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PL-11-20-2635Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 8953 NE 4TH AVENUE RD 8953, Miami Shores, FL 33138 1132060460420 _ a Contacts SHAWN CLARK Owner THE NEW MIAMI SHORES PLUMBING Contractor 8953 NE 4 AVE, MIAMI SHORES, FL 33138 DENNIS MCLAUGHLIN shawn@miami.edu 900 NW 144 ST, MIAMI, FL 33168 Business: 3057512446 mspplumbing@aol.com Other:7865535424 Inspection Requests: Description: REPLACE SINK, REPLACE DISHWASHER TO REPLACE Valuation: $ 800.00 305 762 4949 PL 4 13 683 TotalSq Feet: 0.00 Fees Amount Payments Date Paid Amt Paid 100% Permit Renewal Fee $100.00 Total Fees $100.00 Credit Card 12/01/2020 $100.00 Total: $100.00 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 my7elf, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOO S, 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 cont*tor to do the work stated. Authorized Signature: Owner / Applicant / Contractor /I Date December 01, 2020 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 ocation Address Parcel Number 1953 NE 4TH AVENUE RD 8953, Miami Shores, FL 33138 1132060460420 Dntacts SHAWN CLARK Owner THE NEW MIAMI SHORES PLUMBING Contractor 8953 NE 4 AVE, MIAMI SHORES, FL 33138 DENNIS MCLAUGHLIN shawn@miami.edu 900 NW 144 ST, MIAMI, FL 33168 Business: 3057512446 mspplumbing@aol.com Other:7865535424 Description: REPLACE SINK, REPLACE DISHWASHER TO REPLACE Valuation: $ 800.00 Inspection Requests: PL 4 13-683 � 305 762 4949 Total Sq Feet: 0.00 Fees Amount Payments Date Paid Amt Paid 100% Permit Renewal Fee $100.00 Total Fees $100.00 Credit Card 12/01/2020 $100.00 Total: $100.00 Amount Due: $0.00 Applicant Copy For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. December 01, 2020 Page 1 of 2 Miami Shores Village R ,CEIVF,D BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC 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 FBC 201] jj Master Permit No. RC-10-20-2487 Sub Permit No. P_— i I `'IJ� --7� -3S ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL FM -]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 8953 NE 4th Ave Road City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1132060460420 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): Shawn Clark Address: 8953 NE 4th Ave Road City Miami Shores State: FL BFE: FFE: Phone#: 970-488-0821 Tenant/Lessee Name: Phone#: Email: Shawn@miami.edu p: 33138 CONTRACTOR: Company Name: The New Miami Shores Plumbing INC Phone#: 305-751-2446 Address: 900 NW 144th Street City: Miami State: FL Zip: 33168 Qualifier Name: Dennis MClaughlin Phone#: 305-751-2446 State Certification or Registration #: CFC019205 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ g VU. Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New EZ Repair/Replace ❑ Demolition Description of Work: Replace Sink, Replace Dishwasher. Specify color of color thru the: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ - Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $1 W - CO Bonding Company's Name (if applicable) Bonding Company's Address ___________— City State Mortgage Lender's Name (if applicable) — Mortgage Lender's Address City State Zip Zi 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatures / OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 11th dayof November 202020 by Shawn 061 rl who is personally known to me or who has produced f l a I/C rs Lice. a 171t, as identification and who did take an oath. NOTARY PUBLIC: Sign: ! or-ef { Print: Dayana Perez The foregoing instrument was acknowledged before me this 11th day of November 20 2020 by Dennis Mclaughlin who ispersonally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC - Sign:_ Print: Da ana Perez,.. Seal: rt _ My Commmsen GG 139415 Seal: Expues Qa(2912021 as Vtiny Commission GG 139415 o, oo�A Exp res 08/29t2021 i###tt#t#i#itli#i#tiiii##i###♦#ti####i###ti#it##t•######lift#tt#ltlttt#i####t##tti#lilitt#l##############tlt APPROVED BY tA��a Plans Examiner Zoning Structural Review Clerk (Revised02/24/2024) Miami Shores Village Building Department APR 0 S 2013 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 t 0 BUILDING Permit No. ' PCj —3 PERMIT APPLICATION Master Permit No.y2 L 1 3 S-7 w Permit Type: PLUMBING JOB ADDRESS: 5 l 3 P L- `7� 4le- 3P_�' City: Miami Shores County: Miami Dade Zip:/ Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):hone#:�� Address: �l 5 3 CC City: !/.1Crl/j j 4 State: r_4 Zip: _3 Tenant/Lessee Email: /� 4z.) ® V� �_ CONTRACTOR: Company Name: / \ G{/ Phone#: Address: City: Qualifier Name: State Certification or Registration #: Contact Phone#: DESIGNER: Architect/Engineer: Address: Certificate of Competency #: Value of Work for this Permit: $ 3&Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ;gRepair/Replace Description of Work: -- //o y- AzIalr'.-t Zip: Submittal Fee $ Permit Fee $ �� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ —7G 7- 37'3V' ❑Demolition TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 app and a re nspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of r`/�cZ- �L 20 �, byday of , 20 —, by who is personally known to me or who has produced env ClkyZ,N--1— 51A tt As identification and who did take an oath. A NOTARY PUBLIC: who is personally known to me or who has produced �\�,,r�►1<<�1���,,, ,,.. �\����� Sign: - ------- `.z E..X �G �'�. Sign: Print: _ : NAt.. ��10fo _ Print: as identification and who did take an oath. My Commission Expires: Ei co, s Coo�i My Commission Expires: O \ APPROVED BY� "` Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 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: ADDRESS:/ 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. I 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-�Z 3. 1 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 licens umbers 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 s tially improved it for sale or lease, which violates the exemption. Initial 5. 1 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 ounty or municipal ordinance. Initial 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.. 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not 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 co ation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. 1 agree that, as the party 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. i 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 I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or hftp://www.myfloridalicense.com/dbpr/pro/cilb/index-titml 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 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 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. 1? Was acknowledged before me this day of 20-_ By who was personally known to me or who has Produced there License or � .�=�� � C)2 %ais dentification. ........:... . OWNER NOTARi'NOr4���'/�01g 1. ��O��l! 'COM F�17SS`00 C t �p O 11111,1P ��O����