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RC-07-869Permit Type (circle): Miami Shores Village 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) / Sd / Alt City Miami Shores Vill . e County Miami -Dade FOLIO / PARCEL # 1/ — Z2 30 — — 5 Contractor's Company Name Contractor's Address Value of Work For this Permit $ 1 vo° Is Building Historically Designated YES (3)" Bond $ • Code Enforcement $ Double Fee $ • Owner's Name (Fee Simple Titleholder) Phone # 7 86 2 86 bid 7 Owner's Address r 50, Ao d C / ® ,- 9r1 City 110 r i 54.4 eel State re- . Zip 33/38 Tenant/Lessee Name Phone # 7 f6 2-f6 b/ 67 Phone # Zip 1 1 Structural Review. $ Total Fee Now Due $ ' ;5 See Reverse side -4 mg 0 1 2007 BUILDING CG ® ��� 7 + Permit No. ) PERMIT APPLICATION r Master Permit No. FBC 2004 Electrical Plumbing Mechanical Roofing City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) /I 0+ Phone # Square / Linear Footage Of Work: 2 ZA- to 1/ AA 7f Type of Work: ['Addition 'Alteration ew 0 Repair/Replace 0 Demolition Describe Work: Odd Z pa v4 +rte! 5. e c /a.Ya ©'g . 7 r� * * * * * * * * * * * * * * * * * ** ** * * * * * * * *** F * * * * * * * * * * * ** * ** * * * * * * * * * * * * * ** Submittal Fee $ ruu't Fee 1 S7) Cr t21. CCF $ O 00 CO /CC Notary $ �'' Training/Education Fee $ 0 of Technology Fee $ :75 Scanning $ ( '�)- Radon $ DPBR $ Zoning $ Bonding Company's Name (if applicable) Bonding Company's Address City State . Zip Mortgage Lender's Name (if applicable) .LC/ /VW ? IC q Mortgage Lender's Address City 4-0") s 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 appr v and a reinspection fee will be charged. Signature Owner or Agent The foregoing "instrument was acknowled day of who is personally known to me or who has prod As identification and who did take an oath. NOTARY P ;�� 4 14 , impel vargots Commission #D1:173198 N. • ;aQExires:Ju113 00 0. / ___ ��_ NOT Sign: Print: My Co (Revised 02/08/06) , y ission Expires: * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: 93 79 /vg- 2-9t c State fL , Zip 33/3g Signature Contractor 30 The foregoing instrument was acknowledged before me this 1 day of , 20 , by who is personally known to me or who has produced NOTARY PUBLIC: f r 4 as identification and who did take an oath. Sign: Print: My Commission Expires: Plans Examiner Engineer Zoning INTERIOR REMODEL Passed /7 Inspector Comments el Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP -47749 Permit Number: RC -5 -07 -869 1 Inspection Date: November 03, 2010 Inspector: Bruhn, Norman Owner: POWELL, JEFFREY Job Address: 1501 NE 105 Street 1 -11 Project: <NONE> Miami Shores, FL Contractor: HOME OWNER Building Department Comments November 02, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (786)286 -0107 Parcel Number 1122300530590 Page 1 of 1 Iti VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: T P6.1/--a/ DATE: ADDRESS: / 5 U / /// / SS SdL Please read and initial each paragraph. 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. 1. I hold title to the above property and I am planning on doing this construction 9 ,,' , , Initial Initial 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. 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 e minimum code. l 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. 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. 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. 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. 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