EL-15-2171 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-242183 Permit Number: EL-8-15-2171
Scheduled Inspection Date: December 15,2015 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address:101 NW 108 Street
Miami Shores, FL 33168-4312 Phone Number
Parcel Number 1121360100320
Project: <NONE>
Contractor: HENRY RODRIGUEZ ELECTRICAL CONTRACTOR,INC Phone: (305)218-7878
Building Department Comments
BATHROOM REMODEL TO CLOSE OUT EXPIRED Infractio Passed Comments
PERMIT EL 07-1092 GFI OUT LET INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
December 14,2015 For Inspections please call: (305)762-4949 Page 10 of 43
Miami Shores Village Puff rrk1r,
�. 10050 N.E.2nd Avenue NW
INtsfClaetmrt;Adltionl ration
Miami Shores,FL 33138-0000 Tr"
Phone: (305)795-2204
Q� Permit Status.-APPI � fl
�. �11 Expiration: 04/12/2016
Project Address Parcel Number Applicant
101 NW 108 Street 1121360100320
Miami Shores, FL 33168-4312 Block: Lot: FEDERAL NATIONAL MORTGAC
Owner Information Address Phone Cell
FEDERAL NATIONAL MORTGAGE PO BOX 650043
-- DALLAS TX 75265-
PO BOX 650043
DALLAS TX 75265-
Contractor(s) Phone Cell Phone Valuation: $ 800.00
HENRY RODRIGUEZ ELECTRICAL CC (305)554-5711
... . ._._ .. . .. ....... .. ...__.._ Total Sq Feet: 0
Type of Work:BATHROOM REMODEL TO CLOSE OUT EXPIR Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning:3 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W.W.
Fees Due Amount �Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# EL-8-15-56850
$2.25 10/15/2015 Check#:14112 $ 115.10 $50.00
DCA Fee $2.25
Education Surcharge $0.20 08/25/2015 Check* 13847 $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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 auth ize the above-named contractor to do the work stated.
October 15, 2015
Authorized SI9d Owner / Applicant / Contractor / Agent ate
Building Department Copy
October 15,2015 1
s �
Miami Shores Village
Building Department
AUG 2 s gat 71-
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 20tC4
BUILDING Master Permit No. 2c" 8`(s- f
PERMIT APPLICATION sub Permit No. I,: LIS- 2-i'd
❑BUILDING IM ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING F_J MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 101 Northwest 108th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2136-010-0320 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Federal National Mortgage Association Phone#:305-267-7777
Address:P.O. BOX 650043
City: DALLAS State: TEXAS Zip: 75265
Tenant/Lessee Name: Phone#:
Email: u e /� \
CONTRACTOR:Company Name: Hn cA I_oc <'iy U N_� !C1 jLo 4�e ►%k Phone#: '�o -5-S-`)
Address: t`lS Z2— s
City: State: Zip: 33o 96
Qualifier Name: �'lewii`tq Phone#: _301;_- Z-1 1 -75
State Certification or Registration#: C) 7.'-1 i l Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: 1 City: State: Zip:
Value of Work for this Permit:$ c;,o Square/Linear Footage of Work:
Type of Work: ❑ Addition ® Alteration ❑ New ❑ Repair/Replace ❑ Demolition
L �
Description of Work: -'Cr Gpft6 9a
L`G® 9
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ �'�'O;00 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)
j 1
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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
14 day of.P :,SA 20 I� by / ? day of 20 /5 by
� vdho is personally known to kV-"0%kf who is rsonally know to
me or who has produced `� �� as me or w o has produced as
identification and who did take an oath. identification and who did take an oath.
NOTAR U IC: NOTARY PUBLIC:
Si Sign '
ide
Print: Print:
Seal: Y Cananlssi0n E% res ' iv1v Coninvssion EE 186275
My PI Seal: le®F',,0 Expires 07/02/2016
Yareh 9,2019 :$ `•+�¢; 's '�
APPROVED BY 7 7$/��il� SSP Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-249329 Permit Number: DS-6-15-1621
Scheduled Inspection Date: December 21,2015 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: TORRES, NATASHA Work Classification: Addition/Alteration
Job Address:157 NW 98 Street
Miami Shores, FL 33138- Phone Number (305)582-8897
Parcel Number 1131010240110
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
EXTEND DRIVEWAY CREATE WALKWAY FROM Infractio Passed Comments
DRIVEWAY TO HOUSE INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-238003.wORK MUST BE
ETFINISHED WITH SOD OR LANDSCAPING
No fake grass allowed betwen slabs
Failed ,c jz��
��Correction ❑ _
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
December 18,2015 For Inspections please call: (305)762-4949 Page 20 of 51
e — r
L Miami Shores Village
Building Department ,UN m
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 Y
INSPECTION LINE PHONE NUMBER:(305)762-4949
�FBC120 140
BUILDING Master Permit No{!. 4���j
PERMIT APPLICATION Sub Permit No.
;4BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
r—IPLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 15-4 A)L&) ( n��A 22
City: Miami Shores County: Miami Dade Zip: 7J
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#:, �-
Address:L-S?'
City:alcm.i U State: Zip:
335 y
Tenant/Lessee Name: Phone#:
Email: �G�,
c T
CONTRACTOR:Company Name: { Phone#:
Address:
City: -State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: ^'°�� City: State: Zip:
Value of Work for this Permit:$ I/�0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work: l J�3 F
Specify color of color thru tile: ���``
Submittal Fee$ _O-O'd Permit Fee$ e SO °(Z CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ ®c)
TOTAL FEE NOW DUE$ I
(Revised02/24/2014) C20,
t _ +
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."
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
? _day of 1, 20� •by day of ,20 ,by
�6>�&� l ho is personally known to who is personally known to
me or who has produced E 9o( r 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:
Notary Pu
Seal: a° + Joanna M Felicia Seal:
;p My Commissi rt FF 2753
��pd Hxphe
APPROVED BY i Plans Examiner ! Zoning
Structural Review Clerk
(Revised02/24/2014)
' o
Miami Shores Village
you on 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: 43- Z20
ADDRESS: N� �C� L�J'tC &CAA e�/IcICJS I L J ✓� �`�
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 contr . s.
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
Initial
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 b o or municipal ordinance.
Initial
o
, a
0
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. 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 subject to serious financial risk.
InitialZ
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://www.mvfloridalicense.com/dbpr/pro/cilb/index.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:
yo C,
Initial
12. I 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 I 20
Byl �ri/t!�f �C who was personally known to me or who has
Produced there License or as identification.
- mem s
O NO W
m
Permit NU. EM 6-15-1621
Miami Shores Village PermitTypa DrJvewaysfSIdpWaIktabs
10050 N.E.2nd Avenue NW
Work Cil s0iffaq i6n:Additll n/Alteration.
Miami Shores,FL 33138-0000
Phone: (305)795-2204 P, t, `PROVED
p
Ex iration: 05/11/2016
1»t
Date. 20j#,
Project Address Parcel Number Applicant
157 NW 98 Street 1131010240110
NATASHA TORRES
Miami Shores, FL 33138- Block: Lot: li
Owner Information Address Phone Cell
NATASHA TORRES 157 NW 98 Street (305)582-8897 i
MIAMI SHORES VILLAGE FL 33138- I
157 NW 98 Street
MIAMI SHORES VILLAGE FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
HOME OWNER
Total Sq Feet: 1116
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:NEW DRIVEWAY Additional Info: Review Planning
Bond Return: Classification:Residential Review Planning
Scanning:3 Review Planning
Review Building
Review Building
Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-owners Bond $500.00 Invoice# DS-6-15-56161
CCF $0.60
DBPR Fee $2.25 06/30/2015 Credit Card $50.00 $620.10
DCA Fee $2.25 11/13/2015 Credit Card $620.10 $0.00
Education Surcharge $0.20 Bond#:2904
Notary Fee $5.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $670.10
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,PLUMBI MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I t tall foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zonin e la orize the above-named contractor to do the work stated.
November 13, 2015
Aut rzed Vgnature:`Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 13,2015 1
r +
t
Scone of work
All work to be performed as per Florida Building
Code 2014- Residential
New 5" thick concrete driveway reinforced with
6X6 - W1.4xW1.4 W.W.F.
Material List
-Concrete Mix F'b = 3,500 PSI Minimum
-6x6 - W1.4xW1.4 Welded Wire fabric
-2x4 Lumber for forming
416d double head nails for forming
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