842 NE 96 St (6)Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 7/13/2005
Applicant: CLINTON STAPLES
Owner: STAPLES CLINTON
JOB ADDRESS: 842 NE 96 ST
Contractor
Local Phone:
Parcel # 1132060142900
Building Permit
Permit Number: BP2005 -1020
Contractor's Address:
Legal Description: MIAMI SHORES SEC 3 PB 10 - 37 LOTS 5 & 6 BLK 75 LOT SIZE SITE VALUE
Fees: Description Amount
FEE2005 -9517 Building Fee $125.00
FEE2005 -9521 CCF $1.80
Training and Education Fee $0.60
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Total Fees: $433.60
Total Receipts: $0.00
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C ertaining thereto and in strict
E - 4 E - 9 ;sume responisibility for all work
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BUILDING
PERMIT APPLICATION. *'
FBC 2001
Permit Type (circle): Building `lec': __ Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder)
g t2 r G('G
Owner's Address
City f -V -- -N 5 State f L.
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Villa•e County Miami -Dade
Is Building Historically Designated YES
Architect /Engineer's Name (if applicable)
Type of Work:
Describe Work:
r17-1
- f--1
❑Addition
Total Fee Now Due $ 433, (CEO
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
$ Value of Work For this Permit 4 243C0
❑Alteration
si
A.Qnu.E_
NO�
Code Enforcement $ Structural Plan Review. $
Zip
Master Permit No.
Phone # 365 7 (O F
3g
Phone #
Phone #
Permit No.
State Certificate or Registration No. Certificate of Competency No.
Phone #
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * ** * * * * * * * * * * * * * * * * * * * * **
mss - i0zv
Zip
Contractor's Company Name
Contractor's Address
City State Zip
Qualifier
t
loo°
❑New IN'Repair/Replace ❑ Demolition
').A Nr— -- C
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Submittal Fee $ Permit Fee $ 17-5 4 - CCF $ I - SD CO /CC
Notary $ Training /Education Fee $ O. 60 Technology Fee $ 3 - ZD
Scanning $ 3 • CO Radon $ Zoning 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 1.9- a9achment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be and a reinspection fe- will be charged.
Signature / J n C Signature
f .ry
Owner or Agent _��' Contracftor
The foregoing instrument wwas ackledged before me this The foregoing instrument was acknowledged before me this
day of -7 }a.`1 , 20 by (`',iV+l) /1 S 47 ' day of ,20,by
who is personally known to me or who has produced who is personally known to me or who has produced
2f S,;:jL'j identification and who did take an oath. as identification and who did take an oath.
NOTARY PUB
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
ILL - )22 &4-4.
�7�tie �- Al 14, ��`e'
MY COMMISSION #DD262294
EXPIRES: NOV 03.2007
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
**************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * *// * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
7 `` 65 . Plans Examiner
Engineer
.:% I Zoning
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
H 5 being the legal property owner, for the property
Located at: gy- . NE - 4 % 'S1
Legally described as (- ( 3 — #
Do hereby petition the Village of Miami 5hores to act as my own contractor pursuant to the laws of the
State of Florida, F.S. 489.103(7),_nd I have read and understand the following disclosure
Statement, which entitles me to ,o 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 Iicenses 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.
Proof of ownership provided (( ) initial of reviewing clerk. The foregoing instrument
Was acknowledged before me this day of �� , 20 0,i
BY (. 1 t f - ,1 L e4tt.f:)kS who is personally known to me or who has
Produced
Owner
eirs • Lic as identification and who did take an oath.
JANET M. HANSEN
MY COMMISSION #DD26$2 §4
EXPIRES: NOV 03, 2007 •