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RC-10-1265BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING . ROOFING Miami Shores Village Building Department 10050 N.E:2ndAvenue, Miami Shores, Florida 33138 Tel: (305) 795;2204 Fu: (305) f56 8972 INSPECTION'S PHONE NUMBER: (3©5):762.4949 Owner's Name ( Simple Titleholder) PPriti '6 - 4 l a` gel Ph # Owner's Address sq. b 1 /� 2 State City )11 1 : -D�� '2 S n ty l � . Zip � � Tenant/Lessee essee Name ' :.. Phone # Email d piz a e eerrwe ! /' Job Address (where the work is bein "done) ' 7 NE :: /01 City hags Village County ain -1 ade : Zip 33 /� "/ FOLIO / PARCEL # : 1/ .- a / 3 � 00'1 0 YGc Is Building Historically Designated YES NO Flood Zone ®. ' Contractor's Company Name Contractor's Address City.. State Zip Qualifier Name Phone # State Certificate or Registration Ishl Certificate of Competency No Contact Phone Architect/Engineer's Name (if applicable) Value of Work For this Permit $ ` 1 5 �? ' Square / Linear Footage Of Work: , Co Se ,Q_�- Type of Work °Addition °Alteration . . . dd ���� __ ]New TA Repair/Replace 0 Demolition Describe Work: ) �� _4,414 X- dee Submittal Fee $ Notary $ Scanning $ `,- 0 Permit Fee $ e1/4 ***. ** * * ** * * ***** *** *** * * *** * **** * *x* *F * * * ****** BY- Permit No. -1O'° 1 2GS Master Permit No. Phone # E - mail Phone # ** ** *** * ** * * * * ** r *** * * * **** *:' *fir ** CCF $- CO/CC $ Training/Education Fee $ - keQ Technology Fee $; Radon $ 0 5D DP18R $ 0 i5 Bond $ Double Fee $ Violation date: .0 , ';9 Structural Review. $ Total Fee Now Due $ " " a 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 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 CONDTTIONERS, 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. Signature Sign: Print: My Commission Expires 604 12- Owner or Agent "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: Asa 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 and a reinspection fee will be charged. Signature .. Contractor The foregoing e instrument was acknowledged before me this (C, The foregoing instrument was acknowledged before me this d day of 1 , 201,c_ by . F 2lC,t 8151-to? , day of , 20 , by who is personally known to me or who has produced I 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: \ 0i 1111 mi /il NOTARY PUBLIC; ,\ ice ,,,, •'' '' i'�; / / 1:181,17.11;111:1:::": 5 , \�`\ 1: k * * * * * ** * *** * * ** * & *inY Q rk* drse.�ea�r****�+ k* * * k********** **it /! :. l Plans Examiner Zoning APPROVED BY * ** * *** ** * * * ** ****' (Revised 07 /10 /07XRevised 06/10 /2009) Engineer Sign: Print My Commission Expires: * ********* **** *** *** :4 Clerk checked Scheduled Inspection Date: October 04, 2010 Inspector: Bruhn, Norman Owner: BISHOP, PATRICIA Job Address: 89 NE 107 Street Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Building Department Comments October 01, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 148317 Permit Number: RC -7 -10 -1265 For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1121360070400 KITCHEN REMODELING Passed &/ 1 44E6 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 6 of 33 OWNER BUILDER DISCLOSURE STATEMENT NAME: p , 4/0,p DATE: 'V/ ADDRESS: rel NE /01 " - liy, ; ,, s . s Please read and initial each paragraph. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Pt 33 / 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 new form states 75,000). 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 understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial *4 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial . 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial ` 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http: / /www.mvfloridalicense.com /dbpr /pro /cilb /index.html Initial ' 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: gR npj" ! D 1 ` Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initi Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owners driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. �(r 11 Was acknowledged before me this day of v vv� , 20 By .14-112 1C,1 1 c54) who was personally known to me or who has Produced there License or as identification. T A ;ba;A) OWNER NOTARY '1 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. II ` ) J� "G� G 7 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and s eet /address: q /U i a ' sY" Interest in property: ./fir /,/-P, 2 Name and address of fee simple titleholder: rein 4. Contractor's name and address: Amount of bond $ 6. Lender's name and address: 123.01 -52 PAGE 4 8/02 Rcio- rs Notary Public Print Notary's Na e My commission expires: ° ``o 11 ` /3 L 007 ` OyD6 01 it 41111 /L S 3 'N to/ 2. Description of improvement: Of A..gill ‘12iL 1 ; t 5 VG 1° fcky7 t/v`f -,`C e. p Cail'I err -e N N C1160 I* /b 6 /U 61..0 f& R © `i 6 7. 3. Owner(s) name and address: p 7 ;# 14- ' ' s 4p r°t NE /0.0 f , » : 4 ib , �-d- `�lMW' 1 fir) t2 7 6-7- 5 \h04,1. / =G 3w 5. Surety: (Payment bond required by owner from contractot$ U 6.- �, tl -. !Ia °U .' r . W rrr r I I1I1J1 III11 N!I IIII1III#I1IIII!II!J Iiii llli CFN 20 �a r ' 437 OR Bk 27353 Psr 2213; tins RERECORDED 07/13/2010 11 :34. :>_ii i HARVEY RUUIN, CLERK OF COURT h1IAf1I -DALE COU!'4Ty p FLOE IrA LAST PAGE r. documents may 7. Persons within the state of Florida designated by Owner upon whom provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: j1/0 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a diff ent date is specified) Signature of Owner ;y Print Owner's Name 1 1rt-1f! / • 3, Prepared by ,✓, `.� of ! Sworn to and subscribed before me this of 1 ) !I/ �r 2o� —v Address: / ,o 5 tile di) /4/1. 1 1 , H rvl ; 4/.0A 1 Pt 331,3 kap[ t #44- 4- 6 sow f« 1• 78'-" 50" 15" S o ir k ALLER NEED TO USE A BASE BOX 24 AND MAKE ACCES TO THE CORNER HE SINK BASE. 0 m 5R INSTALLER NEED TO BUILT A WALL HEil 3" BOX FOR THE LOWER AND UP CABIN =T TP INSTALLER NEED TO CREAT A OPEN END SHELF IN A AN 1 144" 30" ( FIE -E tAti 18" 2 P 37" 21" 81'a" fio p, L5 l o 0 54- L Nv /L► 64-t A) � O 0 0116 .1 23" 24" N N w w rn c0 i dze ®/ - /e `�+�� r� /i'av s r<1,6p,ear� � „•to t P fr '7z D e%�ei >vA l' All dimensions size designations given are subject to verification on job site and adjustment to fit job conditions. T 020 This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. PATRICIA BISHOP Designed: 5/13/2010 Printed: 7/12/2010 All Drawing #: 1 co 0) co CNI I I I 1 iii : II N N. i ,.. Ln V t.'":,'!:', C■I -1 i 4 784." 50" 404 W153aNt. r • INSTALLER NEED TO CREA,Tg. A OPEN END SHELF IN A ANN All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. PATRICIA BISHOP 15" 33" 20" W ROT HERE 18" 2 PCS. 81-„F" V,3 0 ,1,11 ALLER NEED TO USE A BASE BOX 24 AND MAKE ACCES TO THE CORNER HE SINK BASE. 2L) 111 7 5R INSTALLER NEED TO BUILT A WALL HEM 3" BOX FOR THE LWER AND UP CABINET. GI ' ...te oe lv W cn (...) B091 - / ry s. .I:. ' 0) W3018 W2136L e. 0 8 -a co 30" / 31-3° / / 37" -7' 23" 30" / 21" / 24" 0 w PT pfr/- 'IA/ ej / 1,/ ,e7 20 This is an original design and must not be Designed. 3.'1 3 • 20 1 0 • I C . 5 A released or copied unless applicable lee Printed: 6 5 2010 has been paid or job order placed. !! I I Drawmg h N W4236 618R BF: S6333423 W3936 WF3 All dimensions size designations given are subject to verification on job site and adjustment to fit job conditions. 20 TECHNOLOGIES J This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. PATRICIA BISHOP Designed: 5/13/2010 Printed: 7/12/2010 El 1 Drawing #: 1 N M 24" WD2436R -GL W2136L BCFD36L 36" 60" 21" "B09 9 " 30" W3018 MW.HOOD 1' 1 " 33612 TP033424 min 21 I" All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. 202 TECHNOLOG ,J This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. PATRICIA BISHOP Designed: 5/13/2010 Printed: 7/12/2010 El 1 Drawing #: 1 N N CO V" N bo N O M N N M N N N 1 M 25" 61" 36" W3618 12" WI 236WD2436R -GL 54" 36" 24" All dimensions size designations given are subject to verification on job site and adjustment to fit job conditions. TECHNOL This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. PATRICIA BISHOP El 1 Designed: 5/13/2010 Printed: 7/12/2010 Drawing #: 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. PATRICIA BISHOP 20 W TECHPIO LOGIES PATRICIA BISHOP Designed: 5/13/2010 Printed: 7/12/2010 Drawing #: 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. PATRICIA BISHOP ZP OLOGIES Designed: 5/13/2010 Printed: 7/12/2010 PATRICIA BISHOP I Drawing #: 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. PATRICIA BISHOP TECH OIOGI PATRICIA BISHOP Designed: 5/13/2010 Printed: 7/12/2010 Drawing #: 1 4 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. PATRICIA BISHOP TECH Ni oc $ PATRICIA BISHOP Designed 5/13/2010 Printed: 7/12/2010 Drawing #: 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. PATRICIA BISHOP 0- , TECHNOLOGIES Designed: 5/13/2010 Printed: 7/12/2010 PATRICIA BISHOP I Drawing #: 1