565 NE 101 St (14)I Type Insp'n 111. . - . �•
Permit No.
Name
Address 54--C i ht C 1 0 f ji
Company CrI/l f/
Phone # 3 QS' �7S • S3
/ D
Inspection Date / /.. p
y
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Approved
Correction
Re- Insp'n Fee
BUILDING RECEOVED
PERMIT APPLICATIO11 JAN n 7 2004
Contractor's Company Name
Total Fee Now Due $
Type of Work: EAddition ['Alteration
Describe Work: ' C b
Submittal Fee $
Notary $
Scanning $ 3
Code Enforcement $
(Continued on opposite side)
State
"a 6 S • (.(
1V11d1111 31101 CS V llid
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Ott) lk.112■ '
5(05 /l/' /O/ 5.7
❑New
1‹...I
Phone #
Permit No. P 2230`l ` CO
Master Permit No.
■-e
Permit Type (circle): wilding Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) A /D ,'/ S C ( )') z ._ Phone # 305- 7 3 - (oOS e-
Owner's Address
City
Tenant/Lessee Name - Phone #
Zip
Job Address (where the work is being done)
City Miami Shores Village County Miami-Dade Zip 33/3?
Is Building Historically Designated YES NO V
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit 4006 i Square Footage Of Work:
p Repair/Replace
1 S.
Vie HC. C41.■
❑ Demolition
* * * * * * * * * * * * * * * * * * * * / * ** * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ / 00 / Ob , CCF $ / 1 8
Training/Education Fee $ , 0 Technology Fee $
Radon $ Bond $
4 6 444 ! 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 occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be a. proved and a reinspection fee will be. charged.
Signatur
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this I The foregoing instrument was acknowledged before me this
day of. n , 20 O ((, by f A ®t■SQ CLP cle_ day of , 20 _, by
who is personally known to me or who has produced 5 5 1( who is personally known to me or who has produced
M n
Va
NOT $UBL.... : �?: Cmisio >lD g qgq NOTARY PUBLIC:
Sign: I► i � ' e c EX ire 1 1 Sign:
Bonded Thru
Print:,( Atlantic Boy Print:
Chc 10/14/03
cx‘e
My Commission Exp
Signature
As identification and who did take an oath. as identification and who did take an oath.
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *. ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: JAN - 6 2004 Plans Examiner
Engineer
Zoning
Located at:
OWNER BUILDER DISCLOSURE STATEMENT
Produced , C y OrS�
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
a7 being the legal property owner, for the property
7t/E" /b! �f
DISCLOSURE STATEMENT
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),.nd I have read and understand the following disclosure:
Statement, which entitles me td cork 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 n 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 $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 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 r day of , 20
By J t Gq Can cQ. who is personally known to me or who has
as identiftion and who did take an oath.
Mabel Var;
Commission #DD ' 1984
° J . , 2007
Bonded Thru
` Atlantic Bonding Co., Inc.
Miami Shores Village
10050 NE 2nd Avenue
Printed: 1 /8/2004
Applicant: VIOLET
Owner: CAUZA
JOB ADDRESS: 565 NE 101
Contractor
Local Phone:
Parcel # 1132060171140
Signed: (INSPECTOR)
Building Permit
Phone: 305 - 795 -2204 Permit Number: BP2004 -6
CAUZA
VIOLET
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOT 21 & 22 BLK 94 LOT SIZE 100.000
Fees: Description Amount
FEE2004 -186 Building Fee $100.00
FEE2004 -187 Building Fee $100.00
FEE2004 -188 CCF $1.80
FEE2004 -189 Notary Fee $5.00
FEE2004 -190 Training and Education Fee $0.60
FEE2004 -191 Technology Fee $5.00
FEE2004 -192 Scanning Fee $3.00
FEE2004 -193 Code Enforcement Fine $100.00
Total Fees: $315.40
Total Fees � 0
$1.40 c
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 7/5/2004 Construction Value: $3,000.00
Work: REPLACE KITCHEN CABINETS
JAN 09 PAID
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:
5,
/1<