490 NE 101 St (11)Correction
2581
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date (31 / °,a 1 c5
Type Insp'n )1)Yt versL ' j
Permit No. eD4: 166,5
Name MaVV ICDOrn
Address 4aO fit€ L01 ST
Company OWnef
Phone # (& 2 4 - 3S
Inspection Date O2 /a 3 /
Re -Insp' n Fee ❑
BUILDING
PERMIT APPLICATIO
FBC 2001
Contractor's Company Name
State Certificate or Registration No.
$ Value of Work For this Permit I , t:J
Type of Work:
Describe Work:
ccen
(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
Job Address (where the work is being done) 7 ' ) J h (0 Cit y Miami Shores Village County ni -D. • Zip 3 3 ( 3 y
Is Building Historically Designated YES NO
Permit Type (circle) �
Owner's Name (Fee Simple Titleholder) )4.4-r V` Ito'\ `e Phone # r7 - - ,,3' / �7 �-
-
Owner's Address q10 ,kW— 10 i Si— `1T—
City / t frt ° c� L '` %> State Zip 33'30
Tenant/Lessee Name Phone #
!IR ECEPVED
DEC 2 0 204
Electrical Plumbing Mechanical Roofing
Permit No.
Master Permit No.
Phone #
Contractor's Address
City State Zip
Qualifier
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
❑ Repair/Replace
CCF$ I, 2,0
Technology Fee $
60- Ko
450
❑ Demolition
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee CO Permit Fee $ /00 CO/CC
Notary $ Training/Education Fee $ � /� leb
Scanning $ 6 Radon $ — Zoning Bond $ Q0
Code Enforcement $ StructuralP w. $
Total Fee Now Due $ 1% D C '
3
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 seve, ays after the building permit is issued. In the absence of such posted notice, the
inspection will not be approv' i .nr•inspectio fee will be charged.
Signature
Chc 05/13/03
My Commission Expires:
APPLICATION APPROVED BY:
Owner or Agent
Signature
Contractor
The foregoing instrument was acknowledged before me this 3 The foregoing instrument was acknowledged before me this
day of Pe.eex e./" 20 0 by k - k gib-or-A , day of , 20 _, by
who is personally known to me or who has produced ! i • who is personally known to me or who has produced
W v' L <'v As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUB %� 41111 NOTARY PUBLIC:
PUB
Sign:
Sign: �.��. /- ���� //�� �� � � nos
Print: ii• u"�M� S ?osr Commission #DD299610
MA" 1 1 2008 Print:
- ••••- . Bo nded �,� My Commission Expires:
'i ' ' ' '' i �'' ' � s' Atlantic B on d ing
********************** * * * * * * * * * * * * * * ** * * * * * * * * * * * * * ** 7.****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
22
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 12 /27/2004
Applicant: MARK
Owner: BLOOM
JOB ADDRESS: 490
Contractor
Local Phone:
Parcel # 1132060170430
NE 101
Building Permit
Permit Number: BP2004 -1665
BLOOM
MARK
ST
Contractor's Address:
Legal Description: 6 53 42
Fees:
FEE2004 -13132
FEE2004 -13133
FEE2004 -13134
FEE2004 -13135
FEE2004 -13136
FEE2004 -13137
FEE2004 -13138
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Builders Bond
Submittal Fee
Total Fees:
Amount
$100.00
$1.20
$0.40
$2.50
$6.00
$300.00
($50.00)
$360.10
Total Fees: $360.10
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 6/18/2005 Construction Value: $1,500.00
Work: ADD PARKING TO SWALE AREA ON EAST SIDE
Page 1 of 1
PB 15 -14 AMD PL OF MIAMI SHORES SEC 4 LOT 1
Signed: (INSPECTOR)
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:
BLK 90
S' CONCRETE Sf=EBALR'
S uR ve Yolk S
.rr; `'.
. ; :r OFF4SDRIAL
c'::
1
license Nurnber6677
PHONE: (954) 777 -4747 • Fax (9 777
5950 W. OAIiAt4O PK. BLVA • SURE 108 • LAUCE -RILL, FL 33313
PAGE
OF
SCALE
LOT -2
BLOCK —E0
F.RP. 1/T
NO LO.
F.I.P. 1/Y
NO f -0,
CC
C
N. E. 1 0 1 S T.
20' PAYEIEIJT 75 TOTAL R/W
9.D AS IIALT ROAD 15 ALLEY
F.LP. T/2
110
INVOICE E 04 -21173
PROPERTY ADDRESS`
490 NE 10TTrr smell?, MIAMI SHORES, FL. 33138
LEGAL DESCRIPTION.'
LOT 1, BLOCK 90 OF'AIM:INDBD PLAT OP MIAMI
SHORES SECTION 4^ ACCORDING TO THE PLAT
THEREOF, AS RECORDED IN PLAT BOOK 15, PACE
14 OP THR PA1IILIC R ECORDS OF DADE COUNTY,
FLORIDA.
CER77F /CA YYDNS:
MARK BLOOM
PASSETT, ANTHONY & TA
FIDELITY NATIONAL, T
WACHOVIA BANK, IT'S
FLOOD ZONE
COMMUNITY ti
PANEL & SUFFIX
FLOOD ZONE
DATE OF FIRM
REVISION SCHEDULE:
4- EGEAID:
d--- F - • - 5 - DE1CrSS face tart
- - DraNTE3YJOOa FENCE Le€
- IL* E2PRnca 311E
ABBREVIATIONS:
AL -AFC Lanni
CP - CVUc Ftaou Fv1D MBAs-FE
CH - Cuc FINN Raono
DD - DEED BOOK
OE - DeuewE EASViPT
EWE - TTRUIUAE etKMeagam EmooNT
• - Otlrrru..
EASE - E13EkWr
F.F. • Frisco Roar,
FED -FcoKm
EFL - Fzas PoYER & Lott
J
t- THIS SURVEY IS BASED UPON RECORDED INFORMATION AS PROVIDED SY
CLAM. ND SPECFIC SEARCH DFTRE PUBLIC RECORD HAS (MEN MADE BY
THIS OFFICE.
2. UNDERGROUND IMPROVEMENTS HAVE rear BEEN LOCATED EXCEPT PT AS
SPECIFICALLY SHOWN.
3. ELEVATIONS ARE BASED UPON NATICNPL GEODETIC VERTICAL DATUM 1W9
IN.G.V.D. 15W.
4. FENCE TIES ARE NOT CENTERLINE OF FENCE.
5. IN SOME CASES. GRPP$C REPRESEITATIC IS HAVE BEEN EXAGGERATED
TO MORE CLEARLY ILLUSTRATE hiFASURM RELATIONSHIPS - DIMENSIONS
SMALL HAVE PRECEDENCE OVER SCALED POSIITONS.
6. AILDIMEN&ONS SHOWN ARE FIELD MEASURED AND CORRESPOND TO
RECORD 1NFORM'AT1CN UNLESS SPECIFICALIY NOTED OTHERWISE
7. OAT OFOEIOKJAL FIELD WORK (p 0
,5U11yEVOR CERTIFICATION!
IHEREBYOERTIFY THAT THIS _ BoustoAar
SURVEY MEETS OE MINIMUM TECHNICAL STANDARDS FOR SURVEYS, AS
SET FORTH I31' THE CHAPTER elG174 DF THE FLORIDA FLORIDA AD*IINIBTRATIV6 CODE, PURSUANT TO
SECTION 41?.027, FLORIDA STATUTES.
BEARINGS, IF SHOWN. ARE BASED UPON MI ASSUMED MERIDIAN
AND REFERENCE ON
SKERr-U:
L -LESS.
M -Mammal
OTC - OnmoaO Perm GENE
OEM . t O:*rw REmms BOOS
PUT
PC - Poor OF CIBSI UWE
FCC - PferrO► OeuOrw
PCP - PEa W JT O®rna. PONT
PK - human Kraal Kr[
• - PaopUnU LI&
FOB • PEarr Or- Sad.'ae
FOC • P,w Or maMW oANT
PRC • Paerr Os RENATE 0115155
PT - Re1ar Os Tarrnacv
NW - RULE Or VW
RP -RISLE Per
SBR -Sail wBatRom
UE - Unary F.umo
WET • W177 55 CORKER
Vat - W+BER Mon
d
W Illlam MiN,,RE cart. ProtceclOnel Sul uolor & Mnppes
FT.:1MM (M9%1(1'l10n N 603
(net valid wilhoat ins slenoluls end °twwine] sem at Tee
Florid. Licensed Survst+or ens Mepper elbow, ebave)
i
e v
Village of Miami Shores
JOB
•
ADDRESS
f4 ~.
INSPECTION V° �' �� '� 7 / 4
TIME READY d `' °' 3 - '�
REMARKS
INSPECTOR
N? 4820
DATE
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N. E.
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