53 NE 98 St (4)rl
BUILDING
PERMIT APPLICATION
FBC 2001
City Miami Shores Village
Contractor's Company Name
Contractor's Address
City State
Qualifier
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work:
Describe Work:
['Addition ['Alteration
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (t 0 .'� t! , -�t 6.8972
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) 1,e,fi SiY1 \ Phone #
Owner's Address 63 N . . 9 O�C�I, $'i( e
's
City �r 1 omi *CPS State F (-
Tenant/Lessee Name
Job Address (where the work is being done) 5 E • ( 1'4 J' 1 .€.-ek
taco co Ikle ;;
County Miami -Dade
Is Building Historically Designated YES NO X
di,. 2 CO. 00 .
❑New
aster Permit No.
zip 33 t 38'
Phone #
Permit NoY ' :i. • �t
3o5_78t -7766 (u')
zip 3s t 3
RC D - t 040
auNuabone# 7010 -go(- (a
State Certificate or Registration No. Certificate of Competency No.
Zip
Phone #
Square Footage Of Work:
Repair/Replace
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
❑ Demolition
Submittal Fee $ Permit Fee $ l Oa I vi CCF $ 0. / Z CO /CC
Notary $ Training/Education Fee $ 004- Technology Fee $ . oZ
Scanning $ 3,00 Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
HO,
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 of be approved and a rein'', -ction fee will be charged
S ignat
NOTARY PUBLI :
Sign:
Print:
My Comm ELcpircir
APPLICATION APPROVED BY:
chc 05/13/03
P 0 40■04 I! 41iii,4/
C -STATE OP FLORIDA
6 Y e rle H , "lez
mmission Vii •
ell
•
ed T Adan ' Bon
NOTARY
•
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before met this c�� . The foregoing instrument was acknowledged before me this
LE
day of Kb V , 20C.by.NC C . SI•i 11-4, day of , 20 _, by
who is personally known to me or who has produced
who 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.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * ** * * * * * * * * * ** ******************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * *S * * * * * * * * * * * * * *I * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * *
C 0� Plans Examiner
Engineer
Zoning
T
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE .STATEMENT
I izAoce, C . OV A4A being the legal property owner, for the property
Located at: 5 1,(t) . E E. l 0 1v1 � Q4 , I 1 ckAtAre
Legally described as
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 t6 a ork 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 Iicensing
ordinances. Any person working on your building who is not Iicensed must Ivork 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. Tlie foregoing instrument
Was acknowledged before me this day of , 20 05
By K72.E C . Sm t t . who is personally known to me or who has
Produced
11
Owner
as identification and who did take an oath.
NOTARY FUBLIC•STATE OF
eny � 1[
ID
CITY
COPY
Issue Date: 12/1/2005
Owner's Name: LENORE SMITH
Permit Type: Residential Construction
Work Classification: Garage Door
Job Address: 53 98 Street NE
Additional Information
Miami Shores Village, FL 33138-
Fees Due ,. Amount
CCF $0.12
Education Surcharge $0.04
Notary Fee $5.00
Permit Fee - Additions /Alterations $100.00
Scanning Fee $3.00
Technology Fee $2.50
Total: $110.66
Building Department File Copy
Applicant Signature
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 12/29/2006
Contractor(s)
HOME OWNER
Phone Primary Contractor
Yes
Type of Construction: REPAIR
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted:
Certificate Date: 12/1/2005
Occupancy:
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
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 responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Invoice Number
RC - 12 - 05 - 1116
Total:
Amt Due
$110.66
Amt Paid
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Permit Status: APPROVED
Permit Number: RC -12 -05 -1040
Phone: 305/525 -1427
Parcel #: 1132060131140
Block: Lot:
Section: PB:
Total Square Feet: 0
Total Valuation: $ 200.00
Required Inspections A
Final
DEC 0 2 PAID
PLEASE CALL AT (305) 789 -7766
INSPECTION TO SCHEDULE TIME
WORKING AND NOBODY IS AT
1:30 BEFORE TO DO
BECAUSE SHE IS
HOME
�v
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: INSP-2
Inspection Date: 01/23/2006
Inspector: Grande, Claudio
Owner: SMITH, LENORE
Job Address: 53 98 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Friday, January 20, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Ph o: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Garage Door
Phone Number (305)789 -7766
Parcel Number 1132060131140
Lot:
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