DS-09-22-2331 & PW-09-22-2332Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit No.: DS-09-22-2331
Permit Type:Driveways/Walkways/Slabs
Work Classification: Addition/Alteration
Permitstatus: Approved
Issue Date:02/14/2023 Expiration: 08/14/2023
Location Address Parcel Number
102 NE 108TH ST, Miami Shores, FL 33161 1121360090080
Contacts
NATHANIEL FELDHACKER Owner
102 NE 108 ST
STAR ISLAND CONCRETE DESIGN CORP Contractor
MIGUEL CORPAS
1018 nw 47 street, Miami, FL 33127
Business: 3057767916 miguelcorpas22@gmail.com
Description: STAMP CONCRETE DRIVEWAY / NEW APPROACH & Valuation: $ 16,100.00 Ins ection Requests
SIDE WALK
Total Sq Feet: 1,400.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$10.20
Concrete/asphalt/pavers, slabs, dways,
$100.00
swalks
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$5.10
Planning and Zoning Review Fee
$70.00
Technology Fee
$15.00
Total:
$254.55
Payments
Date Paid
Amt Paid
Total Fees
$254.55
Credit Card
02/14/2023
$204.55
Credit Card
09/13/2022
$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.
OWNERS AFFI VIT: I certify that all the foregoing information is accurate and that all work will be done in complian with all applicable laws
regulating n n and zoning. Futhernore, I authorize the abol med contra r10 do the work stated. !1�
Authorized Si ure: Owner / Applicant / Contractor:4 Agiint Date
February 14, 2023 Page 2 of 2
Miami Shares Village RFcEjvETL)
Building Department 5EP13zozz
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY: —
INSPECTION LINE PHONE NUMBER: (305) 762-4949
Bc/zo20�'
o. B ILDING Master Permit NV"1 3J
P RMIT APPLICATION sub Permit No.
BUILDING ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F—IPLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
l� CONTRACTOR DRAWINGS
JOB ADDRESS: 14 5 S%
City: Miami Shores n County: Miami Dade Zip:
Folio/Parcel#: ll-2/ DIlo -- tqdogo Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: _Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Title
Address: l� 2
City: / at44
Tenant/Lessee Name:
Email: —Eft AP-
CONTF
Address: /C//
Email: v
Qualifier Name: /CPC
State Certification or Registration #:
DESIGNER: Architect/Engineer: _
Value of Work for this Permit:
Type of Work: ❑ Addition
State:
zz
nek:
Phone#: 7d15
of Competency #:
�l('}gj:jg�T7 City: -State: Zip: 14
c� Square/Linear Footage of Work:
Alteration Vf ew Repair/Replace ❑ Demolition
Specify color of color tnru t►►e:
Submittal Fee $E706(M Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
DCA Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
P&Z Review $ Bond $
(Revised04/05/2022)
TOTAL FEE NOW DUE $
Bonding Company's Name (if
Bonding Comp ess
City State
M
w
Name (if applicable)
State
Z.
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 e tai'ding 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 Dln the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatu�✓�G�
OWNER or AGENT
The foregoing instrumen a acknowle ged before me this
day of 20 Z`l , by
to
�fi
`�� �O ,....., Oni iii
me or who has produced `.?_P�•'..,�SSIONr,'•'�A�i as
S7.' t
identification and who did take an oath.,
NOTARY PUBLIC:
— RH sw
Sign:
Print: ,A — /h C
Seal:
The forego(ng instrument
176 day of
J
me or who has orodua�`�di
identification and 4o c,
NOTARY PUBLIC:
Print:
Seal:
3s,acknowled ed before me this
20 ZZ by
")II Hb personally known to
SI 'o.0 as
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APPROVED BY u/_ Plans Examiner Zoning
Structural Review Clerk
(Revised04/05/2022)
9. STATE OF FLORIDA
DEPARTMENT OF ENVIRONMENTAL PROTECTD
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM (OSTDS)
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ ] New System [x] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: NATHANIEL FELDHAQO;R DANA GIBILARO EMAIL:yosdelalfonsoseptic@gmail.com
AGENT: Alfonso Septic Solution TELEPHONE: 7-718-6460
MAILING ADDRESS: 1391 W 36 St Hialeah Fl 33012
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION OSTDS REMEDIATION PLAN? [ Y / N ]
LOT: 8 BLOCK: 209 SUBDIVISION: DUNNING MIAMr SHORES EXT NO 5 PLATTED: 1948
PROPERTY ID #: 11-2136-009-0080 ZONING: r-17.5 I/M OR EQUIVALENT: [ Y /'.N;]
PROPERTY SIZE: .21 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [x ]<=2000GPD [ ]>2000GPD
9,272.72
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: n/a FT
PROPERTY ADDRESS: 102 BE 108 ST MIAMI SHORES, FL 33161
DIRECTIONS TO PROPERTY: Take coral way to palmetto take dolphing exp
to 295 north to 108 st to the
BUILDING INFORMATION
Unit Type of
No Establishment
1
s.f.r
2
3
4
[ ] Floor/Equipment Drains
59fo�•r+d,(i71
SIGNATURE:
[ x] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table I, Chapter 62-6, FAC
4 1696
/lam
[ ] Other (Specify)
DATE: 11/17/2022
DEP 4015, 06-21-2022 (Obsoletes previous editions which may not be used)
Incorporated 62-6.004, FAC Page 1 of 4
NO
THEREE,N0' STATE OF FLORIDA
PMINEW FfATU98 ON DEPARTMENT OF ENVIRONMENTAL PROTECTION
'ACM l 13
APPLICATION FOR CONSTRUCTION PERMIT
Oct ACR=-TH i
.THAT' Y AFW- THE Permit Application Number
P C t
-SYV@'WTAUATION--------------------PART II - SITEPLAN---------------------------
G
102 NE 108 ST MIAMI SHORES, FL 33161
Site Plan submitted by:
Plan Approved Not Approved Date
11/17/2022
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DEP 4015, 06-21-2022 (Obsoletes previous editions which may not be used)
Incorporated: 62-6.004, F.A.C. Page 2 of 4
o� STATE OF FLORIDA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Ss' ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION
•�r'OD gbtN'
APPLICANT: NATHANIEL FELDHACKER DANA GIBILARO
CONTRACTOR / AGENT: Alfonso Septic Slution
PERMIT #
LOT: 8 BLOCK: 209 SUBDIV: DUNNING MTAMI SHORES EXT NO 5 ID#11-2136-009-0080
TO BE COMPLETED BY FLORIDA REGISTERED
ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC
TANK CONTRACTOR
OR
OTHER CERTIFIED PERSON. SIGN AND SEAL
ALL SUBMITTED DOCUMENTS. COMPLETE ALL
APPLICABLE ITEMS.
COMPLETE
TANK CERTIFICATION BELOW OR
NOTE IN REMARKS WHY
THE TANKS CANNOT BE
CERTIFIED.
EXISTING
TANK INFORMATION
[ 1050 ]
GALLONS SEPTIC TANK/GPD ATU
LEGEND: 9x4x3.7
MATERIAL: Concret
BAFFLED:[Y
/ N]
[ O�]
GALLONS SEPTIC TANK/GPD ATU
LEGEND:
MATERIAL:
BAFFLED:[Y
/ N]
[ ]
GALLONS GREASE INTERCEPTOR
LEGEND:
MATERIAL:
[ ]
GALLONS DOSING TANK
LEGEND:_ _
MATERIAL:
# PUMPS:[
]
I CERTIFY THAT THE LISTED TANKS WERE PUMPED ON / / BY , HAVE
THE VOLUMES SPECIFIED AS DETERMINED BY [ DIMENSIONS / FILLING / LEGEND ], ARE FREE OF OBSERVABLE
544
DEFECT — HAVE A [ SOLIDS DEFLECTION DEVICE / OUTLET FILTER DEVICE ] INSTALLED.
Alfonso Septic 11/17/2022
3IGNA'�r CONTRACTOR BUSINESS NAME DATE
EXISTING DRAINFIELD INFORMATION
[ 400 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS:X
Li —
I 6h(o] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: �t2X
TYPE OF SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [x] BED [ ]
DESIGN: [x] HEADER [ ] D-BOX [x] GRAVITY SYSTEM [ ] DOSED SYSTEM
ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO NATURAL GRADE 30 INCHES [ ABOVE / BELOW]
SYSTEM FAILURE AND REPAIR INFORMATION
[ 1948 ] SYSTEM INSTALLATION DATE TYPE OF WASTE [x] DOMESTIC [ ] COMMERCIAL
[ 400 ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [x] TABLE I, 62-6, FAC
SITE [ ] DRAINAGE STRUCTURES [ ] POOL
CONDITIONS: [ ] SLOPING PROPERTY [ ]
NATURE OF [ ] HYDRAULIC OVERLOAD
FAILURE: [ ] DRAINAGE / RUN OFF
FAILURE [ ] SEWAGE ON GROUND
SYMPTOM: [ ] PLUMBING BACKUP
REMARKS/ADDITIONAL
SUBMITTED BY:
[ ] PATIO / DECK [ ] PARKING
[ ] SOILS [ ] MAINTENANCE
[ ] ROOTS [ ] WATER TABLE
[ ] TANK [ ] D BOX/HEADER
[ ] SYSTEM DAMAGE
[ ] DRAINFIELD
tM+�»sto
w*WAV-
TITLE/LICENSE DATE: 11117122
DEP 4015, 06-21-2022 (Obsoletes previous editions which may not be used)
Incorporated 62-6.004, FAC Page 4 of 4
Wasion:
Hon D,Santis
To protest, promote &improve the healthGoverner
of all people in Florida through maturated
4MEAL
state, county R community effors.
Vision: To be the Healthiest State in the Nation
DOH#
Chapter 64E-6.004(3)(a), F.A.C.:
WELL FORM
A plan or plat of the lot or total site ownership drawn to scale, showing boundaries with dimensions,
locations of any existing or proposed residences or buildings, swimming pools, recorded easements, the
on -site sewage treatment and disposal system components and their location on the property, the slope of
the property and any existing or proposed wells, potable and non -potable water lines, including valves,
drainage features, filled areas, unobstructed areas, and surface water bodies. The site plan shall indicate
the location of wells, on -site sewage treatment and disposal systems, surface waters and other pertinent
facilities or features on contiguous or adjacent property. If the features are within 75 feet of the
applicant lot, the estimated to the feature must also be shown but need not be drawn to scale. The
location of any public drinking water well, as defined in Chapter 64E: 6.002(44)(b), within 200 feet of
the applicant's lot shall also be shown, with the distance indicated from the system to the well, and the
location of limited use public water system or other public wells, as defined in Chapter 64E-6.002(44)
(b), within 100 feet of the applicant lot must also be shown, or as defined in Chapter 64E-6.002(44)(a),
F.A.C., within 75 feet from a private potable water well (well used only by one or two residences).
Chapter 24-12(I8), Miami -Dade County Code:
The minimum separation between a well or wells and possible sources of contamination shall be a
function of the drawdown radius of influence of the well or wells. In no case shall the well be located
less than one hundred (100) horizontal feet from any source of contamination.
I have read the above and to the best of my knowledge I have provided the Department with full
information regarding pertinent facilities and features on all adjacent properties. Furthermore, I
understand that any on -site sewage treatment and disposal system permit issued on the basis of said
facilities and feature as provided by me and found to be incorrect will be subject to revocation in
accordance with the provisions of Chapter 120, Florida Statutes.
Property Address: 102 NE 108 ST ML4MI SHORES, FL 33161
Date: 1111712022
sgtitgatd AN69sA
Signature: �7AC17tus —y'"y
Florida Department of Health
Division of Environmental Health and Engineering
HealthDepartmentCounty
1725 NW 167° Sheet, Miami, FL 33056
Public Heafth ACY$adliation Board
PHONE: 305/623-35M • FAX 305/623-3502
FloridaHealth.gov
AUTHORIZATION LETTER
Date:
Department of Health
O.S.T.D.S. & Well Program
Miami -Dade County Building and Inspection Center
11805 SW 26 Street
Miami, FL 33175
Ref: Permit No:
oe
%L0 2—
Address. /
Street n ber/name
State Zip Code
Property ID No.:
And/Or Legal Description:
(Property owners full name or legal representative of the property)
in re resentation of:C1 7�
r
(myself or property entity's full name)
As: tb
(owners or position into entity)
Hereby authorize:
(property owners' legally authorized agent or c m any name)
To process and obtain the Septic System Permit for thi prop located at the above -referenced site.
/ C 4, _n
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Signature
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This Survey Map and Report are not full and complete without the other. BUI �1 De t. Encroachments and other points of interest: Subject to CofrlpllanC a
—None Vlsible. State and ntwidies d regul lions. td
ABBREVIATIONS &LEGEND
A Arc Pg. Page — an n cote
FND Found R/W Right—of—woy ® Unknown Manhole Fro Hydrant —..—Wood Fence
U.E. Utility Easement Center Line Serer MOnhole E Metal or plastic
IP Iron Pipa ® Electric Bas fence
P M Monument Line � Telephone Manhole ,tp Dght Pole
IR Iron Rebor Tem ors 4 —ski—overhead
TBM p ry ® Water Meter Utility line
Nddl Nail & Oisc Benchmyark °O.. Utility Pole tY
COL Column W/W Wat*Wr %n.P Dw4 water Valve LP Concrete Light Pole +° Spot Elevation
P.B. PLat Book ENC Encroachment ® Catch basin
FormTech MAP OF BOU h 0_ z I LLAC E
Land Surveying, Inc. Anr i�,��,' ��o•'°� � VIE
VVI
State of Florida I'llN 7980 r DATE 1_L3
12955 SW 42 Sent. Suite 3. Miami, FlorMt 33175
Ph:(786)429.3D34 (786)443-0285 (786)443-0678 0' 10' 20' 40'
GRAPHIC SCALE a°,.e 0.a-o
RpCFIVED
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Y:
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N.E. 108th STREET
-- --- Property address:
0
102 N.E. 108th Street
I I
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City: Miami Shores
a 6 5
County: Miami -Dade
State: Florida Zip Code: 33161
u-
Folio # 11-2136-009-0080
z
LOCATION SKETCH
SUBJECT PROPERTY
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SURVEYOR'S REPORT: oniiih'gJJ®a1;t,_ --DaPa tel
-_ Date
1. MAP OF BOUNDARY SURVEY, Fieldwork date of data acquisition: March 24th, 2 1@@t 16 @9fl1GIifANO with all Federal,
State and C 6WMV fblfJS and regulations.
2. LEGAL DESCRIPTION: Pe rI__
.
Lot 8, Block 209. DUNNINGS MIAMI SHORES EXTENSION NO. 5, according to the plat a la Book
48. at Page 21, of the Public Records of Miami —Dade County, Florida.
�
3. AREA:
Containing 9,092 Square Feet or 0.21 Acres more or less by calculations. COPY
4. ACCURACY:
The accuracy obtained by measurement and calculations of a closed geometric figure was found to exceed this
requirement. Suburban: Linear 1 foot in 7,500 feet.
5. DATA OF SOURCES:
HORIZONTAL CONTROL
—The Legal Description was furnished by client.
—North Arrow as per Plat Book 48, Page 21, of the Public Records of Miami —Dade County, Florida.
VERTICAL CONTROL
Elevations are referred to N.G.V.D. 1929.
Benchmark used: Miami —Dade County Benchmark No. N-566 Elevation=10.78' (N.G.V.D. 1929)
located 0 NE 111 Street and N Miami Avenue.
6. FLOOD INFORMATION:
By scale determination this property is located in Flood Zone X, as per Federal Emergency Management Agency (FEMA),
NF1P Community Name: Village of Miami Shores, Community Number 120652, Map/Panel Number 12086C0302,
Suffix L, FIRM Panel Effective/Revised Date 09-11-2009.
7. LIMITATIONS:
No research was made for other instruments than the existing in the plat and provided by client.
No determination was made as to how the site can be served with utilities.
Fences and walls ownership by visual means only, legal ownership not determined.
No underground utilities and/or structures(foundations) was located within or abutting the Subject property.
This Survey is not intended for design or construction purposes. For those purposes a Topographic Survey is required.
SURVEYOR'S CERTIFICATION:
I certify. This Map of Boundary Survey meets all applicable requirements of the Florida Minimum Technical
Standards as contained Chapter 5J-17. Unless indicated to the contrary, the measured distance and directions
shown on the Map of Boundary Survey are the some as the deed distances and directions.
Not valid without the signature and the original raised seal of Florida Licensed Surveyor and Mapper. Additions or
deletions to Map of Boundary Survey by other than signing party or parties is prohibited without written consent
of the signing party or parties. This Survey Map and Re art are not full and complete without the other.
ORDERED BY: WORKING TITLE, LLC
CERTIFY TO:
2030 S. DOUGLAS ROAD
NATHANIEL FELDHACKER AND DANA GIBILARO
CORNERSTONE FIRST MORTGAGE
CORAL GABLES, FL 33134
WORKING TITLE, LLC.
PH.: (305) 461-9682
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
FormTech
Seal: , _ :;. ' . Job # 22-03072
:�r.....:
Land Surveying, Inc.
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State of Florida LB # 7980
12955 SW 42 Street, Suite 3, Miami, Florida, 33175
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Date: -. r'l =' .-
Ph:(786)429-3034 (786)443-0285 (786)443-0678
rogenia Cl7armos6,£"S.M.
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www.formtechsurveyors.com email:info@formtechsurveyors.com
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This Survey Map and Report are not full d o plete without the other. o
Encroachments and other points of interest:
—None Visible.
A Arc Pg. Page ABBREVIATIONS & LEGEND Chain Link Fence
FIND Found R/W Right —of —Way ® Unknown Manhole V Fire Hydrant —Wood Fence
U.E. Utility Easement q Center Line QQ Sewer Manhole E Electric Box Metal or plastic
IP Iron Pipe Id Monument Line Qr Telephone Manhole #yLP Light Pole Fence
IR Iron Rebar Ternora — 0UL —Overhead
N&D Nail & Disc TBM Benchmark CMWater Meter r'pL Utility Pole ppp Utility line
COL Column �aeraPWv Water Valve LPWP Parkway
Pump a Concrete Light Pole + Spot Elevation
P.B. PLat Book ENC Encroachment ® Catch basin O Property Corner
FormTech MAP OF BOUNDARY SURVEY Date: 0324-20 2
Land Surveying, Inc. scale. 1' = 20'
Stale of Florida LB # 7980
12955 SW 42 Street, Suite 3• Miami, Florida, 33175
Ph: (786)429-3034 (786)443-0285 (786)443-0678 0' 10' 20' 40'
www.formtechsurveyors.com email:info@formtechsurveyors.com GRAPHIC SCALE Pape 2 of 2
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'.
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PW-09-22-2332
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Issue Date:02114/2023 Expiration:08/14/2023
Location Address Parcel Number
102 NE 108TH ST, Miami Shores, FL 33161 1121360090080
Contacts
NATHANIEL FELDHACKER Owner STAR ISLAND CONCRETE DESIGN CO
102 NE 108 ST MIGUEL CORPAS
1018 nw 47 street, Miami, FL 33127
Business: 3057767916
Description: FEW APPROACHES CONCRETE
Fees
Amount
Education Surcharge
$0.90
Public Works Permit Fee
$100.00
Technology Fee
$10.00
Total:
$110.90
miguelcorpas22@gniail.com
Inspection Requests:
Valuation: $ 2,300.00 305-762-4949
Total Sq Feet: 280.00
Payments Date Paid Amt Paid
Total Fees $110.90
Credit Card 02/14/2023 $110.90
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
regulating copRitruction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Cv
all applicable laws
Authorized SigAature: Owner
I Applicant / Contractor /
Date
February 14, 2023 Page 2 of 2
I -)
Miami Shores Village
CP_IV .
Public Works Department 5[P"--
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"a Ave., Miami Says: FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: q ,_
Name of Applicant (if utility see below): Z'4 'elk �I/'7so r
Owner off the following des Ibed property:
Legal Des cfi tion:Lot -Block 766 Subdivision
Folio #; '/ �'2,/ >* " 6:�?9 "e�CM
Address: /OZ A-ge ltIweq -C f
UTILITY NAME:
Qualifier/Authorized Agent:
Address: _
City:
Telephone:
State Certification or Registration M
Email:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME:
Qualifier/Authorized A ent: O @ a✓
Address: 9- r
City: G C State: ZIP:
Telephone: 2Z!?K2.ZZr1L
State Certificat' n or Registration #: Certificate of Competency #: <
Requests
way:
Type of Work: &f Paving ti Utility
❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
Value of Work for this Permit:
Permit Fee $ 100.00
Notary $
Bond $
State:
Email:
❑ Sidewalk ❑ Electric
❑ Other:
ZIP:
ry) in the adjoining right of
❑ Irrigation
Square/Lineal Footage of Work: 29 614e,
***** Fees *****
Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
(if required) Total Fee Now Due $
j� cling Company's Name (if applicable):
Bonding Company's Address:
City:
State:
FM
`�' a qr ade to obtain a public works permit to do the work in the right of way and
��' __`ilns�lor�s �in�fd. 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, regulation construction in
this jurisdiction. I understand that separate permits must be secured for
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with applicable laws regulating construction and specifically construction in the
right-of-way.
"WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value
exceeding $2,500, 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 the
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 public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature / 1 fJ/J-f.f Signature-!
�--A lican or Authorized Agent CompanyAJtility Agent
The forinstT e before
The foregoi i trum=wckno
ged before
4aowcedged
me thisday 20 �` by
me this day of0J
by
V/gNY7GJ
is personally nown to e o ho has produced
is personally known to
e r who s produced
as
as
iden ' ' on. ✓�q
identification.
��a n.T •d��i
NOT Y PUBL(Cs� ` °pe °i2 oy'%
NOTARY PUBL C:
�� un ONgn d'ii
c'cq POPUog
0550EO Hr� _
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Sign: =°® =
Sign:
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Print:
Print:
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SEAL: ., b�,.:.':'•••'p` �'
SEAL:
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APPROVED BY:
**********************************************
Public Works Director, or Designee
2017-04-15
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available
from the building department,
10050 NE 2nd Ave., Miami Shores, FL 3313E
s5 my
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY -'rRYk
CFN 202,2FZ r7164` 5
OR Bk 33380 F•9 2827 1 P,
RECORDED 0?13/2022. 13:06:4M
HARVEYt,RUVTNY CLERK OF COURT
siAMI-Mi.DE ;OUI,17 r FLORIDA
c
thin i;� oPy c J
€^c on
C1: y of J/
Courts
Whereas, (hereby referred to as the owner) OG✓
Of the following described p erty:
Legal Description: Lot�Block ZO F Subdivision .P7/ )_14olio#;
Address: /o2 eve /�8
Requests permission to install
necessary) in the adjoining right of way:
IN CONSIDERATION of the approval of this permit by the village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it
becomes necessary for Miami Shores Village or Miami -Dade County to make repairs or maintain said items within the public
right of way including restoration of the street by reason of the Owner's failure to do so, such expense shall be paid by the
Owner or shall constitute a lien against the above described property until paid.
2. The owner does herby agree to indemnify and hold Miami Shores Village or Miami -Dade County harmless from any and all
liability, which may rise by virtue of permitting the installation of these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 14 days' notice by the
Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien
being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the
item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in
full force and effect and be binding on the undersigned, their heirs and assigns until such time as this obligation has been
cancelled by an affidavit filed in the Public Records of Miami -Dade County, Florida by the Village Manager of Miami Shores
Village (or his fully authorized representative).
J�-
'-- CIwner or Authorized Agent
State of 6v�GrJ4
County of P116�%�C�b
The foregoing instrument waas/a�cknow ed before me this A day of 20ZZ Z by
�ZZD W who is personally known to rrt�, fifho has produced
" y 51/F° as identification. ....... O°°
NOTARY PUBLIC*
Sign: w * '. *jH 030950
OJ. '� !-"u SEAL: iU>ry60'd d\h6
Print: �9� •. F�bbc UOde` .��`
pURCIC,
Documents are recorded at the Clerk of the Courts,
MIAMI-DADE COUNTY RECORDER, COURTHOURSE EAST,
22 N.W. First Street, 1st Floor, Miami, FL 33128.
2017-04-11
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. ��-1/3/®' 6�'y `')0 i-b
STATEC; ,=L
STATE OF FLORIDA: f HERESYcERTIFy
COUNTY OF MIAMI-DADE: original filed in fb,.. _
THE UNDERSIGNED hereby gives notice that improvements will be
property, and in accordance with Chapter 713, Florida Statutes, the
is provided In this Notice of Commencement.
1. Legal description of propgrt nd
2. Description of Improvement: _
3. Owner(s) name and address:
Interest in property: o1
Name and address of fee simple titleholder:
4. Contractor's name, address and pgorje nI
/O2 Ale /
5. Surety. (Payment bond required by owner from contractor, if any)
Name, address and phone number:
CFN 21D22RID716454
OF p.lr 7-338n Pi 28 2i
FIARVEY (i W.Y`hl, i.Lc Rf[ f)C'i�1Lit.l F;
.11AMI-DADS t:'!ltFll'ie _7Ri
d this is a tr q copy of the
e on
. en.,_ day Of �J\tiP gen^ �\
Courts
—D.C.
Space above reserved If r use of r
Z�
Amount of bond $ _
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7., Florida Statutes,
Name, address and phone number:
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number:
9. Expiration date of this Notice of Commencement:
(the expiration date is 1 year from the date of recording unless a different date Is specified)
office
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART-1, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature(s) of Ov, yv %s) oL Oyrner(s)' Authorized Officer/Director/Partner/Manager
Prepared B
Prepared By _
Print Name (_�rf Lk ztzi
Print Name
Title/Office
Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoing� nsHment was,eckn/dged before me this
o„ 7�l// 76l'A7/may /OJ�,�GI�FPi'
day of
, or LJ as
for
� C,
ZO6�
CfPersonally known, or ❑ produced the following type of identification:
Signature of Notary Public: F i :! ��ousr'�•-
Print Name:
(SEAL)
z p
VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES -v�, ^�. mo N0309,e
Under penalties of perjury, I declare that I have reed the foregoing end s.
P P 1 ry, 9 9 _ r lhru.,,t
that the facts stated in It are true, to the best of my knowledge and belief. %, �9 ;' •.` !!ear+;`;: •'.;�' `.`
Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above:'<JJ/jtl.�.�tF
e
By
123_m-5e PAora en2
By
oa-
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33138
,00re Is Remoy&t 21
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
VAI�! 0"N
Permit#: -T-�6-0i-22--Z3:?1
q
A 1 1er► -1)1-IZ-]S
Name of Applicant (if utility see below): N rA aLy) Ed J kyzpJ c
Owner off the following described property:t,� r, J t'I Ali 6-
Legal Description: Lot Block Subdivision
Folio #;
Address: 10 Z A(E l OS 541'4e-A—
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone:
State Certification or Registration
permission to install
way:
State:
Email:
State:
Email:
Certificate of Competency #
ZIP:
Certificate of Competency
work, attach separate page if necessary) in the adjoining right of
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
_ State:
Email:
ZIP:
Value of Work for this Permit: $ Square/Lineal Footage of Work
***** Fees*****
Permit Fee $-=.M �00 • cr->
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ ,SW • 00
J 3tr°�j41fY1 �9
Bonding Company s Name (if applicable):
Bonding Company's Address:
City:
State:
ZIP:
Application is hereby made to obtain a public works permit to do the work in the right of way and
installations as indicated. I certify that no work or installation has commenced priorto the issuance of a
permit and that -all work will be performed to meet the standards of all laws, regulation construction in
this jurisdiction. I understand that separate permits must be secured for
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with applicable laws regulating construction and specifically construction in the
right-of-way.
"WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value
exceeding $2,500, 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 the
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 public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature
)Applicant or Authorized Agent
The fore mstrumentw acknowledged before
methis dayof�2022 by
"b�.ti� t='FcIT,N�Crl.c�� �yho
is personally known to me or who has produced
145�7-1.- as
identification
Sign:
Print:
SEAL:
APPROVED BY:
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this _ day of 20� by
is personally known to me or who has produced
identification.
Sign:.
ARLENISSlL ERA
y�ppl,l 0477 Print:
EXPIRES: March 6, 2024 _ SEAL:
as
Public Works Director, or Designee
2017-04-15