DS-16-666 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)785.2204 Fax:(306)7564872
Inspection Number: INSP-254664 Permit Number. DS-3-16-666
Scheduled Inspection Date:July 20,2016 Permit Type: Driveways/Sidewalks/Slabs
Inspector Mesa,Michel Inspection Type: Final
Owner BARBARA BONDRA,RANDALL KING Work Classification: Addition/Alteration
Job Address:10634 NE 10 Place
Miami Shores,FL 33138-2104 Phone Number
Parcel Number 1122320280850
Project: <NONE>
Contractor. HOMEOWNER
Building Department Comments
REPLACE DRIVEWAY IN FRONT OF HOUSE WITH Infractio Passed Comments
PAVERS INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee Is paid
July 18,2016 For Inspections please call:(305)762-4845 Page 7 of 41
Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 WS '
Phone: (305)795-2204 q� .:� I �. ��,.., %•�3... {...}:�'a.K,a �
r Expiration:09/19/2016
Project Address Parcel Number Applicant
10634 NE 10 Place 1122320280850
Miami Shores, FL 33138-2104 Block: Lot: RANDALL KING BARBARA BON
Owner information Address Phone Cell
RANDALL KING BARBARA BONDRA 1350 E LISBURN Road
MECHANICSBURG PA 17055-
1350 E LISBURN Road
MECHANICSBURG PA 17055-
Contractor(s) Phone Cell Phone Valuation: $4,700.00
HOME OWNER
---- Total Sq Feet: 903
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:REPLACE DRIVEWAY IN FRONT OF HOU Additional Info: Review Planning
Bond Retum: Classification:Residential Review Building
Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# DS-3-1"9007
CCF $3'00 03/14/2016 Credit Card $50.00 $601.00
DBPR Fee $2.00
DCA Fee $2.00 03/23/2016 Credit Card $601.00 $0.00
Education Surcharge $1.00 Bond#:3027
Notary Fee $5.00
Permit Fee $125.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $661.00
In consideration of the issuance to me of this permit. I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AF VIT: I certify that all th oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constru and z ning. F re, orize the above-named contractor to do the work stated.
March 23,2016
rized Signatu / Applicant / Contractor / Agent Date
Building Depa ment Copy
March 23,2016 1
6
Miami Shores Village
�� V 1P • •
�,, Budding Department MAR :s
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 if-Q&
Tel:(305)795-2204 Fax:(305)756-8972 ' —
` INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014
BUILDING Master Permit No.'D5 16 - GG V
PERMIT APPLICATION Sub Permit No.
MBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /b 6 3 y /U' l d &woe
City: Miami Shores Countv: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: 7 FFE:
OWNER:Name(Fee Simple Titleholder): ��/�d E9L`— /r / �v� Phone#: ,7// - ���• ! � �
Address: od l
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address:
City: State -Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ /, Square/Linlear Footage of Work: C74"
Type of Work: ❑ Addition ❑ Alteration ❑ New Topa lr/Replace F-1 Demolition
of
Description of Work: A490C v 'V
,4vr�S
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ J- Ulf CO/CC$
Scanning Fee$ �p '" G13 Radon Fee$ ` C DBPR$ 0 Notary$S
Technology Fee$ GD Training/Education Fee$ _ r:1 Double Fee$ ,0
Structural Reviews$_�_ Bond$ 5�cn
TOTAL FEE NOW DUE$ 101 . o3
(Revised02/24/2014) (- n i , 03
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.
Signatu a Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
---"7 day of O/ -'6 ,20 l G ,by day of ,20 ,by
kLJ--- SIN to ,who
Vis personally known to ,who is personally known to
me or who has produced �L-' CJVKII. as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: ``���O�f`d 1111�/p� '''i NOTARY PUBLIC:
Sign: Sign:
Print: rd �g .�;° ` Print:
•• ISS1`P�..•,a `tee
Seal: Seal:
APPROVED BY 611 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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: �
61
ADDRESS: ! _tJ �` &_ /y
1 ey_'
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__60�
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.
Init
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 flied 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 W con cts.
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 lea which oiates the exemption.
Initial
S. 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 required by law and ounty r municipal ordinance.
Initial
r
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.
Initi I
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 regulat
Initia
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
Ucensing Board at 850.487.1395 or htto://www.mvfloridalicense.com/dbor/oro/dIbAndex.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:
I C)(0-3L, tiF" / o F(
Initial
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of info on 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 J y day of . 20 1'6
By �7��- /fl_ IV(, who was personally known to me or who has
Produced there license or `— vr2j vim as Iden ification.
Val
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OWNER s ?sm e :NARY
ym0
s� Miami Shores Village 111111111111111111111111111111111111111111111
men ami Building Department CFH ''016E'+°O 169982
OR BY, 30007 Pq 2328 (lhs)
10050 N.E.2nd Avenue
REf:(IRGEG ai3/22r�20i�; 0?=2313 .
IDp Miami Shores, Florida 33138 HARVEY RUVTN7 CLERK OF COURT
Tel: (305) 795.2204 MIAMI•-DADE COUNTY P FLORIDP!
Fax: (305) 756.8972
COVENANT OF COTRUCTION WITHIN RIGJ-IT OF WAY
Whereas, (owner) /1���!-� C° • ,1'����
hereinafter referred to as the owner of the folll ing described
property (address): /a6 3 n'A LD ;
Legal Description: Lot y Block -5- Subdivision AlPf�l i
Folio# // - Z Z3z -a.2- S-e r 6-6
Re pest_spel,missi n tR install (describe ork): '
Within the p blicWWI
of way of(address) L7G
3
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the
dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to
make repairs or maintain said items within public right of way including restoration of street by
reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall
constitute a lien against the above described property until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County
harmless from any and all liability, -which may rise by virtue of permitting the installation of
these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,
within 60 days notice by the Village to do so. Failure to comply with this notice will result in the
Village causing the item(s) to be removed and a lien being placed on the property and/or
assessed against the Owner for all costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running
with the land and shall remain in full force and effect and be binding on the undersigned, their
heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in
the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village
(or his fu authorized representative).
Si nature
g
Owner orAgent /U���L Q� f 't �
1
State of Florida
County of Miami Dade n
The foregoin instrument was acknowledged before me this- —day ofU WC , 20 �io , by
AO(I �n who is personally known to me or who has pr6di d
— as id tification.
NOTARY PUBLIC
;TA8jr'.FLORIDA,COUNT F &/
HE�n�RTtFY that this is a truek1NN SEAL:
,nQntel feed to this office Mf& 11 day of
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10634 N E 10 Place, Miami Shores Village, FL 33138 2/10/2016
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Signature Front Yard:3,318sW=feet 100%
t? Come Pains:903 square feet 27%
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Randall C. King
10634 NE 10 Place, Miami Shores Village, FL 33138 2/20/2016
SURVEY OF 10634 NE 10 PL, MIAMI, FLORIDA 33138
LOT 14, BLOCK 5, MIAMI SHORES ESTATES, ACCORDING TO THE MAP
OR PLAT THEREOF, AS RECORDED IN PLAT BOOK 47, PAGE 58, OF
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THOSE ON RECORD PLATS,IS REQUIRED,THIS INFORMATION MUST BE FURNISHED TO THE SURVEYOR AND MAPPER IF ANWABIA POOL
FENCES SHOWN MEANER ON OR OFF LINE&OPPROX.}NO EXCAVATION OR MAP>'948 OF UP ID .NTS HAS BEEN son
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Fblk�8 Cel N12 FORTH BY THE FLORIDA NANO OF PRS. LAND SURVEYORS
CERTIFIED EXCLUSIVELY TO THE BELOW PARTIES ,s'G�' � To
SECnOV 472.027, OF THE FLORIDA STAMES AN CHAPTER
y 9 SIG-17-7.0025 OF THE FLORA ADMINIS 710N CODE.
S�Nrayor&M NkmSer48�
RANDALL KING ` '�► DATE of FIELD wOl�c NMI
Zk [�%�,7 DATE SKS B•8-11
VOICE 727-415.6305 FAX727-738.2455
R ORlnARIIRWYnROA(M rnM BILL HYATT
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