REV-17-803 Miami Shores Village RECEIVE®
Building Department MAR2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.TS-- I'' I _" — ( LIP,
PERMIT APPLICATION Sub Permit No \j n --
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �� 9 le ST—
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: r 1 20�"'�)�(-'ZF3t I® —is the
,,B''u``il��din Ig Historically Designated:Yes NO
Occupancy Typ5 '5b• Load: Construction Type:'AFRWf1 41ood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): M T1 aA6 Phone#:
Address:
City: i'�'1 1 (`�! 51-X�ff--e_5 —State: (�('I do- zip: 3 3 iib
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:mo,Hh
, bib O&kA (� Phone#(j) 90
AddressD kA��
City:
`+(Yl10_11i` ' State: FCA%1.1� Zip: !
Qualifier Name: �V-00— I P,t9(,`�r(� Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 430
Square/Linear Foolge cif Work: "
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Demolition
t^ +
Description of Work: ��
C .�..a'..nnlnr r.f i•�1�r ihr�i tile. ��(,� ��`��
o •f��
Submittal Fee$ 2 Permit Fee$ 1�•�� CCF$ CO/CC$
Scanning Fee$ c7 'LID Radon Fee$ DBPR$ Notary$
Technology Fee$ t'V0 Training/Education Fee$ ®' 0 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 110 . 2AD
(ReAsed02/24/2014)
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 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 thata co of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject t atta ment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ich occ rs seven (7) days after the building permit is issued. in the absence of such posted notice, the
inspection will no a an a reinspection fee will be charged.
Signature
VW,NtR or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
p ` day, .hg �of
"� fC� 20 1'4° by ��qday of _ /� 20 1� by
1 1 1 .�—bL�i�a who ii��s,,perrsonally kn'o'wn to �C�.(�� m�C( ,wh 's pers na y know to
me or who has produced, {� y� UM me or who has produced as
entification and whbr! identification and who did take an oath.
y,
NOTARY PUBLIC: r�° Z990�6��11 3 NOTARY PUBLIC:
Sign. Si _
Print: Print ��y��j
.gq �eoeti4°meq; \ • • *! 'fi . v^�
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Seal: Seal: `•�''bo;�z'y��� Q:_�p
(1 C�
APPROVED BY Plans Examiner oning
Structural Review Clerk
(Revised02/24/2014)
-- PP
------------
REQ
EIVED
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V IANCE WITH ALL FEDERAL
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ON PL "
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:C0.
N.E. 96th STREET
GUNTER GROUP, INC.
AND SURVEYING— LAND PLANNING 873 NE 96th Street DATE:
IDA CER11FICA-rE OF AU'1HORIZA710N NO. LB 4507
9350 S.W. 22nd (MACE 06-07-201
MIAMI, FLORIDA 33165 Miami Shores, Florida 33138.
(305) 220-0073
♦SNsc.i�s Di
s� Miami Shores Village R E C E I V ED
n,..� Building Department
10050 N.E.2nd Avenue MAR 2 3 37
0iDp Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WIT I RIGHT OF WAY
Whereas, (owner) � Z- C- D
hereinafter referred to as the owner o he following described
property (address): CP ST__ M 4MI
Legal Description: Lot Block Subdivision
Folio #
Requests ermission to install (descr be work): APP6Z OP 4
Within the public right of way of (address) Cc Sd
ry-1 I A(Y) i -3A(j -fc- 33 Ids
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the
dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to
make repairs or maintain said items within public right of way including restoration of street by
reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall
constitute a lien against the above described property until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County
harmless from any and all liability, which may rise by virtue of permitting the installation of
these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,
within 60 days notice by the Village to do so. Failure to comply with this notice will result in the
Village causing the item(s) to be removed and a lien being placed on the property and/or
assessed against the Owner for all costs incurred in the removal and disposal of the item(s).
4. The undersigne 7further agrees that these conditions shall be deemed a covenant running
with the land d shall remain in full force and effect and be binding on the undersigned, their
heirs and as g , until such time as this obligations has been canceled by an affidavit filed in
the Public rds ade County, Florida by the Village Manager of Miami Shores Village
(or i f ho ' ed representative).
Signature
Owner or Agent
State of Florida
County of Miami Dade
Tmz!=
trument was acknowledged before me this �I day of r� � , 20 °� , by
ho ersonallyknown to me or who has produced
a identifi ation. �,�o°°°➢e°ii°sip,
NOTA PUBLI °QPg+�Sh�1A4, "k,
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C*.;
Si ��0'6 �a�Yt4,� 'Oi;��
Print: SEAL: =
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