1135 NE 100 St (12)Located at:
By
Produced
OWNER BUILDER DISCLOSURE STATEMENT
Ov',4 - ()Oa) s f Ore
t,
Owner
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
being the legal property owner, for the property
oo sr /%
Legally described as 4) t r _
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 td ibrk 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 licenses required by state law and by county or municipal Licensing
ordinances. Any person working on your building who is not Icensed 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. Tlie fore ing instrument
Was acknowledged before me this / ✓ day of
l2
as identification and who did take an oath.
tary
inn Gonell
Commissio DD323870
26 2008
`U Expires: Thn
Atlantic Bonding Co., Inc.
Type Insp'n
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204 b02'
Y ing Inspection Request
Date 't _ I2(C? .
3p
Permit No. 1 PV l J4
Name 0./`Q V`C
Address 11. t k On
Company b
Phone #
Inspection Date
Approved ❑
Correction
Re- Insp'n Fee
bo+ 12e4dY
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
.� Building Inspection Request
(2-(5, S
Type Insp'n
Permit No.
Name
Address
Company
Phone #
Date - �\
Inspection Date
Approved
Correction
Re- Insp'n Fee
78.
//3$ 4,4 100 std
-e de
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L q:7 +
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT 40
305- 795 -2204
Building Inspection Request
Date D
Type Insp'n
Permit No.
Approved
Correction
Re- Insp'n Fee
1
C�3 - Ts y
N'me 2W
Address
Company
Phone # 7)7 Inspection Date l 0
Type Insp'n
Approved
Correction
Re- Insp'n Fee
ICIS ni)
MIAMI SHORES VILLAGEO
BUILDING DEPARTMENT Ws
305- 795 -2204
Bui 'ding Inspection Request
Date
Permit No. f3Pa,5 - 1/2
Name I Wan, S
Address ! / ! i j i z s)
Company DCULeii'
Phone #
Inspection Date
A
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5/20/2005
Applicant: THOMAS
Owner: WENSJOE
JOB ADDRESS: 1135
Contractor
Local Phone:
Parcel # PARC2003 -17
ST NE
Legal Description:
Signed: (INSPECTOR)
Signed: (Contractor or Builder)
Building Permit
Permit Number: BP2005 -712
WENSJOE
THOMAS
100
Contractor's Address:
Page 1 of 1
Fees:
FEE2005 -6382
FEE2005 -6383
FEE2005 -6384
FEE2005 -6385
FEE2005 -6386
Description
Building Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Total Fees:
Amount
$100.00
$3.00
$5.00
$1.00
$2.50
$111.50
Total Fees: $111.50
Total Receipts: $111.50
Permit Status: APPLIED Permit Expiration: 11/9/2005 Construction Value:
Work: RE- PAVE DRIVEWAY
BY:
v 2 0 PP
-
\o $
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.
BUILDING
PERMIT APPLICATION
FBC 2001
Job Address (where the work is being d
Contractor's Company Nanie
Contractor's Address
City
Qualifier
Total Fee Now Due $
Owner's Name (Fee Simple Titleholder)
Owner's Address ,no
� JL?
City /1 ' ( State
Tenant/Lessee Name
f( a
Is Building Historically Designated YES NO
(Continued on opposite side)
Miami Shores Village
Building Department
1 !3 �tT
0
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (315)j '; at 15 756.8972
Th oM- s or
fiR 19-'
aster Permi
Permit Type (circle): Buildin Electrical Plumbing Mechanical Roofing
Phone #
Zip 33(e""(
Phone #
Permit
City Miami Shores Village County Miami -Da. - Zip 33f ?er
Phone #
State Zip
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit # 7 1 ,..SQQ, . Square Footage Of Work:
�F
No # 6 PO 5--7/;--
`7d? - f7e "p Re
Type of Work: ['Addition lteratio New ❑ Repair /Replace El Demolition
Describe Work: pf,s V >i,e x -3 IS r r G (,{_
* * * * * * * * * * * * * * * * ** * * * * * * * *F *, * * * * * * * * * * * * * ** * * * * *30*
Permit Fee $ / 0 0 CCF $ -) CO /CC
Submittal Fee $,
Notary $ _, (> 11 Training /Education Fee $ I Technology Fee $ 56
Scanning $— (3 — Radon $ — — Zoning
Code Enforcement $ � Structural Plan Review. $
Bond $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Nanie (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 be approved and a reinspection fee will be charged.
ature
p r■•••—
owner •r 7 t
going instr
..111— .. i ii
•
o is person nown to me or
ment as acknowledged before me this
Si
The
day of
Pr
My Commission Expires:
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
o has produced
entification and who did take an oath.
NOTARY ' B IC: /
l dId 14 Iff
og
Signature
N RP PUBLIC:
H ign:
Bo
Commi 3 3g7
xptres: May y 26, 200
„ , riot:
antic Bonding Co., Inc.My Commission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Contractor
_'he foregoing instrument was acknowledged before me this
of ,20,by
who is personally known to me or who has produced
as identification and who did take an oath.
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning