BP-05-1383 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax: 305)756.8972a All
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BUILDING A Permit No4aFEL9 —
PERMIT APPLICATIO4 �' Master Permit No.
FBC 2001 7��"� ' �"
Permit Type(circle): Building E cal Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) VA-CD li z. Phone#
Owner's Address 96 UJ 2
City 1 r'Yd j 5t(6 n5 State FY, Zip 3316 9/
Tenant/Lessee Name Phone#
Job Address(where the work is being done) S A7r lc
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name (0 e#
Contractor's Address f
City State fi
Qualifier - t
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
S'Value of Work For this Permit 1 ' (500. CO Square Footage Of Work:
Type of Work: ❑Addition Xiteration [--]New ❑ Repair/Replace
El Demolition
Describe Work: 0*"t rTi" "i (% CA,4r ML `r®f '� d- S dlAA;A tt
e Mn
Submittal Fee$ Permit Fee CCF$ CO/CC.
Notary$ Jr—- Training/Education Fee$ O • 4CD Technology Fee$ Z .1
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$
(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 o .be approved and a reinspection fee will be charged.
Signature 4U&1Signature
Owner or gent �y Contractor
Theoing ins ent was ac owledged before we this —1 The foregoing instrument was acknowledged before me this
day&� 20 by VVV0J6k2&Vof_ ,20b
_, Y
who is personally to me or who has produced who is personally known to me or who has produced
f 4D As identification and who did take an oath. as identification and who did take an oath.
NOTARY P LI .4..... ���I�jry S NOTARY PUBLIC:
Sign: a:¢e OM 10 23 984 Sign:
9
Print: ., rte, �� Th{-�;
Print:
on me o._Inc
My Comm ion Expires: My Commission Expires:
APPLICATION APPROVED BY: �"/ ()
� Plans Examiner
Engineer
Chc 05/13/03
Zoning
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE .STATEMENT
I �Vig®Se UA-L D6Z. being the legal property owner, for the property
Located at: 6
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),sand I have read and understand the following disclosure
Statement, which entitles me to arork 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 bund or
improve a one-family or two-family residence or a farm out-building. l 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 Iicenses required by state la-,,v and by county or municipal Iicensing
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-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.Tfie foregoing instrument
Was acknowledged before me this R day at _ ,20 C)�5
ByYV ZJZZ� k/lAt-- — who is personally known to me or who has
Produced l� • as identification an did take an oath.
1Vd bel
aa 'Vin=Co issi DD 2 984
et "• y ndedThru
;10 Affmti Bondinf?Co..6 r
Owner
I
Miami Shores Village Building Permit
10050 NE 2nd Avenue
Phone: 305-795-2204
Permit Number: BP2005-1383 `
Printed:9/2212005 Page 1 of 1
Applicant: YVROSE VALDES
Owner: VALDES YVROSE
JOB ADDRESS: 86 NW 108 ST
Contractor Contractor's Address:
Local Phone:
Parcel# 1121360110160 Legal Description: DUNNINGS MIAMI SHORES EXT NO 7 PB 52-33 LOT 8 BLK
Fees: Description Amount
FEE2005-12707 Building Fee $100.00 Total Fees:$112.10
FEE2005-12708 CCF $1.20 Total Receipts: $0.00
FEE2005-12709 Notary Fee $5.00
FEE2005-12710 Training and Education Fee $0.40
FEE2005-12711 Technology Fee $2.50
FEE2005-12712 Scanning Fee $3.00
Total Fees: $112.10
Permit Status: APPROVED Permit Expiration: 3/21/2006 Construction Value: $1,500.00
Work: CHANGE TILE. CABINET,TOILET AND SHOWER IN BATHROOM
2PPApI)
C--V— 44=�-13
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:
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