R.
R/W
R
RGE.
SEC.
STY.
SWK,
R.
SLR.
nP.
U.E.
U. P,
W.M.
0
U.H.
PP_
A/C =AIR CONDITION
ASPH. = ASPHALT
BLDG = BUILDING
B.M, =BENCH MARK
.GB. =CATCH BASIN
C B. S =CONCRETE BL
C.L.F. =CHAIN LINK
CONC. = CONCRETE
OW =DRIVEWAY
DIST =DISTANCE
EL. = ELEVA70N
F. H. =FIRE HYDRAN
T:! ° =FOUND IRON
=FOUND IRON
FB. =FIELD BOOK
FF. = FINISH FLOOR
D. =FOUND
U. C. =UNDER CONS
LEGEND:
= MONUMENT UNE
= NATIONAL GEODETIC VERTICAL 047UM
=NAIL & DISC
=NOT TO SCALE
= NUMBER
=OFFSET
=OVERHEAD
=OFFICIAL RECORD 800K
= PLANTER
=PROPERTY LINE
=POINT OF COMPOUND CURVATURE
=POINT OF CURVE
=P01NT OF TANGENCY
=POINT OF COMMENCEMENT
=POINT Cr BEGINNING
=POWER POLE
=PERMANENT CONTROL POINT
=PLAT BOOK
-PAGE
= PARKWAY
= PERMANENT REFERENCE MONUMEN
= PROFESSIONAL LANG SURVEYOR
= RECORDED DISTANCE
=RAILROAD
=RIGHT -0F -WAY
=RADIUS
=RANGE
= SEC70N
=STORY
=SIDEWALK
=SET IRON PIPE
=SET IRON ROD
=TANGENT
-TOWNSHIP
= UTILITY EASEM:,
=u71.1rr POLE
=WATER METER
= INTERIOR
=CENTERUNE
= UTILITY HOUSE
MAY 27 2014
'5' ASPHAL ' ROAD
1ST g? ASS
M1,m
O /
° G.�.F1 , i.P
F•'• a 1f2 75.77
NC CAPifi- , f -� ., i N CAtt
t r,
ts„
l g• ,,r
'.5G
•
25.00'
cp.
puma
'S
ONE STORY
DUPLEX. # 11260
cT
FaC.
F. A! D•
=N.
GAR. EL.
W.R.
L. P,
(M)
MON.
O. W
(BBD
G1Hr
'Yv0
io.1 =ELEVA770N
=FEET
=FOUND a
=FOUND NAIL
=FOUND DR1L
=FOUND NAIL
= GARAGE EL
= WOOD POLE
=LIGHT POLE
= LENGTH
= MEASURED
=MONUMENT
=OVERHEAD
=BASIS OF
=SANITARY
MIAMI SHORE ,VILE
A \ O
/7
65, .
NW 6TH AVE
=CATCH BASIN
= U77LITY POLE
- WOOD FENCE
=FIRE HYDRANT
7L-
= ASP HAL -
=GRASS
A.
1CPCOMPUWE WITH ALL FEDERAL
YRUIES AND REGU1ADO0
CaS WALL
N4.
h
a
U.fP. 11 • F...P 112"
_@
—ti ,_,. _• Ntb CAP
4'
75.67,
LO'' `2 SLK 2
HEREBY CER7F ". THAT vi-!( &OUNDAR„ SURUC" OF 77-16 A80VE DESCRIBED °.ROPE c-TY 15. TRUE
AND CORRECT t0 THE 8E5 OF MY KNOWLEDGE AND BELIEF. AS RECEVTL" SURVEYED UNDER MY
DIRECTION. -? .'S ,4LSG M" PROFESSIONAL OPINION T71A % THIS SUR Vc " MEETS THE MINIMUM 7E:°•1NICAt
STANDARDS SE- FORTH . ' THE FL•:RIDA BOARD OF PROF =SIGNAL SURVEYORS AND MAPPERS IN
O' AFTEr of G -'7 -o OF THE FLORIDA 4DMINIS TRATIVc 000E PURSUANT TC SEC 770N 47. -0E- OF WE
=W:ORIDA STA:711 =.
KARL KUHN.
PROFESIONAL _AND SURVE %OR & MAPPER
•^ R7FICATE Nc 395.
='T,:TE OF FLORIDA
7-iE SUR' E7 i ?OWN .-/!_=00N :VCT '/AL!D ?7THOU ' :7;E SiG,VA TURF AND
L":RIGINAr R.v,:.:.ii =EaL A FL. ✓R.iDa , UTh'77:OR ANC MAPPER
LEGAL DESCRIPTION:
LOT 13 BLOCK 2 "WEST SHORES"
A SUBDIVISION ACCORDING TO THE PLAT THEREOF
AS RECORDED IN PLAT BOOK 42, AT PAGE 18, OF
THE PUBLIC RECORDS OF MIAMI DADE COUNTY FLORIDA.
i
PROPERTY ADDRESS:
11250 NW 6TH AVE MIAMI FL 33158
ERTIFIED
PIERRE PAUL.
I
SURVEYORS NOTES:
1 -OWNERSHIP IS SUBJECT TO OPINION OF TITLE
2- EXAM /NATION OF THE ABSTRACT OF TITLE WILL
HAVE TO BE MADE TO DETERMINE RECORDED
INSTRUMENTS, IF ANY, AFFECTING 77-1I5 PROPERTY
3 -NO UNDERGROUND IMPROVEMENTS WERE LOCATED
4- ELEVATIONS ARE REFERRED TO NATIONAL GEODETIC
VERTICAL DATUM OF 1929 (UNLESS ASSUMED).
5 -THERE MAY BE ADDITIONAL RESTRICTIONS NOT SHOWN
IN THIS SURVEY THAT MAY BE FOUND IN THE COUNTY
PUBLIC RECORDS
6 -LEGAL DESCRIPTION PROVIDED BY CLIENT
7- UNLESS 077rIERWISE NOTED RECORDED AND MEASURED
DATA ARE IN SUBSTANTIAL AGREEMENTS.
8- BEFORE ANY CONSTRUCTION THE SE'' BACKS
MUST BE CHECKED
9- THIS SURVEY IS FOR USE AS PER REQUEST
AND NOT FOR .ANY OTHER PURPOSE.
10 -FLOOD ZONE X BASE -- PANEL
1 1- DATE OF FIELD WORK 3 -23 -2C 14
ID No 77- 2136 -027 -0330
0287
CARIBBEAN REALTY SUPPORT SERVICES, INC.
LB 7360
JOB # JR -1 1250— NWSAVE , DRAWN: D.L. REV: K.F.K.
MIAMI DADE /MON.ROE BRO -4RD
(305) 889 -1 100 (954) 435 -0220
FAX (305) 889 -2900 FAX (954) 438-7272
PALM BEACH MARTIN/ST. LUCIE /INDIAN RIVER
(561) 741 -4260 (772) 398 -6533
FAX (5 1) 7d i -4259 FAX (77 9
WESTCOAS T
PERA Tr.141c
Cp� LIE T r ( 3 ) 149— J f r IAv. `n
o •9 ,• 549— 5t?
TOLL FREE .x.µ T, 7YLDE '866 —j6