RC06-688NAME:
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
Ali di lA9'rJ
FA . DATE:
ADDRESS: Z3 I AJE q S'S i
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 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. I hold title to the above property and I am planning on doing this construction
Initial
2. I understand that as an owner - builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
Initial
3. I have an understanding of the 2004 FBC & FRC and understand that this
department and its inspectors are there to help enforce and interpret the code.
There is a copy of the code in this office for review.
Initiai47t
4. I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code —. only if the structure meets the
minimum code.
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5. I understand that as an owner - builder, that any contractor disputes with sub-
contractors and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate`any contract disputes.
6. I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company or person.
Initial 47/
7. I understand that if any person gets injured on my construction project —they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Initial *?----
8. I understand that under state and local laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my property with out first obtaining
the proper permits by licensed contractors.
Was acknowledged before me this (0 day of Nita._ , 20 (')(o
By ()J il t a# fONA who was personally known to me or who has
Produced there License or as identification.
Initial
Initial //
Notary Public State of Florida
Barnard A Estep
My Commission DD510584
Expires 0312912010
Issue Date: 3/16/2006
Owner's Name: WILLIAM FANN
Permit Type: Residential Construction
Work Classification: Repair
Job Address: 731 95 Street NE
Comments:
Additional Information
• •
Miami Shores Village, FL 33138-
Building Department File Copy
Applicant Signature
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 03/16/2007
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Type of Construction: Occupancy:
Stories: Exterior:
Front Setback: Rear Setback:
Left Setback: Right Setback:
Bedrooms: Bathrooms:
Plans Submitted: Certificate Status:
Certificate Date: 3/16/2006 Additional Info:
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. Futhermore, I authorize the above -named contractor to do the work
stated.
Permit Status: APPROVED
Permit Number: RC -3 -06 -688
Phone:
Parcel #: 1132060142130
Block: Lot:
Section: PB:
Total Square Feet: 0
Total Valuation: $ 1,000.00
Re • uired Ins • ections
Final
Fees Due Amount
CCF $0.60
Education Surcharge $0.20
Permit Fee - Additions /Alterations $100.00
Scanning Fee $3.00
Technology Fee $2.50
Total: $106.30
Invoice Number
RC - 3 - 06 - 24149
Total:
Amt Due
$106.30
Amt Paid
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
3
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MAR 1 6 2005
'Inspection Number: INSP- 12418
Inspection Date: 05/01/2006
Inspector: Grande, Claudio
Owner: FANN, WILLIAM
Job Address: 731 95 Street NE
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Thursday, April 27, 2006
Miami Shores Village, FL 33138-
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone 5)795 -2204 Fax: (305)756 -8972
n
Block:
Permit Number: RC -3 -06 -688
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Repair
Phone Number (305)751 -6013
Parcel Number 1132060142130
Lot:
Page 1 of 2
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
'Inspection Number: INSP- 12418
Inspection Date: 05/01/2006
Inspector: Grande, Claudio
Owner: FANN, WILLIAM
Job Address: 731 95 Street NE
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Thursday, April 27, 2006
Miami Shores Village, FL 33138-
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone 5)795 -2204 Fax: (305)756 -8972
n
Block:
Permit Number: RC -3 -06 -688
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Repair
Phone Number (305)751 -6013
Parcel Number 1132060142130
Lot:
Page 1 of 2
FBC 2004
Permit Type (circle):
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES NO
Value of Work For this Permit $ j 0
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
ponwm
Permit No. Dip - (, 4S PERMIT APPLICATION MAR 1 6 2006 aster Permit No.
BY:
Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Ti a . •er) 14/J(`4 VLi l f ,4N JR Phone # 3o,5 57- (d /
Owner's Address / 7 3/ 4/F
Ci l `! /) / 5 4 q State Zip 7/ 357
Tenant/Lessee Name Phone #
73 ( A(.• 9r
County Miami -Dade Zip $
FOLIO / PARCEL # ! ' 12 lU 4 z oc( /3 1J,/ X81 lu WI/ 'f C / /73 / d i / '7
Contractor's Company Name (r .( /1il f1/ L _ Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work:
Type of Work: Addition ❑Alter. 'on New ® eReplace ❑ Demolition
Describe Work: /iris 1 N S C� a- ice D ►¢��
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ /0 0 t.-- • CCF $ • 4 ' 0 CO /CC
Notary $ •------ Training/Education Fee $ . Z 0 Technology Fee $ 2...5
Scanning $ 3 . Radon $ -- DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ loco. 30
See Reverse side —>
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 ;/X,tg�, 7
Owner or Agent
My Commission Expires:
(Revised 02/08/06)
Signature
Contractor
The foregoing instrument was acknowledged before me this (6 ` The foregoing instrument was acknowledged before me this
day of i. _ V , 2006, by U ∎astA Fc N.N\ , day of , 20 , by
who is person ly known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
• Notary Public State of Florida
/,..I °LI, ,araAEpp
welt
Sign: •
Print: (X(lA 4
APPLICATION APPROVED BY:
Expires 03129/2010
NOTARY PUBLIC:
•
4
Sign:
Print:
My Commission Expires:
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/4' 0Y . Plans Examiner
Engineer
Zoning
•