DRIVEWAYMIAMI SHORES VILLAGE
BUILDING DEPARTM T
305- 795 -2204
Building Inspection Requ
Dat- • • Time
Type Insp'n
Permit No.
ame
Address l 0 d- ( q
Comp • ny
Phone # 9S Y'' M,S tt
For Inspectof? // / 3Name & Date
Approved
Correction ❑
Re- Insp'n Fee ❑
Approved
Correction
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204 ( Th
Building Inspection Request \ ' , _
Da 2 0 D3 Time
Re- Insp'n Fee
r
Type Insp'n /1.
Permit No.? 2 D D , (A _
\ L ) ;- )9 _9
Name
Address LX7' F 9 u'�y
Company ' Jl /19‘l�
Phone # 4-Z ' A -/ D
For Inspector: C/ /i & Date
,
d
0
((Miami Shores Village
10050 NE 2nd Avenue
Phone: 305495 -2204
Printed: 6/11/2003
Applicant: ABIGAIL WILLIAMS
rc) Owner: WILLIAMS ABIGAIL
.D - JOB ADDRESS: 100 NE 99 ST
CJ
Fees: Description
FEE2003 -3540 Building Fee
FEE2003 -3541 CCF
CD FEE2003 -3542 Builders Bond
Building Permit
Permit Number: BP2003 -922
Contractor NATIONAL PAVING & WATERPROOFING Contractor's Address: 3450 N FEDERAL HWY
Local Phone: 954 - 946 - 7119
Parcel # 1132060132280
Total Fees:
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 13 & W1/2 LOT 12 & LOT 14 BLK 17 LOT
Amount
$120.00
$2.40
$300.00
$422.40
r" Permit Status: APPROVED Permit Expiration: 12/3/2003 Construction Value: $3,340.00
Work: INSTALLATION OF BRICK PAVERS
• • CARMAC STONES INC.
954 -658 -0540
252 S.W. 34TH AVE.
DEERFIELD BEACH, FL 33442 -2366
Bank of America
ACH R 063100277 • `�
FOR
. u'00 16 211' . 1 :0 6 30000 4 71: 00 5 48 2 L L4 2 76►I'
Page 1 of 1
Total Fees: $422.40
Total Receipts: $0.00
ertaining thereto and in strict
sume responisibility for all work
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' SURVEY FUR: N B. IALLIAMS & ABICA1L PRICE WILLIAMS
DESCRIPTION
lot 13 and the vest of Lot 12 and Lot 14 Block 17 "AN AMENDED PLAT OF MIAMI
SHORES SECTION NO 1", according to the n-lat thereof recorded in Plat Book 10
Page 70 of the Public Records of Dade County, Florida.
PROPERTv ADDRESS
100 N.E. 99 Street
Miami Shores, Florida
CERTIFIED TO: DOMINION TITLE SERVICEC, INC,
STFvEN B. WILLIAMS & ABICAIL PRICE WILLIAMS,
ATTORNEYS' TITLE INSURANCE FUND, INC., SUNCOAST
SAVINCS AND MAN ASSOCIATION ITS SUCCESSORS
AND/OR ASS I CNS
LAND
DOMINL, TITLE SERVICES, INC.
Zoning
Ap roved
ae 4 0.3
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, 5TVEtv WI LLt A , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description /folio #: )1 3g-01, (013 - / aa $ 0
Lot 13 Block L Subdivision 4 A) pit-t6/1/4- € OF- g11/4 S 1 4 064
Tax Folio #:
requests permissiop to install:
[ Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of
(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 representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLED this da
SIGNED, SEALED AND DELIVERED in the presence of:
M iami SIiori
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 - 2207
Fax (305)_756 -8972
$'''w Nilda Montalvo
A E
* „J *My Commission GC. Q�P
''•l , / Expires Jnuary
f r Fs t' 1 r'--' 1
1
STATE OF FLORIDA)
COUNTY OF DADE) •
The undersigned Affiant,
•
attached survey, performed by
does hereby attest that the
(prop wk.:Finer)
3 �
•
(name of sur•eyor's company)
performed ■-•
• date o slt rvey)
, 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 Miathi 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
any y may agrees to remove or obtain permits for structures wfiich now ma • exist o property which are not
P
Permitted orwhich may violate zoning or building code regulations. The Affia further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this d
day of
Affiant is '— crsoaally lozovrn to me, produced
•
Affiant/Property owner
2 (aS Mvv c,p
ILtc.lS i�SI LV
Witness(siga and print)
.g`°k,� Nilda Montalvo
* ,_ y * ^ tY C ,rssion CC908155
,S .xpn January 30, 20x'
•
•
as identification.
CONTRACTOR
New Construction
Name 5-rEVE Is.) .2 W i LL
Name ,, 9 - 770/■-'4'6 P• 4A'Gt Wt)-TER. p C I A;
License No. C4 C 05 5)426
/
g
Address , 5 .0 A / . y
.- /ply+% /7/
4/ 6. A7�A4 7 f -- 3 3 O �
Telephone 9 sy_zit 5 30 - y4
73 '
Qualifier Name
Fax
ti
PROPERTY OWNER
New Construction
Name 5-rEVE Is.) .2 W i LL
Enclosure
Address 2.00 ME 99 SY
MtAM' Si+o -S . L 3313
g
Home Telephone 30 .7 5 - 8 _ Q 4 6
1
Business Telephone 3236_34
5 5 o (
Fax
ti
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'1 Detachment
Other
Master Permit No. P 9-0 -p2)
Subsidiary Permit No. _
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
MMMED
as
Step 1.
I'1
Complete the attached permit application which must be signed by the property owner and qualifier. Both signature ust be notary�
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application music' '' MI
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.
APPLICATION
Job Address:
Folio Number
Lot
e0 to S i
Address
3aob - oi3-aa3o
Subdivision PB PG
Current Use of Property ►ZES 1 1)Tl/4L
Proposed Use of Property RE. 1 PEIVTAt
Tenant Information N /4
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Block
N /.c
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PERMIT APPLICATION
hit (Am, -FL 33 t��
City State Zip
Description of Work tNSTAI l ATl �n1 of 32 t C(< PA' 2S
Zoning Linear Feet
Square Feet / Units Floors
Value of Wort/ 34 2 0 a
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
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.
44104/
41
rgna" a of Owner
ft "e vE? WI LA - I AA
Print Name
SEAL:
/' r j wom tQ a nd subscribed before me this ` day of A �.,-,-
•
0 MIAMI -DADE
. YYl.a•n -1-a- 2-cn)
Signature of Notary Public - State of Florida
°3ys Nilda Montalvo
*f�J *My Commission CC906155
?u,,.o•" Expires January 30, 2004
Personally known OR, Produced Identification
Type of Identification Produced:
Signature of Contractor / Qualifier
Print Name
S
DR v/D s7 - ?
Signature of Notary Public - State of Florida
SEAL:
d subscribed before me this
PERMIT APPLICATION
4Th
m- 0- rdeL e.�/�t
day of
o'oR'k. Nilda Montalvo
;} *My Commission CC906155
4 , „„o• Expires ary 30, 2004
Personally known OR, Produced Identification
Type of Identification Produced:
ELECTRICAL
TYPE:
Minimum Fee
QTY
TYPE
Dryer
QTY
TYPE
Outlet, Appliance
QTV"
TN IT
Service Repair
QTV"
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
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; QTY.
Minimum Fee
TYPE:
Condensate Drain
QTY. TYPE:
Generator
QTY. "I'YPE Q "TV.
Refrigeration, Tons
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
Bath Fan- Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE:
Miscellaneous Fixture
QTV.
TYPE:
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 ..
Zonin
'..y;
t 9
Electrical
f
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
' \ /?\40,
Page 4
OFFICE USE ONLY
CHECKLIST
® OWNER - BUILDER FORM
(Attach)
• FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
U CONCURRENCY
(New Construction)
® OTHER
(Specify & Attach)
® PROOF OF OWNERSHIP
(Attach)
• HRS / DERM APPROVAL
(Septic / Sewer)
® IMPACT FEE
(New Construction)
m OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee) $
Miami Shores Village $
Bond $ 9
Metropolitan Dade County (C.C.F.) $ _ (sq.ft. = x/1000
�' x ¢.60)
Inspector State Educational Fund $ (¢.005 /sq.ft.)
State DCA (Radon) $ (¢.01 /sq.ft.)
Code Enforcement Fine $
Zoning Review
Notary
PERMIT APPLICATION
O CONDO ASSOCIATION APPROVAL
(Attach)
• BPR APPROVAL (Restaurants)
D CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
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
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the : pproyal of the detailed statement of the plans and specifications herewith submitted for 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.
at
Ownei s Name and Address.- ... �!f�1,," , _ �. No eST= Street,,
Registered Architect and /or Engineer
Name and address of licensed contractor ,�° �...� �ry • �G �/�i7 _ ....
Location and legal description of lot to be built on: / <' ^2
Lot Block Subdivision.
Street and Number where work is to be done
State work to bejone and pure e of building (by floors
Disapproved Date_
Notary Public, State of Florida
(Signed)
Building Inspt tor / v My Commission Expires
19fe
and for no other purpose.
New Building yemodeling Ad 'on Repairs No. of Stories
To be constructed o Kind of foundation.____., Roof Covering
Estimated Total cost of improvements $ Amount of Permit $ , CO CO
Zone cubage required_______.________ ______Plan Cubage
Distance to next nearest building _________Size of Building Lot
Maximum 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 m9y
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an etnbftlyer
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 inspection . ' the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco acto , >rl�/to be perfo ed under this
permit, as are licensed by Miami Shores Village.
Remarks__._ (Signe
STATE OF FLORIDA, 1
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
to me well known,
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 same, and that all facts
therein by him stated are true.
Permit No.__.___ __ _ Date _- __.._ 2 - 7D Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member
Member Member
Member _.. Member
Council Approved .. __ Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
JOB A T
ADDRESS I a
tate
i
MIAMI SHORES VILLAGE, FLA.
sc c)\
INSPECTION
TIME READY /4-'71.% - 2.- /3 — 5-J/
REMARKS:
INSPECTOR DATE
N9 7292