DECKMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp'n 1 F nCI I Peet_
Permit No. V1 O- 15'11
Name n 2.
Address ( 0q N(. 1V2-S)
Correction
Re- Insp'n Fee
( .1- f
Company
Phone #
For Inspector: 11, 14 Name & Date
Approved ❑
0
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp'n W - L •
Permit No. r Loo - /57
Name /
Address (C9L NLE 100-
Company
Phone # a� ��2 zZZ eh lS — 5
For Inspector: l 4/ v / Name & Date
Approved
Correction
Re- Insp'n Fee ❑
BUILDING
PERMIT APPLICATION
FBC 2001
�$ Value of Work For this Permit
Miami Shores Village
Building Department
/ Permit Type (circle): Ouildinj Electrical Plumbing Mechanical Roofing
X Owner's Name (Fee Simple Titleholder) M A 1210 SU A lata. Phone # 4111 3oS • 7S6 - S '16 5
Owner's Address 6a lie 10e STR.c -FT
City U4 'AM 1 S!•}OQe$ State f(— Zip 3313g
Tenant/Lessee Name N 1 IA , Phone #
Job Address (where the work is being done) 6q P(E 10 2 STR¢.e r
City Miami Shores Village County Miami -Dade Zip 3 31 3$
Is Building Historically Designated YES NO X
Contractor's Company Name N / A , Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) fr i 4 . - Phone #
Architect/Engineer's Address
City State Zip
soo=
fr7rP
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit No. (p 2OU5 ✓ l 5 - 7 1
Master Permit No.
Square Footage Of Work: 1 Z Z O
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ['Addition �1 ['Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: Imo' U1md Oeek. lewd
County Escrow Fee $ \ ' 20 Permit Fee li __.. Notary $
Education/Training Fee $ Tech $ Scanning $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ 3 5* Total Fee Now Due $ 3 7 rq yy C / J � 5y. 1 '
ski L f l YL� • a
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Radon $
(Continued on opposite side)
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 curs s ' a s after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap roiand a ection fee . e charged.
Signature
0 ' r or Agent
The foregoing instrument was acknowledged before me this c,2 n
day of 20 by 1 tt .-LArt ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOT
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
chc7tM 3
Signature
argas NOTARY PUBLIC:
ion #DD231984'
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.
Sign:
Print:
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
OCT - 2 2003 Plans Examiner
Engineer
Zoning
• y
OWNER BUILDER DISCLOSURE STATEMENT
Q 10 SUr1a. Z. being the legal property owner, for the property
ocated at: 6c1 1U€ (or-- 5T - EST.
Legally described as (cr4s 2.0 and 2. i , i l 12 , _
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 understand the following disclosure.
Statement, which entitles me to Itrork 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 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 ( ) initial of reviewing clerk. The foregoing instrument
Was acknowledged before me this day of , 20
B who is personally known to me or who has
•
Produced 0 as identification and who did take an oath.
Owner
Owner
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
DISCLOSURE STATEMENT
Notary
•
f
attached survey, performed by LAWS WS 4 i lq ¢-C 114
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, µ fr ru V SVA R.CL , does hereby attest that the
(property owner)
(name of surveyor's company)
performed on L /16 101 , is an accurate representation of the existing conditions and
(date of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or
Further, Affiant sayeth naught.
Witness(sign and print) Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me, produced as identification.