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1115 NE 97 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138• Phone: 305 «'795 -2204' Fax: 305 -756 -8972 Tax Folio Date Job Address N5 /' 9 7 Legal Description Historically Desig s , Owner /Lessee/Tenet Yes Master Permit # ` i Owner's Address J �! � Air 9'7 54- /' C� � i 1 Contracting Co. , �� r?� l (CiiA' o l (Oa( t �' ��Vj �- C ss /9//// f'yY . ii, l ci / ,j l' 5:, ' Qualifier /:, ii (', ' - i: 6 ` SS# A 2/ 0 Phone ,i v'.i (/ i (:, C't,'[ -' State # 6. l.' g Cy Municipal # Competency # Ins. Co. WORK DESCRIPTION: 4 �v /� / /4" 1T r% 14 'e` /2, (-1-- c I l li Square Ft. 7 7 5 f ~ Estim t Cost (value) /: 0 C2— / na7 of owner and/or Condo Presidett t Date caner Builder 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 ROOFING 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 FINANCLNG, 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, I authorize the above named contractor to do the work stated. Date to Owner and/or Condo President ' Date Notary / i Contracto or Owrerr ( Tate Vic. Angell) BA Becker My Co J ssion F,1f Angela �:a�;, n i1�15C aa : om . Fqy ;H�Ire !ixplros Noyembn.r 15, 2C06 TOTAL DUE 0?) Zoning Mechanical Plumbing Structural Engineer ,, ,'d _ i :1 _,1/1 ('1 'y Building ��_. -�� Electrical Type Insp' Permit No. Name Address Company Phone # For Inspector: Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTME 305- 795 -2204 Building Inspection Request Dateee 1 Time o 1 BUILDING PERMIT APPLICATION FBC 2001 Tenant/Lessee Name Contractor's Address 52-014 , 13t1 c* City 1" it`arn i State Qualifier WI' 11 ea ry J: Sans Miami Shores Village Building Department y'L • Permit No. i )PCDS' 12-73 Master Permit No. Permit Type (circle): (*Okra Electrical Plumbing Mechanical Roofmg Owner's Name (Fee Simple Titleholder) } 1 Ct rt et, fern alt ojez Phone # 0 S - 3 3 1 - 3 �/ 1 Owner's Address 11 15 NE 4 14 S t. Shorts , FL 33 1 38 City i a m C Syl ores State Zip 33 P Phone # •- Job Address (where the work is being done) i 1 N Q S t✓ City Miami Shores Village County Miami -Dade Zip 5'3 13e Is Building Historically Designated YES NO Contractor's Company Name St) go e-r S4-a4r ' 4 0 Cow cref Q ' 1C.Phone # S- - 1 1 ( -3 Zip 33145 * * * * * * * * *** * * * * * * * * * * * * * * * ** F ees ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Architect/Engineer's Name (if applicable)` .. - , Phone # • . Architect/Engineer's Address City ` State Zip Cs ©d0 0 0 $ Value of Work For this Permit # Square Footage Of Work: go 3 st• I • Number of: Bays Stories 1 Families 1 Bedrooms 3 Baths 1 Type of Work: ❑Addition ['Alteration [New ❑ Repair/Replace ❑ Demolition Describe Work: p1.40-i r CO cre 41. stet VL.. J County Escrow Fee $ Permit Fee $ c 2.5 N $ Education/Training Fee $ 1 2-0 .. Tech $ .? s 2 7 Scanning $ .l��am ) Radon $ Code Enforcement $ Bond $ ft- 12 9 4 . Struct. $ Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State who is personally known to me or who has produced 7?1 As identification and who did take an oath. NOT Y PUBLIC NOTARY PUBLIC Sign: / c n . 1 .. ,. *6 �7 5'l�/!�to f Si gn: Print: Has' IA. 444-40 ` SA411 My Commission Expires: t) 6 10 g APPLICATION APPROVED BY: chc7/7 /03 Print: 'U _ > ci;a 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, POOL` S, FURNAfES, BOILERS, HEATERS, T*I jKS.agd AD'ONDITION$RS,'rETC 4. OWNER'S AFFIDAVIT: I certify that a$'the foregoing fnforriatioh h 'accuiate'and'that all work will be done in compliance with all applicable laws regulating construction and ,fonipg:: i ' i , , e , I. "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 ATTURNEX, , IBEFARE. : RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a ' 't o to the issuance o a building g permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after, the building permit is {ssued. In the absence_ of such posted notice, the inspection will not be dpprnvtcRart7 a�ction f x%l�be`c�ta'rgdcl ''' ' " + • NOTARY PUEIIC•ST4TE OF FLORIDA 0� •.1Y p e GS o . ''I :AL NOTARY : °:x ri il ' seal '.1 , t. o Yeliss Sans a nco /S - - � � 4UiV96 Signature 0 ��� % -Z �Q ?on DD282247 Signature m � Expires: MAR.' Oli,' 2009 Commission r DD 9 4 0% y • , 1!'e$ /� eU 1 n,A d' C aori Owner or Agent FAi: APRIL 06, 2008 ;' . u h 4 in 4 , i }Y 4a•, Inc. Contractor The foregoing instrument was acknowledged before me this 2y The foregoing instrument was acknowledged before me this_ day of 0Q 2. , 200 by F �v..Q+ r=4-m4-,t40- day of `` ? �� c ',, m - ., 2 0 id by -t1 > c S- who istersonally_known to m`e°or who has produced as identification and who did take an oath. My Commission Expires: J 1 1 (Certificate of Competeac 41der) . ` i y •, . ,•• , , / State Certificate or Registration No. Certificate of Competency No. *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, Ra (amigo Fern 44i. ai (owner) following described property: Legal description/folio #: 11- 310S- O 11 - Coo !o.o Lot Block 1 >i0 Subdivision kev. ft . Mi 4M1i SV ,oroJ i. Tax Folio #: 3 Ol * -0O(00 requests permission to install: [ Asphalt, concrete, brick pavers [ ] Landscaping [ ] Other within the public road right of way of ? I I5 pi cf St. (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: 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. 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 this a day of # ,- SIGNED, SEALED AND DELIVERED in the presence of: I r YT/ jami Shore s i 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 - 2207 Fax: (305)15578972 , hereinafter referred to as the Owner of the .v •11 OFFICIAL NOTARY SEAL %Marola Franco /Sans a= Commission # DD282247 hl Commission Expires 6, 2008 1 STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, attached survey, performed by performed on (date of survey) Affiant is personally known to me, • Miami _ ChoreJ Vt t0ag L AFFIDAVIT Ro Qand® rrDelt044 , does hereby attest that the (property owner) S iare2— SLIry in (name ofsurveyor'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. Affiant/Property owner Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this 3( day of ALeir ® .5 . P f, as identification. %.`;`; y' p OFFICIAL NOTARY SEAL a�• ' � ° isii • e : Marola Franco /Sans �• ��` ; < Anurussion # DD282247 144:0 APRIL 06, 2008 • (ACKNOWLEDGEMENT-INDIVIDUAL) STATE OF FLORIDA ) ) SS. COUNTY OF MIAMI DADE ) The foregoing instrument was acknowledged before me on by who is personally known to me or who has produced as identification and who did (did not) take an oath. Signature of Acknowledger: Name of Acknoweedger: STATE OF FLORIDA ) ) SS. COUNTY OF MIAMI DADE ) Title or Rank: (Typed, Printed, or Stamped) Serial No.(if any): (ACKNOWLEDGEMENT - CORPORATION) The foregoing instrument was acknowledged before me on by , of a corporation, on behalf of the corporation. He/She is is personally known to me or has produced as identification and did (did not) take an oath. Signature of Acknowledger: Name of Acknowledger: (Typed, Printed, or Stamped) Title or Rank - Serial No.(if any): MAP OF BOUNDARY SURVEY ,e c:1 ASP HAL = :::: ID 1.12' FIR 1/2 NO ID RUC COR. SCALE r = 20' 465.00' 3.32 3.15' 0.65' 0.65' O N90 ° =0'00E Z©Th Qp o rroMA ..... l► _JG • •• . . . . . .• • • • 46' ASPHALT PAVEtvl ::.. w:x::�r .::::75 • FR _:s: : :... • `7th' SE . • • • .. ... • • • • • • . • • • • • • • . .. • • • • • • • • • • • .. .. • • • .. .. ... • • • 000 • • z O O O 0 O 0.87' OASIS OF BEARINGS .. • • • • • ... .. • • • • • • • .. • • • .. ••• .. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ••• • • ... • • • • • • • • • • .. • • • • • • • . • • • .. • .. • • • .. .. • • • ... • • • ... FROM :SUPER STAMPCONCRETE INC 65, 1/.95 515.i/61.95945 ONE S IUNY RES. # 1115 COVERED . TILES . • N 1 in/ENT .97th :305 220 1163 !St Sep. 13 2005 08:27AM P1 row= u LAs 4' ax*67 &4914e-porra t1.e761ePW Er 1 wok- w/071 PO FIR 1/2• rz %sea& lammed- NO ID 1 iryirfwEglifri •3000/441$ twx:=7.1. aso l l••• ••••••••••••••••.....o•oelloweoeewie••••••• • •• • • ••••••0400 . 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W. 134 CT. Legal Description: REV PL MIAMI SHORES SEC 8 Permit Status: APPROVED Permit Expiration: 2/26/2006 Construction Value: $6,000.00 Work: PLAIN CONCRETE DRIVEWAY Page 1 of 1 PB 43 -51 LOT 6 Fees: FEE2005 -12489 FEE2005 -12490 FEE2005 -12491 FEE2005 -12492 FEE2005 -12493 FEE2005 -12494 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Builders Bond Total Fees: Amount $125.00 $3.60 $1.20 $3.20 $3.00 $300.00 $436.00 Total Fees: $436.00 Total Receipts: $0.00 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. BY: BLK 180 LOT FROM :SUPER STAMPCONCRETE INC STATE OF FLORIDA COUNTY OF DADE FAX NO. :305 220 1163 S7A1! OF FLORIDA. COU.:i 1-,EREBYCER - Y that thin. / OTici, ^,u Ned in tills c' A ., fiK, \:r' '.•Vi Ti `ii:. 3 my HARVEY RUVIN, By Sep. 16 2005 03:32PM P2 111111111 ct''t -: f - 46a49 OR Elk 23788 Ps 1014i Cies) RECORDED 09/16f2005 15 :40 :24 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA LAST PAGE y �f• - N1 c; ft NOTICE 01? COMMENCEMENT A RECORDED COPY d MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERM , F+ ` J IT NO. _ VL'k TAX FOLIO NO. 1- 3x05 - 01 - 0060 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the fq wig information is provided in this Notice of Commencement: 1, Legal description of property and street address: ,° t b 1 k 1 80 f " r t as-r w-z - , 44.? sa e, Pa- 2. Description of improvement: 3. - Owner (s) name and address: • ` S Interest in property: Name and address of fe imple titleholder: 4. Contractor's name and address: 5. Surety: (Payment bond required by owner from contractor, if any) -Tame and address Amount of bond: $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13 (1) (a ) 7., Florida Statutes: Name and addre 8. In addition to himself, Owner designates the following person (s) to receive a copy of the Lienor's Notice as provided in Section 713. 13 (1) ( b) 7., Florida Statutes. Name and addres 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different « ate in specified) F i+ Signature of Owner Print Owner's Name InenG( Sworn to and subscribed before Notary Public Print Notary's Name My Commission Expires: $ Marola Franco /Sans ' s 's$ion # DD282247 ` . My Commission Expires • %. Z ... APRIL 06, 2008 is 16; day of.W2 2g2 prepared by: Haro )a • S^'" ^ ' Address: / •.Slc) ) 3 1 .l • e • Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 'Inspection Number: INSP-18540 MAY 3 1 ENT D Permit Number: BP2005 -1273 Inspection Date: 05/30/2006 Inspector: Grande, Claudio Owner: DENIS, ALEX Job Address: 1115 97 Street NE Project: <NONE> Contractor: Miami Shores Village, FL 33138- Building Department Comments Passed Failed Correction Needed Friday, May 26, 2006 SUPER STAMP CONCRETE Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. CL Inspector Com Address Compan Phone # For InspectofT Re- Insp'n Fee Permit Type: Imported Permit Inspection Type: Final Work Classification: Driveway Phone Number Parcel Number MIAMI SHORES VILLAGE BUILDING DEPARTMEN 305- 795 -2204 B ilding Inspection Request 1132050170060 O