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EL-08-1577atlib t\yro - BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical f� Owner's Name (Fee Simple Titleholder) �� LS bid ��CL Owner's Address Qt (}T) City VI\ �,,, S�ct � State } , Zip X3 Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) City Miami Shores Village County FOLIO / PARCEL # S an cO °1 O c i 8 Is Building Historically Designated YES NO n 1 Contractor's Company Name ■\ Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Value of Work For this Permit $ oZ s6 °o Describe Work: c i10o Submittal Fee $ Permit Fee $ /0 oo' Notary $ Training /Education Fee $ Scanning $ Radon $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Bond $ Code Enforcement $ Structural Review. $ Permit No. ,1 OS" 1i11 Master Permit No. Miami -Dade Zip Phone # Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration 1New ❑ Repair /Replace ❑ Demolition xxxxxxx xxx xxxxxxxxxxxrxxxxxxxxxxxxxxxxx Fees' Qx' e' e' c' aoc' YQr' ax 'cxxxxxxx'c'axx'c'r'c'rxo°xxxx* * DPBR $ Double Fee $ —c6Oi - 935\ Phone # CCF $ CO /CC Technology Fee $ Zoning $ Total Fee Now Due $ 3"%3 See Reverse side -± 6 22 BY- 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. l 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 properly 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. • PALi is personally known to me or who has •roduced • Y t of edged befo As identification and who did take an oath. me this Signature The foregoing day of h NO (Revised 02/08/06) nstrument was a 200Y, b PUBLIC: 0 Sign: Print: My Commission Expires: xx xx Xxxx xx'x***'X Wx * APPROVED BY: Signature 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. '� co NOTARY PUBLIC: k` 1 o ti� o . G •�� o� �, 4 a' Sign: atiti� 4�� � o Go ? - Print: S ; "`•.,�4 My Commission Expires: X ,I._-, ' xxxxxxxxxxxxxxxxxxxxaY 4c rxxxxrxxxxxx xxxx xx a Yxxx kxd:ic3:icxx xxxxx *ee it aY aY 9:xx / 6'Plans Examiner Engineer Zoning Project Address 9700 NE 12 Avenue Miami Shores, FL 33138 -2544 Owner Information JEFFREY BOERNER Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $100.00 $3.00 $2.50 $111.30 Building Department Copy Parcel Number 1132050170010 Block: Lot Expiration: 02/23/2009 Applicant JEFFREY BOERNER -1 577 rideitl 9700 NE 12 Street MIAMI SHORES FL 33138 -2544 Contractor(s) HOME OWNER Phone Cell Phone Authorized Signature: Owner / Applicant / Contractor / Agent Phone Valuation: Total Sq Feet: Type of Work: ELECTRICAL Additional Info: GFI IN YARD Classification: Residential Total $ 0.00 $ 0.00 Payment Type: Amt Paid I Amt Due WOMBMWSSAVAMOMMT $ 0.00 2 PAID August 27, 2008 Date $ 1,000.00 0 Available Inspections : Cell Inspection Type: Fire Alarm Service Change Relocation Final Alteration Underground Rough Meter Box W. W. 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. Wednesday, August 27, 2008 1 NAME: VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT DATE: O ' 9 -03' ADDRESS: $ in 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 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 Myself. 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. Inactive permits for a period of over 180 days will become null and void (expired) and a new permit will be required to be issued for reinstatement of the permit. 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. By 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. 5. I understand that as an owner- builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. 7. I understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Was acknowledged before me this v2(2 Produced there License or Initial 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Initial day of S , 2000 who was personally known to me or who has identification.