FW-06-2712 (2) D
Miami Shores Village
®� ®-2-7006
g p Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
By.
_______0 Tel:(305)795.2204 Fax:(305)756.8972
BUILDING Permit No. 1�7UJ®(o -Z 1 )
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type(circle): Buildin Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) &V41L, Phone# ��'7 —d V/
Owner's Address
p 3316 /
City �dyn_t ����,s� State Zi
Tenant/Lessee Name Phone#
Job Address(where the work is being done)
City Miami Shores Villaee County Miami-Dade Zip
FOLIO/PARCEL# —6/ � nqov
Is Building Historically Designated YES NO
Contractor's Company Name ® o 2_O 7 Phone#
Contractor's Address
City 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$ Square/Linear.Footage Of Work:
Type of Work: ❑Addi' n ❑ to on
[--]New Rep ' /Replace ❑Demolition
P G
D cribe Work:
�®
�a
Submittal Fee$ Permit Fee$ /�� ��' CCF$ CO/CC
11
Notary$ �� Training/Education Fee$ Technology Fee$ '
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse 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
Signatur Signature
weer or Agent Contractor
The foregmg instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,2� by C Q t/1c day of .20 by
who is personally known to me or who has produced who is personally known to me or who has produced
identification and who did take an oath. as identification and who did take an oath.
NOTARY UBLI : NOTARY PUBLIC:
bel
Sign: 'RR Sign:
Print ®:*` Xp1YeS:nitAtUbtuT
Print:
My Co fission Expires: !,7.
'', ; Atldflfi8l#nd ¢ My Commission Expires:
APPLICATION APPROVED BY: / Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
VILLA GE OF MIAMI S foRES
OWNER BUILDER IDTSCLOSURE STATEMENT
NAME:
DATE:
ADDRESS:
Do hoeby petitiori'the'V.illage.of Miami.Shores-to act.
of the State of Florida, F.S 4$9.103(7). Andl�have read and�derstood the following disclosure4s MY own contradtor Purftiant to the s
statement, which entitles M. to work as my own contactor; 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 bne-family*or twd-family residence. You may
also build or lmpiove a comrriercial`truilding ata cost of$25,000.00 or less.The building must be
.fo r.yoUr own.use and.occupancy. It may'not be Built fot�sale of lease:.If you sell or[ease a
building you have built yourself within otte 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 responsibilityto 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 undor:your supervision and must
be employed by you, which means.thatyou must deduct F.I.G.A and with.-Wdings tax and
Provide workers' compensation for that employ",.all as prpscribed by law. Your construction
must comply with all applicable laws, ordinances, buildings codes and zbning'regulatiohs.
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 ani owner-builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
Initial �
1. .I have an understanding of the 2004 FBC & PRC 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 ate ndt 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
� 1 .
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 Peason they
do not.poses a business license I will be responsible and liable for any wrong
doing from this unlicensed company*or person. .
Initial _
7. I uinderst' M that-if any.person.gets injured on m construction project—they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be h d liable p Y �l cable for all d c�
o for and related cost which could i. cl
loss of wages duri n ude
g ,pg recovery from injury.'
Initial
8: I. and&rstand that under state and local laws I, can not d`o -arty Electrical,
Plumbing, heating, Air & Roof work on my-property with out first-obtaining
the.prop&r permits by licensed*eoniraet&rs.
Initial
Was acknowledged before me this L day of N� 20
By `-�5.:� `�" U► who was personallyknown
to me or who has
Produced there License or as identification.
ER. NO A RY
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Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit Number: FW-1 1-06-2712 Owner Address:
Invoice Number: FW-1 1-06-26609 62 NE 108 ST
Applicant: SCOTT CLARK MIAMI SHORES, FL 33161•
Company Name:
Job Address:
62 108 Street NE
Miami Shores, FL 33161-7036
Date Payment Type Check Number Amount Change
Wednesday, January 3, 2007
01/03/2007 Check 7702 $114.30 $0.00
Total Payment: $114.30
Page 1 of 1
' °I Iy- Miami Shores Village
Mut" 10050 N.E.2nd Avenue
" ""' Miami Shores, FL 33138-0000
z yP Phone: (305)795-2204 Fax: (305)756-8972
Permit
Permit Status:APPROVED
Issue Date: 11/7/2006 Expires: 05/06/2007 Permit Number: FW-11-06-2712
Owner's Name: SCOTT CLARK one:
Permit Type: Fence/Wall Parcel#: 1121360110030
Work Classification: Wire Fence Block: Lot:
Job Address: 62 108 Street NE Section: PB:
Miami Shores, FL 33161-7036
Contractor(s) Phone Primary Contractor
Total Square Feet: 48
HOME OWNER Yes Total Valuation: $ 800.00
Re uired Inspections
Additional Information Final
Type of Construction:Wire Fence Additional Info: Foundation
Classification:Residential
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 FWA 1-06-26609 $114.30
Education Surcharge $0.20 Total:
Notary Fee $5.00
Permit Fee-Wire&Wood $100.00 iAN 4 3 PAID
Scanning Fee $6.00
Technology Fee $2.50
Total: $114.30
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