BP-05-1418Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
BUILDING
PERMIT APPLICATIO
FBC 2001
Te _7 42,204.Fax: (305) 756.8972
SE
Permit N� � 14-18
Master Permit No.
Permit Type (circle): Building Elec al Plumbing Mechanical Roofing
�
Owner's Name (Fee Simple Titleholder) /) /�t'e r � ',77O s Phone # ( :j05) (5- '/53 }
Owner's Address 4/ 5 /(l " E : �7 • 2
City p('( s)-) 0 /1 P F State �1 - Zip 3 3 /3�
Tenant/Lessee Name 1,/9 . Phone # )(///4
Job Address (where the work is being done) / 3C x/' E - , 4' . •
City Miami Shores Village County Miami -Dade Zip 33 /3S
Is Building Historically Designated YES NO g
Contractor's Company Name Phone #
Contractor's Address
City State
Qualifier
Zip
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit Z, 2 0 F 0 Square Footage Of Work:
Type of Work: DAddition DAlteration ❑New ❑ Repair/Replace
❑ Demolition
Describe Work:
'I-eke/1 4 A/ ri f f2 eg o cT! fr 4?)
* * *** * * * * * * * ** * * * * ** * ** * * * ** Fees ** * * ** * * * * * * * * *** ** * * * * ** * ****
Submittal Fee $ Permit Fee $ 6 0 CCF $ 1 - 80 CO /CC.
Notary $Z Training/Education Fee $ 0 • (,C7 Technology Fee $ Z
Scanning $3 . OD Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
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 AI+N'IDAVIT: 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 certed 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 e will be charged
Signature
Signature
Owner or Agent Contractor
The ing instrument was acknRwledged before me this The foregoing instrument was acknowledged before me this
days y t� , 2(C 4 by c-
Y1(f 20
who is personally own to me or who has produced 1 ( who is personally known to me or who has produced
As identification and who °idjake an oath. as identification and who did take an oath.
NOTARY P
Sign:
Print:
My Comm
* * * * * * * **
C0 �6
, • a Sign:
•
Via:, 4l�S l Print:
mo;'40 My Commission Expires:
*** * ** * * ** * *, * *, * *` ' ® *7, * * *, ** . ** * * * ** * *, *, * ** * * * * * * * * * * ** * * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc 05/13/03
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **s * * ** *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
d /e DJ
Plans Examiner
Engineer
Zoning
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE .STATEMENT
/gee - i9/J/ 7S being the legal property owner, for the property
Located at:
Legally described as
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),.nd I have read and understand the following disclosure
Statement, which entitles me td akrork as my own contractor, I further understand that 1 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 bind 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 male sure
that people employed by you have Licenses required by state law and by county or municipal Iicensing
ordinances. Any person working on your building who is not Iicensed 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 2-8 day of`_' 20
fYY�C , who is personally known to me or who has
Produced
• as identific and who did take an oath.
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Owner
Owner
Notary
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