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EL-09-1484Me Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218703 Permit Number: EL -9-09-1484 Scheduled Inspection Date: August 28, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Owner: PHILLIPS, SEAN Job Address: 210 NW 105 Street Miami Shores, FL 33150-1143 Project: <NONE> Contractor: HOME OWNER tsuuamg uepartment comments Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1121360161040 Install smoke alarms Infractio Passed Comments INSPECTOR COMMENTS False 'i permit renewed on 8/1/13 Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 27, 2014 For Inspections please call: (305)762-4949 Page 27 of 27 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 PERMIT APP CATION ❑BUILDING ELECTRIC ❑ ROOFING AUG. 27 2014 iayr: _ FBC 20 �0 Master Permit No. N — I4 I Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS to JOB ADDRESS: p( City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Stu-,, i (hn!z Phone#: A/6) (65 is Address: ei4mi City: dho(eS State: Zip: - Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: LA ei, Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ No 06 Square/Linear Footage of Work: Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Reil eld Specify color of color thru tile: Submittal Fee $ Permit Fee $ l 6/0'0a ev CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 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 OWNER or AGEN The foregoing instrument was acknowledged before me this day of 20 U'l by who is personally known to me or who has produced as identification and who did take an oatfl,,�iluuu//,���s// S tri NOTARY PUBLIC: ..... Sign: v;:" c ; 7 - s Print: ,��� .........°•� Seal: , \` 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: Sign: Print: Seal: �k�k�k�k#�k�k�k+k&*&�k�k�k&�k*�k�k*Ms*�k}+k�k�k**�k�k�k�k�k�k�k+kik&�k�k&*&�k�k�k�k*�ie�k*�Ie*�k�k&�k4�k�k�k�k#+k�k�k*�k�k�k�k�k�h�k�k�k�k�k+ktkakak4�k�k�kffi�k�K�kakak�ktk**�kakffi�h�k�k�k�h�k�k APPROVED BYE/J�� j4ePlans Examiner 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 NAME: Sko-n -Pn t � I c DATE:4o, 1 11 ADDRESS: I (05 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 my own 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 respons' le for the 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 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 umbers 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 improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built tantially improved it for sale or lease, which violates the exemption. Initial - a 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. A Initial 6. 1 understand that I may not hire an unlicensed P;rrson 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 properly 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 -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 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. Infial 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 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 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 h ://www.m oddalicense.comldb r/ ro/Cilbriind r. ml Initial fJ r 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 financially responsible for the proposed construction activity at the following address: Initial ) fle 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the infor;r_ 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 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 .97 day of AL& - , 20 14 By � 1I who was personally known to me or who has Produced there License or ��'�-- C ) 2- as identification. BUILDING PERMIT APPI FBC 20 Permit Type; ELECT] Owner's Name (Fee Simple Owner'(- Address16 City Email f 11�Ziami Shores Villag E 1511 Buildin g Department 10050 N.E.2nd Avenue, Miami Shores, Florida 331 Tel: (305) 795.2204 Fax: (305) 756.8972. II`NSPECTION'S PHONE NUMBER: (3055) 762.49, Per: ,IC I' TION Master Per I CAL � Gideholder) lem 1-11t �yQ� Phone # Job Address (where the work is City Miami §hore V FOLIO / PARCEL # Is Building Historically Desgn Contractor's Company Nam _ Contractor's Address City Qualifier Name State Certificate or Registradi in l Contact Phone Architect/Engineer's Name Qf. a Value of Work For this Per 't Type of Work: ❑Additi n Describe Work: C ►� L a zip 3� Phone # 'i County NO 1� Phone Certificate of Competes h. E-mail. blo) Phone $ ILU Square / Linear Footage Work: ❑Alteration _ ❑New ❑ Repl i epla ❑ Demolition aal�pp Submittal Fee $ •4 Perm: it Fee $ ✓� mr m' d CCF'$ n 0 CO/CC $ Notary $D Tj�aining/F�ucation Fee $ d� Technology Fee $ P _—j Scanning $ RadoDPBR $ Bond $ � $I Double Fee $. Violation date. �Q • Structural Review. $ Total Fee Now D ae $ See Reverse 'side -� 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 V Signature Owne or Ageng Contractor The foregoing instrument was acknowledged before me this��' The foregoing instrument was acknowledged before me this day of r 20vf�. by SC -RN day of .20 _, by , who is personally known to me or who has produced q 12 " who is personally known to me or who has produced- -70-9 roduced -7 U — is14-6 As identification and who dike an oath. as identification and who did take an oath. NOTARY PUB rF;� i t, Sign: Print:r� �� G My Commission Expires: NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY Alans Examiner Zoning Engineer (Revised 07/10/07)(Revised 06/10/2009) Clerk checked VILLAGE OF MIAMI SlJoRES OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE: q ? ADDRESS: AW 16 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). 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 shows you, as the owner of your properly, to act as your own contraotor even though you do not have a license. You must supervise the construction yourgolf. 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 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 fot• sale or lease, which is a violation bf 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.atid by county or muMpipal licensing ordinances. Any person working on your building who is not licensed rimget wgrk und.er your supervision and must be employed by you, which means that you must deduct F.LC.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 hold. title to the above property and I am planning on doing this cons ction Myself. Initial 2. I understand that as an owner -builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application. Inactive permits for a period of over 180 days.. will become null and void (expired) and a new permit will be required. to be issued for reinstatem nt of the permit., Initial 3. I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial u 4. L understand that the building official and inspectors are not there to design, alter or give advice on how to meet code — only if the structure meets the minimum code. Initial S. I understand that as an owner -builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of 0 attorney. The department will not mitigate any contract* disputes. Initial /' 6. I understand that if I compensate any person or company for work performed they are.requited ed to helve a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. initial . 7. I underatand'that if any person gets injured on my construction project—they are entitled to workmen's compensation. -Anil if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include kiss of wages during recovery from injury. Initial r 8. 1 understand . that under state and local laws * I can not do . any Electrical, Plumbing, Heating, Air & Roof work on my 'property with out first obtaining the proper permits by licensed contractors. Initial aWas acknowledged before me this day of, 20 BY � � Pi � L \ i�S who was personally known to me or who has Produced there License or -F_f-1 0 L as identification. NOTARY .0. o�