DS-10-1146Inspection Number: INSP - 154051 Permit Number: DS -6 -10 -1146
Scheduled Inspection Date: February 08, 2011 Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Owner: PETERSEN, JOHN Work Classification: New
Inspector: Bruhn, Norman
Job Address: 893 NE 96 Street
Project: <NONE>
Miami Shores, FL 33138-
Contractor: HOME OWNER
Building Department Comments
February 07, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Mo. Phone Number (305)498 -1440
Parcel Number 1132060142690
INSTALLATION OF PARKING CONCRETE RIBBONS FOR
3 CARS IN EXISTING PARKING AREA. REMAINDER OF
AREA TO BE LANDSCAPE.
Passed � c)
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 146722. Gravel is not an
acceptable ground cover. Sod area. NB
Page 6 of 18
\ to,
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ROOFING _
Owner's Name (Fee Simple Titleholder) ' ` %' ^" rr r " f l ' r�1
✓. Phone #
Owner's Address ;' /
J
City / - //f
Tenant/Lessee Name Phone #
Email ' j; // ,k ;' , /�_ r /i �°'/>y�C" rC!
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City State
Qualifier Name
Submittal Fee
Notary $ 3
Scanning $ ( 00
Double Fee $
D
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
State
Permit Fee $
r`' f. ///
�-
County Miami -Dade
NO
OLLN.k. -�-- it) L "0
Training/Education Fee $ .4
Zip
Phone #
JUN 2 3 2.010
BY ......,.
Permit No. D5 i -- I ilco
Master Permit No.
G(
Zip
Flood Zone /4
Zip
Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ ' Square / Linear Footage Of Work: re
Type of Work: ❑Addition ❑Alteration ErNew Repair/Replace ❑ Demolition
Describe Work: 27/x'`,,/ A1 r4 `` / 17- -"i%r ' <5 Ale' Cr C / i ., , dam_ F
/// '� "2 �i�/� �'�� ,�� PM l41 Gt , 7 i2e ' 6?/
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fe * * * * * * * * * * * * * * * * *�: **** ** * * * * **
CCF $ I. 2.0 coicc
Technology Fee $ 1. 0
Radon $ DPBR $ Bond $
Violation date:
Structural Review. $ Total Fee Now Due $ (04'02,0
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.,.,
or Agent
The foregoing instrument was acknowledged before me this
day of�oAlei , 20 /r , by /c X v4'/2(/ 4.-v4/6'452i
who is personally known to me or who has produced FL (
As identification ,a`� 1 �w i/ &W I,�take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
\ ` '�<,�
" cis ' � �d'��'�
▪ • oiss■wwo3
11 \114 _= •
Iwo
` . satl.......`�� :
.. S St \``'
11 ' 1 1 01 1 i 111 11�� ` \ � `
Plans Examiner
Engineer
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Zoning
Clerk checked
BUILDING
PERMIT APPLICATION
FBC 20
City: Miami Shores
State Certification or Re
Contact Phone#:
DESIGNER
Value
Is the Building Historically Designated: Yes
T
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
OCT ° 5 �
Permit No. PS ,4-0 O ��
Master Permit No.
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): i-e 1 � -'/k- s4 Phone #: 6 C 8 ` 6 6 F—
Address: _ 1 ., y " 1J
City: / ..'!d' State: Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS:
County: Miami Dade Zip:
Folio/Parcel #:
NO Flood Zone:
CONTRACTOR: Company Name:
Address.
City: State: Zip:
Qualifier Name: Phone #:
.a" Email Address:
' Phone#:
emit: $ Square/Linear Footage of Work:
dre O Iteration
O�1ew URe, air/Replac
ODemolition
n #: Certificate of Competency #:
***************************************F * I)
Submittal Fee $ Permit Fee $ c J cJ CCF $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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.
Own I o'rent
instrument was a ,,; owledg
OA
befog me this
Signature
The for
day of
er
Sign:
Print:
y•CComn fission Ex
APPROVED BY
, 20
NOTAR . ' UBLIC:
y
ally known to me or who has pro
'0 -,4id
* * * ** * * * * * * *x: ***** * * ***** **** ****************************** **** *** ****** ** **** ************ ** * * * **** ** * ***
()
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _, by
who is personally known to me or who has produced
Il ion and who did take an oath. �� as identification and who did take an oath.
NOTARY PUBLIC:
'Tt oft
r y'S
Sign:
Plans Examiner
Structural Review
Print:
My Commission Expires:
/0 ` Zoning
Clerk
REVISION
ACHED
Charlie Crist
Governor
Walter F Harper
893 NE 96 St
Miami, FL 33138
June 22, 2010
RE: Contingency Letter
Application Document No: AP969669
Centrax Permit Number: 13 -SC- 1168948
OSTDS Number:
893 NE 96 St
Miami, FL 33138
Lot: 3-4 Block: 74 Subdivision: Miami Shores
Dear Applicant:
This will acknowledge receipt of an application dated 06/21/2010 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
Proposed driveway access to alley at the northwest side of the existing pool.
There is not increase in sewage flow, change sewage characteristic, or compromise the integrity
or function of the system.
From a review of your completed application, it has been determined your existing system is
adequate for the proposed use.
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 Fax: (305) 623 -3645
Ana M. Viamonte Ros, M.D., M.P.H.
State Surgeon General
PART 11- SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Site Plan submitted by:
Plan Appr•v
By
DH4015,10/98 (Replaces HRSH Form4015 which may be used)
(Mod Numbsr:5744.002- 8015.8)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
DcAT1 Ro , S4 arl. oS V bRritW P
t 1- t 3 tVS 9t1/41f,
Signature Title
Not Approved Date 04/? 21/ t
County Health Departmen
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Page 2 of
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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,...... ',,, ..5. , ::.. -.. J.. 4- .;:_...1-:„....L,- .:,--......., .'.- : -11 1 .---,-- , ---$.--'-- - ' -- - "" '- •' — . - '■.' - ----, - , , 7 7 '- '-'' 4
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1 ; t , -i--; --, t : , ■---;--k4 4.5-- ; - ..! . -. -: ',. ;,---:.-- . ':,- -.--,- '. ;. . - --'---,-: : - ,.-' ; : ;-'.- . : - ,..--, ; • -,- . - } . : : .. . . ' . , --7----..--:- ---1--i-1-- .--i-t-,2
Notes: ( 3 9 5 Ne % ST pl SA-0R FS 33138
!AO , S(STe - PA 1 10 kr 1 i PJ
ecC
Site Plan submitted by:
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
I:)H 4015.10416 (Replaces HRS-H F-ortn4015 which may be used)
(Saxe Number: 57444302-4015-6)
PART 11- SITE PLAN-
_A- A .„ .0. •
Signawre
Not Approved
•
6 21
0
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Title
Date
County Health Departmen
Page 2 of
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: & ZiaESd/� / DATE:0 / D
ADDRESS: e7,3 RG �� , / / , / , 072/ i2v& of 1 d 1,Fl 7
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 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.
2. I 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.
5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction.
3. I 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
4. I understand that I may build or improve a one family or two family ;i sidence 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
6. I 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.
7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that
erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner- builder, may be held
liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while
working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an
owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to
perform the work being done. Any person working on my building who is not licensed must work under my direct supervision
and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and
social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for
the employee. I understand that my failure to follow these may subject to serious financial risk.
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable
laws and requirement that govem owner - builders as well as employers. I also understand that the
Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations.
Initial
10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the
United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbm/pro/cilb/index.ht I
11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party
legally and financially responsible for the proposed construction activity at the following address:
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I
have provided on this disclosure.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a
license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to
assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to
understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may
be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for
verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and
returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when
the permit is issued.
Was acknowledged before me this L day of �,l,_%C� \_,, , 20
e
Produced there L' ense or
0 NER
who was personally known to me or who has
11
Initial__ /✓,
Initial
Initial
Initial
Initial
tion.
' % �' .Saa�Ax3.•'�a
S skONS