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FW-15-803Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232833 Scheduled Inspection Date: May 13, 2015 Inspector: Rodriguez, Jorge Owner: , Job Address: 9823 NE 4 Avenue Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Building Department Comments Permit Number: FW -4-15-803 Permit Type: Fence/Wall Inspection Type: Final Work Classification: Wood Fence Phone Number Parcel Number 1132060170330 REPLACE CHAIN LINK WITH WOOD FENCE Infractio Passed comments TO CLOSE PERMIT# FW -13-758 I INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-231988.1x6 slats should be connected to the 4x4 wood post. Failed Correction ❑ Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 12, 2015 For Inspections please call: (305)762-4949 Page 14 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 9823 NE 4 Avenue 1132060170330 MIAMI SHORES COMM CHURCF Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MIAMI SHORES COMM CHURCH INC 9823 NE 4 AVE MIAMI FL 33138-2402 Contractor(s) Phone Cell Phone HOME OWNER Approved: Denied: of Construction: Wood Fence Additional Info: ,ification: Residential Scanning: 1 Fees Due Amount CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee -Wire & Wood $100.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $110.20 Valuation: Y _ $ 1,900.00 Total Sq Feet: 78 Pav Date Pav Tvue Amt Paid Amt Due I Invoice # FW -4-15-55118 04/15/2015 Check #: 18371 $ 110.20 $ 0.00 Avaname Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. April 15, 2015 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Miami Shores Village �= Building Department (SPR 9 7 zn�a 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �B-y Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. An !; — PERMIT APPLICATION Sub Permit No. ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �` I�/ '� / CONTRACTOR DRAWINGS JOB ADDRESS: %?93 fiE Wg Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):): 6%1 Address: 41? o23 IV i :: Li onev : 3Dc� City: &&w w State• f"`L-- Zip: �3 3 13(43 Tenant/Lessee Name: Phone#: Email: VK5 ,�J , 4 e* CONTRACTOR: Company Name: �,t,�/Nj,� r V u( S. T� ` eWL�•4t/F Phone#: Address: City: State: Qualifier Name: hone#: State Certification or Registration #: Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: p: Address: City: State: Zip: i Value of Work for this Permit: $ L SD Square/Linear Footage of Work: 67d `t- I i ) Type of Work: ❑ Addition Description of Work: ❑ Alteration ❑ New - — c/! _/ N Repair/Replace ❑ Demolition Specify color of color thru tile: ffYN 13 _77 jS7g Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ _ i� 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 Zi OL ..0., 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 ignatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of t 20 by who is personally known to me or who has produced - r(D(Z4vK-e as identification and who did take an oath. NOTARY PUBLIC: Sign: dQ��D iii CONTRACTOR The foregoing instrument was acknowledged before me this day of , 20 by , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: as Print: _ >:d� ��-��`'�'- Print: Seal: '�Lo�/�3`' Seal: �1 APPROVED BY ( Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,_ Detail by Entity Name Florida Non Profit Corporation MIAMI SHORES COMMUNITY CHURCH, INC. Wzlffffn•V Document Number FEI/EIN Number Date Filed State Status Principal Address 9823 NE 4TH AVE. MIAMI SHORES, FL 33138 Changed: 03/18/2009 Mailing Address 9823 NE 4TH AVE. MIAMI SHORES, FL 33138 Changed: 03/18/2009 SASTRE, MICHAEL A 2 SOUTH BISCAYNE BLVD. SUITE 3050 MIAMI, FL 33131 Name Changed: 05/20/2009 Address Changed: 05/20/2009 Officer/Director Detail Name & Address Title PT CLARKSON, PAMELLA 20361 NW 4TH ST. PEMBROKE PINES, FL 33029 Title VT N49539 590657328 06/24/1992 FL ACTIVE Page 1 of 3 http://search.sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entity... 4/8/2015 4 , Detail by Entity Name MEDINA, SERGIO, Esq. 623 NE 72ND ST. MIAMI, FL 33138 Title ST JENSEN,KAREN 780 NE 69th St. #2402 MIAMI, FL 33138 Title TT PATTAVINA, DIANE 758 NE 90th St. #515 MIAMI, FL 33138 Title INTERIM MINISTER AND CAO KOCH, WILLIAM N, REV 685 NE 97TH ST. MIAMI SHORES, FL 33138 1�=l Report Year Filed Date 2013 03/19/2013 2014 03/03/2014 2014 06/2712014 Document Images 06/27/2014 -- AMENDED ANNUAL REPORT I View image in PDF format 03/03/2014 ANNUAL REPORT View image in PDF format 03/19/2013 ANNUAL REPORT View image in PDF format 03/20/2012 ANNUAL REPORT View image in PDF format 05/11/2011 ANNUAL REPORT View image in PDF format 03/02/2010 ANNUAL REPORT View image in PDF format 05/20/2009 Reg. Agent Change View image in PDF format 03118/2009 ANNUAL REPORT View image in PDF format 03/14/2008 ANNUAL REPORT View image in PDF format 04/02/2007 ANNUAL REPORT View image in PDF format 07/05/2006 ANNUAL REPORT View image in PDF format 04/14/2005 ANNUAL REPORT View image in PDF format 02/27/2004 ANNUAL REPORT View image in PDF format 05/05/2003 ANNUAL REPORT View image in PDF format Page 2 of 3 http://search.sunbiz.orgllnquirylCorporationSearchISearchResultDetail?inquirytype=Entity... 4/8/2015 Miami Shores Village`p6p 11.5. � (R �y 1. �. J Building Department A.R 1 20B 0 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC � 20 P15 BUILDING Permit No. PERMIT APPLICATION Master Permit No. Permit Type:BUILDING ROOFING JOB ADDRESS: q FaS _N ' -4/ 1409 - City: Miami Shores County: Miami Dade Zip: 3g/Re Folio/Parcel#: `��' f�t/�'�c.S $�e_�t' % PlArt-&--k 1-6, Is the Building Historically Designated: Yes Put -fl 40¢Ey- NO Flood Zone: 0 L `j OWNER: Name (Fee Simple City: State: FZ- Zip: a'Rf'39 Tenant/Lessee Name: "IA Phone#: N�i4 Email: .See -1 4n( . �. CONTRA&OR: Company Name: 0L_j .r (.41,JeA.) Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Contact Phone#: Email DESIGNER: Architect/Engineer: Value of Work for this Permit: $ Certificate of Competency #: Type of Work: ❑Addition OAlteration (( ONew Description of Work: R ---A I A I-®- / Footage of Work: 9 x 9 t_'C . ODemolition �d�4�-+�r• 1�s4-.�was�� l�rara+ nn�e�► /,��c��,car��_ �...:P�'`� t..�� Color thru d1e: of Submittal Fee $ Permit Fee $ e!!�a CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ (0112 Z&U 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature &Goner or Agent 1 Contractor The for oinT tnunenUb lAwledgerf me The foregoing instrument was acknowledged before me this day of , 20 day of , 20 _, by , *, me or who has produced ho is personally known to me or who has produced and who did take an oath. `NOTARYIPUBLIC: Sign: Ail�-✓� OS CL P.,b1ic "Male of Florr cla Print: W,ntary =SAY °gym `Ay" • EE 128810 My Commisskn Expires: # i rotary Assn. �s�"' � '�` ` Bonded Through N�tiona APPROVED BY �� Plans Examiner Structural Review as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: (Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: H/✓-rAZ SkCA_,SG1-1$r1& DATE: ADDRESS: ��'�a !-��' -�� {�e� /` 1'4 It, V-1 ,. Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, KS 489.103(7). And I have read and understood the following disclosure statement, which entities 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_r�ilk 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 SPC 3. 1 understand that, as an owner builder, I am the responsible party o a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having' it filed in his or her name instead of my own � OK— name. I also understand that the contractor is required by law to be li Fjorida and to list his or license numbers on permits and contracts. joP Initial 4. 1 understand that I may build or improve a one family or two-family residence or a f"ilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence 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 worWng 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 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 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:/Aivww.myfoddalicense.com/dbar/pro/Cilbrindde�ex.ht//m'' l Initial �1 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 �t o'er 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 res contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employeiof, afi individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner-builierpe it and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed an e -s tus of the contractors workers compensation coverage. Before a building permit can be issued, this disclosure s"'r t must be completed and signed by the property owner and returned to the local permitting agency responsible for issignak4ie permit. A copy of the property owners driver license, the notarized signature of the property owner, or other type o"W-60tion acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this � � day of , —,20 13 BY—U3tVC�kO wpersonallykn wn m or who h h• was • t• a as Produced there License identification. �eS 0 NER NOTARY t florid p.tbt Mate o23 ZO 8810 -�� e .: M) Gn" # EE 12 Assn• - Co mtsston iNotarY . � ,� de Thro�Sn Nations duo Al % cawo-f Glued._ Ca"camso"P.L. 24.jie (FLT -1 •-0 t.Z*5 4-a 3t Ea xs.z4 P—d a-mm-mv) A F.+io I .2 IFL-M 0 1--' .r_4- > ENGWEM CMRCATE.- I homw cer* T.W + that um Sun" of ft pfmmrty described 1A A I . hemun is true and aornmt to ft best 0 ALI Ott of my knowlefte aW belief as rMenfly syp&" under.my dlrecWn and that there fen encro3chm I nLm on shown or flatad. rveyor No. 66. Stwt&of Rmida. fsc L LU u- uj a: fi AUGUST IME WINICLEN C)wr^J L CIVIL ENGIN-EER NORTH VAIAML FLORIDA cr) Im J: u� E 0 W Lu D. 0 cd 0 Ire Smc.4.AM mmomo (n M ukM x �HOMBM� FLORIDA V I LLA%Cw- S OP According to Plat Book PMB,..t 7.4 XF the Public Recomis td Dade CounWFfm Ew. 3 c1mur'-_6 x co 0D c-- CSl