DS-19-1413Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
270 GRAND CONC, Miami Shores, FL 33138
Contacts
Permit O.: DS -06-18-1413
Permit Type. Driveways/Sidewalks/Slabs
Work Classification: Addition/Alteration
Permit status: Approved
Issue Date: 06/26/2€!19
Parcel Number
1132060136210
Expiration: 12/17/2019
JODIE BLUM Owner CHAMPION CONCRETE Contractor
270 GRAND CONC, MIAMI SHORES, FL 33138 JAIME BASILIO
Home: 4154125469 10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Other: 7864024802
Description: CONCRETE PADS DRIVEWAY Valuation: $ 6,580.00
Inspection Requests:
305.762 4949
Total Sq Feet: 0.00
Fees Amount
Application Fee - Other 50.00
CCF 4.20
Concrete/asphalt/pavers, slabs, dways, 50.00
swalks
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 1.40
Planning and Zoning Review Fee 35.00
Scanning Fee 9.00
Technology Fee 2.50
Total 156.10
Building Department Copy
Payments Date Paid Amt Paid
Total Fees 156.10
Credit Card 06/26/2019 $156.10
Amount Due: 0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulatil construction angzRingNthermore, I authorize the above named contractor to do the work stated.
Signature: Owner / Applicant / Contractor / Agent Date
Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING ELECTRIC ROOFING
JOB
RECEIVED
J U N W %(!i9
FBC 201'1
Master Permit NoD. S 00^19-1 y 13
Sub Permit No.
REVISION EXTENSION [—]RENEWAL
PLUMBING MECHANICALPUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: )' B^— Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: ` FFE:
r/(
OWNER: Name (Fee Simple Titleholder): Jo.0i 'c ow Phone#:: DQ Ot0u V
Address: 2:70 61C AN l0/V t0 V/L$-
7
City: & /A AA4A 5kOn t State: 9= Zip: 3 13 r
Tenant/Lessee Name: ne#:
Email:
CONTRACTOR: Company Name: Cr L A"`'v Phone#: 37L
Address: (0 Z4?Q 0111 163
City: State:/lam Zip:
Qualifier Name: -J 4f t -ft, .4514" Phone#: _
Certificate of Competency #: CC 0 57 OC) e,67StateCertificationorRegistration #:
DESIGNER: Architect/Engineer:
5
ne#:
Address: City: State: Zip:
y
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Addition Alteration New Repair/Replace Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ '>_ Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $ Notary
Double Fee $
Bond $ VD2 (13` S -:?>I
TOTAL FEE NOW DUE $ I o .1 U
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."
Jv a\a ,w_.,
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 suchiosted notice, the
inspection will not be approved and a reinspection fee will be charged. /I
OWNER or AGENT
I 1
The for oing ins rument was acknowledged before me this
ay of
U 20 A9 by
dCt 1 e V who is personally known to
me or who has produced r.11 6 1\b` v has
identification and who did take an oat .
3 S
Signature
The foregoing instrument was acknowledged before me this
day of 51LI '20 by
3A I M (L ;AJ 11.1 O , who ' ersonally kn to
me or who has produced as
identification and who did take an oath.
NY
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APPROVED BY Plans Examiner 4 J // Zoning
Structural Review Clerk
Revised02/24/2014)
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This survey has been issued by the following Landtec Surveying office: PLEAsE NOTE
600 Fairway Drive - Ste.101 S0EffM " , PUNK
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