133 NE 100 St (8)MIAMI SHORES VILLAGE �
BUILDING DEPARTMENT ti
305 -795 -2204
r,
Buil.iin Request
Z3
Date g"
Approved
Correction
Re- Insp'n Fee
Type Insp'nprm_wcALA 5 lob Fl rot
fl
Permit No. � Gi"-ll.00 3 181D.
Name Stalk]
Address 1 i J c") NF cW V
Company
Phone #
Inspection Date' c;-0.4
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 -795 -2204
Building Inspection Request
Date
Type Insp'n
Permit No. Q (�
Name ` ��R XS2.►J
Address
Company
Phone #
For Inspector:
JECEE1VED
0V 3 2003
BUIL 1 ING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Building
Contractor's Company Name /' -(
Total Fee Now Due $
(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
Electrical Plumbing Mechanical Roofing
/ w
Owner's Name (Fee Simple Titleholder) t i '` 1 '` i i" '"� J .T L Phone # 30C 7 8994-
Owner's Address I 3 3 j.. II, (O -
City M` f't 1 St/IL Ct. State F--, Zip 331 3 e
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 13 3 A - E too S-
City Miami Shores Village County Mi ' -Dade Zip 33 /.'
Is Building Historically Designated YES NO
Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit 30 • CO Square Footage Of Work: 2 40 sci
Type of Work: ['Addition DAlteration Wlew ❑ Repair/Replace p 0 Demolition
Describe Work: j�IC;R - - `tom L.A. Pare_ 1�1�R- v�L� -i 6 1 k4 e- .11 -4-2 a
pas( 74—.9 n /_i r s s ' it s ti - o
5 -e
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit No.13FZCD0
Master Permit No.
Submittal Fee $ 50 .Oc Permit Fee $ /0 CCF $ s V! 0
Notary $ c5 •CO Training/Education Fee $ ('J to 0 Technology Fee $ q, 5
Scanning $ Radon $ Bond $ c OO • W .
Code Enforcement $ Structural Plan Review. $
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 o•. urs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not b '.proved a d a rei pection fee will be charged.
1
Signature
The foregoing instrument was acknowledged before m- this
day of ( , 2003, by k I . V � 1via tit
who is pea
NOT
Sign:
Print:
� tics oath.
fission #DD231984
• i '` '� '_ des: Jul 2007
lt "P- VA*1-Rat illaVitiV
My Commission Expires:
Owner or Agent
ly known to me or who has produced
As identific,ation
01Y
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
State Certificate or Registration No.
APPLICATION APPROVED BY:
Chc 10/14/03
(Certificate of Competency Holder)
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:
Certificate of Competency No.
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
NOV 182003
e(/403
Plans Examiner
Engineer
Zoning
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Note:
• All clearances and/or encroachments shown hereon are of apparent nature. Fence ownership
by visual means. Legal ownership of fences not determined.
• Encroachments Noted: 2
• Underground structures, if any, not located.
• Roorinnc if chnwn are based on assumed meridian or Plat of Record.
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Produced •
Owner
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
�
Located at:, ( 3 /Vv ��l s) ` , (ag -"14( S 1 P- S , 1? 6
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 to 31 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 S25,000.00 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 bunt 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 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 1 day of d , 20 (f
being the legal property owner, for the property
who is personally known to me or who has
• as identification and who did take an oath.
Mabel argas
Commission ° I D231984
xpires: J 13, 2007
9 • ... • ed Thru
�' ", �' " Atlantic Bonding Co., Inc.
•
'STATE OF FLORIDA)
COUNTY OF DADE)
attached survey, performed by
The undersigned Affiant,
performed on 2_0 is an accurate representation of the existing conditions and
te of urvey)
• Miami Shoreo VLa
locations of all structures on the property as of this date.
AFFIDAVIT
114— `di - °% , ■_
(property owner)
14o A-P..AlAr sock_ S
(name of surveyor's company)
oes hereby attest that the
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other .e
Affi t/Property owner ,7
Further, Affiant sayeth naught.
Witness(sign and print) Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this day of 1)CUCL-
Affiant is personally known to me, produced as identification.
Mabel
° • • "•xt. Commission
°I 7 -
Expires: Jul
Bonded
Atlantic Bonding
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 11/19/2003
Applicant: WILLIAM STALEY
Owner: STALEY WILLIAM
JOB ADDRESS: 133 NE 100 ST
Contractor
Local Phone:
Parcel # 1132060132050
Signed: (INSPECTOR)
Building Permit
Permit Number: BP2003 -1812
Contractor's Address:
Permit Status: APPROVED Permit Expiration: 5/16/2004 Construction Value: $300.00
Work: SLAB for parking in rear
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 18 & 19 BLK 15 LOT SIZE
Fees: Description Amount
FEE2003 -7271 Building Fee $100.00
FEE2003 -7272 CCF $0.60
FEE2003 -7273 Notary Fee $5.00
FEE2003 -7274 Scanning Fee $3.00
FEE2003 -7275 Training and Education Fee $0.20
FEE2003 -7276 Technology Fee $2.50
FEE2003 -7277 Builders Bond $300.00
Total Fees: $411.30
Total Fees_ $4111.30
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:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3'2244 Job Address /95 ,r / ( 7 0 'ir Tax Folio 11 3 0 P 1 7 -- e ---
Legal Description Lok \ o at--J 1/ Q I IK IS'
- s-c_L
Owner / Lessee / Tenant 44191j GIN Pea V/y /(/.ff Master Permit # 3S 0
Owner's Address /35 ail/ loo T Phone ,67. q
Contracting Co. fid'2tnoAl,r7? Address C45 ,'V€
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company
,� / Address
Mortgagor / v
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING Pi&VING) PENCE SIGN
WORK DESCRIPTION
Reoc0 lDS 3Pco9 7M/ek . cel /M "mom , ANizf fer Rrsaga
2 �
Square Ft. ✓4V 4 Estimated'Cost(value) oo
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 compliance with all applicable laws regulating construction and zoning. Furthermore, I
auth•rize the abo - contractor to do the work stated.
Signature of own and /or G�pndo President Signature of Contractor or Owner- Builder
Date: docAScr'i 70 M f Date:
APPROVED:
/! /4/14 600 of/il S 9
3-2i44
- Notary J,✓to Owner and /or Condo President
M '"‘Y /Y1 S A ` j i GE
GARY M SERVICE
NOTARY PUBLIC STATE OF FLORIDA
*- * COMMISSION NQ CC28497*I * * * * * * * * * * * **
MY COMMISSION EXP. JUNE 26,1997 y�
FEES: PERMIT " /i RADON C.C.F. / NOTARY TOTAL DUE 2''
Fire
Address
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Other
Zoning Buildin Electrical
Mechanical Plumbing Engineering
lvE
Notary as to Contractor or Owner- Builder
My Commission Expires:
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