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RF-16-2098 Gutters I • ?luo ��-. P I e ° t,� Miami Shores Village jBt? ) ^ ; 10050 N.E.2nd Avenue NE41 'k. gosft Miami Shores,FL 33138-0000 hF ro e Phone: (305)795 2204 � IRWO R } � Expiration: 01/ /2017 SSU / Q1g. Project Address Parcel Number Applicant 1201 NE 102 Street 1132050250160 Miami Shores, FL 33138- Block: Lot: MacDAM&DENISE GLINN Owner Information Address Phone Cell MacDAM&DENISE GLINN 1201 NE 102 Street MIAMI SHORES FL 33138-2600 Contractor(s) Phone Cell Phone $ 1,700.00 HOME OWNER Valuation: .. ,... _.,. ._. ,.,. Total$q Feet: 110 Type of Work:Re Roof Available Inspections: Additional Info:NEW GUTTER FOR EAST AND NORTH SIDE Inspection Type: Classification:Residential Scanning:3 Final Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# RF-7-16-60749 $2.00 07/26/2016 Credit Card $50.00 DCA Fee $2.00 $66.20 Education Surcharge $0.40 07/29/2016 Credit Card $66.20 $0.00 Permit Fee-Repairs $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in with compliance t all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I ass me responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICA PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AF I certi �fore �above-�named accurate and that all work will be done in compiance with all applicable laws regulating constructi an g. ore contractor to do the work stated. July,29, 2016 A o ed Signature:Owner / Applicant / Contractor / Agent D to Buildin Department Copy July 29,2016 1 ,r Miami Shores Village RF.CFTVFD ,b Building Department JUL 2 6 2016 g p � ��' 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 y �n Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014 5� BUILDING Master Permit No. 1(0 PERMIT APPLICATION Sub Permit No. 5,J06ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSIOr ❑RENEWAL I ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELL TION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: c,) 0 City: Miami Shores County: Miami Dade Zig) / Folio/Parcel#: /)Is the Building Historically Deeignated:Yes NO ✓ Occupancy Type: R Load: Construction Type: C S Flood Zone&JA BFE: FFE: OWNER:Name(Fee Simple Titleholder): h f +'�CJL�.aJ�, rA �. �r Phone#: '�®� Address: 1 --I o % c Il•� 1_ l®1 CJ City: : ova S►,,� ® S State: 1....C` Zip: ? 1/ Tenant/Lessee Name: Phone#: �5(- Lk K Email: ��� -. �.._0Pyr -0eL. CONTRACTOR:Company Name: Phone# �— Address: City: State: IZip: Qualifier Name: Phone#i State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: A Phone#: Address: City: State: Zip: !Value of Work for this Permit:$ 1 -7 ()o Square/Linear Footage of Work: ( 10 1;-t ec.� -(4 Type of Work: ❑ Addition ❑ Alteration [gew ❑ Repair/Replace ❑ Demolition Description of Work: tj Q ov q.A , S Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ Co/CC$ Scanning Fee$ - Radon Fee$ 2-0 0 DBPR$ a ®® • otary$ Technology Fee$ - b C) Training/Education Fee$ d • Double Fee$ Structural Reviews$ Bond TOTAL FEE NOW D E$ (Revised02/24/2014) 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 certifylthat 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,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 not be approv d and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged befo a me this The foregoing instrument was acknowledged before me this day of ���'� 20 ,by day of 20 , by b1 A CAIXhl-) LY 01 ho is pers ally o to who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: �� �' '�l��� Sign: Print: _Q�Q '• Print: Seal: S i o ® Seal: mss•�/ �A!�1.4'' ,J ; APPROVED BY v L� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) a `gam°I Miami Shores Village ,,,, wilding Department 10050 N.E.2nd Avenue Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 IlOWNER BUILDER DISCLOSURE STATEMENT \ NAME: mc l r d�F^^� (�. �- s� DATE: . ADDRESS: k I c7 i t: t ®�L Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State oflorida,F.S 489.103(7).And I have read and understood the following disclosure statement,which entities 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 anexcfption 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 construction yourself.You may build or improve a one-family or two family residence.You may also build or improve a commercial building at a cost of$25,000.00 or less(The new form states 75,000).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 for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractort is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing orfinances.Any person working on your building who is not licensed must work under your supervision and must be employed by you,which mean.that you must deduct F.I.C.A and with-holdings tax and provide workers'compensation for that employee,all as prescribed by taw.Your construction must comply with all applicable laws,ordinances,buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 understand that state law requires construction to be done by a licensed contractor and have applied fo an owner-builder permit under an exemption from the law.The exemption specifies that 1,as the owner of the property listed,may�a y own contr ctor with certain restrictions even though I do not have a license. initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or he's responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initla 3. I understand that,as an owner builder,I am the responsible party of record on a permit.I understand that i may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my dw,rf�name °understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits a Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I maalso build or Improve a commercial building if the costs do not exceed$75,000.The building or residence must be for my use or occupan It may not be built or substantially improved for sale or lease.If a building or residence that i have built or substantially improved myself is Id r lease in 1 year after the construction is complete,the law will presume that I built or substantially improved it for sale or lease, es the exemption. Initial S. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. Initia 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons wor ing on my b ' ' or residence.It is my responsibility to ensure that the persons whom I employ have the license required by law!77 cFiei�ai�ordinance. r Initial t 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain anwner-builder permit that erroneously implies that the property owner is providing his or her own labor and materials.I,as an owner-builde�'ma be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working n my property.My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner-builder and ware f the limits of my insurance coverage for injuries to workers on my property. Initial 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed con tr or who is not licenses to perform the work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by me,which means that I must comply with laws requiring the withholding of federal income tax and socials curity contributions under the Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employe �dersta myfailure to follow these may subject to serious financial risk. Initia 9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all applicable laws and requirement that govern owner-builders as well as employers.I also understand that the Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations Initi 10. 1 understand that i may obtain more information regarding my obligations as an employer from the Intern l Revenue Service,the United States Small Business Administration,and the Florida Department of Revenues.I also understand that I may corAo the Flori onstruction Industry Licensing Board at 850.487.1395 or httn://www.mvfloridalicense.com/dbpr/pro/cilb/index.htm' Initia 11. I am aware of,and consent to;an owner-builder building permit applied for in my name and understands f hat I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of th i f rmation that 1 have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public.If you contract with a person whoYoes not have a license,the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or employee of an Individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor isdroperly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit.A copy of the property owner's driver license,the notarized signature of the property owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of 20 L� By -"�' ���� who ws personally known mor who ias ------------------------- Produced there License or as ide A&I OWNER �®p�pfd'P6 iPf11944 t� �S DATE SIA N 1r mvv%p, es n 7� - ,'V 117n WITH ALL FEDERAL 7.7 r:1' �tI-1LLS 'P�1DRF-C;ULATInNS � , 177 JUL 2 BY. i I Ira m __ b � . f0 1 .... •ef.•e . . 0 ••fess s 0 0 • • • flee.• tu� e •• •• 0.0600 • 06 66•.• •ei.e• 0666 .. 1 (� � I d 00.0.4 00 • see*** •0004• + .6••6• 4.006• •• 60.6.0 • 06 of f . fes : ' 0 • 0 604• • • 0.00.0 • •0e.