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RC-10-1127Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use , Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number 553 NW 112 Street Miami Shores, FL 33138 -0000 3021360210920 Block: Lot: MYRTIS SPENCER 1 Owner Information Address MYRTIS SPENCER 553 NW 112 Street MIAMI SHORES FL 33168- tl Contractor(s) HOME OWNER Phone Cell Phone Approved: In Review Comments: Date Approved: : I n Review Date Denied: Type of Construction: BATHROOM REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupancy: Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Amount $0.60 $0.18 $0.20 $5.00 $100.00 $0.18 $3.00 $50.00 ($50.00) $0.80 Total: $109.96 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. I 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 June 29, 2010 Phone Pay Date Pay Type Invoice # RC -6 -10 -38230 06/21/2010 Credit Card 06/29/2010 Credit Card Amt Paid Amt Due $ 50.00 $ 59.96 $ 59.96 $ 0.00 Applicant Valuation: Total Sq Feet: $ 1,000.00 35 1 Available Inspections: June 29, 2010 Date Cell 1 Inspection Number: INSP- 147854 Permit Number: RC -6 -10 -1127 Scheduled Inspection Date: July 07, 2010 Inspector: Bruhn, Norman Owner: SPENCER, MYRTIS Job Address: 553 NW 112 Street Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: HOME OWNER Building Department Comments BATHROOM REMODEL. REPLACE TILE, TOILET, SINK & VANITY Passed 7 ,,6 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 06, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 3021360210920 Page 21 of 26 Inspection Number: INSP - 147852 Scheduled Inspection Date: July 07, 2010 Inspector: Devaney, Michael Owner: SPENCER, MYRTIS Job Address: 553 NW 112 Street Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: HOME OWNER Building Department Comments Passed c� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments z> REPLACE TILE, TOILET, SINK & VANITY July 06, 2010 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 -6 -10 -1128 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 3021360210920 Page 20 of 26 t S ' ,c - ' 3 A-7 H 4-0 cowl Y 12: S 55S ivw X12 • •.• • • • ... • •. • • • • •• •• • • • • • • • • • • • • • • • • • :::•: • ••• • p p1/4c610' 553 Nw ! l2 s- M. 2.71 bill 4 C Cja • .. • • 305 -758- 7789 368 Name Phone ## • 3 - 758 =7789 MYRTIS SPL'NCEI2 BUILDING PERMIT APPLICATIOI FBA 2O • .PermitType: BUILDING ROOFING . Miami Shores Village Building Department 10 050 N.E.2nd Avenue,. Miami Shores, Florida 33135 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Owner's Nanie (Fee . Simple Titleholder) 'MYRT I S SPENCER Phone # .' Owner's Address City MIAMI State FLOR IDA Tenant/Lessee Nam Email Job Address. (where the work is being done) 5.5 3 Nw 112 STREET .. . City Miami: Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 4 Phone # I Contractor's Address 1,4 City /Y State Zip Qualifier Name Phone # State Certificate or Registration No Certificate of Competency No. Contact Phone hi E -mail Architect/Engineer's Name (if applicable) Phone # :. Value: of Work For this Permit $ 1 446 4 " . " Square / Linear Footage Of Work: Type of Work: DAddition [Alteration (]New Re air/Re lace Demolition Describe Work: Rif L - / I C r l 6 e �i � �� ��, r ,1 4 * * *** * * * * *** * * * ** * * * * * * * ** * * * * * * * * * * ** Fees***************** * * *** ** *.;e*•x** ** * ***** * ** *: * e*� � , cam } Submittal Fee $ — Permit Fee .�/� CCF $ s (CI' CO /CC $ Notary $ -.)- t'., Training/Education Fee $ 0 . :- Technology Fee $ C) . --- ..- ' - Scanning $ -, C ' Radon $ ,. t 2 DPBR $ C. j d $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ e. I See Reverse side :3 Bonding Company's Name (if applicable) Bonding: Company's Address City Mortgage Lender's Naive (if applicable) Mortgage Lender's Address City State Zip . . (Revised 07 /10 /07)(Revised 06/10/2009) Application is hereby made to obtain a permit to do the work and installations as indicated.. 1 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 budding permit is issued, in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. State Owner or Agent The foregoing instrument was acknowledged before me this day of ``� -At, 20 by M el-13 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: .`z% fr.)) , °.• .r-.. a s.y ., _ •'Cif t� V • 4 ! ! Sign: Print: My Commission Expires: Zip 1 / 1 / . 1 1 1 1 1111 0 • **.*r x******* * * * * ** ** * * * *.** * * ** ** * * * * * ** *** * **** ** * * * * * * *** APPROVED BY C a"? e Plans Examiner Engineer Contractor 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: Sign: Print: My Commission Expires: *** *********** * ** ** * *** * * * * * * * ** * *. * * * * * * * ** Zoning Clerk checked O OWNER BUILDER DISCLOSURE STATEMENT NAME: / h i i $ i)) e,✓eer DATE: ‘" ? —/ O ADDRESS: 653/47v4/2 S-h N(, `a FL. 33 /61 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. Please read and initial each paragraph. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial 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. _ �,p Initial -)`° Initial l 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 144 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. �� Q Initial 1/"`° 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. 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. 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.myloridalicense.com /dbpr /pro /cilb /ind Initial °74""' 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: 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. Was acknowledged before me this _day of ' 70\-k__ , 20 (Z By ( 31 ersonall p Y who was known to me or who has Produced there License or as identification. Initial — Initial Initial 'tea Initial 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 returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's 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. .�`� �� � g ir � rurr , `4..." f A_.•- . es O k . / /.',.,, S TA ii,/ '��� r,int , Project Address Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 , Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee - Additions /Alterations Radon Surcharge Scanning Fee Technology Fee Total: Amount 00.60 $0.18 $0.20 $5.00 $100.00 $0.18 $3.00 00.80 $109.96 Building Department Copy Address Parcel Number Contractor(s) HOME OWNER Phone Cell Phone , Type of Work: REPLACE TILE, TOILET, SINK & VANITY Additional Info: ELECTRICAL Classification: Residential Scanning: 1 Authorized Signature: Owner / Applicant / Contractor / Agent Phone Pay Date Pay Type Amt Paid Amt Due Invoice # EL -6 -10 -38231 06/21/2010 Credit Card $ 50.00 $ 59.96 06/29/2010 Credit Card $ 59.96 $ 0.00 Applicant 553 NW 112 Street Miami Shores, FL 33138 -0000 3021360210920 Block: Lot: MYRTIS SPENCER 1 MYRTIS SPENCER 553 NW 112 Street MIAMI SHORES FL 33168- I Valuation: Total Sq Feet: $ 1,000.00 35 1 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. I 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. June 29, 2010 Date Cell Available Inspections: Inspection Type: June 29, 2010 1 BUILDING Permit No. ra10--1178 PERMIT APPLICATION Master Permit No. 10 - 1 1 en FBC 20 • . Miami Shores Village EtaiEgw3D Building Department 1 0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY: INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) MYRTIS SPENCER Phone # 30 5_758_778 9 Owner's Address 553 NW 112 STREET City MIAMI State FLORIDA Zip 3 3 1 6 8 Tenant/Lessee Name MYRTIS SPENCER Phone# 305-758-7789 Email Job Address (where the work is being done) 1 2 UT County Miami-Dade Zip City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name A44 Phone # Atk i Contractor's Address tNIA 1 , City /\/ State Zip Phone # State Certificate or Registration No. A(.4. Certificate of Competency No. \Sontact Phone I14 E-mail Qualifier Name AM- Architect/Engineer's Name (if applicable) Phone # i i I Value of Work For this Permit $ / 60 - ° 6 Square / Linear Footage Of Work: 35 1 Type of Work: DAddition DAlteration ONew r2; Repair/Replace 0 Demolition , Describe Work: P.e_e/2 c...e.. Ti L. e rb i (.-e 1 6( di< 4 ‘7,3.-.) , /-(.?,.di Afit:e-ei \ ******************************** * ********************************* Submittal Fee $ 5t) .0* Permit Fee $ cit CCF $ CO/CC $ ipM tp Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ .c, Violation date: Structural Review. $ Total Fee Now Due $ EC nte See Reverse side -5 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re- inspection fee will be charged. Sign: Print: Signature `'`" Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 91 The foregoing instrument was acknowledged before me this day 20 by My 127%S e tJ4$tdayof ,20,by who is personally known to me or who has produced 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: NOTARY PUBLIC: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY .0. (Revised 07 /I0 /07)(Revised 06/10/2009) 11111 /1,,� Engineer Sign: Print: My Commission Expires: c °,"y °�_yh � % d -'` 4 ci f �: / e /Ii44*** **16 J gty? *aYiY�r **fir * * *Jt�r * *de***tY�k�isaY * * * * *** *fie* qtr* *atr�r�+r** **�tr�te+� ** *fir \ i //rinnnikti� 'r /Pais Examiner Zoning Clerk checked 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.mvfioridalicense.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: 663 Pfw t_z S f 6viia 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. Initial -2 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. Was acknowledged before me this g9 day of 'L 20 By l 3 Spcb.ada--who was personally known to me or who has Produced there License or OWNER as identification. M iami Shores Village ff-c 1tc_Nc__ Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �1 OWNER BUILDER DISCLOSURE STATEMENT NAME: `� `\f Ir'÷ t S C - e n DATE: C° 2 ?"-*/ n ADDRESS: S VV l 12 S+ k a.M t f L. 1 4 2 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. Please read and initial each paragraph. 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. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initi 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. Initi 7yt 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. y � 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 " Protect Address 553 NW 112 Street Miami Shores, FL 33138 -0000 3021360210920 Block: Lot: MYRTIS SPENCER Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 MYRTIS SPENCER 553 NW 112 Street MIAMI SHORES FL 33168- Valuation: Total Sq Feet: $ 1,000.00 35 Contractor(s) HOME OWNER Phone CeII Phone Type of Work: REPLACE TILE, TOILET, SINK & VANITY Type of Piping: BATHROOM REMODEL Additional Info: PLUMBING Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Technology Fee Total: Amount $0.60 $0.18 $0.20 $5.00 $100.00 $0.18 $3.00 $0.80 $109.96 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. I 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 June 29, 2010 Address Parcel Number Phone Pay Date Pay Type Invoice # PL -6 -10 -38232 06/21/2010 Credit Card 06/29/2010 Credit Card Amt Paid Amt Due $ 50.00 $ 59.96 $ 59.96 $ 0.00 June 29, 2010 Date OVEI Expiration: 12/26/2010 Applicant CeII Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground 1 l OWNER BUILDER DISCLOSURE STATEMENT NAME: tk\f Y -}- 's 5 .P•4Ge - DATE: (' 2' — 1 o ADDRESS: 553 1 t k 2 SA - -kc a- "t `/ F L. 3 .31 6 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. Please read and initial each paragraph. M iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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. J Initial 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. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial yIt 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. , � � p Initial ` -e4 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 7 ` - 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. 1, 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. 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. 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.mvfioridalicense.com /dbpr /pro /cilbfindex.html Initial `714-ef 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: 563 pi 1,0 II S a fL 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. 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 returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's 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. Was acknowledged before me this y .J l day of -Sl A> �, 20 ‘ By � / J , ° o was personally known to me or who has Produced there License or as identification. -(0 JA--e_ OWNER NOTARY Initial ` 74 " ---1 Initial �/ Initial Initial BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING 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 Permit No. Master Permit No. Owner's Name (Fee Simple Titleholder) MYRTIS SPENCER Phone # Owner's Address 553NW '1 12 STREET 305 - 758 -7789 Zip 33168 City MIAMI State FLORIDA Tenant/Lessee Name MYRTIS SPENCER Phone # 305-758-7789 City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated Contractor's Company Name if /4 Contractor's Address City Qualifier Name N Architect/Engineer's Name (if applicable) State YES NO Phone # /IA Phone # Describe Work: Rep aee f i -ro (1e 5 /;`) Vx./;5 Structural Review. $ Total Fee Now Due $ oRmammsn .NON " 2 1 n1 N 'c_ to -\12f Email ST Job Address (where the work is being done) � N � t 17_ Zip Flood Zone k State Certificate or / Registration No. Certificate of Competency No. 1N•4 Contact. Phone /Y A E -mail Zip Phone # I. / Value of Work For this Permit $ 100 ' • c `� Square / Linear Footage Of Work: 35 Type of Work: ❑Addition ❑Alteration ❑New g Repair/Replace ❑ Demolition * * * ** * * *•* ** * ** * ** * ** * * * * * * * * * ** * * * ** ** F * * * * * * * ** * * * * * * * * * * *** * *** * * * ** Submittal Fee $ Permit Fee $ /or CCF $ 0 ,L 0 CO /CC $ VIA( $ 5 Training/Education Fee $ 0 .riAD Technology Fee $ `t' U Scanning $t : U1.. Radon $ 0 . \ E- DPBR $ 0 . , C C 1 Bond $ Double Fee $ Violation date: See Reverse side - <51 ricc, 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. Signature 1' / Signature Owne or Agent Contractor The foregoing instrument was acknowledged bef a me this 9.1 The foregoing instrument was acknowledged before me this day of , 260, by1 ttN4.., day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identifiwtib1i'an id take an oath. as identification and who did take an oath. .�` eCS ... ' 7, NOTARY PUBLIC: ' •' ‘ . .... • • ' % NOTARY PUBLIC: Sign: ' _ 0) Z; • °= Sign: Print: � c ' q' Q �,.� Print: My Commission Expires: ' S j P���` My Commission Expires: /a►►nnrn'" APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) 2 3, 0 * Plans Examiner Zoning Engineer Clerk checked Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL , \ \�2 lU Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 146580 Scheduled Inspection Date: June 30, 2010 Inspector: Devaney, Michael Owner: GOLOFARB, IGHAL Job Address: 8849 BISCAYNE Boulevard Project: Miami Shores, FL <NONE> Contractor: AGUILA ELECTRICAL CONTRACTORS Building Department Comments Phone Number Parcel Number Permit Number: ELC -6 -10 -1132 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Sign (305)868 -8203 PARC2003 -23 Phone: (305)397 -7604 HOOK UP TWO SIGNS TO STORES JUNCTIONS BOXES TIMER INSTALLATION. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 29, 2010 For Inspections please call: (305)762 - 4949 Page 14 of 19