DRIVEWAYMIAMI SHORES VBLLAGE
BUILDING INSPECTION DEPARTME T.
APPLICATION FOR
LULU]
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted foe the build-
ing 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.
Owner's Name and Address ..c � , a. 0..9... _ SQreet -e 27.c, q--
Registered Architect and /or Engineer
Name and address of licensed contractor l.._...
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors) 2 ��_ 1��.Y ��...5�' /� l .4
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation 00 Roof Covering
Estimated Total cost of improvements $ �? O ' > e c Amount of Permit
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
Mfaxirnum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspe tion on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco•.eto; tvoriz to :r .`ormec( under this
pennit, as are licensed by Miami Shores Village.
Remarks..._ (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and tale 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 serve, and that all facts
therein by him j stated are u
Permit No..__! ? ° Date ' 7 ' Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Building
Chairman
Member
Member ...... _....__..._._ ._..__._.._
Council Approved. Date
pector
PLANN/IVG BOARD DATE
Member
Member
Member
Disepprov
My Commission !Ettpires
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re-inspeetion is made necessary by Improper notice for inspection or faulty
materials and /or workmanship.
Lt
E OT
Notary Public, State of Florida
to me well known,
Date
has been obtained from
60,5
,
ce i
Passed � f
ofr,
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
et be
Inspection Date: 06/20/2006
Inspector: Grande, Claudio
Owner: BUTLER, KELLIE
Job Address: 828 97 Street NE
Project: <NONE>
Miami Shores Village, FL 33138
Contractor: R&M DESIGN CONCRETE CORP
Building Department Comments
Monday, June 19, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
Phone Number 305/756 -0272
Parcel Number 1132060142740
Lot:
Page 2 of 2
i nspection Number: INSP -17424
Inspection Date: 06/07/2006
Inspector: Desharnis, George
Owner:
Job Address:
Project: <NONE>
Tuesday, June 6, 2006
BUTLER, KELLIE
828 97 Street NE
Miami Shores Village, FL 33138-
Contractor: R &M DESIGN CONCRETE CORP
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Number. DS -5-06 -1269
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Foundation
Work Classification: New
Phone Number 305/756 -0272
Parcel Number 1132060142740
Lot:
Page 2of2
Passed
Inspector Comments
ia/Uv------.1
0?
LI- .° /7 q--Y,
k
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
i nspection Number: INSP -17424
Inspection Date: 06/07/2006
Inspector: Desharnis, George
Owner:
Job Address:
Project: <NONE>
Tuesday, June 6, 2006
BUTLER, KELLIE
828 97 Street NE
Miami Shores Village, FL 33138-
Contractor: R &M DESIGN CONCRETE CORP
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Number. DS -5-06 -1269
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Foundation
Work Classification: New
Phone Number 305/756 -0272
Parcel Number 1132060142740
Lot:
Page 2of2
4
BUILDING
PERMIT APPLICATIO
FBC 2004
Owner's Name (Fee Simple Titleholder) Nk
Permit Type (circle)
Owner's Address
f City ; -;��.
Tenant/Lessee Name
S . 1 „,. -_
Job Address (where the work is being done)
City
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name / £ `° i' e_ s
Contractor's Address tt. e r
City t f //4.1 e
Qualifier Name e' -.
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ['Addition
Describe Work: : ; ) ./ ( % s k' '
Submittal Fee $
Notary $
Miami Shores Village
Scanning $ Radon $
Structural Review. $
(
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Fee $
f ; • t
State I ct
.✓L -.
�a o
DA Iteration
Electrical
e 6
Bond $. 7: v ; ° Code Enforcement $
NO 1<,
(nov_-/
Training/Education Fee $ i ✓
DPBR $
it .0
State l
Permit No.D O -1Z
Master Permit No.
Plumbing Mechanical
Zip 1 ' 3 - `3
Phone #
Roofing
Phone # f
County Miami -Dade Zip ' ' `l
Phone rc,�
Zip
Phone# (` 7r) ?ff. 9.
Certificate of Competency No. c _iL // S e
❑New
Double Fee $
Phone #
(square / Lear Footage Of Work: ,
Repair/Replace
******** * * * * * * *** * * * *** * ** ** * * * ** *** * ** F ees * * * * * * * * * * * * * ** * * * * * *** * * * * * * * *** * * * * * * ****
CCF $ : CO /CC
Technology Fee $ - =°
Zoning $
Total Fee Now Due $
7
See Reverse side —>
❑ Demolition
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 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 such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature � L t f(t
NOTARY PUBLIC:
Sign:
Print:
(Revised 02/08/06)
4
Owne►4r Agent
The foregoing instrument was acknowledged before me this /
day of Y% , 200c,, by (c'1 !/e /C
who is ftersonally known to me or who has produced
As identification and who did take an oath.
11
17 I' Je ." G F . �_. ✓L .� C
APPLICATION APPROVED BY:
Signature /
My Commission Ex ires., —'
Y P .�...� •.., RDDD;.FOJUNCO
*'I ° ' * * * * * * * * * * * * * * * * * * * * * * * * * * **
Ca CD 25217V
My um m. ag±.rn S, M fir
Contractor
The foregoing instrument was acknowledged before me this
day of if , 20e4 by / 4 7ti, (/ c'
who is personal( known to me or who has produced
,/‹.60 'lam J7 F> c as identification and who did take an oath.
NOTARY P 1 : LIC:
Sign:
Print:
My Com ission Expires:
yl . ?
�o-
**** * * * * * * * * * * * * * * * * * * * **' * * * **
o
7 /�y
Plans Examiner
Engineer
Zoning
• :
•
'`74. WHEREAS, (l\ el1 l C L.1. PQ , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description folio: !/'�dr�`f /B / ?7
Lot [� Alzo COAST 2StorBlock 1y- r/"
Tax Folio R:
requests permission to install:
►g
Sh ,oreo (/iC�ccc�e
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
[ ] Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] OtherT3r ift &— o 43 elf'
within the public road right of way of 6 0 2_e
R0D0LF0. ut:CC
• • .. ,'pride
o..:J07
n ,.. •)c • '3?6a)
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 - 2207
Fax: (305).756 -8972
Subdivision ,4 1 � o� �
•
97' 9-
(address)
by the Village, the Owner agrees as follows:
IN CONSIDERATION of the approval of this permit
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.
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 , day of
SIGNED. SEALED AND DELIVERED in the presence of: /.�;�
019W 00 • gyp•
•r "
�, x ; � �
p GDV. ; ^.:, :41....
,,
owner
‘../i t , wi
f PPR 0 (i
'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, g gn � ��l` t � „, _e_2. , does hereby attest that the
(property owner)
attached survey, performed by L . 9 , i s J es ' f - c c - L 1
(name of surveyor's company)
performed on 0 - 01- ® , 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..
Further, Affiant sayeth naught.
Wi ess(sign print)
--So _A.cp
d
SWORN TO AND SUBSCRIBED before me this /' )9 c "_ day of /
Affiant is personally known to me, produced
RODotra UAW
Wiry .suhaatr.A1 r
COMM. Eci.es iat 16. zn
C+ +04o
Notary
as identification.
Issue Date: 5/23/2006
Owner's Name: KELLIE BUTLER
Permit Type: Driveways /Sidewalks /Slabs
Work Classification: New
Job Address: 828 97 Street NE
Comments:
BRICK PAVERS DRIVEWAY
Additional Information
Miami Shores Village, FL 33138-
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 11/12/2006
Contractor(s) Phone
R &M DESIGN CONCRETE CORP
Primary Contractor
Yes
Type of Work: DRIVEWAY
Bond Return :
Additional Info: BRICK PAVERS
Classification Residential
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
Bond Type - Contractors Bond
CCF
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$300.00
$3.00
$1.00
$5.00
$150.00
$3.00
$3.75
$465.75
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: DS- 5 -06 -1 269
Phone: 305/756 -0272
1132060142740
Lot:
Required Inspections
Foundation
Sidewalk
Landscaping
Final
PB:
Total Square Feet: 1000
Total Valuation: $ 4,950.00
Invoice Number
DS - 5 - 06 - 24898
Total:
MI 3 0 pni3
Amt Due Amt Paid
$465.75
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
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0.10 go 1-1 •
I.
PROPERTY OF:
T1CTT VALJD wiTHOIJT THE =NAME
MO THE OFODDIAL RAISED SEAL OF
FLORIDA LKENSED SURVDOR Mao
SURVEY
Butler, Kellie K.,
A BOUNDARY
I K'r7TE OT CF 1UF THAT THE SURVEY R —
SkT(TED HEREON MEETS THE It811TWY
TECHNICAL, STANOIRDS Sr E FORTH 9Y DIE e OF LMEI SLIFMTCRS 04 CHAPTER
e1C17 — FLORIDA AIRMISTTTATTVE CODE
PUR9JNT 'O SECTION •72.:227. FLA. STATU—
TES THERE ARE NO ENCROACHMENTS.
OVERLAPS. EASEIJEJ(TS APPEAR= ow THE
PLAT QilL:A THAN AS SHOWN HERETO.
G434 -
:This property lescribed aso
Lot 11, and the East 25 feet o:
Lot 12, Block 74
MIAMI SHORES.SECTION NO, 3,
according_to__the -Plat_-_ -
thereof, as recorded in
Plat Book 10, Page 37
of the Public Records of
Miami-Dade County, Florida.
828 N.E. 97th Street, Mia)ni Shores
LANN,E ,AND, cAFRCIA, INC Flori
• ••1:R 2R$
• ••• • • ••• •
SURVEYOR'S—IWAPPERS -[AND PLANNERS
FIELD DATE
-1;e1.-0/ r:04-
•• • • • • •• • • • •• • •
• • •
• •• • • •
.. • .. .. .. • • •
OFFICE ADDRESS 368 ALCATAR CORAL CASLES. FLORIDA 95134
. (rC6) .eee -7409 (R54) 523 -01101
••• • • • • ••• • • -
Page 1 of
BY WM. No.
t --19:1122: ? --- 158989 -
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Da �3 Time
Type Ins'n
Permit No.
Name
Address
Company
Phone #
For Inspector
Approved
Correction
Re- Insp'n Fee
3 ame & Date
`,�f // � p � �j
A l 0 A /,�II t� / V k1
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO.
STATE OF FLORIDA
COUNTY OF DADE
THE UNDERSIGNED hereby gives notice th
certain real property, and in accordance with
the following information is provided in this
1. Legal description of property and street ad
OF Ai/ 1 - doves �Qc
2. Description of improvement: '$ rl c/
5. Surety: (Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond: $
6. Lender's name and address:
NOTICE OF
COMMENCEMENT
TAX FOLIO NO.
. 3 /
— PA -L/ / Q-✓'s 2 - -- ec. ,46, k) -u CU)
1111111 1111111111 11111 11111 11111 11111 1111 1111
CFN 2006R0581112
OR Bk 24571 Ps 3482; (1es)
RECORDED 05 /26/2006 14:38:43
HARVEY R:UVIHp CLERK OF COURT
MIAMI -DADE COUHTYp FLORIDA
LAST PAGE
t improvements will be made to
hapter 713, Florida Statutes,
otice of Commencement: /
ess: Lo7 / // �itc�# 7 6 r. f e,t Go-/ 1 .2 /3Z0ei. 7V
J'2 ? 7 t'
3. Owner (s) name and address: 8` Q
4 - pa 3 .3 / 34
Interest in property:
Name and address of fee simple titleholder:
Contractor's name and address: i?
/Co .47., 4 3 / . 3 3 / c p_.3
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 address:
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 address:
9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified)
of Owner • C
Print Owner's Name
8 u7/lE,_
Sworn to and subscribed efore me this _, day of h4, 20 Qom_
Notary Public 1/ / /, //)
Print Notary's Name IN
My Commission Expires:
Prepared by: - 7 24 c, c7 fedh-n t CZ.
Address:
OVQ4O PleRr n, COUNTY OF DACE
bii4170d gr k77IFY this c py of the
OP16 ?c! pg tato office on day a2
, A D 20
6✓ t PMGSS han Offic,at Seat.
NAMVEY Rat, of Circuit and Coun
(
3 3 /
Forth 101