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1061 NE 91 Terr (8)BUILDING PERMIT APPLICATION FBC 2001 Owner's Address City ; "' V, • Tenant/Lessee Name Total Fee Now Due $ Contractor's Company Name Submittal Fee $ Notary $ 7'f ,! Scanning $ :) Code Enforcement $ (Continued on opposite side) Miami Shores Village Building Department ,I0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type (circle):,Buildingj Electrical Owner's Name (Fee Simple Titleholder) ; - - ; Phone # V4 Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES NO Contractor's Address City State Zip Qualifier Architect/Engineer's Name (if applicable) Phone # County $ Value of Work For this Permit W State Zip - ,; Phone # / (' ['Alteration O r - c_ pry - ja Type of Work: ❑ Addition Describe Work: I( -/' Ili( e Permit Fee $ %t{ Training/Education Fee $ Radon $ ['New 40 Structural Plan Review. $ 401, to t. -3(n_ Plumbing Miami -Dade 4A Phone # Permit No. Mechanical Zip Square Footage Of Work ."' CCF$r1 Technology Fee $ Bond $ 2 • (f) Master Permit No. Roofing 1 E L Repair/Replace ❑ Demolition 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. Signa Owner or Agent The foregoin instrument was acknowledged before me this day of 20 U -.11 ' 0- who is per ly known to me or who has produced As id NOT.L'YP :LIC: Sign: Print: My Commission Expires: �'• ` :, ommissIon DD; oath. Tres: Jul 13, Signature My Commission Expires: Contractor The foregoing instrument was acknowledged before me this day of , 20 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 10/14/03 7 2003 Plans Examiner Engineer Zoning MIAMI SHORES VILLAGE 0 BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date JADM Time Type Insp'n &� -1V-105/ Permit No. `" Name Address /O / l ! ' 9/ Company Phone # For Inspector: /\ 5 \Oifame & Date Approved Correction Re- Insp'n Fee Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date / ` \0 Time Type Insp'n Permit No. A 03 f7 Name Address /06 ` At 12- d G 1 Company Phone # � For Inspector: l\ 1 \ `O ( 1V ame & Date Type Insp'n Permit No. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 `1?-- Building Inspection Request Date 1 Inspection Date Approved Correction Re- Insp'n Fee C-r1C, ` D6 i U-0-1-0(-1 Name Sr Address I0 (0 1 Ne. C H ter Company OW fF,E? Phone # OM. C/ Rev" 5 BankofAmerica Date (1 15 0 Pay To The Order Of V I Mr i A> t .c r :A )i 5 Dollars Not Valid Over $1000 Bank of America is not liable for lost or stolen Money Orders. For your protection against loss or theft, sign and complete this Money Order as soon as possible. Bank of America, N.A. San Antonio, Texas Personal Money Order VOID AFTER 90 DAYS 1 4A ) ( t C j iFo:r No. 3975882 30-1/1143 (NTX) 001641002088 I M47'6(4/ 6J, - 4q being the legal property owner, for the property Located at: (° G ( 4 , 7l re i t 2 4 -- "St' r c��r / z%/. Legally described as S714 c 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),,gnd I have read and understand the following disclosure Statement, which entitles me td 3l ork 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 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 constT uction 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 $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 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 acknowledged before me this 4 31 day of "t' , 20 Ci;3 By 0 who is personally known to me or who has Produced as ide ; fic tion and who did take an oath. • VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT BUILDING DEPARTMENT DISCLOSURE STATEMENT initial of reviewing clerk. The foregoing instrument oeRO : e nded Thru '' Atlantic Bonding Co.. Inc. • / fYFF N P27 6.15' PLAN OF SURVEY $COG' / `r 20' /ex:. or c-. /.F \ 4 0 \g // /Re.- M /,t-vsE• oAv 3. r; -• 3 WALK 2 44' 1 , IL 15.5.9 1 N A G5' 4 3 , to y N C /SYr. 5 co R-.s 40 /( 5 6,/ • 0.60' t 0.95 L .. .. • .l it Y..,. - y ;� • N r a . >•, Y t uy . 3.05 • 1j Miami Shores Village 10050 NE 2nd Avenue Phone: 305-795 -2204 Printed: 11/7/2003 Applicant: DIANA Owner: LEE JOB ADDRESS: 1061 Contractor Local Phone: Parcel # 1132050010070 Fees: FEE2003 -7016 FEE2003 -7017 FEE2003 -7018 FEE2003 -7019 FEE2003 -7020 FEE2003 -7021 FEE2003 -7022 NE 91 Description Builders Bond CCF Scanning Fee Training and Education Fee Technology Fee Notary Fee Building Fee Total Fees: Permit Status: APPROVED Permit Expiration: 5/5/2004 Construction Value: $1,500.00 Work: 2 concrete ribbins to replace existing 30 in each Signed: (INSPECTOR) uil in LEE DIANA TERR 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) Permit Number: P2003 -1762 Contractor's Address: Legal Description: WATERSEDGE PB9 - 141 LOT 8 BLK 1 LOT SIZE 50.000 X 125 OR 19609 - 0988 04 Amount $300.00 $1.20 $3.00 $0.40 $2.50 $5.00 $100.00 $412.10 BY: err it Page 1 of 1 Total Fees: $412.10 Total Receipts: $0.00 ,td (x'1.®0 Cg DEC 2 6 PAID ` CC, , ors Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11/7/2003 Applicant: DIANA Owner: LEE JOB ADDRESS: 1061 NE 91 Contractor Local Phone: Parcel # 1132050010070 Fees: FEE2003 -7016 FEE2003 -7017 FEE2003 -7018 FEE2003 -7019 FEE2003 -7020 FEE2003 -7021 FEE2003 -7022 Description Builders Bond CCF Scanning Fee Training and Education Fee Technology Fee Notary Fee Building Fee Total Fees: Amount $300.00 $1.20 $3.00 $0.40 $2.50 $5.00 $100.00 $412.10 Total Fees: $412.10 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 5/5/2004 Construction Value: $1,500.00 Work: 2 concrete ribbins to replace existing 30 in each Signed: (INSPECTOR) 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Building Permit Permit Number: BP2003 -1762 LEE DIANA TERR Contractor's Address: Page 1 of 1 Legal Description: WATERSEDGE PB9 -141 LOT 8 BLK 1 LOT SIZE 50.000 X 125 OR 19609 -0988 04