BP-04-558BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): �/
Owner's Name (Fee Simple Titleholder) /"!/4 /
Owner's Address Ale 76 Iff sveee
City A-1/411// 57b12' State PL
Tenant/Lessee Name
r 1 n Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Miami Shores Village
,1 l " 0) 756.8972
Electrical
Plumbing
Permit No. & 1 4 — 5
Master Permit No.
Zip 3 3i g
Phone # ! 751}1
Job Address (where the work is being done) i.4I,�
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO X
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) A/ 4 - " Phone #
$ Value of Work For this Permit 1 Square Footage Of Work: Zed 0
Type of Work: ['Addition ❑Alteration ❑New ❑ Repair/Replace Demolition
Describe Work: / Ut /472j /6770` i
h 1/C .
1 % '&(O
Total Fee Now Due $
(Continued on opposite side)
****************************F
Mechanical Roofing
Phoie# 6/7 - '- r y51 - i
Submittal Fee $ 100 • Permit Fee $ /® ` CCF $ t 60 CO /CC
Notary $ Training/Education Fee $ (/ t a Technology Fee $ /
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
6. 3 o
patcl 100 : CEO 1,3 �` �`
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
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 F.T.RCTRICAL 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.
signaure4 aJAA4Azbd,-/2...,
Owner or Agent
The foregoing instrument was acknowledged before me this
Sign:
Print:
NOTARY
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * **
Cho 12/15/03
Zip
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of / _ O0 , by day of , 20 , by
who i rsonally known to e or who has produced who is personally known to me or who has produced
tion and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Arta Bode qy
3f, 205
(Certificate of Competency Holder)
My Commission Expires:
State Certificate or Registration No. Certificate of Competency No.
* * * ** **************************** * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** :******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
APR 2 8 200S Plans Examiner
Engineer
Zoning
TypeInsp'n
Permit N
Na
Address
Company
Phone #
\ cog
MIAMI SHO :E
BUILDING DEPA TMENT
305 - 795 -2204
Building Inspection Request
Dates ' y
Inspection Date
Approved
Correction
Re- Insp'n Fee
Company
P]ione #
inspection Date
Address 6 a . 6 , _ .
Approved
Correction
Re- Insp'n Fee
oct
MIAMI SHOR
BUILDING D
ENT
3C15-795
Building Inspection Request
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IJ
11
ENICSIMINIEINEOPritaltil Millarotan..26 °
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VILLAGE OF MIAMI SHORES
Proof of ownership provided ( )
Was acknowledged before me this 9 day of
By / 7 7(%
•
Produced
Owner
t �
Owner
BUILDING DEPARTMENT
. OWNER BUILDER DISCLOSURE .STATEMENT
I • itt IA/km ( + - 5-04 - A 1 ?A being the legal property awner, for the property
7rf
Located at: , £ ■ Z1/i Z/ f /1A._ � . , /�
Legally described as h 1 �►l'Jr� /41e4441/1t44:441 N// Z r e,
Do hereby petition the Village of Miami Shores to act is my own contractor pursuant to the laws of the in — 3
State of Florida, F.S. 489.103(7),And I have read and understand the following disclosure ',ell 4 - 1 0
Statement, which entitles me td alrork 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, 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.
DISCLOSURE STATEMENT
initial of reviewing clerk. Tie foregoing instrument
who i ovally known to rye or who has
as identification and who did take an oath..
. �
4/ ;!L , `j
Notary
t' *f st, Michael 7. Nava
so
Muds Daft
d LM I ZJ< <'f-
Dom.
9 ps. e pAuei 601
eletac
."p 7:
7 17
Miami Shores Village
10050 NE 2nd Avenue
Building Permit
Phone: 305 - 795 -2204 Permit Number: BP2004 -558
Printed: 5/3/2004
Applicant:
Owner:
JOB ADDRESS: 602 NE 96
Contractor
Local Phone:
Parcel # 1132060141410
ST
Contractor's Address:
Permit Status: APPROVED Permit Expiration: 10/23/2004 Construction Value: $500.00
Work: REMOVE PART & EXISTING AWNING ON PARK DRIVE
Page 1 of 1
Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 1 TO 10 INC BLK 61 LOT SIZE
Fees:
FEE2004 -4447
FEE2004 -4448
FEE2004 -4449
FEE2004 -4450
FEE2004 -4451
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Total Fees:
Amount
$100.00
$0.60
$0.20
$2.50
$3.00
$106.30
Total Fees: $1.V.A9
Total Receipts 0. 0
0
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 1 assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2004 -558
Printed: 5/3/2004
Applicant:
Owner:
JOB ADDRESS: 602 NE 96 ST
Contractor
Local Phone:
Parcel # 1132060141410
Building Permit
Contractor's Address:
Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 1 TO 10 INC BLK 61 LOT SIZE
Fees: Description Amount
FEE2004 -4447 Building Fee $100.00
FEE2004 -4448 CCF $0.60
FEE2004-4449 Training and Education Fee $0.20
FEE2004 -4450 Technology Fee $2.50
FEE2004 -4451 Scanning Fee $3.00
Total Fees: $106.30
Total Fees: $0 g
Total Receipts: ' 0.00
b r.3
Permit Status: APPROVED Permit Expiration: 10/23/2004 Construction Value: $500.00
Work: REMOVE PART & EXISTING AWNING ON PARK DRIVE
Page 1 of 1
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 Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5/3/2004
Applicant:
Owner:
JOB ADDRESS: 602 NE 96
Contractor
Local Phone:
Parcel # 1132060141410
Signed: (INSPECTOR)
Building Permit
Permit Number: BP2004 -558
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 1 TO 10 INC BLK 61 LOT SIZE
Fees: Description Amount
FEE2004 -4447 Building Fee $100.00
FEE2004 -4448 CCF $0.60
FEE2004 -4449 Training and Education Fee $0.20
FEE2004 -4450 Technology Fee $2.50
FEE2004-4451 Scanning Fee $3.00
Total Fees: $106.30
Total Fees: $a 6.30
Total Receipts: l 0.00
43o
Permit Status: APPROVED Permit Expiration: 10/23/2004 Construction Value: $500.00
Work: REMOVE PART & EXISTING AWNING ON PARK DRIVE
PLAY 0 4 PAID
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: