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373 NE 92 St (13)BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Owner's Name (Fee Simple Titleholder) I'' Yl1 P4 L L Phone # o`` ?S ( 23 l Owner's Address ..°` ) ?" City p /ett-4^1 S /411/11V4 State el— Tenant/Lessee Name Phone # 3 Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO X' Contractor's Company Name OW rl" Contractor's Address City State Qualifier ngineer's Name (if applicable) PINK A e.A14,96 Phone # 3 r • S Z 8' . 3 0$ 7 4) j_/ Miami Shores Village Building Department $ Value of Work For this Permit Type of Work: ['Addition ❑Alteration Describe Work: /J W t MO M/ Total Fee Now Due $ (Continued on opposite side) 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Electrical Plumbing Mechanical Roofing ['New Permit No. Zip 3/'3 8 Phone # Square Footage Of Work: Code Enforcement $ Structural Plan Review. $ Master Permit No. ❑ Repair/Replace Vt. /9 €4 ,s 5 * * * * * * * * * * * * * * * * * * * * * * * * * ** *F * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 159004-Ps . Zip Zip ❑ Demolition gut Submittal Fee $ CO Permit Fee $ CCF $ 0/ 60 CO /CC Notary $ .'°9 Training/Education Fee $ /Pi b Technology Fee $ Scanning $ Radon $ Zoning F' Bond $ '� Bonding Company's Name (if applicable) Bonding Company's'Address City State f k 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 pennit 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 fir sp do whit occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspec ppr einspec o fee will be charged. Signature r Agent Contractor The foregoing instrument was L ackn wledged r b � foore me this 5 The foregoing instrument was acknowledged before me this day of OV 20 00k by Q ( L� l.� 1 1 1 day of , 20 by who is personall known to me or who has produced who is personally known to me or who has produced as identification and who did take an oath. NOTARY Sign: Print: My Conunission Expires: Zip As identification and who did take an oath. Mab ©1 Vaxg mis NOTARY PUBLIC: 1 Sign: Print: My Commission Expires: (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *, *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 12/15/03 NOV 1 5 1004 Plans Examiner Engineer Zoning VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMENT Located at: S NC 612-'5, t -- I VMpk W. A C r being the legal property owner, for the property Legally described as �°1 t 2t 6t 9 in Sae,S ea ,L0 P 70 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 understand the following disclosure Statement, which entitles me td cork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT 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 construction 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 525,000.00 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 ( ) initial of reviewing clerk. The foregoing instrument Was acknowledged before me this it. day ofNU'l , 202_ By Q q t @Qfl(\f I JLQJ?. who is personally known to me or who has Produced as identif on and who did take an oath. g r a, T 13, 2007 M nnrle Winding Co., Inc Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11 /30/2004 Applicant: DEBRA Owner: CAMPBELL JOB ADDRESS: 373 Contractor Local Phone: Parcel # 1132060136400 NE 92 Signed: (INSPECTOR) Building Permit Permit Number: BP2004 -1495 CAMPBELL DEBRA ST Contractor's Address: Legal Description: MIAMI SHORES SEC 1 AMD PB 10 - 70 LOTS 21 & 22 Fees: 4 FEE2004 -11756 1FEE2004 -11757 EE2004 -11758 FEE2004 -11759 FEE2004 -11760 FEE2004 -11761 FEE2004 -11762 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Scanning Fee Submittal Fee Total Fees: Amount $240.00 $0.60 $5.00 $0.20 $6.00 $15.00 ($50.00) $216.80 Total Fees: $216.80 Total Receipts: $0.00 I■3 Permit Status: APPROVED Permit Expiration: 5/14/2005 Construction Value: $500.00 ork: 5 NEW WINDOWS AND 9 NEW SHUTTERS Page 1 of 1 BLK 47 LOT SIZE DEC 0 2 PAID 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: