PT06-1014 Miami Shores Village
s Building Department
C%0 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING Permit NoT",1 a 101
PERMIT APPLICATIONL'" APIA 2 0 2006 j Master Permit No.
FBC 2004 '
Permit Type (circle): uildi Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) 6, "Phone# 3k5'S_— ?Sb' CESS n
Owner's Address 6l� 03•
City\&_� SV State crt,JUA Zip
Tenant/Lessee Name Phone#
-1�� `
Job Address(where the work is being done) � ��"1�V�
City Miami Shores Village County Miami-Dade Zip 1>3
FOLIO/PARCEL#
Is Building Historically Designated YES NO
Contractor's Company Name e UyNk�(' Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ (� t 060 QD Square/Linear Footage Of Work:
Type of Work: nAddition \ ❑Alteration Xew ❑ Repair/Replace ❑Demolition
Describe Work• C'r�`n�T
Submittal Fee$ Permit Fee$ CCF$ Q , 60 CO/CC
Notary$ 6- C:)0 Training/Education Fee$ Technology Fee$ t �
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due
See Reverse side—�
F
t 3
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 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 foreping instrument was acknowledged befor me this_1Qy The foregoing instrument was acknowledged before me this
day of 200fpby day of ,20 by ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUB NOTARY PUBLIC:
Sign: Sign:
Print: Print:
,o�►e P alga,
My Commissio xpires: =Commission 4DD2319,, My Commission Expires:
or
AtbiticBondingCn„Inc
APPLICATION APPROVED BY: Plans Examiner
Engineer
Z a Zoning
(Revised 02/08/06)
15NORES Inspection Worksheet
Miami Shores Village
6 10050 N.E. 2nd Avenue Miami Shores, FL
�toR�oQ' Phone: (305)795-2204 Fax: (305)756-8972
JUL
Inspection Date: 07/03/2006 Permit Type: Roof
Inspector: Grande, Claudio Inspection Type: Tile In Progress
Owner: HARNAGE, HENRY& FRANCES Work Classification: Roof - New
Job Address: 257 91 Street NE
Miami Shores Village, FL Phone Number (305)187-27_
Parcel Number 1132060133450
Project: <NONE>
Block: Lot:
t2oo � G
Contractor: QUALITY Ge9tMM SYSTEM Phone: 305-255-9439
Building Department Comments
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re-inspection fee is paid.
Friday,June 30, 2006 Page 1 of 2
Miami Shores Village
Paint Color Approval and Agreement
Date ► c.. is -10o
Owner's Name TGp mdie, 1 9-,os� Phone#
Owner's Address ok *-5OQ
CityIaYYII < State --- Zip
Job Address (where the work is being done)-- 17i 13 N t=- Z fT�l
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name(if applicable) Phone#
All elements on the site must be listed and indicate the color to be painted
Walls C,L�i V) E , ,\j M Z5
Fascia GL_I&w 0 cy �^ S
Drip Cap/drip Edge C_ 'a
Soffit
Roof 4
Flower bins Fes.;a• Attach Color Samples
Shutters 1,3 rr With Numbers
Awnings
Chimney N -
Doors and door jams ] �—
Garage doors I"j Q
Railings ^'
Fences N'�
Decorative metal
All brick(simulated or regular) _c .Lv b,[-::: M 2 fS
Stucco banding r"i 4
Any other stucco features
Accessory Buildings ~'
Other
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 regula ' construction and zoning.
Signature
Date PC;
Oor Ag
Owner t l
APPLICATION APPROVED BY: ! Date
P&Z Official chc 6/18/03
Claude VM25
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: DATE:
ADDRESS: 912D P
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 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 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 thatyou 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. I hold title to the above property and I am planning on doing this construction
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
Initial V
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,
alter or give advice on how to meet code — only if the structure meets the
minimum code.
Initial
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 business license I will be responsible and liable for any wrong
doing from this unlicensed 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 for all doctor and related cost which could include
loss 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 J day of N Ot , ( , 20 (,
By 1 Gu. az C aj S C who was personally known to me or who has
Produced there License as identification.
/ l J
OWNER GARY
Doris Carohe Rivas
=ot�, PUp, =Commission#DD 87189
:ate Expires:Mar 17,2008
Bonded Thru
Atlantic Bonding Co.,Inc.
!`�5K°RES Lit PLANNING AND ZONING BOARD
OWNER AFFIDAVIT
�FN_s3 IH 10
FL0R11V
I/We_ —T OSO'
as Owner(s)of Lot(s)
Block- Section S►{Cil?5 5L--. Plat Book&Pagegzotl0 � �.,
� �, t-1 11 (the Subject Property)
('
located at "1 � 3 NG 2, � � desire to file an application for a public hearing before the
Planning and Zoning Board and Itwe understand and agree with the following:
1. The application for a variance will not be heard unless the applicant is present at the hearing.
2. Requirements of the zoning code,Miami-Dade County,the South Florida Bulding Code and other government agencies
may affect the scheduling and ability to obtain/issue a permit far the proposal
3. The only exceptions to the zoning code are those that have been specified in the written application,and arty other code
or plan issues will be corrected by modifying the plans to comply with the respective codes and ordnances of the Village.
4. The applicant will be responsible for complying with all of the condifions and restrictions imposed by the Planning and
Zoning Board in connection with the request and will take the necessary steps to make the request effective if approved
by the Board.
5. That it is the responsibility of the applicant to submit a complete application with all of the documents necessary for the -
Planning and Zoning Board to hear the appGcanrs request
6. The applicant is responsible for the timely submission and accuracy of a0 items requested on the application
fOTE: SURVEYS, SITE DEVELOPMENT PLANS, LANDSCAPE PLANS MUST BE SUBMITTED AT
TANDARD PLAN SIZE. AN APPLICATION WILL NOT BE CONSIDEREDCOMPLETE UNLESS 10
OPIES OF THE APPROPRIATE PLAN DRAWINGS ARE SUBMITTED WITH PROPERTY SURVEYS.
I/We as the owners of the subject property:(Please check one)
Do hereby authorize hit L6 k\ to act on my/our behalf as the applicant
O Will on my/our own behalf act as applicant(s),and make application in connection with this request for a public hearing before
the Planning and Zoning Board.
I/We understand that if my/our appeal is denied. Iiwe may appeal the decision of the Planning and Zoning Board within
(10)days to the Village Council.
JTE,0F,FL ORIDACOUN ry OF D STATE OF FLORIDA.COUNTY OF DADE
SignatureoOwners) Signature of Applicant(if different from Owner)
Print N.me(s) Print Name
Sworn to and subscribed before me this day of ✓u / Swom to and subscribed before me this day of
Signature of Notary Public-StmtE of Florida Signature of Notary Public-State of Florida
SEAL:
'/ SEAL:
Personally known 1' OR,Produced
{{Identification
Type of Identification?-o,:uced:
o,►�pGB', Doris Caroiilte lovas
Commission#DD287189
-Expires:Mar 17 2008
OF N,, Bonded Tbru
Atlantic Bonding Co.,Inc.
`SHOREES Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
.EB .� Phone: (305)795-2204 Fax: (305)756-8972
Permit
Permit Status: APPROVED
Issue Date: 4/26/2006 Expires: 1011712006 Permit Number: PT-4-06-1014
Owner's Name: TANYA DE LA ROSA
Phone:
Permit Type: Paint
Parcel#: 1132060134220
Work Classification: New
Block: Lot:
Job Address: 9713 2 Avenue NE
Section: PB:
Miami Shores Village, FL 33138-
Contractor(s) Phone Primary Contractor Total Square Feet: 0
HOME OWNER Yes Total Valuation: $ 1,000.00
ommen : Re uired Ins ections
EXTERIOR PAINTING Final
Additional Information
Type of Work:Exterior Color:CLAUDE VM25
Additional Info:RALPH LAUREN Classification:Commercial
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.
Fees Due AmountLInice Number Amt Due Amt Paid
CCF $0.6006-24557 $67.30Education Surcharge $0.20l:
Notary Fee $5.00
Permit Fee $60.00MAY 0 8 PAID
Technology Fee $1.50Total: $67.30C _C
Building Department File Copy NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS,STATE AGENCIES,OR FEDERAL AGENCIES.
Applicant Signature