FW-05-1291e
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: 56.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Building
:v-.1 O 12-c:11
ref 1 .r:.t `1aii
Permit No.
aster Permit No.
Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Y'I V \&r! Phone #
`S'itO C CourS•C_
City ( ;am ( S s State Zip 33 (3g
Owner's Address
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Villa e
Is Building Historically Designated YES
County Miami -Dade Zip 3 3 (3
NO AK-
Contractor's Company Name
Contractor's Address
City State
Qualifier
Phone #
Zip
State Certificate or Registration No.
No
Architect/Engineer's Name (if applicable)
Square Footage Of Work:
$ Value of Work For this Permit
Type of Work: ❑Addition DAlteration ❑New Repair/Replace
❑Demolition
Describe Work:
�V t»e 3 cClr / I) Year c
Submittal Fee $
Notary $
Scanning $
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ Z00 �/ — CCF $
Training/Education Fee $
CO /CC
Technology Fee $
Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ 2 17
(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 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appr einspection fee will be charged
Signature
Signatu
Owner or Agent Contractor
The foregoing insstt rument was acknowledged befo me this 1 The foregoing instrument was acknowledged before me this
day of —' , by --0"'' ri K 1't day of , 20 _, by
who is rrpersonal] ow to me or who has produced who is personally known to me or who has produced
NOTARY
Sign:
Print:
s identification and who did take an oath. as identification and who did take an oath.
TARY PUBLIC:
i Sign:
',mos
My Commission Expires:
Print:
My Commission Expires:
************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13103
3/.110
Plans Examiner
Engineer
Zoning
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE .STATEMENT
kbeing the legal property owner, for the property
Located at: 546 C- r tr rSiC
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),_nd I have read and understand the following disclosure
Statement, which entitles me to .cork as my own contractor, I further understand that I as the owner
rnust appear in person to complete all applications.
DISCLOSURE STA'T'EMENT.
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 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. Tlie foregoing instrument
Was acknowledged before me this /GI day of , 20 0 5
By
Produced
r r t K Sr-,r) t +—
who is personally known to me or who has
as identifica
d who diahta)�e Vargas
'+: Commission ##DD2 1984
Wes: Jul 13,200 7
{4
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Issue Date: 12/21/2005 Expires: 12/21/2006
Owner's Name: DARIK & MARLENIS SMART
Permit Type: Fence/Wall
Work Classification: Wire Fence
Job Address: 540 GRAND CONC
Miami Shores Village, FL
Contractor(s)
Phone Primary Contractor
Comments:
REPLACING FENCE AROUND PERIMETER OF PROPERTY ADDING A DRIVEWAY
GATE IN REAR OF PROPERTY
Additional Information
Type of Construction: Wire Fence Additional Info:
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.
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Wire & Wood
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$5.00
$200.00
$6.00
$5.00
$217.60
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: FW -12 -05 -1291
Phone:
1132060171411
Lot:
PB:
Total Square Feet:
Total Valuation:
Required Inspections
200
$ 2,000.00
Final
Foundation
Invoice Number
FW -12 -05 -23203
Total:
Amt Due
$217.60
DE 2 "1 Palo
G
Amt Paid
ZI1.(, )
0
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
ALARMS TO BE PROVIDED ON
ALL DOORS AND WINDOWS WITH
DIRECT ACCESS TO POOL DECK
15.00
15.18
• •
WATER
,4' CHAIN
L INK FENCE
2.8
125.-
3025
28.'18
SELF CLOSING
'SELF LATCHING
GATE
L-
rti
EQUIP
PANEL
91.94
O.H.
ELECTRIC
SERVICE
SEPTIC
TANK
15.02
GIRAND CONCOURSE
SITE FLAN
I " =20'
pip -o5-��
CITY
COFT
POOL REQUIREMENTS:
SELF - CLOSING/ SELF -LOCI,
GATES REQUIRED
FENCE: 4' HIGH (MIN.)
AND NON - CLIMBABLE
IF NEIGHBORS REMOVE FE
WALL, OWNER MUST REPL
WITH A 4' FENCE ON
"-' OWNER'S PROPERTY