WS-06-2172 Miami Shores Village {
Building Department AUG 1
10050 ei(3 SAvenue,?2 �IMiami30hores,6 oda 33138 B Ya .. . __
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BUILDING Permit No.
PEIUWr- APPLICATION Master Permit No.
FBC 2004
Permit Type(circle):` uildin Electrical Plumbing.. Mechanical Roofing
Owner's Name(Fee,Simple Titleholder) GA'6Ij e_ Su!�S/I e Aftone 0
Owner's Address -70 f p
citylGtiA�•�rre state f=C. . zip
'>ienantlL.essee Name Phone#
Job Address(where the work is being done)
City_ Mai Shores Villaee county NL�'m Dade_ ._ P
FOLIO/PARCEL#
Is Badding Historically Designated YBS NO
Contractor's ��~.
cto s CompanyName Phone#
Contractor's Address ca
:City State Zip
Qaalifier Name Phone#
State Certificate or Registration No. Certificate of Competency No. .
1
ArchitectlEngitreer's Name(if applicable) Phone#
Value of Work For this Permit$ a Square!Linear Footage Of Work:
Type of Work: []Addition []Alteration []Nee' &jI--R-"epaiMeplace [I Demolition,'
Describe Work 4b(L1G ltlt�/QO�.tJ'S (
Submittal Fee$ Permit Fee$ CCF$ COICC
.Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$ t
Bond$ Code Enforcement$ Double Fee$
.Structural Review.$ Total Fee Now Due$
' See Reverse side-->
Bonding ComPUny's Name(if applicable)
Bonding Company's Address
City - State_ _ zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City state
Application is hereby made to obtain a•perm t to do die work and installations as indi ,sated. 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,TANKRand.AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurateand that all;work wiffbe done iwcompliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR p'ATLURE`TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING'TWICE*FOR IMPROVEMENTS TO YOUR PROPERTY. . EF YOU INTEND TO OBTAIN FINANCING,
_CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMBIENCEMENT."
.Notice to AN11cartt. As a con&'Ion to tyle issuance of a bul ig pw*ft 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 attaurynuterut. Alsa,'a certi)led copy of the recorded notice of commencement must be posted at the job site
for.the first inspection-which occurs seven (7) days *er the building permit a issued In the absence of such posted notice, the
inspecdon will not be approved and a reinspection fee will be2 ed
ti
Owner or Agent Contractor
The forego' instrument was acknowledged before me this The foregoing instrument was.acknowledged before,me this
day of� ,l �20 Os by`_ \ day of, .20 by
who is pully known to me or who has produced who is personally known Ito me or who has produced
kiAQY U As identification and who did tie an oath. ,as identification and who did take an oath.
NOTARY PUB NOTARY PUBLiC:
i
Sign: Sign.
Prints- tzL S I ZSYt. Print:
My Commission Expires: o RICSYS M1.TOR1810 � My C6mmission Expires:
Iy� PAI State of ROrida
c�mmexpi'r"es*`f3`ci`�t�"`It1b� a*,�,r,�,�,� kirfa 4dninir4nkirWk4rfir9e4r4ir4einlrinlninU4nirfnU4rTrfnY4rdnirinh4rYr
No.DD 159409 l
APPLICATION APPROVED BY: b PlansExaminer
Engineer
Zoning
{Revised
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: !!e. DATE: , S / 7 z aa,G
ADDRESS: 70 AV-4., 5SG oA21 r FG
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 4$9.1403(7).And I have read and understood the following disclosure
statement,which entitles isle to work as my own corttrctor;I further understand that I as the
owner must appear in person to complete all application.
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
congteuotion yourself.You may build or improve a one-family*or two-family residence. You may
also build or Improve a commercial building ata cost of$25,000.06 or fess.The building must be
for.yopr own•use and-occupancy.It may not be Built for sale or lease:.Tfyou sell or lease a
building you have built yourself within one year after the cons'tructlon is e6inplete,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 riot licensed must work underyour supervision and must
be employed by you,which means.thatyou must deduct F.I.C.A and with-holdings tax and
provide workers' 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 eacE.paragraph.
1. I hold title to the above property and I am planning on doing this construction
Initial
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
Initial
3: .I have an understanding of the 2004 FBC & FRC and und6stand 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. P 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 he
minimum code.
Initial �
6-.
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
6.. I understand that if I compensate any person or company for work performed
they are required to-.have a business license in the cbunfy. If for any Beason they
do not.passes a business Hca** I will be responsible and liable for any wrong
doing from this unlicensed company-or person.
7. T=understaihd that-if any person.gots 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 duripg recovery from injury.
Initial
8. I. undor'stand that under.state and 1�Eal laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my property with out first.obtaining
the.proper permits b licensed•contractors.
Initial
Was acknowledged beforeme this_ day of t9 , 20 O �p
BY "'�' � �! who was personally known to me or who has
Produced there License or � t,�-e-+?'L- <<-- as identification.
.OWNER
ae, A RICSYS M.TORIBIO
r Notary°ublic.State of Florida
E = Ahy comm. expires Oct.20.2006
[' No.DD 159409
ORE ii Shores Village
1 . 10050 N.E.2nd Avenue
"" "" Miami Shores,FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit
Permit Status:APPROVED
Issue Date:8/22/2006 Expires:02118/2007 Permit Number:WS-"6-2172
Owner's Name. one: (305)491-2129
Permit Type: Windows/Shutters Parcel 41 1121360131210
Work Classification: Window/Door Replacement Block: Lot:
Job Address: 70 105 Street NW Section: PB;
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor Total Square Feet: 0
HOME OWNER Yes Total Valuation: $ 1,100.00
Comments: R uIred lnsR2g-tlons
REPLACE 3 WINDOWS Window Door Attachment
Shutter Attachment
Final Shutters
Final
Additional Information
Type of Work:WINDOWS No of Openings:3
Additional Info: 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 $1.20 WS-8-06-25934 $140.85
Education Surcharge $0.40 Total: O i PAID
Fee $130.00
SP Scanning Fee $6,00 �\
Technology Fee $3.25
Total: $140.85
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.
YA
Applicant Signature