PT-5-14-1049Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 212859 Permit Number: PT -5 -14 -1049
Scheduled Inspection Date: December 22, 2015 Permit Type: Paint
Inspector: Rodriguez, Jorge
Inspection Type: Final
Owner: HERNANDEZ, MARIA A Work Classification: Addition /Alteration
Job Address: 826 NE 92 Street
Miami Shores, FL Phone Number
Parcel Number 1132060050170
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT WHITE Infractio Passed Comments
INSPECTOR COMMENTS False
December 21, 2015 For Inspections please call: (305)762 -4949 Page 2 of 33
Miami Shores Village
Building Department MAY 6 01
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
I
�... UIL ING Permit No. C
.... -. �-- .--- - - -- --
P:RMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PAINT
OWNER: Name (Fee 511111 lC.Titleholdet
Address. t ..� 6 __.— _ _ —
City: _....
l "crt: art[jtLessee Name:
Email
P1
State:
I
p-
Gll:
JOB ADDRESS: '
City: iialni Shores _..._._...._......_Count _ ._.,�1�1iK�mi Dyad . � _ _�_ �✓�ip: ...... 5 13
Folio /Parcem: I 3),42 �) � (' ) `76
Is the Building Historically Designated: Yes _.__... ..... NC;� _... mm Flood Zonc;
CONTRACTOR: Company Name: """ � " " Phtanck
Address:
City: .State: ........ ... Zip,
Qu tliE icr Nang _ .. ................. ............................... 1'1101,101:
State Certification or Registration #: _ . Certificate of Competency #:
Contact Phone #: Email Address:
Value of Work for this Permit: $ S narelL�inear Footage of Work:
p
Description of Work: T W_ 'l
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.....
"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 an inspection fee will be charged.
Permit Technology Fee � CCF �". Double Fee Notary $ Training/Education Fee $ ,,_ �'_o
gy $ ,. TOTAL FEE NOW DUE $
l
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and i rid ic ate the color to be aintwed
DIRECTIONS: Please circle corresponding number to appropriate color sample.
Walls: 1
2
3
4
Fascia: 1
2
3
4
Drip edge: 1
2
3
4
Soffit: 1 _
2
3
4
Roof: 1
2
3
4
Flower Bins: 1
2
3
4
Shutters: 1
2
3
4
Awnings: 1
2
4
Chimney: ...................................
A.----..-.... .,.2...............__..........
3 ._..._
..._ 4..................... ............................�..
Doors & Jambs: l
2 ___..____....
.......3..........._._.........
4
Garage Doors: 1
�w. 2 ............._�..?
.........�.�.....,
4
Railings:.....�.� .............�.��
2
......._3
4 .........�
Fences: 1
2
3
4
All Brick: 1
2
3
4
Stucco Bands: 1
2
3
4
Other Stucco
Feature: 1
2
3
4
Accessory Bldg: ?—
.......2—
3 w....... .�.......................4
Attach color sample with name and number
2..
3,
4,
,J�j� / 1L,
OWNER'S AFFIDAVIT: I rrti]`y that all the 1gcairtg information is accurate and that all work will be done in compliance with all
applicable laws regulating co stNuction and the
tiigraarar °e: r Agent ���....j.
0 a or
.
The foregoing instrument was aaekno� edged before an this �d
Y
who is personall known to me or who has produced
�
, 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 - aas identification and who did take an oath.
NOTARY PUBLIC:
MA R ileY6a1 HAWKIN3
Sign: d � MY COMMISSION #
d� a
! a i EXPfPES September 1 , 14
Print:
._.�'1� .+ �M�t0.Ie�+w 'l a�....
My Commission 1 ,xpires: �� /� �2 D I C,4 My Commission Expires:
APPROVED BY: _ Code Official
Preservation Board
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: DATE:
ADDRESS:
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the ate of Florida, F.S 489.103(7)
And I have read and understood the following disclosure statement, which entitles me to work as my o n contractor; I further
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 l
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 k" -
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 rrr bers on
permits and contracts. r
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 it proved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I br't or su.tantially
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.
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 Wandb .,un ty 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 wG6lfuily acting as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
Inpt
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 ay contact the
Florida Construction Industry Licensing Board at 850.487.1395 or htt :�"1www,m tloddallcense.comlr b rl rolc ll in x,hNm
lnttiat _ '
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
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.
Was acknowledged before me this day of 20
gy h --au �C , ,
Produced there License or L 1 t , / � A
was personally known to me or who has
;s identiiication
.
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