DS-10-1643gigolo klcitaei\
(1360)
Job Address (where the work is being done)
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
['Addition
Type of Work:
Describe Work: P
S � f X, rfpk4 c e e 1 ° 1 /
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name 4 r
(Fee Simple Titleholder 4 v I 't'c
� P ) n f M U A ci Ph one # _rO f— rd> � r J� C t 6
Owner's Address ® A/ (^ toy r �-
City (h.. 4. U re f State � CI r c II Zip
S' r O S xP
Tenant/Lessee Name
Email
2j6 NE lay f �4�, or-c=zr .
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # j / — ( 61.7 -67(76
Is Building Historically Designated YES NO Flood Zone
Contractor's Company N a m e ( k ft C 0 e u e (ap ryl en L Phone # 7 F6 (P 1 11T4 .7
Contractor's Address c-'( ?s ..11 -1 a A-c f l—
City c . G (■ c State F L Zip 3 '? (c/ Y
Qualifier Name f a b C r 4- � h Ct CO ^ Phone # 7 a 2 / y C 2
State Certificate or Registration No. C 06 c? S ‘ Y Certificate of Competency No. /
Contact Phone q c l Y e l l—, 6 g 1 E -mail rr- C a e v e �v �, , 1 eel T {i G, C p�
3 ('o
['Alteration
CV C.
Square / Linear Footage Of Work:
New ❑ Repair/Replace
Training/Education Fee $
r '1j e
s f
Permit No. `dJ s i '�`�
Master Permit No.
71 / 7?
Phone #
Phone #
❑Demolition
c 41( Cancrc
** * *** * ** * * * * * * * * * * * * * * * * * * * * * * * *** F ees * * * ** ******* * * * * * * * * * * * * * * * * * * * * * *,* * * * * * **
Submittal Fee $ Permit Fee $
CCF $ CO /CC $
Notary $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 13�
l'
D
Technology Fee $
Bond $
40
See Reverse side -*
F
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 s 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 recorde' , of commen.'m t must be posted at the job site
for the first inspection which occurs seven (7) days after the building p • i i is , e ` � bs nce of such posted notice, the
inspection will proved and a reinspection fee will be charged.
)(Signature
The foregoing instrument was acknowledged before me this tD
day of Sirtzi, 20 LQby (WO Al3"7A)
who is personally known to me or who has produced Y
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
APPROVED BY
Owner or ent
• CO
My Commission Expires:
• 3 a
* * * * * * * * * * * * * * * * * * * * * * * * * *aY** o4'-ktRw+tk il*9rdek 4e*+Y9r9e9eoY**3e9rk****de4z **** dr9r4c4r9r9r4ek*****9e*9r9e** ***
(Revised 07 /10 /07)(Revised 06/10/2009)
MARI
4C''R „�, ����- Notary PubliV to of Flo
•My Commission Expires �Oct ' •, . 1 •
COmmISSI akar M11IT1TT
S 1i17� 4:
VLl'Y/V sio
�,,,,, Bonded Through National Notary Assn.
Plans Examiner
Engineer
IIPAINIYAI
Signs �.�
�Z._ —
Contractor
The foregoing instrument was acknowledged before me this /3
day of r ,20 / by i tl 29, C%i c ®.v
who is personally known to me or who has produced , -
t y who diid take an oath.
NOTARY PUBLIC:
* * * * * * * * * * * * * * * **
7/e/a / Zoning
Clerk checked
Inspection Number: INSP - 151240
Scheduled Inspection Date: October 21, 2010
Inspector: Rodriguez, Jorge
Owner: AUSTIN, OSMOND
Job Address: 250 NE 104 Street
Project: <NONE>
Miami Shores, FL 33138 -2016
Contractor: RRC DEVELOPMENT COMPANY
Building Department Comments
October 20, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762-4949
Permit Number: DS -9 -10 -1643
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360130340
Phone: (305)598 -8761
NEW CIRCULAR DRIVEWAY
Passed
/
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 8 of 21
B
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. Of 1 D � t; 11 TAX FOLIO NO. `[ _213 6 013 6i Y0
STATE OF FLORIDA
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following U omration,
is provided in this Notice of Commencement.
1. Legal descri
2. Description of improvement
3.Owner(s) name and address:
Interest in property:
Name and address of fee simple titleholder
4. Contractor's name, address d hone n be
4s - s
5. Surety: (Payment bond required by owner from
Name, address and phone number. ^ /
Amount of bond $
6. Lender's name and address: n� (
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1Xa)7., Florida Statute§, ^ i /�
Name, address and phone number. / v
8. In addition to himself, Owners designates the following perso (s) to receive a copy of the Uenor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number:
9. Expiration date of this Notice of Commencement.
(the expiration date Is 1 year iron the date of recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YO , • • ND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR • " V A F COMMENCEMENT
Signature(s) a l.0 ['}i� -1' � o •
of
Prepared By
Print Name
Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The foregoing instrument was a
or
❑ Personally known, or ❑ produced the following type of identification:
Signature of Notary Public:
Print Name:
0
on of property and street/ad
f 1'lte n..
N e ctij 0 r c Ucw 6.
u
rttra ctor, if any)
owledged before me this f b day of
(SEAI-)
C 110 TO SECTION 92.525 STATUTES
I declare that I have read the foregoing and
are true, to the of owiedge and belief.
o re r e c
or/Partner/Manager
Prepared By
nt Name
Title/Office ' Y ? I l V
s3'
. y '
/ ei j,�
Cer/DireCto��P,e e�r/Q larlF9 g sl "vac
Etv; rz,,WY C"'.ERTiFYSh 'Irisis a lea
91;01.Ain 5 .
Yvt., h , �, r
Wi r rt9ESS hand nd O i5t iol Seal.
HARA 4
S)r A d
1 111111 11111 11111 11111 11111 11111 11111 1111 1111
IIIIIIII,
CFN 2010R0648224
OR Bk 27431 Ps 3635; Ups)
RECORDED 09/23/2010 13:39:55
HARVEY RUVIHr CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
LAST PAGE
above reserved for use O � reco m ng offa
�'� COu
Whereas, (owner)
1111111 11111 111111111111111 RN ME 11111111
CFN 2010R0648225 OR BK 27431 P9s 3636 - 36371 (299s)
RECORDED 09/23/2010 13:39 :55
HARVEY MIN? C1 K COURT?„.ANI -DADE C
V
r FLORIDA
iami
COVENANT OF CONSTRUCTIQN WITHIN RIGHT OF WAY
US (°,- i ds Mon
hores Ilage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
hereinafter referred to as the owner of
the following described property (address): re) ,4 (d f
Legal Description f e c
olio:# ' -- 2 C .,C, ,-. '0 3 Li` U
Within the public right of way of (address)
ANa r el° 1 L 3 Pl
� .. f
Lot 7 Block ((' Subdivision (1�,'c� r:. r ' .4x
Requests permission to install (describework): ' . e C ✓&C.jc
1
CL t .
IN CONSIDERATION of the approval of this permit by the .Village, the owner agrees as
1. To maintain and repair, when necessary, the above - mentioned item(s) inetflled .a #hin -ded a light 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.
Signature
14
The foregoing instrument was acknowledged before me his , day of
who is personally known to me or who has produced
an oath.
NOTARY UBLIC:
Sign:
Print:
My Commission Expires:
2
LAST PAGE
3. The Owner does hereby agree to remove OttlFelboat&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 coining the item(s)
to be removed and a lien being placed on the property and/or assessed against the Ownetfor 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 obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village *his fully authorized representative).
Owner or Agent
4 of r\ -rnr`d
NOTARY Mile-STATE eit FLORIDA
Ciatiat V. CUb11103
Commision #13D7179
% Expir SER 23, 2011 -----
BONDED TEO ATLANTIC BONDINGCO,DIC.
C3tATE 07 FLORA, COUNTY OF DADE
1 1-i,!-:REBY CERTIFY tilE,t c p "
Pztis 71/~
, A a 20 11
V1INESS my hend a Official &at
iARVEY RK, of Circ Own
eV:11W P .0.
By
20 ID, by
- As identification and who did take
■