RC-15-1242 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-235322 Permit Number: RC-5-15-1242
Scheduled Inspection Date: August 14, 2015 Permit Type: Residential Construction
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: SUPREME, GERARD Work Classification: Repair
Job Address:535 NW 112 Street
Miami Shores, FL 33168-3317 Phone Number
Parcel Number 1121360210900
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
REPAIR CEILING Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 13, 2015 For Inspections please call: (305)762-4949 Page 8 of 29
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s+�°RES Miami Shores Village elrlTl#gyp a OeF
10050 N.E.2nd Avenue NW 3 E drlCClass lc�tfoaRepair
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Miami Shores, FL 33138 0000 r �
PeEmtt Stator.APPROVED
tie= m Phone: (305)795-2204
�.hr¢s M Jil
x/201 i Expiration: 11/29/2015
Project Address Parcel Number Applicant
535 NW 112 Street 1121360210900� � _
Miami Shores, FL 33168-3317 Block: Lot: GERARD SUPREME
Owner Information Address Phone Cell
GERARD SUPREME 535 NW 112 Street
MIAMI SHORES FL 33168-3317
Contractor(s) Phone Cell Phone Valuation: $ 1,500.00
HOME OWNER
Total Sq Feet: 00
Approved: In Review Available Inspections:
Comments:
Inspection Type:
Date Approved: : In Review
Final
Date Denied:
Review Building
Type of Construction:REPAIR CEILING Occupancy:Single Family
Stories: Exterior:
Front Setback: Rear Setback:
Left Setback: Right Setback:
Bedrooms: Bathrooms:
Plans Submitted:Yes Certificate Status:
Certificate Date: Additional Info:
Bond Return : Classification:Residential
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
Invoice# RC-5-15-55698
DBPR Fee $2.00 05/26/2015 Cash $50.00 $71.20
DCA Fee $2.00
Education Surcharge $0.40 06/02/2015 Cash $71.20 $0.00
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $121.20
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.
_,,,j:Sr/ June 02, 2015
Authorized Signature:Owndr / Applicant / Contractor / Agent 7ate
Building Department Copy
June 02,2015 1
E ,
Miami Shores Village RIVED
MAY 2 6 2015
Building Department
!BY.—
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2_0 10
BUILDING Master Permit No.�C
PERMIT APPLICATION sub Permit No.
F-IBUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
10B ADDRESS: n t)f i J ( ( S�L
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):r �� S ca a-.-C WA—Q Phone#:
Address: l
City: iflA i�� i/I!f f4 N a�e State: C Zip:3_3[6/9
Tenant/Lessee Name: Phone#:
Email: c7
CONTRACTOR:Company Name: � 2.E L� C d.,( S� �yK {'_I4A�t4 Phone#:
Address: ^ ty W f 0� 5l r
City: lM I��ri I/1/t)` Stater, c Zip, S y l 16,g
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$14—o cn = 50 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: I---_ _ - e �y�, G D N�e a Ir
Specify color of color thru tile:
Submittal Fee$ 4:10 Permit Fee$ O O• � 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)
i
c a
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 NOTICE OF COMMENCEMENT.Pil
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
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
It day of ,20/ !�-- by day of ,20 by
CerQ/Q 2 ,who is personally known to who is personally known to
,me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: - Sign:
Print:
Sea �n Notary Public State of Florida Seal:
� Joanna M Feliciano
My Commission FF 082753
110,1� Expires o 111212018
**** * ***************** ****************************************************************************
APPROVED BY ( ` Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
�sH°; 5 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 '�ca
C r , �G0l��—e DATE:
GIS
ADDRESS: oT � ,4
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. 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.
I ,
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.
1 Initial(--- s`
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. 1
I Initial 5.
5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction.
/ Initialo- S
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 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.
1 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& .-!S;
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�j
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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.mvfloridalicense.com/dbi)r/pro/cilb/index.html
Initial C S
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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:
I 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 ho does not have a
license,the Constr4uction Industry Licensing Board and Department of Business and Professional Re ulation 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 thisday of , 20
ByC7 e rar-d .Sc..0 ezem E! who was personally known to me or who has
Produced there License or as identification.
NER NNOTAr---__�
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Notary Pudic State of Florida
Joanna M Feliciano
My Commission FF 082753
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RESIDENCE: GERARD SUPREME LOT 4 BLOCK 5
ADDRESS: 535 NW 112th. AVE. PLAT BOOK 42 PAGE 18
MIAMI, FL. 33168 DADE COUNTY FLORIDA
I SCOPE OF WORK: I
1.) REPAIR SOFFIT AS SHOWN ON PLAN.
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2.) REPAIR CEILING AS REQUIRED IN PATIO &
! PORCH AREA. •••
3.) INSTALL NEW FLOOR TILES IN PATIO & PORCH • •: .•; ;
�• •Y• ••♦ ••• • •
I AREA AS SHOWN ON FLOOR PLAN. 09
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