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MC-07-87010050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING ©G J PERMIT APPLICATION to' FBC 2004 Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) J 41/ C/ h Plfone # g-of5 war / Owner's Address / �® / 4 / City A V State �� Tenant/Lessee Name E -MAIL: /11- V �Q' Job Address (where the work is being done) l S' / /7/E City Miami Shores Village County Miami -Dade FOLIO / PARCEL # it' *11 -3 0 ' 0 C3-- 0 C Is Building Historically Designated YES Contractor's Company Name Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Value of Work For this Permit $ '7 Square / Linear Footage Of Work: L / �k c� l / Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace �r� El Demolition Describe Work: T. `n `$ P p� 6 PC e Pk c.� aC7�0� 1�7�j E 0 ?cl Reps 44 d- - n ei0 Pe J Submittal Fee $ Notary $55 Scanning $ C Structural Review. $ xxwxa° xx*x Ica; xxxxxxx *w *w *wxxxxxxxxry� y. © l Training /Education Fee $ Radon $ Miami Shores Village Building Department ©U /8140 /i,: Phone # Permit Fee $ Yn3J 0 DPBR $ Permit No. Master Permit No. Zip 3� /3 lay Phone # sat. Phone # xxrxxxx* *** xxxx*w**aYxxxxxxxxxxxaFxxxx CCF $ 0 CO /CC Technology Fee $ '315 Zoning $ Bond $ Code Enforcement $ Double Fee $ Total Fee Now Due $ Zip See Reverse side Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 60¢ 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. l 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 ap roved and a reinspection fee will be charged. Signature • r r % Owner or Agent 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. `P v c NOTARY P j C: Sign: Print: My Commi APPLICATION APPROVED BY: (Revised 02 /08/06) ion Expires: ********xxxxx,:x9ex • • . Signature Contractor The foregoing instrument was acknowledged before me this day of ,20 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: xxx,4xxxxxxxxxxxxxxxxxx a Yxxx+'c**** u, Y *xxxxxxxxxx** **x49e Plans Examiner Engineer Zoning Lf [ 2 : 2D an. 12/3 N D aKs2.. t vim.. DEC 0 5 2007 Passed Inspector Comments W 1, 1( 7 WA& Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Inspection Date: 12/03/2007 Inspector: Grande, Claudio Owner: POWELL, JEFFREY Job Address: 1501 105 Street NE 1 -11 Project: <NONE> Miami Shores, FL Contractor: HOME OWNER Building Department Comments Thursday, November 29, 2007 Inspection Worksheet Miami Shores Village 12C 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 CL- O79 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number (786)286 -0107 Parcel Number 1122300530590 Lot: Page 1 of 2 VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: " PA A 6 c c_ -e • DATE: 57 6 ADDRESS: e 5 / /k /6 5----5--- Do Do hereby petition the Village of Miami Shores to act as my own contradtor 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 underyour 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 emplqyee, 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 co _ truction Initial 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 3. :I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. jij // 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 structur _ts minimum•code. Initial 5. I 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 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. Iffor any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed ceimpany-or person. 0y/ 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. Initi Initial 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my with out first obtaining the proper permits by licensed contractors. Was acknowledged before me this day of , 20 By who was personally known to me or who has Produced there License or as identification.