PAVERSDate
Type Insp'n(
Permit No.
Name
Address
Company
Phone #
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time
f
fla
I c")) G9,-f1'
For Inspector: I / l / /00:034
FORTIN, LEAVY, SKILES, INC.
C. .
Daniel C. Fortin, For The Firm
Registered Land Surveyor No. 2853
State of Florida
"NOT VALID UNLESS SEALED"
/78
NE
SKETCH OF SURVEY
/99 "y s7'.
B 7 G 5 ¢ J Z 1�
I
/C. /7 /8 / 9 ZO / IO
98 s7
/80
PO R T. OF SEC. 5 TYVP. 53 S - RGE.42E'
L O CA r /O/V SKETCH
LEGAL DESCRIPTION:
Lot 3, Block 179, REVISED PLAT OF TRACTS 178B, 178C, 179A, 179B, 179C,
180A and NORTH 1/2 180C OF REVISED PLAT OF MIAMI SHORES SECTION 8,
according to the Plat thereof as recorded in Plat Book 43, page 69 of
the Public Records of Dade County, Florida.
Lying and Being in Section 5- 53 -42, Miami Shores Village, Dade County,
Florida.
SURVEYOR'S NOTES:
- Lands shown hereon were not abstracted for easements and /or rights -
of way of records.
- Lands shown hereon containing 10,441 square feet or 0.240 acre,
more or less.
SURVEYOR'S CERTIFICATION:
We hereby certify that the attached "Sketch of Survey" of the above
described parcel of land is true and correct to the best of our
knowledge and belief as surveyed January 26, 1987 under our direction
and complies with the minimum technical standards set forth by the
State of Florida Board of Land Surveyors.
Fis Fortin, Leavy, Sidles, Inc.
Consulting Engineers & Land Surveyors
O 855 South Federal Highway / Boca Raton, Florida 33432
0 180 Northeast 168th Street / North Miami Beach, Florida 33162
Dade 653 -4493 / Broward 463 -7180 / Boca Raton 395 -7378
Dote a So /er Scale
i -26 -87 /'_ - 2O'
Job No. Dwg. No.
870064 /67 -072
Fd. 3 4 p/
(/• 26-87)
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O�
F /o! Boot 395- 22
N
N
CSC` Gi�` t',
20. / . 0.
Roof
ove/ho/i9
/ 75'
/8.8'
•
2 STY.
RES_ 770 1/78
to
C,g6e�'
�,�a�ndO � , `/ Zoning Sod( -�
s s ree ees p p r o v e d- ►4
cox. (2 /0. /5: /af
o;
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overhead
L - 00
aric6 fcce
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9.0'F'aved.
(/ /5' if L L E Y
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to
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�n
//.5' `n
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/.9.3'
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/v
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(/-2C- 87)
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e /Q'9. tie
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o verhev
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Or 01' � 0 ,
0
2 2..49'
B /d9 /eE
2'
wires - t\, //e
y
Fd.3 /4 ;o /Pe°
B /oc,' ear
(/- 26 -87)
Fd 3 /4rr /pe
(/-z2- 9 7)
/45.20 /nos. 1
f I
l
Tax Folio #:
M SIiorej
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, Pia r fA. (+4r n , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description /folio #:
Lot 3 Block /7&7 Subdivision s v-pi e C G P
requests permissjon to install:
3• D5 -6l
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (305)_756 -8972
�pR1uECv f
PPR0
[.] concrete, brick pavers
[ ] Landscaping
[ ] Other !'
within the public road right of way of II7d ive S ;(tM: s 4
(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 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
(owner)
SIGNED, SEALED AND DELIVERED in the presence of:
, ?t/& r SHAWN OTOOLE
* MY COMMISSION # DD 026739
EXPIRES: July 10, 2005
Nr, FoF F 0 ,53' Bonded Thru Budget Notary Services
STATE OF FLORIDA)
COUNTY OF DADE)
performed on
The undersigned Affiant,
attached survey, performed by
(date of survey)
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me, produced
AFFIDAVIT
P CA, (4Gy`�Mftr\ , does hereby attest that the
(property owner)
F1, :1 L C&• K i le s C ,,
(flame of surveyor's company)
, 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 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. ' /
Affiant/Property offer
itness(sign and print) Witness(sign and print)
as identification.
r�� ".R �• '� ¢ % SHAWNO'TOOLE
* . * MY COMMISSION # DD 028739
EXPIRES: July 10, 2005
o ' Bonded Thru Budget Notary Services
my
CONTRACTOR
Name /"'�riAAMGA
Address //'( No- 99
M to "; AAg ,e,,,3
Name r4 W 4.
Business Telephone
Fax
License o. 5"1-1
Alteration Interior
Address y7 4 r l NW l 0 A'''
/ (C.4 lJA Rut
Demolish
TelephoneSecche70z Fax j
/► /
v
' /
Qualifier Name /I 4 , _ (
Foundation Only
PROPERTY OWNER
Name /"'�riAAMGA
Address //'( No- 99
M to "; AAg ,e,,,3
Home Telephone 3 6 5 767 y
Business Telephone
Fax
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
Step 1.
Job Address: 1 /7k Ni 99 �7
Address Apt.
Folio Number ( l �aoJ l J (' 0 ( t
Bloc $ (co
Lot
Subdivision U `'\) PBi3 PG 61
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other Pwv �w�
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Square Feet
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. 50 /3 C7
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
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 submitted
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
City
Description of Work elk )4
/1 ; '.MOF•t5
State
Zoning Linear Feet
Value of Work 90 0 Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Units Floors
ENGINEER
License No.
Name
Address
Telephone
Fax
33/. -r
Zip
Page 2
PERMIT APPLICATION
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•nd Sewer Department (MDWASD) approval is required for applications' involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made torobtain a peril 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.
STATE OF FLORID
SEAL:
Signature of Notary Public - State of Florida
Type of Identification Produced: •
UNTY OF MIAMI -DADE
•
Signature of Owner (-1-kest.AA a`^ ct
Print Name
Sworn to and subscribed before me this day of
• SHAWN OTOOLE
1 MY COMMISSION # DD 026739
rxo!PES: July 10, 2005
nd -rr Notary Services
t
Personally known OR, Produced Identifica ion
SEAL:
F FLOR COUNTY OF MIAMI -DADE
Print Name
Sworn to and subscribed before me this
• Signature of Notary Public - State of Florida
Type of Identification Produced:' "
SHAWN OTOOLE
. MY COMMISSION # DD 026739
EXPIRES: July 10, 2005'`
Fo OF Bonded Thru Budget Notary Services
Personally known OR, Produced Identification
day of
SECTION
BY
DATE
Zoning
4,l" e-t y
/q&J
/
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
/7/‘6
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ 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
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
( sq.ft. = x/1000
x0.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ Q., t� b
DATE:
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http:/ /www.miamishoresvillage.com
ELECTRICAL
TypE
Minimum Fee
Q.Ly.
.I.YI,E
Dryer
QTY
TYPE
Outlet, Appliance
QTY.
TYPI;
Service Repair
Q ' I ' Y
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 QTY.
Condensate Drain
TYPE
Generator
QTY. TYPE QTY.
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
Q'I'Y.
TYPE
Drains, Roof
QTY.
TVPE
Miscellaneous Fixture
QTY.
'I'YI'E
Soakage Pit
Q'I'Y.
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: