DRIVEWAY3b(71
MIAM,SWRES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date g I Time
Type Insp'n 11 CA
V,I Dr 1 V
p
Permit No. ) P (X) .3. 1335
Name l l sn
Address (60 0 N E "1
Company
Phone # 3O51553
For Inspector: (Al,
Approved
Correction
Re- Insp'n Fee
Name & Date
9
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) /�a.` / G/Lt .� Phone #
Owner's Address E! e fi ��� / A �
City 73
/. /,vc..
�' State Zip '5/ 3 T
// Phone #
Tenant/Lessee Name
Job Address (where the work is being done) (D Y' 75 5"
City Miami Shores Village County Miami -Dade Zip 3 l 3
Is Building Historically Designated YES NO
Contractor's Company Name 0_sf w 5 �ti.,c soh
Contractor's Addr ss tk b \ S -A • 1 8 a,''�R
City State
Qualifier
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit
Miami Shores Village
Building Department
r
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Square Footage Of.Work:
Number of: Bays Stories Families Bedrooms
Type of Work: ['Addition . . ❑Alteration ew ❑ Repair/Replace ❑ Demolition
Describe Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ (� a Permit Fee $ ter Notary $
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ 3 0 0 strut. $
Minus Plans Check Fee $ Total Fee Now Due $ 3 ( jt ,
0
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
70 ,4 ax: (305) 779565..282904n
Permit No. Ze 1 35 -
Master Permit No.
Phone # 1.2c) 32g _ 0 4
Zip 333 S
0.�
s4o
Baths
tr's
(Continued ogopposite 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 b- 'osted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the abse ce of h posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature' i 024—L �c�
Owne# or Agent
The fore :. ing instrument was acknowledged before me this /Z
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es:
n
ho di
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e or who has produced
dentification • • +d w+. +id tak
The fore §eing ins
day of L1 20 U , day of (.
who is personally kno ;/"o me or who has produced who is personally known t
NOTARY P •
�o •
Sign: _ _ � �.��I'
Print: IIKMMat � ' '
State Certificate or Registration No.
APPLICATION APPROVED BY:
Chc7/7 /03
Commission Ex
As identifica i s
-
er
Signature
NOTARY PUBLIC:
Sign:
y Commission
* * * * * * * * * * * * * * * * * * * * * **
etency Holder)
Certificate of Competency No.
yh
ent was acknowledged before me this /
20 a
AUG 1 9 2003
C •ntrac r
• 06
CO 0:2536
Plans Examiner
Engineer
Zoning
This property described as: ) -rr ,
Lot 10 and the West 1 of Lot 9, , Cc 3 , i ,..e. `"t --
MIAMI SNORES SUCTION NO. 3, ,'`, / u.;d' "''
I according to the Plat thereof, as r • :', „ .
J recorded in Plat Book 10, Page 37 ;
of the lublie Records of Oade County,
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75.62 !J -S
75
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Kriston, 680 NE 93rd Street Miami Shores
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LANNES and GARCIA, INC.
ENGINEERS • LAND SURVEYORS • LAN) PLANNERS
P. O. Box 56113 I
Miami, Florida 33156
1. HEREBY CERTIFY thel the survey
represented hereon meele the mint.
mum requirements adopted by the
F.S.P.L.S., the F.L.T.A, and tno
F.B.L.S. (Technical Standards
S. 477.071. There are no encroach -
ments, overlaps, easements appear-
ing On the plat or Warble easemenla
Whet Men ae hown tuition.
deem AI
kl. Reg. Surveyor No. 2243 q DA rot SCALE. - URAWN HY DRWG. NO.
2 • I• B4 /" s 20' E3.n, ,184 - 639
requests permission to install:
fl2LCLmi SJorQj %4
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (305) -756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, / 1 -/ /1 , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio #:
Lot ( 0 Block Subdivision
Tax Folio #:
SIGNED, SEALED AND DELIVERED in the presence o
DRluEcufrV
APPwo t
[`'( sphal concrete brick pavers
[ ] Landscap
(] Other
within the public road right of way of Zo '6
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
l . 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 repres ntative).
Y
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this day of �J 0 J v 5
'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affi. .x' /o 7*
attached survey, performed by
Affiant is personally known to me, produced
roperty owner)
(name of surveyor's company)
performed on 02 is an accurate representation of the existing conditions and
(date of urvey)
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.
•!�_ Nown r
Witness(sign and print)
Affian
SWORN TO AND SUBSCRIBED before me this / z day of
oes hereby attest that the
t ess(sis and print)
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as identification.
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