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RC-07-1321I I t Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 D 1COMETM, Permit No. JUN 2 2 200 ter Permit No. BY:.P .. , Permit Type (circle)• Buildin Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) Phone Owner's Address . f2y &Y-01��' City���,� State Tenant/Lessee Name Job Address (where the work is being done) Zip City Miami Shores Villaae County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company NamePhone # Contractor's Address City Qualifier Name State Certificate or Registration No. Architect/Engineer's Name (if applicable) Value of Work For this Permit $ State Zip Type of Work: QAddition []Alteration Describe Work: Phone # Certificate of Competency No. Phone # Square / Linear Footage Of Work: Repair/Repl, 9 ❑ Demolition Submittal Fee $ Permit Fee $ Lo 6 0� CCF $ 4 (:c CO/CC Notary $ Training/Education Fee $ 20 Technology Fee $ no Scanning $ -be-- Radon $ Bond $ Structural Review. $ DPBR $ Zoning Code Enforcement $ Double Fee $ Total Fee Now Due $ See Reverse side CV4+45 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 not be approved and a reinspection fee will be charged Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this -� day of�1T= 20Qj, by _�r-A-Af who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: NOTARY PUBLIC - STATE OF FLORIDA nn •. Print: RI O -N GI ComtnissioD #DD632876 . My Commission Expires: B0'NDED TasU MAN77c BONDING co, INC. APPLICATION APPROVED BY: (Revised 02/08/06) 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: Plans Examiner Engineer Zoning 4 . . f NAME: VILLAGE OF MIAMI SHORES OWNER BUILDER DISCT.OSYJRE STATEMENT DATE: ADDRESS: Do -hereby petition the Village of Miami Shores to*aet as my own contractor pursuant to the laws of the Mate of Florida,. F.S 489.103(7). Ana I have.read and understood the following disclosure stdt®merit, which entitles m fo work as mx owp cotrtractor; I further understand tli�t 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 liui'fding at a cost of $25,000.00 Or less. The building must be for y6or.own use and occupancy. It may ndf 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 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 uder'your supervisionan that you trust dedd must 6e employed by you, which means deduct F.I.C.A and wl&holdings tax and provide workers' compensation for that emplgyee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this construction Initial 1-52, 2. I understand that as art owner -builder I must abide by all zoning ordinances and building regulations in effect at -the time of permit application Initial 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. I understand that the building official and inspectors are not there to design, after or give advice on how to meet code -- only if the structure meets the minimum -code. Initiaf�. 5. I 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 an 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 required to have'a business license in the county. If•for, any reason they do 'not posses a bysiness license I will be responsible and liable for any wrong doing ftom this uiilicensed company -or person. Initial 7. • I• understand that if any person gets injured* on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable far all doctor and related cost which could include loss of wages during recovery from injury. Initial—_,6—/ I understand that. under state and local laws I• can* not do any llectrical, Plumbing, Heating, Air & Roof work on my -property with out first obtaining the proper permits by licensed contractors. Ioitial �. Was acknowledged before me this day of MA,1 .20DJ By_ '�� 9. f' Roy who was personally known to me or who has Produced there License or pt identification. ER N0 Y NOTARY PUBLIC -STATE OFFLOPMA ' ! ltNriam Grand -Pierre t: = nD632876 4-4 k 24, 2011 BONDLO TC 11UhJjNr, CO, NQ Receipt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit Number: RC -6-07-1321 Invoice Number: RC -6-07-28965 Applicant: PIERRE LEROY Company Name: Date Payment Type Check Number Friday, July 13, 2007 07/13/2007 Check 1045 Owner Address: 9301 2 Court NW MIAMI SHORES, FL 3315C Job Address: 9301 2 Court NW Miami Shores, FL 33150 - Amount Change $109.30 $0.00 Total Payment: $109.30 Page 1 of 1 yKORes `®r Miami Shores Village M 10050 N.E. 2nd Avenue I Miami Shores, FL 33138-0000 `4ANt��4 �'toxto� Phone: (305)795-2204 Project Address 9301 NW 2 Court Miami Shores, FL 33150 - Parcel Number Applicant 1131010150400 Block: Lot: PIERRE LEROY Owner 1,0ormat3on Address Phone Cell PIERRE LEROY 9301 NW 2 Court MIAMI SHORES FL 33150-2212 Contractor(s) Phone Cell Phone HOME OWNER N/A Date Approved:: N/A Date Denied: Type of Construction: BATHROOM TILES Stories: NA Front Setback: NA Left Setback: NAN Bedrooms: NA Plans Submitted: Yes Certificate Date: Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Occupancy: Single Family Exterior: NA Rear Setback: NA Right Setback: NA Bathrooms: NA Certificate Status: Additional Info: Classification: Residential Amount $0.60 $0.20 $100.00 $6.00 $109.30 Valuation: $ 1,000.00 Total Sq Feet: 0 Total Amt Paid Amt Due $ 0.00 $ 0.00 $ 0.00 Payment Type: PAND� Ib4'S Available Inspections: Inspection Type: Drywall screw Final 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 June 27, 2007 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Wednesday, June 27, 2007 1 Permit No. 'RC -6-07-1321 M Permit Type: Residential Construction I Work Classification: Alteration ..Per Pemrit Status: APPROVED Issue Date: 6/27/2001 Expiration: 12624/2007 Parcel Number Applicant 1131010150400 Block: Lot: PIERRE LEROY Owner 1,0ormat3on Address Phone Cell PIERRE LEROY 9301 NW 2 Court MIAMI SHORES FL 33150-2212 Contractor(s) Phone Cell Phone HOME OWNER N/A Date Approved:: N/A Date Denied: Type of Construction: BATHROOM TILES Stories: NA Front Setback: NA Left Setback: NAN Bedrooms: NA Plans Submitted: Yes Certificate Date: Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Occupancy: Single Family Exterior: NA Rear Setback: NA Right Setback: NA Bathrooms: NA Certificate Status: Additional Info: Classification: Residential Amount $0.60 $0.20 $100.00 $6.00 $109.30 Valuation: $ 1,000.00 Total Sq Feet: 0 Total Amt Paid Amt Due $ 0.00 $ 0.00 $ 0.00 Payment Type: PAND� Ib4'S Available Inspections: Inspection Type: Drywall screw Final 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 June 27, 2007 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Wednesday, June 27, 2007 1