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358 NE 101 St (15)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job A �S8 • io i �p A Tax Folio e5k t 2 0„ 1-or 4 o Y. J11 G- " 1..T S YL Legal Description ji Ilistorically Designated: Yes Date Owner/Lessee / Te i i 7 )=k' Ge, nant Owner's Address • O Contracting Co. ©•A NQ R Address Qualifier State # SS# -r Phone Municipal # Competency # Ins. Co. Address Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING G■ N \�, vs C 2� cL� 0,1.(O WORK DES RIP (1 - c:a ,ez) e.1 �° �.5 \Kg 27o S (ak 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.) Square Ft. Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). 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. 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 zonin_. Furthermore, I authorize the above -named contractor to do the work stated. . ondo President Notary as to My Commiss OFF! IALNOTARYSEAL DELL MARIE S! 1GEId NOTARY PUBLIC Ei'.4TE OF FLORIDA COMMISSI:2N NO. C070/_76 MY CD MISS) RI 1 ?, m.7 9. 2ti 002 FEES: PERMIT — APPROVED: Zoning/ Mechanical Plumbing p 11:3 Phone (3 X 51 S 1 I s Address Mast Permit # (D PAVING FENCE SIGN Estimated Cost (value) pd ° " °41 do President Datle Signature of Contractor or Owner- Builder Date 7-h2 -a ( Date Notary as to Contractor or Owner- Builder Date My Commission Expires: C.C.F. b° NOTARY r� r BOND3 0 C J TOTAL Structural Engineer 0 PERMIT NO. • ADDRESS: • MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT • SECTION BY DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Subject to compflanca with sit Federal, State. Cocxdy,YMlaga rules grid rezetations. VRtage sssucaes no responsiblttty for &ccvrecy oftor mutts from these pans, 2. This copy of pleas amt be &Yalltbte ors balling site or no Inspectton win ba conducted. JOB ADDRESS ,C 2 N e l0 I S CRITIQUE SHEET APPLICANT PHONE # APPLICATION CT' SHEET OF MISCELLANEOUS DATE COMMENTS INITIALS k�' t a uwilmA cwicu THOMAS J. KELLY, INC. CORAL OASLES, PLA. U13 UM UMW: LOCATION SKETCH SCALE: 1"• 0. of. e. • \ 11 2 , cr L 4 2 e-3 3 t c a 5 NOTE s SUflVEY No. c31. 1 144 min or I_ fa:1MM 441- 4444 LAND. SURVEYOR T Of LOT 1 si ocK=- 11111101VISION .• • 4 ACCONOINS TO TM PLAT THEREIN AS RIXOROSO IN PLAT BOOK No. Q AT AWE No. PUBLIC NECONIS 04 DATE : * I 'I r;XkliVir COUNTY, monioc. t.P. 4. POLL. Km, 1=1. 6r F-It 101 • TF 140 lot sr. i i-tor.Ob rL. 3313s FIAXM 7.0NE X •i• t Is is A moon low,ARD ZONE us is mur A mum HAZARD 7JUNB UbliffUff ITY PANEL NO. lq_09 PANRI. 110. vOO NUITINIF DATE or riopilik- 4 - es7 UASF: moon r.l.r.v oja howrarr rwmt II I GIIRWP onnor.. ISA/C121a4cAlkeel= t7�7 1 vatia UNDERGROUND ENCROACHMENTS, IF ANY, NOT LOCATED. I Wel" 'evilly Noel Ilio ekoloh of server of 114 skive deeerlbed properly Is Iroe end wrest le the best of my knowledge and belief el wormed end /lolled tinder my dream! %Mar 'witty 1141 flie survey meet the mInknom requirements oft1od by Sado" of Profs Lend efa men end Ike Merida Lend Ilfle Pasedellon end Wee CH El 11114 U. soh. There 1k 1111, Neter; 1.1f eh mimed own,beerInge ore Is en ed merldlen 1 by 00 ) 11 4a , P themes . IL If obewn,elevellene ors referred N.O.V. Osborn ISIS ifi 'S A. IMUL (luvrs or rim!) WORK) 3 gig I enamel ' q " 4858 I 9 9 9 lend MVO' Closurn nbovo ' e of Florid, _, _ 1011 1%.4 Wyse legirinIo4 NIA An (mb0000d "svoyor INN) SCALE 1"- 'Miami _ Chore6 ?La r AFFIDAVIT STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, e1 I 1 Sipe% Vl -2k/ , does hereby attest that the (p'doperty o attached survey, performed by - ft C>rkQ S J e J l (name of surveyor's dompany) performed on 5 �„ I , is an accurate representation of the existing conditions and (Late 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 si (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. Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this 7, day of Affiant is personally known to me,V"produced as identification. ry 0I p sin. nt.' .' dv,r4 Cpl VILLAR NOTARY PUBLIC STATE OF FLORA COMM/SSION Not Ca 4103 p 1MMLSS EXP. P :.4 gr Tax Folio #: following described property: Legal description /folio #: Lot t. Block Subdivision SIGNED, SEALED AND DELIVERED in the presence of: S/iorei (/iC�ccc�e 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (3051756 -8972 )1 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, S {I 'AShereinafter referred to as the Owner of the (owner) requests permission to install: ].Asphalt oncret- brick pavers [ ] Landscaping [ ] Other ' /r sf � within the public road right of way of ��g NC> >0� m/ a m ��Lp �C (address) 3 3 1 3 IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: 0 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 ACKNOWLEDGE o this 1 day of DRtuECuiW f PPS o ( too ( nn owner) ct .AnVS I vn.r.AR NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC714103 MY COPAMISSION EXP. MAR 1 002