770 NE 97 St (5)CONTRACTOR
NameC. o. T. l.0 pis i !LJ GT O N
License No. G(Tt.0 5$ $1c.,
Address p . (,)43 n - i 5
p r r, 333
Telephone / "11'1 <G,Lt Fax ( a (.lbb -- g4xSN
Qualifier Name 10341,41, N �1 G N `Sr c4 GJ
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address: /. 70 L �t .✓ l� `'
aa.o�0 Apt.
Correction
Re- Insp'n Fee
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION
a te' lad C7
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
NV
City
State
tion of Work P t—t „' "''" y
Zip
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT Linear Feet
305- 795 -2204 Feet Units Floors
B ilding Inspection Request ,f Work q °1707
sessed/Appraised Value
Zone Base Floor Elev.
Date - D--
Type Insp'n
Permit No.
Natri
Address r l `T 0 74 C e ,y
a00 'i3n
Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
S TE OF FLOR , COUNTY OF MIAMI -DADE
"% Non— (r"5.4. QP--
Signat i of Owner
�
C \ e_k
4 7 l �•. ex A!
Print Name
Sworn to and subscribed before me this
t"
OF FLO ' j ) A, COU Y OF MIAMI -DADE
cure of
S g}� ontractor / Qualifier
PrO—rji =>t L c J c
Print Name
and subscribed before me this
PERMIT APPLICATION
..W. ..,� lic tate of Florida ure of No • Public - Sta g of on
OFFICIAL NOTARY ;ILL j
SEAL: II OFFldAI ti r� SEAL: 0.■?' PU 6' ANGELA M BECrCEH
, � COM'nsnoI NUMBER
9 < 1. ANGEI rra
vC Personally known ". 011,Troduced_klentifica'bo '_______- . Personally known -OR, ProdU i catio .
Type of Identification Produced: p) TO 4, 1 1 -La 39 ) of Identification Produced:FA D,L, 1_,._s ....q. cwi-.)
ELECTRICAL
TYI'E
Minimum Fee
()Ty.
.1YP1.
Dryer
QTY.
.1.11,1,;
Outlet, Appliance
Q.FY.
.
Service Repair
Q . 1 . 1 .
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low - volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY.
TYI'1;
Condensate Drain
QTY.
TYPE:
Generator
QTY.
TYPE
Refrigeration, Tons
Q'T'Y.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUMBING
TYPE:
A/C Condensate
QTY
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
Q
. 1 . 1 . 1 , E
Soakage Pit
Q
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
CHECKLIST
U1 OWNER - BUILDER FORM
(Attach)
UJ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
® CONCURRENCY
(New Construction)
Ell OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
® PROOF OF OWNERSHIP
(Attach)
® HRS / DERM APPROVAL
(Septic / Sewer)
13 IMPACT FEE
(New Construction)
® OTHER
(Specify & Attach)
$ (¢.01 /sq.ft.)
$ �� v C
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
( x .6 x/1000
0)
(¢.005 /sq.ft.)
PERMIT APPLICATION
IU CONDO ASSOCIATION APPROVAL
(Attach)
® BPR APPROVAL (Restaurants)
CI CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OFAPPROi' AL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL 0 (305) 795 -2207 0 FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com
(1.
The Sunshine State!'
LICENSE NUMBER
L523-068-58-218-0
BARNEY H LOWENSTEIN
19201 COLLINS AVE 09$13
SUNNY ISL BCH, FL 3316O•2202
BIRTH DATE SEX NOT. REST. ENDORSE.
06-18-68 M SOO A
ISSUED EXPIRES DUPLICATE
042B02 06-1806 00-0040
XII20:2042402ST
of a motor vehicle cohstkutes consent to any sabrietytest requlred byjay.
el 99000643
CONTRACTOR
■Name I C 1, —. - I t .. N \ c
License No. c G G c£ p 1 0 I
O o
Address /3/9 E . L i} S L "4 S' - s Z-vo rE
F7kauGt', F/. 33 3 /
Telephonv4J T . - ,i 36%2 / Fax (QJ J5:C 3 /
Qualifier Name
PROPERTY OVVIEV i. } ., r, j , 3(,$ A J
2 h ,5, Otd '4, r 2t' ':)
" , a
Name"T z p" 1�� ; An.q << 7 ,
, -....1 R. 41, e.G, r. : *Yfo P e:
;;..
o . �t -0 X
Address ..- -, .. ..t; .
– 7 . r ' 70 �? .
•
Home Telephone 3 03-
7 5 2 ?"•
7
Business Telephone. O J �^
q � ?3
6 J
Demolish
Fax
Relocation of Structure
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other
INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
A PPLICATION
Job Address: t 70 l`l E [ Cr
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Apt.
Folio Number
) C Description of Work ilr jr-- Q �,,,. « e � f i ✓ w
Lot Block t
Subdivision PB PG Zoning ar Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property Value of 'ork'. �-/ 00 U . Oe) Bldg Value
Tenant Information Tax As essed/Appraised Value
Flood
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
ores
City
State
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. B
33136
Zip
e Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
S TE OF FLORIDA, COUNTY OF MIAMI -DADE
«O K
Signatur f Owner
C&'°- ► l 2 hJ N e<
Print Name nn
Swom to and subscribed before me this (1 day
. Alk
ture o+ otary Publi
SEAL:
Personally kno
OFFICIAL NOTARY SAL
(IV 1)4/496 ANGELA M BECKER
. " coem ssou NUMBER
CC 7866
O NIY
commis-slow EXPIRES
PdO
OR, Produced Identification
Type of Identification Produced:
PERMIT APPLICATION
Print Name
Sworn to and subscribed before me this
_7O Z
SEAL:
3 0 day of
_1(A ly ,
Personally known OR, Produced Identification , �
Type of Identification Produced: 4 �... Z 3 0 ° CEO �(�. 334-V
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
ThpE
Outlet, Appliance
QT\.
'11I'1:
Service Repair
QTV
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
-`
A/C Central 4 -7 Ton
Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8 -15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
Pressure Vessel
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY.. TYPE
Condensate Drain
QTY. TYI'1:
Generator
QTY. TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump and Abandon
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
i'YPF:
Miscellaneous Fixture
QT1'.
rvi'1:
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
D . TE
Zonin_
/' lik`7wyeArz
Electrical
'
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
4
OFFICE USE ONLY
CHECKLIST
® OWNER - BUILDER FORM
(Attach)
® FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
• CONCURRENCY
(New Construction)
Ca OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
m PROOF OF OWNERSHIP
(Attach)
• HRS / DERM APPROVAL
(Septic / Sewer)
® IMPACT FEE
(New Construction)
® OTHER
(Specify & Attach)
$ 9 7 O
• (
$
$ 0 <9
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
( x .6 x/1000
0)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
C3 CONDO ASSOCIATION APPROVAL
(Attach)
BPR APPROVAL (Restaurants)
1:1 CONTRACTOR REGISTRATION
(On File)
TOTAL 1 7 ► `l v
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2" AVE., MIAMI SHORES, FL o (305) 795 -2207 a FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 7/12/2002
Applicant: HELEN
Owner: MENNES
JOB ADDRESS: 770 NE 97
Contractor
Local Phone:
Parcel # 1132060142200
Permit Status: Approved
Permit Expiration:
1/6/2003
MENNES
HELEN
ST
Contractor's Address:
Fees:
FEE2002 -3823
FEE2002 -3824
FEE2002 -3825
FEE2002 -3826
Description
Buildier's Bond
CCF
Building Fee
Notary Fee
Total Fees:
Amount
$300.00
$2.40
$70.00
$5.00
$377.40
Total Fees: $377.40
Total Receipts: $0.00
Work: BRICK PAVERS DRIVEWAY
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
Col1!O71
iV James F. Mennes
or Helen C. Mennes .
305 - 754-2397
,`770N.E 97th St t ' r c7ti "
Miami Shore, Fr 3138 2526;; ,
PAY,TO
ORDER OF
Bankof America, o'
ACH P � i
R/r061100271
FOR .�' /c'w 6 ''
1:06300004 ? I: 00 L L95359 L4 4u'
�y " % .v i b 63+4%680 FL''
1348'i
90 L ?
9017
LL-ARS,'. '8 •
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 3 & E1/2 OF LOT 4 BLK 69 LOT SIZE
Building Permit
Permit Number: BP2002 -1220
Construction Value: $4,000.00 -
e equipment or device described in the application herefor in strict compliance with all
ith any plans, drawings, statements or specifications that may have been submitted to
not done in compliance with such ordinances or if the plans are changed without
tor or builder named above assumes the responsibility for a thorough knowledge of the
gs or in the statements or specifications and that he assumes responsibility for work done
compliance with all ordinances and regulations pertaining thereto and in strict conformity
s Village. In accepting this permit I assume responisibility for all work done by either
BY:
BY:
Page 1 of 1
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, V (� , e s p., n. , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description /folio #:
Lot Block C c t Subdivision
Tax Folio R:
requests permission to install:
[✓ / Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of
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 representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLE'GE on this 3 day of
SIGNED. SEALED AND DELIVERED in the presence of:
fl /hami _ ch,oreo
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (305)_756 -8972
x " 7 c l7 Cr
(address)
pRtuECv/ y
APPeor`}cti
.4
Witness(sign and print)
, o> >'
1r pU 6e ANGELA 114 t3c.C∎ r t ,
- rr 2r - Coura!ssro� rain. +�e.a
by Q CC766697 •
_lam' C) NOV. 15.
OF F f
‘ Muini Shored Vd4e
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, s Z . P...e N `P, lOh : does hereby attest that the
(property owner)
attached survey, performed by PR. 0,1. Are ci-- -• s c" L
(name of surveyor's company)
performed on M,a. 1 c l 7 0 , is an accurate representation of the existing conditions and
(da 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..
Further, Affiant sayeth naught.
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me,�roduced
Witness(sign and print)
)
as identification.
Concurred
BUILDING DEPARTMENT
10050 N.E. SECOND AVENUE
MIAMI SHORES. ,FLORIDA 33138 -2382
TELEPHONE (305) 795.22.04
FAX (305) 756-8972
OWNER BUILDER AFFIDAVIT
In order to induce the Village of Miami Shores to issue an Owner /Builder permit, I agree
to concur with State Statutes 489 (7) "Disclosure Statement" as follows:
"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 with certain restrictions even though you do not
have a license. You must provide direct onsite supervision of the construction
yourself. You may build or improve a one - family or two - family residence or a farm
outbuilding. You may also build or improve a commercial building, provided your costs
do not exceed $25,000. The building or residence must be for your own use or
occupancy. It may not be built or substantially improved for sale or lease. If you sell or
lease a building you have built or substantially improved, the law will presume that you
built or substantially improved it for sale or lease which is a violation of this exemption.
You may not hire an unlicensed person to act as your contractor or to supervise
people working on your building. 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. You may not delegate the responsibility for supervising work to a
licensed contractor who is not licensed to perform the work being done. Any person
working on your building who is not licensed must work under your direct supervision
and must be employed by you WHICH MEANS THAT YOU MUST DEDUCT
F.I.C.A. AND WITHOLDING 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. Further, comply with Florida Building Code and Miami Shores Code
of Ordinances.
Acknowledged
Owner Building Official.
JHHJ_
11,
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SURVEY
"MIA7I
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ORDER 217
105 Pg. 9
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1
WE HEREBY CERTIFY that
ao..-2 described proer
our knowledge and bell
under our dirsction.
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0 6 2 0
SKETCH OF SURVEY
of LOT 3 and the EAST 1/2 of LOT 4, of BLOK 6:?, of
SHORES, SEC?T0 o. 3", accordim7 to the Plst
of recorded in - P1 - ;t 7 1ook 10 at Page 37 of the Public Records
of Dade County, Florldn bein7 located In the Villag.e of
Miami Shores, Florida
DATA May 1L, 1")70
SCALE: As shown
the attached SKETCH OF SURVEY of the
ty is true and correct to the best of
ef as recently surveyed and platted
A. R. TOUSSAINT & ASSOCIATES, INC.
LAND :
628 N.E. 126th Street North 1amt Fla.
,„. - ( T. Pres. • 0
Howarl C.
Rezisterc Lald 5urveyor No. 1,5.3
of Floriaa
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