FENCEType Insp'n
Permit No.
Name
Address
Company
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Phone # 3 O5. 7_S F-
s' /a.sl
Inspection Date
Approved
Correction
Re- Insp'n Fee
BUILDING
PERMIT APPLICATION
FBC 2001
City State
Architect/Engineer's Name (if applicable)
3 000 00
$ Value of Work For this Permit ?c
Submittal Fee $ ) Permit Fee $
Notary $ Trainiiduca%on -Fee $
Scanning $ Radon $
Enforcement $
Total Fee Now Due $ / b, ( t
(Continued on opposite side)
Miami Shores Village
Bonding Department
10050 N.E2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: ('305) 756.8972
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) 22 / 7X.5s,� Phone #
Owner's Address At A)e
City /714I?!i 4 State ( L Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) ?& ,oe g
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO _ l/
Contractor's Company Name at) J /
Contractor's Address
Qualifier
Type of Work: DAddition ❑Alteration []New
Describe Work:
S OAa 64 0• ka
* * * * * * * * * * * * * * * * * * * * * * * * * ** *F * * * * * * * **
Zoning
Structural Plan Review. $
Permit No. OPLON
Master Permit No.
Plumbing Mechanical
Phone #
Zip
Phone #
Square Footage Of Work: refl e
Repair/Replace ❑ Bern: , :n
Technology Fee $
Bond $ tr2I' •
poci c ti a3R-
RECEIVED
APR 2 1 2804
Roofing
CO /CC 'e"•'"•
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 w lch occurs . L en (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not ap roved an a reinspection fee will be charged.
Owner or Agent' Contractor
The foregoing instrument was ack owledged before mee f The foregoing instrument was acknowledged before me this
day of L 20 49T', by N46 cad'/` JU4 day of 20 _ by
who is personally known to me or 4te- kris - produced who is personally known to me or who has produced
As ide tification and who did take an oath. as identification and who did take an oath.
NOTARY
Chc 12/15/03
Sign: p
Print: ,G l.t/dr'i
My Commission Expires:
APPLICATION APPROVED BY.
USA RODBIGUEZ 1
. *_ MY CCMMISSION # CC 941341
i' � EXPIRFS• .6ina 1, 2004
%,Ro • Bonded Thru Notary public Undenm:ers
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
/%
Signature
NOTARY PUBLIC:
fi
Conunission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APR 2 6 2004
Plans Examiner
Engineer
Zoning
Further, Affiant sayeth naught.
W3tness(sign and print)
Affiant is /personally known to me, produced
'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,�AZZ /x' 1,0X- c7- Z , does hereby attest that the
(property oNimfer)
attached survey, performed by A ALT A/ r 6
(name of surveyor's company)
performed on /- O2-'Z'/ , 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,o+ther p
Affian
SWORN TO AND SUBSCRIBED before me this / day of
IL. TS 6/1 e-- c .7 ,e
Witness(sign and print)
LIRA RODRIGUEZ
MY COMMISSION 0 CC 941341
EXPIRES: June 1, 2004
80Adid TAM Wiry public Underwriters
•
er
as identification.
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
. OWNER BUILDER DISCLOSURE STATEMENT
I JAZI r/!}&s iAJ'r/ being the legal property owner, for the property
C 3
Located at: 01S 1 e- .F1 og e -5-
Legally described as ,
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the
State of Florida, F.S. 489.103(7),And I have read and understand the following disclosure
Statement, which entitles me td alork as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
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
even though you do not have a license. You must supervise the consti uction yourself. You may build or
improve a one - family or two-family residence or a farm out - building. You may also build or improve a
commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the
construction is completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person as your contractor. 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. Any person working on your building who is not licensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with- holding 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.
Proof of ownership provided ( ) initial of reviewing clerk. The foregoing instrument
Was acknowledged before me this d day of )4N) / , 20 0 V
By /AZ HASsoxSRPoOr ,, ijttCz— who is personally known to me or who has
Produced • as identification who did -• • an oath.
/ �eel.6
No• �'
LISA RODRIGUEZ
MY COMMISSION GC 941341
- EXPIRES I e 1, 2004
Bonded th u r!.. ublfc Underwriters
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Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/30/2004
Applicant: LAZZ MASSON
Owner: RODRIGUEZ
JOB ADDRESS: 25
Contractor
Local Phone:
Parcel # 1132060131270
NE 99
Signed: (INSPECTOR)
Building Permit
Permit Number: BP2004 -529
RODRIGUEZ
LAZZ MASSON
ST
Contractor's Address:
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 15
Page 1 of 1
BLK 9 LOT SIZE 50.000 X
Fees:
FEE2004 -4356
FEE2004 -4357
FEE2004 -4358
FEE2004 -4359
FEE2004 -4360
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Total Fees:
Amount
$200.00
$1.80
$0.60
$5.00
$3.00
$210.40
Total Fees $21&,140
Total Receipts: 0.00
4o.4
--
Permit Status: APPROVED Permit Expiration: 10/18/2004 Construction Value: $3,000.00
Work: WOOD FENCE 5 FT
ddu0AYH
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:
Pt MIT' APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address DS i ' E ' 1 : sr•
Legal Description C'5 9 71Lf Lei/
Owner / Lessee / Tenant C � £ l /'ild e .Q- kk k I � ,Q O'
Owner's Address
Contracting Co. Q>92e Z a J)1 - X 2 Address 40
Qualifier / , J. 6797e2 SS# . Gs - - ,/Phone
State #
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION C\A 4 1 M L l vk. T 1. 0 9 6 ' k .
Square Ft.
OWNER'S AFFIDAVIT:
will be r e in
44 Furthermo aut /
/Ap"'
Si: - ure of Owner an
Date:
Notary '"bo
My Co issio
* *
PERMIT FEE:
er an
xpire
* *
APPROVED:
Competency # (/0J(7 hi e/ Ins . Co.
Address
Address
Address
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated. I 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, SIGNS,
POOLS, ROOFING, and MECHANICAL work.
I certify that all the foregoing information is accurate and that all work
compliance with all applicable laws regulating construction and zoning.
on e, he above -named contractor to do the work stated.
r
sident
* *
QC1 ' < Zoning
3 Mechanical
%'dr ndo
Nofar Co
i r- y Public P
c
d. o , . , 'i Cn S r .. . °{ Flo ..
/or Condo Pk'� +sciceiU a l Notary
My Comm
Fire
Plumbing
Tax Folio// 3.16 a /vet
Master Permit #
phone
Estimated Cost
r
ignature of Contractor or 0 e r- Builder
Date:
4011 Adedgigi
ota J.htrac ) or Owne - Builder
r tiSffilA'of
Com ion Ex pi Flril 30, I P [nr
abndod Thru Maynard Bonding n it 30, en
Other
)101,1.—
Elect'ricaL.. <.
Engineering
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SCARF = • I =20
THESE PLANS ,•.. E A(';'... ..; FOR ISSUANCE OF A BUILDING PERMIT
• WITH NO V,,.nNCE •• 1 - WITH VARIANCE(S) LISTED IN "REMARKS"
NO OTi ?E^• 72" ''D ,S F' .: ' :HE MIAMI SHORES BUILDING AND ZONING
ORD!i'P,' r•■' "'' Pr ' ':D, UNLESS SPECIFICALLY LISTED BELOW.
ALL OT''F :: ::•i ;l.'; 7 AND COUNTY LAWS MUST BE COMPLIED
WITH 31 at •
Authorized S'gnature Date
Fr; ii' *
,:I •
KIP DING' Ors,:27
4A- --
PLAY' I :C r{ ;. : . . .
VILLAGE LOU.:..".'
APPROVAL
P;;::LIMIN ARY: MALL
REMARKS:
` COMPLIANCE WITH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED
BY MIAMI SHORES VILLAGE IS REQUIRED. THE ARCHITECT, BUILDER &
SUB CONTRACTORS A.RE C }',.' ..Fn WITtd THE' (Nowt_FncE nF nt i gtth D-
-, ING REGULATIONS WHETHER OR NOT SPECIFICALLY INDICATED HEREIN. fit
Owner's Name and Address
MIAMI SHORES VILLAGE
Disapproved _ __ . gate _ ___
(Signed) `21!,_ 1` . .. ! ' (G
Buildi /Inspector
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal 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.
Registered Architect and /or Engineer
Name and address of licensed contractor ---'—
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ / // v� Amount of Permit $ (au_t2 Q
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 may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws • lorida, Pennanent Sup )Iement,
and has complied with the provisions thereof, and will require similar compliance from all contractors .r • b- contractors em toyed by him
in the work to be performed under this permit; and will post or cause to be posted for insp tio, on a to of the work su public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco to be perf ed under this
permit, as are licensed by Miami Shores Village.
Remarks _ (Signed)_ .... .
Location and legal description of lot to be built on: t ^ � n �_
Lot._. f5 Block y Subdivision. / A t . ,L:1ct..�' let - 1 iCj
Street and Number where work is to be one .il q 7 `4 le/7o
State work to be done and purpose of building (by floors)
Date
'�,�
G l-�'u- =ti-L " No `- Street.
- - - - -- • - 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.____. 2
Date. - _ - .._.� — _ !!__ 7e�
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires__
PLANNING BOARD._ __ . DATE
Chairman __ _ _ Member
Member Member
Member _ Member
Council Approved
_Date Disapproved
ji
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.
91'
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