RC-14-2771 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-242124 Permit Number: RC-12-14-2771
Scheduled Inspection Date: August 25, 2015 Permit Type: Residential Construction
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: RANDLE,JULIA Work Classification: Alteration
Job Address:285 NE 103 Street
Miami Shores, FL 33138-2430 Phone Number
Parcel Number 1121360130440
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
KITCHEN REMODEL REMOVE A PORTION OF A Infractio Passed Comments
PARTITION RELOCATE WATER HEATER RELOCATE INSPECTOR COMMENTS False
REFRIGERATOR STOVED AND MICROWAVE INSTALL
NEW CABINETS REDO FLOORING IN KITCHEN
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 24,2015 For Inspections please call: (305)762-4949 Page 30 of 33
t ;
L Miami Shores Village
Building Department DEC I S 2014
` 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 I
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
V FBC 20 10
BUILDING Permit No.12 C ILA
Fil
PERMIT APPLICATION Master Permit No.
o ,
Permit Type,
JOB ADDRESS: 2—pp s i\,\F t
City: Miami Shores County: Miami Dade Zip: 3 L
Folio/Parcel#: I t -?—1-3(0 1-{4()
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): t �i C £ t' � Ql/1�' Phone# H
Address: 2S5 t� I ()z!) a
r
City: M I(fit State: 1 ®�l /A Zip: �. a)!2)
Tenant/Lessee Name: Phone#:
Email: �1 (1 n Cwr-A-S(9 CL 0 C c lon
CONTRACTOR:Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER: Architec ngineer ZtajLa XCp Phone#: 0-5--'S222-- [ yQ
Value of Work for this Permit: $ 12 T (Do ,®® Square/Linear Footage of Work: "C)7
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: OL-
-Fl
Submittal Fee$ a Permit Fee$ VCS CCF$_ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ 14�) : 1 �
TOTAL FEE NOW DUE$ �53 1
Bonding Company's Name(if applicable)
Bonding Company's Address
City State zip
Mortgage Lender's Name(if applicable) �! � �� �—cd cr-0
Mortgage Lender's Address P 0
City B®1 app State ` zip S O O
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 f performed to meet the standards of all laws regulating
p o a permit and that all work will be p o gu g
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, ,, `
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Sign Signature
Owner or Agent Contractor
TheTo g instrument was acknowledged before me this_8 The foregoing instrument was acknowledged before me this
day oQj-20 ,byJL3]1% �..aae3�� , day of ,20_,by ,
who is personally known to me or who has produced; who is personally known to me or who has produced
� . !�L-2 Zi�Y® As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign Sign:
rtnt: Print:
>
My Commission x ®¢ Notary Public State of Florida My Commission Expires:
Joanna M Feliciano
u� My Commission FF 082753
9dF®FFyo4 Expires 01/12/2018
4e�Y$e4e4e�oY�Y�9ede4e4t 4c 3:3e3e:4�Y��Yk3:�3:k:k���Y3ek�Y�Y3ekkikY�Y�Y3:4e�kzF�YatnY3e4e3:��Y3:��3:Y��Y9e:'r�F4e4r:F��Yk�Y�Yk3e4e�Y�Y
APPROVED BY }�Z3�� Plans Examiner zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
' 6
, o Miami Shores Village
Building Department
10050 N.E.2nd Avenue
eds► Miami Shores, Florida 33138
�oR Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: DATE:
ADDRESS:
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 ano 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.
In'
C2. 1 understand that building permits are not required to be signed by a property owner unless he or s JesponFsible for the
construction and is not hiring a licensed contractor to assume responsibility.
In'
3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understan that I ay 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.
I
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I�' �ab uild 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, "
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i'
5. I understand that,as the owner-builder,I must provide direct,onsite supervision of the construction.
al
6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise pers s wor ' g on my building or
residence.It is my responsibility to ensure that the persons whom I employ have the license requir y law and by county or
municipal ordinance.
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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.
8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contra who is of licenses to
perform the work being done.Any person working on my building who is not licensed must work under irect supervision
and must be employed by me,which means that I must comply with laws requiring the withholding of federal income tax and
contributions Act FICA and must provide workers compensation for
r he Federal Insurance Contnb P
social security contributions under t (FICA)
the employee.I understand that my failure to follow these may subject to serious financial risk.
Zwillabi
9. 1 agree that,as the party legally and financially responsible for this proposed Construction activityby 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 odes, and zoning regulations.
ndia
10. 1 understand that I may obtain more information regarding my obligations as an employer from the Inte( e)ve�n�ueService,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 htti):/Avww.myfioddalicense.com/dbi)rlpro/cilbrindox.htmI
Ctham
11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and undeparty
Dallyand financially responsible for the proposed construction activity at the following address:
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12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any o e inform on that I
have provided on this disclosure.
Licensed contractors are regulated bylaws designed to protect the public.If you contract with a p I",on who does of have a
license,the Constr4uction Industry Licensing Board and Department of Business and Profession . ulation y 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
retumed 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 Dor-!g n' , 20
By l I i lea P who was personally known to me or who has
F/ovi ClG- P. /
Produced there License or r1 - 2M(A 31--3 23 �'® as identification.
OWNER Public Florida
®,�ppE P��� No4ary 4a o o .
r. Joanna M Feliciano
MY Commission itF 982753
t; ��- Expires 9111 212 0 1$
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