61 NE 102 StType Insp'n .C.t l .Q,, Li
Permit No.
Name 69
Address
Company
Phone #
For Inspec
Approve
or:
Correction
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Ti
e
Re- Insp'n Fee ❑
V /� Name
Date l a ��/81
Type Insp'n - 1 i.
Permit No. 6, 0 `f' — d ig
Name
Address
Approved
Re -Insp' n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Company
Phone# (5T 7 r p - ? a e l
Inspe / Date � !�/ — .03
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buildin: Inspection Request
Date D e �
Type Insp'n
Permit N
Name
_
Address &l Ai /
Comeany
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
Permit Type (circle):
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Electrical Plumbing Mechanical . Roofing
R 4 /44, 7 �$1^ /419 �j1 Owners Name (Fee Simple Titleholder) /1b J� Phone # �D 2
N , G .
Owner's ddress
City 1 St
Tenant/Lessee Name
Stat
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
$ Value of Work For this Permit
Type of Work: Addi on
Describe Work: WODA
S(A3 Pa g .c_
Submittal Fee $1 • 00 Permit Fee $
Total Fee Now Due $ • l
(Continued on opposite side)
Miami Shores Village
17
�' Ali C. . /
Architect/Engineer's Name (if applicable) L/'VY 11 / 6
I a ■ 0
Notary $5 / , 0 0 Training/Education Fee $ . "a D
Scanning $ h . OD Radon $
Code Enforcement $
Master Permit No.
Zip 33138
Permit No. 6e04-1015.
Phone # it) —
County Miami -1 )1de Zip 3/.3e
NO V
,U/,1- /J Y 6(4‘41 e #
Contractor's Company Name
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Phon
-) /BD---7B4
,CCD
uare Footage Of Work: 2/6 , f =Q Q
❑New • ❑ Repair/Replace ❑ Demolition
Alteration II " � �
�G K . j 4JDf 11 CSl 11) (or at- T-6
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
CCF $ r 4 0 CO /CC
Technology Fee $ 3 • II_
IjC).0U -i
Zoning Bond $
Structural Plan Review. $ 50.00 ..°
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 he 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 no fyapproved and a reinspection fee will be charged.
Signature �"J a d " — , Signature
who is perso
NOT
Sign:
Print:
Chc 05/13/03
Owner or A4 ent Contractor
The foreg i ' : instrument was ac ledged bef me this le foregoing instrument was acknowledged before me this
day of , 20 _ , by
J' )( I C )3f ,20 —,by
known to meor}ivho has produced who is personally known to me or who has produced
as identification and who did take an oath.
•
I
Y
iraYMPIOA
lre. ul 1, 2007
mmission Expires: `s 1 1 •1 . 1 .
v .
As
My Co
* * * * **
APPLICATION APPROVED BY:
tification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* n 3k • *********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ***************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
4/1 ' ' SfI L ( e f Plans Examiner
Engineer
Zoning
B
Produced
• BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE .STATEMENT
I J f )1 r b I' pdtb, being the legal property owner, for the property
Located at: 6
- 102 /I etAr
Legally described as 2 L
Do hereby petition the Vil age of Mia Shores to act as my own contractor pursuant to the laws of the
State of Florida, F.S. 489.103(7)4nd I have read and understand the following disclosure
Statement, which entitles me to grork 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 $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 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 licensed 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 ( )
Was acknowledged before me this day of ) , 20
Owner
initial of reviewing clerk. Tlie foregoing instrument
who is personally known to me or who has
as identification who did take an oath:
Notary
��+� lvi t:iel V ar'g'
�=•`° ommission liDD23 4
.5; ` . : Q
J9� p@ xpires: Jul 13,200
`) I3onded Thru )
O '
'" Ail 'c Bonding Co.. In `
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: BP2004 -1015
Printed: 8/3/2004
Applicant: JULIO
Owner: REGALADO
JOB ADDRESS: 61
Contractor
Local Phone:
Parcel # 1132060131670
NE 102
Signed: (INSPECTOR)
Signed: (Contractor or Builder)
Building Permit
REGALADO
JULIO
ST
Page 1 of 1
Contractor's Address:
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 19 & E1/2 OF LOT 18 BLK 12 LOT SIZE
, C,�U
Fees:
FEE2004 -7802
FEE2004 -7803
FEE2004 -7804
FEE2004 -7805
FEE2004 -7806
FEE2004 -7807
Description
Building Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Scanning Fee
Total Fees:
Amount
$125.00
$0.60
$5.00
$0.20
$3.12
$6.00
$139.92
Total Fees: $1 9.9 100
Total Receipts: $0..00
271, 9
3q -qa
Permit Status: APPROVED Permit Expiration: 1/19/2005 Construction Value: $800.00
Work: WOOD DECK AND CONCRETE ADDITION SLAB TO PORCH
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 responisibility for all work
done by either myself, my agent, servants or employes.
BY: