PL-06-1945BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 2p71 iv_
Permit No. r I id OP q4--5 ,
PERMIT APPLICATION Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: 1 a 3 L & "` 6 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: .113a 0 too g 3 q 3 D
Is the Building Historically Designated: Yes NO
X
Flood Zone:
OWNER: Name (Fee Simple Titleholder): SU sa (/ ( l en Phone #:
Address: f eD 3 t f (fU,
City: k ( a (-11. 1 S V` Ws State: Zip: 3 ( a sx
/
Tenant/Lessee Name: Phone #: 30S
Email: R G ( I e-n
ea 51--er Fi I) t deo f o lip
CONTRACTOR: Company Name:
Address:
Phone #:
City: State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Address UAlteration UNew ORepair/Replace
Description of Work:
gPAAJA,k,)af
ODemolition
********* * * * * * * * * * * * * * *,x * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * *** * **
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 AF'N'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 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 afier the building permit is issued. In the absence of such posted notice, the
inspection will not be .proved and a reinspection fee will be charged.
Signature
The foreg
day o
who is p
NOT
Sign:
Print:
My Commission Expires:
Owner or Agent
instrument was a
,200,by
owledged be��te me thi
me or who has produ
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:
Sign:
Print:
My Commission Expires:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3 /12/2012XRevised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: SQ f f I: I DATE: 6-9 s
ADDRESS' I a 3 4 N E 15°G
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, l 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 new form states 75,000). The building must be for your own use and
occupancy. It may not be built for sale orlease:If you sell or lease a building you have built yourself within one year after the
construction is °coiplate, the latv will::presume thatyou built for sale or lease, which is a violation of this exemption. You may not hire
an unlicensed person as a 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.I.C.A and with- holdings tax and provide workers'
compensation for that employee, all as prescribed bylaw. Your construction must comply with all applicable laws, ordinances,
buildings codes and zoning regulations.
Please read and initial each paragraph.
1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner- builder
permit under an exemption from the law. The exemption specifies that 1, as the owner of the property listed, may act as my own
contractor with certain restrictions even though I do not have a license.
2. I understand that building permits are not required to be signed by a property owner unless he or she Is responsible for the
construction and is not hiring a licensed contractor to assume responsibility.
3. 1 understand that as an owner builder, I am the responsible party of record on a permit I understand that I may protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own
name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on
permits and contracts.
4. I understand that !may build or improve a one family or two-family residence or a farn outbuilding. I may also build or improve
a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may
not be built or substantially improved for sale or lease. If a building or residence that 1 have built or substantially improved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially
improved it for sale or lease, which violates the exemption.
5. 1 understand that, as the owner - builder, I must provide direct, onsite supervision of the construction.
Initial
6. b understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or
residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or
municipal ordinance.
7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that
erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder may ; mar be held
liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employeeswhiie
working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully. acting as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who Is not licenses to
perform the work being- done. Any person working on my building who is not licensed must work under my direct supervision
and must be employed by me, which means that I must comply With laws requiring the withholding of federal income tax and
social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for
the employee. I understand that my failure to follow these may subject to serious financial risk.
Initial
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable
laws and requirement that govern owner- builders as well as employers. I also understand thatthe
Constructibn must comply with all applicable laws, ordinances, building codes, 'and zoning regulations.
10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the
United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or htto://www.mvfloridalicense.com/dbodorokilbAndex.html
Initial
11. 1 am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party
legally and financially responsible for the proposed construction activity at the following address:
fa34 Ne
12. I agree to notify Miami Shores Wage immediately of any additions, deletions, or changes to any of the informatl n that I
have provided on this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a
license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to
assist you with any financial Toss that you sustain as a result of contractor may be in civil court. It Is also important for you to
understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may
be held liable for damages. If you obtain an owner- builder permit and wish to hire a licensed contractor, you will be responsible for
verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and
returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when
the permit is issued.
Was acknowledged before me this ' day of
By q&ro AI1e�n
Produced there License or
who was pe
ovally known
to me or who has
d = tification.
OWNER
CLAUDIA V. CUBILLOS
;." Notary Public - State of Florida
My Comm Expires Sep 23, 2015
p ? Commission # EE 128810
, ,,,,,, Bonded Through National Notary Assn.
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 -22787
Permit Number: PL -7 -06 -1945
Scheduled Inspection Date: May 13, 2013
Inspector: Hernandez, Rafael
Owner: ALLEN, SUSAN
Job Address: 1234 NE 96 Street
Miami Shores, FL
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number
Parcel Number 1132060143930
Building Department Comments
PLUMBING WORK FOR GAS INSTALLATION FOR
GENERATOR
Passed
Failed
/y/.
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
May 13, 2013
For Inspections please call: (305)762 -4949
Page 39 of 39
Miami Shores Village
Building Department NGV 02012
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �(� ,
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
F_Ds 20
Permit No. 1 & (0
Master Permit No.
Permit Type: BUILDING ! ROOFING
JOB ADDRESS: 1g- /V.6". '7 u kee
City: Miami Shores County: Miami Dade Zip: 3313 $
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): / / t knee: .?c4 75 4)5'7
Address: •) S S. A). S. 94 S ,4ee 1'
City: M14,0 a s44 S State: F .
Tenant/Lessee Name: Phone #:
Email: K r •. 0 Ttgs, , ar
CONTRACTOR: Company Name: /1/, �' /1e°. Te %O) (Phone #: 32,j)gig 24"
Address: /i7 73 k r /o 4/ i /-
City: 1 l l 1
Qualifier Name: 00100
Zip: 37/1g
State:
‘72;///'1.--
Zip: 33/74
Phone #:( 7/3 934
State Certification or Registration #: C4 C /.�� V.0 -93 Certificate of Competency #:
Contact Phone #: `S J 51 —C 244 Email Address: ,e °i % c � %t�/J p!/ /l�� . —•
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ o ° `)quare/Linear Footage of Work: 4100
Type of Work: Addition ❑Alteration .'
Description of Work: 4,.a
ew
ORepair/Replace ODemolition
Color thru tile:
******** * * * *** * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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
14/4
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 approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this c2
day of) ,2012„by 5Am S • -CE,
who is personally known tQ me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:L OJ.i_hc C S2-A,J
Print: NOTARY l t tC•8TATE OF FLORIDA " Martha labrbes
My Commission Expire =.'. `:Commission #DD865073
,.,,;.* ° Expires: APR. 13, 2013
BONDED THRII ATLANTICB0NDfl G CO., INC.
Signature •
Contractor
The foregoing instrument was acknowledged before me this
day of // — 3C— ,20f2,byw /46'P,1 l4911,7-1.4
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commi
'On "" :44. VICTORIA MARIA FAGUNDO
P y COMMISSION # DD991538
?,��<<,.• EXPIRES May 13, 2014
(407) 398 -0153 Floridallotaryservice.00n1
**** ** Y *dF**********3:*9c9c9:*** Y****k ***k: F3e*****: Y* 3: *9r9,> FoY*k 9c9c9e* *9c3e9c9e*9F4e3c9e9e**9, oY4e**** ie9eoY*4,**** *9c9e4 :3c*3c9c9e3e3:9F3e4e*4:>F***
APPROVED BY Plans Examiner
/9901 VII
Strilctukal Review
(Revised 5 /2 /2012)(Revised 3/ 12/ 2012) )(Revised Ot 110 /2009XRevised 3 /15 /09XRevised 7/10/2007)
Zoning
Clerk
To: Miami Shores Village
From: Kaye Fee
Re: Permit #RC -11 -12 -2264
Date: 4/26/13
Please be advised that we are closing the permit request for a new patio roof. Ther permit number is
RC -11 -12 -2264.
Thank you.
Kaye L. Fee
C7
9
3as- q S>
-1 X66 - 6‹ s�
(3
.he
ills la--
131 \ileripacatrne-t4ro
BUILDING
Mi. Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE N1UMBER: (305) 762.4949
PE • T APPLICATION
Permit Type: B 1 DING
Permit No.
Master Permit No.
FB 2010
0/6
4-kg
ROO
1
JOB ADDRESS: Ire.,■:7 N1E- CDG4.1" 4.e.e€
Miami Dade Zip: 'W3e-e3
City: Miami Shores Cour
Folio/Parcel#: - 2.2. - oze, ec,cio
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder):
Address:
City: I (*„ tk E.
Flood Zone:
-Phone#:
State: F L
Zip: 3 t
Tenant/Lessee Name: ne#:
Email: kf, -V Ca de, Q.,, mac , co Yr\ )
Wee_ e5DrWC\rlQ.k)
CONTRACTOR: Company Name: Phone#:
Address: -4-6b0 'k-x) IL-V-13A. '9\4?-4220--
Zip: aS
City: 111-WA% State; 1 (---
Qualifier Name: caekos rPcAesiatir0 Phone#: 35 32-ct 1 36
State Certification or Registration #: C.- 61C 1 :/c0 C:7(7)3 , Certificate of Competency #:
Contact Phone*: Email AddresS:2 /
DESIGNER: Architect/Engineer: / Phone#:
Value of Work for this Permit: $ &par
I •
of Work:
Type of Work: ElAddition ElAberation [;:lNew C3Repair(Re
DescrlFlon of Work: „„et. Ir I xi, / Air
f)finill P
Demolition
********
Color thru tile:
*********************Fees********************************************
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
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 AN.F'!DAVIT: 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 li=en 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 t' .sence of such posted notice, the
inspection will not be app oved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this"
day of 00 2 ; by Vei-,con i .te.
who is personally known to me or who has produced
As identification and who did take an oath.
N41#74,
;PUBLIC:
Sign: '
Print:
My Commission E
STATE OF FLORIDA
Comm# DD0927983
Expires 9/24/2013
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of r , 20 Lby0a r ic)S Pa& Sa.®o0 ,
who is persohOty kp'o, to me or who has produced
cation and who did take an oath.
Sig
P
M Commission
STATE OF FLORIDA
Comm# DD0927983
Expires 9/24/2013
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)