PT-06-15 Miami Shores Village
Building De artment
10050 N.E.2nd vr a 33138 /
Tel: (305) 93.24 Jax. 3 .8 72
�
JAI nn�
BUILDING Permit No. T�"--
PERMIT APPLICATION Master Permit-No.
FBC20HQ� � C�. I C7 � � C:)2_ gD
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) T� C, f�Lr L /Phone#
Owner's Address l 2(t) IV W j G D T Lj4�
City hL/&! fl SllplUfr State P' L_ Zip
Tenant/Lessee Name -7 ! *,u L �`�/ / lT Phone#
Job Address(where the work is being done) &(2 /7 W 0 C) ��4r
City Miami Shores Villa e County Miami-Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name C lull. -IZ Phone#
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit 7s C9 Square Footage Of Work: 2— c
Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace ❑Demolition
Descri a Work: � LL/ /
/'
tv ec
UJ ) I T
****************************Fees******************************
Submittal Fee$ Permit Fee$ (-::(0- . co CCF$ VO co/(=cc
$ �` Training/Education Fee$ Technology Fee$ ( ,�l.J
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$
1 - O
(Continued on opposite side) "AN 0 3 PAID
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 foregoing instrument was acknowledged before me this
� The foregoing instrument was acknowledged before me this
day of JA N ,20�by l (�Itil>gS T��Z,S`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 IC: I NOTARY P C-STATE OF FLORINOTARY PUBLIC:
Sign: eny H z Sign:
Print: �- v 9 Print:
Bonded dantic din o.,Inc.
My Commission ExI fres:-------____.._ My Commission Expires:
APPLICATION APPROVED BY: l `� Plans Examiner
Engineer
Zoning
chc 05/13/03
Miami Shores Village
Paint Color Approval and Agreement
Date
Phone#
Owner's Name
Owner's Address
City
State Zip
Job Address(where the work is being done)
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
Fascia
Drip Cap/drip Edge
Soffit r
Roof V v l 1 I7
s
Flower bins
Shutters _
�N �fll �
Awnings
Chimnev
Doors and door jams – tiJ
rt�ti� 1ti�li(c�
Garage doors
Railings
Fences 001
Decorative metal
All brick(simulated or regular) /i 1
Stucco banding '
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 regulating construction and zoning.
Signature_,
Date
Owner orA end
Date
APPLICATION APPROVED BY: r p&Z Official chc 6/18/03
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
being the legal property owner, for the property
Located at:1(�, ti I00 `7.62—fZ9-r
Legally described 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),;nd I have read and understand the following disclosure
Statement, which entitles me to jVork 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 build or
improve a one-family or two-family residence or a farm out-building. 1 You may also build or improve a
commercial building at a cost of 525,000.00 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
constriction 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 Iicensing
ordinances. Any person working on your building who is not Iicensed 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 3� day of,J 20 OC-D
By r who is personally known to me or who has
Produced as identification and who did take an oath.
f
G� C_ �..eL �-
Owner Notary
a •STATE OF FLORIDA
t` Yorleny Hernandez
Owner Commission#DD476455
Expires: SEP. 27, 2009
;3onded Thru Atlantic Bonding Co.,Inc.
,oREs y�<< Miami Shores Village
mac, 10050 N.E. 2nd Avenue
goal Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
eNrra t�+
AL0Permit
Permit Status: APPROVED
Issue Date: 1/6/2006 Expires: 01/0312007 Permit Number: PT-1-06-15
Owner's Name: THOMAS FRELL one:
Permit Type: Paint
Parcel#: 1131010230280
Work Classification: Miscellaneous
Block: Lot:
Job Address: 166 100 Terrace NW Section: PB:
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor Total Square Feet: 1200
HOME OWNER Yes Total Valuation: $ 750.00
Comments: Re uired Ins ections
PAINT EXTERIOR OF HOUSE Final
Additional Information
Type of Work:Exterior Color: INDIAN CLOTH
Additional Info:
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 Amount Invoice Number Amt Due Amt Paid
CCF $0.60 PT-1-06-23334 $67.30 $67.30
Education Surcharge $0.20 Total: $67.30
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $1.50
Total: $67.30
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
1REs � Miami Shores Village
9� 10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
'�LORtDp`
Permit
Permit Status: APPROVED
Issue Date: 1/6/2006 Expires: 01/03/2007 Permit Number: PT-1-06-15
Owner's Name: THOMAS FRELL one:
Permit Type: Paint
Parcel#:_ 1131010230280
Work Classification: Miscellaneous Block: Lot:
Job Address: 166 100 Terrace NW Section: PB:
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor
Total Square Feet: 1200
HOME OWNER Yes Total Valuation: $ 750.00
Comments: Re uired Inspections
PAINT EXTERIOR OF HOUSE Final
Additional Information
Type of Work:Exterior Color: INDIAN CLOTH
Additional Info:
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 Amount Invoice Number Amt Due Amt Paid
CCF $0.60 PT-1-06-23334 $67.30 $67.30
Education Surcharge $0.20 Total: $67.30
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $1.50
Total: $67.30
NOTICE: In addition to the requirements of this permit, there may be
Finance Copy 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.
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, FI 33138
12/27/2007 Tel: (305)795-2204• Fax; (305)756-8972
To: Current Owner
166 NW 100 Terrace
Miami Shores Village, FL 33150
Permit: PT-1-06-15
Address: 166 NW 100 Terrace Miami Shores Village FL
Date Expired: January 3, 2007
Type: Paint
Dear Sir or Madam
In order for us to serve you better, we need to keep our files up to date. Our records
indicate that the above reference Permit has expired.
The Building Department has determined that the work applied for has been completed
with out the required inspections and it has been more than 180 days since your last
approved inspection and thus your permit has expired as per Sec. 104.5.of the Florida
Building Code. You are required to renew your permit and schedule all required
inspections.
In the event you do not comply with the requirements herein, the Building Department
will file a complaint with Miami-Dade County Building Code Compliance Office for
possible disciplinary action against your licensed contractor And/or if permit was
obtained by the home owner the requirements of the Unsafe Structure Code of Miami
Dade County Sec. 8-5. (3) will apply. "The building shall be presumed and deemed
unsafe and a permit shall be obtained to demolish the structure or bring the building in to
compliance with applicable codes as provided herein."
Please contact the Building Department, immediately upon receipt of this letter.
Sincerely,
C udio Grande C.13.0
ilding Official/Director