RC-06-2551Issue Date: 10/13/2006
Owner's Name: DORA WATLER
Permit Type: Residential Construction
Work Classification: Repair
Job Address: 6 106 Street NW
Additional Information
Miami Shores Village, FL
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 04/11/2007
Contractor(s)
HOME OWNER
Phone Primary Contractor
Yes
Type of Construction: OVERHANG
Stories: NA
Front Setback: NA
Left Setback: NA
Bedrooms: NA
Plans Submitted: Yes
Certificate Date:
Bond Return : NA
Occupancy: Single Family
Exterior: NA
Rear Setback: NA
Right Setback: NA
Bathrooms: NA
Certificate Status:
Additional Info:
Classification: Residential
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.
Fees Due Amount
CCF $0.60
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee - Additions /Alterations $100.00
Scanning Fee $3.00
Technology Fee $2.50
Total: $111.30
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: RC -10 -06 -2551
Phone:
1121360050170
Lot:
PB:
Total Square Feet:
Total Valuation: $ 350.00
Re, uired Ins . ections
Final
0
Invoice Number
RC - 10 - 06 - 26419
Total:
Amt Due
$111.30
Amt Paid
OCT 1 3 PAID
1 SI �-
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Permit Type (circle):
Owner's Name (Fee Simple
Owner's Address
City 41/4 /
Tenant/Lessee Name
FOLIO / PARCEL #
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
State
Miami Shores Village
• iD ) o� ,
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION aCTi 1 2006
FBC 2004 `f
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
Permit No.
aster Permit No.
Electrical / Plumbing Mechanical Roofing
D 1 1 4 A Hee_ Phone # 50 S /7sh -572 7
Zip 5'3 fSD
Phone #
Job Address (where the work is being done) 4 U) / 0 ia
Cit AO M Shores Village County Miami -Dade f/ Zip 3 '3 /�
Is Building Historically Designated YES NO
pOOM
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Phone #
Square / Linear Footage Of Work: f . ? Q ..eviV
Type of Work: 0Addition ..['Alteration ['New -- « Repair/Replace 0 Demolition
Describe Work: �� �' ' , r / C'( .1 yQ
** * ********************************F , *, * * * ** ** * * ***** * *** * * * * * *** * * * **
Submittal Fee $ Permit Fee $ 100 CCF $
Notary $ Training/Education Fee $ Technology Fee $
Total Fee Now Due $
CO /CC
Zoning $
See Reirerse side --*
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 approvr and a reinspection fee will be charged
Signature
Own* or Agent Contractor
The foregoing instrument was acknowledged before me this ii The foregoing instrument was .acknowledged before me this
day of � , 20 by -- P /ldli Iva( ( , day of , 20 , by
who is personally known to me or who has produced 8 ¶77 ir) z /who is personally known to me or who has produced
B M -14 4651a ® As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
r e , to sachussenova
Ccoms 20,2009
Bandedthol • pybUcUn a ®re
Sign:
Print
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 42/08!06)
Signature
Sign:
Print
My Commission Expires:
03/oc.
Plans Examiner
Engineer
Zoning
NAME:
VILLAGE OF MIAMI SHORES
OWNER BUILDER OTSCLOSURE STATEMENT
DATE: /
ADDRESS: �l 1 �, �
'' r✓iei Fl 3 *5 (SO
Do hereby petition the 'V.illage Miami Shores -to act as my own contractor pursuant to the laws
of the State pf Florida, F.S 489.1.00(7). And I have read and - understood the following disclosure
statement, which entitles Me to work as my own contractor; I further understand that 1 as the
owner must appear in person to complete: all a'pplicationg.
State Law requires construction to be done by a licensedcontractor. 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.yotir own. use and. occupancy. It may not be built for sate or lease:.If you sell or lease a
building you have built yourself within one year after the.constructlon 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.thatyou must deduct F.I.C.A and with - holdings tax and
provide workers' compensation for that employee,. alt as prescribed by law. Your construction
must comply with all applicable laws, ordinances, buildings codes and zoning regulations.
Please read a.ndinitial each paragraph.
1. I hold title to the above property and I am planning on doing this construction
Initial l'
2. I understand that as ari owner - builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
Initial J &)
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.
Initial l� 1�
4. 1 ' understand that the building official and inspectors are ndt 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 an
attorney. The department will not mitigate'any contract disputes.
Initial 31 W
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 teason they
do not .posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company'or person. ,
Initial
D b°D
7.
t' understand that if any.person.gets injured on my construction project —they are
entitled to Wdrkrtien'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 focal laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on thy property with out first obtaining
the proper permits by licensed contractors.
Initial 11'
Was acknowledged before Ime this 11 day of OGT , 20 0`
By ?Y& - jry . who was personally known to me or who has
Produced there License or Snip s Lt. .�� it' -h as identification.
APPROVED
DST
®LDG DEPT
SU.OJECT TO COMPUAN s. ft TN ALL
STATE AND COUNTY RULES AND REGULATIONS
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