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29 NE 96 St (5)Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date `7 `0z Time Type Insp'n yy�� d / v / y Permit No. l/ ? . 2 0 2 — ? Name I `1ig Address 2 9 Ng 05','" 0244;:a �� Company L G�'�!/ �/4 `�/ a L Phone # 7 ? ! / 61 s' For Inspector: 7_ 8 Name & Date Re- Insp'n Fee ❑ Date Type Insp'n Permit No. Name Address- Company MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Phone" / (3 o) ;9 For Inspector/ /// . i / 0).—J Approved 111 Correction Re-Insp'n Fee ❑ 0 Time Name & Date (i BUILDL PERMIT AJPLICATION FBC 2001 Owner's Address 2( Ae 6- 9 6" S Z'& E r City /NOV ,S' (-1 State r`Z.— Tenant/Lessee Name Job Address (where the work is being done) City Miami Shores Village County Miami -Dade is Building Historically Designated YES Contractor's Company Name Contractor's Addr.. '-- —C— _ State Certificate or Registration NoCf► e- /SC 7- 00 0 Architect/Engineer's Name (if applicable) r/ /At Ste/ 7»- Notary $ Scanning $ Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) Miami Shores Village Building Department •!fit 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 8 ?0 - 611Iff NO Training/Education Fee $ Radon $ Master Permit No. 0 2 4 s r AE - 7 Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * ** * * * * * * ** Submittal Fee $ .00 Permit Fee $ / i l O CCF $ r of Technology Fee $ Zoning Bond $ . • CO /CC 3, 73 $ too c cJC Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) / (4H *L4 /KE- d ffm-w L..to Phone # 305 Z g 2 2- ! ? 3 Zip 3 3/3e Phone # 33i 3�' 50,y6-3-2,5 36, ,s Phone # 30' $ 30 g £ 3 zg City State / _... Zip 3 3 / 3 � Qualifier . R ®A-t/'NE L-L- 0 Phone #ya 9' $ Value of Work For this Permit 4 d OO Square Footage Of Work: 300 St. Type of Work: EAddition ['Alteration ❑New ❑ Repair/Replace El Demolition Describe Work: IJ° C b P ! E C K tfe v , " S Structural Plan Review. $ C A . (-"C) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip r" Mortgage Lendelame (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: 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 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. Signatt rrf C � Owner or gent The y fore oing i,nstrument asy 12 acknowledged before e�V day of Y 0 20 by V 1 who is personally known to me or who has produced As identification and who did take an oath. t ss NOTARY PUBLIC: NOTAR Sign: Print: My Commission Ex-pi * * * * ** * * * * * * * * * * * * ** APPLICATION APPROVED 13Y: Chc 05/13/03 Signature Contractor The foregoing instrument was acknowledged before me this yof , 20 _ ,by who is personally known to me or who has produced as identification and who did take an oath. Sign: Print: My Commission Expires: , p c.,1�Qs , O oa� / � uc': -2:Gs,- •a .o_ .,n\ * * * ** * ** mks' c************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APR 12 2 Plans Examiner Engineer Zoning STA'1 OF FLORIDA COUNTY OF MIAMI -DADE SURVEY AFFIDAVIT BEFORE ME, the undersigned authority, personally appeared MADELEINE ROMANELLO, who, after being first duly sworn, deposes and says as follows: 1. This Affidavit is based upon Affiant's personal knowledge. 2. Affiant is the owner of the following described real property located Miami -Dade County, Florida: Lots 15 and 16, in Block 6, of MIAMI SHORES SECTION ONE, according to the Plat thereof, as recorded in Plat Book 10, at Page 70, of the Public Records of Miami -Dade County, Florida. (hereinafter referred to as the "Property "). 2. That the street address of the Property is 29 NE 96 Street, Miami, Florida 33138. 3. Attached hereto is a true and correct copy of a survey of the Property prepared by Miguel Espinosa, Land Surveying, Inc. Registered Land Surveyor No.6463, under Survey No.M20700, dated January 22, 2004 (the "Survey "). 4. The Affiant has reviewed a copy of the Survey and has confirmed that the Survey shows all buildings and structures currently located on the Property, together with any and all other improvements currently located on the Property, whether belonging to the Affiant or to any adjoining property owner. 5. Since the date of the Survey, there have been no additions, modifications or alterations to the improvements depicted on the Survey, nor has there been any change in the location of any improvements depicted on the Survey. 6. Since the date of the Survey, no additional improvements of any kind, including fences, boundary walls or additional structures have been erected on the Property, nor have any fences or boundary walls been erected on any contiguous property which may encroach upon the Property. 7. Affiant has not created any easements of any nature affecting the Property. 8. No street adjacent to the Property has been closed or vacated. 9. Affiant has no knowledge of any claim made by anyone to the ownership or use of the Property whether with or without the permission of the Affiant nor has there arisen any dispute over the legal right of access to and from the Property or other location of any boundary or to any claim that any improvement actually exists within an easement or upon adjoining land, or that an improvement owned by a neighbor actually exists within the Property. CATLIN SAXON EVANS FINK NOLSNI & ROMANEZ, P.A. 2600 DOUGLAS ROAD, SUITE 1109, CORAL GABLES, FLORIDA 33134.0143 • (305) 371.9575 ♦; 4 • 10. This Affidavit is given to induce COUNTRYWIDE HOME LOANS, INC. to exteno mortgage loan secured by a mortgage encumbering the Property, and to induce CATLIN SAXON EVANS FINK KOLSKI & ROMANEZ, P.A. and ATTORNEY'S TITLE INSURANCE FUND, INC. to issue a mortgagee title insurance policy insuring the mortgage to be held by COUNTRYWIDE HOME LOANS, INC. 11. Affiant is familiar with the nature of an oath and with the penalties prescribed by laws of the State of Florida for falsely swearing to an instrument of this nature. Affiant has read this Affidavit or has heard this Affidavit read to Affiant and fully understands its contents. FURTHER AFFIANT SAYETH NOT. SWO TO and sub c ribed before me this day of January, 2005, by. She produced EL k -e r . /..r as identification and did take an oath. ENGA PAUL( MY COMMISSION M DD 294222 EXPIRES: April 18, 2008 4,Rr„hs; Boded fins Notary PuWk Underwrit er+ MADELEINE ROMANELLO Notary Pu FA/Lja , State of Flori a Y � My Commission Expires: 2 CATLIN SAXON EVANS FINK KOLSKI & ROMANEZ, P.A. 2600 DOUGLAS ROAD, SUITE 1109. CORAL GABLES, FLORIDA 33134.6143 • (3051371.9575 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 4/19/2005 Applicant: MADELEINE Owner: ROMANELLO JOB ADDRESS: 29 Contractor Local Phone: Parcel # 1132060130830 NE 96 Building Permit Permit Number: BP2005 -511 ROMANELLO MADELEINE ST Contractor's Address: Fees: Description Amount FEE2005 -5011 Building Fee $150.00 FEE2005 -5012 CCF $0.60 FEE2005 -5013 Notary Fee $5.00 FEE2005 -5014 Technology Fee $3.75 FEE2005 -5015 Training and Education Fee $0.20 FEE2005 -5016 Scanning Fee $6.00 FEE2005 -5017 Submittal Fee ($100.00) Total Fees: $65.55 Total Fees: $65.55 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 10/9/2005 Construction Value: Work: WOOD DECK Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 15 & 16 BLK 6 LOT SIZE 100.000 APR 1 PAID Signed: (INSPECTOR) 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: MIAMI 1, VIA % MI VILLAGE' BUILDING DEPARTMENT 305- 795 -2204 Budding Inspection Request Date Type Q^ n e Ins � \ c) C, YP Pn D ' Permit No. $F D - 511 Name 2 -Onn CQ li Address cP1 NE E q 6 Company Phone # Inspection Date Correction Re- Insp'n Fee )cf eeer— / r /9 4 BUILDING DEPARTMENT 305- 795 -2204 Building Insp ction Request /0 0 Type Insp'n Permit No. P 6 5 '" S^ / Name /? v e i e (I o Address >� ? //r S l Company S y lo if L., 4. Phone # Inspection Date g ° /0- O Date Correction 3Z619 4/ MIAMI SHORES VILLAGE Re- Insp'n Fee ❑ G cm) MCC riase-F4t i / ZSs).: ct. Z"siopz :-..,43 = t i - I 5,50)14 1 .4 aots- z . 0.50 1(...r-4.. I.,- 0,17 rc Zoc!atieN ei*I'l t G . 1-410 6-• t KY )4, I it al+ i5 g0C) if e. riazi 1•42 . t t , 0 'Srlik.11.14 V2E. fz? r re 4 , 9.. 0 V.. " t 10.25 - Ev 7 —We° cz, -- cc; 6 cz,F=3Di.:4 ti4-1 GRE/ 4 66;- 1 ° ° ....:- .v3 ..........L...., arAL to. zs Z 0 4 2 1 7 STATE OF FLORIDA) SS COUNTY OF DADS A F F I D A V I T Robert Hepburn of the Village of Miami Shores, County of Dade and State of Florida, being duly sworn, doth d€pose and say, that under the provisions of. Ordinance iTc. 185, dated June 15, 1948, auend- ing paragraph (d) of Section B--36E of Ordinance No. 97 of the Building Code of Miami Shores Village, he desires to build a single family residence on Lot 15AJ6 _Mock 6 of Miami Shores Sect. 1 Subc'.iv: sion, that he is the owner of said property, and will be the owner of sric. _ residepge , that he will do the work personally, and that he mill, at such times as are required by the Zoning and 1ilciing Director:- 1. File plans and specifications and obtain approval of the Planning Board and the Building Inspector. 2. Apply for and secure a Permit. 3. Pay the required fees. 4. Execute the work in accordance with the provisions of this Code. 5. Apply for inspections. 6. File with the Building Inspector certificates that provision has been made to carry the necessary Workmen's Compensation, Public Liability and Property Damage Insurance. 7. File with the Building Inspector as the job progresses certi- ficates showing the payment required by the Federal Social Security Act to the State of Florida or the United States of America. 9. Not set himself up as a "contractor ". And Further this Deponent says not: 8. Assume the responsibility of not employing other than properly licensed contractors by Miami Shores Village for any part or portion of the work. 10. Sign an affidavit before commencing work to the effect that he has read this Article and will do the work personally and observe all of the requirements of the Building, Electrical, Plumbing and Zoning Codes of Miami Shores Village. Such affidavit to be properly notarized upon blanks to be supplied by the Building Inspector. 11. In order to prevent abuses and subterfuge the right of such owner- builder as herein provided, is limited to but one owner- builder permit each 2 years, and where an owner - builder has once exercised the privilege herein conferred no second application for owner - builder permit shall be granted in less than 2 years, unless the applicant is qualified as a licensed General Contractor under the applicable Ordinances of said Village. NOTARY PUBLIC SUBSCZIBED AND SWORN TO B2FORE ME this day of A. D . , 19 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 other 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 plans and specifications must be kept at building during progress of the work. I Owner's Name and Address_________________ ____________ ___________________ No Street Registered Architect and /or Engineer Name and address of licensed contractor__ and legal description of lot to be built on: Lot Block Subdivision _______ __ N , 4 ,,.,_ – --- -- � – --------------------------------------- purpose (by floors) �� - .� ,, , 0 w Street and Number where work is to be. done State work to be done and u ose of building uildin g( b _ Date , 19 and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $ Zone cubage required y_ _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 the 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. Remarks ( Signed )_ OF FLORIDA, COUNTY OF DADE. j ss. 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 No Date Read, Sworn to and Subscribed before me. Disapproved -A 4- Date r t Notary Public, State of Florida ( Signed) k Building 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 Planing Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. N° SO Miami Shores Village, Fla , • °' ,' !'! Owner, Agent or Tenant of Building !' ' f ' ' ✓ 4..4..., r Lot //"./ Mw -' Block o Subdivisio r f �- Street Address s Approved use by occupancy .. -- / Remarks • 1, This Certificate of Occupancy is issued to the above named . r, ... 4_i- I Lam• for building at above named location only upon thqtkpress provision that the applicant will abide by and comply with all conditions of Ordina es Nis. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordina ces o ' Miami Shores Village pertaining to the erection, construction, alteration or re ► o b l e l 4 4 4 g . . , f ildin s, or rpntnr Jii - . . , A BUILDING. DIVISION f CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION i Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other 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 plans and specifications must be kept at building during progress of the work. Owner's Name and Address... APPLICATION FOR BUILDING PERMIT Date / _ / t2�t ffv� No street./Y. f 6-4-V/ / Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block G Subdivision. ,Street and Number where work is to be done -...Z . r Statg work to be done and purpose of buildiii � _ P rP �Y fl�oois �._ Rirdr X 74.1 O 2 •' I Al; ✓S i_ New Building Remodeling. Addition Repairs G' No. of Stories To be constructed of Kind of foundatio Roof Covering O Estimated Total cost of improvements C d \ 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 ins ection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such s . 1't actors, on wo fo be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed STATE OF FLORIDA, COUNTY OF DADE. ss • Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 No d-,/et Date / Z — Disapproved _ �✓ Date ( Signed) Building Ins. or MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT PLANNING BOARD Member Member Member Date Disapproved Chairman Member . -. Member Council Approved NOTE: A charge of $1.00 will be made for making corrections the Planning Board. A re- inspection fee of $1.00 will be charged materials and /or workmanship. and for no other purpose. to me well known, Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires DATE or changes to this application after approval Date has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty PAID BY �it1 pp .00. �... 12 -16 -�9 YEAR ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID RECEIPT NUMBER Hephrrn, Robert (o) /'r PPd ! - $12.00 /v'- 1/49 • S °51 /-v----a-5 /.37 9 " /156 '/ /a -3/- /a. oo /, -,a -yy /gyro i9 1 „ la•31 $i 0 / -.90-3/ i - - 3 1 ---5-- /683 o 4 A . -1 • � . -' i / 95 / a °© J Z •3/• 62 A� V ADDRESS ?9 N. E. 96th St_ LEGALLOtS 15- 16,B1k.6, MSS #1 RECORD GARBAGE TAX CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION N? 870 Miami Shores Village, Florida, 12 -3n -51 Owner, Agent or Tenant of Building a ELYi? li,�LRRS3 Lot 15 -15 Block 6 Subdivision : iiar,i Vn_ore s Street Address 29 ' 4 ' • °4t'' St. Approved use by occupancy PD:ICII ADDITION Remarks • This Certificate of Occupancy is issued to the above named n:.1 for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildi.gs or structures Plan C u'be 1487.52 Tc:r. jcluc 74A BUILDING D ' - ON K OWNER•S NAME t e, e4- 1, 5 PRESENT ADDRESS 2 9 . ✓c• ,G c.c`. LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) zy d.0 >'G"- s°6 S LOT /4 -i4 BLOCK G SUBDIVISION r9. ,,: .S GENERAL CONTRACTOR Pe 1 /3,G ADDRESS /o.‘," ,/&. /i2 T PHONE NO. LICENSE NO. ZfrS BUILDING PERMIT NO. 74,4-- � DATE 'Z." PERMIT FEE $ b s o . BUILDER'S BOND NO. DATE 1400, 7, e...) ZONE REQUIREMENTS CU. FT. PLAN CUBE 1 1 7. S'z CU. FT. MD EST. COST $ 7 a r ✓004. u a.- 37 DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY:C. oe siwfcie s=c_... DATE' 8 ZO ry NEW CONSTRUCTION TYPE sc..e daJ STORIES 0I/e6. ROOF CONSTRUCTION 4?v i 4.y 4/. INTERIOR CONSTRUCTION � - .r l c hi REPAIRS 0 4,.e. //��� ��++ DESCRIPTION �T/a /7ie 4-O CG40F"S, DESCRIPTION ALTERATION �6 -T,,L, iFc. ADDITION 3 ` /f s S y n �i, € / f � - SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RESUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO. 0 / I ISSUED BY TO BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE INSPECTIONS DATE BY INSPECTIONS DATE BY FTJUNDATION SOLAR HEATER ROOF GAS 4EAMS & LINTELS 5 POOL 5 FRAMING INSPECTIONS DATE BY AIR COND. BY RE - INSPECT FINAL ROUGHING CLEAN UP SLAB TUB & TOP OUT SLAB FIXTURES & FINAL SEWER SEPTIC TANK I 1 $ BY SEWER $ RE - INSPECT BY SOLAR HEATER $ GAS 5 5 INSPECTIONS DATE BY RE - INSPECT BY RE - INSPECT BY ROUGHING TUB & TOP OUT FIXTURES & FINAL SEWER SEPTIC TANK SOLAR HEATER FIXTURES GAS ELECTRICAL PERMITS & INSPECTIONS CONTRACTOR PHONE PERMIT NO. I DATE FEE $ NEW BLDG. 1 ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. 5 MOTORS $ FIXTURES $ S INSPECTIONS DATE BY RE- INSPECT - BY RE - INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL CONTRACTOR PLUMBING PERMITS & INSPECTIONS PERMIT NO. 1 DATE BUILDING INSPECTIONS NEW BLDG. I ALTERATION I ADDITION SPECIALS PERMITS PERMIT NO. DATE TEMPORARY SERVICE APPROVAL TO POWER CO. FOR SERVICE DATE PHONE FEE $ REPAI RS BY FEE ,LarL ifC MIAMI SHORES VILLAGE 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 other 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 plans and specifications must be kept at building during progress of the work. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor.. State work to be done and rpose of building (by Location and legal description of lot to be built o Lot fir d- - / Block C/ Subdivision. Street and Number where work is to be done and for no other purpose. New Building Remodeling. Addition._ Repairs No. of Stories 1 To be constructed of KindOeundation._____ iaxe_� . Roof Covering... ( Estimated Total cost of improvements $ e r-a 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 pennit 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 the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such Alba) actors, o performed under this permit, as are licensed by Miami Shores Village. v , Remarks (Signed). STATE OF FLORIDA, COUNTY OF DADE. ss. Building Inspector Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 No Date Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Chairman Member Member Council Approved Date NOTE: A charge of $1.00 will be made for the Planning Board. A re- inspection fee of $1.00 will be charged materials and /or workmanship. BUILDING INSPECTION DEPARTMENT Date 6(4 rte---- / 1 ; to me well known, Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Member Member Member Disapproved Date making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty FZ.42--) 74 - v- 2 1' i s z 8J' I. 2 " ® a Li; Zjr- KIND OF INSURANCE LIMITS POLICY NO: EXPIRATION Workmen's Compensation Statutory W114691 8 -24 -50 Public Liability 10/20,000. 1 /10,000. CMP62294 8 -24 -50 Name of Au NORWICH UNION INDEMNITY COMPANY This is to certify that the following described policy or policies covering as stated have been issued by the NORWICH UNION INDEMNITY COMPANY, and are in force at this date. OPERATIONS COVERED No. 373D 76 MAIDEN LANE, NEW YORK 7, N. Y. CERTIFICATE OF INSURANCE THIS IS NOT A POLICY MISC. • : ; R1 Address of Ass» 197 N - E • 89th St - - Miami . Florid Location covered 197 N • E. 89th St., Miami, Florida and elsewhere in the StatA of Florida. General Contracting All subject however, to the Terms, Conditions and Agreements of the Policy or Policies. In the event KagfaiiiiNDIKEBMKOOfiCiik cancellation of the policy or policies, the NORWICH UNION INDEMNITY COMPANY will MINIM notify the party to whom this certificate is issuedatafila ?.s a , ■ 4 :• , la•]'i•4 4' j �''f.1,.►I: V:Ph• I 1034'4 0 Y0'1 t 1:11,`I•if•!IR,?0!"1 1 1r .)•. i XIDENKEKNKNKX by a ten day written notice by Registered Mail prior to such cancellation. Dated this 6th day of October 19 THIS CERTIFICATE ISSUED TO Miami Shores Village Bldg. Dept (NAME) Miami ShorAg, Florida (ADDRESS) NORWICH UNION INDEMNITY CO. b`��ISR INS CE AGENCY, INC. b y W LP. AUTHORIZED REPRESENTATIVE. OWNER'S NAME HEPBURN, ROBERT PRESENT ADDRESS _ IF LICENSE NO. 197 N. E. 89th Street PHONE NO. JOB LOCATION (ST. OR AVE.) 29 N. E. 96th Street LOT 15 & i6 BLOCK 6 SUBDIVISION Miami Shores Sect. #1 GENERAL CONTRACTOR Owner ADDRESS 197 N. E. 89th Street PHONE NO. LICENSE NO. 3380 0 -B QQ BUILDING PERMIT NO. 83 1` 1 DATE 10 1 PERMIT FEE $ 19 p BUILDER'S BOND NO. 890 DATE 10/8/49 ZONE REQUIREMENTS 20.000 CU. FT. PLAN CUBE 20,426 CU. FT. EST. COST $ 15,000.00 DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: Mli DATE 10/8/49 X NEW CONSTRUCTION TYPE CBS STORIES 1 ROOF CONSTRUCTION Tile INTERIOR CONSTRUCTION Asphalt Tile Floors - Plaster 1 REPAIRS DESCR IPTION Liv Rm - Din Rm - Kit - Service Rin - Jal. Porch - 3 Bed Rms - 2 Baths ALTERATION DESCRIPTION Car Porte ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS p CERTIFICATE OF OCCUPANCY NO. 80 0 I ISSUED 1 BY JI H I TO Robt. Hepburn, 29 NE 96th St. BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE la INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION 10/13/49 ne TEMPORARY SE.RVICE $ 100 lit MPORARY W. HEATER CONN. S BEAMS & LINTELS l� 1 J 9 10 28 S 1.00 SEWER S S FRAMING 11/ /45 -a JL41 $ GAS $ $ INSPECTIONS S INSPECTIONS DATE ' WI NAL 12/ 15/49 JDH BY RE- INSPECT BY ROUGHING CLEAN -UP J DR 0 1- • dDH ROUGHING 11/18/49 CONTRACTOR Rose Plumbi • L C'As , ' & . PHONE PERMIT NO. 8 DATE 10 1 FEE S7• NEW BLDG. X ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SE.RVICE $ 100 lit MPORARY W. HEATER CONN. S SEPTIC TANK p L 8 6 10 28 S 1.00 SEWER S S SOLAR HEATER S FIXTURES $ GAS $ $ INSPECTIONS S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING 1 0 1 J DR 0 1- • dDH ROUGHING 11/18/49 GAS - H. W. HEATER CONN SEWER -_ RANGE CONN. SEPTIC TANK 10 1 .TDFI SOLAR HEATER FIXTURES & FINAL 12/8/49 FIXTURES mg= PERMIT NO. 849 DATE 11/15/49 FEE $ 11.50 NEW BLDG. X I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE SERVICE 8415 10/28/9 $ 100 lit MPORARY W. HEATER CONN. S RANGE CONN. S MOTORS S FIXTURES $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY P TEMP. SERVICE 10/28/!9 ME ROUGHING 11/18/49 JDH H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL 12/8/49 T�v JDH BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS CONTRACTOR Hurst Electric Co. PHONE APPROVAL TO POWER CO. FOR SERVICE DATE 12/15/49 BY JDH 1 PEEING 8 ertaining Architect Builder •'�" Legal lot t II Bh Descsiption ;. Address of Building Thie paw to the con fa a ordinances pertaining thereto and with the unde herefor drawings, Or that may have been submitted d approv time if time is ce with such ordinances or if e Plans are an t ibat e r Subdi- vision Value of it; *4 Project $ 1 e assumes • r awings Amt. of Permit $ granisd is us p to the done by Ws age Work BUILDER MIAMI SHORES VILLAGE, FLOM PERMIT T° 9979 ed under this Perini buitdertamed above to cea► tractor or builder named ab Nether shown on the plans o ce to me of this perms a to pe rm the work covered hereunder in compliance w yi ordinances d regulations nformity pith the plans, drawl i ° ., , . is or specifications submitted to the proper authorities of Miami shores Village. responstility for all w done by either, myself, my agent, servant or employee. DA Contractor's License No. nstruct the building or to install the a uipment or device described in the nding that the work will be performed in compliance with any p e proper municipal authorities. This Permit may he revol at any without authorization. A further condition u•on which this permit is sibility for a thorough knowled and at -yen ECT OR BY AUTHORITY Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA BUILDING [A ELECTRICAL o PERMIT N° PLUMBING ROOFING ❑ Bi. 7 6 ,. ,,,,,,..,.. Work to be performed under this Permit Subdi- vision DAWE ' Contractor's License No Sq. Ft Value of Project $ Amt. of Permit $ J iff This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed • - BY INSPECTOR 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 cogfor with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this' relit I assurge,Api 901,14-tfor all work done by either, myself, my agent, servant or employee. r f • BY AUTHORITY Application is hereby r cie for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This applicatioVs 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 ordinarAes if 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 ■kepy of approved plans and specifications must be kept at building during progress of the work. Location and legal description of lot to be built on: v�,� /� /fit j / Lot L6 Block 4J Subdivision Wile,/ w bdivision J e, / %V il' ) / / 5oG t � QO /1 d ��/o f 9 Street and Number where work is to be done 1 , E. q 6 S+ t M (G' w` ( S kO s-4.1 t f l t u &o. 3 3 1 3 CAS 4.. work to be done and purpose of building (by floors), state exterior colors (submit samples) A. C. a. R p " ' ' `' 4....$- � s - k - . �q P 4 r CA. , V and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ $ 3, ..S O Amount of Permit $ 56 `lO Mo Zone cubage required Plan Cubage \- �/� V tt , / Distance to next nearest building Size of Building Lot ' 1 1 d Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to tr Owner's Name and Address ( ( c. O. h et C. l S No. . 9 � c'^ Street 9 ( S Registered Architect and /or Engineer 9 0 ,a M.cLr Name and address of licensed contractor The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 the 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. Remarks (Signed) �µ'� ' ' (z. STATE OF FLORIDA COUNTY OF DADE. Permit No. Disapproved (Signed) J ss MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Before me, the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgments, personally appeared 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. Date Date Read, Sworn to and Subscribed before me. Date V 1 .1 19 V Notary Public, State of Florida to me well known. Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved ate Disapproved Date NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. Building Inspection Req est tJ' Date R't°' 10 Type Insp'n Q / C Permit No. !1♦ Pal ( 4 Name • Address P C I N ( aE 34 Company Phone # Insnection Date 3LIC)1 MIAMI SHOR1S VILLAGE `b6' BUILDING DEPAaTMENT '" c 305- 795 -2204 '' 0 e- orna►nd/l Re -In r e ❑ c Le) d xu$ o f 1 �-1-r MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Z' I D ro) 1 t'e s Permit No. M C Name eon9CId Address a-1 1\1E_ E q 6 Type Insp'n Correction Re- Insp'n Fee Company Phone # c�' Inspection Date C� 0�' Dat Type Insp'n Permit No. Name Approved Correction Re- Insp'n Fee Comp Phone # Inspection Date MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Address C I /11 0 OF I MIAMI SHORES VILLAGE BUILDIlWC 305`- 795 -2204 Building Inspection Request DateV� J ) ) O x " � Type lnsp' n � R i� � � s •P it,: A Permit N. Pj —� - !1 ,1 Name / r Address Inspection Date ` 7 Approved Correction Re- Insp'n Fee ��. c-k , 71 Company ---) } (RA M A .� Phone # 0 k( 91_ 1 4 MIAMI SHORES VILLAGE BUILDINQ. DEPARTMENT 305- 795 -2204 Building Inspection Request Date S ) 2 Type Insp'n r) Permit No. P ' �4 37 Name f2orrri\len Address a N 9C9 34 Company 2.0 YOntIr it Phone # Inspection Date el "7 Approved ❑ Correction ) 1(.% Re- Insp'n Fee ❑ �� Heck MIAMI SHORES VILLAGE BUILDING- pER4RTMENT 305 -795 -2204 Building Inspection Request Date PI Type Insp'n V . �' ' In Name Phone # Permit No. f3P (14 5 7 s ec) Address aq MP. c i(e) 54 Company 0 Irb o u Inspection Date RI • V. i Approved ❑ Correction Re- Insp'n Fee MIAMI SHORES VILLAGE 5001 ( BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date - 1'D-1( 0 1 Type Insp'n Permit No. er o' - 3 Name 1\.0a Address g e 9 e.t G Company �1 Phone # Inspection Date l )_ b 1 Approved Correction ❑ Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE UCi u BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date - 7(alk®l Type Insp'n Permit No. b U o - 3 I Name K Yn Address 0-9 ME- 9 Qt 'St Company • Phone # Inspection Date Approved Correction ❑ Re- Insp'n Fee ❑ Application is hereby r »de for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This applicatioiVs 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 ordinar trs i` 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 t 'spy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address Lk ( r t c. o` h at J € av F r O. C. l S No q Street 9 ( S Registered Architect and /or Engineer 0 v., Name and address of licensed contractor MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Location and legal description of lot to be built on: v/ ,� f� n' �J J Lot /.6 Block () Subdivision ! // J,,gp(// , 4 - M / / 5 5G g , / /J P & 947 Street and Number where work is to be done 9 14 L 1 12 S+ , M ((Kw. ( S L0 & i F l ert Ct4L 3 3 1 State work to be done and purpose of building (by floors), state exterior colors (submit samples) E A. C_X. -A a.. V V " ' "e ' .fL....‘s-k--,. \ Pta.r C.1. and for no other purpose. New Building Remodeling Addition Repairs No of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements S $ 3 + ..S 0 Amount of Permit $ 56 `10 Zone cubage required Plan Cubage • ° / Distance to next nearest building Size of Building Lot 1 1 6 Maximum live load to be borne by each floor I hereby submit all 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 obligatons 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 the 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. Remarks (Signed) 8 a- I's . STATE OF FLORIDA COUNTY OF DADE. } ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 No. Disapproved (Signed) Building Inspector Date' Date 9 Read, Sworn to and Subscribed before me. Date V ' 1 19 81 Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): City Miami Shores Village Is Building Historically Designated YES Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Electrical RIECENTEITI MAR 29 2004 Mater Permit No. Plumbing Owner's Name (Fee Simple Titleholder) / i4b E LE•I NC- ktoSidietotetiRione # Owner's Address Z - N � ( 6 S v�- City HOW S ffo eel' State ?— Permit No. 6 :2004 - yaQ zip 3 3 ! 31 Mechanical Roofing 305 2F2 --2/ 33 Tenant/Lessee Naine Phone # 305 ?-S 9- So S Job Address (where the work is being done) 2 Ate / 6' 4 .t/ County Miami - Dade NO ✓ Zip Contractor's Company Name Phon Contractor's Address City Zip I� Qualifier Architect/Engineer's Name (if applicable) y r . Phon $ Value of Work For this Permit Type of Work: EAddition ❑Alteration New ❑ Repair /Replace CYRDemolition Describe Work: 3 E / d 0 r K t rC. Submittal Fee $ 50 •0 0 Permit Fee $ /6) "- Notary $ Training/Education Fee $ �, Cl a Scanning $ 3, Code Enforcement $ (Continued on opposite side) * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Radon $ Total Fee Now Due $ (, 3 D Zoning Structural Plan Review. $ Square Footage Of Work: CCF $ 300 >_ a 60 CO /CC Technology Fee $ 0/ -S Bond $ 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: 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 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. NOT S Print: Chc 12/15/03 Signature //,/� /� l 1 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 2.C1 The foregoing instrument was acknowledged before me this day of r(1)10n , 206` by f nn (O ( ' (IO. , day of , 20 _, by who is personally known to me or who has produced J) LL.Lk Ica.. is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. u Val?T as mission #DD231984 My Commission Expires: APPLICATION APPROVED BY: !7 '�nnck.4 Thn NOTARY PUBLIC: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ****************************** * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** ********* * * * * * ** * * * * * * * * * * * * * * * * * * * * * * ** MAR 2 9 2004 Sign: Print: My Commission Expires: Plans Examiner Engineer Zoning OWNER BUILDER DISCLOSURE STATEMENT I k( eitt...L G the legal property owner, for the property Located at: / ' ,(,� ,�O Legally described as 4O P` / 5°4 / 6 ig/O (� r "t It ^-' �� " Sec. / / v / 6 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the it State of Florida, F.S. 489.103(7),�nd I have read and understand the following disclosure (� Statement, which entitles me to 3irork 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 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 $25,000.00 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, `vhich 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 ( ) Was acknowledged before me this 2, vl By -A nncl P-oroan elk). Produced (kiQ T cO . ®2 9 eve 96 6. Owner Owner VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT DISCLOSURE STATEMENT initial of reviewing clerk. Tlie foregoing instrument day of '(YYW ((h 20 O1 • who is personally known to me or who has as identification and who did take an oath. Mabee Varga , �� - #DD2 Expires: Jul 13, 2007 Bonded Thru • Atlantic Bonding Co., Inc. Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 3/29/2004 Applicant: MADELEINE Owner: ROMANELLO JOB ADDRESS: 29 Contractor Local Phone: Parcel # 1132060130830 NE 96 Building Permit Permit Number: BP2004 -420 ROMANELLO MADELEINE ST Contractor's Address: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 15 & 16 BLK 6 LOT SIZE 100.000 Fees: FEE2004 -3320 FEE2004 -3321 FEE2004 -3322 FEE2004 -3323 FEE2004 -3324 FEE2004 -3325 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $100.00 $0.60 $5.00 $0.20 $2.50 $3.00 $111.30 Total Fees: $111 Total Receip 0.0 6 /.3 a Permit Status: APPROVED Permit Expiration: 9/25/2004 Construction Value: $1,000.00 Work: DEMO ONLY OF KITCHEN C AR 3 0 PAI® Signed: (INSPECTOR) 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: