RC-16-631 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
inspection Number: INSP-254674 Permit Number: RC-3-16-631
Inspection Date: March 17,2 16 Permit Type: Residential Construction
Inspector: NPW_ e1 igzaT.
Il4 Inspection Type: Final Building
Owner: REVELO,JOANNA Work Classification: Alteration
Job Address:126 NW 100 Terrace
Miami Shores,FL Phone Number
Parcel Number 1131010220270
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
REMOVE PAINTED WOOD PANELING OVER FIRE Infractlo Passed Comments
PLACE IN LIVING ROOM AND REPLACE WITH MANTLE INSPECTOR COMMENTS False
AND TILE AROUND SURROUNDING FIRE PALCE.
DRYWALL ABOVE MANTLE ON LIVING ROOM WALL.
AREA IS RE-FRAMED WITH DRYWALL& DUROCK
TO CANCEL PERMIT#RC12-416
Inspector Comments
Passed q�
Failed El
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
For Inspections please call: (305)762-4949
March 16,2016 Page 1 of 1
Miami Shores Village Y,
10050 N.E.2nd Avenue NW f E f
Miami Shores,FL 33138-0000 R
� M
R Phone: (305)7952204r
Expiration: 09/11/2016
&��Tff?Pt"J E
Project Address Parcel Number Applicant
126 NW 100 Terrace 1131010220270
Miami Shores, FL Block: Lot: JOANNA REVELO
Owner Information Address Phone Cell
JOANNA REVELO 126 NW 100 TERR
MIAMI FL 33150-1210
Contractor(s) Phone Cell:Phone Valuation: $ 360.00
HOME OWNER
Total Sq Feet: 0
Approved:In Review Available Inspections:
Comments: Inspection
Type:
Date Approved::In Review Window Door Attachment
Date Denied:
Framing
Type of Construction:REMOVE PAINTED WOOD PANELI Occupancy:Single Family Insulation
Stories: Exterior.
Drywall Screw
Front Setback: Rear Setback: Final PE Certification
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted:Yes Certificate Status: Review Building
Certificate Date:
Additional Info: Review Planning
Bond Retum: Classification:Residential Review Electrical
Review Plumbing
Fees Due Amount Pay y Type Date Pa T Amt Paid Amt Due Review structural
_
CCF $0,80 Review Mechanical
DBPR Fee $2.00 Invoice# RC-3-16-58969
DCA Fee $2.00 03/15/2016 Credit Card $119.60 $0.00
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $119.60
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 info
rmation is accurate and that all work will be done in compliance with all applicable laws regulating
construction an ning. Futhermore,I aqorize the ab ve- amed contractor to do the work stated.
March 16,2016
Authb&p Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 15,2016 1
Miami Shores Village RECEIVE-1--.
MA 102016
Building Department artment
.C� BY°
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 � 4
FBC 20 I
BUILDING Master Permit Nol�% [6—b3 l
PERMIT APPLICATION Sub Permit No. •
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
f (` CONTRACTOR DRAWINGS
y
JOB ADDRESS: �% !u W tC) �Cf
City: Miami Shores County: Miami Dade Zip: k 6c>
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#:Z 05 " 5 Lf' , 314
Address: 1. I Lo lel W l00 �[�CE
City:ON A(Y1l �5- U 6kE S State: t- Zip: f3 �5 d
Tenant/Lessee Name: 1\J/A Phone#:
Email• 1 O
CONTRACTOR:Company Name: N Z A "'wOCe- 1 �U�U� Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
GV
Value of Work for this Permit:$ 3 d Square/Linear Footage of Work:
Type of Work: ❑ Addition ElAlteration ❑ New [Repair/Replace [:1Demolition
Description of Work: R F OO V E WOOD Fl del L ti rpt 0464 r l R.6. -AAA& WALL
11\J 1, j"AG 1�00(n A R 1` i)LACF- (,& f TI LF a- -9,'-VyUA LL
A 2.6 A 15 P o*, TO WNCE Z1:2-4K
Specify color of color thru tile: Tb tj 4,-" T I Ll.
Submittal Fee$ 0 Permit Fee$ t OD - CO CCF$ 0 -GO CO/CC$
Scanning Fee$ - Radon Fee$ `C-(3 DBPR$ "0 Notary$ —t:Z,
Technology Fee$ ` Training/Education Fee$ e-% > Double Fee$ 1
Structural Reviews$ Q Bond$ )z
TOTAL FEE NOW DUE$ l [q
(Revised02/24/2014)
Bonding Company's Name(if applicable) 1A
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 ASignature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
VO day of N ('�� C\-A ,20 1 ,by day of ,20 .by
" (,&A tt1l-1 is personally known to who is personally known to
me or who has produced rtl-M-1 LJC9�N:Cas 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: I, Sign:
Print: 51NwP-- i Print:
Seal: 40°e Notary P"biic S��of Florida Seal:
?Q �; Sindia Alvarez
my Commission FF 158750
��cf Expires 09/03/2018
a%
APPROVED BY 7�71(e Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
0
Y Servs 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: - J O A lu rkl (A �C&L,b DATE:
ADDRESS: Q,U N w W0
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,RS 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 al as my own
contractor with certain restrictions even though I do not have a license.
Initial
_-4--:'
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 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 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. I 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 regWred 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 acting as an
owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
Initial—_ L
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
_4�n-
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___��1[/
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 httt)Jhv*w.mvfloddalicanse.com/dbpr/t)roldlbfindox.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:
ao , 3 5 0 Initial
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the informo at 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 Constr4ucfion 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 property 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 thisy day of VVI AQW .20 lt?
Byjt?.M Z-Ute,. 1 who was personally known to me or who has
Produced there License or - VAI W-'Q— UQ) N S�Z asidentification.
Awww"',f-A
OWNER NOTARY
° Notary Public State of Florida
• Sindia Alvarez
� My Commission FF 156750
P� Ekpltes09l0312p18
e
r ;
'F
�e
`s
o 0 000
0* 40
040
9 -0 i 0 •4;0 *0
A.*
TT7
E RMI
RECUMD'
0
iamiShor Shorts Village
MAR 0 202
e lti}c. 1: M11,1 DATE
z
ONIN ' DEPT
BL,DG DEPT
SUBJECTT-rO CC, NMPLI, CE V'VTPri ALL FEDERAL;
STATE Af4b Cr
APID REGULATIONS
• i w • • •: • • •
• • • • • • • • • l4 d-I
Al LA)
Fj
a�
i
'
• 1
, � It
�1 4 s,n
yy�
1