DS-11-19-2741, 53 NE 107th StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
53 NE 107TH ST, Miami Shores, FL 33161
Contacts
Permit NO.: DS-11-19-2741
- Permit Type: Driveways/Walkways/Slabs
y
work Classification: Addition/Alteration
Permit status. Approved
issue Date:11/13/2020 Expiration: 02/02/2021
Parcel Number
1121360070370
DOUGLAS GARBER Owner
CHAMPION CONCRETE Contractor
53 107
JAIME BASILIO
10280 NW NW 63 terr 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Mobile: 7864024802
Home: 3059784333
Other:7864024802
Description: DRIVEWAY PAVERS, POOL DECK AND PATIO Valuation: $ 18,000.00 Inspection Requests:
305-762-4949
Total Sq Feet: 1,640.00 :::
Fees
Amount
Application Fee - Other
$50.00
CCF
$10.80
Concrete/asphalt/pavers, slabs, dways,
$125.00
swalks
DBPR Fee
$2.63
DCA Fee
$2.00
Education Surcharge
$3.60
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$4.38
Total:
$242.41
Payments
Date Paid Amt Paid
Total Fees
$242.41
Credit Card
11/15/2019 $50.00
Credit Card
11/13/2020 $192.41
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.
OWNER 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 the above named contractor to do the work stated.
Signature: Owner
/ Applicant / Contractor / Agent
Date
November 13, 2020 Page 2 of 2
y EI
Miami Shores Village N
Building Department BYr° '
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
VED
15 Z019
FBC 20 io-?
BUILDING Master Permit No.
PER IT APPLICATION Sub Permit No.
®BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: -3 P G to-) 5
DRAWINGS
City: Miami Shores County: Miami Dade Zip: J 11"I
Folio/Parcel#: 11' 1126 m 00-2 0 3 -211 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: o
OWNER: Name (Fee Simple Titleholder j� �/�, A Phone#:41-07
City: 44 42Z (,ids State: /` L Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: e NAMP J DA) 6V AeL'eltp Phone#: �iL)25 Z-d',05'5'
Address: 3 Tir Li1- !9
City: _ by &Alc State: Y l Zip: 3-317
Qualifier Name: J 1�-ile kgC !40 Phone#: %a' �1S`'�
State Certification or Registration M Certificate of Competency M LG 05t;5 aafjs_
DESIGNER: Architect/Engineer:
Address:
ne#:
City: State: Zip:
Value of Work for this Permit: $ ��7- two Square/Linear Footage of Work: &4 l�
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: jQ iyewii)� -oJyA
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1"IZ , 41
is
i'
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will a delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement m st be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absent of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. /l
The foregoing instrument was acknowledged before me this
��day of_ ,, Se 20 1J by
�sn c l�Kf�"� who i rsonally know to
me or who has produced as
identification and who did take an oath.
/ CO NTRACTO R
The foregoing instrument was acknowledged before me this
�St-N day of NoV 20 1 by
301., TPt cSA c Cf who is per to
me or who has pro ed `\�-t�`:,�_
•••�
Centi icat n and ho diid ake an oaf Q_0.GH25,?
TA YPUI§LIC: _*:
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poOded the i�°.�'• ��:
Sign: .Ybric UadO•' 0�S
Print: C uaiAIr >- Yl //��4C_STAM'o\\\\N
Seal:
3
Plans Examiner � Zoning
Structural Review
Clerk
(Revised02/24/2014)
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PUBLIC WRKS REVIE
.APPRQVE?M±0��E 4/-A\UW IN . .....
U:Qu DncpdpT n. DRAMS* D. .
LO'S 13, BLOCK 210, OF DUNNING'S MIAMI SHORES EXTENSION NO.3,
V� ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 42, PAGE 33,
OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA
C No. Eno o FIELD DATE: 7/15i1019
sTATF oP CERWICATIQ .
DOUGLAS GARBER & FRANCIS W MUSCARELLA SURVEY NO: 19-OMM