WS-03-21-534Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
t Expiratlon:09/02/2021
Location Address Parcel Number
10400 NE 12TH AVE, Miami Shores, FL 33138 1122320310010
Contacts
William Ruiz & W Ivet Owner
10400 NE 12 AVE, Miami Shores, FL 33138
HOME OWNER Contractor
HOME OWNER
Inspection Requests:
Description: CHANGE OLD DOOR TO NEW ONE AND ADD Valuation: $ 200.00 ru
SHUTTER TO REPLACE PERMIT#WS-1-07-3t��}
Total Sq Feet: 0.00
Fees Amount
Payments
Date Paid Amt Paid
100% Permit Renewal Fee $110.00
Total Fees
$110.00
Credit Card
03/02/2021 $110.00
Total: $110.00
Amount Due:
$0.00
Building Department Copy
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
reaulat'Aa c'dRstruction and zonina. Futhermere. I authorize the above named contractor to do the work stated.
re: Owner � / Applicant / CopWa`ctor / Agent Date
March 02, 2021 Page 2 of 2
V4
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY._�^
INSPECTION LINE PHONE NUMBER: (305) 762-4949 �
FBC 20
Master Permit No. WS- 0 '-::,? - 2J -5—
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION FRENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
]� j CONTRACTOR DRAWINGS
JOB ADDRESS: 10 400 1 �.d L I a -A(`��
Folio/Parcel#: I ���" J D3 1 O(-J 0 Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �r ( Iz: l Phone#: .
Address: t ll J `� l .'CJ IS. JT I r;L :I�'
City: ( ovyy%- (, A f'eN State:
Tenant/Lessee Name:
Email
-Zip:,_2S1_S&
i
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: $� �' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: e'er -� «� r e �` �`�
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)
d•T
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.) ) J
NAME: 1�'V t DATE: !'
ADDRESS: _10 `C � � � � ! (s�' ALIE
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 ii''"s responsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Initial
3. I 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 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 I which violates the exemption.
Initial 7C
5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
Initial__ <- 1
6.' :;Iiunderstand thafiJimayl6t hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence
ism re'sponsibUity tti eri ure that the persons whom I employ have the license required by law and by county or municipal ordinance.
F * )•� Initial
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit
Permit Status: APPROVED
Issue Date: 113/2007 Expires: 07/02/2007 Permit Number: WS-1-07-3
Owner's Name: SHIRLEY PATIN one:
Permit Type: Windows/Shutters
Work Classification: Window/Door Replacement
Job Address: 10400 12 Avenue NE
Miami Shores Village, FL 33138-
Contractor(s) Phone Primary Contractor
HOME OWNER Yes
Additional Information
Type of Work: shutters/door No of Openings: 1
Additional Info: Classification: Residential
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.
Fees Due
Amount
CCF
$0.60
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$3.75
Total:
$162.55
Building Department File Copy
Parcel #: 1122320310010
Block: Lot:
Section: PB:
Total Square Feet:
Total Valuation: $ 200.00
Window Door Attachment
Shutter Attachment
Final Shutters
Final
Invoice Number Amt Due Amt Paid
WS-1-07-27142 $162.55
Total:
1 w JUN I 1 PAID
VI
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Applicant Signature
(Y5k)6- , Miami Shores Village C METM
W rnJAN ° 2007
BuildingDe Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY'
Tel: (305) 795.2204 Fax: (305) 756.8972
omlolBUILDING ( ;.- Permit No. W�
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type (circle)
-uilding Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simer)V�1 Phone #����-�l i
Owner's Address �0400 `y E to AVE
City(�,t rYl I S V C:i PS State t Zip ,3J
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 10/4(:�O NE I a ►— 0L
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # I - jo=J I - Cam® I (.
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City
Qualifier Name
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit$
State
Type of Work: ❑Addition ❑Alteration
Describe
Zip
Phone #
_ Certificate of Competency No._
Phone #
Square / Linear Footage Of Work:
❑New Repair/Replace ❑ Demolition
e,�,%��,�*,�*�**,����*�,�**�*n,�*�*�*��**�**�******�
Submittal Fee $ (Jr P rmit Fee $ U v� CCF $ l✓ a(oo CO/CC
Notary $ 6(11
n Training/Education Fee $— Technology Fee $. ) �
scanning $. �J'VRadon $
Bond $ Code Enforcement $
Structural Review. $
DPBR $
Zoning $
Double Fee $
Total Fee Now Due $ 1(�P`00_
See Reverse side -
/i
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: U DATE: J)PW n
a,2�00
jo
ADDRESS: t V �-- I (Jt✓ /�C 1 C lil (� � d --2S `#-- 1
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws 33(3
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 I L----
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.
Initial Y�--
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.
Initial i�-T4-
M.
JAN 0 2 2007
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IM I A M I-Qft&X
BUILDING CODE C
PRODUCT CONTRI
5617929281-
NOTICE OF AWAAWMWEIN, JYA)
M C 7a, 9 V/ Ee
JAN 0 2 2007.
BY--------------------
I
Mb%A13-DA10E COUNTY. r.
METRO -DADS FLAGLE."R PUIL"","
140 WEST FLAGLER STREET, -5017 F, I Li
MIAMI, FLORIDA33130- il..
(305)375-2901 FAX (305)
roma corporation
9040 Belvedere Ro
West Palm Beach,
C4
SCOPE:
This I NOA is being issued under the applicable rules and regulations governing the use of constructim ma!LniAs.
The docurnentation submitted has been xvviewed by)vliami-Dade County Product Control Division and accepted
by the Board of Mules and Appeals (BORA) to be 1z,!ji in Miami Dade County and other areas where allowed by
the Authority Having Jurisdiction (AHI),
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Coritro�
Division (7n Miami Dade County) and/or the AM (in arm other than Miami Dade Coimty) reserve the right tr-
have this product or materiattested for quality assurance purposes. If tbisprpduct or material fails to perform it
the AHJ may di t
the accepted manner, the manufacturer will incur the expense of such testing and f IR elV;
product or material within their I cir juhs iction. 'reser.
revoke, modify, or suspend -the use of such d B011A ves, the rig
ll
to revokcthis acccptance if it is determined by Miami-Dadc County, Product Control Divisionibat this Product 6-,,v
material fails to meet the requirements of the 41icable building code.
This product is approved as described herein, and has been designed to complywith the High Velocity 11wTicane.
Zone of the Florida Building Code
IDESCMIFTION: 0.063.'Alum1n.am Stu
sheets I vug 0
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panery
APPROVAL DOCUMENT: Drawing No. 96-47, titled tbr
vich & Associates, Iq c., dated 31:15/96, bearing the Miami-DadCo
unty otirity Prodtuc
3, prepared by Xncze Cont ' ro ' i
Renewal stamp with the Notice of Acceptance number and approval date by the Miami -Dade County Product
Control Division_
MISSILEIMPACT RATING: Large and Small NXissile Impact
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LABELING: Each unit shall bear a perina ' vent label -with the manufacturer's name or logo city, smote and
following statement: "Miami -Dade County Product Co; !trot Approved", unless. . otherwise noted hcrein.
RENEWAL of this NOA shall be consid6red after a.vn'twal application has beery filed and there has btmv m.
change in the applicable building code negatively affecing the perIkormanceof this product, TEWYMATION of this NOA will occur after the exyiration date or if there bAs been a revision or chan-r:,t i,'r ti
rnatcrials, use, and/or manufacture of the product or pr1jcess. jvjisuse of this NOA as an endomement of any
product, for sales, advertising or any other purposes shill automatically terminate this NOA. Failure try
with any section of this NOA shall be cause for termin-ation and removal of NOA.
ADVERTISEMENT: The NOA nurnber preceded by the words MiaMI-Dade County, Flonda, wand '_ol_nLaVd, -C'
d, tmc 0A i S d i wlzyc d, t e,
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�,'..6w Glazed 4
�We s3rtd Full IN4vd ids- C) wA csr solo
Hinged Door Units idelitds,amd w/
Or wlo Transom
'14 9 '"tile and RE61 Wood Side. V-0'" Glazed VS
PHingged Door Units IDoubla Boor
11.4 10 •�and, Rail Wood Side.. I V-Q° Glazed
Hinged Door Units Doubla Door
U.......
tarminect by ASOF 7,
ninwm Design Loads
Suftnas and Other
,uctures, dws not
teed the desNan
inures tilted T-0" x at
max norrinall sizo. Max
1 1= -4-85 Of -00 0. When
go missile ihIsact
LrWnft is roqulmd,
7104rte prste.-ctive
.ter» is required, See
tallation drawing DWG-
,ln.olS&05 fbr
16mrZiln'IMUM
valuated for use in
catonsadhering to the
orida Buildirtgi Code
dudrng the High Woe
urricane Torre, and
ere pressure
qulrornonty arctermined by �►S02 7,
DO$Ign LOVIS
for 12ulldings and {ether ADO 0 °
Structures, dpea; Apt 0
Gsed the design o 0 0 0 0
c ures iistev •61-0" x 8'-., ° ' °
rMxIriQmItvdi°a Max 00 0
GP = +45 6 /40 o Men 0
fame rnistile ifvpMq ° 0 0
resistance's I1?�q'i�Ir,- 0 0 .0
urricane pinta"c�v� 00
system is regU14 °bee °
inafallat(on dr'�culrsLPOWG_ ° ° ° °
-FL0135for° 0 0
dditiomil infdrmailob, COOOV
Evaluated Tot` Use.. In °
0000
(4Cations adn�lrog tgthu
Morid,i Buildling rode ° ° ° 0 0 .
Including the High Velocity ° °
Nurdeane Zane, and
+where pressurd
egii(rorngnts as
fetirrninedd by AI3Gi= i,
Ainimurn Design Loads
or Buildings and Other
hwdtures, does .not
mc*ed the datigo
Iressum listed, 15'-0" x S'
P° max nominal size, Max
)P ; +60 0 / -50 r). When
irge missile lmrmat
mistance is requ(r+ed.
urricone protractive
stern is required. $ee
wtaltation drawing DWG.
IA-FLO130-05 for,
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900-:1 6l0/E00'd M -WDNd WdN9:ll 1002-£11-001
Pradunt Approvw Mothgdi:
Application Sfatus-
Date Vaffdamd-
Dam A,pgrcvsd:
Dala CerOod to the 2004 Code -
Page.
IE
VApp/a"`eq Product Model 0 or
wjuus�uln
Glazed Aff
ZU.D Si 14 i TzMjj$ tom$
Method Y O,pdonA
ApprowA
0y1.t'//2005
10106200E
b"-S" Opaque US
114 9 Stfe3 and Rau Vviodd Side- and O/S Single
WirrgQd Door Units 0 cor w/ or w/o
ransom
94 2 S#ile and pail Wood Side- I 8'�W Opaque l/$
Hinged Door upps 18inqie Doer Unit
page I ! Y
Evaluated €or im in
;cations adherfng to the
torida Sulldlrlti Code
CIOCIItlg the High Velooityr
ui-dcane Zone, and
here preurr
lgoirements aw 0000,
atermint4l PYASCE 7, o 0 o o
inimurn 04sW LSods 0 000
r guilding%grbd, P°trier I ° °
UO 0
rust ev, dow oon of
toad the des1gn °
assures x S' ° ° o °
Max norninaNgize klax ° °
+1.70.&lddiw large ° 0
s�il� trftpact;tl�l�ancer ° ° ° ° o
required, �c�re °
att cfiv sjn3` oin a
jutrad 8 e8 in-MalYstion ° ° ° ° °
wing DWID-Nee- ° ° ° ° °
0136�75 fow�tldii�ana; ° ° °
i"vaivatw fbr use in
local one adhering to the
Florida Builcitng made
including the Hir Velw
Hurricane gone, sand
Owe pressure
-squirements as
letermined by ASCE~ 7,
Alaimurn Design Loads
Or SUEldings and Other
yt Mtwes, does not
mreed the desion
rMaures luted 31-8" x 8'
max nominal size Max
iP - +g$ 0 / -70 U. When,
rNselle IrnpacF.
:slstancA is required,
urricane prote(*Ie
/st$m is required See
0000If
0 °I
0 0 0 0 0 C
0 {
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0
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0
0
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0 IO
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0 0
800-J £I0/£00A IZ1-1 -Hui 6HYZra:II 1002-£Z-AaIN
VU1Aj)d4,VI IIL1L IA-_xif 13"1 4i PV a.s, ■"jI
143
144
145
„
and Rall Wood Side- '- Single �
t7uar
9d Door Units , -t.
6'-f8" Opaquo l,`a
anO Roil Wood Side- land VS Door w1
rd moor Units or w/a Sidelites
na' ns errl
and Rarl Vybod Side- V-tl" Opaque ilk
ed Dow Units Door w/ rar w/o
0
Installation cirowing DWG-
MA-FL0137-0 for
additional infcrrnafi ri.
IEvaluated foi use in
orstions adheering b, the
lorida Building Code
including the Hign velocity
urricane Zone, and
here prewuim
rNpIrements 1W
determined by ASOF, 7,
inimum Design Loads
forSuRdings and Other
tructures, does not
exceed the deisign
ressulw lined 3k6" x a'-
" max naltilVil Size. Max
Lap=+%0.01-fl50 When
gge rrfissile impact
reslstonce is requlmd,
urrlcana prbtactive
stem Is requires, See
installation draiving DWG•-
MA-FLO137.06 for
nnatien.
l~valubto fmwia in °
°000
locations adfi9r.Ing So thii 0 000
°
par Ciuildln Code ° °
including the W&I"Velority ° 0 °
Hurricane 2ei9G,cwM 0
hers pressum ° ° ° 0
raquirementA iw. 0 ° , 000
°
atoiTnined i;o rX 7,
alilirYV I 91911 Lowds 1 ° o
Por,Pulldings°gnif Other 00 ° °
Structures, ctmm
0
coed the desfiNn o 0 0 0 0
Pressures listed. &.11' x 8'. 0 ° ° 0 °
6" max no miiie6.§ixg Max
Gp = */> 60.6, when. large
missilrr impact misistanoe 00
is required, hurri-me
prestect ve systern Is
required See Ins-,Wlatian
:fraMng DVVG-MAr
RLO1•36-05• for %ididonal
nformation.
Evaluated For use in
ocal:lons adhering to the
lorida Building (,'ode
noluding the High Vel=iry
lwfcane Zone, tern(
Mere pressura
squiraments as
etarmined by AE'Gld 7,
dinirnurn Design I:oeds
irSuildings and ;.ther
tructurev, does riot
xCem the,deaigr,
ressures listed El-l" is ti'.
0
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0
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0
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800-d 61W00'J izi-1 4U:1 NYWH 10ONz-Aw
Ub)!Lil'LUU 1 WEL' AG! aU N'A.X 6 iU All 4727
Mile and Rail Wood Side-Lo:%%
c�paquo1 Hinged boor Units 1dali, or
�o Sideline
OCettl4ns adhirrPiHg ter the
i lorida pull4fiFce QIe
ncluding thq 8161hNeloci
Hurrl�ne T®®e•"e,'t41
here presorc 0 o
requirements as
aterminedi By ASftE 7,
inimum ResYMi Lads
6-8" Glazed .113 , for Buildings and Qthar
14 7 Stile and Rani Wood hip- Doorw/ orwln truafUrw_s, does not
Hinged Door UnIhs Sidelines and wr xceed me desfgin
r tak Tmn•sarn pra"urns listed 61.0" x 6'.
" max nominal vtize. t67ex
DP - }50.01-85 n When
rge missile Impact
esIntones is reglrired,
hurricane proteelive
yatam is, required See
Jnstetippon drawnig DI-
MA-PL0438-05 t,r
ddldonal informartion,
IEval�rated for wade in
iodations adhering to the,
';lorida Suilding Code
including the High veloony
Hrarricane Zone, snd
ere pre"Ury
requirernerlts as
►" nrdx nomlr!ai size Max
)P - +55 0 / -80 0. When
arc�e rnis$pe impact
asrstance st required,
uritcans proteetive
yatam is required' See
r$taila!tion drswing OW0-
1A-a1.'t}1.37-05 for•
dditini nal inform lone,___
;valuated idr use in
cati0rm adhming to the
lorida Building Cade
eluding the Iiigh Velocity
urrleana Zone, and
here pressure
giiirements ras
rtvrmined by ASCE 'r,
Wrnum Design L *Ods
SulOngs acid Other
ructures, do".s riot
Geed the ds±sign
33030res fisted W-l"x V.
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