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BP-05-553Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Evr-F cU 201 FBC 20 BUILDING Master Permit No. OP 25'5S S • PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION 0RENEWAL ['PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I '2— k h g ! O (5 4' ST City: Folio/Parcel#: Miami Shores County: Miami Dade Zip: 13e) Is the Building Historically Designated: Yes NO X Re cy,_244-10:,11 Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): NIC� 1; A e. 8 ritn 53c Phone#: — 8 8 I Z, Address: 1 7L—' i -r City: NA L �,1 a �v State: L_ Zip: 5 3 0� Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: ki + Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: P) A Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Description of Work: Pwce p p T _ ❑ Repair/Replace TO CO n `a 1;52 ?iDOS — fS3 • ❑ Demolition 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 $ (Revised02/24/2014) Bonding Gompany'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. Signature OWNER or AGENT (0/31 � II Signature CONTRACTOR The foregoing instrument pwas acknowledged before me this The foregoing instrument was acknowledged before me this day of 0C, ,20 —9,by day of ,20 ,by MOT i 0 ViChiji aarZally known to , who is personally known to me or who has produced 4-1 (i as 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: 1'5' Print: Seal: •ti'd'JPLe•. MAHARAI K. GONZALEZ 1 a '"s MY COMMISSION # GG 044602 =* i""'' ' EXPIRES: November 2, 2020 ••, a o?�i`` Bonded Thru Notary Public Underwriters Sign: Print: Seal: ************************************************************************************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 5144, yes '13(d. rote. 10(31 /17 Re: Fit Perrr;,.1. Ce();;_, 125o NJE Iots4.,�;�,�tar;.►s SP,..ores Zst ar Si r /►-'! 0044 k,., 414c. ow -+— (wi+b rn h K sh uP , Ne;1 4 12 50 146 lois+ $4 t4t 5L -es . 1 wo wlet- t Le,, -1 o c c t,l -j c. tx p i rid feAA cz p e-rnt if- (2oo) oil ecce /0 e. CcAAkst 11,0 -Fi ca 104 s5 (kol . �uc,+� I r+ le lou �e (dAAA-14-1.1i n e �u,�,�jv�.0 r a.a st GwGi hte. l (1:))31+z-tti2,. (�r+vi� .rr bKr 45514(444q. S W1(14 1 (-11,(_tt.A.C42C-4.0wee4L)15.111/Ce--.4-- M -rt a A+2V /P J PCG -ti I h hes s BUILDING W1111 fV 11 V 1 d+/ IJ ♦ 1116.{. Building ]Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel (3 S.2 04 'd ( 5)1756.8972 AP 1 9'f PERMIT APPLICATION FBC 2001 C_,:Jof1(0Jo— Permit No. SPOS-SSj Master Permit No. l'erntit Type (circle): ' Building Electrical Plumbing Owner's Name (Fee Simple Titleholder)�,/,,le vim/letv.1.1' Phone #4.0 Mecl'; 14 iaii jca1 Owner's Address /25 ,412/ CityGam!'!/04,9%il State C j�ip�y Zip 33/ 3c, 'Tenant/Lessee Name Phone # Job Address (where the work is being done) Roofing City Miami Shores Village Comity . Miami -Dade Zip Is Building Historically Designated YES NO r/ Contractor's Company Name 4e:W/f,• 0 .0-1 Phone # Contractor's Address City State Qualifier Stale Certificate or Regis Architect/Engineer's Name (if applicable) Zip Certificate of Competency No. $ Value of Work For this Permit 4 1000 . 00 Phone # Square Footage Of Work: � Ids � � Type of Work: ❑Addition ❑Alteration ❑New LJ Rep' e air/Re p lace p ❑Demolition Describe Work: �4a/,p/ «7 4��Q✓ G�/ �/ , ,. � ��— (74- ff./e. (0 6.70 - Submittal Fee $ dit ***********************Fees****************************** 450.00 Notary $ / Scanning $ Permit Fee $ /O® Training/Education Fee $ 6 a ('ode Enforcement $ Radon $ Zoning Structural Plan Review $ Total Fee Now Due $ 624 .S° (Continued on opposite side) CCF $ 660 coicc Technology Fee $ Bond $ ~' Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) ti 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 constniction 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 01? 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 Signature Owner or Agent Contractor The foregoing instrument was ackn vvltdgedfibef re me this , The foregoing instrument was acknowledged before me this day of ## 0 _, by 1l�hvv��((CV y9 �� (, . day of , 20 , by who is perso ally knbwn to me or who has produces 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. NOTA P NOTARY PUBLIC: «o it►ty1 Sign: t ���i° �: 4 9-,ft19 Sign: Aston'2.i 1 084 Print: 1111111111.4111Milii ' • ' Expire :Ju t� Print: ,ndef },r,, - My Co . -'^tIc Rom -Imp M My Commission Expires: "mission Expir ******************* ******** **************************************************************************1 **:t **************************************** ; f 'k************'k**>k******+kik#******** ****************** hd d•*** 4.d}• APPLICATION APPROVED BY: Clic 05/13/03 APR 252 Plans Examiner l f Engineer Zoning VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE .STATEMENT being the legal property owner, for the property Located at: /25 Legally described as 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),,rd I have read and understand the following disclosure Statement, which entitles me td *ork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that 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 or a farm out -building. You may also build or improve a commercial building at a cost of 525,000.00 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 completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that 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 -holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) Was acknow • By I Produced edged before me th;� initial of reviewing clerk. The foregoing instrument ,dayof ,20 (d4 Ikis personally known to me or who has Owner t, Owner as identificat. d who did take an oath. Notary PUe Gti'. non ;ion Exp'rt •Ji 9oFFl°Q ,nj, nuc Rnndmp '251984