PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 2 ('/ Job Address '/66 ' /r /t'2 f r Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant
Owner's Address
Contracting Co.
71 Ol4 °z '797/ 51V/11
4/. i ' Sr
coyowe I 6
Qualifier / Ait r 0 4P/00(A'
Phone 8 93 - 23yy
State # C G C 007059 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ? q r 74 4 & illefr
9
9'qe%
7 / WJ // 8e<qnh /
(value) 2 Uao, OG
hat all work 'll be d one
u... r u�„cc .,� tract j 0
CEMENT AND YOUR FAILURE TO DO SO MAY
PERTY (IF YOU INTEND TO OBTAIN FINANCING,
G YOUR NOTICE OF COMMENCEMENT.)
ed above, and on the attached addendum (if applicable). I
onstruction in this jurisdiction. I understand that separate
d MECHANICAL WORK.
wi /
do the work sta
i
S'gna ' e of ontract•r or Owner -
Mi er/
N. ary as to IF tractor or O
My Commission Expires:,
t•
SEAL
OFFICIAL NOTAR
ALETHA JACKSON
NOTARY PUBLIC STATE OF FLORIDA
WMMISSION NO. CC358111
NOTARY TOTAL DUE 01 afl
Building 4
Plumbing Engineering
Electrical
: ' er
� A Ui400W
ompliance with all applicable
P76
ate
arAtuitztesi 3 71 20 1 9
er -B ilder Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date /x/ /39* Job Address 46(9 N "' S 1' Tax Folio 7/ go? ®,6 6 0 l
Legal Description ‘127 ..1'. fc -- f/ ,D ,L S -fcG• /P
Owner / Lessee / Tenant G ° & 4/I, R -CM /' 4 Master Permit 4i .,_.;31'
A la 6 /v E 1O2.' 1 Phone 76 2 5' q
Owner's Address /(
Contracting Co. arte0w�e Address 616,6 N E (U." 51
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
n .464eafuJP
WORK DESCRIPTION 4 - Q Q " 5 I.14o4 F`o° R S -
a e i roo ent eof
Square Ft. 2-5 Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I
authorize the above -named contractor to do the work stated. �I
r in^ 0, - 'frl-kk
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
APPROVED:
Zoning
Signatu e o Contractor or Owner- Builder
Date: t �1.. 2 - /9,y
``• to .' as to C • F � N tCMNNise
My Commission s p 3 r• M CC187545
** * * * * * * * * * * * *
FEES: PERMIT-1
ERMIT `� ,5 -61 RADON C.C.F. Pe NOTARY ' TOTAL DUE
**
Fire Other
c
uildin
Electrical
Mechanical Plumbing Engineering
Per 489.103(7) F.S.S.
DISCLOSURE STATEMENT
State law requires construction to be done by licensed
contractors. You have applied for a permit under an exemption to
that law
property,
have a li
The exemption allows you, as the owner of your
to act as your own contractor even though you do not
cense. You must supervise the construction' yourself.
You may build or improve a one - family or two - family residence or
a farm outbuilding. You may also build or improve a commercial
building at a cost of $25,000 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 more than one building you have
built yourself within one (1) year after the construction is
complete, the law will presume that you built it for sale or
lease, which is a violation of this exemption. You may not hire
an unlicensed person as your contractor. Your construction must
be done according to building codes and zoning regulations. It
is your responsibility to make sure that people employed by you
have license required by state law and by county or municipal
licensing ordinances.
�1 _ 71/(11Q
�
zz 3
D to Owner's signature
Village Use Only
Owner's name(print)
Permit No
M cirk , °4-11
MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT
INSTRUCTIONS TO OWNER- BUILDER
You have, this date, made application for a building permit as an owner -
builder. You should be advised of the following provisions and requirements
that apply to owner - builder.
Proof of Ownership - Prior to a building permit being issued to you,
you must submit proof of ownership of the land concerned in the
application in the form of a recorded deed, showing you own the property,
or a copy of mortgage or warranty deed of the land, or a Dade County tax
receipt, statement to contain legal description of property and indicate
property is in your name. Legal description and name on document of proof
must correspond to the name and legal description on the application.
Responsibility - You will be responsible for all work done by your day
labor employees, and you must either employ licensed contractors or
persons to be paid on an hourly or per diem basis. Any one contracting
(including labor) with you, verbally or in writing, on a fixed fee basis
for any work, who is not properly licensed, will be subject to a fine of
$500.00 and /or imprisonment for six months.
Insurance - You should be advised that if your day labor employees cause
any damage to persons or property, or if any of your day labor employees
are injured on the job, you are liable. Your regular home insurance
policy ordinarily does not cover this type of liability.
Withholding Taxes, etc. - You should be advised to investigate your
responsibility for withholding Social Security, Federal and State
Unemployment Insurance Taxes and Federal Income Taxes from the wages
of employees working for you on the proposed construction, and for
making returns thereof to the proper agencies.
Work Permitted Owner - Builder - An owner - builder subject to the foregoing
provisions and requirements, is limited to constructing one single family
residence each year for his own use and occupancy; or maintaining, altering
or repairing his own single family residence.
If you do not intend to do the work involved yourself, or with day labor, please
list below,' the name of the individual or firm with whom you have entered (or
will enter) into a contract for the work.
NOTICE: SEPARATE PERMITS REQUIRED FOR ELECTRICAL, PLUMBING,
ROOFING AND MECHANICAL WORK
2-16,G ti 10Z ti Sst
X16. Sm 1
Name of Individual or Firm Address
I, the owner of property described as 6/ 4 / /"9/a
do hereby certified
that I have read the foregoing instructions; and am aware of my responsibilities
and liabilities under my application for a building permit for construction work
on the above described property.
vkPie L�LC 041/ ,2 2),
Witness Owner
Date
2:4?h
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
/D .2 S ired
Job Address
Legal Description LUT E ,624 9/ Aftidge .S 4/ Master Permit # � �Y
Lessee / Tenant 710 All 0 11-5 9L SCA... SA441 e4f' c/2�
Owner's Address phone #75-3,0,0
Contracting Co. M_30 rVe - IbLe_i e3F O Address
Qualifier SSA - - phone
State# Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION 6C(_ .4- U "$(1"h t t O r" o
(-494rei)
Square Ft. Estimated Cost 4 IS SO
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated. I certify
that all work will be performed to meet the standards of all laws regulating construction in this
jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS,
POOLS, ROOFING, and MECHANICAL work.
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.
Furthermore, I authorize the above -named contractor to do the work stated.
-- 1 4-f -4 e x./ a - T��L/2.2J1J
Signature of Owner and /or Condo President Signature of Contractor or Owner - Builder
Date: Date:
J/ di CC d d FL
Notafi► as t o Owner and /o ZOTA� PUBLPI i �ATE
5l�Jf�IDA Notary as to Contractor or Owner - Builder
My C�Smmission Expires: My Commission Expires:
* * * *MY COMMD EXP�S APRIL 199'2 * * * * * * *
BONDS NRU SiEMBI - ADAMS & S EL D
PERMIT FEE: APPROVED: Fire Other
Tax Folio l / ,3)4 /7 4),:W/
3 .5 - ; D it Zoning :uilding Electrical
• .SO Mechanical Plumbing Engineering