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RC-09-199zt lost krti - Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATI FBC 2004 Permit Type (circle) Building Roofmg r Owner's Name (Fee Simple Titleholder) 11AA:_. kO il(�1U tPhone # 7 �6 `t'� 3 a��1d Owner's Address a30 ( N E, Q (0 ST �J City tt7C..s C� State Zip Tenant/Lessee Name Phone # Permit No. IkL O� — qq Master Permit No. Job Address (where the work is being done) 30 1 NE,./ C/(0 24-- City Miami Shores Village County Miami -Dade Zip?a FOLIO / PARCEL # Is Building Historically Designated YES NO ')( Contractor's Company Name Phone # 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 # Value of Work For this Permit $ Type of Work: ❑Addition t-co c) ,rr5Q ❑Alteration Square / Linear Footage Of Work: ❑New ' Repair/Replace ❑ Demolition Describe Work: iiat Submlittai Fee $ Notary $_ Training/Education Fee $ * * * * * * * * * ** Fees* :x**** * *** * * * * ******** * **** ** +x*:x:x****** **** Qao CCF $ Iic0C0/EE- Permit Fee $ Scanning $ Bond $ Structural Review. $ Total Fee Now Due $ Ft ' s Radon $ Technology Fee $ "..5 DPBR $ Zoning $ Code Enforcement $ Double Fee $ See Reverse 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 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil ot be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this oi day of V' J who is personally k nown to me or who has produced ,20 ,by anti 1-1Ciottots ') As identification and who did take oath. Signature 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: NOTARY PUBLIC: 0 Sign: Print: My Commission Expires: *** *** * * * ** * * * **** ****** Sign: Print: My Commission Expires: ***************************** *** ** * * * * * * * * ** * * * * * * * * * * ** * * ** APPLICATION APPROVED BY: (Revised 07/10/07) Plans Examiner Engineer Zoning WNW q..q. Man MOM Mira WNW m c MIN CO bra• G CC J C.3 w r. c'3 ¢ IMO sonstu- h 1,0 a,, CC s3 . * r^.- c- J ra*3 Cr- r.�I C -4 N 17.4 rZ3 CG 1.:7 C. Lai GC C4 UJ ct t:• Cc: £a3 to w¢¢ Ca�'1" This Instraa nt Prepared 7s Name Address X Permit No OCH _4 STATE OF 11,.. 111-e S 4.33138 NOTICE OF COMMENCEMENT Tax Folio No. COUNTY OF ei , . THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Description of property: (legal description of props , and street address if available3 y (� ®( N , t currt 1 or-e.S m 1 4 � c m ron ki() l 41016Artlyn,net.6-61estirepliac--e �)t 2. General description of improvement: X -‘ 3. aOwNnear mine foarnmd aatdiodn ress: susay) L -ti 1� v� tt b. Interest in property: ( 4~U �� �ECt (..,'\-. 4' v t� S c. Name and address of fee simple (1 e older (if other than owner): YW� • x ` 4. Contractor: ,(34,-"Pt kivyib0;tq 5 5tt, s'w Q 1 /►v� a. Name and address: ei,— �h Y/ -2 b. Phone number: L�"�� ��� l- ( 3'� t 5. Surety ��C� �P a. Name and address: b. Amount of bond $ c. Phone number: 6. Lender a. Name and address: b. Phone number: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: a. Name and address: b. Phone number: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 7.13.13(1)(b), Florida Statutes: a. Name and address: b. Phone number. 3313? 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. iF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCINt3 WORK OR RECORDING YOUR NOTICE OF COMME CEMENT The foregoing Insst r],e�tt was acknowledged befo foraying (name authority, ...e.g, officer, trustee, ,. behalf of whom instrument � f® gnatu a of Owner or Owner's Authorized Officer irector Partner /Manager �0 ti ���j �� �tdA Signatory's Title /Office (jku,Y me this /7 day of , 07 (year) by _I$O1 on) as oL .t (type of _(name of party on Slgnatur= of Print, Type, Commission Personally Known to of Florida ssioned Name of Notary Public or Produced Identification Verification Pursuant to Section 92.525. Florida Statutes Under penalties of perjury, I declare that I have read the foregoing a d that the facts stated in it are true to the best of knowledge and belief. of Natural Person Si ning1Abq J05c11Di 3.1)4 r1 \r° INTERIOR RENOVATION DEMOLITION PLAN LOCATED AT: 301 NE 96th Street MIAMISHORES, FL. 33138 OWNERS: SUSAN & TONY RODRIGUEZ TEL: 786 / 546.3942 SCOPE OF WORK: MASTER BATHROOM — 30 BATHROOM • • ■\, CeNoesZitly • N / A INTERIOR RENOVATION LOCATED AT: 301 NE 96th Street MIAMISHORES, FL. 33138 OWNERS: SUSAN & TONY RODRIGUEZ TEL: 786 / 546.3942 SCOPE OF WORK: - MASTER BATHROOM BATHROOM 6las rr ? roo r c_li` in94-etEi er • • •• • • • •••• • • •••• •••. • • • •• • art ° on all waUlsl femaloor'ir>q Ye A* shc►e r ae 's�in� }ub LEGEND: EXISTING PARTITION TO REMAIN AREA NOT IN CONTRACT SCALE: 3/32° = 1' -0° INTERIOR RENOVATION REFLECTED CEILING PLAN LOCATED AT: 301 NE 96th Street MIAMISHORES, FL. 33138 OWNERS: SUSAN & TONY RODRIGUEZ TEL: 786 / 546.3942 SCOPE OF WORK: - MASTER BATHROOM - BATHROOM 11 room • • �'Iqt eft' '+; • • • Ei ),4C;•' •• • • • • • •• • •••• • • •••• -�vi raked ee r.r% te`,�.p (' " hc7�Uu� be4u€,�� LEGEND: c 1 4z EXISTING PARTITION TO REMNN , ? , k 5 r e . " r 7 �°, Pe'' 7 f AREA NOT IN CONTRACT SCALE: 3/32° = 1' -0° VILLAGE OF MIAMI SHOR1 S OWNER BUILDER DISCLOSURE STATEMENT NAME: %$ailk. P rt DATE: EN)) Gl' f q • ADDRESS: 36i PE q(04/k ta4uut . 24116eSt S 313 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 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 it 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.LC.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 hold title to the above property and I am planning on doing this co lion Myself. In 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 permit. 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. 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 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. 6. I understand that if I compensate any person or company for work performed they are requited to have 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 wrong doing from this unlicensed company or person. 7. I understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Was acknowledged before me this I day of By S‘i 'r)rc Initial ,206( who was personally known to me or who has Produced there License or f, -7>ti 4 ,3 tic 10 I 4'60 as identification. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Scheduled Inspection Date: April 30, 2009 Inspector: Bruhn, Norman Owner: RODRIGUEZ, JUAN & SUSAN Job Address: 301 NE 96 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration ttosos Phone Number Parcel Number 1132060135880 Building Department Comments Inspector Comments Passed W:3../11;9 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. A - :1 .fll flnnf Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 c! Inspection Number: INSP - 106145 Permit Number: EL 2-0 9-200 1 Scheduled Inspection Date: April 28, 2009 Inspector: Devaney, Michael Owner: RODRIGUEZ, JUAN & SUSAN Job Address: 301 NE 96 Street Miami Shores, FL 33138- Project: <NONE> Contractor: DAY STAR ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060135880 Building Department Comments APQ 2 Nri Passed Q Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comment -c7t- , ',A .0'7 w — _s LEI "AA" rb\l--eS\ % BUILDING PERMIT APPLICATION FBC 20 Miami Shores pillage Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type (circle): Building Roofmg Owner's Name (Fee Simple Titleholder Q. �! ! 1 In Own 's Address KE_, City t0-14/-1. or State Tenant/Lessee Name 44- l� Email y� SD a g- g0.J 0 mmomEwrcl it teas i s 2009 lUa Permit No. ec lJ'' I ° l `"I" !Master Permit No. Phone # "`-7P40 4/3— (wp7 ( zio 33 d 8 Phone # Job Address (where the work is being done) \90 / -A E., ey( City Miami Shores Village / County Miami -Dade FOLIO / PARCEL # a a c)(0o 11 3 S p g 6 Is Building Historically Designated YES NO X Contractor's Company Nanie zip S3) Flood Zone Phone # Contractor's Address City State Qualifier Name State Certificate or Registration No. Certificate Contact Phone E -mail Zip Phone # of Competency No. Architect/Engineer's N a. applicable) Value of Work F Type of Wo Describe Phone # Square / Linear Footage Of Work: ❑ Demolition Submittal Fee $ Notary $ Training/Education Fee $ Scanning $ UL1 Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ a >. Fs di : bye. ' ri ., et n Ar r/ Permit Fee $ CCF $ core- Technology Fee $ Zoning $ See Reverse 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 FJ F.CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFNIDAVIT: 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 by , 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 identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: *************** ** * * * **** ** * * * **** ** * * * * * * * * * ** ***********************:** s*** * * * ** * * * ** * * * * * * * * ** * * * * * * * * * ** �PIO? APPLICATION APPROVED BY Plans Examiner Zoning Engineer (Revised 07/10/07) Clerk checked • • • • • • • • • • • ------6-6-6.--10—E 6 • ii ow---e-- • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • -.6(111 • •• • • • • • • • • • •• • • • • • • •-- . r • •• 11#1• •p• •• • • 6" • • • • • • •• • • • • • , • •--": : : • • • INTERIOR RENOVATION tOCATED AT: 301 NE 96th Street trilAMISHORES, FL. 33138 OWNERS: SUSAN a: TONY RODRIGUEZ TEL; 786 / 546.3942 SCOPE OF WORK: — MASTER BATHROOM _ > BATHROOki thkJk art on All waits, not& -Picoit vs ate 4404 i 174 Abb,sliealer . _ 64°64 BATHROOV 1- • - )-1r1C1 s 11F-111ffin 4'404, As Are rwr,..,m6, replOke 1 su 1=1 MTV PARTITION TO RENYIN oo`:A 1,,J 000 - AREA Nur IN CONTRACT ' 11# curd Walh ##. \j‘ giALEeffe&-.01:e ad-14s •••• • • •••• • • • • • • • • • • • •• • • • • •• •• • • • • • • • • •r fa ••••• • • • • • IX@XVIR MAR 1 62009 PERMIT #: e',Cg -jC le) Miami Shores Village APPROVED BY DATE ZONING DEPT BLDG DEPT t?p,:647 SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) Owner's Address City /14 /Awl / $u 5 A ,/ 17.302261)9 BY: Permit No. PLO? Master Permit No. ?COI /Z,d4 cc.-e 2_ Phone # Sot kI.t• sr- State Tenant /Lessee Name E- MAIL: Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # e( 3 , z-'6 6 Zip 33 138 Phone # I' 6 sr. County Miami -Dade Zip 33/38 Is Building Historically Designated YES Contractor's Company Name NO �e [ NIA 2 p(-J6- Contractor's Address 5Y63 5 tJ Cj Z AW-C City lyt,i Nom: State Fl 3 3 ( S' SSG -- fl Z 4 State Certificate or Registration No. G f G (41- -1-2-4y Certificate of Competency No. E -MAIL: Phone # 3 °5 2 "} l i8 00 Qualifier Name & CCM 4.9 %Zo ,,,/ Zip Phone # Architect /Engineer's Name (if applicable) Phone # Value of Work For this Permit $ /sa , ,o o Square / Linear Footage Of Work: Type of Work: ❑Addition ViA lteration ['New ❑ Repair /Replace j El Demolition Ele4 cribe Work: AM // �✓ A %y — /? e„c 9de s oar ��. I /4 re % T 4t..- d A-�- N1 -/3 a -- Re/0 c,9..7-c .s h -19 4v -Pit •°f 700-e IL, A e i- v vim_ 4-1-- //2 /4 l 2 S rev /e S . mss✓ s Willer/ 5- <,„( p, zAytti F 164 Submittal Fee $ 2 Permit Fee $ 2 2-c9 Notary $.S*l Training /Education Fee $ n •� CCF $ I•DO CO /CC Technology Fee $ S`SO Scanning $ 3- Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $) . "' See Reverse 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 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection w be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was a owledged be 2(0 I, by day of who is ersonally k own to me or who has produced NOT RY '. As identification and who cif ,oath. UBLIC: • Sign: �____ ..J A./ ,I � � � ��? Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED (Revised 02/08/06) Signature The forego day of who is p Con tractor ng instrument was ackno , 20 by wn to me or who has produced cation and who did take an oath. Sign: Print: My Commission Expires: f Ii '�..;� c eb��Vic. gi��ti * :********* ** * * * * * * * * ** * * * * * * * * * * * * * * ** * ** l II' 114.. * * * * * * * * * * ** 6O�V Plans Examiner Engineer Zoning Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Scheduled Inspection Date: April 01, 2009 Inspector: Perez, JanPierre Owner: RODRIGUEZ, JUAN & SUSAN Job Address: 301 NE 96 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER �:i�. *,. Rail: 7;. C, 47: t: F} YF! F.; f>::.'! F7� ;F:7l;I.•R::?NM:;S, ;:!6FiF,.;� ;15!IL]Y!f•:# Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060135880 Building Department Comments Passed '0 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 31, 2009 Page 6 of 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 756.8972 BUILDING PERMIT APPLICATIO FBC 2004 Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) S stu Owner's Address 30 1 jam, 9(04k sf City Lb awl %oil State Tenant/Lessee Name h k E -MAIL: Permit No. hin Master Permit No. tt �dtc, one# JR 21-`1 Q1 7( Zip 3313? Phone # ' Ora re,prYl4 a.► l ' Carr% Job Address (where the work is being done) City Miami Shores Village County FOLIO / PARCEL # 1, Is Building Historically Designated YES NO 1� Miami -Dade Zip Contractor's Company Name Contractor's Address • C Mil Phone # City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Value of Work For this Permit $ r�7 Type1of Work: ['Addition Describe Work: re f* 11 � SbQ .00 Phone # Square / Linear Footage Of Work: ❑Alterati n New ❑ Repair /Replace ❑ Demolition rovil eyhau Intisity-a.ihresisry) eir)-ct tt * * * * * * *xxxxxxx * * * * * * * * * * * * ** Fees * * * * * * ** * * * * * * * ** * * * * * * ** Subi`it a1�Fee $ Permit Fee $ CCF $ Jo Not 4$ SOD Scanning $ ' Training /Education Fee $ * * * * * * * * * * * * * * ** Technology Fee $ Radon $ DPBR $ Bond'_$ Code Enforcement $ Structural Review. $ Double Fee $ CO /CC 3:75 Zoning $ Total Fee Now Due $ V i e See Reverse 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. [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: 1 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." 0 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 of be approved and a reinspection fee will be charged Signature 4 1 Owner or Agent The foregoing instrument was acknowledged befo day of f(60 , 20 , by 4 4 who is personally known to me or who has produce 1,-/C. 70 q4 O As identification and who di NOTARY PUBLIC. Signature • Contractor e this l 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: xxxx+Y*** kxx'xxo:x'xa:oYxx: NOTARY PUBLIC: Sign: Print: My Commission Expires: x4c *xxxxxxxxxx :x:Yxa**x *xx*&xse*** ***xxxic aY*** * *xx****xxxxx******** ** ******* APPLICATION APPROVED BY: (Revised 02 /08/06) Plans Examiner Engineer Zoning VILLAGE OF MIAMI SIIO:RES OWNER BUILDER DISCLOSURE STATEMENT NAME: I`1 a yr / DATE: ADDRESS: 30 I M E, RECEIVED 9. 444 klicupu_. 5313E1 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 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 bf this exemption. You may not hire an unlicensed person as It 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.LC.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 hold title to the above property and I am planning on doing this construction Myself. Initial 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 permit. 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. 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 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. Initial 6. I understand that if I compensate any person or company for work performed they are requited to have 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 wrong doing from this unlicensed company or person. Initial 7. I understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Initial Was acknowledged before me this 9 day of reb , 20 Oq By burl '6ve3U tl iC who was personally known to me or who has Produced there License or F /, Lic 70'i 4 0 as identification. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Owner's Name (Fee Simple Titleholder) Owner's Address 301 i,, q (per- .- City jj 1 a"tk State q- Tenant/Lessee Name tr ■I E -MAIL: St00l� C ..41.110,40A2: ail .-' •CCTV-% Job Address (where the work is being done) �, () J up, �C" City Miami Shores Village County Miami -Dade FOLIO / PARCEL # 412ZnieggiggE 113ea04,0135350 Is Building Historically Designated YES NO )c Permit No. tL 01-111) RECE 1VED Master Permit No. COT. �`Gq Phone # 78 41-73 c (o.7 (o Zip 3513 i Phone # Contractor's Company Name 3 4'Y 574R. ELC C..%i(C. /NC. Contractor's Address 230 A'. E. / a' ST: Zip Phone# 3O3 -G1 16-3i7g City Aio /11 /4(11 State Fl.- Zip 3311( Qualifier Name J4(2J . P. C pL E%'m�j Phone # 3 ()Ls= a o6 -3073 State Certificate or Registration No.EIFOo;4 /6 ' Certificate of Competency No. 0000 /666) E- MAIL: AY STA0- M r e_c) #+'CAST, 'J ET Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ g OCR.®® Square / Linear Footage Of Work: / (J QO r•. ,)Type of Work: ❑Addition ►1 Alteration ['New ❑ Repair /Replace ❑ Demolition 'Describe Work: srea. , lyt/•f q 1-I6-1475 o kECePrasct -E DivE ExAtAutgr FAO RD .bTN- ONE IG-NT ( ONE 1ni$C.eArteLE1 ONE. El4NJLIST FIA). � o ) L,&I -I 1-1d C/< OF blouse, ZAJSTALL. 'f SMo ZESTlac'tORS.� ICS- YGOnd 1 haittout bejaxeh b d rbca1.S) Ake f " b "Submittal Fee $ `;Notary $ . Training /Education. Fee $ 0 :' Scanning $ ' ' Radon $ DPBR $ Zoning $ ,?`.Bond $ Code Enforcement$. Double Fee $ Structural Review. $ A ************ Fees xxxxx******* xxxxxxx * *** *x * * *xxxxxxxx * ** * * * Permit Fee $2 Ga' ©ee,e'.' CCF $ 1.80 CO /CC Technology Fee $ �S ., • Total Fee Now Due $ `t • See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address rte? rAf 3r' ;y City State r 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 AhataltvaitiC,WAI3:eZMfprmed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secued 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law. brochurre will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature LULU( Roctlet Owner or Agent The foregoing instrument was acknowledged before me this 4- day of rff/ , 2009, by 514lj kraal dl► , -Rodpew who is personally known to me or who has produced 10 948 As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: xxxxxxxtr* ** ;xacxxxxxxxx$rxxx ** ***,xx xxxxx x xx Signature The forego ay of f-e, b , 20 0 ? , by SaWy'e P. 041 d t►A who is person known to me or who has produced as identification and who did take an oath., NOTARY PUB Contractor instrument was acknowledged before me this Sign: Print: C: a .fea _ .95)0 old My Commission Expires: tem. * . 9:xxxxxxx rxx xxxxxxxxxx xx xxrx xxxx**xxicx******xxxxxx** APPLICATION APPROVED BY- (Revised 02/08/06) ans Examiner Engineer Zoning