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EL-09-1698 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305). 762.4949 BUILDING �� Permit No: _ � � ` —� to q b PERMIT APPLICATION �� 5 Master Permit No. FBC 20 Permit Type: ELECTRICAL 'L Owner's Name (Fee Simple Titleholder) � (�� �� Phone # 78 6 ' oZ-95 _ T Owner's�Apddress _ � � n �p A c[ City & 'T State r c.. Zip _ 3 �la C'3 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) I V C 1 N I' 0 SWPP City Miami Shores Villaee County —Miami—Dade—z FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name N / 13­ Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E-mail I Architect/Engineer's Name (if applicable) /V Phone # Value of Work For this Permit $ 1,600 Square / Linear Footage Of Work: Type of Work: ElAddition ❑Alteration []New .2 Repair/Replace ❑ Demolition Describe Work: /ZA., D . k' } yr, ,- Submittal Fee Permit Fee $ 116�® CCF $ CO /CC $ Notary $ .--- Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double'Fee $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side �4 Bonding Company's Name (if applicable) Bonding Company's Address t 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 re- inspection fee will be charged. i ature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me thi� The foregoing instrument was acknowledged before me this day of 200 by �L� +h �(}�Q h-0 , day of , 20 by , who is personally known to me or who has producedJF I J L who is personally known to me or who has produced M A0 IS C--� As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ou a Sign: Print: o' 'mac Print: My Commission Expires: �0�f °' My Commission Expires: z 0 4V 19 APPROVED BY K , ; ,,Oo ��rgu *ans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) • VILLAGE OF MIAMI SI ..OWNER BUILDER DISCL SURE TATEMWNT NAME: : 1 DATE: / , 9 /S l� ADDRESS: �� 7 //e) �q / Do hereby petition the Village of Miami Shores to act as myown 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 41lows you, as the owner of your property, to act as your own contractor even though you do not have a license. You ' supervise the construction yourself. You may build or improve a one - family or two- family residCnce. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use slid 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 bf this axempti®rt. You May not hire an unlicensed person as s contractor. It is your responsibility to make sure the people employed by you have licenses required by static law.axid by county or muriiolpal licensing ordinances. Any person working on your building who is not if dwat wgrk under your supervision and must be employed by you, which means that you must deduct F.LC.A and with - holdings tax and provide workers' pompensation for that employee, all as presorlbed bylaw. Your construction must comply with all applicable laws, ordinances, -buildings codes and zoning regulations. Please road and initial each paragraph. 1. I hold.title to the above property and I am planning on doing this construction . Myself. Initial � vv\- -- 2. I understand that as an ow ner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application. •Inactive permits for a period of over 180 days -will become null and void (expired) and a new permit will be required. to be issued for reinstatement of the permit., Initial V y� 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 4. I• understand that the building official and inspectors 'are not there to design, alter or give advice on how to meet code — only if the structure meets the minimum code. Initial V�( 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 0 attorney. The department will not mitigate any contract disputes. Initial rp 6. I understand that if I compensate any person or company for work performed they are requited to halve a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrozig doing from this unlicensed company or person. Initial T. 1 undefatand'that if any person gets injured on my construction projcct they are entitled to workman's compensation. if they do not posses a workmen's policy I could be held iiabte for all doctor and related cost which could include kiss of wages during recovery from injury. `"� Initial 8. •I understand . that under state and local laws ' I can not do . any Electrical, Plumbing; Heating, Air & Roof work on my with out first obtaining the proper permits by licensed contractors. Initial �� Was -acknowledged before me this lV day of 15 , 20 © 9 By who was personally known to me or who has Produced there License or _ I O -- 04 D as identification. OWNER NOTARt) �2 . rsf °d CO,