FW-10-231 z
d, Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
° Phone: (305)795- 2204��
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� Expiration'
6. 221201
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Project Address Parcel Number Applicant
10682 11 Court 1122320280500
DELORES HAGAN
Miami Shores, FL 33138 Block: Lot
Owner Information Address Phone Cell
DELORES HAGAN 10682 11 Court
MIAMI SHORES FL 33138 -2123
Contractor(s) Phone Cell Phone Valuation: $ 1,500.00
HOME OWNER
Total Sq Feet: 100
Approved: Yes For Inspections please call:
Comments: (305)762 -4949
Date Approved: 2117/2010: Yes Available Inspections:
Date Denied: Inspection Type:
Type of Construction: Wire Fence Additional Info: BUILDING Final
Classification: Residential Foundation
Fees Due Amount Invoice # invoice Total Amt Paid Amt Due
CCF $1.20
FW -2 -90 -37053
Education Surcharge $0.40 $106.20 $106.20 $0.00
Permit Fee -Wire & Wood $100.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $106.20
Building Department Copy
February 25, 2010 2
Miami Shores pillage
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v
Building Department 16 2010
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel; (305) 795.2204 Fax: (305) 756.8972.
INSPECTION'S PHONE NUMBER: (305) 762.4949 .��.,........
BUILDING
Permit No. w'
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type BUILDING ROOFING
Owner's Name (Fee Simple Titleholder) Phone # (. (�-
Owner's Address 1 yr
® City. s State O A Zi
Tenant/Lessee Name o Phone #
Email
Job Address (where the work is being done) C(q
City -t-ef!� Miami Shores Village County v' Miami -Dade Zip
.FOLIO / PARCEL
Is Building Historically Designated YES Flood Zone
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
i
State Certificate or Registration No. Certificate of Competency No.
Contact Phone Email
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ _'� • 6�� Square 1 Linear Footage Of Work: 00 Lp j
Type of Work: []Addition []Alteration ONew pair/R.eplace [I Demolition
Describe Work: \;: ,C P 2' IC 1S ism ('�Z J�� �nC_�� kkv-
O Q .C__6 _ PP YL . 4 CSC, LAM
I
Submittal Fe e; - Permit Fee $ CCF $ I' � CO /CC .$
Notary Trai ' ddc tion -
Y ruugJE a Fee $ � ' Technology Fee
gY -
Scanning $ L Radon $ DPBR $ Bond
Doable Fee .$ Violation date:
Structural Review. $ Total Fee Now Due $ LAD•a'o
See Reverse side
I
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
COMMENCE 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 certifted 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 acknowledged before me this 16 The foregoing instrument was acknowledged before me this
day of r , 20 Lp, by day of 20 by
who is personalfily owu to-lAe or who has produced who is personally known to me or who has produced
and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign•
Print: . .0 Arrr 1 Print:
My Commission Expires V4 4041e '...... My Commission Expires
AhltEt •
.gow Comm# DD072 °
r a E)0M 1111312
e �htt
..o neae■ .
APPROVED BY ! r ! Plans Examiner l Zoning
Engineer Clerk checked
(Revised 07/10 /07)(Revised 06 /10/2009)
Miami Shores Village
.p. Building Department
10050 N.E.2nd Avenue
Miami Shares, Florida 33138
Tel: (305) 795.2204
+ Fax: (305) 758.8972
OWNER BUI ER DISCLOSURE:,STATEWNT
NAME c)( C DATE:
ADDRESS: AL M U39
Do hereby petition the Village of Miami Shores to act as my own contractor to the lairs of the State of Florida, KS 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 fora 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 frost of $25,000.00 or less (The new form states 75;000). The building must to for your tam use and
occupancy, it may not be built for sale or lease, if you sell or lease a building you have: built yourself within one year after the
construction is complete, the law will presume that you built for sale or lease, which Is a violation of this exemption. You may not hire
an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state
law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your
supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers'
compensation for that employee, all as prescribes by law. Your construction must comply with sli applicable laws, ordinances,
buildings codes and zoning regulations.
Please read and initial each paragraph.
1. I understand that state law requires construction to be done by a licensed contractor and hAve applied for an owner - builder
permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own
contractor with certain restrictions even though I do not have a license.
Initia
2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the
construction and is not hiring a licensed contractor to assume responsibility.
• Initi
3. 1 understand that as an owner builder, I am the responsible party of record on a permit. I understand that 1 may protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed In his or her name instead of my own
name. I also understand that the contractor is required by taw to be tic,onsed in Florida and to list hiss or dicer number$ on
permits and contracts.
Infial
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 butift or residence must be for my use or oxuponcy. 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 constriction is complete, the law will presume that I built ors tially
improved it for sale or lease, which violates the exemption.
Initial
5. 1 understand that as the owner - budder, I must provide direct, o>sits supervision of the cormtruction.
fd
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 by county 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 properly 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 properly. My homeowner's insurance may not provide coverage for those injures. I am willfully aging as an
owner - builder and am aware of the limits of my insurance coverage for injures to workers on my property.
Initi -
8. I understand that I may riot 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 js not licensed must work under my direct supervision
and must be employed by me; whi means that) must comply with laws requiring the withholding of federal income tax and
social security contribution under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for
the employee. I understand that my failure to follow these may subject to serious financial risk.
Initial _14k
9. 1 agree that, as the party Dally 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 liars, ordinances, building codes, and zoning regulation.
Initial
10. I understand that I may obtain more information regarding my obligation 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 ho. /h rww.mynowalicerse.comldbpr /pool dibrndex.html
Initial
11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that 1 am the party
legally and financially responsible for the proposed construction activity at the following address. ' a
Initial V
12. I 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. ® i
Initial +1
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 Deparlmad 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.
Was acknowledged before me this day of . 20 a ��
By who was personally known to me or who has
Produced there License or _ F 1117:) as identification.
All OWNER NOTARY
Planning
Miami Shores Village Permit No. FW - 2 -10 -231
10050 N. E. 2nd Avenue
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Miami Shores, FL 33138 -0000 fi r g sx
Phone: (305)795 -2204 Fax: (305)758 - 8972:,'
w' Issue Date: Not Issued Expir:Not Issued
Folio Number) 122320280500
Owner's Name: DELORES HAGAN Owner's Phone:
Job Address: 10682 11 Court Total Square Feet: 100
Miami Shores, FL 33138- Total Job Valuation: $ 1,500.00
Contractor(s) Phone Primary Contractor
HOME OWNER Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 2/17/2010: Yes
Comments:
L
iorez; Vi!jp_ge P. FEB 6 2010 Bj
APPROVED POINT
y DATE
i 13Y
DEPT
BLDG DEPT
a)
SUBjf'CT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY RULES nND REGULATIONS WALL COR. u i
-------------------- LOT G. 2's
OF PL
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FOUND .
BLOCK 3 13011'( FOUND
15.0'- IRON PIPE 130.00'(P)
IRON PIPE 25.0'
89 P 90
89*58'53 M 90 f
— WALL COR. 35.2'
1. CONC.
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& ON PL .'
– 10.8 ,
RESIDENCE 0
O� o LOT 22 S Iff) #10682 - ut n
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35.1y 24.9
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90'18 a!
15.0' j 419141
A - a 25.0'
FOUND 130.00'(P) FOUND 4"
IRON PIPE IRON PIPE
WALL COR. 130-37'(M)
1.8'e 1
WALL COR.
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PAGE 2 OF 2 PAGES Li. Li
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BOUNDARY SURVEY 0 .00•
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N0.2883
SURVEYORS CERTIFICATE
I HEREOYCaRmy THAT THIS BouNmRysuRvEy S UR VE U NO INC,
ISA TRUEAND CORRECT REPRESENTATION OFA
SURVEYPREPAREDUACERAWDIRECTION.
STATE ACT VALID MMOUrAN AUrHEA07r.4 rED a ECMONIC
siGmA ruREANDAUTH&MCA rED ELECTROAUC SEAL, SERVING ALL FLORIDA COUNTIES
OR RAISED EMBOSSED SEAL AND SIGNATURE.
ns sw"Way"o. 5601 CORPORATE WAY SUITE 210
lycle 0. WEST PALM BEACH, Fl. &UO7
PHONE (561) 6404=
(SIGNED) M cNeal FACSIMILE (561) 640-0678
STATEWIDE PHONE (800) 226-4807
CLYDE a MO HEAL, PROFESSIONAL SUR VEYOR AND MAPPER #2883 STATEWIDE FACSIMILE (800) 741-0578
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Lot 22, block 3, MIAMI SHORES ESTATES eccomft to the Piet thereof as recorded to Paf Book 47, Page 58, of Me Public Records of County, RwW.
Commun>7y Number 120652 Panet: 0093 SUM. J F I.R M. Dab. 32/1994 Flood Zone. AE Field Work 5130/2008
Certthed To.
DELORES HAGAN, JAMES N. BROWN, PA; AT TORNEYS' ITLE INSURANCE COMPANY; JAMES a NUTTER & COMPANY, ds sumsm mver assigns.
Pmperty Ad*m-
10682 NE 11TH COURT
MIAMI SHORES, R 33138
Survey Number. 139393
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 135577 Permit Number: *W -2 -10 -231
Scheduled Inspection Date: March 16, 2010 Permit Type: Fence/Wall
Inspector: Bruhn, Norman Inspection Type: Final
Owner: HAGAN, DELORES Work Classification: Wire Fence
Job Address: 10682 NE 11 Court
Miami Shores, FL 33138 -
Phone Number
Parcel Number 1122320280500
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Inspector Comments
Passed Z4 s eL"-
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 15, 2010 For Inspections please call: (305)762 -4949 Page 11 of 23