RC-06-2004Issue Date: 8/21/2006
Owner's Name: RUTH POLLEY
Permit Type: Residential Construction
Work Classification: Repair
Job Address: 935 95 NE
Additional Information
Miami Shores Village, FL
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 02/17/2007
Contractor(s)
Phone Primary Contractor
Comments:
IN THE BACK NEAR BACK DOOR, GUTTERS
Type of Construction: Occupancy: Single Family
Stories: 2 Exterior: YES
Front Setback: Rear Setback:
Left Setback: Right Setback:
Bedrooms: Bathrooms:
Plans Submitted: Certificate Status:
Certificate Date: Additional Info:
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 responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
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. Futhermore, I authorize the above -named contractor to do
the work stated
Fees Due Amount
CCF $0.60
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee - Additions /Alterations $100.00
Scanning Fee $3.00
Technology Surcharge $0.00
Total: $108.80
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: RC -7-06 -2004
Phone:
1132060143110
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 1,000.00
Required Inspections
Final
Invoice Number
RC - 8 - 06 - 25966
Total:
Amt Due
$108.80
C- 0415
11 r 1 ID
Amt Paid
$108.80
$108.80
NOTICE: In addition to the requirements of this permit, there may be additional
restrictions applicable to this property that may be found in the public records of
this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES .
Date
Monday, August 21, 2006
08/21/2006 Check
Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Number: RC -7 -06 -2004
Invoice Number: RC -8 -06 -25966
Applicant: RUTH POLLEY
Company Name:
Owner Address:
935 NE 95 ST
MIAMI SHORES, FL 33138•
Job Address:
935 95 NE
Miami Shores Village, FL
Payment Type Check Number
795
Amount
$108.80
Change
$0.00
Total Payment: $108.80
Page 1 of 1
BUILDING .: D Permit No. PERMIT PLICATIOi'�T �� Laster Permit - No.
FBC 2001
BY: --------------------
Permit Type (circle) Building : Electrical Plumbing Mechanical Roofing
I KeAlne- li
Cit 11 I t8m t S es state 'PC_ `
Owner's Name (Fee Simple Titleholder)
Owner's Address
r
Zip 32i? )$
Tenant/Lessee Name Phone #
Job Address (where the work is being done) '436 U E q5 ST
City Miami Shores Villa e
Is Building Historically Designated YES NO
Contractor's Company Name cd() via
Contractor's ess q `i (..43 S-f re ' »
City m'ar 1 / (
(Continued on opposite side)
Total Fee Now Due $ V V • 1
Miami Shore
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tek (305)- 795.2204 Fax: (305) 756.8972
State
County Miami -Dade Zip 33I36
Phone # 305 - 15 q w 3 L4 Lt
Phone # 30.5- au/9_3E503
Zip 312o
State Certificate or Registration No.t i9 a V
Architect/Engineers Name (if applicable) Phone #
Certificate of Competency No.
Square Footage Of Work: 1
Submittal Fee $
Notary $ 5.0)
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
AP S
$ Value of Work Entaxgrjatt
ZCS1A
h' 4F,ve,:azzlZtimmo3
s r
Type of Work: q ,, worse
-b N3 � J
Describe Work:.-6...- . ° _ » oa »» � e� 1 n C cic e i s ° -rK./ 8oc (c. ..Lacsbuu
* **** * * * * *** ** ** * * * * *** F ees * * * * * * ** * ** ** * * * * * * * * * * ** * * * **
Permit Fee $ G • CCF $ � CO /CC
❑New ❑ Repair/Replace ❑ Demolition
Training/Education Fee $ i L 0 Technology Fee $ Z. SD
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 thisjurisdiction. I understand that a separate permit must b secured for LECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONER 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 BE!'ORV RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copyfifthe recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Contractor
The foregoing instrument was ac owl before me this p The foregoing instrument was acknowledged before me this II
ge
day of , 20 _, by i� 1 f ) iV L- 7" I n day of '3U ',Li , 20 0(,0, by - -Jt f0 (1f
who is personally) gown to me or who has produced i who is personally known to me or who has produced
NOTARY
Sign:
Print:
My Comr
ohc 05/13/03
As identification and who di, �batleas
�v o 0" 3ru 22 OTARYPUBLIC:
_o.• o
piC "�
a'. • _ EX s a nd Sign:
Prmt•
ssion Expires:
Orme 0130525711
tieBonding � bows ato
t ru (�)432.4�{
My Commissi
■ . B � H Notary Assn.. Inc t
N on Expires:
******************************************************* * * * * * * * * * * * * **
as identification and who did take an oath.
tu�U�n�i
r 7 I�M'WY/
�
***************,********* ** ** ** ** * * * * * * **** * * ** ** * * * * * ** * ** * * *** / * * *** * j ** * * * * * * ** * * * * * * * ** ** ** ** * * * * * ***
APPLICATION APPROVED BY: ` ( r =
6/
•
Plans Examiner
Engineer
Zoning
r
1
REVISED:
Z
NOT VALID UNLESS 1BOS$ O #?j-I ? • • • • • • • •
• • ••• •
• • • •
• • • ••
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N
ENCROACHMENTS NOTED:
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Yap
-0
2.4.
cn
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J... drat,
141d
c /r - orH
01\1E, S1:r
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RE.s• U - 935
SURVEYOijS *g;L: : •LF+ NO :• FIP= Found Iron Fite F N /D= Foun.d Nail S Disc
• • • • • •S. 9=T 1 /2" PIN & CAP L84789 FIR =Fccnd Iron Ra�ar
•• • • • • S.PtP= • sl? PERMANENT CONTROL POINT LB4789
q= CENTERLINE. P /L= PROPERTY LINE. O /L= ON LINE
M.H.= MANHOLE. WM= WATER METER PP= POWER POLE
• • • • • F.C. = FENCE €ORNER, R= RECORD, M= MEASURED ,
• • • • • W Aarl'•Nl�' WIRE FENCE- •
• • • • . • • Cjp f�t
• • ••• • •. •MA @NAY•4VALL=
• • • • CONCAETE='j:• . ,:• -• • • . • • .._ • ••
NOIES. BEAi:YCS 22!Y S:?CW'I Al" REFE3?7 TO AN A35CYED YaLCE's. \:? ?3. _ P.
NOTES: UNLESS OTHERWISE SHOWN, THE FOLLOWING NOTES APPLY.
: Cai s!.�'&caparison is shcin, ail bearings and distances stcan are the same as _Elate values.
• Ur rnound portions of Footing.s,FFoundations or other Improvetrents were no_t located.
:iletritiolts are based cn National Geodetic Datum. Fence ownership by visual means
Elevations based
CBM #
ELev: NGV Datum.
f4 '2
A
X
LEGAL DESCRIPTION :
BOUNDARY SURVEY
LEGAL DESCRIPTION: LOTS 20 and 21
OF MIAMI SHORES SECTION NO. 3
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK
OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIDA.
I HEREBY CERTIFY That the survey represenled
hereon meets the minimum technical requirements
adopted by the STATE OF FLORIDA Board of Land
Surveyors pursuant to Section 472.027 Florida
Statutes
There are no encroachments. overlaps. easements
appearing on the plat or visible easemems other
than as shown hereon ��'
111
MARK M. KRAJNTK
Registered - Land Surveyor No. 3371
only State of Florida
LOCATION SKETCH
SCALE: N T S
OZ £ 1 9fltl
mazmmt
(Furnished by Client)
DATE:
— IJ - 95
a `°°19
2s
24.
1
111111
3
PAW
2•
40
Survey fo
Miami - Shdr
.A9
IJ•E • t 0T AV E.
SCALE:
1" = 20
••
F. 'IAN •
9
935 N.E. 95th St.
38.
BLOCK 76
SUBDIVISION
10 AT PAGE 37
••
BLANCO, DANIAL • & • AS�SO ; . '••
Land Surveyors ••• Mtn eft* • • • ••
555 North Shore Drive
MIAMI BEACH Florida 33• 05) 853 — X200••• •••
Fax: (30578:55— `791Or �• • •
FLOOD ZONE: SUFFIX: :J DATES 3/ 2/94 BASE:
PANEL : ( COMMr]NTrtbY• JMRFB .: 1 20h
DWN. BY: : SOB Ko. :.: 9 • r 7 • col
•• •• • • • •• ••