DRIVEWAYMIAMI SHORES VILLAGE % / oRS 76
BUILDING INSPECTION DEPARTMENT // 3 ( Ili ‘
APPLICATION FOR BUILDING PERMIT S S� 3
Application is hereby wade for the approval of the detailed statement ut the plans and specifications herewith submitted for the build •
inc or other structure herein 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.
C t ,,
u i -
Owner's Name and Address 6E11 4 Ros t k l � f ._ .l..
._ No.. ._ . Street.a_ ....__' • .
Registered Architect and /or Engineer . ,,...,,,.,,,, „ „,,,.,... St. . „
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision __
_ ....._ .. __..
Street and Number where work is to be done........ i..Q.. N..F,. _.. . c 1-5__ :..�.._ _
State work to be done and purpose of building,(by floors) nS9.S..
Cf`i1A.Fh057.. /`r`M.t?,.A.A. St.t` 1.1141JS... SO.RCh.S./NR ... _
_..__ and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation Roof Covering
Estimate Total cost of improvements $ / (' Amount of Permit S. 5 ;
Zone cubage required .Plan 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.
The undersigned applicant for this building perinit 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 .% ith 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 are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village. ) _
Remarks (Signed) C .t� S..._.
STATE OF FLORIDA, `
COUNTY OF DADE. J ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 fads
therein by him s ted g e.
Permit No.
._...._.... /� pate _ ...
r P - Read, Sworn to and Subscribed before me.
Disapproved Date. Notary Public, State of Florida
(Signed)
Building Inspector
My Commission Expires r
to me well known,
PLANNING BOARD DATE
Chairman Member _ ....... _ ...... .-._..._
Member 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 nfter approval has been obtained from
the Plannir.t.t hoard.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address /d13 ,W 95 W J 1 Tax Folio //— 320, - Cllr ' „F6
Legal Description 42-/...2a a 3 a / a s ,� /4' � '� Historically Designated: Yes No
Owner/Lessee / Tenant CWA/S/04
Master Permit # ef tto
Owner's Address /05'3 'Utm '6 jh€/ Phon 53• °?
Contracting Co. as //c, 67 c/J s /m$ ,A4(. Address 17/ /// -�'1 /eva
Qualifier "Old 11714e' / SS# Phone (9q'J?90. 0076
State # C t' S g 1 S Municipal # Competency # 01'1.. Ins. Co.
Architect/Engineer Address
Bonding Company Address
Address
Mortgagor
Permit Type (circle one): BUILDING n C E�LEC�TRICAL PLUMBING MECHANICAL ROOFING
WORK DESCRIPTION � f 1 A , /!// 447 AMA
/gy
Estimated Cost (value) OS) 6S0- 0 0
Square Ft. 75
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 AN 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 ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
instruction and z • ' g. Furthermor I authorize the above -named co actor toy • the work stated.
laws regula
ature of owner and/or Condo President
Notary as to Owner and/or Co
My Commission Expires:
FEES: PERMIT a
o President
0s
S ri P. I
Date
Keith Seabridge
=o p u ;' ^ Commis'sion # CC 924801
• - 7 { _ �� Expires 3,2004
��s son
� �'��,����`�� AtlarUcsondinu
Co., Ino.
RADON C.C.F.
wner- Builder ate
No
o' ctor o
My Commission Expires.
7 O
NOTARY
wner - Builder
Keith Seabridge
o • ••' Commission # CC 924801
'• ,,1;, ;o Expires April 3, 2004
#�9j� �`� it1ARd� �11uu
�h� , ' % Atlantic Bodo Co„ Inc
TOTAL DUE
FENCE SIGN
0 • BOND3190 ✓
vS
APPROVED: /9 /I,D7 - C r ( 2"\
Zoning 6 //uilding
Mechanical Plumbing Engineering
Electrical
0/
PERMIT NUMBER: TAX FOLIO NUMBER: //- 3a 06 -0 ( 3G o6
STATE OF FLORIDA - COUNTY OF DADS
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information in provided in this Notice of Commencement
Legal description of property and street address: 5 C 5 ya ' S eiz s 5-1 c 3 P6) o _ 3 7
L /L r 22- c/S - a yt Uas. - , /Z , � [r �1
�I sZB' //c26-91//42
Description of improvement �.DAy ‘gic /l / ,rr O� � r� �.�y 44//.4i /l t i
D 1 e.r'f {ov f /5",A/,o / 1--
Owner(s) name and address: L5 .- 4 -41 $i , &
Interest in property.
Name and address of fee simple titleholder.
Contractor's name and address: l•S 7 B�oc/l , S'ysfer '/S /A'C 9 7 /V
��irtf D/L « g33/7 (9.J �) 27 Z 0676,
Surety. (Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond: S
Lender's name and address:
Persons within the state of Florida designed by Owner u
provided by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
SIGNATURE OF OWNER
Print Owner's Name: 0 $ E tQ1� Ft E
Swom to and subscribed before me on this
day of ?IA y .1.g /
Personally Known, or
L. ID
REV 1/97
Oath taken, Oath not taken
Nv I SCE OF COMMENCEMENT
/45,3 , /e 93 fr ,cee-/
UP FLORIDA, COUNT OF DADE
I HERE=BY 01 t) r ..
� tvt
0FIgIRd1 Ell avvnrr v :n qc on
U.0
CLC,g
E
k 751
D.C. �.,
notices or other docu ay be served as
In addition to himseff, Owner designates the following person(s) to receive a copy of a Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes,
Name and address:
Expiration date of this Notice of Commencement (the expiration date is one (1) year from the date of recording unless
a different is specified)
, p Keith Seabridge
o'' "',:Commission # CC 924801
' �
Expires April 3, es
Prepared by:
Address:. 4'P/ /i.S /e /�dadl
7 -6� '/�4)fd f" dr r 53
r
Notary Public:
Print Notary's Name: /1•1//`,14 s�9g' i �f
Commission Expiration .9 O y
C.
a
STATE OF FLORIDA)
COUNTY OF DADE)
(�roperty owner)
attached survey, performed by CV�(/J—
performed on
/053 /1/6' �� cr.
The undersigned Affiant <' S`'6 € et, 5e , does hereby attest that the
(date of survey)
AFFIDAVIT
(name of surveyor's company)
, 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.
SWORN TO AND SUBSCRIBED before me this /-S day of
Affiant is personally known to me, produced
.•
•
•
pUg
AT 1 �LL41
CO /vILSSIU` No OF FLORIDA
/4103
MY COMMISSION EXP. C A..
MR
! ? CO2
OD
re
•
Affiant/Pr
tip :prty
r
W i tn - :(sign and print)
o
oO0- 7k0- v3- /26=
CLADSIVTLLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
L MY COMM E"aS1ON EXP. MAR 1,2002
- I h's identification.
FROM : APPROVED PERMIT SERVICES
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS d5 • ��,.P4,_ , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio #: P/ /0 " 3 ~ f S z-g
Lo( a 023 ay / ' Block � Subdivision
Tax Folio #: ,5a D‘ -0 N -3606
requests permission to install:
Asphalt, concrete, brick pavers
[] andscaping
[ ] Other
/515 ///. 9,6 S74reer 7`
within the public road right of way of
SIGNED, SEALED, EXECUTED AND ACKNOWLED
FAX NO. : 954 567 9024
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
I . 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
hems 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.
3. 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. SCALED AND DELIVERED in the preset= of;
10050 N.E. SECOND AVE
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795
Fax: (300.756 -8972
on this " y of � l.P ?h' /
'( O wner)
s
May. 31 2001 10:25AM P2
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