RC-09-475Protect Address
141 100 Street
Miami Shores, FL
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Building Department Copy
Address
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$5.00
$100.00
$6.00
$50.00
($50.00)
$2.50
$114.30
Authorized Signature: Owner / Applicant / Contractor / Agent
Expiration: 09/29/2009
Parcel Number
1131010220330
Block: Lot:
Phone
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Construction: STUCCO EXTERIOR
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted:
Certificate Date:
Bond Retum :
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Invoice #
RC -3-09 -34349
RC -3-09 -34349
Total Amt Paid Amt Due
$ 114.30 $ 64.30
$ 114.30 $ 114.30 $ 0.00
OILO
Applicant
MARCEL LUC
April 03, 2009
Date
CeII
MARCEL LUC
141 NW 100 ST
MIAMI SHORES FL 33150 -1205
1 . W§K , EIARAVAgialvitV.3.3iMaakaMffaiusftsW. , kn.
Valuation:
Total Sq Feet:
$ 1,000.00
Available Inspections:
Inspection Type:
Final
Electrical
1
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.
April 03, 2009 1
BUILDING
PERMIT APPLICATION
FBC 2004
Qualifier Name •/4
FOLIO /PARCEL #// f c7 ' t d t OE n. 3
Architect/Engineer's Name (if applicable) 1ft
eli/AY1
Miami Shores village Py•
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Job Address (where the work is being done) 14 hl tic' 100
(G)
j (0/E8VR
i 1 MAR 2 4 200
3Y;
Permit No. — 415
Master Permit No.
Permit Type (circle): Buildin Roofmg
Owner's Name (Fee Simple Titleholder) ilit 'Y"Pi Phone #C. b, 75 0 73
Owner's Address t 4 j Vd M/ f (� 0 -
State F ( Zip 3'8 / S
Tenant/Lessee Name NV Phone #
City Miami Shores Village County Miami -Dade Zip -3 / b
Is Building Historically Designated YES
Contractor's Company Name -tt.
Contractor's Address AV tfl
City DI P `i* State PV 1 Zip A V.4
Phone ## NA
State Certificate or Registration No. Certificate of Competency No. � l 4
Phone # ( ? &i 7 o 1 3
Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: ['Addition ['Alteration ONew VI eplace O Demolition
Describe Work:
CGD fieac,S2
I4AR 5 pt***** * **** * ** ***** ** * * **** *** * ** * * ** Fees************** * * ************* * *** * * *********
Submittal Fee $ O O Permit Fee $ /?2 , CCF $ G020 ., C.0
Notary $ Training/Education Fee $ 0 OJ Technology Fee $ a '(1, t� ^ _
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $ A
Structural Review. $ Total Fee Now Due $ ( _
See Reverse side -4
Bonding Company's Name (if applicable) N /i
At li
City iflt t state 14 /4-
Bonding Company's Address
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address
City AI fit-
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.
Signature Signature
Owner or Agent CC�� Contractor
The foreg g i trument was acckn ledg be f e me this O�.J The foregoing instrument was acknowledged before me this
,
day o /, , 20 byQ teA day of , 20 —, by
who is pe '.onally known to me or who has produced o r who is personally known to me or who has produced
NOTA
Sign:
Print
My Commission Expires: '' a o 49 My Commission Expires:
***************** *** *• x******* *: x******, x******** ****a: ***** ************•x***•x***** * **** :******* ****** *** **** * ***
APPLICATION APPROVED BY:
(Revised 07/10/07)
At/4
State
,s,
NOTARY PUBLIC:
Zip d+
Zip d►1�
identification and who did take bath. as identification and who did take an oath.
0414\
s IZ + '1L
Sign:
Print:
r .2009 Plans Examiner
Engineer
Zoning
VILLAGE OF 1VIIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: km, L a C. DATE: L? 3 • 5'. 1) 9
ADDRESS: /4 1 t? 9.R( / 0(9 54 • "VC brv7 1 g 1 ,S2)
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 understood 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 a licensed contractor. You have applied for a
permit under an exception to the 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. You may
also build or improve a commercial building at a cost of $25,000.00 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 complete, the law will
presume that you built for sale or lease, which is a violation of this exemption. You may not hire
an unlicensed person as a contractor. It is your responsibility to make sure the 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- holdings tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction
must comply with all applicable laws, ordinances, buildings codes and zoning regulations.
Please read and initial each paragraph.
1. I hold title to the above property and I am planning on doing this construction
Myself.
Initial A f t L
2. I understand that as an owner- builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application. Inactive
permits for a period of over 180 days will become null and void (expired)
and a new permit will be required to be issued for reinstatement of the
p ermit.
Initial 114 L
3. I have an understanding of the 2004 FBC & FRC and understand that this
depaitrnent and its inspectors are there to help enforce and interpret the code.
There is a copy of the code in this office for review.
Initial p L
4.
I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code — only if the structure meets the
minimum code.
Was acknowledged before me this
Initial /kilt
5. 1 understand that as an owner- builder, that any contractor disputes with sub-
contractors and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate any contract disputes.
Initial_j4 C
6. I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company or person.
Initial IJ, ,t
7. I understand that if any person .gets injured on my construction project—they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Initial
8. I understand that under state and local laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my property with out first obtaining
the proper permits by licensed contractors.
Initial
day of a2KAL, 20 V
By \Jtd 6 who was personally known to me or who has
Produced there License or IT a) 449 )1: tn' 2,0 0 as identification.
f A loo
wCiL97 worts
IMMERVIE
MAR 2 4 2009
BY:
laG .6 r1S-
D
WW
Sick
PERMIT #: e
Miami Shores Village
APPROVED BY
DATE
ZONING DEPT
BLDG DEPT 4' 0 Fjp-oce
SUBJECT TO C OMPUANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
tx bar
A ettelor.C.-0 eei.. fl -