DGT-16-24717 Miami M'
� J Shores Village
Building Department
artment
f
BUILDING
PERMIT APPLICATION
(BUILDING ❑ ELECTRIC ❑ ROOFING
10050 N.E.2nd Avenue; Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
PLUMBING ❑ MECHANICAL [I] PUBLIC WORKS
JOB ADDRESS: -72 NW'
91 re 7r
S P26 016
S t
FBC 20('
Master Permit N (i41
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF r? CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores • County:. Miami Dade
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): a iC) a iVasioctui<
Address:
' BFE:
zip: 5iI5
NO
FFE:
Phone#:����7_����
-72NW9151
City: ' M' C 11 C �� ��� State: Zip: ,~ / 5
Tanant/Lessee Name:Phone# c31 Gf 7 ' )13
Email:
CONTRACTOR: Company Name: Phone#:
Address:
City: t 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: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Woork:
❑ New ❑ Repair/Replace
n Demolition
rD
9-c-
Specify color of color thru tile:
Fi lV.)44
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ `CO/CC $
DBPR $ i . _. r �......' _ _Notary $ _.r......_.._
Double Fee$
Bond $
tRPvispdn7 /74/70141
TOTAL FEE NOW DUE $
ar
t'
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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. A a certified copy of the recorded notice of commencement must be posted at the job site
for the first' inspection which occurs sev: n (r) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approve and aj ei sp -ction fee will be charged.
Signature
'gnature
OWNE or ANT CONTRACTOR
The foregoing instrument was acknowledged before me this_ The foregoing instrument was acknowledged before me this
:f 1 ' day of J(^ .l , , 20 /l F7 , by day of , 20 by
(who is personally known to, , who is personally known to
_ as me or who has produced as
a identification and who did take an oath.
melor who has produced
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
J aal
Sign: :L.r-, t-!,t!�'.Z.�• L ��21
yl vier \//r6)7-763
Print:
Seal:
:4'PV PVe.,,
i;F: fi SYLVIA WROMAS
'' MY COMMISSION #FF019752
'''•'f or'F�` ' EXPIRES May 20. 2017
vtii*sti'fi�t'tr*** *da*t o't` rysrv,ce y e* ***
APPROVED BY
Sign:
Print:
Seal:
Plans Examiner
Zoning
Structural Review
F\ rDc�dcc.�n�/-n Nn11
Clerk
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Miami Shores Village
Building Department
10050 N.E. 2nd Avenue
Miami Shores, FI 33138
Tel: 305-795-2204
Fax: 305-756-8972
12/4/2017
Owner: 72 NW 97 Street
Miami Shores FL 33150-
Process No: DGT-1-16-247
Address: 72 NW 97 Street
Dear Sir or Madam:
Our records indicate that the above referenced permit application has expired.
According to section 105.3.2 "Time limitation of application. An application for a permit for
any proposed work shall be deemed to have been abandoned 180 days after the date of
filing, unless such application has been pursued in good faith or a permit has been issued."
In order to serve you better, we need to keep our files up to date.
Please be advised that an expired permit application will hinder your ability to obtain
new permits, refinance or sell this property. It may also suspend a contractors permit
privileges in Miami -Dade County.
Please contact the Building Department, within 15 days of receipt of this letter in order to
take care of this matter.
Sincerely,
21/X2
Ismael Naranjo, CBO
Building Director
305-795-2204
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
RECTA•T1,,T
JAN292015
BY -
INSPECTION LINE PHONE NUMBER: (305) 762-4949
PERMI III'LICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS:
City:
li/Irel#:
Occupancy Type:
�2 NW9isT
Miami Shores
1131010330350
Load:
County:
lNCfUEit Fsc2o�4. sw\
M No.���4
No. 1 l (0—'24 4-
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade
Zip:3S I( O
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zones, BFE: FFE:
OWNER: Name (Fee Simple Titleholder): g, O r) a "6)kM l7 —,50
Address:
City:
Zip:
Tenant/Lessee Name: Phone#:
9mrec`1/ac ,nd
Email:
CONTRACTOR: Company Name:
Address:
City: State: Zip:
Qualifier Name: Phone#:
Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address: /�
Value of Work for this Permit: $ 42
Type of Work: ❑ Addition
Description of Work:
ate of Competency #:
Phone#:
City: �1 State: ) Zip:
5`` Square/Linear Footage tfirt% (P
❑ Alteration ❑ New [� Repair/Replace` } I Demolition
p Ia cn 60 d er_. won Ezx 33
Specify color of color thru "` ' t
Submittal Fee $ Permit Fee $ CCF $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
•
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City - State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address ! }' Alt.
.i. .-'11.• ..,.4' 't y .1,•. '�
City .'` State"' Zip Olt fig'; i. ki . 1.i. `r
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 MAYr
RESULT IN YOUR PAYING TWICE FOR'. IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULTWITH 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 • ' the job site
for the first inspection which occurs seven (7) d• s after, t`lie building •permit,is issued. In the absene uc p•. notice, the
inspection will not 'e approved a d a reinspec o 'ee will be charged.
Signature
r
0 Effo AG
The foregoing instru ent was acknowledged before me this
02. 5 day of £ _.rl , , 20 /_ by
6-1,..-` a AAAlo.. , who is personally known tg
me or who has produced as
4
identification and who,did take an oath.
NOTARY PUBLIC:
Sign:
i
Print:
Seal:
SYLVIA WROMAS
MY COMMISSION #FF019752
EXPIRES May 20, 2017
' Signature
ONTRAC
The foregoing instrument was acknowledged before me this
l day of -JAM-4 , 20o� by
F 2V - j'Yl 43k1 ACKartit
is personally known to
ael Fm, ix
e or whJYo'has produced P ' — 1V(T. as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
(4.7)318•0153 Flor °U1Y1YS:iYl4C 'sP***y*********************************************sF�4 I1l� ,0
APPROVED APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
r1
(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: aloria � i `%4i1+C/% DATE: 1
ADDRESS: /2 NW 9-1 Si 1 "I''Om S 9O 5Ft,/SD
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 thoug��you do not have a license. You must supervise the
construction yourself. You may build or improve a one -family or two-family residen .K•t ; y 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 c upancy. 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 const I , 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 . • - ctor. 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
CANrgj
I understand that state law requires construction to be done by a licensed contractor or 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. I understand that building permits are not required to be signed by a prop rty owner unless he or9 the is responsible for the construction and
is not hiring a licensed contractor to assume responsibility.
3. I understand that, as an owner builder, I am the responsible party of record on a permit. I underst. • 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 .f 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.
GA c IsidgrInitial
4. I understand that I may build or improve a one family or two-family re0t7a farm outbuild' . 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
5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the constructi
Initial
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise pers s 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
7. I 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. I understand that I may not delegate the responsibility for suervising work to be a licensed contractor who is not licenses to perform the
work being done. Any person working on my building who ipP.,1 i.!C r r� �� _r my direct supervision and must be employed by
me, which means that I must com I with laws re uirin the, . t. i al t •' tax and social securitycontributions under the
Federal Insurance Contributions Act (FICA) and must provide workers comp e employee. I understand that my failure to follow
these may subject to serious financial risk.
9. I agree that, as the party legally and financially responsible for this proposed C
requirement that govern owner -builders as well as employers. I also underst
Construction must comply with all applicable laws, ordinances, building codes,
Initial
tr ction activity, I,/rill abide by all applicable laws and
Initial
Fr
10. I understand that I may obtain more information regarding my obligations as an employer from the In rnal 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.myfloridalicense.com/dbpr/pro/cilb/index.html
Initial
11. I am aware of, and consent to; an owner -builder building permit applied for in my name and understa
legally and financially responsible for the proposed construction activity at the following address:
s that I am the party
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of th information that I have provided on
this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public. If you contract with a perso
Constr4uction Industry Licensing Board and Department of Business and Professional
loss that you sustain as a result of contractor may be in civil court. It is also important
employee of an individual or firm is injured while working on your property, you may be held ia.le o
ho does not have a license, the
1 sist you with any financial FI an unlicensed contractor or
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 J C-ii1 , 20 ne
Produced th - re Li ense .- r
who was personally known to me or who has
SYLVIA WROMAS
MY COMMISSION #FF019752
EXPIRES May 20. 2017
ication.