DRIVEWAY AND APPROACHBUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No? 1 " �a
Master Permit No.
Permit Type (circle): Building Electrical _ Plu bing Mechanical Roofing
1 Phone
Owner's Name (Fee Simple Titleholder) #(.10C) f Owner's Aildress .. a' £ . ` G
2 2S)r
City C:$‘1; S State '--- 4- Zi 3 i 38
Tenant/Lessee Name Phone #
SArte
Job Address (where the work is being done) co • �' '12
City Miami Shores Village Count�Miami -Dade Zip 3 31 3 t
Is Building Historically Designated YES
TC�j , c 32G -404, Contractors Company Name on #
Contractor's Addr ss 11 01 S • `4 • 1 g C1J CiT
City
--roc . . • it O c • State tl-
Qualifier
n Zip S3
r t2 •4CS). rc) •
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit :300 Square Footage Of Work: 4
Type of Work: EAddition DAlteration
Describe Work:
lyjNew
❑ Repair/Replace ❑ Demolition
Rzl c,_3
" 4 * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee Permit Fee $ /t% CCF $ l` 90
Notary $ Training/Education Fee $ r Technology Fee $ 1 ��
30
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
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 . e posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence o ch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was ackno edged before me this ke
day of
Sign:
Print:
e or who has produced
identification and who
who is personally known
NOTARY PUBLIC
200
A J i r /�.�YA�3� 11
/jR/ /�' -i rr�03 ba
i-.� x k C STA�f
),,,,, CL z . ie arL. je m ■
. MC• 7 '_ , m y Commission E
Or
State Certificate or Registration No.
APPLICATION APPROVED BY:
Chc 10/14/03
Con ' . ctor
The foregoin instrument was ackno dged before me this /7
day of 20 / ,by
LIC A l161 . 111 K- 4
YPUB
Sign:
or who has produced
.
entification and who
id
who is personally known t
NOT
M ommission Expires: `,� — —
**********************************************,******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Certificate of Competency No.
Engineer
Zoning
//411
t a-3
* * * * * * * * * * * * *' * *_ -
****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
FEB 1 8 2
Plans Examiner
WHEREAS,
following described property:
Legal description/folio #:
Lot
Tax Folio
requests permission to install:
SIGNED. SEAL
COVEN NT OF CONSTRUCTION WITHIN RIGHT OF WAY
.7
Th iarni S (/iCCccc�e
(owner)
Block
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 -2207
Fax: (305)-756 - 8972
Subdivision
, hereinafter referred to as the Owner of the
D - RtU elk)
fty
f� PPR or4cff
[ J Asphalt concrete brick pavers
(] Landscap
[ J Other
within the u lic road right of way ' £
p b ro rg o y of N ' 92 4(ticA--.
(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 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 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 t 's day of
RIUI8.s JOSE Lop
W HAwv tU'tl.tf< ; TATS OP FLORIDA
CIMMI clON No. bdaan
� 1lt3alBRf EXP. FED. le, 2aro
e of:
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date I t
Type Insp'n 1 ( tlICIA C) 0!i L .Q
Permit No 6P 0/4- ZZA
a jubbi
Name
Address 350 �E 5+
Company Tenn
Phone #
Inspection Date 3
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
\ti
BUILDING DEPARTMENT
305- 795 -2204
Buil ing Inspection Request
Date 3 2:2_
Typelnsp'n 1 u (V•--
Permit No. e)(2 O t 2Z�
Name
Address
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
350 N, qa 5 / -
.i COG
=STATE OF FLORIDA)
The undersigned Affiant,
?c)
COUNTY OF DADE)
J ‘C
QL4
oes hereby attest that the
� (prope owner)
'r0 -Q A O2S '-LAS
attached survey, performed by
12 31 09 performed on
(
to o " survey)
(name of surveyor's com
y)
is an accurate representation of the existing conditions and
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
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..
Further, Affiant sayeth naught.
Witness(sign and print)
4 4 ir
"
min
Affiant/Pr
ibn ess(sign and print
SWORN TO AND SUBSCRIBED before me this X day of
Affiant is personally known tome, produced as identifica
A 0/
i
OPPICIA. NOTARY SEAL
k fl IAS JOSE LOPEZ
atitiO PUBLIC STATE OF FLORIDA
{".+ ax EXP. FEE. '08,
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305-795 -2204 Permit Number: BP2004 -224
Printed: 2/19/2004
Applicant:
Owner:
JOB ADDRESS: 350 NE 92
Contractor ICOA CONSTRUCTION
Local Phone: 786- 326 -4041
Parcel # 1132060136450
Fees: Description Amount
FEE2004 -1757 Building Fee $100.00
FEE2004 -1758 CCF $1.80
FEE2004 -1759 Training and Education Fee $0.60
FEE2004 -1760 Technology Fee $2.50
FEE2004 -1761 Builders Bond $300.00
Total Fees: $404.90
Total Fees: $404.90 9 -
Total Receipts: - $.00
L1 3s \t t if-D
Permit Status: APPROVED Permit Expiration: 8/16/2004 Construction Value: $2,300.00
Work: STAMPED CONCRETE DRIVEWAY AND APPROACH
Signed: (INSPECTOR)
Building Permit
ST
Contractor's Address: 1101 S.W 18 COURT
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 W3OFT LOT 6 & E45FT LOT 7
MAR 0 1 PAID 4 3 0O .v0
at-
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
0.50'
clear
cV
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N
a> C/3
U 0
a)
C
J
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a
N
10.00'
19.00' 3.5
One Story
Residence No.350
34.00'
Entry
18.85'
12.00' 11.70'
19' Pavement '
Concrete
�E._ 92tfi STREET
centerline
12.30'
5.21'
Measured: 75.00'
15' ALLEY
Asphalt
pa oad•'
$U1u07
5' Sidewalk
, c)
= Q
L Z , N c `a d 9. �,
- CO
X O jO� O u s i� r;
�
�_r1 f � rP— �— n _r_R_p_, — n— n _n n�
Wood Fence --1 Record & Measured: 75.00' s. ' , __ w } o d Pole
Block Corner
Measured 275.45'
0
0
N
O
� Z
0
°'
BOON
Found 1/2" Pipe
LEGAL DESCRIP110N:
48, AN AMENDED PLA.
thereof, as recorded
Florida.
SURVEY FOR: ROGER
KATHL
350 h
MIAMI
I HEREBY CERTIFY:
was completed under
This survey meets or
of Lcnd Surveyors in
472.027, Florida State
DELTA SURVEYORS, IN
13205 SW 137TH AVE
SUITE 225
MIAMI, FLORIDA 331£
305 -253 -0909
FAX: 305- 253 -0933