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WS-05-1226 Miami Shores Village ' ` r Building Department 10050N.E.2nd Avenue,Miami Shores,Florida 33138 i//� Tel:(305)795.2204 Fax:(305)756.8972 j BUILDING PZing Permit No. �5�-' PERMIT APPLICATION Master Permit No. FBC 2001 DECPermit Type(circle): Building ttElectrical Mechanical Roofing Owner's Name(Fee Simple Titleholder)A l `'t aALAa �� n— hone# (1), Owner's Address (()( k)U–) 10�L l.-L. City State L Zip Tenant/Lessee Name Phone# Job Address(where the work is being done) �k-- , City Miami Shores Vilia e County Miami-Dade Zip '3(-�6 Is Building Historically Designated YES NO, Contractor's Company Name S,` 0 'C Phone# Contractor's Address City State Zip Qualifier State Certificate or Registration No. kQ A. Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# $Value of Work For this Permit Square Footage Of Work: Type of Work: ❑Addition ❑AI ration ❑New ReRairlace ❑Demolition Describe Work: itx� /U/N 2. w ✓aT-s Z- Shu Submittal Fee$ Permit Fee$ l L" 0 CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Total Fee Now Du (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 wk fandstallations 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 permitwith 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 a fbv and a reinspection fee will be charged Signature Signature tOwner or Agent Contractor The f oing instrument was cknowled 2eore me this The foregoing instrument was acknowledged before me this day o� :i(k n. day of ,20_,by who is personally own to a or who has produced who is personally known to me or who has produced As'dentification and who did take an oath. as identification and who did take an oath. NOTARY P LIC: r NOT Y PUBLIC: Sign: V Sign: Mpg•..''<r; Print: Print: My Comm' sion Expires: My Commission Expires: APPLICATION APPROVED BY: 1 Y OJ ' s Examiner Engineer chc 05/13/03 Zoning VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMEeIT being the legal property owner, for the property Located at: ( tU /� Ct_% 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 irork 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 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 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 Iicenses 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 acknowle 11ged before me this ' day of 20-_! — Ey �Ir �'t�' who is personally lmo to me or who has Produced as identifica 'on who did take an oath Owner No 01 -VIC Owner Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 � ,. Phone: (305)795-2204 Fax: (305)756-8972 h"Tes Std Permit Permit Status: APPROVED Issue Date: 12/19/2005 Expires: 12/14/2006 Permit Number:WS-12-05-1226 Owner's Name: H MORGAN one: Permit Type: Windows/Shutters Parcel#: 1131010220050 Work Classification: Window/Door Replacement Block: Lot: Job Address: 101 102 Street NW Section: PB: Miami Shores Village, FL 33138- Contractor(s) Phone Primary Contractor Total Square Feet: 0 Total Valuation: $ 1,250.00 Comments: Re uired Ins ections Window Door Attachment REPLACE WINDOWS AND DOOR WITH SHUTTERS Window ShuffeDoorAttac ftachment Final Shutters Final Additional Information Type of Work:WINDOWS,DOOR AND SHL No of Openings:4 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 WINDOW � S, 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 $1.20 WS-12-05-23154 $159.10 Education Surcharge $0.40 Total: O Notary Fee $5.00 Permit Fee $140.00 D�� 2 PAID Scanning Fee $9.00 Technology Fee $3.50 A1C , Z Total: $159.10 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