BP-04-953 Miami Shores Village RFS V
ED
f, Building Department AIL ' 20
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 4
99 Tel: (305)795.2204 Fax: (305)756.8972
BUILDING Permit No. 15P
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) in le„( 4 C'/R,p a, Phone#
Owner's Address 116 5 nY 1023 g--
City a . . & ," State �[, Zip S-B`3 f
Tenant/Lessee Name AZzY&C ,g0_C S Phone# 3®5'
Job Address(where the work is being done) &gene ��� �-.
r .
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES CN!D__
Contractor's Company Name ,. $A j r,;' '� Phone#
Contractor's Address _,/A�-l
City ` � a �1v� - State- Zip
u
Qualifier_ - _� - "'� A" 7
State Certificate or Registration No._C' , ' 4 _Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit 0 / (OC, . Gf� Square Footage Of Work:
Tyke of Work: ❑Addition ❑Alteration ❑New ;<Repair/Replace ❑Demolition
Describe Work: a 441" V ze:,Z Y,
Submittal Fee$ 6C • 08 Permit Fee$_� CCF$ CO/CC
Notary$ Training/Education Fee$ 19,, 440 Technology Fee$ S®
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."
Noticc to Appliratit: 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.
Signatuk,_ 5 ��--� Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me tills The foregoing instrument was acknowledged before me this
? n
day of 5-jz4,1120 4�y,by 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' on and who did take an oath. as identification and who did take an oath
NOTARY PUBLIC: RUBEN T.THOMPSON N ARY PUBLIC:
r MY COMMISSION#DO 263523
Sign: s;� EXPIRES:Novejr
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My Commission Expires: /���2e�[� My Commission Expires:
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APPLICATION APPROVED BY: JUL 14 2004 Plans Examiner
Engineer
Zoning
Chc 05/13/03
I
Exhibit A
Lot 4, Block 2 BISCAYNE RIVER HEIGHTS, according to the Plat Thereof, recorded in Plat Book 43, Page 73 of the
Public Records of Miami Dade County,Florida.
Parcel identification Number: 11 22320310080
File Number.(Closing File Number) DoubleTimm
♦5" OR
Miami Shores Village Building Permit '
10050 NE 2nd Avenue ---+-
Phone: 305-795-2204 Permit Number: BP2004-953 OR
Printed:7/16/2004 Page 1 of 1
Applicant: ALEX HERNANDEZ
Owner: HERNANDEZ ALEX
JOB ADDRESS: 1155 NE 103 ST
Contractor Contractor's Address:
Local Phone:
Parcel # 1122320310080 Legal Description: BISCAYNE RIVER HGTS PB 43-73 LOT 4 BLK 2 LOT SIZE 78.380 X 106 OR
Fees: Description Amount
FEE2004-7104 Building Fee $100.00 Total Fees:$'10.10
FEE2004-7105 CCF $1.20 ^ �°
FEE2004-7106 Training and Education Fee $0.40 Total Receipts: $0.�0
FEE2004-7107 Technology Fee $2.50
FEE2004-7108 Scanning Fee $6.00
Total Fees: $110.10 ('
Permit Status: APPROVED Permit Expiration: 1/10/2005 Construction Value: $1,070.00
Work: GARAGE DOOR
' JUL 2 0 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:
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE .STATEMENT
being the legal property owner, for the property
Located at: �'� ��� e,3 &
Legally described as_ // &6-3 /00 o
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 understand the following disclosure
Statement, which entitles me to'3 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
constriction 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 Icensed 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 prescnbed by law. Your constriction 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 day of 20 O!Z
B (1,6p who is personally known to me or who has
Produced/i� �. as identification and who& oath.'
er Notary
""""'•. RUBEN T.THOMPSON
t ', £ MY COMMISSION#DD 263523
Owner A' I�N� ICU�00�