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BP-04-1471 Miami Shores Village Building DepartmentX � l 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: 3 04 Fax: (305)756.8972 c eneD �O �� BUILDING Aft 9 �®� f Permit No. � � 7/ PERMIT APPLICATIO Master Permit No. FBC 2001 Permit Type (circle): Building Electrical lumbing Mechanical Roofing Owner's Name(Fee Simple (Titleholder) p ` � Phone# Owner's Address Citya1/l{t( 1'P S Stater Zip -j 3 (o 7 Tenant/Lessee Name Phone# -3o J 7 S</ "a Sr Job Address(where the work is being done) "50A",— city A", _City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO Contractor's Company Name _!:�e(,( Phone# Contractor's Address City State rINZip Qualifier State Certificate or Registration No. Cert' i ency No, Architect/Engineer's Name(if applicable) Phone# � S $Value of Work For this Permit Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New )j�rRepair/Replace ❑Demolition Describe Work: Submittal Fee S Permit Fee$ CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ 91 50 Scanning$_ Radon$ Zoning "^ Bond $ Code Enforcement$ Structural Plan Review. Total Fee Now Due$47 ' (Continued on opposite side) 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 A Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of_NO V 204 ,byLunn r r l, 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 P LI NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer Zoning Chc 05/13/03 } VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMENT I G cit 9-4 r_/t_) being the legal property owner, for the property Located at: I Y AJ tk) 12 — Legally described.as f' S(�yP� 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). qnd I have read and understand the following disclosure Statement, which entitles me to a ork 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. '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 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 licensing 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 ay of 20 O k gy who is personally known to me or who has c Produced as identificat' d who did take an oath.` • G Owner Notary Owner BF-I 01=9010111 . . 14=t"1:101 ,of sections and levels,clearly identify dimensions of d pressure zones and location of parapets. Perimeter Width(a):[�Comer Size(a'x a'):F-37—�j MENNEN sun PEENRC! ■■■■i ■■■/■■■■■■ ■■■■■■■■■■■/■■■■■■■■■■■■■■■■■n!�■■%■ Nil■t■Noun/ ■■■ I■r/■■■■et■rl■■■■■/ ■■■t�■■■■■■■■■■■■■■■■■rte•■■■■■..��..■■■��■��■■■■■.■r�■■�■■■ ■■■�I■■■■■■■■■■■■■■■■■//■n■■■■■■■■■■■■■ ■ > >■, �■� � ■/■�■■/ ■■■!1�■ ■■■��■■■■�■■■■■,r■■■/■■■■■■■■■■■■ NEW NNS Holt ,iE/■■■■/ ■■■■■■■■■s�■�■�■■■�■■/��■■■■■■■■■■■■■■■, Ir"'Ir■r IMM, >•MI■■■■■■ 11 i W I[■■ Miami Shores Villageildin Permit Bu g 10050 NE 2nd Avenue Phone: 305-795-2204 Permit Number: BP2004-1471 Printed: 11/17/2004 Page 1 of 1 Applicant: LYNN CHAVES Owner: CHAVES LYNN JOB ADDRESS: 114 NW 109 ST Contractor Contractor's Address: Local Phone: Parcel# 1121360100180 Legal Description: DUNNINGS MIAMI SHORES EXT 6 PB 51-31 LOT 2 BILK 213 Fees: Description Amount FEE2004-11500 Building Fee $100.00 Total Fees:$111.30 FEE2004-11501 CCF $0.60 FEE2004-11502 Notary Fee $5.00 Total Receipts: $0.00 FEE2004-11503 Training and Education Fee $0.20 FEE2004-11504 Technology Fee $2.50 FEE2004-11505 Scanning Fee $3.00 l Total Fees: $111.30 Permit Status: APPLIED Permit Expiration: 5/8/2005 Construction Value: $600.00 Work: REPAIR FLAT ROOF ,NOV 18 PAID Signed: (INSPECTOR) 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 responisibility for all work done by either myself,my agent,servants or employes. Signed: (Contractor or Builder) BY: