FW-16-2892 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-269687 PermitNumber: FW-10-16-2892
Scheduled Inspection Date: December 14,2016 Permit Type: Fence/Wall
Inspector: Naranjo, Ismael Inspection Type: Final
Owner: MOORE, REBECCA Work Classification: Iron/Ornamental
Job Address:9118 NE 5 Avenue
Miami Shores, FL Phone Number
Parcel Number 1132060140010
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
ALUMINUM REAR 5' HIGH, SIDE 3'6" HIGH FENCE. Infractio Passed comments
BROWN INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
reinspection fee is paid.
December 13,2016 For Inspections please call: (305)762-4949 Page 15 of 40
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10050 N.E.2nd Avenue NE � �
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Miami Shores,FL 33138-0000
Phone: (305)795-2204 ' �`'' ? �
Rte► d a.Ex iratton: 04/23/2017
I tats 102"lt}1 p
Project Address Parcel Number Applicant
9118 NE 5 Avenue 1132060140010
Miami Shores, FL Block: Lot: REBECCA MOORE
Owner Information Address Phone Cell
REBECCA MOORE 9118 NE 5 AVE
MIAMI SHORES FL 33138-3141
Contractor(s) Phone Cell Phone Valuation: $ 4,800.00
HOME OWNER
Total Sq Feet: 174
Approved: Available Inspections:
Comments: Inspection Type:
Date Approved:: Final
Date Denied: Foundation
Type of Construction:Other Additional Info:ALUMINUM REAR 5'HIGH,SIDE 3'6' Review Planning
Classification:Residential Scannlp 3 o d. a Review Building
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Jot&
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Fees Due Amount Pay Date Piii& A'tnY,b ie
CCF $3.00
Invoice# FW-10-16-61769
DBPR Fee $2.61 10/25/2016 Credit Card $201.22 $0.00
DCA Fee $2.61
Education Surcharge $1.00
Notary Fee $5.00
Permit Fee-Wire&Wood $174.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $201.22
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 information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. re,I authorize the above-named contractor to do the work stated.
October 26,2016
A er / Applicant / Contractor / Agent Date
Building Department Copy
October 25,2016 1
Miami Shores Village cEaVIED
Building De p artment oc Zoos
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY-
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014 6�'
BUILDING Master Permit No.-FW 10--16^?Sq2
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION F-1 EXTENSION RENEWAL
F-IPLUMBING F-] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
A
CONTRACTOR DRAWINGS
JOB ADDRESS: l) �E S Irl A Ire.
City: Miami Shores County: Miami Dade Zia•
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
Ke,ln v►e�ln J� ��cl�,o is
OWNER:Name(Fee Simple Titleholder): Re beC LGC M Q n re M w C,"0 k Phone#:
Address: RI UK A-X-
Tk S
State: Zip:
City: E
Tenant/Lessee Name: Phone#:
Email:�"'e c V--V1 Can �e- S d L4`4"n. I!1
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: -7
Value of Work for this Permit:$ 'y. Square/Linear Footage of work: A
Type of Work: ❑ AdditionEJ Alteration [z New ElRepair/Replace ❑ Demolition ��++
Description of Work: , A l c. m:n Lt-nn rear- S' ��� S t�d� S '& "
Is'
M L.l)1-1
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ L 0
(ReAsed02/24/2014)
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.
P
Signature f'h. Signa e
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing i rument was acknowledged before me this
day of�1_+0%blQ t ,20 ,by day of 20 by
kb'eCCA id& ho is personally known to who is personally known to
me or who has produced D risHy ( j C;i%kR•Q, as me or who has produced as
identification and who did take an oath. identification and who did take a ath.
NOTARY P IC: CD NOTARY PUBLIC:
Sign: b Sign:
Print: Print:
Seal: � Seal:
�. YANADY PRIETO
:,. .., MY COMMISSION N FF 214031
EXPIRES:March 25-2019
APPROVED BY Plans Examiner /Dzs-
Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Q Building Department
�,-�- 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
OWNER BUILDER DISCLOSURE STATEMENT
iOPC
NAM E: Ra N i CV)cZ s DATE: 101
ADDRESS: 01 <<1 5- h A; z
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.CA 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 permlt.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
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 by county or municipal ordinance.
Initial_`fL,�
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
S. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who isnot 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 parry 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 1 may contact the Florida Construction Industry
Licensing Board at 850.487.1395 or htto:/Iwww.mvfloridalicense.com/dbt)r/pro/diblindex.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:
Initial 1 I/
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.
Initial—4Z
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����r,20
By��IQ,CCA�QA iC�10IC who was personally known to me or who has
Produced there License or as I e cation.
��� _,ia�^`t�"jmL. YMMY PRIETO
OWNER N OTAR =*: +" MY COMMISSION#FF 214031
Pq EXPIRES:March 25,2019
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.' PETER DC LA ROSA, P.LS. INC. •• •
LAND SURVEYORS • LAND PLANNERS
SUBDMSIONS • CONSTRUCTION SURVEY . PLATnNG
400 959 S.W. 1 Q4nd AVENUE
•�C'su�s MINORCR PLAZA.MIAMI,FLORIDA 33184 i
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L.:-;AL VESCRrIFnOW PH. {305) 552-SS45 FAX (305] 551-6SS6
LOrr��lyL'Of E OF BLOCK QA Will SS WS SEGTSb0j 41
ACCORDING TO THE PLAT 17fERrOF.AS RECGRD'V IN PLAT BOOK ld , AT PAGE 3� OF THE PitBLIC RECORDS OF VAVE COUNTY, FLOWA
C- eFTED TO: REBECCA J. MOORE AND KENNETH J. NICHOLS JOB. NOM.. IO9Fyb C
BARNETT BANK OF SOUTH FLORIDA, N.A. FIELD BOOK: leS, E
ATTORNEYS' TITLE INSURANCE FOND, INC. DATE PIED T+=.. 1..-
GM47AL W rM CAROS J. ARBOLEYA, JR., P.A.
11 OaerEtStfrP•IS JtXJECr TO OPINION OF TITLE
21 ExANINATION OF THE AESTRACr OF TITLE mrCL KAVE Tp BE XM TO DEr=-RINE R=RVW IN ,-ZmQyrS. IF ANY. Afi ECr TING THIS PROPERTY.
31 LOCATION Aw IDENTIFICATION OF UTTLITIES Ok AWIOR AVJACWr TO 77M PROPERTY WERE Nor S"CrmW AS 4= INFOR;VM0N WAS•WOT jLcgUESrED.
l) NO Sea=OF FOLIC RECORDS HAS REEwNUDE &Y THIS,OFFrC-a FOR ACfC=ALY Awl= vUz=ajV&
SI EF.ARD4 SNOW NaEZM IIF ANY)-ARE:Lksw Cla AN ASSsraD NEWMX EL6,4TIVa-VSQ f NEREW•f IF ANY) ARF RELATIVE TO NATIONAL Gwpmc
VEV7CAL'VATRUR.
6) nu CER77nczrou ZS ONLY FOR Thar Lum AS pvs,RIBw, It rSWr A CER7MCATTON OF TITLE.. ZONW. EAS30=0 OR FREE M Fog
DC34WANCEL AEST/TACr NOr ZMEWEV.
;) THE
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BY THE(GVZTED SATES VE7AxfNFXI OF IIOUSD�G ANO tOt4RN V>:VELOPf�7tr.
1) -TNFL 1tAY DE AppITTONAt "'t "1 rONS r,[AT ARE NOT S1f R! O!f TTfLS�YI v y TAY c naw IN THE Ptt UC IECMWS OF TKIS CMWY.
91 TRIS SURVEY ILLS EFJs'f PREPARED FOR TWE E=S=CSE OF TME B TITLES NAKED HEREON AND Tiff C.samc j WU NOT EXrw TO ANY Upaa EV
PARTY
01 Wr VALW LWLESS SEL"WM AN EMSSE7 SUV/P OR_S SELL.• N -
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LARD SUMMMYORS W CHAPTER 6IG77-6, FLORIDA AVuLvZS/ZG"IvE CODE, pU ZSTIAWr TO
SEMON 471.017, FLORIDA STATUTES. - !9
-Lrnless it bears the signature and the original raised seal of a
Florida licensed surveyor and mapper, this drawing, sketch, plat
or nap is for informational purposes only and is not valid'
AM to 20 Coast to oast Iron Work Corp. g N
* 10115 SW 19r Sheet Unit 44 Miami,R 33151
0011:786-370-9257 W.788-713-0411
INVOICE N2 0922
NAME:
STREET:
CITY: STATE:
DATE: PHONE:
WORK SPECIFICATIONS AND MATERIALS: A
L&A
�`• •• •• •••
...... .... .. ...
Fences Good Side Out. The vertical and horizontal •
'
supporting members of •••• •• •
a fence shall face the ' ' • •
interior of the plot on which the fence is located •••• • • • •
and the finished side shall face the adjoining 0006•• • 00• •• ••
'
lot or any abutting right-of-way. •• �• •' ':'
{� .66666
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•• •6•
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The balance of paid price is due and payable immediately upon AMOUNT:
completion of the work unless otherwise set both.The owner upon signing
the contract represents and warrents that he has read the agreement. DEPOSIT:
It is expressly agreed that no statement,arrangement or understanding,
oral o written expressed or implied,not contained wlll be recognized and BALANCE:
that this contract constitutes Me entire agreement.
SALESMAN: SIGNATURE:
SIGNATURE: SIGNATURE:
BANK CHECK#
♦SNuREs `i
Miami shores Village
WHIM Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
lOR1DA Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant, gJxccGf e cyot S does hereby attest that
(Property owner)
The attached survey,performed by �2+e'C - ,ClL.5, L n C .
(Name of surveyor's company)
For address: g N F Pt v-e.
Performed on l ILI Q S (date of survey)is an accurate representation of the existing conditions and
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.
Fur ,er,Affiant say eth naught
Reloec co, kit ck 0�S
Property Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this 2-5 t-r day of oc- n l o (6
Affiant is personally known to me,✓produced T)r &ty as identificati
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Revised on 5/22120091 Revised on 6112109
tr pya,, YANADY PRIETO
MY COMMISSION#FF 21431
* EXPIRES:Wtd
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