PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
--`1 ? Job Address 1 CA t.- q ( )
Date .
_` r L � Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 1; , t i (in ? e Z - C.4 -i _i: aster Permit # .6-
d
Owner's Address Phone .-- `' ` ' 7/
Contracting Co. l kO fl (" Address
Qualifier SS# P:aone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION X
Square Ft. Estimated Cost (value).4,jz
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder
My Commission Expires: My Commission Expires:
FEES: PERMIT L'
APPROVED:
Zoning
Mechanical Plumbing
RADON
B
C.0
Electrical
Signature of Contractor or Owner Builder
Date
Date
NOTARY 5, BOND
TOTAL DUE
—Engineering
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or ctltes structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
n'ans and specifications must be kept at building during progress of the work.
Street and Number where work is to be done
Date 3- ' � � ���_ , 19
Owner's Name and Address ._...__..' No Street
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision , --
State work to be done and purpose of building (by floors)
,,,,_
, - -- and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof vering
Estimated Total cost of improvements $ V 0 Amount of Permit $
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent SuPplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on fhe site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. l� �.� /
Remarks (Signed). X -- � -L a 1 ' . _.�__,;..;
STATE OF FLORIDA, ss.
COUNTY OF DADE. f
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true. _
Permit NG.___ ---- I_I_ _ Date d ' Read, Sworn to and Subscribed before me.
■
Disapproved Date.`
-�'------ Notary Public, State of Florida
( Signed)
Buildilij/Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Date - % / Address 1 v V . ", eel() 1 Tax Folio // 320, /y JS
Legal Description/7'
escription/ 7 gy .1,, /g
Contracting Co. ; °��'�� - - ess
Qualifier SS# - - Phone N,
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Owner Lessee / Tenant _ - - E.CkQ.) C-8. Master Permit #3
Owner's Address ca :.,. --�_- Phone l f'(
APPROVED:
Zonin
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
•
WORK DESCRIPTION 7 \'
\/i L) JS4,
Square Ft. Estimated Cost(value) ?a C. C.,
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
Mechanical
Signatur Contractor or Owner- Builder
Date:
My Commission
** * * * * * * * * * * * * * * * **
FEES: PERMIT 57/ ' RADON C.C.F. f lJ' O NOTARY S ' ®O' TOTAL DUE q '
Fire Other
Buildins Electrical
Engineering
Plumbing
Per 489.103(7) F.S.S.
DISCLOSURE STATEMENT
State law requires constriction 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 outbuilding. You may also build or improve a commercial
building at a cost of $25,000 or less. The building must be for
your own use and occuipancy. It may not be built for sale or
lease. If you sell or lease more than one building you have
built yourself within one (1) year after the construction is
complete, 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. Your construction must
be done according to building codes and zoning regulations. It
is your responsibility to make sure that people employed by you
have license required by state law and by county or municipal
licensing ordinances.
;D__) / T S
Date/ Owner's Owner's signature
Village Use Only
Owner's name(print)_ _ E u e_
Permit No.
ENS)
MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT
You have, this date, made application for a building permit as an owner -
builder. You should be advised of the following provisions and reauirements
that apply to owner- builder.
Proof of Ownership - Prior to a building permit being issued to you,
you must submit proof of ownership of the land concerned in the
application in the form of a recorded deed, showing you own the oroperty,
or a copy of mortgage or warranty deed of the land, or a Dade County tax
receipt, statement to contain legal description of property and indicate
property is in your name. Legal description and name on document of proof
must correspond to the name and legal description on the application.
Responsibility - You will be responsible for all work done by your day
labor employees, and you must either employ licensed contractors or
persons to be paid on an hourly or per diem basis. Any one contracting
(including labor) with you, verbally or in writing, on a fixed fee basis
for any work, who is not properly licensed, will be subject to a fine of
$500.00 and /or imprisonment for six months.
Insurance - You should be advised that if your day labor employees cause
any damage to persons or property, or if any of your day labor employees
are injured on the job, you are liable. Your regular home insurance
policy ordinarily does not cover this type of liability.
Withholding Taxes, etc. - You should be advised to investigate your
responsibility for withholding Social Security, Federal and State
Unemployment Insurance Taxes and Federal Income Taxes from the wages
of employees working for you on the proposed construction, and for
making returns thereof to the proper agencies.
Work Permitted Owner - Builder - An owner- builder subject to the foregoing
provisions and requirements, is limited to constructing one single family
residence each year for his own use and occupancy; or maintaining, altering
or repairing his own single family residence.
If you do not intend to do the work involved yourself, or with day labor, please
list below, the name of the individual or firm with whom you have entered (or
will enter) into a contract for the work.
NOTICE: SEPARATE PERMITS REQUIRED FOR ELECTRICAL, PLUMBING,
ROOFING AND MECHANICAL WORK
Name of Individual or Firm Address
I, the owner of property described as
INSTRUCTIONS TO OWNER- BUILDER
do hereby certified
that I have read the foregoing instructions, and am aware of my responsibilities
and liabilities under my application for a building permit for construction work
on the above described property.
'? ar
X24
Wi ness
c7;
Owner
Date