DS-14-1540Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-216383
Scheduled Inspection Date: July 28, 2014
Inspector: Rodriguez, Jorge
Owner: PALMER, MICHAEL
Job Address: 920 NE 99 Street
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: HOME OWNER
Isui
comments
Permit Number: DS -7-14-1540
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (305)793-6914
Parcel Number 1132060143401
PAVER WALKWAY REAR OF HOME TO ALLEY STREET I ' '
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-216085. No permit posted
PERMIT WILL BE POSTED ON THE BACK DOOR IN A ZIP LOCK BAG
ROBERT BOURNE 786-281-8376
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
July 25, 2014 For Inspections please call: (305)762-4949 Page 16 of 30
Rk
BUILDING
PERMIT APPLICATION
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
❑BUILDING ❑ ELECTRIC ❑ ROOFING
JUL IT
FBC 20 L
Master Permit No.
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /o'4�> N� q1 sr -
City: P15 Miami Shores County: ;h ►dd Miami Dade Zip: 5519
Folio/Parcel#: is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: NQS Flood Zone: BFE: FFE:
A -r u �. Pwv rpt . P�-
OWNER: Name (Fee Simple Titleholder):A
_ Phone#:105 _X3 6q1T
Address: q`z Afl_- Cpy ,S
City: l*ft T #DA1dff State: Zip: _q,30F
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: O-A)AA:�X, Phone#:
Address:
City: State:
Qualifier Name:
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engine Phone#:
Address: _ City: State: Zip:
�
Value of Work for this Permit: $ P50 Square/Linear Footage of Work: 5� zl t
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: P& -W4 (+CAL&sC ±v ( 9c4o, 6F— 4--r*6 7 STaeVT—
A0_ T
Specify color of color thru tile:
Submittal Fee $ " Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Radon Fee $ DBPR $ Notary
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $b�
P
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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
inspection will not be approved and a reinspection fee will be charged.
Signature g
Si nature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
!16 day of .20 by
,is personally known to
me or who has produced -613S
—res
identification and who did take an oath.
NOTARY PUBLIC:
Sign
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
, who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
as
Seal: v� NotarY �� scat' of Florida
°� Joanna M Feliciano Seal:
• My Commission FF 082753
''�m�� EXWrea01N212018
>Kt>K>K��>K#�k � >k�k*x�wM+k***�k� �kile�R�F+b�k�kak+kik**�k�k�k�k�k+k�k�k�k�k�k�kakakakak#�k�k�k+k�F�kak�k�k�k�kak�k�k�k�k�k�k�kak�k ah�k�kak�le&�kt��k�k�kk�9� `IIe�ffi&*�k*ffi�R**K�ffi*�k
APPROVED BY Plans Examiner / / oning
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
AA
OWNER BUILDER DISCLOSURE STATEMENT
4wrixNAME: t 1 Ili 1" , �l. 6 P 4 ►nom --21P511 Y
ADDRESS: Ak�'qq 57 f/4-lw1-Si toiLc PA— 331 3V
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 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 bunt 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. 1 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
2. 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. Yf
Infial
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 understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on
permits and contracts. Q
Initial rr
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, 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 NO
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. 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 govern 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 contact the
Florida Construction Industry Licensing Board at 850.487.1395 or http:lAwAv.myfloddalicanse.com/dbDr/Drolcilbfindex.html
Initial
I 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 fine nci esponsible 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 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 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 day of , 20 f
By e'�1 6�iwho was personally known to me or who has
Produced there License or �� ^� as identification.
OWNER NO
IN% Notary Public State of Florida
Joanna M Feliciano
My Commission FF 082753
pr q0� Expires 01/1212018
VM%4U'S � -
SUN2610
HF.�LSH M1A�1 DADS COUNT
REVISED:
P
W
ABBREVIATIONS:
Sri(=SIDEV 01LK C&S--CONCRETE BLOCKSTRUCTURE. CLF=CHAIN LINKFENCE. PL=PROPERTY LINE• DUE=DK4tNAGE UTILITY EASEM ENT IP=IRON PIPE.,
F=FOUND. A(C=AIR CONDMONER PAD, PIC -PROPERTY CORNER. D/4 -DRO LED HOLE, WF=V0ODEN PENCE. RES -RESIDENCE. CL -CLEAR, RB= iEW..,
UE-umrry EASEMENT. COAC-CONCRETE SLAB. RAVaRIGHt OF VWX DE -DRAINAGE EASEMENT. CIL=CENTER LINE, O=DU4MTER. TYp=Typr—v,
M -MEASURED. R=RECORDED• ENCR-ENCROACHMENT, COMP -COMPUTER. ASH -ASPHALT. N/D=NAIL & DISC, S SEr• FEE -FINISH FLOOR ELEVAnOt.
O/.-OFFSEr, P/P=POVJERPOLE.OHP=OVERHEAD POWERLINE. WA=VIATERMETER
`
MASONRYWV= ELEVATION BASED ON LOC. # 3550' S
AsoNR
CONCRETE= .•r a:.,r••: -:: r .:•.r , •.r :•.r .•..r •:.
MAINTENANCsE&DRAINAGE EASEMENT= M 80.E GBM# B-62 ' ELV.B .741 TYPE OF SURVEY: BOUNDARY SURVEY .
3LO/E)FOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE
AND RAISED SEAL OFA FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NCI
COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5)
UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC
VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL
RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAYBE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 9)
CONTACT THE APPROPRIATE AUTHORrrY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING -
INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDEC
INSTRUMENTS. IF ANY. AFFECTING THIS PROPERTY.
Additions or deletions to survey maps or reports by other than the signing party or parties is prohibited
Without written consent of the signing party or parties.
BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PS � 10 PAGE 37
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LOCATION SKETCH
SCALF,: NTS
owlway
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PROPERTY ADDRESS: 920 N..E. 99TH ST., MIAMI SHORES, FL. 33138.
LEGAL DESCRIPTION: LOT 10 AND WEST 1/2 OF LOT 9 BLOCK 80 '
OF MIAMI SHORES SECTION
3 SUBDIVISION
ACCORDING TO THE PLAT THEREOF AS
RECORDED IN PLAT BOOK 10 AT PAGE 37
OF THE PUBLIC RECORDS MIAMI—DARE COUNTY, FLORIDA
HEREBY CERTIFY That the survey represented
SINCE 1987
t
thereon meats the minimum technical requirements
BLANGO SURVEYORS INC.
adopted by the STATE OF FLORIDA Board of Land
Surveyors pursuant to Section 472.027 Florida
Engineers • Land Surveyors • Planners . LB # 0007059
Statutes.
7555 NORTH SHORE DRIVE
There are no encroachments, overlaps, easements
appearing on the plat or visible easements other than
MIAMI BEACH, FL 331.41
as shown hereon.
'305111654200 Email: blancosurveyorsinc@yahoo.com Fax: (305) $65-7$10
'
FLOOD ZONE: .g SUFFIX L DATES/11/09 BASE N/A
ADIS N. NUNEZ
PANEL: 0306 COMMUNITY # 120652
REGISTERED LAND SURVEYOR
DATE: SCALE: DWN. BY JOB No
STATE OF FLORIDA #5924
3/20/14 IV= 20' F. Blanco I . 14"281
EXECUTOR NOMINATION
I nominate my son, Michael Palmer, to be the executor of this Will.
if, for any reason, my first nominee executor is unable or unwilling to
serve or to continue to serve as executor of this Will, I nominate my daughter,
Mary Ann Cole, to be the successor executor.
if none of the nominated executors are able, willing, and authorized to
serve or to continue to serve, and the vacancy is not filled as set forth above, the
majority of estate beneficiaries shall nominate a successor executor. If the
majority of estate beneficiaries are unable to nominate a successor executor, the
pursuant to a tion filed by the resigning executor or any
vacancy will be filled p P�
person interested in the estate in a court of competent jurisdiction.
MISCELLANEOUS EXECUTOR PROVISIONS
The term "executor" includes any executrix, personal representative, or
administrator, if those terms are used in the statutes of any state that has
jurisdiction over all or any portion of my estate.
My executor will have broad and reasonable discretion in the
administration of my estate to exercise all of the powers permitted to be
exercised by an executor under state law, including the power to sell estate assets
with or without notice, at either public or private sale, and to do everything he or
she deems advisable and in the best interest of my estate and the beneficiaries
thereof, all without the necessity of court approval or supervision. I direct that
my executor perform all acts and exercise all such rights and privileges, although
not specifically mentioned in this Will, with relationto tosuch PrOPeTtY, as if
make,execute,d
the absolute owner thereof and, in connection therewith,
deliver any instruments, and to enter into any covenants or agreements binding
my estate or any portion thereof.
If there are two co-executors serving, they shall act by unanimous
agreement. If there are more than two co-executors serving, they shall act in
accordance with the decision made by the majority of co-executors.
Subject to specific provisions to the contrary, I authorize my executor to
distribute a share of mestate given to a minor beneficiary, up to the whole
y
applicable Transfers to Minors Act or Gifts to
thereof, to a custodian under the
Minors Act, if in the executor's discretion, it is in the best interests of the
Page 6 of my Last Will and Testament �tt� (initia4
IN WITNESS WHEREOF, I, the undersigned testator, declare that I sign
and execute this instrument on the date written below as my last will and
testament and further declare that I sign it willingly, that I execute it as my free
and voluntary act for the purposes expressed in this document, and that I am
eighteen years of age or older, of sound mind and memory, and under no
constraint or undue influence.
(Signature of Aim Palmer)
Date: /// Sl 1Z..
Page 9 of my Last Will and Test ment o tP (Initial)
Mission: Rick Scott
To protect, promote & improve the health ,
Governor
of all people in Florida through integrated John H. Armstrong, MD, FACS
state, county & community efforts.
HEALTHState Surgeon General & Secretary
Vision: To be the Healthiest state in the Nation
July 01, 2014
Ann Palmer
920 NE 99 Street
Miami, FL 33138
RE: Modification to a Single Family Residence - No Bedroom Addition
Application Document Number: AP1141801
Centrax Permit Number: 13 -SC -1530597
920 NE 99 Street
Miami, FL 33138
Lot: na Block: na Subdivision:
Dear Applicant,
This will acknowledge receipt of a floor plan and site plan on 04/02/2014 for the use of the existing
onsite sewage treatment and disposal system located on the above referenced property. No
Objection. New Walkway. Reviewed by N. Gumbs on 7/1/2014.
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.
Sincere ,
Nicole
Engineering Specialist II
Department of Health in Dade County
Florida Department of Health www.FloridasHealth.com
in Dade County • • , Florida TWITTER:HealthyFtA
PHONE: (305) 623-3500 FACEBOOK:FLDepartmentotHealth
YOUTUBE:fldoh