623 NE 97 St (8)NAME:
ADDRESS:
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
DATE:
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
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
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
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 contract disputes.
Initial
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
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
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
Was acknowledged before me this day of , 20
By who was personally known to me or who has
Produced there License or as identification.
OWNER NOTARY
t
1
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Owner's Name and Address.. /
Registered Architect and /or Engineer
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.
Name and address of licensed contractor ____. -. ___.
Location and legal despriptiog of lot to be built on:
°,/ /'
Lot __,/ /, _ _ Block Subdivision
Street and Number where work is to be done r-
State work to be done and purpose of building (by floors) __________
and for no other pwposc.
�
New Building ______._ __ - . Remodeling _ Addition �, .�__�_ .- Repairs No. of Stories ._
To be constructed of Kind of foundation "____a __ ___ " r� -, _ Roof
$ Covering = _�
Estimated Total cost of improvements (- Amount of Permit $ ,
■ c
P ��
� .
Zone cubage required r_ t---- -
___ flan Cubage y . _._'_ �` '
7
Distance to next nearest building
Maximum live load to be borne by each floor - -
NOTE: A charge of $1.00 wills be made for making
the Planning Board.
A re- inspection fee of, $1.00 will be charged
materials and /or workmanship.
Permit No
Disapproved Date
(Signed)
Building Inspector
Chairman
Member
Member
Council Approved Date
Date
No. ___. Street
A
" I l l
l i
Size of Building Lot ;' "°
I hereby submit all the plans and specifications for said building. Alt 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 em )loy er
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supph rneiit,
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 of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks _ (Signed)_
PLANNING BOARD DATE
Notary Public, State of Florida
Date Read, Sworn to and Subscribed before me.
/ /
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 rae 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.
My Commission Expires___. ___________________ _ _
Member
Member
Member
Disapproved _ -
Date
corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
••••
3 i Amounti.
l
KNOW ALL MEN BY TH E PRESENTS that I, � �. < , . fi
Address t. .0' i �, t ,r
1f. b •'•• f•• f.••' ••If. ]f. U. if. ••• lfr ] a� !f••..••11.0*•.••l f•.....•]I.•dyy••.11••....,t f,....., * *,...., *,.....,t f, ti 1 , ....,, 1 f,.....,tf,.....,al.•• �f••....•1 f•.....s
t► rc tf rco t7CDVO tri viii - 4 1rc va y r mirioVm�rc Irco.mitc ' tifiA/a1rMRm IZI rce �icWSI fiiM m�Ic :
Issued - ! • 19
No. Houses
• Cost of clearing and repairs done by Village
Balance due Builder
BUILDER'S BOND
$ �
Miami cShores9llage
F L O R ID A
N°
li
r= in consideration of the issuance to me by Miami Shores Village, Florida, of a permit or permits to construct or repair a building or
' buildings at the following addresses:
to
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s do hereby deposit with Miami Shores Village, Florida, the sum of , and I agree with said Village that, when such construction shall have t
been completed by me within the meaning of the ordinances of said Village, I will clear all premises and repair any Village property damaged by me,
i.4 ▪ used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately upon the
r.
completion of such construction within the meaning of such ordinances, the Village may clear and repair the same and pay the costs of such clearance and .;..
4 repairs out of the aforesaid , and return the remainder to me; and that, if I shall clear and repair said property immediately, as aforesaid, then
'" said shall be returned to me.
WITNESS MY HAND and Seal at Miami Shores Village, Florida, this 2 ` day of •'•" • ' 1 A ' e / f, F
's v ( Seal)
• I NSTRUCTIONS TO BUILDER —When above mentioned construction is completed and the premises' are cleared and repaired take this bond to the = ;.
s Village Building Inspector and obtain his approval, after which Miami Shores Village will refund your money in accordance with the above agreement.
VILLAGE BUILDING INSPECTOR'S APPROVAL 9.
I hereby certify that the construction contemplated under this Bond, has been completed and that the builder thereof has caused F.
9i•
the surrounding premises to be cleared and repaired in as good condition as they were before commencing said 41
WHEN CLEARED AND REPAIRED BY THE VILLAGE - 1 t_
r
Amount of Bond $ hL. 1:- `e. I (,-' -
Village Building hr l mi Shores Village:
Cancelled 19 By
construction.
791
MIl -ct` 71 M ie' f faNr e/CMMM! MVIr• OEr •' i •'•i °••'• i r °.•'• ierM `• °•'•ii •'• ** ** `•`
BUILDING
ELECTRICAL
PLUMBING
Owner of j / *
Building ,Ij %�
Architect S
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA —
Legal L� ,f '
Description �V' .
CONTRACTOR OR BUILDER
PERMIT N9 7543
Work to be performed under this Permit
'
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BL ,
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i-
Subdi-
vision ` ___,.,f/ f r
INSPECTOR
DATE 194
License No.
•
Address of , �"'j Value
€ G p - Amt. of
Building / -,r / ,.:.rv- Project .4,2 4 f v , r Pe rmit ` �•-
:. .3 / , e ,,�
This perniit is granted to the contractor or builder named above to construct the uil ding or to install the equipment or device described in the appli-
cation herefcr 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 tlat 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 pertainin to the work covered hereby whether shown on the plan s.% drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed., ,.j#` 3' . c t F,, ��‘. K - Rv t
hi consideration of the issuance to me of this permit I agree to perform/the work covered hereunder in compliance with . ordinances d
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami5hdi'e§ village.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servaiit employee.
BY AUTHORITY
Date Time
Type Insp'n
Permit No. .��•"
Name i3,.
Address 4 a3 ✓i/ 97 S
Company
Phone # e
� % %SS �.� �. ,:4
For Inspector: 7 1Z' � Name & Date
n
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
fr Zuz,