822 NE 96 St (5)MIAMI SHORES VILLAGE
BUILDING DEPAIVIMENT .>
305-795-22647
Building Inspection Request
Date Time
Type Insp'n
Permit No. i.9(..9-(2)63
. N
Name 5
Address g L2
Company
ff>7
Phone #
For Inspector:
Approved
Correction
Re-Insp'n Fee
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Name & Date
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1/ /5 ,
A/Ct/ M
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MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Bui ding Inspection Request
Dateis Time
Type Insp'n I `nal Dr uQ
Permit No. 6P0
Name
Address
Company
Phone #
For Inspector:
Approved
Correction
Re- Insp'n Fee
tiv5/
Name & Date
0
bnai:72, 5/dei,m4/K
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VA-
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): wilding Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simplelitleholder) 1- 7,r ) L 1r 1 14 / L ■ � - t Phone # ( e z } , ° i.:
Owner's Address _ --a ''j (. > -
City / : ", �_. - ) ,1 , State / — - _ Zip
Tenant/Lessee Name ' / ' Phone #
Job Address (where the work is being done) L iU
City Miami Shores Village Coun Miami -Dade Zip
Is Building Historically Designated YES N
Contractor's Company Name Phone #
Contractor's Address ' U ■ ` ' ..„ . t `' - 2 �
City -=E\ . 'lc.) L - Q 9:0AQ
Qualifier 1 12 , i � cr. '0 c . r
Architect/Engineer's Name (if applicable) Phone #
2, •J CC
$ Value of Work For this Permit Square Footage Of Work
Type of Work: ❑Addition
Describe Work:
CMS
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: (305) 756.8972
State ` Zip �' . '�
❑Alteration ❑New
Permit No. g2003
Master Permit No.
❑ Repair/Replace ❑ Demolition
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ COQ Permit Fee $ /00 ' O Notary $ Training/Education Fee $ (. 6 0 Technology Fee $
Scanning $ 3 Radon $ Bond $ YO0
CCF $
1, 8C
Code Enforcement $ Structural Plan Review. $
•
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 ab p ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent ontractor
The foregoing instrument was acknowledged before me this y The foregoing instrument was acknowledged before me this y
day of 1 -..
day ,20 by , day of /C ,20 3b
who is personally known to a or who has produced who is personally known to or who has produced
identification and riL did • : - - .�*:ath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: / � Sign:
Print — P
�
My Co ssion E it OFF1� IA�NOTARY S AL
**************** ******09 * *2* * * * * * * * * * ** * * * * * * * * * * * * * **
NOTARY PUBLIC STATE La rLu �
COMMISSION No. Dd26(kertificate of Competency Holder)
MY COMMISSION EX B 19, 2005 W
State Certificate or R alio itI"To.
APPLICATION APPROVED BY:
Chc 10/14/03
Certificate of Competency No.
***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
41 7/63
y Commission
* * * * * * **
************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
DEC 17 2003
ntification and vho
AL NOTARV SI AL
AS .inset. i.CP.7
COMMISSION No. Dd2623
MY COMMISSION EXP. FEB. 19, 2005
Plans Examiner
Engineer
Zoning
WHEREAS, Dw' R
following described property:
Legal description/folio #:
Lot Block Subdivision
Tax Folio #:
requests permission to install:
[1]/Asphalt, concrete, brick pavers
[ Landscaping
[ ] Other
(owner)
within the public road right of way of
SIGNED. SEALED AND DELIVERED in the presence of:
M iami _ Choreo (/iCCac�e
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (305) -756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
, hereinafter referred to as the Owner of the
1.Ji tvt 7
n PPR 0 r4Cf - t
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
1. 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 pbligation 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 repres ntative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this d /0-0°3's
=STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,
attached survey, performed by
®q
performed on
gn and print)
' /' 4 [iumi SIlor?�
8
C tipqa 0.S ` ..) '
, does hereby attest that the
n (prope owner)
vo- R . Gib 1,1,12 p a s5- c
(name of survey
Affiant is personally known to me, produced
mPanY)
is an accurate representation of the existing conditions and
Affiant/Property owner
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this 1 1 day of C/ ,2dd"
(date of surve
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..
er, Affiant sayeth naught.
I" as id cation.
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v
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NOTE: The Nationat Ftood 1)14(1/Lance Rate Map, pubtizhed by the U.S. Department o6 Houzing
and Urban Vevetopment, de.Uneate4 the henein ducnibed tAnd .to be 4ituated
Zone "6".
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PERMIT NO.
ADDRESS:
MIAMI SHORES
BUILDING / ZON
VILLAGE
NG DEPARTMEN
SECTION
BY
DATE
ZONING
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Subject to compliance with all Federal, St
County, Wags miss Ind regutationsr. Vtaage us;s-
no responslbtl(ty for accuracy offoc mutts If
these plans.
2. This copy of plans most b• `Yalltbte
biding site or no Inspection wtfl be condcrci
JOB ADDRESS
r,p2„1 iu,g.?a, 5 r
CRITIQUE SHEET
APPLICANT
PHONE #
APPUCATION
SHEET OF
MISCELLANEOUS
DATE ZONING COMMENTS
63 . /R-05 ire z- -
-- C-
- - ) 5-e7
1)
f&1 !\•0 \f)
- S - 1\)... I.\
�pp fc:1,6,.,30.,„
(Al.sk .:(s-s.szes. _
v co ,zu . 1 Cav, C� l ac ; .r
A - 4 - 'V cR._o ra_ g____ cY al,::,.. . .,', r‘ss. -s 1-1 ,
51 03 0 Arm E1`75t0 (=0'2 ia/Lo is ot.4 r of
5CAt - TO
t. at` (2 i °)
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• 111
lNflTl LS
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 12/18 /2003
Applicant: THOMAS
Owner: HURST
JOB ADDRESS: 822 NE
Fees:
FEE2003 -8425
FEE2003 -8426
FEE2003 -8427
FEE2003 -8428
FEE2003 -8429
FEE2003 -8430
96
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Builders Bond
Total Fees:
Signed: (INSPECTOR)
Building Permit
Permit Number: BP2003 -1912
HURST
THOMAS
ST
Contractor ICOA CONSTRUCTION Contractor's Address: 1101 S.W 18 COURT
Local Phone: 786- 326 -4041
Amount
$100.00
$1.80
$0.60
$2.50
$3.00
$300.00
$407.90
Permit Status: APPROVED Permit Expiration: 6/6/2004 Construction Value: $2,380.00
Work: STAMPED CONCRETE DRIVEWAY
Page 1
of 1
Parcel # 1132060142910 Legal Description: MIAMI SHORES SEC 3 PB 10 - LOTS 7 & 8 BLK 75 LOT SIZE 100.000 X 142 OR
Total Fees: $407.90
Total Receipts° Go
3.s1
V
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: