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WS-07-478Permit Type (circle): City rn / M I S / jj1 tate Tenant/Lessee Name A Is Building Historically Designated YES NO Contractor's Company Name � (L-' /(iE 2 044 A . / F . `t 7 & Contractor's Address Ci M Qualifier Name ty 1/�M 6 � Aotas �i s State rt' Architect/Engineer's Name (if applicable) Value of Work For this Permit $ /COO Type of Work: ❑AVtion iteration ['New D _ cribe Work: / • _� . , kl Submittal Fee $ Permit Fee $ Miami Shores Villa Building Departm Notary $ Scanning $ 3.00 Radon $ Bond $ Electrical Plumbing Training/Education Fee $ DPBR $ Code Enforcement $ Double Fee $ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING I/ECM/MM Permit No. t ,S 07 - 1 17 if PERMIT APPLICATIOA IU3 2 9 2007 M Master Permit No. FBC 2004 Owner's Name (Fee Simple e1 ' leholder 0 dU l c (74 Phone # Owner's Address Fed A/ E 97 S7 r1 Zip 3 3 l -3 a Phone # Phone # Phone # Mechanical Roofing Square / Linear Footage Of Work: 1 7 / 30• 7.5 Job Address (where the work is being done) 'e / v E 97 TA S 1 City Miami Shores Villa e County Miami -Dade Zip 33 / 3 sr FOLIO / PARCEL # L. b 1110 c ? U ! AN i. S A. 103 S4 Phone # 3 0S 76 / yg (ft zip 3 3l 3ir State Certificate or Registration No. Certificate of Competency No. / Repair/Replace L1 Demolition w � J �i iii ► ; fir iii ire MIWAIII2L1111011111111111111 CCF $ Co /CC Technology Fee $ Zoning $ Structural Review. $ Total Fee Now Due $ 'be) 00 See Reverse side -+ Bonding Comp Name (if app4caale) iv A Bonding Comp:. Agldre // A CT State Zip Mc. tgage Lender's Name (if applicable) /(/A 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 &F 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. Signature OE .J'� C�S+-t..04 The foregoing instrument was acknowledged before me this day of Aug OS , 20 dl by 16 iId ? eh who is pe onally known to me or who has produced /2'7)700 LQ. 4 l(i o NOTARY PUBLIC: Sign: Print: My Commission Expires: Owner or Agent As identification and who did take an..ka d 4�� � e� 4 0 J � * * * ** * ** * * * * * * * * * * * * * * * * * * * * * ** " ,<! * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) * * * * * * ** Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Plans Examiner Engineer Zoning Q • • •r• i • r • ••• •• •• • • • •• •• • • • • • • • • • • • • • • • / p ••• • • • 7 • • 0 7 1 4 " MOMEV Auk 2 9 NV PERMIT APPROVED BY DATE ZONING DEPT BLDG DEPT, Miami Shores Village D'COUNTY P ' " • • /y • • • • • • • • • • I • • • • • • • • • • • •• • • • • • • • • • • • a •- •. • • ••t_ • • • a.� c • • BJEc T ?,TF AI rills is 1 /= Ro Nr" a �. 545 7- SIdF' OF A / ,- v7"l�iT ' sArV AT TAE ICE/92 OF 7h5 � ov s �� cl g c !,geed 6?-E.5 ',v7 AIry loo/.. off R /A_ifoie. c ,Ecl w >7 _ , i/ s g I /'4 x • 7 o P e is 3' .3.4* ' K j'' (i rr h i X Y �� vP tR 6 9 ? � . 7 �! / ! fi ) / Z / i 14. AT l r i p - 5 6: L4740T ' o _ X PA. mod 7&E, (kJ /017 of T/ r d oo, OPE NhvG T"o S C k 08 ,9 N / of 7� Fl ( 7/ RFAovite-/ of , , c 1 7 : 1 1 1 11 Sost'/li2 /7' l c T l o L� �.c> 7-' ... ` .e Q o o k. 1� x_Y ,Gva// .Sutfa/2..T A XvR2 44 xYy'' h gi4d' r TA e Roor 0AF74 w ill b s v f/.32 4V. hY c /9, .6. =' ,g oy 7< .- ._ ._ � ;.. ©O12 ti )//theed /tip, srie'ucri o Z o d 00 l'_s d 7 tad // A F 'on .s;Flk re p To' ti 7 w hE c/90. b /4,4 s F'o r ? 5 7 ac R. en cog . 7y, Neu, do , • ••• • • •. • •• t" r To c_o4rsc.,RvcrFj.. of ',r� f'J Va , 00d.__cuirh i / 'x Pf ti Re, t- FOB. e. A , •• •• • •• • • ••0' • • • • ••• •. • •• • • • • • ... � ... • • • • • • • • •• ••• • • • • • • • • • •..• • •• • --• 't • -* ._ ...• __- •. WO- _ i !•• .- -• _• __ • .••• • • • • • • • • • • • ••• • • • • • • • • ••. ••_. •... .•. !. •s..• _.•. • • ••• • • • ••• BUILDING n 5 7-- - Permit No.1 ' 11- PERMIT APPLICATION ter Permit No MAR 0 9 2007 Tenant/Lessee Name Is Building Historically Designated YES NO C Value of Work For this Permit $ a Q a Type of Work: DAddition EgAlteration Submittal Fee $ Bond $ Structural Review. $ Miami Shores Village r Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Fee $ Phone # Job Address (where the work is being done) O In Mj et 7 TA s f City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # /1 , a 4 0/11— . 7 0 0 ['New Nr Repair/Replace CCF $ Code Enforcement $ Double Fee $ Total Fee Now Due $ l(7 FBC 2004 ], � -- BY: __ _ P;4) Permit Type (circle): Electrical 'fuinliifr Mechanical Roofing Id Owner's Name (Fee Simple Titleholder) %VA 4 C h le S/ C (ffk Phone # 3 0 5 7 S 4 f!o Owner's Address 0E4 me 77 ?k S City /A ffi j 5 f„s_ State i t Zip 3 3 3 ,v 3 3/3� Contractor's Company Name D (,V/l!0 Phone # Contractor's Address City State Zip Qnalifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) /t! A Phone # Square / Linear Footage Of Work: 4 L F Describe Work: R P f e E W b o cl E,! e,4 ,v c e dooR. © �v Cir i _ _ i 2. D ' ' o ' � R. 7' . ( S ♦NG /, CO /CC Technology Fee $ 2 -50 D Demolition Notary $ 5— Training/Education Fee $ Scanning $ Radon $ DPBR $ Zoning $ Icctej See Reverse side -, Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) A/49 it/A 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, I EATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accu and that all wdrk will be done in 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 rill 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. Signature P Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 1 The foregoing instrument was acknowledged before me this day of ninth , 20 ®7, by P kwei Id C14 , day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced F! � D/ 1,ej' ) 1° I As identification and who did take an oath. - -.w " as identification and who did take an oath. NOTARY PUBLIC: � WtO *G°"ogg5 NOTARY PUBLIC: r e' M \SS\ON 2009 Sign: 'lhtuN t°a�Y Print: My Commission Sign: Print: My Commission Expires: APPL'ICATION APPROVED BY: ` ' ` � ` , , � /�� � � Plans Examiner , Engineer Zoning (Revised 02108/06) VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: e0 N,} ( c . E • DATE: (1Q-/ I?, 0)-007 ADDRESS: e6' g ei 7 l/ 57 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 a 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 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 opt 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 hold title to the above property and I am planning on doing this construction Initial RC. 2. I understand that as ari owner - builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application Initial e C 3. :I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial RC, 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code —. only if the structure meets the minimum code. Initial C 5. I understand that as an owner- builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial 19 C. 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company-or person. 7. I understand that if any .per gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial Ac. 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. By76 C) c/e K Produced there License or .OWNER Was acknowledged before me this day of /4/ 20 (75 : who was personally known to me or who has ire, „ „'s 0.c Initial pc Initial C as identification. 1;1 ti •, pow MAR 0 9 2007 N 7 Qr 0 T Fir • 9 / 7 / 1 f .., • • • • • • •• . • . • •• • 1 / • • • • I••• • • • •: •• • • • • • • • • • • • •• • • • • • • ••• •i.•• • • • • • 7 1 I • • • ..` '«...� -_ • . ,��_ • • ••• • ••• • S6 1 L r h 1 5 r s T A F l= 6 , r7 a Q. eA sr s/ d E © f A /D/1-s01- uT///Ty sAeci AT TA g. (.x'42 o F 'TA 1 /iZovf dEs c 2 i gd pio&A,7" y. / S INS ! Pe- EsE,jT °h/N6 -6 Dock. OF %'J j°lytc i rA /" )44 " Afs s g 1/f4 ,' x (,. 7"h o fe,u/,/G.. f s 3' 3/ /1 K 6i Ccr r i 1 S X Y ,f UP I h T f Nil i x 9 1/ .x / 3%" h5AdEi rim/ 11E AT TII To P. 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