DRIVEWAYMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed state„ u► isle plans and specifications herewith submitted for the build
in¢ 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.
/ le42.21 _ _. . ,19. V) rl Owner's Name and Address ........... lam' e u' 0 ._ No.. _..... Street —L.,. k ..
Registered Architect and /or Engineer
Name and address of licensed contractors....... ! I /e qO tvtiesreOcrooll
Location and legal description of lot to be built on:
Lot Block Subdivision �
Street and Number where work is to be done '92 ALE�_.
State work to be done and purpose of building (by floors)
/. CQte!Pe
X... /./a 1/4/6cFad
and for no other purpose.
•
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundati� Roof Covering
Estimated Total cost of improvements $ f iiC Amount of Permit S....1:) •
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
be sent to.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obi'
of labor under the Honda Workmen's Compensation Act, being Section 5 ►066, Compil
and has complied with the provisions thereof, and will require similar compliance fro
in the work to be performed under this permit; and will post or cause to be posted
or notices as arc required by the Act. The undersigned agrees to employ only such
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signe
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
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.._...`2 2 '.Q_..6 7 Date P - 1 i J Read, Sworn to and Subscribed before me.
Disapproved :• .. Date
(Signed)
Building Inspector
Chairman
Member
Member .. .. — ..._......_..._._...._....._
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A rc•impeution fee of $L00 will be charged
materials and/or workmanship.
with reference
PLANNING BOARD DATE
to the building and
eneral Laws of Florid
contractors or sub-co
ection on the
ntractors, on
arc
its construction may
as an employer
ent Supplement,
rs employed by hips
work such public notice
be performed under this
to me well known,
Notary Public, State of Florida
My Commission Expires
Member
Member
Member ...._
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
4+01/4)6 its.
N E qs-
'?P. pobsz
Building Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: BP2005 -473
Printed: 4/8/2005
Applicant: ALLISON ZELKOWITZ
Owner: ZELKOWITZ ALLISON
JOB ADDRESS: 420 NE 95 ST
Contractor
Local Phone:
Parcel # 1132060140461
Contractor's Address:
Legal Description: MIAMI SHORES SEC 2 PB 10 - LOTS 9 & 10 BLK 52 LOT SIZE 100.000 X
Fees: Description Amount
FEE2005 -4683 Building Fee $150.00
FEE2005 -4684 CCF $4.80
FEE2005 -4685 Training and Education Fee $1.60
FEE2005 -4686 Scanning Fee $3.00
FEE2005 -4687 Technology Fee $3.75
FEE2005 -4688 Builders Bond $300.00
FEE2005 -4689 Submittal Fee ($50.00)
Total Fees: $413.15
Total Fees: $413.15
Total Receipts: $0.00
4579 .
Permit Status: APPROVED Permit Expiration: 10/1/2005 Construction Value: $7,500.00
Work: REPLACE EXISTING ASHPHALT DRIVEWAY AND WALKWAY NEW PAVER DRIVEWAY
Page 1 of 1
pv
r t PAID
Signed: (INSPECTOR)
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:
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
D /Gb /O
Type Insp' n P i na I L7 l LICUJQ y
Permit No. 1 2)RJ 433
Name Al ! 15Ur) z e_ 1 +Z
Address 4}ZD r4E, 95 ST
Company
Phone # (3(.5 ) 458 3430
Inspection Date /CDR" /o5
Approved
Correction
Re- Insp'n Fee
o�
0 k- 6/6443e
Z 5 7 � 4 ('�
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Bu ing Inspection Request
Date /
Type Insp'n
Permit No.
Name
Address
Company 3OS as + - CZ 00
Phone #
Inspection Date
proved
Correction
Re- Insp'n Fee
El
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) 1 / vt - 20,A I i'12 Phone #
Owner's Address
City M State Pt Zip '21 07 f
Tenant/I,essee Name N /,a Phone # /A
Job Address (where the work is being done) , iAv44c /1 ANS .D ...e
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name Lt �ne
Contractor's Address _
City
Qualifier
State Certificate or Registration No.
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building D epartment
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
1 .
State
Structural Plan Review. $
r C c
Master Permit No.
Zip
ur competency No.
Permit No. — 4
Architect /Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit — 16 - 1..t.: Square Footage Of Work: (toUD c k l
Type of Work: ['Addition ❑Alteration New tg. Repair /Replace ❑ Demolition
Describe Work: VA L, aXth- , c't- s� A/' i vevi t.., '( t ' ` w /
1' e.AA" P ati .e -T tk i v e4"..) e U thn.S. � � 'k.e , k , t., ‘ le_ . i s urf' S
t" t\ ¢)l #4.; tw.. 4c 1tl ; -' 1: Nn* c...t v`+- 1AT:!✓t .
1 6,`m
* * * * * * * * * * * *** *** * * * *** * * * ** F * * * * * * * * * * * * *** * * * * * * * * * * * * **
Submittal Fee $`' .e. %r -' Permit Fee $ l S o CCF $ 50 CO /CC
Notary $ Trai /Education Fee $ It 6 O Technology Fee $
Scanning $ 3 �� Radon $ — Zoning Bond $ 36V
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. 1 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. 1 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: 1 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
day of , 20 OS, b)516 rL I ta/LQJ
who is personally k _,
AI
•
NOTARY P
My Commission Exp
* * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
As identification and who did take an oath.
n to nee or who has produced who is personally known to me or who has produced
AP
res:
* * * * * * **
NOTARY PUBLIC:
Sign: t _ ;, Mabel Vargas Sign:
' � omission 4
Print: ��� : *= Exeires: Jul 13 2007 Print:
MP!xae0, :. Bonded t'hru
\tlar.!!r gnvdine Co I nc
* * * * * * *Ye* * * * * * ** * * * * * * * * * * * * * * * * * * # #* * * * * *
Signature
Contractor
The foregoing instrument was acknowledged before me this
. day of , 20 , by
My Commission Expires:
as identification and who did take an oath.
************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
• VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
I. P1vx . 42_ being the legal property owner, for the property
Located at: 4 Pe c4 e.A.4° e,.... 51 - Ft. 42-,‘W:),
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),gnd I have read and understand the following disclosure
Statement, which entitles me td 3krbrk as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
Proof of ownership provided ( )
Was ac owledged before me this C4
By DIU In wt?
. 77...3(LQ
Produced
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 525,000.00 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 Iicensed 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. The foregoing instrument
day of
20(3S
who is personally known to me or who has
• as identification and who did take an oath.
y reoc P�' \ I;tnti'' r t I
Tax Folio #:
7//'/ iami Sh.ore
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (305)_756 -8972
f} 0 r4��
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal descripttion/folio #: 4 Lot `� /0 Block 5"2- Subdivision f r t-Oc9. .
P
requests permission to install:
Asphalt, concrete, brick pavers
[ ] Landscaping
[]Other
within the public road right of way of 4 � �1'' ' ' '4 -ee — 0.4- �,., '��lc -c , PL
(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
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 tiie 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 day of
owner
SIGNED. SEALED AND DELIVERED in the presence of: _