DS-19-3018Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: DS-12-19-3018
J � ���;� � � Permit Type: Driveways/Sidewalks/Slabs
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Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date: 02/25/2020 1 Expiration: 08/24/2020
Location Address Parcel Number
118 NW 101ST ST, Miami Shores, FL 33150 1131010220200
Contacts
Folios Andreopoulos Owner CHAMPION CONCRETE Contractor
118 NW 101 ST JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Other:7864024802
Description: PAVER PATIO Valuation: $ 4,200.00 Inspection Requests:305-762-4949
Total Sq Feet: 700.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.00
Concrete/asphalt/pavers, slabs, dways,
$75.00
swalks
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$1.00
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$3.13
Total:
$180.13
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$180.13
Credit Card
02/25/2020 $180.13
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
regulating construction and zoning. Futhermore, I authorize/lhe above named contractor to do the work stated.
117-)
Authorized Signature: Owner / Applicant
/ Agent
Date
February 25, 2020 Page 2 of 2
RECEIVED
Miami Shores Village D 27 2019
Building Department BY:
rA-"-
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
PERMIT APPLICATION
UILDING ❑ ELECTRIC ❑ ROOFING
FBC 20 I_7�
Master Permit No.DS - t2 ( `"/— �v
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
A / CONTRACTOR DRAWINGS
'
JOB ADDRESS: J , V Ai ( -:5 r
City: Miami Shores County: Miami Dade Zip: `J
Folio/Parcel#: 3101 0 ZZ, 020 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): -5 -7v V
Address: /l/ Gv� P '57r
City: l/E [I& r VV/
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name: _
Address: ��0' o an (/ Mll
City:
Qualifier Name: 1/4-/y` -
State Certification or Registration #:
DESIGNER: Architect/Engineer: _
Address:
State:
'/OA) 69
0
Phone#:
h o n e M 945'2-f -2-j-4X3
State: 1'ly'- Zip:
',��
/!/I 0, Phone#: _�t w3;>
Certificate of Competency #:
Phone#:
City:
Zip:
Value of Work for this Permit: $ �-i. 149 -0 Square/Linear Footage of Work: `7 C
Type of Work: ❑ Addiitiion� ❑ Alteration �1 ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
1
Specifycolor of co'lo'r thru tile:*,i
Submittal'Feb$` '��P.ermit-.
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
Y=
jai
i i +
N km�11 .., r . "', •,..
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ \ G O • U
(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 $250 ,the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be livered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of ch posted notice, the
inspection will not be approved and a reinspection fee will be charged. A
47�
Signature Signatu
OWNER or AGENT
The foregoing instrument was acknowledged before me this
�L day of QeL 20 _�� by
"J-) t'Wi* 440 who is personally known to
me or who has produced
identification and who did take
NOTARY PUBLIC:
Sign:
1PI .
ath.
Print:
Seal: :�� MMEAMVJWSASM
•
Tlw Notary Pablo tMidwwft
APPROVED BY
as
The foregoing instrument was acknowledged before me this
day of 20 ��i by
who is personally known to
me or who has producedy-L 'bo lF(Z- U—C)E-7 as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: I Nb (P-
Seal: SINDIA ALVAREZ
MY COMMISSION N GG 236273
: EXPIRES: September 3, 2022
F`' ' Banded Thru Public
***s**r***»*** **s
Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
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1136.3' > 7
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SURVEYWDARY Flood Data: Date:
ZONE: X
IPERTY ADDRESS: COMMUNITY NUMBER: 120652 9/9/2014
PANEL & SUFFIX: 0302 L
M 101 STREET DATE OF FIRM: 9/11/2019
NH SHORES, FL. 33150 FF ELEV = 13.35
GARAGE = 11.17
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LOT 5 BLK. 3
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Scale: 1 " = 20'
IMPROVEMENTS • •C ' •
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Invoice No. 14-40623 DENNIS
PROFSSSI011
Shebt Fo.:1; o •f. • : NV. L.S. 571
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
HERMIT #:
R I Ci—'30 I L9 DATE: k2- 12-� 1( q
(Name)
u,e'ontractor
❑ Owner
❑ Architect
Picked up 2 sets of plans and (other)
Address: I t(9 N I O I T
From the building department on this date in order to have corrections done to plans
And/or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Signature:
(SIGNATURE)
PERMIT CLERK INITIAL:T�
RESUBMITTED DATE: �I (� "
PERMIT CLERK INITIAL: