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�