EL-09-1876BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) I l Ltil GCS Zti ie 7. Phone #
Owner's Address 1 `7 At r/ ' if C �—
e e
City State ' L- Zip
Tenant/Lessee Name
Email
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL #
Is Building Historically Designated YES
Contact Phone
Value of Work For this Permit $
Type of Work: DAddition
Describe Work:
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
❑Alteration
154 ^lam uis
hoe, Obouir'
E -mail
Master Permit No. PCC:5 13
Phone #
NO
Phone #
Permit No.
❑New ❑ Repair/Replace
1
FtV,MV{Elir
NOV 12 1009
BY:
99 - 63/ —C6J
33 <6f
Zip
Flood Zone
Contractor's Company Name
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work:
❑ Demolition
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * *** * * * **
Submittal Fee $ Permit Fee $ /5 - ®/m6 3 `•�Sdx'G7CCF $ 0 •�'J CO /CC $
Notary $ S Training/Education Fee $ 0 • 2..0 Technology Fee $ 0 • C
Scanning $ Radon $ 0 44 DPBR $ 0 •44 Bond $
(Double Fee $ One Violation date:
Structural Review. $ Total Fee Now Due $ W • (.00
See Reverse side ->
Bonding Company's Name (if applicable)
a .
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 re- inspection fee will be charged.
Signature
6 2 1144 wner or Agent
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of ,20,by
nn�� who is personally known to me or who has produced
(411 entification and who did take an oq as identification and who did take an oath.
w o g e ti
Sign:
Print:
My Commission Expires:
fore me this f
The for oin g i instrument as ac . owledge.
dayofl ylJ� , 2 b t Yfl Jig to
who is p sonally known to me or who has produced - ^'
1 •I•
My Commission Expires:
APPROVES BY z j/ t b='.9/t, Plans, Examiner Zoning
•
` Engineer
•E
(Revised 07 /10 /07XRevised 06/10/2009)
NOTARY PUBLIC:
Clerk checked
Inspection Number: INSP - 151358
Scheduled Inspection Date: September 20, 2010
Inspector: Devaney, Michael
Owner: GONZALEZ, SONSIRE
Job Address: 154 NW 111 Street
Project:
<NONE>
Contractor: HOME OWNER
Building Department Comments
September 17, 2010
Miami Shores, FL 33168 -4323
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Number: EL -11 -09 -1876
Permit Type: Electrical - Residential
Inspection Type,„ B .0 t1'
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360030450
ELECTRICAL WORK FOR KITCHEN REMODEL,
INTERIOR LIGHTING AND SMOKE DETECTORS
AS PER EXTENSION APPROVED BY NB, OK TO EXTEND
IT 45 DAYS 8/3/10
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 19 of 26
NAME:
VILLAGE OF MIAMI SPORES
OWN +R BUILDER DIS CLOSURE ,STATFMFNT
ADDRESS: 0 - 1 V f W,
0- s
DATE:
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 reaidbnce. 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 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 viohttion of this exemption. You may not hire
an unlicensed person as a contactor. It is your responsibility to make sure the people employed
by you hav® licenses. required by state law.and by county ar muniolpat 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.LC.A and with - holdings tax and
provide workers' compensation for that employee, all an prescribed by law. Your construction . •
must comply with all applicable laws, ordinances, buildings codes and zoning regulations.
Please read and initial each paragraph.
1. I hold. title to the above property and I am planning on doing this construction
Myself.
Initial /4 Ci
2. I understand that as an owner- 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
p ermit,
Initial c
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.
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.
Was .acknowledged before me this 102 day of
Initial
Initial
Initial
S1
6. I understand that if I compensate any person or company for work performed
they are requited to have a business license in the comity. If for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company or person.
Initial s
7. I understand' that if any person gets injured on my construction project-they are
entitled to workmen's compensation, Anil if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
kiss of wages during recovery from injury.
Initial 7,(
8. 1 understand that under state and local laws . 1 can not do . any Electrical,
Plumbing, Heating, Air & Roof work on my 'property with out first obtaining
the proper permits by licensed contractors.
who was personally known to me or who has
Produced there License ort Q O o a - N.0)1-] as identification.
NOVO PUBLIC-STATE OF FLORIDA
4a,,,,,..,,, Claud V. CA 11
' Cos+' 9P.7
23, 2011