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PL-06-2960 oRr Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Date: 01/19/2007 Permit Type: Plumbing - Residential Inspector: Levrack,James Inspection Type: Underground Rough Owner: WILSON, DONNA Work Classification: Addition/Alteration Job Address: 9942 4 Avenue NE Miami Shores Village, FL Phone Number Parcel Number 1132060171220 Project: <NONE> Block: Lot: Contractor: HOME OWNER Building Department Comments OWNER WANTED TO PULL PERMIT 2 BATHROOMS JAN 2 2 2007 Ins r o ments Passed Failed Correction Needed Re-inspection Fee ($75) No Additional Inspections can be scheduled until re-inspection fee is paid Thursday, January 18, 2007 Page 1 of 1 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL r"' 4Z Phone: (305)795-2204 Fax: (305)756-8972 IN Inspection Date: 03/08/2007 Permit Type: Plumbing - Residential Inspector: Levrack,James Inspection Type: Top Out Owner: WILSON, DONNA Work Classification: Addition/Alteration Job Address: 9942 4 Avenue NE Miami Shores Village, FL Phone Number Parcel Number 1132060171220 Project: <NONE> Block: Lot: Contractor: HOME OWNER Building Department Comments OWNER WANTED TO PU PERMIT 2 BATHROOMS _ C> 3 Z_ Inspector Comments Passed Failed El Correction Needed Re-Inspection Fee ($75) No Additional Inspections can be scheduled until re-inspection fee is paid. Wednesday, March 7, 2007 Page 1 of 2 Miami Shores Village Old 0-k y • - Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fag:(305)756.8972 BUILDING � � �� Permit No. PERMIT APPLICATION Master Permit No. �� FBC 2004 BY'.-- -----------Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Feeple Titleholder) W (l. hone# -`j 2�' ^ COO j `"�C Owner's Address Q— 0(a 4x�\ PK,�� mkZ > City � '1�1. �. State Zip :R3 V-3 Tenant/Lessee Name Phone# Job Address(where the work is being done) City Miami Shores Villapte County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name hU 0-10 0 qA-\, Phone# Contractor's Address � % City State Zip Qualifier Naive Phone# State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit$ 1C"� Square/Linear Footage Of Work: Type of Work: ❑Addition Alteration ❑New Q Repair/Replace ❑Demolition Describe Work. 1 Submittal Fee$ Permit Fee$ C/ CCF$ k, 2,O CO/CC Notary$ Training/Education Fee$ i Technology Fee$ -J Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse 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." 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 approved and a reinspection fee will be charged Signature pa-,,,, �'lD.� Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of_DcymbeV,20 Pk by 1,jecr-re o?Q 140&b.-7 S®.-7 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 identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: ��,unuu„�� .�`:\� � � �% NOTARY PUBLIC: Sign: �� - 0512412010 Sign: Print 64/1 J rr,a✓1NOTHY PUBLIC � = pmt My Commission Expires: �f'�9•.D05 366,.-�Q�� My Commission Expires: 77 APPLICATION APPROVED BY: 2 - 1Plans Examiner Engineer Zoning (Revised 02!08/067 VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: Aja e-Ce,, //I. . A r 14-y' DATE: a 7 ADDRESS: IV 67. yee� 1' ate X,(, 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 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 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 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 contractor. It is your responsibility to 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 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-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 each paragraph. 1. I hold title to the above property and I am planning on doing this construction Initial 40(Z GJ 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 (,J(t.G-� 3. I have an understanding of the 2004 FBC & 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 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 meets the minimum code. Initial w (Z W 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 �i a 6. I understand that if I compensate any person or company for work performed they are required to have 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. Initial 0(1 W 7. I understand that if any person gets 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 during recovery from injury. Initial t( 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Initial LJ Was acknowledged before me this �) day o , 20DI Byj�DfML ISQ&who was personally known to me or who has Produced there License or D*4� as identification. OWNER NOTARY I MYCpMM SS yD/ AZ � S:O ber�p 3886 r ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM.IF A MASTER PERMIT HAS BEEN OBTAINED,THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. t7 r PLEASE CIRCLE O DISCIPLINE APPLIED FOR: PERMIT# PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER ILIGHT OUTLETS CENTRAL HEATING DISPOSAL IRECEPTACLES A/C (WIND) FLOOR DRAIN SERVICE TEMPORARY A/C(CENTRAL) GREASE TRAP ISERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR I SERVICE REPAIR/METER CHANGE IREFRIGERATION LAVATORY JAPPLIANCE OUTLETS IPROCESS AND PRESS PIPING LAUNDRY TRAY IRANGETOP I UNDERGROUND TANKS CLOTHES WASHER JOVEN JABOVE GROUND TANKS SHOWER IWATER HEATER JU.F.PRESSURE VESSELS SINK.POT/3 COMP. IMOTORS 0-1 HP ISTEAM BOILERS SINK,RESIDENCE. IMOTORS OVER 1-3 HP I HOT WATER BOILERS SINK,SLOP. MOTORS OVER 3-5 HP IMECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5-8 HP ITRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8-10 HP ELEVATORS/ESCALATORS WATER CLOSET MOTORS OVER 10-25 HP I FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25-100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP IVIOLATION A/C UNIT A/C WINDOW IREINSPECTION FIRE SPRINKLER JAIR CONDITIONERS HEATER-NEW INST. I STRIP HEATER HEATER-REPLACE IGENERATORS TRANSFORMERS LAWN SPRINKLER-WELL IGENERATORS TRANSFORMERS SWIMMING POOL I GENERATORS TRANSFORMERS WATER SERVICE ISPECIAL PURPOSE SEWER CONNECTIONS JOUTLETS COMMERCIAL UTILITY-SEWER ISIGN TUBES UTILITY-WATER I SIGN TRANSFORMERS SEPTIC TANK ISIGN TIME CLOCK RELAY IFIXTURES FAINFIELD,4"TILE/RES. JANTENNA PUMP&ABANDON SEPTIC TANK ITELEVISION OUTLETS SOAKAGE PIT CU.FT. IVIOLATION CATCH BASIN IREINSPECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET(GAS) GAS PIPING ReCelpt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit Number: PL-12-06-2960 Owner Address: Invoice Number: PL-12-06-27134 9942 NE 4 AVE RD Applicant: DONNA WILSON MIAMI SHORES, FL 33138 Company Name: Job Address: 9942 4 AVE Miami Shores Village, FL Date Payment Type Check Number Amount Change Thursday, January 18, 2007 01/18/2007 Credit Card $189.10 $0.00 Total Payment: $189.10 Page 1 of 1 Miami ills 10050 N.E. 2nd Avenue m Miami Shores, FL 33138-0000 ye= f Phone: (305)795-2204 Fax: (305)756-8972 0 R111D) Permit Permit Status: APPROVED Issue Date: 12/29/2006 Expires: 06/27/2007 Permit Number: PLA 2-06-2960 Owner's Name: DONNA WILSON one: Permit Type: Plumbing - Residential Parcel#: 1132060171220 Work Classification: Addition/Alteration Block: Lot: Job Address: 9942 4 AVE Section: PB: Miami Shores Village, FL Contractor(s) Phone Primary Contractor Total Square Feet: 0 HOME OWNER Yes Total Valuation: $ 1,300.00 Re uired Inspections Additional Information Underground Rough Type of Work: BATHROOM Type of Piping: Water Main Additional Info: Bond Return: Top OutMain Drain Classification:Residential Lavatory Water Service Re Pipe Heater Final 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 PL-12-06-27134 $189.10 Education Surcharge $0.40 Total: Permit Fee-Additions/Alterations $180.00 Scanning Fee $3.00 �Ale 8 PAID Technology Fee $4.50 Total: $189.10 �V Building D artment 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. Applicant Signature