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RC-13-601BUILDING 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: (30S) 762-4949 ° -\,7 -7- FBC 20 ioj Master Permit No.0?N0 - C3 I Sub Permit No BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION `RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 0&0 t NE S St. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: %131° o136 23C� Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: y' Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): `I.'"''7 Phone#: • Si2 • �`�� Address: 191 • NYE t13" City: r"�'���' ( JW' State:- Zip: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: ScptT L44Le Phone#: �� • � $ Address: X45 1 I TUS *rv• City: 09"4WLA-' State: 4— Zip: Value of Work for this Permit: $ 61 oad - � Square/Linear Footage of Work: ul Type of Work: ❑ Addition F Alteration ❑ New. ❑ Repair/Replace ❑ Demolition Description of Work: X L Ttue -) k"na. Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ �1 -00 Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ G4 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 NOVICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated -value exceeding $2560,athe applicant must promise in good faith that a copy of the notice of commencement and clonstruction 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. Signatu or The foregoing instrument was acknowledged before me this �J day of l/ . 20 . by who is personally known to me or who has produced ��ms identification and. who: did take an oath. NOTARY PUBLIC: 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: Seal: Seal: APPROVED BY / Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) NAME: At Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 'ADDRESS: saC we l 7,10 • �• Do hereby petition the Village of Miami Shores to act as my own contractor pursugnt to the laws of the State of Florida, RS 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. 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 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. 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 numbers on permits and contracts. Initial 4. 1 understand that I mayabiUikt or impr?va 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. x Iriitial 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 personworking on my building or nse residence. It is my responsibility to ensure that the persons whom I employ have the licerequir by law and by county or municipal ordinance. Initial I 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_ I 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 sobject to sedouis fihariciaNsk. Initial_ I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem 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_ 1-- 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.myfloddalicense.com/dbor/oro/cilbfindex.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: -SO\ f E Initial 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. Ct Was acknowledged before me this day of rCEWl grdL , 20 By volt " C"_ &APTt;.A— who was personally known to me or who has Produced. there License or T S-�2-01�0 2�%���-`�' as identification. WNER ro`�p ivocaryPublicState � RY • Joanna M Feliciano oe My Commission FF 082753 oFRo� a Expires 01/72/2018 Miami Shores Village Building Department 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( BUILDING' Permit No. PERMIT APPLICATION Master Permit No. vc Permit Type: JOB ADDRESS: BUILDING ROOFING City: Miami Shores County: Miami Dade zip: 37 1 3 1) Foho/Parcel#: 11'1;2,0(0 - 0 13 - fC 2 3 0 Is the Building Historically Designated: Yes NO Zone: OWNER: Name (Fee Simple Titleholder): �, .0 Aty dgn� Phone#: 78C Oct Address: 5c> ( X 93" Sr. City: A4 Awl ( 5tt—W State: F�— Zip: 3 38 Tenant/LessName: _ Email: I 10 tlr . C.6 M CONTRACTOR: Company Name: 0-, _rz_ Phone#: Address: City: State: Qualifier Name: Phone; State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: JC -61T f, LJOA C Phone#: .08 2t4 -2.fos • ! Gas- Value 8S Value of Work for this Permit: $ (5,, 00d Square/Linear Footage of Work: _ 5.0 SAIfT° Type of Work: ❑Addition gmteration Description of Work: ❑New ❑Repair/Replace ❑Demolition P ftp C.04%PVIS , f_f-*t*V& tN M9406L Wp-U,gom�'D , 160wVe A Wc.S{L F/.00iRti Color thru tile: Submittal Fee $ :-moi Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ' Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) n Mortgage Lender's Address 2860 1.5� City (004-c CA& Les State vw lroo 3,40 e L- s Zip • l 04 1- (7L -O -- zip 35 t3q 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 vgdnnxe�,spection fee will be charged. Signature Signature ne gent Contractor kL- The foregoing instrument was acknowledged db�before me this 2l The foregoing instrument was acknowledged before me this day of 20 t3, by day of ,20_,by who is personally known tome or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY ��, I / � 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 06/10/2009XRevised 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: a4"Ib ,� 1 t�—s DATE: ADDRESS: 30[ TV" 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 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. 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. 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 numbers 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 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. . Initi 6, 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It my responsibility to ensure that the persons whom I employ have the license required by law and by cqunty 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 —*7 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 oNdalicense.comidb r/ rolcilbfiindex�htmi 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 16- 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 owners 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 2-4+1- A"APA day of , 20 %S By --'� m m S who was personally known to me or who has CFN: 20130216639 BOOK 28540 PAGE 2998 DATE:03/21/2013 04:45:09 AM DEED DOC 3,030.00 HARVEY RUVIN, CLERK OF COURT, MIA DADE CTY Preparlad by acrd rstum to: Abbts R. Salt, Esq. 710 NE 126 Street North Miami FL 33161 Tax Folio. 11-3206-013-6230 WARRANTY DEED THIS WARRANTY DEED, made the 2e day of February, 2013, BETWEEN Helen C. Emerson, a single woman, Let. F. Emerson, Jr., a married man and Thomas R. Emerson, a married man, Grantor AND Chv" Donald J. Tims and Melanie g Tims, his wife whose post offce address Is 301 NE 93 Street, Miami Shores FL 33138, Grantee*; IWA=ewr used hereto tonna -grantor- and -grenW include all the paid" to this fnwrvment and the hire, Isai repwwntaf m, and assigns of hrd'&uahs, and the succo ors and as*ns of ewpt:r morn, VW and trustees) WITNESSETH that said grantor, for and In consideration of the sum of Ten and no/100 Dollars ($10.00), and other good and valuable consideration to said grantor In hand paid by said grantee, the receipt whereof Is hereby acl=mledged, has granted and sold to the said grantee, and gnarrie's helm and assigns forever, the following described hand, stude, lying and being In MIAMI-DADE County, Florida, to wit Lot 17, Block 46, AMENDED PLAT OF MIAMI SHORES, SECTION ONE, according to the Plat thereof as recorded In Plat Book 10 at Page 70 of the Public Records of Miami -Dade County, Florida. 'Grantors Lee F. Emerson Jr. and Thomas R. Emerson hereby corlfirrn and certify that the Property is not and has never been any of their homestead property, as defined In Article X, Section 4 of the Florida Constitution, nor contiguous to their homested, and that neither Grantor nor any member of their tamlly resides at the Property and that their permanent residences are located as follows: Lee F. Emerson, Jr. - MM Springs NC 28756; and Thoma R. Emerson - 7421 SW 948 Street, Mlamh FL 33159 Together with all the tenements, hereditaments and appurtenances thereto belonging or In anywise appertaining. To Have and to Hold, the sarrm in fee simple forever. And the Grantor hereby covenants with said grantee that the grantor Is lawfully seized of said land in fee simple, that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever, and that said land is free of all encumbrances, except taxes accruing subsequent to Dumber 31, 2012. CFN: 20130216639 BOOK 28540 PAGE 2999 In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written. /Q, Y.4..k Witness W ness - r� Witness ,,elle cksa*� S�liE- STATE OF Florida COUNTY OF Mismi-Dade J611�r HELEN C. EMERSON 1458 NE 104 Street, Miami Shores FL 33138 r LEE F. EMERSON, JR. PO Box 185, Mill Springs NC 28756 THOMAS R. EMERSON '921 SW 148 Street, Miami FL 33159 The foregoing instrument was acknowledged before an on this :" day of February, 2013 by HELEN C. EMERSON, LEE F. EMERSON, JR., AND THOMAS R. EMERSON, who are personally known to me and who did not take an oath. P� ► ;^lFE6 A'gatf ��TwNk NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST.•INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal descriptio of property an !R%,% silt , 2. Description of improvement: CFH 2013R0257479 OR Bk 28563 Ps 4107; ( fps ) RECORDED 04/04/2013 11:15919 HARVEY RUVINY CLERK OF COURT MIAMI-DADE COUNTY? FLORIDA LAST PAGE Space above reserved for use of recording office 0-70 l.Oi 3.Owner(s) name and address: T AXN lof PX Iq 3" . 111491114A SK0945 FC t$1Z8 Interest in property:gr Name and address of fee gimple, titleholder _ 4. and phone number. 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(ixa)7., Florida Statutes, Name, address and phone number_ 8. In addition to himself, Owners designates the following 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR N T10E OAF COMMENCEMENT. Signatures) of uthorized Offlcer/Director/Partner/Manager Prepared By , Prepared By. Print Name Print Name Titie/Officet9 W = Title/Office STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing In trtfinentas ack rledt before me this day of tv> A rr11 Ai A -- ,, I tnn 9Ipdivldually, or ❑ as 1 for Personally known, or ❑ produced the following type of ident' Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92525, FLORIDA STATUTES Joann Ferber Under penalties of perjury, I declare that I have read the foregoing and 9&. . Z MISSIOiI#EE176216 that the facts stated in It are true, to the best of m knowledge and belief. :�°•- EXPIRES: MAR. 06 2016 y �,' � www.AAR0NN0TARywm SigVa�) er(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: By By 123.0 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-188121 Scheduled Inspection Date: May 12, 2015 Inspector: Rodriguez, Jorge Owner: TIMS, DONALD & MELANIE Job Address: 301 NE 93 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: HOME OWNER tiunamg uepartment comments Permit Number: RC -3-13-601 Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060136230 REMODEL KITCHEN. REPLACE CABINETS, REMOVE Infractio Passed Comments INTERIOR PARTITION. REMOVE AND REPLACE I INSPECTOR COMMENTS False WALLBOARD AND FLOORING. Inspector Comments Passed � U11 Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid May 11, 2015 For Inspections please call: (305)762-4949 Page 1 of 42