RC-16-2871 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-270040 PermitNumber: RC-10-16-2871
Scheduled Inspection Date: November 01,2016 Permit Type: Residential Construction
Inspector: Mesa, Michel Inspection Type: Final
Owner: HODGE, HILDA Work Classification: Alteration
Job Address:443 NE 103 Street
Miami Shores, FL 33138-2456 Phone Number
Parcel Number 1122310150160
Project: <NONE>
Contractor: HOMEOWNER
Building Department Comments
SOFFIT, FACIA AND EVES REPAIR Infractio Passed Comments
TO REPLACE PERMIT RC13-1409 INSPECTOR COMMENTS False
Inspector Comments
Passed
I
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 01,2016 For Inspections please call: (305)762-4949 Page 28 of 38
t 4
m o, Miami Shores Village ��T� � � � 0N18tnli �l
10050 N.E.2nd Avenue NE on
Miami Shores,FL 33138-0000emi
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Phone: (305)795-2204x;
0� Q6 Explration: 0 2612017
y
Project Address Parcel Number Applicant
443 NE 103 Street 1122310150160
HILDA HODGE
Miami Shores, FL 33138-2456 Block: Lot:
Owner Information Address Phone Cell
HILDA HODGE 443 NE 103 Street
MIAMI SHORES FL 33138-2456
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
HOME OWNER
m __.... __ _. _W...... ....... _.n_. ..._- 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:SOFFIT,FACIA AND EVES REPAIR 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:No Certificate Status: Review Building
Certificate Date:
Additional Info: Review Planning
Review Electrical
Bond Return: Classification:Residential Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review structural
CCF $0.80 Review Mechanical
Invoice# RC-10-16-61744
DBPR Fee $2.00 10/20/2016 Credit Card $50.00 $63.60
DCA Fee $2.00
Education Surcharge $0.20 10/28/2016 Check*1048 $63.60 $0.00
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $113.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict con rmity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assu esponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRIC LUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS DA ce ify that all th% eg in nformation is accurate and that all work will be done in compliance with all applicable laws regulating
construc�e* n and onin Futhermore,1 authoriz h above- contractor to do the work stated.
October 28,2016
uthorized Si na re:Owner Applicant / Contractor / Agent Date
B ' ding Depart ent Copy
O tober 28,2016 1
2� (b
. 2�1
�- Miami Shores VillageF`!�
uilding Department OCTG1 � 216
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 'SA
FBC W4
BUILDING Master Permit No. C® I(P '-• ®� I
PERMIT APPLICATION Sub Permit No.
F-1131,111-DING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
cf CONTRACTOR DRAWINGS
JOB ADDRESS: G 0
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: �� �.��b l Is the Building Historically Designated:Yes NO
Occupancy Type: / W Load: Construction Type: dolceale— Flood Zone: 1%J 0 BFE: FFE:
OWNER:Name(Fee Simple Titleholder): �1-11,/ �� Phone#: 7 o i.•a f• Z3lc'.,
Address: "/Yc3 W4 �y3 J?-.
City: State: C— Zip:
Tenant/Lessee Name: Phone#:
Email: dit./Gtt G/»�� !. G Z'ati,17
CONTRACTOR:Company Name: Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit:$_0�1 2 . CP� Square/Linear Footage of Work:
Type of Work: ❑ Addition [:1 Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: - ���e �r ��cJ I r'
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ GD" CCF$ d • E0 CO/CC$ 0
Scanning Fee$ 3' Radon Fee$ 2 •CO DBPR$2.0� Notary$ 10
Technology Fee$ Q• QD Training/Education Fee$ 0. 20 Double Fee$ Q
Structural Reviews$ Bond$ jo
TOTAL FEE NOW DUE$ �� (53
(Revised02/24/2014)
� r
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low hrnrhura wUJ hp r1p1h ed a-thap---n
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occucs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved y a reinspection fee will be charged.
Signature &1 6- Signature
OWNER or AGE CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 ?v by day of 20 by
Wcyl-LAX- I L F-�,who is personally known to ,who is personally known to
me or who has produced I:q - ]Day Eras me or who has produced as
identification and who did take an oath. r�a�a;` 6611ts$j identification and who did take an oath.
NOTARY PUBLIC: >Yp �N�� �e°O° NOTARY PUBLIC:
Sign: Sign:
Print: °` 'h2 �a� Print:
Seal: .,ffffP�/ OR,D, e��� Seal:
��x�x����*r��*��r**�a**w*a��**•e�x��:�� *�� �� **x.��s+s�a�s***x��x�**��s��sse*�****x�*�+��a����x�a�s��e*��*�*�x���x��a���:x�e��a��a�s
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
S ° Miami Shores Village
RUNpm Building Department
10050 N.E.2nd Avenue
7W1�`` Miami Shores, Florida 33138
Tel: (305)795.2204
Fax:(305)756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: DATE: n
ADDRESS: 7 V_ X4� 3 S
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 co acts.
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,w . �riolates the exemption.
Initial C_
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 bylaw and by c my 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
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 withal[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/dbr)r/pro/cilbAndex.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:
L/Y Al- 1v3 .51.
r 5/41 / 1-3 Initial
12. 1 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. C�
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 90—day of ��� , 20 l
By_ �r/t L .L(e t who was personally known to me or who has
Produce there License or �� ' l� as identfrjp�;4,1�����r
� @ d,Sat Na
OWNIR NOTARIpcalfft ® tib�ztF;Z=E
��.AZ
F • � spa;•
6=016 3:44 PM FILEN FOR RECORD
IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT,
IN AND FOR MIAltrll-DADE COUNTY, FLORIDA
PROBATE DIVISION
IN RE: ESTATE OF: 111411nA EGBERTA HODGE [E
Case Number 12016002269CP02
Deceased. Format Mint se YYYYNNNNNN@002 Whefs @@ is GO,MH of CFS
Section: 03
ORDER APPOINTING PERSONAL REPRESENTATIVE
(intestate-single)
E t✓.l ES for administration of the
On the petition of ed on1CJd06 014 and that
above estate (°Estate"), the Court finding that the Decedent d�intment as pew{representative by reason of
is emitted to app
y R A ��OE Fly.stat. and is quaxmea co be personal representative("Personal Representative"),it is
is appointed
ADJUDGED that IMELEEf—I ES
Personal Representative oft Decedent's Estate, and that upon taking the p Letters s of Adm ni trrationi shall be issued.agent and acceptance, and entering into bond in the sum of
This Order is subject to the fallowing restrictions: date is extended by court
1. This Estate must be closed within 12 months, unfiess it is contested or its dosing
order.
2. Unless a band has been issued and approved.by this court,the Personal Representative still place all liquid
assets in a depository designated by the Court pursuant to Section 69.431, Florida tatutes (°Depositary").
This is a frozen account. Na funds can be withdrawn without a court order.
3. If Florida real estate is sold,per court order,a closing statement shall be filed,and the sale's net proceeds shall
be placed in the Depositary;
receipt of assets by the Depository within thirty days from the issuance of the
4. The Attorney of Record shall file
Letters of Administration.
5. There shall be no sale,encumbrance,borrowing,or gifting of any assets without a court order.
%,�,;y of 20-10 �
ORDERED on this 1�� �`"
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Miami Shores Village —
APPROVED BY :'` DATE
ZONING DEPT
BLDG DEPT G
SUBJECT TO CCMPLIANCE NTH ALL FEDERAL
STATE AND CCUNiY RULES AMID REGULATIONS