PW-17-1303Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
123 NE 97 Street
Miami Shores, FL 33138-2332
Pe
•mit
Permit NO. PW -5-17-1303
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 5/11/2017
Expiration: 08/09/2017
Parcel Number
1132060132440
Block: Lot:
Applicant
JUAN R. DEL RIO
Owner Information
Address
Phone
Cell
JUAN R. DEL RIO
123 NE 97 Street
MIAMI SHORES FL 33138-2332
123 NE 97 Street
MIAMI SHORES FL 33138-2332
Contractor(s) Phone
CONCRETE SERVICES PUMP & FINIS
Cell Phone
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$3.00
$0.00
$0.00
$1.00
$100.00
$9.00
$4.00
$117.00
Pay Date Pay Type
Invoice # PW -5-17-63994
05/11/2017 Check #: 1656 $ 117.00 $ 0.00
Amt Paid Amt Due
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
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 t
construction and zoning. Futherm
-t �I
for going information is accurate and that all work will be done in compliance with all applicable laws regulating
r t/ above-named contractor to do the work stated.
May 11, 2017
Authorized Signature:
/ App ica t
Building Department Copy
Contractor / Agent
Date
May 11, 2017 1
BUILDING
PERMIT APPLICATION
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
RECEIV
AY 1 1 2017
FBC 20
Master Permit No. DS -11-16-3187
Sub Permit No d � - 13 03
E] BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
❑PLUMBING ❑ MECHANICAL ElPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 123 NE 97 Street
Citv: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:1132060132440 Is the Building Historically Designated: Yes NO X
Occupancy Type: residential Load: Construction Type: Driveway Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple 'Titleholder): Juan R. Del Rio Phone#: 3057264334
Address: 123 NE 97 Street
City: Miami Shores State: FL Zip: 33138-2332
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Concrete Services Pump & Finish, Inc. phone#: 3052182467
Address: 10061 SW 44 ST
City: MiamiState: FL
Qualifier Name: Hector L. Roman
State Certification or Registration #: CRC057635
Zip: 33165
Phone#: 3052182467
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work: ��bO 3N 1:t"
Type of Work: ❑ Addition d Alteration
❑ New
❑ Repair/Replace
❑ Demolition
Description of Work: - • • _ _ - _ _
Also, new 6"+3000 PSI plain concrete.
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ l
TOTAL FEE NOW DUE$ ill) , IN
(Revised02/24/2014)
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 alt 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 clone 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 ill be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commence ent st be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued./ n the ' bsence f such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
Signa
The foregoing instrument was acknowledged before me this The forego
03 day of May
20 17 , by
Juan R. Del Rio , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY P BLIC:
•
Sig
Print: ~AI`s#
Seal:
ET PEREZ
fw EXPIRES October 15, 2019
(407•:498-u 5; Flnrs • ...porn
CTOR
was acknowledged before me this
02 day of May , 20 17 . by
Alberto Perez , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PU . C:
Sign:
Print:
Seal:
T1s
• c MY COMMISSION # FF927989
EXPIRES October 15. 2019
14071395-0153 F oflddNote• Service.con
******************** **********************************************************rk**************ski********* *
APPROVED BY
(Revised02/24/2014)
_Plans,Examiner Zoning
Structural Review Clerk
DOCUMENT COVER PAGE
For those documents not providing the required 3 x 3 inch
space on the first page, this cover page must be attached.
An additional recording fee for this page must be remitted.
Document Title:
(Mortgage, Deed, Etc.)
111111111111111111111111111111111111111111111
CFM • 2017R 3261227
OR BK 30526 P s 3687-3690 (2F'ss)
RECORDED 05/09/2017 11L01„18
HARVEY RUVIN• CLERK OF COURT
NIANI-DADE COUNTY? FLORIDA
(Space above this line reserved for recording of5ce use)
w006o4 Conrkiigw/i o°u12,7,
��
Return Document To / Prgpared 4 n,
�r�� 1)►'f )
1006/ S) Li+il4P1Cemf �Z 33/63-
R-ale
3/63
Rale 2.520 (d) On all ... documents prepared ...which are to be recorded in the public records of any county ... a 3 - int by
3 - inchsp ace at the top right-hand comer on the firstpage and a 1- inch by 3 - inch space at the top right-hand come=
oneach stibsequentpageshall beleftblankandreservedfor use by the Berk of court.
CLIC/CT 155 Rev. 08/16 Cleric's web address: www.miaml-dadeclerk.
L
OR Bic 30526 PG 3690
LAST PAGE
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
on i2DdK
Whereas, (owner)
owner of the following described propertyddress): 1
Legal Des i tion Lot // Block
Folio # 1(3� • 060/32R-0
0
Requests ,•ermis ion to inst.II desFribe w
••-
herein ftgrtreferred to as the
Subdivision MOM 'J'
.rk) 0 I. I ,/.Ari! A. C4 a see l r`r*
. .1 • f/ res v'rza'o%I. iI &JI'NN'I amtele.
Within pub�i�n ly way of (address)
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 undersigned further agrees that these conditions shall be deemed a covenant
running with the land and shall remain in full force and effect and be binding on the
undersigned, their heirs and assigns, until such time as this obligations has been
canceled by an affidavit filed in the Public Records of Dade County, Florida bathe
Village Manager of Miami Shores Village (or his fully s u)hed rertroxstaibintZ
Signature n
.T foreflf
Uai
a identification
NOTARY
Sign:
vvTurlckg61 Rio 4t'f
acknowledged before me this 03 day of , 20 IT/, by
/0 who is personally known to me or who has produced
nd who did take an oath.
MY COMMISSION # FF927989
..;,, EXPIRES October 15, 2019
-444y1396-0153 FloridallotarySenice con,
•
Print:
My Commission WA
0/1120/61
LISVET PEREZ
•ec MY COMMISSION # FF927989
,, EXPIRES October 15. 2019
(1011 396-0153 Fb.idallota. ySrr ice con
STATE OF FLORIDA. COUNT OF DADE
HEREBY CERTIFY that this rs a cue copy of tiro
1ripinal, # iIjn uilsRffl a Qo, day of
MAT (J ,AD20
WITNESS my hanAnd Ofti I Seal.
HARVEY RUVIN, CLERK.. Gaud and County Courts
gY D.C.
TANASHIAARNOLD #201144