Loading...
DGT-15-1363�s►► �,r Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 hF Phone: (305)795-2204 Project Address Parcel Number Applicant 161 NW 107 Street 1121360100110 EDITH MURPHY Miami Shores, FL 33168-4308 Block: Lot: Owner Information Address Phone Call EDITH MURPHY 161 NW 107 Street (305)778-0029 MIAMI SHORES FL 33168- 161 NW 107 Street MIAMI SHORES FL 33168- Contractor(s) Phone Cell Phone HOME OWNER In Review Approved:: In Review Denied: Const: Pergolas sification: Residential ning: 1_ Fees Due Amount CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Notary Fee $5.00 Permit Fee $112.50 Scanning Fee $3.00 Technology Fee $1.60 Total: $127.70 Valuation: $ 1,800.00 Total Sq Feet: 150 Additional Info: PERGOLA TO REPLACE DGT14-112 Scanning: 1 Pay Date Pay Type Amt Paid Amt Due Invoice # DGT-6-15-55847 06/15/2015 Credit Card $ 127.70 $ 0.00 Avauame Inspection Type: 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 AFFIDtFrVIT: /I rtify t`kat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and ening. hermorc�, I authorize the above-named contractor to do the work stated. June 15, 2015 Autha Signabre: Applicant / Contractor / Agent ua�e Buildin Departwner t Copy June 15, 2015 1 (01 10 01 =Lri BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F�z' JUN �a k' FBC 20 tO Master Permit No.1 (o -T I S-- I -� 6 Sub Permit No. /14 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP I I W 10"I S CONTRACTOR DRAWINGS inR ennoGcc. 1[ If City: Miami Shores County Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type Flood Zone: BFE: FFE OWNER: Name (Fee Simple itl holder : ' ' ' ' ' ur hone#: u " Address: 14 8 6 � � 5 City: S Tenant/Lessee Name: Email:il \/1166-t State: A L--* Zip: r5` CONTRACTOR: Company Name: (O�U `--� Phone#: Address: City: State• Zip: Qualifier Name: Phone#: State Certification or Registration M Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: R Address City: State: Zip: Value of Work for this Permit: $ -®lam Square/Linear Footage of Work: I SCS Type of Work: ❑ Addition ❑ q)teration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: -TO �z: rY.*-r 14 '— 1) 2-0 • .j E i Specify color of color thru tile: Submittal Fee Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ! G• 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 instal latiorrhas 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... 9 OWNER'S AFFIDAVIT: I certify that all the foregoing information is acburate and that all work willabe done in compliance with all applicable laws regulating construction and zoning. • s "WARMING 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 �- .,Y�,URPTIrte COMMENCEIulE1tT.". ° a Noti&e to Applicant: As a condition to the issuance of a building permit witW an estimated value exceeding $2.400; the applicant must promise in govd.=pith that a copy of the notice of commencement and construction lien law brochure will be OIiSerld -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 ofRsuch posted notice, the inspection will not be approved and a reinspection fee will bich&ged. "-g`, Signature 1E4L�_`�' Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this ^S day of 20 by MUZ P '-t`e , who is personally known to me or who has produced as identification and who did take an oath. NOTARY ME= Print: The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: as Seal: �' _ / 12016 _ Seal: PUBLIC •"••. Commission fT3059 :•` �'. **t®`******x�****x�*a�******w**�x**�x**+�*a�*�x*w*wx�ixr****wxx�* OF��-� APPROVED BY ' "��Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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: DATE: ADDRESS: IC, 6 "" �0 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 entities 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 b6 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 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 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 by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 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 1 -do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or he is responsible for the construction and Is not hiring a licensed contractor to assume responsibility. Initial 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 ad contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm 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 I 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 lea ,which violates the exemption. initial 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the constructi Initial 6. I 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 a by county or rigwnicipal ordinance. Initial 7. 1 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 be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while orking on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder a am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contracto who is not licenses to perform the work being done. Any person working on my building who is not licensed mgst wo!� andeemy dir'4ct supervision and must be employed by me, which i'eens that I must comply with laws requiring the witbholdiog of federal oincorhe tax and.social security contributions under the Federal Insurance Cdntnbufidns Act (FICA) and must provide °workdirs compensation foie the'emp4wWi,* derstand that my failure to follow these may subject to serious financial risk. T w Initial 9. 1 agree that, as the party legally and financially responsible for this proposed Construction activiide by all applicable laws and requirement that govern owner -builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulati s. Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Inte nal 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 htti)://www.mvfloridalicense.com/dbpr/pro/cilb/index.htmi t& A 11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands hat I am the party legally and financially responsible for the proposed construction activity at the following address: 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of t e ihformation that I have provided on this disclosure. r�• 1 t " Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person wh does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be un ble to assist you with any financial loss that you sustain as a resulf,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,firin 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 responsib[ for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of veril 6ation acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this _s- day of 20 i 'Z> �� �� By �� �� �� who was personally known to rRo\ 011nuurrrr o hofs,,,, Produc "there License o" 7 �-- Die IV%CL OW ER NOTARY..: