BP-2003-1540 Miami Shores Village
RCEaE® Building Department
10050 N.E.2nd Avenue
SEP
232003 Miami Shores,Florida 33138-
Tel:
3138Tel:(305)795.2204
Fax:(305)756.8972
BUILDING Permit NO.
PERMIT APPLICATION 5� -Master Permit No.
TBC 2001
Permit Type(circle): Building Electrical Plumbing Mechanical oo5ng
Owner's Name(Fee Simple Titleholder) Phone# �
Owner's Address lsSud P R L4.) 4- t (off
City 'l-Nstate .n zip �31(oS
TenantUssee Name Phone#
Job Address(where the work is being done)
City Miami Shores Village County Miami Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name c Phone#
Contractor's Address � �..
Qualifier — .
Architect/Engineer's Name(if applicable) - Phone# _
Architect/Engineer's Address
City t State Zip
$Value of Work For this Permit Square Footage
®0�
Number of:Bays Stories Families 1 Bedrooms l3
Type of Works ❑Addition ❑Alteration ❑New Repair/Replace ❑Demolition
Describe Work:
1
• +iiinhiilriin4iriiiriNilntrir4r#tntrintriir* Irik4iiri#iniririiTriirintriiiintei4inirininTr ..
Tn
County Escrow Fee$LL Permit Fee$ 00 Notary$ •w
Education/Training Fee$ Tech$ Scanning$ ,,.4 �.�.-. Radon$
Code Enforcement$ Bond Strict.
Minns Plans Check Fee$ Total Fee Now Daer(Con0990sl on;gpposite 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
COIVE%MACEMENT."
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 not be approved and a reinspection fee will be charged.
AV
Signature S,Y\ ignature
Owner or Agent Contractor
The foreggo�in�g-f instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 W by �0 day of .20 by
who is personally known to me or who bas produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTJY LIC: NOTARY PUBLIC:
Sign; 4, , `'° y Sign:.
Print: _ s DD231984'
Print:
4"1 11 2OF7
My Commission Expires; C ded Th>U My Commission Expires:
Atlantic Bonding Co.,inc.
i t i r it it i it Ar it it it#,t it int,r i r it i*ii r 4r*flnr it 4nir ie it Ont iTnlr it it inr,t,rt,t i,r Tnlr 4,r*int,r,t,t 8 r inr i#it it t rr*,r t i t i i,t lntt Inint 4 dr in r i inirle pit t r 4nTr 4r i nt i tt it*Tr d nTntrt i r sir int nir it
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY: Plans Examiner
Engineer
Chc7r1/03
Zoning
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
I (Q*ke-?_ being the legal property owner, for the property
Located at: 9 1 1 73 N 104 ST ,
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),end I have read and understand the following disclose
Statement, which entitles me td.cork as my own contractor, I further understand th t 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 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$25,000.00 or less.The building must be for your own use and occupancy.It
may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the
construction is completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption.You may not hire an unlicensed person as your contractor.It is your responsibility to make sure
that people employed by you have licenses required by state law and by county or municipal licensing
ordinances. Any person working on your building who is not licensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with-holding tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction must comply
with all applicable laws,ordinances,building codes and zoning regulations.
Proof of ownership provided( ) initial of reviewing clerk.The foregoing instrument
Was acknowledged before me this— ) day of ,20�
By who is personally known to me or who has
Produced as identific ion and who did take an oath.
41 / 0
caner Not `
Mabee arga
ppY P
Owner :Commission#DD231984
Expires:Jul 13,2007
-0° Bonded Thru
Atlantic Bonding Co.,Inc.
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D*PPgM Fes: 1173 NE 104 Stllmt Mi.M . Sheke®y. F1�lax 33138.
xam PTI'b"s Lot 4,. 18100k 1r 'ftia 333°['t�" MOM!', a �.s1g to
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LaRal Tisk Services, IAc.
Attorneys' Tt%).m Inamrance Fund, Inc.
Gh*A* manhattan Mortpoe. its ,succa"ars and/or efaaigns, as theIr
1,nt.Pr@DC,may ePPe®r.
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6)BaenblatfOA OF the. '*'ac$of The"a hwp Its in moo 1D dowwiml►Y074ad e,riy 1VOSt1ns H16 RYCmV.
nweisi of Pub%AOaords rot Wo""t V 1191m*POW. i
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any aawtwm DeaftaUr or Unataiton fa WNtW MOM4W%ems CM ttxnwhu.
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5 7)rt,$WAkW Im not%a}Id WOMIA Ow WWWO r Oft0!rsb MA60 o11f1 t.)atshOW Lwin 1learvrllor and MsaW.
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�l0 DA
• 1• .. •.• . AFFIDAVIT_ . . . .. . , ' • . •.
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant ��E`' 2 —
� � does hereby attest that the
(property owner)
attached survey,performed by
(name of surveyor's company)
performed on ,is an accurate representation of the existing conditions alnd
(date of survey) .
locations of all structures on the property as of this date. -
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
Property without first providing a survey less than six(6)months old. The Affiant,as property owner,further
agrees to remove or obtain permits for any structures which now may exist on the prop °` ich are not
a
Permitted or which may violate zoning or building code regulations. The Affiant fit ' un the
its that
existence of an such structures may affect final
Y y inspections as applicable to this or other
Further,Affiant sayeth naught. /
Affi owner
Vitness(sign and print) Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this, day of
Affiant is personally Imown to me,_produced as identification.
Mabel Vargas
Commission#DD231984
Expires:Jul 13,2097
Bonded Thru
Atlantic Bonding Co.,Inc.
s
• CRITIQUE SHEET
JOB ADDRESS
APPLICANT PERMIT NO.
PHONE# ADDRESS:
- MIAMI SHORES VILLAGE
APPUCA1lON � ���� `� BUILDING /ZONING DEPARTMENT.
SHEET .OF . SECTION BY DATE
ZONING
MISCELLANEOUS
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
• STRUCTURAL
_ BUILDING OFFICIAL
1. Subject to compflanoe with af6Federal,State.
Cowly.VMAo rtites tad rogvfaUwj.YHfage
cw rrespo sstbulty for accuracy offor resutts from
2. Th(s copy of plans trust be uraltabie on.
buHdinj Site or no fnspoetlon will be condccted.
DATE ZONI.JVG • COMMENTS INITIALS
7,9(j- ems/ l
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