DS-14-2517Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-223447 Permit Number: DS -11-14-2517
Scheduled Inspection Date: February 26, 2015 Permit Type: Driveways/Sidewalks/Stabs
Inspector: Naranjo, Ismael Inspection Type: Final
Owner: SAINVIL, THEOPHILE Work Classification: Addition/Alteration
Job Address: 535 NW 111 Street
Miami Shores, FL 33138-0000
Phone Number
Parcel Number 3021360210730
Project: <NONE>
Contractor: HOME OWNER
tiunamg uepartment comments
DRIVEWAY 50 X 10 CONCRETE AND WALKWAY Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed 41
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
February 25, 2015 For Inspections please call: (305)762-4949 Page 9 of 40
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
Nov 14 2014
FBC 20 10
Master Permit No.w
Sub Permit No.
❑BUILDING F-1 ELECTRIC ❑ ROOFING ❑ REVISION F_� EXTENSION RENEWAL
[PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: iZ om g 'Okyhe'�'6 Phone#:
Address:
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
hone#:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: _�Zip:
Value of Work for this Permit: $_ 620, Square/Linear Footage of Work: 5-40 /Ff�
Type of Work: ❑ Addition ❑ Alteration ElNew 9 Repair/ eplac ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ : Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
CONTRACTOR
DRAWINGS
JOB ADDRESS:
4'3'r/ykj /,�/'gr
City:
Miami Shores
County: Miami Dade
Zip:_
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
Occupancy Type:
Load:
Type: Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
—rConstruction
c
/ s/� .di �(�/ /
Phone#:'3A7— r9
Address:
w
sarr
City:
State: lz
Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: iZ om g 'Okyhe'�'6 Phone#:
Address:
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
hone#:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: _�Zip:
Value of Work for this Permit: $_ 620, Square/Linear Footage of Work: 5-40 /Ff�
Type of Work: ❑ Addition ❑ Alteration ElNew 9 Repair/ eplac ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ : Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
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 Signature
OW or AGENT CONTRACTOR
Theforegoinginstrument was acknowledged before me this
ti day of N�M� 20 y by
L---0P1,Itt- 'S -N('4 \CC , who is personally known to
me or who has produced
identification and
NOTARY PUBLIC:�
Si
Print:
did take an oath.
The foregoing instrument was acknowledged before me this
day of
as me or who has produced
20 , by
, who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Notary public State of Florida Seal:
Sindia Alvarez
*Ory
My Commission FF 156750
Expires 09/03/2018 _ `
as
1 ` f 2.J t 7'
i Z.��t- f
APPROVED BY Plans 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: _ �%T �!] �is �-P / 1;�I I!l / DATE: 1
ADDRESS: NW /8 47�j/aLiryL" S`& Oka i l.3 319,*
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 l have
read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that l 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. 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 f S
2. 1 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
3. I 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.
Initial 75;!
4. 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 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 /2
5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
Initial Z
6. 1 understand that l 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 I'
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
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. 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 /.rte
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://www.myfloridalicense.com/dbpr/pro/cilb/index.html
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
legally and financially responsible for the proposed construction activity at the following address:
Initial / o�
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 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 I �_i day of NKU , 20 1 VA
ByCJ�1yi\/1 who was personally known to me or who has
Produced there License or
as identification.
#0 P Notary Public State of Florida
+� y Co Alvarez
ER '` m
ARY :,� MY commission FF tsei'so
t expires 0910912018
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami shoresViliage
Building Department
SURVEY AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiant, / hW,0kle Ai 4i_/does hereby attest that
(Property owner)
The attached survey, performed by L l �P.Ri
(Name of surveyor's company)
Foraddress: 5 �5 /11Y� //�S r /�,2`r�,� IF
Performed on /2. 2. (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 affe t final inspections as applicable to this or other permits.
Furt nt ay eth naught. y
�r f;344i ,. A
Prop wner 'gnature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me, produced L,t r Q_ as identification.
s
i-"
Nofary
Revised on 5/22/20091 Revised on 6112/09
RNotary Public Stale of Florida
Sir►dia Alvarez
My Commission FF 159750
Expires 09103*018
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BEARING NOTE:
Bearings shown hereon are to an assumed meridian, Due
East Is assumed to be parallel with N.W. 111th Street as
shown hereon.
NOTES:
1.) ELEVATIONS WHEN SHOWN REFER TO THE NATIONAL GEODETIC VERTICAL DATUM (N.O.V.D.j
1) THIS FIRM HAS MADE NO ATTEMPT TO LOCATE FOOTINGS ANDIOR FOUNDATIONS (UNLESS OTHERWISE MOTED).
S.) THE LANDS SHOWN HEREON HAVE NOT BEEN ABSTRACTED BY THIS FIRM REGARDING MATTERS OF INTEREST BY
OTHER PARTIES. 61 AS EASEMENTS. RIGHTS -OF -WAYS. RESERVATIONS. ETC -
4.1 THS SURVEY WAS PREPARED FOR AND CERTIFIED TO THE PARTY ANDADR PARTIES INDICATED HEREON AND S
NOT TRANSFERABLE OR ASSIGNABLE.
Q ALL IRON PIPES AND MALS a DISCS, SET BY THIS FIRM, SET WITH CAPADRaW WITH L.& B460B,
PREPARED FOR: I -kw hi le. grid AT'iotani6 aainN) I
LEITER & ASSOCIATES. INC. DATE: 6-12-g2
LAND DEVELOPMENT CONSULTANTS Joe ORDER: n_
CIVIL ENGINEERS - LAND SURVEYORS FILE NO.: 1?1_-1101
LAND PLANNERS - ENVIRONMENTAL F.0 PG.
Ery%
160 N:N.176TH ST.. SUITE 403. MIAMI. FLORIDA 33169
PHONE: DADE (305) 652-5133 BROWARD (305) 624-2202
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SURVEYOR'S CERTIFICATE: WE HEREBY CERTIFY,
THAT THIS SURVEY IS TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF AS RECENTLY
SURVEYED AND DRAWN UNDER OUR DIRECTION. AND THAT THIS SURVEY MEETS THE UNILBRA TECHNICAL
STANDARDS' AS SET FORTH BY THE FLORIDA STATE BOARD OF LAND SURVEYORS IN CHAPTER 2IHH•B.
FLORIDA ADMIWSTRATIVECODE.PURSUANTTpB TION 472.W. FLORIDA STATUTES.
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