DS-18-2302PERMIT #
CONTRACTOR:
SUBMITTAL DATE:
ADDRESS:
NAME:
PROJECT TYPE:
PUBLIC WORKS 'Z ;'
ZONING
PLUMBING
STRUCTURAL
MECHANICAL
ELECTRICAL
BUtEQING ''"'�
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Permit No.: OS-8-18-2 02
Permit Type: Driveways/Sidewalks/Slabs
Work Ciassihcation: New
Permit status: Approved
Expiration: 04/23/2019
Location Address Parcel Number Project
1201 NE 96 ST, Miami Shores, FL 33138-2553 1132060143830 <NONE>
Contacts
POL ZAZADZE Owner POL ZAZADZE Applicant
1201 NE 96 ST, MIAMI SHORES, FL 33138 1201 NE 96 ST, MIAMI SHORES, FL 33138
Other:3057902785 Other:3057902785
HOME INTERIOR SERVICES AND Contractor
INVESTMENT INC
JUAN PABLO BETANCOURT
1690 W 38 PL 131, HIALEAH, FL 33012
Business: 3053288590
Other:7865978093
Inspection Requests:
Description: INSTALL DRIVEWAY AND WALKWAY (CONCRETE Valuation: $ 6,000.00 Ins 7ction Re
SLABS)
TotalSq Feet: 245.00
Fees
Amount
CCF
$3.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$1.20
P&Z Review Fee
$35.00
Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$4.80
Total:
$157.60
Building Department,Copy
Payments
Date Paid Amt Paid
Total Fees
$157.60
Credit Card
10/25/2018 $107.60
Credit Card
08/28/2018 $50.00
Amount Due:
$0.00
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 accurate and that all work will be done in compliance with all applicable laws
regulati truction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
e
Authorized Signature: Owner / Applicant / Contractor / Agent Date
October 25, 2018 Page 2 of 2
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 _
FBC 210 I
*t
BUILDING Master Permit No. �C I 1b _ ( /
PERMIT APPLICATION Sub Permit
/BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
4
City: Miami Shorties
County:
Miami Dade Zip:
I p
Folio/Parcel#: I — d'(J b4
— 3 W
Is the Building Historically Designated: Yes
NO ✓
Occupancy Type: Load:
Construction Type:
Flood Zone:: BFE:
OWNER: Name (Fee Simple Titleholder):
f� � Q Phone#:
nFFE: / r'
Address: 1
City: IM t L_ >t
Tenant/Lessee Name:
Email: --4c, vctt
1 1
CONTRACTOR: Company Name: 1 "`�C•
Address: � 6�O W - Z, 6 7v'
State: Zip: 3 2,13 q)
ne#:
p`ne#4 bo 3 36 b S `� 0
City 'd.���.� n Stater T l Zip:—
qualifier Name: '� a -. - `lhC_ J'A . c.4 rPhorie#:i
fSt74fe Certification or Registration #: C Z `�� `�'� Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ r6ice Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
vo
Submittal Fee $ G Permit Fee $ �� • CCF $ 3 • 6 d CO/CC $
Scanning Fee $ 1 Radon Fee $ Z DBPR $ Notary $
Technology Fee $ 4 . 6O Training/Education Fee $ 1.2o Double Fee $
Structural Reviews $ & Bond $
? % �, S d• TOTAL FEE NOW DUE $
(Revised02/24/2014) �-
Bonding Company's Name (if applicable) _
Bonding Company's Address
City ' State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
3
Signature
OWNER or AGENT
The foregoing instru nt was acknowledged before me this
T day of 20 b by
Tl 7 &ae--1 who is personally known to
me or who has produced : WL-- as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
o�pnr °� Notary Public State of Florida
Seal: ? Dennis Lefton
@o` MY Commission GG 073636
or no Expires 02/15/2021
APPROVED BY /
(Revised02/24/2014)
Signature
_ P=� -
NTRACTOR
The foregoing instru nt was acknowledged before me this
day of C+ 20 1 it by
Ra fit•- t , who is personally known to
me or who has produced 9/!_._ as
identification and who did to
NOTARY PUBLIC:
votary Public State
D211nls Leiton '
v+y�,, MY Commission GG is'
Tort Expires02/15/2021
Sign: `"',• r,"'
Print: Cv%.�t
Seal:
OSp0 P1,. Notsry : •:: ' . "nte Oi Florida
o' w �9 t,�yl; n«. ^fG073f35
Plans Examiner Zoning
Structural Review Clerk
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ABBREVIATIONS
S1M(=SIDEW4LIt CBS=CONCRETE BLOCK STRUCTURE. CLF=CHAIN LINK FEN CE,PL=PROPERTY LINE: DUE=DRAINAGE UTILITI'EpSEMEN7 IP=IRCNPIPE.-
F=FOUND, A/C=AIR CONDITIONER PAD, P/C --PROPERTY CORNER. D/H=DRILLED HOLE, WF=V:OODEN FENCE, RES=RESIDENCE CL-CLEAR RB=REBARI'
UE=UTILITY EASEMENT. CONC=CONCRETE SLAB. RAN -RIGHT OF VAY, DE=DRAINAGE EASEMENT, CIL=CENTER LINE, O=nIAMTER, TYP=TYPICAL,
M=MEASURED. R=RECORDED. ENCR=ENCROACHMENT, COMP=COMPUTER. ASH=ASPHALT• N/D=NAIL & DISC. S=SET, FEE=FINISH FLOOR ELRATION.
OIS=OFFSET, P/P=POVYER POLE. OHP=OVERHEAD PQ"ERLINE, 1hM=VW.TER METER t
•:-V100DFENCE= p
MA$oNRYl114L6= ELEVATION BASED ON LOC. # 325() S
CONCRETE=,.':•:•.:••s••:•:•:-:::••s::••s:.••s.•:.•s.•:. CBM# .. . MAINTENANCE&DRAINAGEEASEMENT=M&D.E B-62 ELV. 8.661 TYPE OF SURVEY: BOU14DARY SURVEY
SURVEYOR'S NOTES- 1)- OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE
AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT'
COVERED (BY PROFESSIONAL LIABILITY INSURANCE.. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT . 5).
UNDERGROUND ENCROACHMENTS NOT LOCATED- 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC
VERTICALDATUM OF 1929_ 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL
RESTRICTIONS NOT SHOWN ON THIS S URVEYTHAT MAYBE FOUND 1N THEPUBLIC RECORDS OF THIS COUNTY. 9) '
CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING
INFORMATION, 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADETO DETERMINE RECORDED
INSTRUMENTS, IFANY,AFFECTINGTHIS PROPERTY.
Additions or deletions to survey maps or reports by other than the signing party or parties is prohibited
'Nithout written consent of the signing party or parties.
BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE_OF-& ,D P8 -PAGE
LOCATION SKETCH
SCALE: NTS
N,E• 12
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PROPERTY ADDRESS: 1201 NE 96 ST., MIAMI SHORES, FL. 33138
LEGAL DESCRIPTION: LOT 17 AND THE WEST Y2 OF LOT 16, BLOCK 83, OF MIAMI SHORES SECTION NO. 3,
ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, PAGE 37, OF THE PUBLIC RECORDS
OF MIAMI-DADE COUNTY, FLORIDA.
I HEREBY CERTIFY That the survey.represented
theteon meets the minimum technical requirements
adopted ty the STK E OF FLORIDA Board of Land
Surveyors pursua it to Section 472,027 Florida
Statutes.
There are no encroachments, overlaps, easements
appearing on the plat or visible easements otherthan
as shown hereon.
ADIS N. NUNEZ.
REGISTERED LAND SURVEYOR
STATE OF FLORIDA #5924
SINCE 1987 -
BLANGO SURVEYORS INC.
Engineers • Land Surveyors • Planners • LB # 0007059
555 NORTH SHORE DRIVE
MIAMI BEACH, FL 33141
(305) 865-1200 Email: blancosurveyorsinc@yahoo.com Fax: (305) 865-7810
FLOOD ZONE: X SUFFIX: L DATE. 9/11/09 BASE: N/A
PANEL: 0306 JCOMMUNITY* 120652
DATE: SCALE: DWN. BY: JOB No
1 1"=:30F.[3lanco 18-147
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
STATE OF (FLORIDA)
COUNTY OF (DADE)
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiant,��1 i�rA a -e, does hereby attest that
(Property owner)
The attached survey, performed by la-vi Svs —Lnc .
(Name of surveyor's ompany)
For address: i a-0 1 �� � S-t-r "' I�l' Icvu,L,j - 3 t � ,
Performed on W ,- aD (date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Further A nt say eth naught.
�
Prop rty Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this 0 day of
Affiant is _personally known to me, _produced -Y L as identification.
Notary Florida
wY P Public State of
;otP, p�rinis Leiton GG 073635
< iAy Commission
4y oe Expires 0211512021
�o,� Notary
Revised on 512212009/ Revised on 6112/09