1216 NE 93 St (2)1
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): � Bu'lding Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) V v 651' AJ& Phone #
Owner's Address I ( to h /L`� 3 �'t'" sr
City �'ii , State 'A___ Zip 1 31
Tenant/Lessee Name Phone #
Contractor's Company Name
Contractor's Address
o
$ Value of Work For this Permit 21
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenje, Miami.hores, Florida 33138
Tel: (3O5)24a$ fF51:'150.8972
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
is Building Historically Designated YES NO
C) r - )e' i r l ( s Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit No.r)SCi abci
Muster Permit No.
3D5 - 75i -3 - 3 - 1 1 /
Zip
City State Zip
Qualifier
Square Footage Of Work: (O0
Type of Work: ['Addition ❑Alteration ❑New ZRepair/Replace ❑ Demolition
Describe Work: �1
Submittal Fee CC Permit Fee $ 1 CCF $ 1 . tC . CO /CC
Notary $ Training/Education Fee $ 0 • Technology Fee $
Scanning $3.0 Radon $ Zoning Bond $ 500 - C`'
Code Enforcement $ Structural Plan Review. $
c_ �c (c,Z(o(, . ` 7. lX. (p,onci )
c,.z.6 - 1 4 &3
+-1- . J r,c-c
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will ,not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this ? The foregoing instrument was acknowledged before me this
day of , 20O,,by kO &yC T/ , day of ,20by
who is personally known to me or who has produced /Who is personally known to nil or who has produced
As identification and who did take an oath. 1 — as identification and who did take an oath.
NOTARY PUBLIC:
Sign: t . Z/ • a kit Print: .J 0 t7 /V J - k i t Apr
Signature
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:.
My Commission Expires: : %. JOHN J. HEARN
* * * * * * * * * * * * * * * * * ** '� # *MYCOMM*.$t,,v�*#**A* ******************************** * * * * * * * * * * * * * * * * * * * * * ** * * * * * * **
: OC[ooer
Bonded Thru Budget Notary Services
chc 05/13/03
APPLICATION APPROVED BY:
Contractor
Plans Examiner
Engineer
Zoning
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
i'<0 a. T Gu,s 64—(Z
(owner)
following described property:
9� Cu Yc, t 3 L f
Legal description/foliog:
WHEREAS,
Lot Block Subdivision
Tax Folio R: 1 / 3 705 677 ~ 0 /60
requests permission to install:
'Asphalt, concrete,
[ ] Landscaping
[ ] Other
within the public road right of way of 12"
(address)
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 Dade County to make repairs or maintain said
items within public right of way including restoration of 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 hereby agree to indemnify and hold Miami Shores Village or 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 60 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 ttie 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 canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this c r day of f
SIGNED, SEALED AND DELIVERED in the presence of:
Thiarni SIores
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (3051756 -8972
q
, hereinafter referred to as the Owner of the
3 C, w a-s w Vic ?-
ST
(owner)
JOHN J. HEARN
* MY COMMISSION # DO 245792
EXPIRES: October 23, 2007
'to ` oa O Bonded Taro Budget Notary Services
4,J 1- a v 1, w• I
n PPR oll-cti
I
Located at:
Proof of ownership provided ( )
Was acknowledged before me this
By
Produced
OWNER BUILDER DISCLOSURE STATEMENT
Owner
Owner
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
being the legal property owner, for the property
Legally described as
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the
State of Florida, F.S. 489.103(7), end I have read and understand the following disclosure
Statement, which entitles me to A ork as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
DISCLOSURE STATEMENT
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor
even though you do not have a license. You must supervise the construction yourself. You may build or
improve a one - family or two-family residence or a farm out - building. You may also build or improve a
commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the
construction is completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure
that people employed by you have licenses required by state law and by county or municipal Iicensing
ordinances. Any person working on your building who is not Icensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction must comply
with all applicable laws, ordinances, building codes and zoning regulations.
initial of reviewing clerk. Ttie foregoing instrument
7
day of
6G
who is personally pia one or who has
as identification and who did take an oath.
?�1ARY P`,/C+
JOHN J. HEARN
MY COMMISSION 0 DD 245792
s; '1 EXPIRES: October 23, 2007
4 F oe Bonded Thin Budget Notary Services
Further, Affiant sayeth naught.
AFFIDAVIT'
'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, I I A woes hereby attest that the
(property owner)
r
attached survey, performed by L- • r Cir V/ C4 f `'C
(name of surveyor's company) (
performed on 1/ v v is an accurate representation of the existing conditions and
(date o i survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
C. rf, e
Witness(sign and print) Witness(sigr and print)
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
SWORN TO AND SUBSCRIBED before me this 7 day of ,/0
Affiant is y personally known to me, produced as identification.
+ PN. JOHN J. HEARN
* MY COMMISSION t DO 245792
EXPIRES: October 23, 2007
o,'rF F ie' Bonded Thru Budget Notary Services
Issue Date: 2/16/2006
Owner's Name: KURT GUSTINGER
Permit Type: Driveways /Sidewalks /Slabs
Work Classification: Addition /Alteration
Job Address: 1216 93 Street NE
Comments:
PAVERS DRIVEWAY
Additional Information
Miami Shores Village, FL
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 02/13/2007
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
Type of Work: PAVERS Additional Info:
Bond Return :
Classification: Residential
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 with all applicable laws regulating construction
and zoning. Futhermore, I authorize the above -named contractor to do the work
stated.
Fees Due
Bond Type - Owners Bond
CCF
Education Surcharge
Permit Fee
Scanning Fee
Submittal Fee
Submittal Fee
Technology Fee
Total:
c_ti , = 626tD
c.K t4 f.24..7
Amount
$300.00
$1.80
$0.60
$125.00
$3.00
($300.00)
($50.00)
$3.20
$83.60
Building Department File Copy
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: DS -2 -06 -369
Phone: (305)751 -5554
1132050270160
Lot:
PB:
Total Square Feet: 800
Total Valuation: $ 2,100.00
Required Inspections
Final
Invoice Number
DS - 2 - 06 - 23855
Total:
FEB 21 pro
a` 7 D
Amt Due
$83.60
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Permit No.: DSO (0-30
Applicant: kvr Gvd
Job Address: 1 a 14 ,E 9 3rd
Miami Shores Village
Building Department
Planning & Zoning Critique Sheet
Date
.31112114._ S'Jetrc Ik n
10050 NE 2" Avenue
Miami Shores, Florida 33138
5,-de
Comments
a `N in iM1/f1
Initials
Tel: (305) 795 -2204
Fax: (305)756 -8972