RC-09-1486Miami 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 (circle): Building
Permit No. Q C —0-0 q —I i PUY
Master Permit No.
Owner's Name (Fee Simple Titleholder) veto �lil Phone #
Owner's Address
Cityo hl1 rP ' State zip 33 is 6
Tenant/Lessee Name Phone #
Job Address (where the work is being done) - % 14 &9 S�
City Miami Shores Village County Miami -Dade zip
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name &Y e Q&)Ae � �', PMfV" Phone
Contractor's Address
City State Zip
Qualifier Name
State Certificate or Registration N
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ /ayc
Type of Work: ❑Addition ❑Alteration
Describe Work:
Square / Linear Footage Of Work: 3?
❑New ❑ Repair/Replace ❑ Demolition
?� f
Submittal Fee.", Permit Fee $ Zf CCF $ 10 COW --
Notary $_j ° Co Training/Education 4Feee $ �td Technology Fee $
Scanning $ y Radon $ t 00 DPBR $ L 00 9ning $
Bond $ Code Enforcement $—L— Double Fee $ �/
Structural Review. $ Total Fee Now Due
See Reverse side -� I A t
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
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 no a approved and a reinspection fee will be charged
Signature Signature
wne or Agent Contractor
The foregoing instrument was acknowledged before me this (c The foregoing instrument was acknowledged before me this
day o&p0-0,bya C)n PI.QVII14PS. dayof. ,20_,by_
who is personally known to me or who has produced who is personally known to me or who has produced
0— 9.2 i, it
As identification and w tia
a14�� ,rtO9ath. as identification and who did take an oath.
1! 011D
NOTARY PUBLIC: ,��+�I!!!,,, %50 W; S�rz..r q, 4ov a NOTARY PUBLIC•
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 07/10/07)
Sign:
Print:
My Commission Expires:
Pians Examiner
Engineer
Zoning
SKETCH CSE SURVEY
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BJEGTtO Gt3MPU/NCE NVITH ALL.EEDERAI.
STATE AND COUNT( RULES AND REGULATIONS
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TFE SUBJECT PROPERTY FALLS IN FLWD 120652 1 0092 J 1 7/17 1995 "X" N/A
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�CEA/ITH,4LL FEDERAL
VILLAGE OF MIAMI SHORES
n�1 OWNER BUILDER DISCLOSURE STATEMENT
NAME: J�Q�7 �li`/ Z DATE:
ADDRESS: v%%® Al
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 pontractor. You have applied for a
permit under an exception, to the law. The exemption 41lows 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
cons motion yourself. You may build or improve a one -family or two-family rediidence. 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 sate or lease, which is a violrition hf this exempti®t7. You may not hire
an unlicensed person as a contractor. It is your responsibility to mike 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 tityst work under your sypervision and must
be employed by you, which means that you must deduct F1C.A and with -holdings tax and
provide workers' poinpensation for that employee, all as prescribed by law. Your construction
must comply with all applicable laws, ordinances, -buildings codes and zoning regulations.
Please re4d 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., • I n
Initial F.
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.
Initial
4. 1� 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. 1 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 w
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 halve 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 wrodg
doing from this unlicensed company or person.
initial
7. I understand that if any person gets injured on my construction projoct-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
Ides of wages during recovery from injury.
Initial
8. 1 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 ��'� day of �— , 20 tJ
BY �i ► l � I who was personally known to me or who has
Produced there License or �LI p as identification.
9` y
Miami Shores Village
10050 N.E. 2nd Avenue
CCF
$1.20
Miami Shores, FL 33138-0000
R
Phone: (305)795-2204
Address
Parcel Number
210 105 Street 1121360161040 SEAN PHILLIPS
Miami Shores, FL 33150-1143 Block: Lot:;'',
Owner Information Address Phone Cell
SEAN PHILLIPS 210 105 Street
MIAMI SHORES FL 33150 -
Contractors) Phone Cell Phone
HOME OWNER
In Review
Date Approved:: In Review
Date Denied:
Type of Construction:
t Setback:
Setback:
Submitted:
tate Date:
Fees Due
Amount
CCF
$1.20
DBPR Surcharge
$9.00
Education Surcharge
$0.40
Notary Fee
$0.00
Notary Fee
$5.00
Permit Fee - Additions/Alterations
$150.00
Radon Surcharge
$9.00
Scanning Fee
$3.00
Submittal Fee
$50.00
Submittal Reversal Fee
($50.00)
Technology Fee
$3.19
Total:
$180.79
Occupancy:
Exterior.
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Valuation: $ 1,500.00
Total Sq Feet: 1800
For Inspections please call:
(305)762-4949
Invoice # Total Amt Paid Amt Due
RC -9-09-35807 $ 180.79 $ 50.00; %� 9.
RC -9-09-35807 $ 180.79 $ 180.79 $ 0.00
AvanaDre
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
October 09, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 09, 2009
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-197617
Scheduled Inspection Date: September 12, 2014
Inspector: Rodriguez, Jorge
Owner: PHILLIPS, SEAN
Job Address: 210 NW 105 Street
Miami Shores, FL 33150-1143
Project: <NONE>
Contractor: HOME OWNER
tsuliaing uepartment comments
Permit Number: RC -9-09-1486
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number
1121360161040
Replacing cabinetry in kitchen Infractio Passed Comments
INSPECTOR COMMENTS False
permit renewed on 8/1/13
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-147420. CREATED AS
�M REINSPECTION FOR INSP-123739. No Access NB
Need elect
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
September 11, 2014 For Inspections please call: (305)762-4949 Page 1 of 35