DS-19-2743Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
TD)'s �I(111J�S
Permit NO.. DS-1 1 -19-2743
Permit Type: Driveways/Sidewalks/Slabs
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date:11/26/2019 Expiration: 05/13/2020
Parcel Number
1230 NE 95TH ST, Miami Shores, FL 33138 1132060144080
Contacts
ROSARIO DUMAS Owner CHAMPION CONCRETE Contractor
1230 NE 95 ST, MIAMI SHORES, FL 331382550 JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Other:7864024802
Description: CONCRETE DRIVEWAY Valuation: $ 6,200.00 Inspection Requests:
305-762-4949
Total Sq Feet: 1,040.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
Concrete/asphalt/pavers, slabs, dways,
$100.00
swalks
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$1.40
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$3.75
Total:
$207.60
Payments
Date Paid Amt Paid
Total Fees
$207.60
Check # 3244
11/26/2019 $157.60
Credit Card
11/15/2019 $50.00
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
e—
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermgre, I authorize above named contractor to do the work stated.
Authorized Signature: Owner / '--,4ppJk- ant / Contractor / Agent Date
November 26, 2019 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY;
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
00
V IV 1019-
1\
FBC 20 C�
Master Permit No,�I ` I-1 1 214 l 3
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: (2,3 D (25
f �_
City: Miami Shores^ County: Miami Dade Zip:
Folio/Parcel#: '3:)-0( d I � � �DCIs the Building Historically Designated: Yes NO
Occupancy Type: load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): f2_t'1✓/�J Phone#:
Address:_% 231?/V;-' 45 %
City: M 1 .A Al S ftW &I State: -P — Zip: 3J -3 ff
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: OLZ41-10 44) aA0 `! c Phone#: J J5 ,?,5z U v/7
Address: /LVd tS 71YTI2
City:2% V�
Qualifier Name:
State Certification or Registration #:
hone#:
Certificate of Competency #: 6f, C�5 uv too$!5
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ G.2O Square/Linear Footage of Work:
Type:of Work: ❑ Addition ❑ Alteration
,❑' New ❑ Repair/Replace ❑Demolition
Description.of Work:
Specify color of color T
ru tile:
�� Submittal Fee $ A Permit Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $ S00
TOTAL FEE NOW DUE $ I 0
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 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 low brochure, will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement mus a posted bt the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
)v OWNER or AGENT
The foregoing instrument was acknowledged before me this
1 day of OC,'C i*'ft., 20 _ by
zAjAo Avx is personally known to
me or who has produced 19L, as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
IF
Print: J'VNE� ��L11/
Seal: ,.•� wy
} `•1' y MEARMN OO MAKO
F M" COMMbssaN # co 2VIO
•AM 1Z2022
APPROVED BY
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of N16y 20 101 , by
PVSA
,101,M,R
I o who is personally known to
s produced L ..111wftilli as
and wh did take an oatl���yPPR4
qdentific
Sl0,y O LIC:
#GG287268
Print:
i 9 • •�A°4de01h�� Off:
q fa a ���•'•�ei; deN'r' <A;C
Seal:
�/�V;��_ STA(Eo.�����\\
`� Plans Examiner
Structural Review
i ! S Zoning
Clerk
(Revised02/24/2014)
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