DS-05-1252Inspection Date: 08/13/2007
Inspector: Grande, Claudio
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Owner: STAPLES, CLINTON
Job Address: 842 96 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: New
Block:
Phone Number
Parcel Number 1132060142900
Lot:
Building Department Comments
DRIVEWAY CONCRETE BACK
ME 1 5 Zt la
fi
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled
re-inspection fee is paid .
until
Friday, August 10, 2007
Page 1 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: 305) 756.8972
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circl
Building
Electrical.
Permit No. 115 033 1 7-52
Master Permit No.
Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titieh der) Phone # /C
Owner's Address •eZ ' -�-
Zip
City \�
Tenant/Lessee Name Phone #
Job Address (where the work is being done) t i S 42- AZ--- q C' CI
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name
Phone #
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: DAddition
Describe Work:
Phone #
DAlteration
LjNew
Square Footage Of Work:
t3 <o
epair/Replace
❑ Demolition
l!
w
N P reA, IAA...)
i. . *********************Fees***************** **
Submittal Fee $ Permit Fee $ ,..---e CCF $ CO /CC.
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(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 pennit 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 ANN'IDAVIT: 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 tha, ca iy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is sub' pct to a achment. Also a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspec an ` hic occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will nq be approved and a reinspection =e will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 16 64_, 2y
Signature
Contractor
p The fore g instrument was knowledged before me this
9 , day of l.. 20 bi9by
who is personally known to me or who has produced who is personally known to me or who has produced
NOTARY P
Sign:
Print:
As . �nt;fic io d who did take an ath. as identification and who did take an oath.
{{�� t•-" 11 (' vi ® ®l NOTARY PUBLIC:
Notary Public, State of Florida
09
My Commission Expires:
****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *. * * * * * * * * * * * ** * * * * ** **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
No. DD445823
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
chc 05/13/03
Plans Examiner
Engineer
Zoning
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
I C,, -�►,- r --_ being the legal property owner, for the property
Located at: 444-'Z
Legally described as .
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 td *brk 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 525,000.00 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 Iicenses required by state law and by county or municipal Iicensing
ordinances. Any person working on your building who is not Iicensed 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 cotnply
with all applicable laws, ordinances, building codes and zoning regulations.
Proof of ownership provided ( ) initial of reviewing clerk. Tlie foregoing instrument
Was acknowledged before me this (6 day of e3JFee,,file0 D j
By who is personally known to me or who has
Produc
Owner
as identification and who did take an oath..
ETA WAGNER
No • ` Pur ic. State c, o.-ida
My co . expi. ' June 28, 2009
No. DD445823
,2f
=STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, O1-\ N 1 171- does hereby attest that the
(property owner)
attached survey, Performed by
(name of surveyor's company)
performed on ,t2 23 , is an accurate representation of the existing conditions and
to 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 s roperty which are not
permitted or which may violate zoning or building code regulations.
existence of any such structures may affect final inspections as
Further, Affiant sayeth naught.
044
Affiant/Property owner
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this C, day of 9-2L ' S
3 oli
Affiant is _T personal known to me, ✓ produced
VIOLETA WAGNER
Notary Public, State of Florida
My comm. expires June 28. 2009
No. DD445823
entification.
ZONING CRITIQUE SHEET
PERMIT # / 5 .
JOB ADDRESS:
APPLICANT:
C\ k 6. 5
APPLICATION:
DATE COMMENTS Q INITIALS
vS Q I A1 1 ��C
G ®0 1 X rgzal
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 08/13/2007
Inspector: Grande, Claudio
Owner: STAPLES, CLINTON
Job Address: 842 96 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
Block:
Phone Number
Parcel Number 1132060142900
Lot:
Building Department Comments
DRIVEWAY CONCRETE BACK
l�
Al
NS 1 a MN
Passed --il/ g
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Friday, August 10, 2007
Page 2 of 2
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: 305 795 -2204 Fax: 305 756 -8972
Bill To
CLINTON STAPLES
842 N. E. 96 ST.
Return to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Invoice Number: DS -3 -07 -27793
Invoice Date: March 09, 2007
Permit Number: DS -12 -05 -1252
Date
Fee Name
Fee Type
Fee Amount
03/09/2007 Expired Permit Renewal Fee
Payments
Calculated
$75.00
Total Fees Due:
$75.00
Date Pay Type Check Number Amount Paid Change
03/09/2007 Credit Card $75.00 $0.00
BAR .n ) PAIE
Total Paid:
$75.00
Total Due: $0.00
Friday, March 9, 2007
-7
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