FW-07-17414 -
iff
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle):
Contractor's Company Name
Contractor's Address
City
Submittal Fee $
Notary $ 5
Total Fee Now Due $
(Continued on opposite side)
Owner's Name (Fee Simple Titleholder) j)/l re h9. ICOST • Phone # „34S 7J `R33
Owner's Address /4 ^ f� //p c,T
City 1YJ/d1/ 4oftS State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Villa e
Is Building Historically Designated YES
Architect/Engineer's Name (if applicable)
•
Scanning $
Code Enforcement $
Il4VC.J'
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Fee $
Electrical Plumbing
Training/Education Fee $
Radon $
County Miami-Dade
NO v
Structural Plan Re
?AV$ 3 OPAJD
Permit No.
Master Permit No. Fit) 01-1-ILI
Zip .0/0/
Phone #
/5i Ale /!a sr
Phone #
Zip
Q L - c-I - Phone #
State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
,1p $ Value of Work For this Permit # 3,0 0 ' Square Footage Of Work:
Type of Work: EAddition ❑Alteration New
Describe Work:
tc re ace Aid 9 %E
set #4,' -e t t c ei-c.14 fl S . /�- e�.�ir ,. /2C-O� -/330
0
P li : -L ;20 '-' 0 /' ; ---- ,!..) :14
i
BY _
Mechanical Roofmg
17Repair/Replace ❑ Demolition
CCF $ 0 CO /CC
Technology Fee $ 2`50
Bond $
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this i 7
day of 0 S , 20 , by (. 01. @ ® iSnc '�
who is personally known to me or who has produced
As identification and who did take an oath.
Signature
NOTARY PUBLIC:
Chc 05/13/03
Sign:
Print: d�y�P�
My Commis
Sign:
Print:
My Commission Expires:
Ayy
MY COMMISSION N OD 174
EXPIRES: Doecmber 11), x000
FL Notey Dlteewnt Moo, Co.
APPLICATION APPROVED BY:
* * * * * * * * **
Signature
Contrac
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
/6 if 7,
,tL 6 s z n7D I &S rn L S TA- kvzc
toss_ oor. SI7 a 7t As
)47. Zd 1417
Plans Examiner
Engineer
Zoning
ti
t ,
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
I % )11.1- e:ix 4e ®crQ•
Owner
Owner
being the legal property owner, for the property
Located at: /54 AdC irl' ST ov?rai/ Sl7re$ T- 3311, 1 .
Legally described as ,
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),,.Tnd I have read and understand the following disclosure
Statement, which entitles me to l ork as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
DISCLOSURE STATEMENT
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that 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 or a farm out - building. You may also build or improve a
commercial building at a cost of 525,000.00 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 a building you have built yourself within one year after the
construction is completed, 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. It is your responsibility to make sure
that 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 Iicensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction must comply
with all applicable laws, ordinances, building codes and zoning regulations.
Proof of ownership provided ( ) initial of reviewing clerk. The foregoing instrument
Was aclaiowledged be ore me this 18 day of
13 UJILf14d0 090 /!ob$0
Produced as identification and who did take an oath.
who is personally known to me or who has
OF N ORIDA
bel Vagas
on #1)1)679170
o,,,, Expires: JULY 13, 2011
BONDED TIONI ATLANTIC BOND M 6,Vo INC
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number:1121360040450
Owner's Name: WILFREDO ACOSTA
Job Address: 158 110 Street NE
Miami Shores Village, FL 33138-
Owner's Phone:
Total Square Feet:
Total Job Valuation:
13
$ 1,000.00
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
1
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 8/17/2007
Comments: FENCE AND GATE MUST BE OF APPROVED MATERIAL, MASONRY, WOOD, CHAIN LINK OR
ORNAMENTAL METAL (NOT INCLUDING SOLID SHEET METAL)
$
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Owner's Name: WILFREDO ACOSTA
Issue Date: Not Issued
Permit NO. FW-8-07-1741
Owners Phone:
er
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 8/17/2007
Comments: FENCE AND GATE MUST BE OF APPROVED MATERIAL MASONRY, WOOD, CHAIN LINK OR
ORNAMENTAL METAL (NOT INCLUDING SOLID SHEET METAL)
Expires:1 /1 /2999
Folio Number:1121360040450
••
•
•,
•
•
••
••
•
••
•
Job Address: 158 110 Street NE Total Square Feet: 13 ••
....
•
•
••
Miami Shores Village, FL 33138- •
••
•
Total Job Valuation: $ 1,000.00
........
Contractor(s) Phone Primary Contractor
HOME OWNER Yes
Date
Thursday, August 30, 2007
08/30/2007 Credit Card
Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
1
Permit Number: FW -8 -07 -1741
Invoice Number: FW -8 -07 -29663
Applicant: WILFREDO ACOSTA
Company Name:
Owner Address:
158 N. E. 110 ST.
MIAMI SHORES, FL
Job Address:
158 110 Street NE
Miami Shores Village, FL 33138-
Payment Type Check Number
Amount
$114.30
Change
$0.00
Total Payment: $114.30
Page 1 of 1
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
158 NE 110 Street
Miami Shores Village, FL 33138-
1121360040450
Block: Lot
WILFREDO ACOSTA
Address
WILFREDO ACOSTA
158 N. E. 110 ST.
MIAMI SHORES FL
Contractor(s)
HOME OWNER
Phone
Cell Phone
Approved: No
Comments: FENCE AND GATE MUST BE OF APPROVED MATERIAL MASONRY, WOOD, CHAIN LINK OR
Date Approved:: No
Date Denied: 8/17/2007
Type of Construction: Concrete Precast Additional Info: FENCE 5 FT
Classification: Residential
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Wire & Wood
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$5.00
$100.00
$6.00
$2.50
$114.30
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. 1 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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Thursday, August 30, 2007
Phone
Total
$ 0.00 $ 0.00
Payment Type:
Amt Paid 1 Amt Due
$ 0.00
Available Inspections :
August 30, 2007
Date
CeII
PROVED
Expiration: 02/26/2008
Valuation:
Total Sq Feet
$ 1,000.00
13
Inspection Type:
Foundation
Final
1
1