FW-09-1704 r 3
s Miami Shores Village
g t
a 10050 N.E. 2nd Avenue 'W ` t3�d
Miami Shores, FL 33138-0000
Phone: (305)795 -2204
Tr
Expiration: 041 2010
Project Address Parcel Number Applicant
1700 105 Street 1122300500010
Miami Shores, FL Block: Lot: SHORES CONDOMINIUM
Owner Information Address Phone Cell
SHORES CONDOMINIUM 1700 NE 105 ST
MIAMI SHORES FL 33138
Contractor(s) Phone Cell Phone $ 1,000.00
HOME OWNER Valuation:
Total Sq Feet: 60
Approved: Yes For Inspections please call:
Comments: (305)762 -4949
Date Approved: 10/16/2009: Yes Available Inspections:
Date Denied: Inspection Type:
Type of Construction: Wood Fence Additional Info: Final
Classification: Commercial Foundation
Fees Due Am ]$2.50 Invoice # Total Amt Paid Amt Due
CCF FWA 0-09 -36169 $ 109.30 $ 59.30
Education Surcharge
Permit Fee - Wire & Wood $FW-10 -09 -36169 $ 109.30 $ 109.30 $ 0,00
Permit Technology Fee Check * 9638
Scanning Fee Submittal Fee Submittal Reversal Fee ( Total: $10
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.
November 03, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 03, 2009 1
Miami Shores Village
OY Building Department
{V 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305). 762.4949
BUILDING Permit No
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type:
Owner's Name (Fee Simple Titleholder) J4 S G:OW) 0 1 t5 C Phone #
Owner's Address / 700 I%X .
City /,GSA -1., %57, r State �� Zip
Tenant/Lessee Name Phone #
Email -�
Job Address (where the work is being done) 17610 A/. ,9!F.
City Miami Shores Villaee County Miami -Dade Zip 33«
FOLIO / PARCEL #
Is Building Historically Designated YES NO k Flood Zone
Contractor's Company Name 49WI agile Phone #
Contractor's Address _ /70o A ' AF L -
City /r/C �-4-,ri! i J 1010 � S State 7 -1:::: / Zip 3.S' l3
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace .
❑Demolition
Describe Work: e��1 %J " @e OA,) eo 7A,/
Del 2 6 Fr� ,g pp� / o
Submittal Fee !r V �.J Permit Fee $ ��� CCF $ `mil./ CO /CC $
Notary $ Training/Education Fee $ • Z0 Technology Fee $ 2
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date: ,
Structural Review. $ Total Fee Now Due $ S ci - 9 )o
See Reverse side -a
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable
Mortgage Lender's , Addre
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 approved nd a re- inspection fee will be charged.
Signature Signature
Owner or A ent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day o 2001 , by day of 20 _, by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si Sign:
Print: L. UGIZET tA = Print:
My Commission Expires: r Na y Puboa;t J@ of P10�rI� My Commission Expires:
Luwds 8 PayMn
My CommIsWo DD000711
a, Expim s 07/12/2013
APPROVED BY Plans Examiner �!� Zoning
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)
Planning and Zon"ng Cifteria
Miami Shores Village Permft No. FW-1 0-09-1704
10050 N. E. 2nd Avenue ...................................................................................
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Miami Shores, FL 33138-0000 .................
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................ .. M.A.
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-22 -A
Phone: (305)795 04 Fax: (305)756 8972 . ........ __ ............................. . ..................
f.
Issue Date: Not Issued Expires' Not Issued
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-1. 1 .................
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Folio Number: 1122300500010
Owner's Name: SHORES CONDOMINIUM Owner's Phone:
Job Address: 1700 105 Street Total Square Feet: 60
Miami Shores, FL
Total Job Valuation: $1,000.00
;377.
............. I ................. ........................ ................ ............................................ .............................................. I.-I .............. . ........................................
Contractor(s) Phone Primary Contractor
HOMEOWNER Yes
........... . . . .. . .... .........
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 10/16/2009: Yes
Comments:
V OF MIAMI SgO:RES
OWNER BUILDER DISCLOSURE STATEMENT
NAME. j lil e DATE:
AD 0 .tF Q (G� y�c/ 0/`�5
Do hereby petition the Village of Miami Shores to act as myown contractor pursuant fo th lawns �
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
constmotion yourself. You may build or improve a one - family or two- family retidence. 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 attd 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 fot sale or lease, which is a violation of this exemptieul. You enay not hire
an unlicensed person as A contractor. It is your responsibility to make sure the people employed
by you hav ®licenses required by static law -Add by county or muuiicipal licensing ordinances. Any
person working on your building who is not licensed ctiget work under your sgpervision and must
be employed by you, which means that you must deduct F.LC.A and with - holdings tax and
provide workers' compensation for that employee, all as prescribed bylaw. Your ootruotion
must comply with all applicable laws, ordinances,.buildings codes and zoning regulations. ns
Please road and initial each paragraph.
1. I hold. tide to the above property and I am planning on doing this construction
Myself.
Initial t
2. I understand that as an ovcinnr- 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
permit.,
Initial • ,
3. I have an understanding of the 2004 FBC & FR.0 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.
Initiac
4. h 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. ,
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 0
attorney. The department will not mitigate any contractdisputes.
Initial — 0 �
6. I understand that if I compensate any person or company for work performed
they are requited to helve 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 wroitg
doing from this unlicensed company or person.
Initial `Y ` '
7. I understand that if any person gets injured on my construction project they are
entitted to workmen's compensation, And Ik they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
kiss 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
Was .acknowledged before me this _ day of , 20
BY t rlW f Y who was p Y ersonall known to me or who has
Produced there License or 1(Q9'd ' • entification.
OWN NO ARY
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 127209 Permit Number: FW -10 -09 -1704
Scheduled Inspection Date: January 19, 2010 Permit Type: Fence/Wall
Inspector: Bruhn, Norman Inspection Type: Final
Owner: CONDOMINIUM, SHORES Work Classification: Wood Fence
Job Address: 1700 NE 105 Street
Miami Shores, FL Phone Number
Parcel Number 112230050001
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
BUILD 5' WOOD FENCE ON BOTH SIDES OF EXISTING
SHED WITH ONE GATE
Inspector Comments
Passe /� / �G
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 15, 2010 For Inspections please call: (305)762 -4949 Page 5 of 23