DS-16-446 Miami Shores Village ='.
J� rBuilding Department 10050 N.E.2nd Avenue, Miami Shores, Florida 3313a
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014
BUILDING Master Permit No. Ds i� LH} o
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: (?.+OR' NE -IT
City: Miami Shores Countv: Miami Dade Zip:
Folio/Parcel#: 4-3-2-05 - 001-07,30 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): LA/L-5-WA-) 'P_e7E-A,St-rV Phone#:
Address: 12c0q N E ag 5T
City: fjjAA4j 5'ko/tj:�; State: Zip: 3313
Tenant/Lessee Name: Phone#:
Email:,
CONTRACTOR:Company Name:�}fA&j)D/V 6acAe7e Phone#: 305 2�;Z M55
Address: 10((3a NSU -14 5; a /►�
City: 300C State: — Zip: _3 -3l7f
Qualifier Name: _jAing- 6AstU a Phone#: 74?6'KOZ 4IF0•Z w
State Certification or Registration#: Certificate of Competency#: moo, 9,SOoa��S
DESIGNER:Architect/Engineer: Phone#:
. r
Address: City: State: Zip:
Value of Work for this Permit:$ //,?.d d Square/Linear Footage of Work: I�yOI�
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: :pA4_5 JA41` "At Z
I
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ "OZ) CCF$ 2JQ CO/CC$
Scanning Fee$ b Radon Fee$ DBPR$ a oL5 Notary$
Technology Fee$ G Training/Education Fee$ cP-`40 Double Fee$
Structural Reviews$ Bond$ JW Q
TOTAL FEE NOW DUE$
(Revised02/24/2014)
632 - `�a
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City r 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 ch posted notice, the
inspection will not be approved a tion fee will be charged.
Signature Signature `
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of v 20 7' by day of 001 20 by
who is personally known to t7lf— � 1' ho is personally known to
me or who has produced 71L P3421dJ44q'1Y/'Pas me or who has produced S�l�� as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: ' Sign:
Print: Print:
�MYry RUTH '*r = UTNCEO
LEDESMA =g: * EXPCOMM.I ESMA
Seal *' *= MYCOMMISSIGNM Seal: SSI
.4 ': FF 172019 %�� P:' 1 S: ON of FF 17 19
;= EXPIR :January 18 p, ,b AE Ja u 20
, •... ES ry 2019 f,)
Bonded Thru Notary Public Underwriters a
ed Thru'Npyry pubry UnderKO��
APPROVED BY /7 ` Plans Examiner / oning
Structural Review Clerk
(Revised02/24/2014)
ROLE- UTILITY EASEMENT _ � - W O I — CA ' ► ���mawh���� rt
T
(PER ORB.13423, PG. 209) -Z ALIP-ilA ll 43 X vteazW • WeJ CC)j-qOeTtV
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LOT-9 -* SC U�. b zsc N�?!C`iC�t7- f
BLOCK-2 J I n ? 4D VN -�� CbIU�� W� e.
F.I.P. 1/2'0 in I I� �g1e� 4'WIRE to
LQ �s�7` C— 'A1��� 1 bCA4'l -T4A� _ FENCE m
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Of f
I N o UTILITY
M EASEMENT 20.70' ..
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15' 26.55 PORCH •-- .• •••
zI ASPhALT 15.90WI REMAINDER LU LOT-10 F DRLSEWAY o0 LOT-11: ::.... BLOCK-2Q BLOCK-2 T-10
= BLOCK-2 . ONESTONRY••••.THE EAST
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rI r 20 FEET I :::: : ,..." / RESIDENCE9'••1 ...
W IENNCE I # 1209 :",' T��•.
ZI30.12' .....-
I ^ I $I •••••1 •.�3's, : WALL•
p 30.53' I �6y LOT ••.• mss. /
Y;;: 13.38'
}_ O CO-
2.53'
0•2 53'CL LOT UNE I �.. o_
It 8.75
R--25' W
PL
A=49.87- I I PL o
I Ta►r-3?.34' in OR
A=102"50'10" pktALL DR1 p` �o I o M
r - r I PL
. - N I N
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PL tl I 90' -
126.71' o
a-o�
P.c. Q.S.T,U.S. &1AWrogram kt FEB I 01�
F.I.P. 1/2 0
ation No.: BY.
F.I.P. 1/2"o -
gca7N ruc
1=---- 2. ` --�
3 ' 21 ASPHALT PAVEMENT }.
0 . ... ... _
#i
Q I"+?i #1t36 53� `
Ish►Ir :: N"E. 98th STREET { .
.... ......
Bea ng, any,s o ce) N/A
REVISIONS:'" U I - V ELEVATION NOTE: OF APPL
FLOOD ZONE COMM.No. PANEL No. SUFFIX: L.F.Elev= N/A (lowest hab'
X 120652 0306 L Elevation shown hereon refer-
`>Uii,,L CT TO'�C1�'PI.IA'.CE WITH ALL FEDERAL
1 I l F.LR.M.DATE F.LR.M.INDEX BASE ELEV.
Lowest adjacent grade elevab
0 I,iY RUI ES ANn nFrt I(ATInNIS
BM. #N/A
- - -
09/11/09 09/11109 +N/A N.G.V.D. Garage Elev.= NIA
Permit No. DS-2-16-446
�sKO1s y,� Miami Shores VillageM Permit Type:Driveways/SidewalkslSlebs
10050 N.E.2nd Avenue NE ' Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000 Per Permit Status:APPROVED
Phone: (305)795-2204
fitORIDp'
Issue Date:3/1/2016 Expiration: 08/28/2016
Project Address Parcel Number Applicant
1209 NE 98 Street 1132050090230
Miami Shores, FL 33138-2562 Block: Lot: CARSTEN PETERSEN
Owner Information Address Phone Cell
CARSTEN PETERSEN 1209 NE 98 Street (305)807-2221
MIAMI SHORES FL 33138-
1209 NE 98 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
Valuation: $ 11,200.00
CHAMPION CONCRETE (305)252-8055 (786)402-4802
..... ..�..,...............w..� �.., r_.. Total Sq Feet: 1400
Approved:In Review Available Inspections:
Comments: LInspection Type:
Date Approved: :In Review Date Denied:Type of Work:CONCRETE PADS DRIVEWAY Additional Info: nningBond Return: Classification:Residential ding
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00
Invoice# DS-2-16-58731
CCF $7.20 03/01/2016 Check#: 1648 $500.00 $182.70
DBPR Fee $2.25
DCA Fee $2.25 03/01/2016 Check#:2129 $ 132.70 $50.00
a;
Education-surcharge $2.40 02/18/2016 Credit Card $50.00 $0.00
Permit Fee. $150.00 Bond#:2999
Scanning-fee $9.00
Technology Fee $9.60
Total: $682.70
a_
.a.
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 fob ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS, DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVI 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 zoni g. Futhermore,I aut a the above-named contractor to do the work stated.
March 01, 2016
Aut rued Signature:Owner / Applicant ! Contractor / Agent Date
Building epartment Copy
March 01, 2016