EL-15-3180 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-250442 PermitNumber: EL-12-15-3180
Scheduled Inspection Date: January 07,2016 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: HOLDER,QUINTON Work Classification: Alteration
Job Address:10643 NE 11 Avenue
Miami Shores, FL Phone Number
Parcel Number 1122320280340
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
RENEWAL OF EXPIRED PERMIT EL2005-292 Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
EZI -
Failed
Correction
Needed J
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
January 06,2016 For Inspections please call: (305)762-4949 Page 30 of 34
Permit No. EL-12-16-3180:,,
Miami Shores Village Permit� e:E14dr,1081-Residential
10050 N.E.2nd Avenue NE
er
lk6rk Classification.-Alteration
•"' ""'�' Miami Shores,FL 33138-0000
Phone: (305)795-2204 Permit5taitS:APPROVED
R �sste �a�: !2l24t2t1� Expiration: /2182016
Project Address Parcel Number Applicant
10643 NE 11 Avenue 1122320280340
QUINTON HOLDER
Miami Shores, FL Block: Lot:
I
Owner Information Address Phone Cell
QUINTON HOLDER 10643 NE 11 AVE
MIAMI SHORES FL 33138-2120
Contractor(s) Phone Cell Phone $ 1,500.00
Valuation:
HOME OWNER
Total Sq Feet 00
Type of Work: Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:3
Fees Due ]AnPay Date Pay Type Amt Paid Amt Due
CCF Invoice# EL-12-15-58158
DBPR Fee 12/24/2015 Credit Card $ 166.70 $0.00
DCA Fee Education Surcharge Permit Fee-Additions/AlterationsScanning Fee Technology Fee Total:
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 AFFID/VIT: I certi thataJl the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction anal"'zonirrb, Futh r e,,Vauthorize the above-named contractor to do the work stated.
! December 24, 2015
Authorizeb Signature:?femer / Applicant / Contractor / Agent Date
Building Department Copy
December 24,2015 1
• Miami Shores Village
Building Department DEC
� 2015
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 20
BUILDING Master Permit No._Z/ 1 f 20t:;)
PERMIT APPLICATION Sub Permit No.
❑BUILDINGLECTRIC ❑ ROOFING ❑ REVISION E] EXTENSION RENEWAL
E
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /0 �- d S "!� /z �e �-
City: Miami Shores County Miami Dade Zip _7/ 31
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
0
OWNER: Name(Fee Simple Titleholder): s--12� l L6 G
Address
City: J, f' 1 State: !� Zip:_ e
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or R!egistratii iii:ir Certificate of Competency M
DESIGNER:Archi ngineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �L !Z_eZ7 O Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: � ���� � ��� ��yp i��,l, jc -- I),ZP
Specify color of color thru tile: p
Submittal Fee$ Permit Fee$ /r/ � df� CCF$ ! 2-0 CO/CC$
Scanning Fee$—F�j!:p Radon Fee$ 2�,Q. DBPR$ 0 2S0'_ Notary$
Technology Fee$ 1. -6 to Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ °
(Revised02/24/2014)
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 rein ec on a charged.
Signature' /T� G` Signature
OWNER or AGENT /' CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 by day of_ 20 by
/J �' �/1 ii1l�C1 Jr'who is personally known to who is personally known to
me or who has produced �i�/�� 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: Print:
Seal:
�vo vua Notary Public State of Fbrida Seal:
°; Joanna M Feliciano
' MY Commission FF 082753
Expires 01112f2018
APPROVED BY �f ✓ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
5e s Miami Shores Village
son o,,,1, Building Department
--� 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
R
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: @ `.(7Z DATE:
ADDRESS:- Z ' � V-? l/(�"�� z � Z��/.�
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,FS 489.103(7).
And I have read and understood the following disclosure statement,which entities 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 y 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 r the
construction and is not hiring a licensed contractor to assume responsibility.
r•
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 my own
name.I also understand that the contractor is required by law to be licensed in Florida and to list his or licens n mp�s 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 iirpro%ed
myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or ubsttially
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 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 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.
J/—
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 maycon ct the
Florida Construction Industry Licensing Board at 850.487.1395 or http://www.mvFloddalicense.com/dbor/aro/cilbfindex.1.11 it
Initial r
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:
O
Initial
'21
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the information t
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 DO-c- ,20
t
By l�i'n /�����/ : 'was personally known to me or who has
Produced there License or / �- as identification.
OWNE
iiig
of Florida
Felicianoo
8082753