RC-15-1886 Miami Shores VillageeNtt'�1Gtn
10050 N.E.2nd Avenue NW
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Miami Shores,FL 33138-0000
Phone: (305)795-2204
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Expiration: 02120/2016
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Project Address Parcel Number Applicant
340 NW 112 Terrace 1121360010240
Miami Shores, FL Block: Lot: EMMA MUNIZ
Owner Information Address Phone Celt
EMMA MUNIZ 340 NW 112 TERR
MIAMI FL 33168-3300
Contractor(s) Phone Cell Phone Valuation: $ 400.00
HOME OWNER
Total Sq Feet: 120
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Slab
Date Denied:
Final
Type of Construction:SHED 10 X 12 Occupancy:Single Family Review Planning
Stories: Exterior: Review Building
Front Setback: Rear Setback: Review Building
Left Setback: Right Setback:
Bedrooms: Bathrooms:
Plans Submitted:Yes Certificate Status:
Certificate Date: Additional Info:
Bond Retum: Classification:Residential
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# RC-7-15-56490
$2.00 07/28/2015 Cash $50.00 $64.60
DCA Fee $2.00
Education Surcharge $0.20 08/24/2015 Credit Card $64.60 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.60
Total: $114.60
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 A DAVIT: I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constru n oreauthorize the above-named contractor to do the work stated.
August 24,2015
A t orized Signature:Own / Applicant / Contractor / Agent Date
Building Department Copy
August 24,2015 1
Miami Shores Village
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Building Department JUL 28 01
5 ,
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972Y°---
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 C)
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C�� CONTRACTOR DRAWINGS
JOB ADDRESS: ,./ I V �W i I TC,�-�i
City: Miami Shores Countv: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: �Construction Type: Flood Zone: BFE: // FFFFE: --7J6(/ /
OWNER: Name Fee Simple Titleholder): u.(%I NVQ i C IrYI� f�l Z P�#: M 5—606-7
Address: NW
City: )Iakx� S V O RZA State: 6L• Zip: 3SI(A
Tenant/Lessee Name: Phone#:
Email: Ir' 1
CONTRACTOR:Company Name: I`�A w` Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
f Value of Work for them* Square/Linear Footage of Work:
Type of Work: ❑ A i ion ❑ AI ation ❑ New Repair/Replace ❑ Demolition
`—Descri do of Wa T:
) JG LL�a�&& ' I -Or,]
Specify color of color thru tile:
Submittal Fee$� o� Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ G 41 GO
(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 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 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 at be approved and a reinspection fee will be charged.
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Signature ;4 a Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Z��w day of Sx;l ,20 '/ by day of ,20 ,by
lr,r/)l /3- rn(1N i�- ,who is personally known to ,who is personally known to
me or who has produced - L">��r✓L,J as me or who has produced as
identification and who did take an oath. „, ��� ,,, identification and who did take an oath.
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NOTARY PUBLIC: ...• • •••.. %� NOTARY PUBLIC:
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Sign: sign:
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Print:
Seal: '�, �'lan�ls 5 \\\`�� Seal:
APPROVED BY �I ° Plans Examiner 710 T7;5 Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Boom Building Department
10050 N.E.2nd Avenue
^pgo Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENTNAME: 1 ►` U I�Iz DATE:
ADDRESS: "v N lA� lie T-49,. Y)6afw' J`'1dRQ i 3-31
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,RS 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 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 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 understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder
permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own
contractor 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 she is responsible for the
construction and is not hiring a licensed contractor to assume responsibility.
Initial_r�,-m..
3. 1 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 own
name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on
permits and contracts.
Initial e ;W.
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve
a commercial building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy.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 sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially
improved it for sale or lease,which violates the exemption.
Initial
5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction.
Initial�����
6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or
residence.It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or
municipal ordinance.
Initiaor