RC-09-794 MT ry Miami Shores Village Pelt y A ildolfit)s1,901t#St CtitlFlt
10050 N.E.2nd Avenue
� � IN�ttc�lat�a6�a�i�I�l+�ln c��ill
"'• '"" Miami Shores,FL 33138-0000
P6""N�e Status:
Phone: (305)795-2204OD -
ORiD�
Expiration: 11
Project Address Parcel Number Applicant
1077 96 Street 1132060143680
Miami Shores, FL 33138- Block: Lot: AURORA LOAN SERV LLC
Owner Information Address Phone cell
AURORA LOAN SERV LLC 2617 COLLEGE PARKSCOTTSBLUFF NE 69361- i
Contractor(s) Phone Cell Phone
HOME OWNER Valuation: $ 13,000.00
Total Sq Feet: 0
Approved:In Review For Inspections please call:
Comments: (305)762-4949
Date Approved: :In Review Available Inspections:
Date Denied: Inspection Type:
Type of Construction:KITCHEN&BATHROOM REMODEI Occupancy:Single Family Drywall
Stories: Exterior: Final
Front Setback: Rear Setback: Framing
Left Setback: Right Setback: Insulation
Bedrooms: Bathrooms: MEN
Plans Submitted: Certificate Status:
Certificate Date: Additional Info:
Bond Retum: Classification:Residential
Fees Due Amount Invoice# Total Amt Paid Amt Due
CCF $7.80 RC-5-09-34786 $408.77 $358.77
Education Surcharge $2.60 }
Notary Fee $5.00 RC-5-09-34786 $408.77 $408.77 $ 0.00
Permit Fee-Additions/Alterations $375.00
Scanning Fee $9.00
Submittal Fee $50.00
Submittal Reversal Fee ($50.00)
Technologyr'Fee $9.37
Total: $408.77
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
June 08,2009
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 08,2009 1
%-IOR . Miami 0 VM9v9
l�ox i Shores Village
Building Department
MAY 1 1 ZQOg
p
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
d Tel: (305)795.2204 Fax: (305)756.8972
BUILDING Permit No. J
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type(circle): Ij�uild:i:nDg Roofing
Owner's Name(Fee Simple Titleholder) 1)6 0 Eja _MPhone#(V (V® amu
Owner's Address
City a —State IC- Zip_ -Z�Mps
Tenant/Lessee Name Phone# 14
Email ks�rqz
Job Address(where the work is being done) 10-4q Ve 0)u *
City Miami Shores Village County Miami-Dade Zip_
FOLIO/PARCEL#
Is Building Historically Designated YES NO ✓ Flood Zone
Contractor's Company Name 1 1"bR ow Phone#
Contractor's Address
City State 7,ip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E-mail
Architect/Engineer's Name(if applicable) Phone#
hLI
Value of Work For this Permit$ Square/Linear Footage Of Work: k
Type of Work: ElAddition 4Alteration ❑New Re air/Re lace
p ❑Demolition
Describe Work: tU-1r k.A om6I-S �_mojjo ON
• Yom` �t P
AM
s
a
Submittal Fee$ Permit Fee$ '��
_ CCF..$ 1CO/
Notary$ Training/Education Fee$ o Technology Fee$
Scanning$ Radon$ DPBR$ Zomig$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due'$ 7
See Reverse side-�
1
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 ND TO OB
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR OBTAINFINANCING,
OF
9
COMMENCEMENT.-
Notice
OMMENCEMENT."Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved anda reinqpection fee will be charged.
Signature Signature
Owner or Ag t Contractor
The foregoing instrument, ac owledged bef me this The foregoing instrument was acknowledged before me this
day of ,20� by da of
' Y >20,_,by
w ) is personal known to me or who has produced who is personally known to me or who has produced
� s identification and who did take an oath.
as identification and who did take an oath.
N TARP PUBLIC: NOTARY PUBLIC:
Sign: `{' G�`"�'icy• 'Si n:
Fps
Print: �+�'�' ���� Print:
My Commission Expires:
� �, 4�,d' My Commission Expires:
y ' h
�k:k�e4e�::k�k�:k:k>k�k:h�k�k�k%�>R:kok�og:k�k*:sekek�:Fs:k�kae�esksk:k:k�;c��e:k�kek:k=k'kue:k�:k�k�Fskik3S�FoksF��:k�$��kok�kskek�keIa:k��k>k:k�ks:����3e&ask:k��kvesk�koIark�:>k:R��k.F:k:k:k:k�k:k�:�k�k
APPLICATION APPROVED BY d&P Plans Examiner Zoning
Engineer Clerk checked
(Revised 07/10/07)
l
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: DATE: '
ADDRESS: 10;q te . S e ' 1" , I'S3
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 it 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 that you must deduct F.I.C.A and with-holdings tax and
provide morkers' 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
Myself.
Initial
k_�F
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. Inactive
permits for a period of over 180 days will become null and void (expired)
and a new permit will be required. to be issued for reinstatement of the
permit.
Initial
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.
Initia
v
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. 1 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. 1 understand that if I compensate any person or company for work performed
they are requited 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
�De
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. I 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
.7,Dle
Was acknowledged before me this day of , 2
By who was personally known to me or who has
Produced there License or 0 as identification.
OWr A C
NOTARY
Pt.
This LaLtrument repared
f_X, Name a
a Address Q" _ (GVkA S�r6I 331
C5
Permit No. Tax Folio No.
NOTICE OF COMMENCEMENT
STATE OF w�
�• �-y COUNTY OF- y�2 �A�
s m THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with
W Chapter 713,Florida Statutes,the following Information is provided in this Notice of Commencement.
a el.De$criplion of property:(legal description of pro erty,and street address if ava>ble)
,2.General description of improvement:
� � ��� •d `�� ` ��
64Ls
3.Owner information
ozl "° a. Name and address: 10 4--� b6
�C-a.-, _ b. Interest in property:
..� C-4 C. Name and address-2%simple titleholder(if other than owner):
e i.-a Cl
C,;Cr-:4 4.Contractor: f
C3;=,0:' / a. Name and address:
e:,C14-j b. Phone number:
o�a 5.Surely
r)to t-a a. Name and address:
�: ==W b.Amount of bond$
cr-Ci clr W c. Phone number:
W <L-
_•1=1:Y--rj-
C•3 re W s.lender
Cd H-- a. Name and address:
U-U X�x b. Phone number:
7.Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7.,Florida Statutes:
a. Name and address:
b. Phone number:
a.In addition to himself.Owner designates the following person(s)to receive a copy of the Lienors Notice as provided in
Section
7.13.13(1)(b),Florida Statutes:
a. Name and address:
b. Phone number.
9.Explration date of notice of commencement(the expiration date is 1 year from the date of recording unless a different date is
specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTiCE"OF COMMENCEMENT.
I iri-
1 t M . " Nota Pubk State if fbft
Carol wahier -
My Cantnis Ibft OD538S7 Ignature of Owner or Owner orized Officer/Director
orr►° Exptrds�Al07l2010 Partner/Manager
�1.awl �► �C
' Signatory's Tittl�lyye/Office
aforegoing in ent walacknowledgad before me this day of /�[/�2� (year)by _
Kt (name of person) as�17� (type of
i C-1 authority, ...e.g. officer, trusts , attorney In fact) for _(name of party on
{ ¢h a, behalf of whom instrument was executed).
y S ature of Notary Public-State of Florida
fi rint,Type,or Stamp Commissioned Name of Notary Public
x Commission Number
r ,� •� ��
Personally Known_or Produced Identification.
a- Verification Pursuant to Section 92.526,Florida Statutes
Under penalties of perjury, I declare.that I have read the foregoing and that the facts stated in it are true to the best of my
knowledge and belief.
�J)
A
_
rr 4 . Si re of Natural Person Signing
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