DS-19-1040Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Permit NO.: DS-05-19-1040
A UqPermit Type: Driveways/Sidewalks/Slabs
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date:05/10/2019 1 Expiration: 11/06/2019
Parcel Number
501 NE 106TH ST, Miami Shores, FL 33138 1122310140090
Contacts
JAMES FIELDS Owner Yani Prieto Applicant
501 NE 106 ST, MIAMI SHORES, FL 331382045 10050 ne 2 av, miami shores, FL 33138
prietoy@msvfl.gov
CHAMPION CONCRETE Contractor
JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Other:7864024802
Description: TRAVERTINE PAVER DRIVEWAY, WALKWAY AND Valuation: $ 6,000.00 Requests:
Inspection r-762-4949
PORCH
TotalSq Feet: 900.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.60
Concrete/asphalt/pavers, slabs, dways,
$75.00
swalks
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$1.20
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$3.13
Total:
$180.93
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$180.93
Credit Card
05/10/2019 $180.93
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 info tion is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize t e above named contractor to do the work stated.
Authorized Signature: Owner / Applicant /"'�ntractor / Agent
Date
May 10, 2019 Page 2 of 2
Miami Shores Village �TIMAYO
v�
019
Building Department10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 h
FBC 20 )7 �
BUILDING Master Permit No!-OS-0 1040
PERMIT APPLICATION Sub Permit No.
UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
�CONTRACTOR DRAWINGS
JOB ADDRESS:1J 0�E- // 06 2Y f
Fol
Occupancy Type: Load
OWNER: Name (Fee Simple Titleholder):
� Address: Ol A) 5_
City: F Ulm/y
Tenant/Lessee Name:
Email
CONTRACTOR: Comp/any Name:
Address: / 19Z U t/ /v�
the Building Historically Designated: Yes NO
Construction Type: Flood Zone: BFE: FFE:
5 Phone#:
State: r,�L Zip:
Phone#:
hone#: ?d � v
City: 1� c State: Zip: 3 3 1/ r7
�j
Qualifier Name:
Phone#: ;01`7 5 J
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: . City: State: Zip:
Value of Work. for this Permit: $ 6 00) Square/Linear Footage of Work: —! 00.5
Type of Work: ❑, Addition I Alteration ❑ New 17 Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 12,S CCF $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CO/CC $
DBPR $ Notary $
Double Fee $
Bond $((�0 q
TOTAL FEE NOW DUE $ 1 8c) • dz
t?)O , � 2
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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 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 b osted 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.
SignaturSignat
OWNER or AGENT
The foregoing instrument was acknowledged before me this
v"t�2 day of
p� i^Gf�� `� , 20 �2, by
who is personally known to
me or who has producedAl/�f 4,
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 7-6 , 20 1% by
Q' /l%P/q'�✓�l; who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
,fir' MY COMMISSION # FF213776
Seal: MY COMMISSION N FF213776 Seal:
p?ate` EXPIRES March 25, 2019
NA! PPP EXPIRES March 25. 2019 N07 3%,C,53
Fla+dallota rySery we.car
en739flC'S3 FlondaN�ldryServn,e.ca'
################################ ########################################################################
APPROVED BY r I Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
,c
O -z L
G "X
THE NFIP FLOOD MAPS HAVE DE!
-%': f_ERE"J LE;CFIBED !'.D
�A:ZD IN ZO:JE_- �j
7Z1.r1 Ft'106'40'
-!N„_
Vi
�''gV DATE
/QG,►`� �T
I C Iw 9 f' ,a 1 f "
Pl�OPI R Y OF.
Not valid unto- , etnboswd
with Sur.•epr S 5cal.
A BUUII!>j'%RY .
_ SI.RVEYt
1 her- b1 certify that the sx,.ey i, pr+-
sented hereon r-nects the minimum
tc•chn cal % indard. :et forth by the
go. 4 0 Lr Id Surwrvws pi rsc.ant 'o
section 4-2.C27 rl 1 )%.t itn. There are
not ncrmchr,ents,oser!ap• ease-nenis
F,. not n the Plat, r.thcr thzn as
>how•t tr..to.
, Plorid,.
LANNES and GARCIA, INC.
ENGINECRS - LAND SURVFYORS - LAND PLANNERS
Office addrt-;,;. 4080 S.W 84th Avenue, Miami, Florid,; 33155 ►
M,liling address: P.O. Box 561131, Miami, Florida 33156