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DS-18-3607Permit NO.: DS=12-18-3607 Miami Shores Village ! �-'' 1, Permit Type: Driveways/Sidewalks/Stabs 10050 2 Averrlr Miami Shores FL 33138 ,J Work Classification: New 305-795-2204 Permit Status: Approved issue Date: 12/18/2018 1 Expiration:06/17/2019 Location Address Parcel Number 9301 NE 2ND AVE, Miami Shores, FL 33138 1132060133650 Contacts MIAMI SHORES VILLAGE Owner CHAMPION CONCRETE Contractor MIAMI SHORES VILLAGE JAIME BASILIO 10050 NE 2 AVE, MIAMI SHORES, FL 331382304 10280 NW 63 TER 105, DORAL, FL 33178 Other: 3057511271 Business: 3052528055 Other:7864024802 Inspection Requests: Description: PAVER WALKWAY Valuation: $ 1,000.00 305 762 4949 TotalSq Feet: 170.00 WMERMENMONNEEMMEMM Fees Amount Application Fee - Other $50.00 CCF $0.60 Concrete/asphalt/pavers, slabs, dways, $50.00 swalks DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Notary Fee $5.00 Planning and Zoning Review Fee $35.00 Scanning Fee $3.00 Technology Fee $2.50 Total $150.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $150.30 Credit Card 12/18/2018 $150.30 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, WIN)JOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing infor ation i ccurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize ttee abovetamed contractor to do the work stated. Authorized Signature: Owner / Applicant / Agent Date December 18, 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 BUILDING PERMIT APPLICATION UILDING ❑ ELECTRIC ❑ ROOFING Master Permit No Sub Permit No. RECEIVED I EC 0 6 2018 FBC 20 r`l ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP r3 NjC- , (���O2 .K. CONTRACTOR �j �y DRAWINGS JOBADDRESS: DPTIH�ST PAXPe- (60ttKl�'�- 2 �AO NO City: Miami Shores County: Miami Dade Zip: ` Folio Parcel#: 0 ul �-3WS� / 3 2CxIs the Building Historically Designated: Yes NO Occupancy Type: Load: -To(-( Type: LM Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1 O Pl JgPIV fOK) d nMi s�7an+�y)�Je' Address:JOOSy NL 2-41/ City: ti%,Ake M"Y%?-S State: Zip: 33 /31 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: ZS'ZA95 r City: J42 14:1- State: Zip: Qualifier Name: _ f i b r- hil'"y Phone#: State Certification or Registration #: Certificate of Competency #: & 053S 04 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 10010 Ok1 -*J O Square/Linear Footage of Work: % 70 s f Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1GWIiO " A��►w 9c�� Grp 0AJ M1-,�&q;_c >M Specify color of color thru tile: Submittal Fee $_ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ c17 TOTAL FEE NOW DUE $ ( � O (Revised02/24/2014) 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 law brochure will be d livered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must b 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. / Signature OWNER or AGENT v CONTRACTOR The %foregoing instrument was acknowledged before me this The f regoing instrument was acknowledged before methis �V day of . 20 l� by day of ��` �— 20y , by who is p<�n to y �— 13G.5 luowho is rsonal kno to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. ����►►►►►►Illlllll��N NOTARY PUBLIC: �j�bd10N llll �iii�NOTARY PUBLIC: ��\\d��u Naaun�•,j�¢ �N¢\ • •tea '�c'o:v � _ �• eyy� Sign: _ a I • p Sign: .. Print: = ° P o A °' ��: z= Print: Seal: %�c)•'•• S3a1dX ' ���� Seal: ,�`i`S'��*' Z fib. r LAPPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Qm r MP •��� � i,.� � �\`> .err �r � �� ,�,,,,,��� ,.__:_. /_ . /,//,' - -'_ r - _•= EAST. SCUUMM - EMTM WEE/ IN TO F431M Vol `ate EMT. 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