FW-15-2988 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-253638 Permit Number: FW-11-15-2988
Scheduled Inspection Date: February 29,2016 Permit Type: Fence/Wall
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: BERGNES TRS,ADRIANA DIAZ Work Classification: Wood Fence
Job Address: 101 NE 102 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060131790
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
6' HIGH WOOD FENCE HORIZONTAL Infractio Passed Comments
INSPECTOR COMMENTS False
spector Comments
Passed CREATED AS REINSPECTION FOR INSP-248554. Gates must be self
closing
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
February 26,2016 For Inspections please call: (305)762-4949 Page 53 of 60
Miami Shores Village / 7pE � Ce�s1
ON
10050 N.E.2nd Avenue NE � � INorsClc8lron Pence
Miami Shores,FL 33138-0000
Phone: (305)795-2204 sot
�ZoRNP'
�z
issue Date:111912016Expiration: 7/1712016
Project Address Parcel Number Applicant
101 NE 102 Street 1132060131790
ADRIANA DIAZ BERGNES TRS
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
ADRIANA DIAZ BERGNES TRS 101 NE 102 Street
Miami Shores FL 33138-
101 NE 102 Street
Miami Shores FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
HOME OWNER Total Sq Feet: 95
Approved: Available Inspections:
Comments: Inspection Type:
Date Approved:
Final
Date Denied: Foundation
Type of Construction:Wood Fence Additional Info:6'HIGH WOOD FENCE HORIZONTA Review Building
Classification:Residential Scanning:3 Review Building
Review Building
Review Planning
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80 Invoice# FW-11-15-57901
DBPR Fee $2.00 11/30/2015 Check#:9288 $50.00 $72.80
DCA Fee $2.00
Education Surcharge $0.60 01/19/2016 Credit Card $72.80 $0.00
Notary Fee $5.00
Permit Fee-Wire&Wood $100.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $122.80
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: 1 cert' that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni . Fut rmore, orize the above-named contractor to do the work stated.
�- --- _ �.._ January 19,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 19,2016 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 '
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 �r —
FBC 20 ( `✓
BUILDING Master Permit No. -V4 Is —
PERMIT APPLICATION Sub Permit No.
ABUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: � d/ k--
City: P
'City iami Shores County Miami Dade Zip: 33/
Folio/Parcel#: 1 —3�d ( !-r
lQ _ d ��- 7�(�_Is the Building Historically Designated:Yes _�y
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
n
f
OWNER: Name(Fee Simple Titleholder): h f)(�i ,Pjv,4 0l2 Phone#: �'
Address: r ice° LZ
City:_ tiff G(6LU,l _ �`�/ State: Zip: 5 /
Tenant/Lessee Name: 1 � I Phone#:
Email:
CONTRACTOR:Company Name:_ '43V14 0 WrysV Phone#:
Address:
City: —State: Zip:
sy
Qualifier Vie: Phone#:
State mortification or egist�ation#: 'Certificate of C petency#:
DESIGNER:Architect/Engineer. z Phone#: f
Address: ;ry 0f City: State: Zip:
Value of Work for this Permit:$T�l U V Square/Linear Footage of Work: TS
Type of Work: ❑ Addition Alteration F-1 New ❑ Repair/Replace ❑ Demolition
Description of Work: l
1 �1 wo-OA C
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ {W CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 3z go
(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 reinspection fee will be charged.
ASignature / Signature
OWNER or AGENT CONTRACTOR
The foregoing instr-u}m-ent was acknowledged before me this The foregoing instrument was acknowledged before me this
6') day of1)et�te .20 19 by day of ,20 by
'k-1QVA NA �v 42' 1� � �who is personally known to who is personally known to
me or who has produced � — y`�'C� � me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PU C• NOTARY PUBLIC:
Sign: Sign:
Print: �1 r` Print:
Seal: gW% 21 Notary Public State of Florida Seal:
?4 Sindia Alvarez
o� My Commission FF 156750
ot�oe` Expires 09!03/2018
Ti
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
f
Miami Shores Village
oma Building Department
10050 N.E.2nd Avenue
R Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: DATE: 'L
ADDRESS: I I i uJ Li ��' 2- l
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 1,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,1 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.
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 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 by county o unicipal ordinance.
Initial
d
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. 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 may contact the Florida Construction Industry
Licensing Board at 850.487.1395 or http://www.mvfloridalicense.com/dbpr/pro/cilb/index.html
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:
Initial
12. I agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the infor tion 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 09 day of (=�" 20 1
By A -Dr+Qwho was personally known to me or who has
Produced there License or \1E !.f CJC N as identification.
` gyVLI°4e Notary pufalie Mata of Florid"
`� Sindia Alvarea
OWNER NOTARYdig
a MyC8f,091 3"2 FF 15670
o@ExPlrer O9lp3i�D19
M�' v
Miami Shores e Villa
g
Building Department cv 'i k� zub
10050 N.E.2nd Avenue,Miami Shores, Florida 33138 k_0
`, Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
1 FBC 2019
BUILDING Master Permit No.°r--c^1� 15—
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�i CONTRACTOR DRAWINGS
t
JOB ADDRESS: N �- o 1
City: Miami Shores County: Miami Dade Zip: 3 1
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Typed Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): �-� �� V,J ➢ Phone#: n
Address: 12 Y L 10222, S
City: Ir�PA I�/ ®� (X_S State: Zip: 3 313
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address:
City: State_3 Zip:
Qualifier Name: Phone#:
State Certification or Reg istr tion#: Certificate of Competency#: 0031
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$_--}�,t l� uare jUnear Footage of Work:
® Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
4� Description of Work:
Specify color of color thru tile:
Submittal Fee$ SQkl'�D Permit Fee$ ( ®® CCF$ CO/CC$ 6)
Scanning Fee$ Radon Fee$ ®� DBPR$ 2 v Notary$ �5
Technology Fee$ Z : Training/Education Fee$ 0160 Double Fee$ 0
Structural Reviews$ 0 Bond$
TOTAL FEE NOW DUE$ .
go
(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 reinspection fee will be charged.
Signature j5A
ig►1tue
^
OWNER or AGENT .- CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument wa"ow d b re this
day of�-)� V • ,20 L , by day f2� by
� , personally known to ho is personally known to
me or who has produced as me or who a produced as
identification and who did take an oath. identification and who ake an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
a�
RODRj iii ii
S' Sign: * ',•a�Q��g\
Print: Pri
Se S9IO18N�5lF9,6�A9/9.F1.�*�o�s
wdhdl
=_
L' Expiresol/12/2018
otary Public State of Florida S l:
oanna M Feliciano 00 •4, Bon ;ycommission FF 082753 9+ q'®® �BLIC,* * ** **** *�*****>K�***�*x�****x��*******�**��*>k�x�x*******�**>k**�*w*�
iqq,
APPROVED BY Plans Examiner �� Zoning
Structural Review Clerk
(Revised02/24/2014)
NMA�
IN C. Gi
Miami shores Village
09111 , oil Building Department
L^ ,y� 10050 N.E.2nd Avenue
okme too Miami Shores, Florida 33138
NOR 1Dp' Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant,Air'u-N& lSiR2--Tkoaa 5 ,does hereby attest that
(Property owner) Ae'
The attached survey, performed by o MX-5
(Name of surveyor's company)
For address: ® I 1J ia- t8 S mi&kA `,�'Jwfe s:�K- '33/-71y
Performed on (date of sut ey Is i naccura �sentation of the existing conditions and
7 s
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Fu er Affiant say eth naught.
Property Owner Sign ture Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this m7' day of e l -
Affiant is personally known to me, produced as identification.
nv Notary public Stat,of Florida
Notary
_�'� �; Joanna M Feliciano
a MY co 01!1212018FF
082753 82753
Revised(6/25/12)Revised on 5/22/2009/Revised on 611 �'�or ti°�� E"p
h pF�
5 ))P
� ll
Sry{,^�( �j I,�-f ftr J
ti��v�
- Local Business Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOTA BILL-DO NOT PAY
LBT
3025558
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
HENRYS FENCE INC RENEWAL SEPTEMBER 30, 2016
3931 SW 63 AVE 3162419 Must be displayed at place of business
MIAMI,FL 33155 Pursuant to County Code
Chapter 8A-Art.9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
HENRYS FENCE INC 196 SPECIALTY BUILDING BY TAX COLLECTOR
CONTRACTOR 75.00 09/14/2015
Worker(s) 1 93BS00624 0221-15-007806
This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license,
permit or a certification of the boldees gaati6catimm tlLdo business.Holder must comply with any governmental
or nongovernmental regulatory lawns and requirements which apply to the busing.
The RECEIPT N0.above mast be displayed on all commercial vabicles-Mlami-Dade Code Sac 80-276.
®� For more Information,visit www.mlamidedo&g- taxcallector
Municipal Contractors Tax Receipt
Miami Dade County, State of Florida
THIS IS NOT A BILL-DO NOT PAY
CC NO: 93BS00524
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
HENRYS FENCE INC
3931 SW 63 AVE 7471722 SEPTEMBER 30, 2016
MIAMI,FL 33155
Pursuant to County Code
Sac 10-24
OWNER TYPE OF BUSINESS
HENRYS FENCE INC SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED
BY TAX COLLECTOR
175.00 09/14/2015
0221-15-007806
This receipt is not world In the following Mooiclpalit_Aventma,Doral,Hialeah,Key Biscayae,
Miami 6animm,Miami lakes,Palmerta Bay,PtnecreA Sonny Islas Beach,Town of Coder Bay.
® For more info
nnatioa,visit www.migmida&••p/taxeolleetor
255 ALNAMBRA CIRCLE-SUITE 404 \
- CORAL GABLES, FLA. 33134 444:7692
THOMAS .1 , KELLY, INC, suRVE�?i moo,,
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9ewD 1!051779use LAND 'SURVEYOR
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