DS-09-2118 Miami Shores Village
10050 N.E.2nd Avenue
Miami Shores,FL 33138-0000 '
Phone: 305 795-2204 z � ZM
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t � '�� 3 � � Expiration: 07!1212010
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Proj dress Parcel Number Applicant
210 105 Street 1121360161040
Miami Shores, FL 33150-1143 Block: Lot: SEAN PHILLIPS
Owner Information Address Phone Cell
SEAN PHILLIPS 210 105 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 300.00
HOME OWNER
„............ Total Sq Feet: 42
Approved:Yes For Inspections please call:
Comments:APPROVAL IS FOR SLAB ON GRADE OWN* (305)762-4949
Date Approved:1/8/2010:Yes Available Inspections:
Date Denied: Inspection Type:
Type of Work:SLAB Additional Info:CONCRETE Final
Bond Return: Classification:Residential Sidewalk
Landscaping
Foundation
Fees Due Amount Invoice# Total Amt Paid Amt Due
CCF $0.60 DS-12-09-36722 $104.60 $50.00
5
Education Surcharge $0.20
Permit Fee $100.00 DS12-09-36722 $104.60 $104.60 $0.00
Scanning Fee $3.00
Submittal Fee $50.00
Submittal Reversal Fee ($50.00)
Technology Fee $0.80
Total: $104.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS.DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is :curate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-oa .ed conlrae*or to do the work stated
January 27,2010
Authorized Signature:Owner / Applicant Contract;=r�/ Ageot Date
Building Department Copy
January 27,2010 1
Miami Shares 'Village
Building p �Department AC � RECD
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
BUILDING Permit No.D S 0q -2 g
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: BUILDING ROOFING-
Owner's Name(Fee Simple Titleholder)
. Se An `Pi'1 �)LDS rPhone# 305 46W-0+4
Owner's Address
City iAMi State }, Zip 3�ISO,
Tenant/Ussee Name Phone#
Email
Job Address(where the work is being done)__.o?I Q M L5 hS
City Miami Shores Villaee County . i '-Da d— Zip j3158
FOLIO/PARCEL#
c1rB0dkj Historically Designated YES NO Flood Zone
Contractor's Co any Name_ otjgjer Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
7
,Contact Phone E-mail
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$. a b.0® Square/Llnear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑Neffw ❑ Repair/Replace ❑Demolition
Describe Work: i,s'Ect.��p„� PDd1G�` S�Bt�
ubmittal Fee$SQ-0DWgermit Fee$ CCF$ CO/CC.$
50 Notary$ Training/Zducadon Fee$ • o Technology Fee$ •
Scanning$, •Ott Radon$ DPBR$ Bond$
Double Fee$ Violation date:
Structural Review.$ Total Fee Now Due s--n4,�
See Reverse side
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
P
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
COMMIENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
EVIPROVEMENTS 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 fob 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..
0 �
A Signature
4Afft- All
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 2)1 The foregoing instrument was acknowledged before me due
day of _,20(fes' ,by ��► f � P,S, day of .20_,by
XwIF V/
who is personally known tome?Cvh � .l who is personally known th me or who has produced
v IQ••�•gym
As iFM olnl�vh �i oath as identification and who did take an oath.
ir '
NOTARY PUBLIC: •-r m o� o �++' NOTARY PUBLIC:
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Sign: ��� Sign:
�ntlull
Print:. Print:
My Commission Expires: My Commission Expires:
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APPI OVM BY � �'"`.!'� ' .Plans Examiner Zoning
A
Engineer Clerk checked
(Revised 07/10/07)(Revised 06/10/2009)
Parcel Owner Report
Parcel Number: 1121360161040 210105 Street
Miami Shores FL 33150-1143
Tax ID: 1121360161040
Owner Information
SEAN PHILLIPS Current Owner:Yes
Phone:
�-\ Related Permits Permit Number Application Date Expiration Date Status
U Driveways/Sidewalks/Slabs DS-12-09-2118 12/31/2009 02/15/2014 EXPIRED
Electrical-Residential EL-9-09-1484 09/03/2009 08/04/2014 EXPIRED
Imported Permit BP2002-1021 05/31/2002 01/01/2999 CLOSED
Paint PT-5-09-819 05/13/2009 01/01/2999 CLOSED
Plumbing-Residential PL-9-09-1485 09/03/2009 01/01/2999 CLOSED
Re-Occupancy RC-7-08-1347 07/22/2008 01/01/2999 CLOSED
30 Residential Construction RC-9-09-1486 09/03/2009 08/05/2014 EXPIRED
LPC1 NG 'L31
Monday,August 25,2014 Page 1 of 1
Planning and Zoning Criteria
1R g Miami Shores Village Permit No. DS-1 2-09-2118
10050 N.E.2nd Avenue
3
Miami Shores,FL 33138-0000
-` R6 Phone: (305)795-2204 Fax: (305)758-8972 t ,.
Issue Date:Not Issued Expires:Not Issues!
Folio Number)121360161040
Owner's Name:SEAN PHILLIPS owner's Phone:
Job Address: 210 105 Street Total Square Feet: 42
Miami Shores, FL 33150-1143 Total Job Valuation: $ 300.00
Contractor(s) Phone Primary Contractor
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 1/8/2010 :Yes
Comments: APPROVAL IS FOR SLAB ON GRADE ONLY.
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 a the
minimum code.
Initial r-
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 0
attorney.The department will not mitigate any contract disputes.
Initial P_
6. I understand that if I compensate any person or company for work performed
they are requited to We 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.
I�pitial
7'. I undaittot that if any person gets igjured on my construction pmjoet—they are
entltlbcl to workman's compensation:-And if they do not posses a workmen's
pglicy I could be hold Liable for all doctor and related cost which could inc de
[otos of wages during recovery from igjury.
. Initial `
B. I understand.that under state and local laws•I can not do.any Eleotrical,
Plumbing, Heating, Air & Roof work on my'property with out first obtaining
the proper permits by licensed contractors.
Initial
Was.acknowledged before me this_ 3 1 day of ,20 0
13y SfL!,�N PA LUA 11'2 who was personally known to me or who has
Produced there License ot- as identification.
O
OVMtR Z140TARY
zo
CO
(� ///lllillll�
VILL14GE OF 1M 1,4MI S.FI"O=1zES
OWNER BUILDER DISCLOSURETATEMENT
NAME: ��e�n ., .
` ' `S ' DATE: 0
AD'I3RESS: �)i ) 105
Do hereby petition the Village of Miami Shores to act as myown contractor pursuant to the laws
of the State of Florida,F.S 484.103(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 4llgws you,as the owner of your property,
to act as your own contractor even though you do not have a license,you must gupervise the
construction yoursolf.You may build or improve a one-family or two-family redidbnee.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 fot sale or lease,which is a viohttion bf this exemptlep.you May not hire
an unlicensed person as k contractor.It is your responsibility to make Bore the people employed
by you haive1censes required by stay law.and by county er mtaiioipal lieansing ordinances.Any
Person working on your building who Is not licensed rivet work under your 84pervlsion and must
be employed by you,which means that you must deduct F.L•C.A and with-holdings tax and
provide workers'00mpMation ft that eMloyee,all as presoribed bylaw.Your construction
must comply with all applicable laws,ordinances,-buildings c6des and z6ning regulations.
Please rogd and Initial each paragraph.
I. I hold.title to the above prop81ty and I am planning on doing this cons
Myself.
Initial
2. I understand that as an OWher-builder I must abide by all zoning ordinances and
building regulations in effect at the time of
en
permits for a period of over 180 days-will become nun
and void (expired)
v and a new permit will be required.to be issued for reins f the
permit. e
Initial
3. I have an understanding of the 2004 F13C & 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.
Initial
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XRDING TO THE NATIONAL FLOOD ISE PROGRAM! r lIt '
THE SLWXCT PROPERTY FALLS IN FLOOD ZONE, 1120652 G----- J 7 117/19951 "X" N/A