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EL-04-205Miami Shores Village RECr J uilding Department 100 0 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDIN(T a o o Permit No. PERMIT FBC 2001 APPLICATION Permit Type (circle): Owner's Name (Fee Owner's Address L City Master Permit No. Building Electrical Plumbing Mechanical Roofing Titleholder) Phone #_�o OS ► �S� • 3 If eo C/9? State Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) 5aAnx_ A-Apo—e. City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name�� ., Phone # Contractor's Address City Qualifier State Certificate or Registration State Zip. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit IZ Type of Work: ❑Addition ❑Alteration [--]New Describe Work: Square Footage Of Work: ❑ Repair/Replace ❑ Demolition Submittal Fee $ Permit Fee $ /®'O" ®® CCF $ - 6 CO/CC Notary $ -5 • 0 D Training/Education .Fee $ , )I Technology Fee $ ._5 Z? Scanning $ Radon S Zoning Bond $ Code Enforcement $ Total Fee Now Due $ b b (Continued on opposite side) Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State zip 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 subje t to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspectiovhich occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not b a proved and a reins ection fee will be charged. Signature Signature Owner or Agent The eg ' g instrument was acknowledged re me this C 0 day o 204, by wka is ply known tow-,/rwho has produced As identification d take an oath NOT PUBLIC A,ng I esker Sign: _�yrapin 3 Ra�� r 7 �, '008 Print: 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: My Commission Expires: Engineer Zoning Cho 05/13/03 VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE .STATEMENT I Sbeing the legal property owner, for the property Located Legally descnbed_ 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),qnd I have read and understand the following disclosure. Statement, which entitles me to' aVork 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 bund 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 Tlie foregoing instrument Was acknowledged before me this day o 20 BA who is personally known to me or who has Y Producedas identification and who did take an oath:' Owner a® v v% ,angels M ®eckcr e My rommission ®®950048 "sora Expires November 15, 2006 ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL ITEM BATH TIB UNIT FEE ITEM SWITCH OUTLETS LIMIT FEE ITEM UNIT FEE SPACE HEATERS BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER I RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT YORK FLOOR DRAIN SERVICE"REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGRDUND.TANKS LAVATORY OVEN ABOVE GROX TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS QVER 1- 3 HP HOT WATER BOILERS SINK, POW COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER -REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL RMOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP 8 ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN 4da 27 DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANSPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER. SET (GAS) GAS PIPING Miami Shores Village 10050 NE 2nd Avenue Phone: 305-795-2204 Printed: 7/23/2004 Applicant: SHIRLEY Owner: DAVIS JOB ADDRESS: 405 Contractor Local Phone: Parcel # 1132060170390 NE 99 Electrical Permit Permit Number: EL2004-205 DAVIS SHIRLEY ST Contractor's Address: Page 1 of 1 Legal Description: AMD PL OF MIAMI SHORES SEC 4 LOT 12-13 & W1/2 OF LOT 14 BLK 89 Fees: Description Amount FEE2004-7415 Building Fee $100.00 Total Fees: $1_08.30 FEE2004-7416 CCF $0.60 FEE2004-7417 Notary Fee ts: Total Receipts: $0.00 $5.00 p $ FEE2004-7418 Training and Education Fee $0.20 FEE2004-7419 Technology Fee $2.50 Total Fees: $108.30 Permit Status: APPROVED Permit Expiration: 1/16/2005 Construction Value: $150.00 Work: ADD 4 OUTLETS IN REAR PATIO DECK Signed: (INSPECTOR) 'JUL 2 7 PAID 4K L 'so )D-, 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: