262 NE 97 St (7)/ 3004
MI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
`N
Date /125
Type Insp'n 3✓'UHe'S
Permit No. ` 740
Name CV1S'fI ha N I Iey
Address Z6Z WE 91 ST
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
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BUILDING
PERMIT APPLICATION
FBC 2001
Contractor's Company Name
Contractor's Address
City
Qualifier
$ Value of Work For this Permit
(Continued on opposite side)
Building
Total Fee Now Due$ ! ( :If5
Miami Shores Village
Building Departl
10050 N.E.2nd Avenue, niami Shores, I. � -� L t l'
Tel: (305) 795.2204 Fax: ( 05) 75(
Permit Type (circle): ) Electrical Plumbing
Owner's Name (Fee Simple Titleholder) 11G1. WI% \(J \�c�j
Owner's Address ,.k` (�� t 6 { 1 �, (`(�
City ��1�Q 1 c it( j State _ T L-- Zip
Tenant/Lessee Name ) 4- Phi
.lob Address (where the work is being done) `JQ e ( ( t V J t ve-
('ity Miami Shores Village _ County Miami-Dade Zip
Is Building Historically Designated YES NO ](.
State
Phone #
Zip
State Certificate or Registration No. Certificate of Competency No.
Architect /Engineer's Name (if applicable) Phone #
Square Footage Of Work:
cilia-
Type of Work: ❑Addition ❑Alteration / ❑New ❑ epair /Replace yDen 'bon
Describe Work: S)') (� � l ��r-J ( J D / � ( 1
• * * * * * * * * * * * * * * * * * * **1. * * * * ** Fees * ** ** *** * * * * * * * * * * * * * * * ** * * * **
Permit Fee $ 422- / --" CCF $ �� CO /CC
Submittal Fee $
Notary $ 5; Training /Education Fee $ ( 10 Technology Fee $
Scanning $ j,.
Radon $ � Zoning Bond $
Code Enforcement $ / Structural Plan Review. $ /
f ■
, ry
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 AFFIDAVIT: 1 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 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.
Signatu
The fore
Owner or Agent
oing instrument was ackjowledged before me this
day of �f / , 20 �" by
who is personall nown to m
'4- rj 7
NOTARYBLI:
Sign:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * **
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
APPLICATION APPROVED BY:
chc 05/13/03
*
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or who has, produced
and who did take an oath.
uirin A Q 6B PUBLIC:
= Commission #DD323M1
� Expires: May 26, 20 n
cF COQ' s Bonded Thru
"''° c ° -ding Co
****** ar************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
SignaturX
Contractor
T e foregoing instrument was acknowledged before me this
f , 20 , by
is personally known to me or who has produced
as identification and who did take an oath.
Print:
My Commission Expires:
Plans Examiner
r
Engineer
Zoning
Proof of provided ( )
Produced
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
I Ctneotra- qcen 1C J
Located at: 6 e} � «, S iloe es ➢3"
being the legal property owner, for the property
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),And I have read and understand the following disclosure
Statement, which entitles me to. al ork 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.
initial of reviewing clerk. The foregoing instrument
Was acknowledged before me this 1 C day of l ' l-` 20 ®S
who is personally known to me or who has
as identification and who did take an oath.
N ', tart
:i;23 I984
Expnres: Ju 3 200
9 OF Fl onded r hru
antic Bonding Co F■
•
•
SHUTTER PRODUCT APPROVAL. AUTHORIZATION FORM
Date:
To:
Fuji Aluminum & Shutters Inc is the Dade County Notice of Acceptance holder for:
ACCEPTANCE NO. EXP. DATE
ASSA/RESIDENTIAL 02- 0531.08 06/24/2007
ACCORDION SHUTTER
• This letter authorizes to use the above named product at
the following job sites:
Juan Jesus So
President
Fuji Aluminum & Shutters Inc.
1.This form must accompany the application for building permits and shall become part of the permit
Documents.
2.The authorized signature must bearthe raised corporate seal of the company holding the Dade County
Notice of Acceptance.
Contractor
Local Phone:
Parcel # 1132060134000
Signed:
(INSPECTOR)
Building Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2005 -740
Printed: 5/26/2005
Applicant: CHRISTINA MCGINLEY
Owner: MCGINLEY CHRISTINA
JOB ADDRESS: 262 NE 97 ST
Contractor's Address:
Permit Status: APPROVED Permit Expiration: 11/15/2005 Construction Value: $1,895.00
Work: SHUTTERS FOR 11 WINDOWS
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 5 & W1/2 OF LOT 4 BLK 30 LOT SIZE
Fees: Description Amount
FEE2005 -6710 Building Fee $210.00
FEE2005 -6711 CCF $1.20
FEE2005 -6712 Training and Education Fee $0.40
FEE2005 -6713 Technology Fee $5.25
FEE2005 -6714 Notary Fee $5.00
FEE2005 -6715 Scanning Fee $3.00
FEE2005 - 6716 Submittal Fee ($50.00)
Total Fees: $174.85
Total Fees: $174.85
Total Receipts: $0.00
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:
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