1224 NE 96 St (4)BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle).
Owner's Name (Fee Simple Titleholder)
12
Owner's Aal
W..-■1.
City
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name CoL
110 -vJ. tg 0o _,R!t
Contractor's Address
City ' L R pc�Si' State '"rL
C) Zip .333 I 5
Qualifier q �ls�`�" "''
Architect/Engineer's Name (if applicable) Phone #
2, �d0
$ Value of Work For this Permit
Type of Work; ['Addition ❑Alteration
Describe Work: # `'
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (3051JSG.8972
RECE pNED
J�'c! 2004
gg5a
Submittal Fee $ 5 • QU Permit Fee $ / 00
Notary $ Training/Education Fee $ (9/ t / O
Scanning $ 3 Radon $ Zoning
Code Enforcement $ Structural Plan Review. $
Permit No.6 Z6Qy — 5 -
Ma ter Permit No.
Electrical
6
State Zip I 3 d
Phone #
Plumbing Mechanical Roofing
(3c 1“-- 44g)
s
X22¢ A F. q 6
County Zip
i 6New
Phone #
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
T c)32.6 - 4041
❑ Repair/Replace ❑ Demolition
1 , 8 CO /CC
Technology Fee $ p E0
CCF$
Bond $
3
oilfc
who is personally kn
NOTARY P
46.
Sign:
Print:
State Certificate or Registration No.
APPLICATION APPROVED BY:
Chc 12/15/03
o me or who has produced
As identification
e an oath.
wd/o,
Bonding Company's Name (if applicable) 1
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 this jurisdiction. I 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: 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 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 suc posted notice, the
inspection wil of be .'pproved and a reinspection fee will be charged.
Signature
NOTARY PUBLIC
Sign:
P
LOPEZ
My Commission Expire :No'' ' STATE OF FLORIDA / y Commission
* * * * * * * * * * * * * * * * * ** * Ili'} 117N1� ` RM1 ,%* * * * * * * * * *** * * * * * * * * * * * * * * **
('ee " "rtificiiile of Competency Holder)
Certificate of Competency No.
or Agent Con actor
The foregoing instrument was acknowledged before me this / The foregoing instrument was a
day of v i'E , 20 a`I , • y , day of 1 Vim-= 20
who is personally know
owledged before me this
me or who has produced
identification and who
* * * * * * * * **
******************************************* Jv:*************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
JUN - 2 2004
Plans Examiner
Engineer
Zoning
'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,
(property owner)
attached survey, performed by
Further, Affiant sayeth naught.
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me, produced
1
O tJ
(name of s eyo 's company)
, does hereby attest that the
0 s J-kl
performed on , 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..
Witness(sign and print) Witness(sign and print)
VALC
as identification.
Of
ROTAS • SE OPEZ
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION No. Dd2625
MY COMMISSION EXP. FES 1%, 2005
OVENANT OF C STRUCTION WITHIN RIGHT OF WAY
WHEREAS, \ 0 . � J , hereinafter referred to as the
Owner of the
(owner)
following described property:
Legal description/foliog:
Lot IS Block 4 Subdivision
Tax Folio R:
requests permission to install:
Yl7/iami SIiorQ
SIGNED. SEALED AND DELIVERED in the presence of:
OFFICIAL NOT
FIAIAS JOS
NOTARY PUBLIC,STATE OF FLORIDA
COMM /SSMON No. Dd2e26' .
MY COMMISSION EXP. FEB. 19, 2006
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 - 2207
Fax: (305)_75678972
pRtue V
f� PPR o4ckt
3P G. ZLe42.4
M , concrete brick pavers
[ ] Landsca - o
[] Other
within the public road right of way of I / 2- 4 q ‘sk9.4._ tL;
(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 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 re. esentative).
on . • J(/(/ -2 L'l
SIGNED, SEALED, EXECUTED AND ACKNOWLEDG
ritheTACIP
5582 N.W. 71h STREET, SUITE 202
MIAMI, FLO.' DA 33128
TELFF'HONE;(305)204.2680
FAX: (305) 284-0229
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LAND SURVEYORS
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Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2004 -752
Printed: 6/3/2004
Applicant: LINDA TONDEUR
Owner: TONDEUR LINDA
JOB ADDRESS: 1224 NE 96 ST
Contractor ICOA CONSTRUCTION
Local Phone: 786 - 326 -4041
Parcel # 1132060143931
Signed: (INSPECTOR)
Building Permit
Page 1 of 1
Contractor's Address: 1101 S.W 18 COURT
Legal Description: 5-6 53 42 MIAMI SHORES SEC 3 PB 10 -37 LOT 15 & W3OFT OF LOT 14 BLK 84
so
Fees: Description Amount
FEE2004 -5624 Building Fee $100.00
FEE2004 -5625 CCF $1.80
FEE2004 -5626 Training and Education Fee $0.60
FEE2004 -5627 Technology Fee $2.50
FEE2004 -5628 Scanning Fee $3.00
FEE2004 -5629 Builders Bond $300.00
Total Fees: $407.90
Total Fees: $407.90
Total Receipts: $0.00
Permit Status: APPLIED Permit Expiration: 11/23/2004 Construction Value: $2,200.00
Work: STAMPED CONCRETE DRIVEWAY
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: