PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Address 1 � ` // /T- 9PsIT Tax Folio 4/11)5---
/ 7f
Legal Description
Owner / Lessee / Tenant a7-/M/47-6 Master Permit #.,
1 Address j/ 7g A " • 9s hog-".c, 6'u r Phone
Contracting Co. �,e,- Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle o ne)): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
W ORK DESCRIPTION I n urfc(2f L J 4 O U ce
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compl' nce with all applicable laws regulating construction and zoning. Furthermore, I
autho ize th ove -named contractor to do the work sta'ed.
Si e o �,o�ner an or Condo President
Date: P 20 f `I'� 1/
N/ ary s to Owner :nd or Condo Pregje040430.
My Commission Expir s :,.
** *
APPROVED:
PCB
* * * * * * * * * * * * * * * *
FEES: PERMIT, � < � '�' RADON C.C.F. NOTARY TOTAL DUE 90 ' D
Fire
Buildi
Mechanical Plumbing
Zoning
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
Other
Electrical
Engineering
i0
ai‘lt IT! 14 2005
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date ill HOS
Type Insp'n r Mil
Permit No. q > J - 'av
Name 1Jovios
Address (� "l fvt: vl r vt
Company OVA �
Phone # 'I)S l 3 -Y Z-1
Inspection Date 11 IA5
Approved i 1/ 1 t)
Correction ❑
Re- Insp'n Fee ❑
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: BP2005 -1380
Printed: 9/27/2005
Applicant: YIANNIS & VERONIC
Owner: DUMAS
JOB ADDRESS: 1179 NE 98
Contractor
Local Phone:
Parcel # 1132050180290
Signed:
Building Permit
DUMAS
YIANNIS & VERONIC
ST
Contractor's Address:
Legal Description: REV PL MIAMI SHORES SEC 8
Permit Status: APPROVED Permit Expiration: 3/21/2006 Construction Value: $300.00
Work: PAINTING OF EXTERIOR OF HOUSE
(INSPECTOR)
3 0F
( /315
Page 1 of 1
PB 43-69 LOT 20
Fees:
FEE2005 -12851
FEE2005 -12852
FEE2005 -12853
FEE2005 -12854
FEE2005 -12855
Description
Building Painting Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Total Fees:
Amount
$60.00
$0.60
$5.00
$0.20
$1.50
$67.30
Total Fees: $67.30
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:
BLK 179 LOT
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleholder) YfA/Aii,S -f 142 a1/64 Qv/145 Phone # 305 7 5V3 get
Owner's Address //7 it/E 98 Ty S r
City // M dQ State G
Tenant/Lessee Name
N/A
Job Address (where the work is being done) S`�f 45 y 9,6 1 jj Li G"
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name NO
Miami Shores Village
Electrical Plumbing Mechanical Roofing
Co,vr,e4 reLe US Ft
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect /Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit $‘-- Square Footage Of Work: .2., Q'D C7
Type of Work: ❑Addition EAlteration New []' Repair/Replace
❑Demolition
Describe Work:
Submittal Fee $
Notary
Scanning $
Code Enforcement $
79A.) 7 gx 7'eie/Orte_
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $
Training /Education Fee $
Radon $
(D
O.ZD
Structural Plan Review. $
Total Fee Now Due $ �� v J
(Continued on opposite side) CH! 613D
zip 3R
Phone # /1//i4
Phone #
CCF $ O , UD CO/CC
Technology Fee $
Zoning Bond $
1 r - ..
Permit No.Z ^ 1
Master Permit No.
Zip
r
1
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 he approved nd a reinspection . fee will be charged.
4
Signature
Signature
Owner or Agent Contractor
The for oin2 instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�i�
day of - day of
who is personally known to me or who has produced ��
As identification and who did take an oath.
NO A Y PUB C:
Sign:
Print:
My C mmission Expires:
* * * ** . * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
2OCC, by �d t CO xrr ,
.a.,dz,
, 20 _, by
who is personally known to me or who has produced
as identification and who did take an oath.
,; 'jt; '' Y PUBLIC:
n rint:
nirr R nn coded eL Th�o('h . I i•
" mmy Commission Expires:
**************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * **1* * * ** # * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
Walls
Fascia
Date ."
Owner's Name
Owner's Address
City Hail/
Miami Shores Village
Paint Color Approval and Agreement
'e'0 A1164
//7 Ate 9V ripe s 7'
,_ , VIe5 State
.lob Address (where the work is being done)
.g4`rj" /42-5 ,ego
Cit Miami Shores Village County Mianii- Dada. Zip
Is Building Historically Designated YES NO
Contractor's Company Name (if applicable)
A/ 4- Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
(.?J1 I
Drip Cap /drip Edge (.014 / re,
Soffit UJ ltt I a- •
Roof A/A"
Flower bins / 'JA
Shutters i1/4)
Awnings /V /,'
Chimney Ill/)'
Doors and door jams N
! 1 .
Signature
APPLICATION APPROVED BY:
Owner or Agent
Phone #
Zip 3 3/ A''Y
Garage doors / /� A'/4'
Railings N( /-�
Fences AO'
Decorative metal A)/4
All brick (simulated or regular)
Stucco banding /11 7
Any other stucco features / 1�/4
Accessory Buildings �l I /
Other
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
8
Lo
Ls)
C13
carrington beige
Date
Date 43r/L- /ok —
chc 6/18/03
BUILDING DEPARTMENT
Located at:
OWNER BUILDER DISCLOSURE .STATEMENT
I U'8,()'&4 au/1,4- S being the legal property owner, for the property
// AA= 9B r e s7
Legally described as Q- Xere 5e____ ,
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 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 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 Iicensed must tivork 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 ( )
Y P
Mabei Var . , - I
Was acknox), ic@dianfis #1)132. ; i s ; ' • .
. Expires: JuI 13, 2007
By ,7 F; r ;c Bonded 1bn; who is personally known to me or who has
Produced
•
Owner
Owner
VILLAGE OF MIAMI SHORES
DISCLOSURE STATEMENT
initial of reviewing clerk. The foregoing instrument
y of
as identification an ho did take an oath.
Notary
• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date // Job Address //79 AL L if Tax Folio 1/ X0205' e G7Z1 g
Legal Description Lot 1. -- g( ock /7q fg 62 ae. PA )mom - sloiLe.<, redid A-) No • e.
Lessee / Tenant - dN A eAl Ag , '?e' Master Permit # S
Phone 05 7 736 / 70O A
Owner's Address_SG7A1 e
{
tar as to Owner and
My Commission Expires:
APPROVED:
ft -S 33o'e.
Contracting Co. Address
Qualifier 00442 SS# - - Phone 7,4 — 7 3 ar
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION�-Q VvLOd - L Foot-, h 6UG2 h14-rsl v U nJQ.o011
00
f2 1,64 c.e Pne sk o Ue ttsv L C so e r rLe 4s)
Square Ft. Estimated Cost(value) :,;' 1) U
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in comp iance with Brliis t.w icmaOlgeneloi car ga ipeting construction and zoning. Furthermore, I
authorize th = bove -named cl'6iftegtiWr lEaQ$d'rthe tated .
Type .ind nu be of I.D. produced:
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * * * * * **
FEES: PERMIT / RADON C .0 . F . T �'T' . OTARY S c 0 TOTAL DUE 7 17
Fire
Zoning Building
VIff
Other
Electrical
Mechanical Plumbing Engineering
Per 489.103(7) F.S.S.
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 outbuilding. You may also build or improve a commercial
building at a cost of $25,000 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 more than one building you have
built yourself within one (1) year after the construction is
complete, 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. Your construction must
be done according to building codes and zoning regulations. It
is your responsibility to make sure that people employed by you
have license required by state law and by county or municipal
licensing ordinances.
D to
DISCLOSURE STATEMENT
2
wn signature
Village Use Only
Owner's name(print), �/� e ke'v.„43_L
Permit No.
MIAMI SHORES VILLAGE BUILDING'AND ZONING DEPARTMENT
INSTRUCTIONS TO OWNER- BUILDER
You have, this date, made application for a building permit as an owner -
builder. You should be advised of the following provisions and reouirements
that apply to owner - builder.
Proof of Ownership - Prior to a building permit being issued to you,
you must submit proof of ownership of the land concerned in the
application in the form of a recorded deed, showing you own the Property,
or a copy of mortgage or warranty deed of the land, or a Dade County tax
receipt, statement to contain legal description of property and indicate
property is in your name. Legal description and name on document of proof
must correspond to the name and legal description on the application.
Responsibility - You will be responsible for all work done by your day
labor employees, and you must either employ licensed contractors or
persons to be paid on an hourly or per diem basis. Any one contracting
(including labor) with you, verbally or in writing, on a fixed fee basis
for any work, who is not properly licensed, will be subject to a fine of
$500.00 and /or imprisonment for six months.
Insurance - You should be advised that if your day labor employees cause
any damage to persons or property, or if any of your day labor employees
are injured on the job, you are liable. Your regular home insurance
policy ordinarily does not cover this type of liability.
Withholding Taxes, etc. - You should be advised to investigate your
responsibility for withholding Social Security, Federal and State
Unemployment Insurance Taxes and Federal Income Taxes from the wages
of employees working for you on the proposed construction, and for
making returns thereof to the proper agencies.
Work Permitted Owner - Builder - An owner - builder subject to the foregoing
provisions and requirements, is limited to constructing one single family
residence each year for his own use and occupancy; or maintaining, altering
or repairing his own single family residence.
If you do not intend to do the work involved yourself, or with day labor, please
list below, the name of the individual or firm with whom you have entered (or
will enter) into a contract for the work.
NOTICE: SEPARATE PERMITS REQUIRED FOR ELECTRICAL, PLUMBING,
ROOFING AND MECHANICAL WORK
e 11/1 // 7 f /t/ . , •
9
Name of Individual or Firm Address
I, the owner of property described as jigAiu e � y
//71pe /r9
441 %Oa/
Witness
7 211" / M Date
do hereby certified
that I have read the foregoing instructions, and am aware of my responsibilities
and liabilities under my application for a building permit for construction work
on the above described property.