1155 NE 102 St (2)MIAMI SHORES VILLAGE v (,¢i
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date U 0 Time
Type Insp'n i C CJ ( Paver
Permit No. 6o — l S3 1
Name f) ()f).Q.1 l J -
Address ` ` SS 1 ' 102 51-
Company O Wn I "U`
Phone # /51 S T
For Inspector: 101 Name & Date
Approved
Correction
Re- Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 9\3 Time
Type Insp'n 4(1) / A
Permit No. 4P 03 -1 5 3 C(
Name SUC/1046
Address L /ST /1/S iO 37
Company
Phone #
For Inspector: 16\1\0 \D 3 Name & Date
Approved
Correction
Re- Insp'n Fee
•
ECLFqv
2003
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Buildin _ Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) E S`1-n��,( l �J co, Phone Phone # J O S - • s) -' ) 1
Owner's Address 1 �� K) L \O a. 2
Cit Air) Yn 1 51') 0 (�e S State Fi Zip J 1 ? g
$ Value of Work For this Permit
Miami Shores Village
Building Department
Tenant/Lessee Name Phone #
Job Address (where the work is being done) E mv-i
City Miami Shores Villaze County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City State Zip
Number of: Bays Stories
4A600
Families
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. 5Pda - i s 1
Master Permit No.
Zip
Phone #
Square Footage Of Work: 5 0
Bedrooms Baths
Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: , 4. 1/1 /1 rt & • 1)
'1 • . • .1 111 ILA
- •_ •
- 10 1 X
av■ r v e s
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ Permit Fee $ Notary $
Education/Training Fee $ Tech $ Scanning $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
l(Ck $ a0v00 C
Radon $
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 seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reins section fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 2 3
day of n% , 20 1 by Lc21Y `Q 6 00•Q
who is personally known to me or who has produced
As identification and wh c1,d take ap oath.
: �pr a
o
Chcl/7/03
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY:
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _ , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signature
My Commission Expires:
Zoning
SEP 2 9 2003 Plans Examiner
Engineer
Pompano
Plant
P A V
APPLICATIONS
• Patios
• Terraces
• Pool Decks
• Roof Gardens
• Beach Promenades
• Sidewalks
• Streets
• Golf Cart Paths
• Pedestrian Malls
• Entrance Areas
• Driveways
• Parking Lots
• Gas Stations
• Bridge Underpasses
• Highway Rest Areas
• Shore Fortifications
• Median Strips
• Industrial Yards
• Container Ports
E R
1590 North Andrews Avenue Extension
(Via N.W.15th Avenue)
Pompano Beach, Florida 33069
954/972 -7400 • Fax 954/972 -7433
Y O U R B E S T
M O D U L E
COMPOSITION AND MANUFACTURE
Pavers by PaverModule are made from no -slump concrete
mix, manufactured under extreme pressure, high frequency
vibration and cured in a controlled environment, which
explains their incredible strength and durability.
Our Pavers Have The Following Characteristics:
• 8000 PSI Minimum Compressive Strength
• 5% Water Absorption Maximum
• Excellent Abrasion Resistance (method C -418)
Our pavers meet or exceed the standard specification for
"Solid Concrete Interlocking Paving Units" ASTM
Designation C936 -82.
TYPICAL CROSS SECTION OF MODULAR
PAVER INSTALLATION
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A
A - Sub -Base: Existing Compacted Soil
B - Base: Leveled And Compacted Material
C - Curb Edge Restraint
D - Curb: Optional Height
E - Pavers: By PaverModule
F - Joints: Filled With Builders Sand
G - Bedding: 1" Clean Builders Sand Or Screening
Refer to the Technical Installation Sheet for detailed
instructions.
PAVER Moo ULE
16::p i.or i3 s Pav ®r C0
Two Convenient
Plant Locations
www.pavermodule.com
N
11.2 114t
1.4
1980 Marley Drive
Haines City, Florida 33844
863/421 -7422 • Fax 863/421 -7433
P A V E R C H O I C E
Haines City
Plant
OCTO C
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P A V E R M OD UL E
OCVOCOO
SHA
ON C
BLE
PES
ECE
The Octo Cobble offers two distinct shapes - the
octagon and the square - yet simplicity by being a
small octagon and square that is a continuious
flowing pattern. This stone offersa high degree of
interlock and is ideal for small or large areas.
PAVERS ARE CCONORUCAL
DURABLE AND Ensv msTQILL
Pavers are the modern replacement for concrete
and asphalt paving. These interlocking stones are
visually pleasing, stronger and more durable than
any other paving material available today.
Furthermore, the multitude of shapes, patterns and
colors gives architects, landscapers, contractors and
homeowners a host of new design options. When
you consider the initial cost of pavers is comparable
to a poured concrete surface, the additional
advantages of pavers are even more remarkable.
COLORS
Please contact your PaverModule sales
representative for color selections. PaverModule
has a complete selection of colors, both pastels and
earth tones. These colors are offered as solid colors
or color blends. Color blends are a combination of
two or three solid colors to give the paver area a
variegated appearance.
Note: Colors will vary due to the inherent qualities
of raw materials used to produce pavers.
OC
CONSIDER 11 ESE VALUABLE
O DURABLE:
Pavers are stronger than regular poured
concrete surfaces and more durable than black
asphalt. They can take more abuse and last for
generations with little maintenance.
O °Ga( STMILEnC:
The beauty of pavers adds value and visual
appeal to any property, while the pattern
possibilities are virtually unlimited.
O REUSABLE:
Pavers can be removed and replaced with ease
to allow access to existing utilities or placement
of new ones — making the paver a reusable
system. This procedure is known as the "zip and
unzip" concept.
O SAFETY FEATURES:
Pavers have a non -skid surface even when wet.
The color mixes offer many options to perm-
anently designate or highlight areas such as
pedestrian crossings, school zones and hazards.
Furthermore, the use of light colors at night
together with a strong surface texture (joints
system) improves the overall safety of pavement.
O MO SURFACE C(PQC (D'\ G:
Pavers are a segmental paving system which
allows for expansion and contraction without
producing surface cracks, unlike that of mono-
lithic concrete surfaces and stamped concrete.
O [PRO -( MVaROMi!lJC KT:
Pavers are made of local natural aggregates with
no petroleum based products. Water percolation
through the joints of pavers is another favorable
quality of this beautiful product.
O EASY TO aSTIaLI:
Pavers can be laid in any weather conditions and
require no grouted joints, no mortar, no concrete
sub -base and no curing time.
SHAPES
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SOME POPULAR PATTERNS
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®Bmensiions:
TMcG r esss:
Stones Per Sq. (Foot:
CoOou's:
Teut res:
Nominal measurements
2 For Standard Use
3.55
Colors range from earth tones to
pastels. Refer to our product
samples or color chart.
Smooth, non -skid surface.
B
ICPI
INTERUCKING CONCRETE
PAVEMENT INSTITUTE
I E ?(1CQLOD being the legal property owner, for the property
o Located at: 1155 M E \D 1 $ , • Nt S110 l0 ItoS 3313'8 .
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),..qnd I have read and understand the following disclosure
Statement, which entitles me td .work as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
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 construction 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 c . 1 day ofc (2f - , 20(J
By who is personally known to me or who has
Produced
Owner
Owner
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
DISCLOSURE STATEMENT
as identification and who did take an oath.
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NOT VALID
UNLESS SEALED
WITH THE
EMBOSSED SEAL
OF
CERTIFYING
SURVEYOR
0 1'H1p eXO EK'1'Y DESCRIBED AS: LOT 8, BLOCK 175, " REVISED PLAT
" bF PORTIONS OF THE REVISED PLAT OF MIAMI SHORES, SECTION 8 ",
ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 43,
PAGE 67, OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIDA.
CERTIFIED TO:
ESTHER T. BUDEBO.
PRIME MORTGAGE INVESTORS, INC., ITS SUCCESSORS AND /OR ASSIGNS.
PONCE DE LEON TITLE SERVICES, INC.
ATTORNEYS' TITLE INSURANCE FUND, INC.
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Date: I
CERTIFICATE BOUNDARY SURVEY
I hereby certify that this sketch of survey of the hereon
described property Is a true and correct representation of
a survey made under my direction and that said survey is
accurate and correct to the best of my knowledge and
belief, and unless otherwise shown, there are no visible
encroachments. I further certify that the survey repre-
sented hereon meets the Minimum Technical Standards
as set forth by the Florida Board of Professional Land
Surveyors in Chapter 61G17 -6 ,Florida Administrative
Code, pursuant to Section 4 027 on Statues.
76 • ey
FL. Reg. No: vz (?0 MANI til . LANNIE
SCALE:
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37.5
A= 5(0.22
= 25
X 52.24'
Z
ROMAN M. LANNES
PROFESSIONAL LAND SURVEYOR
999 Ponce de Leon Blvd.
Suite 510
C. Gables FL 33134
Ph:(305) 951 -5470
I JOB NO.
IS 203
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PROPERTY ADDRESS: 1 155 NI . 102. N t) • �T , KA �. M ► SHo (Le S , 1-x,0 2 I DA
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby upndc for the approval of the detailed statement tit the plans and specifications herewith submitted for the build •
intt 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.
Date / 2.12
r r
Owner's Name and Address ........ ... y d � /jJp��� - _ No
Registered Architect and /or Engineer ,.
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done (
, G _
State work to be done and purpose of building (by floors) . _ ...t ( 1..15 . 2'.l.!/ +�
Name and address of licensed contactor...
Disapproved ! s Date
(Signed) -
Building Inspector
t
_..__ and for no other purpose.
New Bui!ding Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation oo
Estimated Total cost of improvements $ Ll..te" . Amount of Permit $.
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 per:nit does hereby certify that he understands and accepts his obligations as an employer
of I.tbur under the 'rlonda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennant•nt Sup plcment,
and has complied \kith 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 on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. /
•
Remarks (Signed)...._
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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. �(� 1�
Permit No...
_ __ . _L , Date f� 'VV,L 9...._..___ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
,tember .. .. Member _.._.....
Council Approved Date Disapproved Date
NOTE: A charge of S1.00 will be made for making corrections or changes to this application after approval has been obtained fmm
the 1'i.i nir.;; Board.
A re m.pection fee of 31.00 will be charged when such re inspection is made necessary by Improper notice for inspection or faulty
materials and /or workmanship.