DS- 16-3327Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. DS -12-16-3327
ps Permit Type: Driveways/Sidewalks/Slabs
e r rn
Issue Date: 12113/2016
Work Classification: Repair
Permit Status: APPROVED
Expiration: 06/11/2017
Parcel Number
Applicant
289 NW 92 Street
Miami Shores, FL 33150-
1131010331140
Block: Lot:
NATHAN GOLDSTEIN
Owner Information
Address
Phone
CeII
NATHAN GOLDSTEIN
289 NW 92 Street
MIAMI SHORES FL 33150-
289 NW 92 Street
MIAMI SHORES FL 33150-
Contractor(s)
CHAMPION CONCRETE
Phone CeII Phone
(305)252-8055 (786)402-4802
Valuation:
Total Sq Feet:
$ 5,000.00
950
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Work: CONCRETE DRIVEWAY REPLACEMENT
Bond Return :
Scanning: 3
Additional Info: CONCRETE DRIVEWAY REPLACEM
Classification: Residential
Fees Due
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$500.00
$3.00
$2.00
$2.00
$1.00
$5.00
$125.00
$9.00
$4.00
$651.00
Pay Date Pay Type
Invoice # DS -12-16-62301
12/13/2016 Check #: 223
Bond #: 3276
Amt Paid Amt Due
$ 651.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
Review Planning
Review Building
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 for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accu at all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the - ,� ... - work stated.
December 13, 2016
Authorized Signature: Owner / Applicant / Contractor Ag- 't
Building Department Copy
Date
December 13, 2016 1
1)5 l(9 -332
HomeParmexs
..
Title
L' J
('s
_DG DEPT
cc
w
0
w
J 0
J W
< CC
_ 0
1cnQ
U J
<
J }
a.
2 z
O L
H 0
U z
F.AP. 1/Y
N.W. 3rd A
ON
NO REVIEW REQUIRED
Florida Health Miami -Dade County
O.S,T.D.S, & Well Program
ac Application
F.LP. "Date:
Signature
LDT 12
BLOCK 135 BLOCK 135
ASPHALT PA190VT: ':
5
it REMAINDER OF
LOT 14
BLOCK 135
ON P▪ L
eF-Hove
Fd 1' 1/2'
0' 15' 30'
1 Inch m, 30' ft.
i01 -F seri_
11 1r -%L
• •
•• • •
• •
•• • •• • •
•
(�•
n, • • •
•
••••
• •
••••
•t
•••• • •
• •
••1•
'7r iior-CF-HDI YIL • ••••
:1D't
ASPHALT PAIBMBVT: • • • ••••
:.
:: #NW92nd STREET:.:::: :a::
•• •
• •• •
•• • ••••
• • •
u• •
• •
• •
•
•
• • •
• • •
w (-GNI/vele- 44,1Q ipf
y A440 .,1)►tD '7►AAS11 ,
•Pnk.)6L 3 iscin {S i Coyu girelyd-ll c.-14Uvb
1J42.4 ti -e14`2 & eb4 ► )
POINTS OF INTEREST:
C.B.S. WALL EXTENDS BEYOND LOT LINES.
•
MAP OF BOUNDARY SURVEY
Property Address:
289 NW 92 ST
MIAMI SHORES, FL 33150
ALEIWalairaWiriAnak I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY IS A TRUE
AND CORRECT REPRESENTATION OFA SURVEY PREPARED UNDER MY DIRECTION, THIS
COMPLIES WITH THE MINI, STANDARDS, AS SET FORTH BY 788 STATE OF
FLORIDA BOARD OF SIONAL S `8 AND MAPPER IN CHAPTER 51.17.051, FLORID,
ADMINISTRATIVE CO::' ' ' SUANT TO SEC 472.027, FLOIRDA STATUTES.
fir
BUILDING
PERMIT APPLICATION
0BUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS:
City:
Folio/Parcel#:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
FBC 20 int
Master Permit No. DS ( (Q -332,14-
Sub
?R -
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
2e1 1 iv
❑ CANCELLATION ❑ SHOP
DRAWINGS
Miami Shores
rl_3/oI-o33 - iiy()
County: Miami Dade
Zip: 336. e�
Occupancy Type: Load:
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): NA77-10111 GQSS7 '/✓
Address:
2irci rot;
BFE: FFE:
Phone#:
City: !.t t6,i4 J cry
State:
Tenant/Lessee Name: Phone#:
Email:
Zip: 0/CO
CONTRACTOR: Company Name: Ciiiii10)OJvj Corc•pei e
Address:
/D'15i AhV TQC Si 5.47<_ LDV
City: Jt>/i - State:
Qualifier Name: .,/jrtfl
Phone#:317 z>2--,453-
City:
,c3'
Zip: 33/71)
Phone#:3W�17"y�i3
State Certification or Registration #: Certificate of Competency #: Gv o5_ 4_
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Square/Linear Footage of Work:
Value of Work for this Permit: $ vox
Type of Work: ❑ Addition ❑ Alteration
Description of Work: (vim*e A14.914,
State: Zip:
❑ New ❑ Repair/Replace
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
CCF $ CO/CC $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
w
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 . pplicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delIv to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be pat the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of sucted notice, the
inspection will not be approved and a reinspection fee will be charged.
R or AGENT --
Theforegoinginst s acknowledged before me this
67k_ day of ' (�--�_ , 2 l , by
i\_PVo is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
TEE)
• la CY1 0 6''yso: