117 NE 95 St (3)MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT
INSTRUCTIONS TO OWNER- BUILDER
You have, this date, made application for a building permit as an owner -
builder. You should be advised of the following provisions and requirements
that apply to owner - builder.
Proof of Ownership - Prior to a building permit being issued to you,
you must submit proof of ownership of the land concerned in the
application in the form of a recorded deed, showing you own the property,
or a copy of mortgage or warranty deed of the land, or a Dade County tax
receipt, statement to contain legal description of property and indicate
property is in your name. Legal description and name on document of proof
must correspond to the name and legal description on the application.
Responsibility - You will be responsible for all work done by your day
labor employees, and you must either employ licensed contractors or
persons to be paid on an hourly or per diem basis. Any one contracting
(including labor) with you, verbally or in writing, on a fixed fee basis
for any work, who is not properly licensed, will be subject to a fine of
$500.00 and /or imprisonment for six months.
Insurance - You should be advised that if your day labor employees cause
any damage to persons or property, or if any of your day labor employees
are injured on the job, you are liable. Your regular home insurance
policy ordinarily does not cover this type of liability.
Withholding Taxes, etc. - You should be advised to investigate your
responsibility for withholding Social Security, Federal and State
Unemployment Insurance Taxes and Federal Income Taxes from the wages
of employees working for you on the proposed construction, and for
making returns thereof to the proper agencies.
Work Permitted Owner - Builder - An owner- builder subject to the foregoing
provisions and requirements, is limited to constructing one single family
residence each year for his own use and occupancy; or maintaining, altering
or repairing his own single family residence.
If you do not intend to do the work involved yourself, or with day labor, please
list below, the name of the individual or firm with whom you have entered (or
will enter) into a contract for the work.
NOTICE: SEPARATE PERMITS REQUIRED FOR ELECTRICAL, PLUMBING,
ROOFING AND MECHANICAL WORK
Name of Individual or Firm Address
I, the owner of property described as / /' ZJ
do hereby certified
that I have read the foregoing instructions, and am aware of my responsibilities
and liabilities under my application for a building permit for construction work
on the above described property.
-Wi ness Owner
Date
STATE OF FLORIDA - DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM- CONSTRUCTION PERMIT
Authority: Chapter 381, F.S. Building Permit M:
& Chapter 10D -6, F.A.C. Application /Permit Number:
Date Application Received: -
Fee Amount Paid: !J
Application Is For: New System [ J Repair f,4
Receipt t: / O 5,-
Existing System [ ] Experimental System (
(Temporary) [ ] Tank Abandonment [
Holding Tank [ ] Other (Specify)
NOTE: PERMITS EXPIRE ONE YEAR FROM DATE OF ISSUANCE AND ARE NOT RENEWABLE. REPAIR PERMITS
AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM DATE OF ISSUANCE. APPROVAL OF A SYSTEM DOES
NOT GUARANTEE SATISFACTORY PERFORMANCg FOR A SPECIFIC PERIOD OF TIME.
TO BE COMPLETED BY APPLIcAN _
Owner: ; 2 S`,� e (1% 3 y(l� A Telephone: (Work) (Home) 7 , �a3O
Owner' s Mailing Address: // 7 NE 94 !N ' P p_ei City: /91X 4?, v; State: Zip: 75/ f=
Owner's Agent: S 4 .0i-7—c— Telephone (N) (H)
Agent's Mailing Address: City: State: Zip:
Property Street Address: 117 /V,e 9 S /YJa a t
Exact Directions to Property: 4Y CL
Lot t /y Block #,2Q Subdivision 121J t it / Date Subdivided
Section: Township: Ranger
Property Size: Square Feet /Acres
Water Supply: Private [ J Public [ ] Limited Use [ j
Parcel 0: Zoning Designation:
Is Sanitary Sewer Available: Yes [ ] No ( J If No, approximate the distance to the sewer
line closest to your property:
Is Public Water Available: Yes ( J No [ J If No, approximate the distance to the water
line closest to your property:
•
Type of
Establishmen 0 of Units
Commercial se idential •
(circle
Applicant'S Signature:
BUILDING INFORMATION
O s e' l -4 1 4[d/` -
Building t of Persons SF of Seats Hours of
Area (sq ft) Operation
t of Bedrooms
Plumbing Fixtures: Garbage Grinders /Disposals Spas /Hot Tubs Floor /Equip. Drains
Ultra -low Volume Flush Toilets Other
BUILDING PLANS MUST BE ATTACHED SHOWING OFFICES, BEDROOMS, TOTAL BUILDING AREA, AND ANY
PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, F.A.C. IN ADDITION, A DETAILED SITE PLAN AND /OR
SURVEY, DRAWN TO SCALE, MUST BE ATTACHED SHOWING PROPERTY DIMENSIONS, BUILDING LOCATIONS,
AND PERTINENT FEATURES REQUIRED TO BE SUBMITTED PER CHAPTER 10D -6.046 F.A.C.
Date: (j ! L
ONSIIE SEWAUE DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND APPROVAL
Inspection Requested 6 / . Application /Permit Number
Inspection Performed '
Property Owner: . .a E: -+ r r • Lot:
Property Street Address: i i 'r 1 ; •
Abandonment: Tank Pumped_) ; /
Installer: L,:: r Z.-. '?
Tank SIze(s): r ; , gal
Proper Legend: Yes No
Excavation & Fill as required:
Construction Approved: By:
Absorption Bed /,- –/ Other(descrlbe)
PLEASE PROVIDE A SKETCH OF THE SYSTEM LAYOUT IN
THE APPROXIMATE AREA WHERE IT WAS CONSTRUCTED
IF DIFFERENT FROM SITE PLAN. --.
Additional Comments: ► '--
' ( 7 Block: z G SubdMslon:
Section: Township:
et
Absorption area adequate: Yet ),/ho Amount of Drainlleld installed:
Range: Parcel:
Crushed and FMled - r Approved 714_
r ,APP +M.
roved: Yes No Registration
ons Tank Material: (_ �.'- -Z Baffle Requtred'_ .Yes No �- 4 Yes No t ;•
evel: Yes Novi; -� Watertight: Yes No r j outlet Device: Yes 1 /No
k ° - - ystem at proper elevation: No ate. FIII Adequate: Yes No r
S yst l oca ped a I iNo
M setbacks em mainta ted as ermitt
ahs requir Yes
Square Feet
Installed In ; Trenches _ ..
No
Well Setback • , jnFt '/ o Une Setback ,. F
Property Une Setback ;, ' / j Ft "aundatlon Setback / 7 F
Surface Water Setback � / } FI ')ra lnage Setback Ft
Aggregate Suitable: Yes .-.ti DOT Grade
Aggregate Depth: Minimum: / j Maximum: r 'f
Dralnfleld Dimensions: - r: X / r
Number of Unee: ' Length of lines: / Et I j Ft % S Ft
Pipe separation OK 4—.Froper slope Yes
Distribution Box-PI rider PI L am: Yes IV No
Unobstructed red: el �) Sq Ft
Unobstructed area available: ' :_ ! : Sq F
Depth of Cover Material:
High Water Alarm:
2. 4/ Inches
I Pump Size:
Construction Status:Disapproved Date / /
Reason:
Construction Status:Disapproved
Reason:
Consttuctio Approval: Yes �o
B `iN-1
y�- r
Date / /
FINAL INSTALLATION APPROVAL
Building Area: Square Feet Number of Bedrooms: Number' of Units:
Well locations proper: Yes No Drainage Structures Located Properly: Yes . - No
Final System Approval Status:
Disapproved: Date: . / / Reason:
By: CPHU
Disapproved: Date: / / Reason:
By: CPHU
Relnspectlon Fees Paid: Yes No N/A Date Paid /_/ Amount Fee Pald:
Final System Approval: _,JB rS(: n
HRS -H Form 4010, January 1992 (Obsotsrss AI Previous Editions)
CPHU Date:
Unit:
MOUND & FILLED SYSTEM INSPECTION
System stabilized Yes No Shoulders Adequate: Yes No Slopes Adequate: Yes No
Approved Stabilization MManal: Yes No Stabilization Material Used:
Construction Status:
Disapproved: Date: / / Reason:
Disapproved: Date: / / Reason:
/ CPHU Date
6 7/
Page 2 of
l
Per 489.103(7) F.S.S.
ro ot.
Village Use Only
Owner's name(print)
Permit No.i2I4-
DISCLOSURE STATEMENT
State law requires construction to be done by licensed
contractors. You have applied for a permit under an exemption to
that law. The exemption allows yogi, 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 outbuilding. You may also build or improve a commercial
building at a cost of $25,000 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 more than one building you have
built yourself within one (1) year after the construction is
complete, 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. Your construction must
be done according to building codes and zoning regulations. It
is your responsibility to make sure that people employed by you
have license required by state law and by county or municipal
licensing ordinances.
:7 /f e vGtY
Owner's signature
Jo - 4 / Ge4aod -.
Job Address
Legal
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Owner's Address
Contracting Co.
Qualifier 4
State #
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle
WORK DESCRIPTION
ota a to Owner and
My ission Expires: nyOn
* * * * *
PERMIT FEE:
1/7 •/V g' .f
Qt. / / �/�'
Descript ion L W
/') A (q Y l v �F '
/ Lessee / Tenant
30,00 A
lo,IZ
1/7 Ai Qj ° 9.eL
APPROVED:
Zoning
Mechanical
Competency #
Address
SS# - - phone
Address
Address
Address
one): BUILDING ELECTRICAL (PLUMBING MECHANICAL PAVING FENCE SIGN
Square Ft. Estimated Cos
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated. I certify
that all work will be performed to meet the standards of all laws regulating construction in this
jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS,
POOLS, ROOFING, and MECHANICAL work.
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.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Owner and /or Condo President
ate:
a ka NOtAptl SEAL
df .,
1r& A
. WT. 0994
Fire
Building Electrical
Tax Folio // 2, 2W /v °Via
Pias Permit # p •
phone 7s ay 0 V
Ins. Co.
Signature of Contractor or Owner - Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * *
Other
ngineering
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application. is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address 1_ 4/ Lam-• 913 Ll__ Y5:047 4/
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block l t Subdivisi
Street and Number where work is to be done j l 7 ' 4
State work to be d. ne and purpose of building (by fl
Date
7 N street___91
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of f ation Roo .Covering
Estimated Total cost of improvements $ - ` Amount of Permit $
Zone cubage required Tian Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site .f the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such ,. tractor o. w q be per der this
permit, as are licensed by Miami Shores Village.
Remarks ( Signed ) _
STATE OF FLORIDA,
COUNTY OF DADE. j ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the_
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No. Date Read, Sworn to and Subscribed before me.
Disapproved Date__
Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member ___________ Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA J _ t _
Date Lam! 19
ELECTRICAL ❑
PLUMBING ❑ PERMIT N° 8913 Contractor's tt
License No. i {� G�
ROOFING ❑
Owner of
Building d'
Architect
Contractor .�
or Builder 41 ,
Legal Lat
Description
Address of
Building
I t ""Ir
t
❑ Work to be performed under this Permit
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on thd'lplans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants ,or employees. ° ,
Signed ' 4 ' : ` — °' 615; I NSPECTOR) BY
In consideration of the issuance to me of this permit I agree t. erform t e work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, ments or specifications submitted to the proper authorities of Miami Shores Village.
In accepting thi ermi as . e responsibility for all work done . : ther, myself, my agent, servant or employee.
II Bl
"rF
f t
raj f �. -,
Subdi-
vision
Sq Ft
Value of 11 Amount of -
Project $ 11 Permit $
BY AUTHORITY
BUILDING
ELECTRICAL ",,.'
PLUMBIN (,r
r f
o f
Owner of /"
Building `-f
Lot
MIAMI SHORES VILLAGE, FLORIDA
P - RM1T N° 6040
Contractor's
License No.
Work to be performed under this Permit
Architect
Bl.
Contractor
or Builder
Legal
Description
Address of
Building
This permit is = anted to contractor or b der named above to construct the building or to install the equipment or device described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which Phis
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the state is or specifications and that lie t respon-
By AN •
Subdi-
vision
Value of
Project
sibility for work done by his agents, servants or employees.
Signed•
CONTRACTOR
BY
INS
DATE
0
Amt. of
Permit
F t '- 4
1
9
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the pla rawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting )his permit I assume responsib' ' for ork done by either myself, my agent, serval or employee.
AUTHORITY