FW-10-750Fees Due
Amount
Pay Date
Pay Type
Amt Paid Amt Due
CCF
$1.20
Invoice #
FW - 5 - 10 - 37740
Education Surcharge
$0.40
05/12/2010
Check #: 1630
$ 206.20
$ 0.00
Permit Fee - Wire & Wood
$200.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$206.20
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795 -2204
Project Address
457 NE 95 Street
Miami Shores, FL 33138-
1132060140630
Block: Lot:
JENNIFER QUINTON
Building Department Copy
Address
Authorized Signature: Owner / Applicant / Contractor / Agent
Phone
Approved: Yes
Comments: FENCE IS 10 FEET FROM REAR PROPERTY LINE.
Date Approved: 5/4/2010 : Yes
Date Denied:
Type of Construction: Wood Fence
Classification: Residential
Additional Info: & CHAIN LINK FENCE
JENNIFER QUINTON
457 NE 95 Street
MIAMI SHORES FL 33138 -2729
Valuation:
Total Sq Feet:
$ 2,000.00
0
1
Available Inspections:
Inspection Type:
Final
Foundation
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.
May 12, 2010
Date
Cell
May 12, 2010 1
A
Scheduled Inspection Date: July 08, 2010
Inspector: Bruhn, Norman
Owner: QUINTON, JENNIFER
Job Address: 457 NE 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
July 07, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 142032 Permit Number: FW -5 -10 -750
For Inspections please call: (305)762 -4949
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number
Parcel Number 1132060140630
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 4 of 19
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 Wag `L t o -'15
PERMIT APPLICATION Master Permit No.
FBC20
Permit Type: BUILDING ROOFIN
Owner's Name (Fee Simple Titleholder) Sal fl (� I Phone #
Owner's Address 1 I O! 5 f
Cit ka l Y L5 State
Tenant/Lessee Name Phone #
Email flot (O Q . COM
Job Address (where the work is being done) 6a ,m°. as above
City Miami Shores Villa a County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO x Flood Zone I
Contractor's Company Name OW t) v�
'Contact Phone
Y-alue of O'F' F€-r s -P� nit $ 1 U U
Type of Work: ❑Addition ❑Alteration
e War
ft 5Th
Submittal Fee $ Permit Fee $
Notary $
Scanning $ 7j 'C) Radon $
Double Fee $
Structural Review. $
Miami Shores Village
Building Department
E -mail
c)oo°
Zip a 131
Phone #
?os -11-2z
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
[New ❑ Repair/Replace ❑ Demolition
Square / Linear Footage Of Work:
ciAa.. Wood h ( Y
*: a****** * * * * * * ** * *** ** * * *** ** * ** * * * * *** F e es ************** * *,* ** * * * * * * ** * * * * * * * * *** ** ****
CCF $ 1- (9O
CO /CC $
Training/Education Fee $ '40 Technology Fee $ 9d�
DPBR $
Violation date:
Total Fee Now Due $ go 90
c
Bond $
See Reverse side --3
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
conunenced 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 afier the building permit is issued. In the absence of such posted notice, the
inspection not be approved a ' % a reinspection fee will be charged.
111
Signature 41111
NOTARY PUB
APPROVED BY
The forego ing ent was acknowledged before me this
day of Ara, lc,240,by59L au,
who is personally known to me or who has produced PC-
Sign:
Print:
My Commission Expires:
(Revised 07 /10 /07)(Revised 06/10/2009)
As identification and who did take an oath. as identification and who did take an oath.
C: \��� ��f1�3 S;/ 4,,,
92
�• MOIssr"Bl /c
� . 00795 94 ;
Plans Examiner
Engineer
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _ , by
who is personally known to me or has produced
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * *fir * * * * * * * * * **
Zoning
Clerk checked
ASS:
q
t ' ' P ( '1(
5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construct()
OWNER BUILDER DISCLOSURE STATEMENT
�- ( 04114+On L t ` 56/
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
S cam. S 3' 13 ce
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 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 new form states 75,000). 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 understand that state law requires construction to be done by a licensed contractor and heve 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
2. I understand that building permits are not required to be signed by a property owner unless he or she Is ponsible for the
construction and is not hiring a licensed contractor to assume responsibility.
A AI
3. I understand that, as an owner builder, I am the responsible party of record on a permlt l understand that I m 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 law to be licensed in Florida and to list his or license numbers on
permits and contracts.
Initial Cl lr
4. I 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 building or residence must be for my use or occupancy. 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 construction Is complete, the law will presume that I built • r substantially
improved it for sale or lease, which violates the exemption.
Initial ,f
1
Initial
6. I understand that I may not hire an unlicensed rson to act as
pe 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.
7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that
erroneously implies that the property 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 property. My homeowner's insurance may not provide coverage for those injuries. I am wit Ity acting as an
owner-budder and am aware of the limits of my insurance coverage for injuries to workers on my property.
8. I understand that I may not 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 is not licensed must work under my direct supervision
and must be employed by me, whih means that I must comply with laws requiring the withholding of federal income tax and
social security contributions 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.
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable
laws and requirement that govem owner - builders as well as employers. I also understand that the
Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations.
10. I understand that I may obtain more information regarding my obligations' 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 htto://www.mvfloridalicense.comidbar/oro/cilbti :.html
11. t am aware of, and consent to; an owner- builder building permit applied -for in my name and understands that I am the party
legally and financially responsible for the proposed construction activity at the following address:
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.
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 Department 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
retumed 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 L , 20
By t ( Dui 1\ who was personally known to me or who has
Produced there License or G3' �'7) °fs► �''� t ' %, as identification.
03/06 412
: C(7 cssron # : NOTARY
-;;u)-.. D16590t, . ..`���
�� tof iFi � J',0s e
mo
N 6 ic s 1 lam( S
Initial
Initial
Initial
PROPERTY LOCATED AT: i 5-4- Ub �1�� l 16k,(58a-3 P
As legal owner of subject property, I request the cancellation of permit nurradr FW 0°1 - 761 (®
issuIN ow- Lr Vl e I ruf2t(t r corl j f
for the following reasoo ✓ Gth( rt .
Date of last inspection: I hereby apply as owner - builder, or authorize (new contractor) J-0/1,
Y1 l VEY' l (41 Li
to apply for such permits as necessary to construct or complete the construction on subject property.
I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from
any responsibility or liability for any legal action or damage, cost or expense (including attorney's fee)
resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume
responsibility for the correction, if required, of work performed under the permit for which I am requesting
cancellation.
(Owner's
State of Florida
County of Dade:
nature)
QuIttii-kw)
Miami sti
Reif Deprememe
10050 NE 2nd Ave
Miami Shores, Fl 33138
Phone 305-795-2204; Fax 305-756-8972
www.miamishoresvillage.com
HOLD HARMLESS
DATE:
(Print Name) (Print Name)
(Prime Contractor -Only if subcontractor
holds permit or if change of qualifier)
The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the above
property.
Sworn to and subscribed before me this day of
Notary Public, Sate of Florida at Large
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756-8972
Owner's Name: JENNIFER QUINTON
Job Address: 457 95 Street
Miami Shores, FL 33138-
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 5/4/2010 : Yes
Comments: FENCE IS 10 FEET FROM REAR PROPERTY LINE.
Issue Date: Not Issued
THERE IS SUFFICIENT ROOM BETWEEN FENCE AND REAR PROPERTY LINE FOR TRASH AREA.
Folio Number:1132060140630
Owner's Phone:
Total Square Feet:
Total Job Valuation:
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
1
0
$ 2,000.00
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