Fillable Re-roof Permit Checklist BLDG Cop 364e-20170525235736

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Re-roof Permit Checklist BLDG Cop 364e-20170525235736

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U.S.A. forms for Town of Cutler Bay

BROWSE TOWN OF CUTLER BAY (FL) FORMS

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CHECKLIST PERMITS REQUIREMENTS FOR
RE-ROOF
PERMIT APPLICATION
OWNER BUILDER AFFIDAVIT(IF APPLICABLE)
2 COPIES OF ROOFING PACKAGE
2 COPIES OF N.O.A (NOTICE OF ACCEPTANCE)
UP FRONT FEE OF $130.00 IS REQUIRED TO
REVIEW (non-refundable)
*NOTE TO OWNER BUILDER ONLY SHINGLE ROOF
AND PEEL & STICK IS ALLOW TO BE DONE BY
OWNER.
Building Department
Town of Cutler Bay
Building Department
10720 Caribbean Blvd., Suite 110
Cutler Bay, Florida 33189
Tel:(305)234-4193 Fax (305)234-5873
PERMIT APPLICATION
Permit No.
Master Permit: Job Address: Unit No.
1. Owner Information 2. Contractor Information
Owner Name: Company Name:
Address: Qualifier Name:
City ST Zip Address:
Phone No. City ST Zip
Phone No.
Owner Builder Yes No License No.
3. Permit Type: (Check One Only) 4. Type of Improvement: (Check One Only)
□ BUILDING □ CHANGE CONTRACTOR
□
NEW CONSTRUCTION □ ADDITION ATTACHED
□ ELECTRICAL □ EXTENSION
□
A
DDITION DETACHED □ ALTERATION INTERIOR
□ MECHANICAL □ RENEWAL
□
A
LTERATION EXTERIOR □ REPAIR/REPLACE
□ PLUMBING/GAS □ SHOP DRAWING
□ PAVING/DRAINAGE □ SIGN
□ ROOFING □ ZONING
□ PUBLIC WORKS □ OTHER
5. Architect/Engineer: 6. Legal/Use/Work:
Name: Folio No: No. of Units:
Address: Lot: Block:
City ST Zip Subdivision: PB/PG:
License No. Current Use of Property:
Phone No. Description of Work:
Estimated Value: Work Classification:
Square Footage : Residential Multi-Family Commercial
Application is hereby made to obtain a permit to do work and installation 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, MECHANICAL,
PLUMBING, SIGNS, WELLS, POOLS, ROOFING, SHUTTERS, WINDOWS, FURNACES, BOILERS, HEATERS, TANKS, and AIR
CONDITIONERS, etc. I understand that in signing this application I am responsible for the supervision and completion of the
construction including scheduling of inspections and obtaining final inspections in accordance with the plans and
specification. WARNING TO OWNER: Your failure to record a notice of commencement may result in you paying twice for
improvements to your property. If you intend to obtain financing, consult with your attorney or lender before recording your
notice of commencement. Owner/Contractor 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.
Signature of Owner or Authorized Agent Signature of Qualifier
Print Name Print Name
State of Florida, Miami-Dade County State of Florida, Miami-Dade County
Sworn to and subscribed before me this day of Sworn to and subscribed before me this day of
20 . 20 .
By (Seal) By (Seal)
Personally known or ID Personally known or ID
NOTICE: In addition to the requirements of this permit, there may be additional deed 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.
Issuing Clerk: Date:
DISCIPLINE APPROVED DATE DISAPPROVED DATE ZONING
/
PW FEES FEES $ (√)
Zoning
Building
Fire
Structural
Electrical
Mechanical
Plumbing
Roofing
P/Works
Flood
(# )Violation
Plans out Date Clerk Check -in Date Clerk
Base Permit
State Radon
Code Compliance
(% Concurrency)
Total
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Town of Cutler Bay
OWNER/BUILDER AFFIDAVIT
NAME OF OWNER/BUILDER:
LEGAL DESCRIPTION/ADDRESS:
Congratulations and good luck with your Owner/Builder project. Please feel free to call the Building
Department if you require assistance. This affidavit is designed to help you avoid common problems that
Owner Builders often encounter. Please read and initial each of the following items.
I do certify that, as a Owner/Builder, I understand and acknowledge the following:
1) I am personally responsible for knowledge of all applicable laws and regulations.
2) I will personally reside in the house after completion and the issuance of the Certificate of
Occupancy.
3) Neither I, nor any member of my immediate household family, have made an application for,
or have been issued either an Owner/Builder permit or a Certificate of Occupancy based upon
an Owner/Builder permit (for a single family residence) within the past three (3) years.
4) I will be on the premises either supervising or performing the actual work at all times. I will
submit an accepted form of identification upon request by the Building Department’s agent.
5) I understand that if an inspection is not approved after three attempts, the Inspector may place
a Stop Work Order on the job; and require that a licensed contractor complete the work.
6) I understand that any person whom I may wish to hire to aid me in the construction of my
home, except common laborers, must hold a valid Miami-Dade County Certificate of
Competency or be State licensed contractor. All employees hired by me shall be covered by
Worker’s Compensation Insurance. (Typically Homeowner’s Insurance does not provide this
coverage; Please check with your insurance carrier).
7) I understand all the requirements and responsibilities involved in obtaining an Owner/Builder
permit. I have read and understood the foregoing disclosure, and am aware of my
responsibilities and liabilities under my application for building construction work on the
above-described property. I further understand that failure to comply with all the required
regulations may cause the revocation and/or denial of the permit and /or certificates of
occupancy/completion.
X
Signature of Owner Print Name
STATE OF FLORIDA COUNTY OF MIAMI-DADE
Sworn to and subscribed before me this
day of 20 .
By
(SEAL)
Personally know
or I.D.
10720 Caribbean Blvd. Suite 110
Cutler Bay, Florida 33189
Phone (305) 305-234-4193
Fax (305) 234-5873
AFFIDAVIT OF COMPLIANCE WITH ROOF DECKING ATTACHMENT AND SECONDARY
WATER BARRIER HURRICANE MITIGATION RETROFIT FOR EXISTING SITE-BUILT
SINGLE FAMILY RESIDENTIAL STRUCTURES
PURSUANT TO
SECTION 553.844 F.S.
To: Town of Cutler Bay Building Department
10720 Caribbean Blvd. Suite 110
Cutler Bay, FL 33189
Re: Owner’s Name: ___________________
Property Address: ______________________________________________
Roofing Permit Number: __________________________________________
Dear Building Official:
I ________________________, the qualifying agent for _________________, certify that:
□ The decking attachment and fasteners will be strengthened and corrected as required by
the “Manual of Hurricane Mitigation Retrofits for Existing Site-Built Single Family
Structures” adopted by the Florida Building Commission by Rule 9B-3.047 F.A.C.
□ A secondary water the roof barrier will be provided as required by the “Manual of Hurricane
Mitigation Retrofits for Existing Site-Built Single Family Structures” adopted by the Florida
Building Commission by Rule 9B-3.047 F.A.C.
Qualifying Agent
______________________________________
Signature of Qualifying Agent
_______________________________________
Print Name
STATE OF FLORIDA COUNTY OF MIAMI-DADE
Sworn to and subscribed before me this ______________
day of ___________________________, 20___________,
____ personally known
____ or Produced Identification
____________________
Signature of Public Notary (SEAL)
10720 Caribbean Blvd. Suite 110
Cutler Bay, Florida 33189
Phone (305) 305-234-4193
Fax (305) 234-5873
OWNER’S AFFIDAVIT OF EXEMPTION
ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING
SITE-BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION
553.844 F.S.
To: Town of Cutler Bay Building Department
10720 Caribbean Blvd. Suite 110
Cutler Bay, FL 33189
Re: Owner’s Name: ___________________
Property Address: ______________________________________________
Roofing Permit Number: __________________________________________
Dear Building Official:
I _________________________________ certify that I am the legal owner of the above referenced
property and I am not required to retrofit the roof to wall connections of my building due to the fact
that:
□ The ad valorem taxation valuation, based on County records is less than $300,000.00
□ The property is not insured for more than $300,000.00.
□ The building was constructed in compliance with the provisions of the Florida Building Code
(FBC) or with the provisions of the 1994 edition of the South Florida Building Code (1994
SFBC).
______________________________________
Signature of Property Owner
_______________________________________
Print Name
STATE OF FLORIDA COUNTY OF MIAMI-DADE
Sworn to and subscribed before me this ______________
day of ___________________________, 20___________,
____ Personally known
____ or Produced Identification
____________________
Signature of Public Notary (SEAL)
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Re-roof Permit Checklist BLDG Cop 364e-20170525235736

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Completed 12 July 2020

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