806 NE 92 St38I5
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date q 1 i ( p Time
Type Insp'n d rive w1i , Ratty j
Permit No. B ' q 5 4-I
Name loan Gard
Address RN. NF Q a S4
Company hornek)u)n
Phone #
For Inspector: Q I 1 1 Name & Date
Approved
Correction
Re- Insp'n Fee
305- - 154- • L IR 09
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Type Insp'n
Address
Date 18 Time
. 6.1iCCh
Permit No. ( 9 2033 - 1
Name �OCXifn1'n .
Company r� n �l
Phone # 1 —
For Inspector: elI q
Approved
Correction
Re- Insp'n Fee
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Name & Date
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Type Insp'n
Permit No.
Name
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Address F o l; 01 1 E o�
Company
Phone # - 3 OS ' 1S Y 9.1
For Inspector: D l Zc r f
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
• 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305 - 795 -2204 • Fax: 305- 756 -8972
Date Job Address c / Aik 9 ! ' S / g E Tax Folio
Legal Description Historically Designated: Yes
Owner /Lessee/Tenet j A ALL o
1. per's Address 8 O (-t lu.- e. 9 L'`" S t- r
Master Permit ? 2001 --••••
P noh a 05 ¢ — ')
"ontracting Co. dress
A d
Q ualifier SS#
Phone
State # Municipal # Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL 'PAUL WORK DESCRIPTION rno - e7>� I - 1 - � p Kel. i t- Q .. oL �� p l A �'-�. 1.J.)L [ id- 8 eL
7 72 OP/ T 5 I>
Square Ft. Estimated Cost (value) -sr 0
a
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required
for all disciplines.
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. Furthermore, 1 authorize the above named contractor to do the work stated.
esident
otary as to h wner a ' or Con
My Commission Expires
f .,, Angela M Becket
yy "•, Ay Commission D0150040
._noires November 15, 2006
FEES: PERMIT • V RADON
APPROVED: 3a,ao
,e ,y � c
' '7- £'�" / /f "! ✓ il ✓/
Zoning � -' C y Buildi ng
Mechanical Plumbing
Si; ure of owner and/or Condo President _ Date Signature of Contractor or Owner Builder Date
Notary as to Contractor or Owner Builder Date
My Commission Expires
C.C.F • i n NOTARY �� v a BOND 0 "
S / 3 1 � 4 � . /643 TOTAL DUE J b 6 - f
Electrical 7 77 3 76 / 7 6--
Structural Engineer
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ORD11R NO. 4149
Revised this 19th day of October, 1972, to show Final Survey. F.A. 132, n. 57
LOT DtMENStoms ON LocAT tocv
MAP AiZE r T 1 ,F Ei . 6 P. 130
P AT ' hel 6 MEAS
N.e
ORDER No. 3654
F.B. 132, Pge. 8 & 9
1
Gam} s 1 'j' R
�76.'j4 P�.AT `-� i 610.3'x' t�eAs
AT c, MAP
SCALE : 1 i1 = 106
SKETCH OF SURVEY
DATE: February 7th, 1972
SCALE: As shown
WE HEREBY CERTIFY: that the attached SKETCH OF SURVEY of the above described
property is true and correct to the best of our knowledge and belief as recently
surveyed and platted under our direction.
25
SURVEY of Lots 12 and 13, Block 2, of "GOLDEN GATE PARK ADDITION ", according to the
Plat thereof recorded in Plat Book 6 at Page 130 of the Public Records of Dade
County, Florida.
A.R. TOUSSAINT & ASSOCIATES, INC.
LAND SURVEYORS
620 N.E. 126 Street, North Miami, Florida
By: C • V Pros.
Howard C. Gamble
Registered Land Surveyor No. 1683
State of Florida
requests permission to install:
M iami SIlorQ� VJ/r
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, ..1 A-A C A - , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio #:
Lot 18L &racL 13 Block p2 I 6) %ER4Q/4 4 het 7 0
Tax Folio #:II 3.04 Do: 0 ..to
( Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 - 2207
Fax: (3051756 -8972
8 G AI t E. 941 i MiAn71 Tj. 33J 3 J'
(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 alien 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 1 is ) L day of
SIGNED. SEALED AND DELIVERED in the presence of:
A. 6 . - na Ll,SSat t/1 C41-5 o . 4- ► 3 r (N/�
306 • 8•1 — 3
ORluEcv/1-'/
'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,
A-u D/ / , does hereby attest that the
(property owner)
o14S5A1W l c4 ASSOGf&i € S , /Alc_. •
(name of surveyor's company)
attached survey, performed by A :1-
performed on 1'b-6
/9 �oZ- - , is an accurate representation of the existing conditions and
(date of 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
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) Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this / G day of
Affiant is personally known to me, p roducedF2.) L, identification.
Angela DA Becker
ea. r'nmmissim+ 00150098
o sis' LAS , 1•.• • J4b ,a' '5. 2008
•
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Located at: t� b 01_ C -
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
being the legal property owner, for the property
DISCLOSURE STATEMENT
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 id I have read and understand the following disclosure
Statement, which entitles me to work as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
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 licensing
ordinances. Any person working on your building who is not licensed 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.
Proof of ownership provided ( )
Was acknowledged before me this I b day
Owner
Owner
initial of reviewing clerk. The foregoing instrument
By who is personally known to me or who has
Produced Fi. DL( as dentition and who did take an oath.
, 20S21
Not
. F Angela M Becker
• My Commission DD150048
aoi „d , Expires November 15, 2008
Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure ht -rein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date...—..—...—E2 / ..__._.. -. —.... ,19.72
Owner's Name and Address Q -YseY, S N ►1fY - ._. No ... .......__. Streetr
Registered Architect and /or Engineer..... t,.... ,.,.... «.,<,- :,.....,.. - ,,.,,.._.,.....
Name and address of licensed contactor 5 ...:v :_t r l.11. C a. , re r ..1/19A[_..5..3..Tt' yr :rl.... 7 .....fl.Y.l. ). @vri./.._..__
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 70 6 _ Y r E pi 2 S t
State work to be done and purpose of building (by floors) 1aa1 I r..lmi 1.n.Y.1... E ttt.... .....3.c't.Y.S.*...._.__
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ G 6 4' DD Amount of Permit $.
Zone cubage required _._ ._.Flan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to... e . .e-'r......¶ i? Cp-
The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared - _......... • -- -
to me well known,
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
X063°
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No.._.1L_ / ._ ._ r7.._ Date... . ,,.9 - - . Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Notary Public, State of Florida
uilding Inspe My Commission Expires
PLANNING BOARD DATE
Chairman Member
\Iernber Member
Member ...... - ----- _..._._ ...._....._ Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained froth
the Pl Board.
A re inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection ar faulty
materials anti /or workmanship.
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15 ) •( Sur
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