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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 •• • • ... ■e,. •••• • • CEP • ."._._. •••• ••. • • • ••• ••• • •• •a. •a -. • f••••r • • • • • • • • • •••• • • • • • • • • • . - _ •