DS-15-702Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-231189 Permit Number: DS -3-15-702
Scheduled Inspection Date: May 14, 2015 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez, Jorge
Owner: ATASH, KARIM & METIS CORINA
Job Address: 1195 NE 100 Street
Miami Shores, FL
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
DRIVEWAY AND WALKWAY
inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (305)790-5551
Parcel Number 1132050190360
INSPECTOR COMMENTS False
Inspector Comments
Passed
04 --
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
May 13, 2015 For Inspections please call: (305)762-4949 Page 8 of 30
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number Applicant
1195 NE 100 Street 1132050190360
KARIM 8 METIS CORINA ATASF
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
KARIM & METIS CORINA ATASH FL (305)790-5551
1195 NE 100 Street
MIAMI SHORES FL 33138 -
Contractors) Phone Cell Phone
HOME OWNER
In Review
Approved:: In Review
Denied:
of Work: DRIVEWAY AND WALKWAY
Retum :
nina: 3
Fees Due
Amount
CCF
$3.60
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$1.20
Permit Fee
$150.00
Scanning Fee
$9.00
Technology Fee
$4.60
Total:
$173.10
Additional Info:
Classification: Residential
Valuation: $ 5,800.00
Total Sq Feet: 1170
Pay Date
Pay Type Amt Paid Amt Due
Invoice #
DS -3-15-54969
03/27/2015
Credit Card $ 50.00 $ 123.10
03/31/2015
Credit Card $ 123.10 $ 0.00
Avauaoie inspections:
Inspection Type:
Final
Building
In consideration of the issua to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in stri conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I as me responsibility for all rk d ne by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELEr+CTRICA , PLUMBING. MECHANIC W} D DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFF DAVI I certify that all the f ing 'h ormation is accurate and that all work will be done in compliance with all applicable laws regulating
construction an� zorEing. Futhermore, I �athhe�g6ve named contractor to do the work stated.
/
Buildi g Departmenttopy
March 31, 2015
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
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
❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS
JOB ADDRESS:
FBC 20 10
Master Permit No.!:�s,
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:` (�
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
OWNER: Name(Fee Simple Titleholder):
Address: 11 '7,,)'- 1 C9 t)
Flood Zone: BFE: FFE:
one#: '� c: 5 ) 7o — 55-15- )
City: AZA A State: Zip:
Tenant/Lessee Name: Phone#:
Email: l � _,- --0 l C
CONTRACTOR: Company Name:COC: w�Ia =ie �� Phone#:
Address:
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 6 To 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 1 )oC -\( e
Specify color of color thru tile:
Submittal Fee $ ''iii Permit Fee $ Iso ' M CCF
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
k�- Ay
DBPR $
CO/CC $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ Qas.
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 att chment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspecti which occurs seven (7) days a he b ding permit is issued. In the absence of such posted notice, the
inspection will not bpprov d and a reinspection f be c ged.
Signature
OWNER or AGE
The foregoi g instrument was acknowledged before me this
day of W , 20 of , by
ks , who ' ersonally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
SigncD.._qn
rent:
Signature
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:
Print:
Seal: Seal:
as
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:14 1 f DATE:
ADDRESS:
100 c
s ff0?1�-S• �G
-5-3
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 owe 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 ow er-b 'Ide
permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, ac rp 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 resp nsible r
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 in tead y own
name. I also understand that the contractor is required by law to be licensed in Florida and to list his r lic nse b 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 substa 'ally ' pro
myself is sold or leased within 1 year after the construction is complete, the law will presume that I bui r s to ' Ily
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 buildi g or
residence. It is my responsibility to ensure that the persons whom I employ have the license required by law d b co ty or
municipal ordinance.
Initial
w
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 willful y ting 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 cc ensa' for
the employee. I understand that my failure to follow these may subject to serious financial risk.
Initia
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 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 h ://www.m oridalicense.com/db rl ro/cilbfiin e
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 nartv
legally and financially responsible for the proposed construction activity at the following address:
1®®
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of thi
have provided on this disclosure.
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 day of /YJda/ h , 20—/,4—
By
0J,4—
By )c !2LI'17-) &.4 s h. who was personally known to me or who has
or J— 0.1X==-1 as identification.
FLP\fW � ' /�IV•••
I tvsi _DUg hfotary Pubi'° State
r° 4; Joanna M Feliciano
• a Commission FF 082753
�Mpires0111212018
9.12' ASPHALT PAVEMENT . � }� �
78.60 t P M
T
15' ALLEY l Nwr- r
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r.LP.W
TUE
PA 710
39.75'
0
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MAR 27 2013
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06.75
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ASPHALT
DRIVEWAY
�' I$ 19.80'
1?.00'
N, E. 100th STREET
20.5' ASPHALT PAVEMENT
Accepted By:
ropsrly Address: 1195 N.E. 100 STREET NOTES: NO NOTES
MIAM SHORES, FL 33138
-1 rHATTf$S'BOUPIDARY 9/RVE1'IaATRUEANU CORRECT M.E. Land Services, Inc.
REPR6HJT 'RON OFABU ABED MYWRECTION. TMS COA�8WRHTF¢AOMMl147
TECHNICAL BTANOARDB, TFORTH BY TM TE OFFIARmA BOARD OF PROFE9SIQAIAI.LAM
aumtEraRaw n. FlgramLt�BNt rnEcooEwmaiuNrromzovFL°wuasrarurEs 106855W190THSTREET
SUITE 3110
SIGNED FOR THE FIRM MIAMI, FL 33157
�OUFL PHONE: (305) 740-3319
Mn ¢�
P.S.M. No. 6101 FAX: (305) 689-3190
Norvaffo� TUREaPIDAURiFMICATEDELECTHOPllCaEALAN010R LI3#:6463 --
Tws¢vwrsNorvaw umrr�owotNURasmSEAL oFau°ENSMauRVEroR
AND
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RESIDENCE
#1195
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20.35'
39.75'
0
-0.89
MAR 27 2013
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06.75
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ASPHALT
DRIVEWAY
�' I$ 19.80'
1?.00'
N, E. 100th STREET
20.5' ASPHALT PAVEMENT
Accepted By:
ropsrly Address: 1195 N.E. 100 STREET NOTES: NO NOTES
MIAM SHORES, FL 33138
-1 rHATTf$S'BOUPIDARY 9/RVE1'IaATRUEANU CORRECT M.E. Land Services, Inc.
REPR6HJT 'RON OFABU ABED MYWRECTION. TMS COA�8WRHTF¢AOMMl147
TECHNICAL BTANOARDB, TFORTH BY TM TE OFFIARmA BOARD OF PROFE9SIQAIAI.LAM
aumtEraRaw n. FlgramLt�BNt rnEcooEwmaiuNrromzovFL°wuasrarurEs 106855W190THSTREET
SUITE 3110
SIGNED FOR THE FIRM MIAMI, FL 33157
�OUFL PHONE: (305) 740-3319
Mn ¢�
P.S.M. No. 6101 FAX: (305) 689-3190
Norvaffo� TUREaPIDAURiFMICATEDELECTHOPllCaEALAN010R LI3#:6463 --
Tws¢vwrsNorvaw umrr�owotNURasmSEAL oFau°ENSMauRVEroR
AND
euaFER.
Survey:A-50790
Client File t. 1440048
Page 1 of 2 Not valid without all pages.
Survey:A 50790 Client File*. 14-0048 Page Z of 2 Not valla without 811 pages.
Sulveyol's Legend
PROPERTY LME
STRUCTURE
FO FOUND IRON PPE / B.R. BEARING REFERENCE TEL TELEPHONE FACILITIES
® CONC. M= WALL
PIN AS NOTED ON PLAT A CENTRAL ANGLE OR DELTA U.P. UTILITY POLE
—X—X— CHAIN-LINK FENCE OR WIRE FENCE
LBO LICENSE O - BUSINESS R RADIUS OR RADIAL E.U.B. ELECTRIC UTILITY BOX
--�H/— WOOD FENCE
LSO LICENSE O - SURVEYOR RAD. RADIAL TIE SEP. SEPTIC TANK
—o---o-- ILON FENCE
CALC CALCULATED POINT N.R. NON RADIAL D.F. GRAINFIELD
— — — — EASEMENT
SET SET PM TYP. TYPICAL A/C AIR CONDITIONER
— - — CENTER UNE
A CONTROL POINT I.R. IRON ROD S/W SIDEWALK
® WOOD DECK
CONCRETE MONUMENT LP. IRON PPE DWY DRIVEWAY
r�
V BENCHMARK M" NAL h DSK SCR. SCAN
O CONCRETE
ELEV ELEVATION PX NAIL PARKER-KALON NAIL GAR GARAGE
®ASPHALT
P.T. POINT OF TANGENCY D.H. DRILL HOLE ENOL ENCLOSURE
P.C. POINT OF CURVATURE ® WELL N.T.S. HOT TO SCAM
BRICK / TILE
P.R.M. PERMANENT REFERENCE MONUMENT ® FIRE HYDRANT F.F. FINWSHED FLOOR
WATER
P.C.C. POINT OF COMPOUND CURVATURE M.H. MANGLE T.O.R. TOP OF BANK
P.R.C. POINT OF INVERSE CURVATURE O.H.L.OVERNfAO 1U1E3 EA.W. EDGE OF WATER
/------- APPROXIMATE EDGE OF WATER
P.O.B. POINT OF BEGINNING TX TRANSFORMER E,p.P EDGE OF PAVEMENT
COVERED AREA
P.O.C. POINT OF COMMENCEMENT CATV CABLE TV BSER C.V.G. CONCRETE VALLEY CUTTER
P.C.P. PERMANENT CONTROL POINT W,M, WATER METER B.S.L BUILDING SETBACK LINE
•� TREE
M FIELD MEASURED PA POOL EQUIPMENT S.T.L SURVEY TIE LME
POWER POLE
P PLATTED MEASUREMENT CONC. CONCRETE SLAB q CENTER LME
�TT�T
i1W CATCH BASIN
D DEED ESMT EASEMENT R/, RIGHT-OF-WAY
C.V.E. COUNTY UTILITY EASEMENT
C CALCULATED O.E. DRAINAGE EASEMENTP.U.E. PUBLIC UTILITY EASEMENT
I.E./E.E. INGRESS / EGRESS EASEMENT
U.E. UTILITY EASEMENT
L.M.E. LAKE OR LANDSCAPE MAIM. ESMT LB.E. LANDSCAPE BUFFER EASEMENTC.M.E. CANAL MAINTENANCE EASEMENT
R.O.E. ROOF OVERHANG EASEMENT LA.E. LIMITED ACCESS EASEMENTA.E. ANCHOR EASEMENT
Property Address:
General Notes:
1. The Legal Description used to perform this survey was supplied by others.
1195
1195 N.E. 100 STREET
R ET
This survey does not determine or is not to imply ownership.
2. is survey only shows above ground Improvements. Underground umm,
SHORES,
footings, or encroachments are not located on this survey map.
3. If there is a septic tank, wall, or drain field on thft survey, the location of such
items was shown to us by others and the Information was not verified.
Flood Information:
4. Examination of the abstract of title will have to be made to determine recordix
instruments, if any, effect this property. The lands shown herein were not
Community Number 120652
abstracted for easement or other recorded encumbrances not shown on the plat
of
Panel Number. 12086CO306
e. Fence ownersship Is no a tternflneum
d.
Suffix: L
7. Bearings referenced to line noted B.R.
8. Dimensions shown are platted and measured unless otherwise shown.
Date of Firm Index: 9/11/2009
9. No identification found on property comers unless noted.
Flood Zone: AE
10. Not valid unless sealed with the signing surveyors embossed seat.
11. Boundary survey means a drawing and/or graphic representation of the
Base Flood Elevation: 8.0
survey work performed In the field, could be drawn at a shown scale and/or not to
mai®'
Date of Field Work: 7/29/2014
12. Elevations If shown are based upon NGVD 1929 unless otherwise rated.
Date of Completion: 7/30/2014
13. This is a BOUNDARY SURVEY untess otherwise noted.
14. This survey is exclusive for the use of the parties to whom it is certified. The
certifucations do not extend to any unnamed partes.
15. This survey shall not be used for constnaon 0emlting purposes without
consent from Miguel Espinosa.
Legal Description:
LOT 15 LESS THE EAST 5 FEET, BLOCK 177, OF SUBDIVISION MIAMI SHORES SECTION 8 REVISED, ACCORDING TO
THE PLAT THEREOF AS RECORDED IN PLAT BOOK 43, PAGE 67, OF THE PUBLIC RECORDS OF MIAMI-DADE
COUNTY, FLORIDA
PRINTING INSTRUCTIONS:o.
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C)
M.E. Land Services, Inc.
10665 SW 190TH Street, Suite 3110 MIAMI, FL 33157
_ PHONE:(305) 740-3319 FAX #:(305) 669-3190 LB # 6463 _
WVWV.MELANDSERVICES.COM
Survey:A 50790 Client File*. 14-0048 Page Z of 2 Not valla without 811 pages.