134 NE 102 St (3)ate 5d11-01
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Tax Folio
/ 31/ NE /0ZS /IA
Job Address 33 J 3�
Legal Description Jj Historically Designated: Yes No
6wner/Lessee / Tenant e h � Si yheir / v / , g f > J t INJ Master Permit # q/11.
Owner's Adds l 3 NE iOa s/7- PA-m1 .313 4 / - 3 of
Contracting Co. v., ire ✓,
Qualifier
State # Municipal #
Address
SS# Phone
Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
ll
n c.YC 4 f CN1 a f c d, 41, G ► I/e VJG �
WORK DESCRIPTION
Square Ft. Estimated Cost (value) 1/) 'O
NCE SIGN
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 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.
construction and zoning. Furthermore, I authorize the above -named contractor to • : the •rk sta
Af
Notary as to Owner and/or Condo President Date ''tary a• to Con
My Commission Expires: My Commission
Signature of owner and/or Condo President Date
FEES: PERMIT I O RADON
APPROVED:
Zoning age Building
Mechanical
Contractor or
i- Build
sy,�'1 )– o
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and tha work ;jjy do„ ompliance with all applicable laws regulating
OFFICIAL NO-ARY SEAL
X5W:P0 ANGELA ? i PECKER
i C;: COLT SSION NuLSaEI:
4 ¢ CC78660
4 C1Y COM?L■SSION EXPIRES
NOV. u., :1,2..002
C.C.F. 6v NOTARY 5 0 v BOND
er
Date
20115
°
Date I
\ Electrical
Plumbing Structural Engineer
WHEREAS,C/Y V S
following described property:
Legal description/folio#:
Lot 10
Tax Folio #:
requests permission to install:
Asphalt, concret , brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
)r Ea l s
(owner)
Block L J Subdivision
013 ig?0
(3 NE
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
l . 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).
7 1011V—p. ,
o r �►
owner)
SIGNED, SEALED, EXECUTED AND ACKNOWLED
SIGNED, SEALED AND DELIVERED in the presence
Y/7/Lamj Shorej WCtQ
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (305)_756 -8972
, hereinafter referred to as the Owner of the
pRtuetwWW
A PPR or4crf
Sec lo/10
ja 2 sq- IuM qI 3313
day of MN"7 22n (
STATE OF FLORIDA)
COUNTY OF DADE)
performed on
gdl0does hereby attest that the
The undersigned Affiant,Cnil
roperty owner)
attached survey, performed by La AneS 10 G or C I. ri4C.
(date of survey)
IDAVIT
SWORN TO AND SUBSCRIBED before me this
Affiant is personally known to me,V producedf4
(name of surveyor's company)
, is an accurate representation of the existing conditions and
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. Th ► . further understands that the
existence of any such structures may affect final inspections as a .lica . le to t .:
Y P P or titL�lrmtts..
Further, Affiant sayeth naught.
Witness(sign and print) Witness(sign and print)
identification.
21PRY P411e' PoE t + s ��
cn
ODraM Ei;OEy MUb 3HA
' -w` Q Ce766697
7l 9 �OF Fl� � \ O 117Y MIS
CO SION EXPIRES
_.__ NOV. '1.5,2002
STATE OF FLORIDA
) SS.
COUNTY OF MIAMI DADE )
The foregoing instrument was acknowledged before me on
f, ii s9
STATE OF FLORIDA )
) SS.
COUNTY OF MIAMI DADE )
(ACKNOWLEDGEMENT - INDIVIDUAL)
ho is personally known to me or who has produced
as identifica
Signature of Acknowledger:
Name of Acknowledger•
nalay, A DD/ by
d who • 'd (did not e an oath.
(Typed, Printed, or Stamped)
Title or Rank:
Serial No.(if any):
(ACKNOWLEDGEMENT - CORPORATION)
The foregoing instrument was acknowledged before me on by
of
a corporation, on behalf of the corporation. He/She is
is personally known to me or has produced as
identification and did (did not) take an oath.
Signature of Acknowledger:
Name of Acknowledger:
(Typed, Printed, or Stamped)
Title or Rank:
Serial No.(if any):
i
This property described as:
Lots 10 and 11, Block 14, '•
AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1,
according to the Plat
thereof, as recorded in
Plat Book 10, Page 70
of the Public Records of
Dade County, Florida.
1
r ,
PROPERTY OF:
•
/ / /S
r, , " ,
•
•
Not valid unless embossed
with Surveyor's Seal.
Ct
2G1
Cr'
ift
•
r ;
r
q
,9 /oedva /,
i
2'
. ,a • •
II NJ
A BOUNDARY
Fla. Reg. Land Surveyor ao/
tl
2G.Z0'
N
30.0 " 2 > 5:2'
7,5J1 Ili 1 '
r., • , 75''ff. r 'rte
f•. !j ,� ,, I
11
r , i • •; e/�
r • ,.
�� 1 52 BO r r• . F..C.OIP._
pro o � �� - -i/
T .=
SURVEY
I hereby certify that the survey repre-
sented hereon meets the minimum
technical standards set forth by the
Board of Land Surveyors pursuant to
Section 472.027, Fla. Statutes. There are
no encroachments, overlaps, easements
appearing • the PIat, other than as
shown her t•. /
2{ I' / 7
•
/2• GO'
• otr.�
01efr
S �/ - ----ter
/00.00'
4S`l // ,aQU//1
2QGQ• «.
x -�
z ' 0
./3,=G' ,
/A 2.7'
DATE
0
• v,
// 1 it
Bellows, 134 N.E. 102nd Street, Miami Shores, Florida.
da.
SCALE
// = 20
OC.AT /OIL/ d7A
Sc'& L E,' /" = /90'
Certified To: American
A" Southern Mortgage
Corporation is Successors
and /or assigns as their
interests may appear.
&OS'
AWE
DRAWN BY
L.L
LANNES and GARCIA, INC.
ENGINEERS - LAND SURVEYORS - LAND PLANNERS
Office address: 4080 S.W. 84th Avenue, Miarni, Florida 33155
Mailing address: P.O.. Box 561131, Miami, Florida 33156
DRWG. NO
186 - 4655
This property described as:
Lots 10 and 11, Block 14, '•
AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1,
according to the Plat
thereof, as recorded in
Plat Book 10, Page 70
of the Public Records of
Dade County, Florida.
t +:
11 ' ( - .5 S/o ?'a /%
N
• , ,r G '. 75 , . I 3 , ,
• I I
/ ' .. ' • • ! I
p,a o J y // / / ----d/
PROPERTY OF:
Not valid unless embossed
with Surveyor's Seal.
A BOUNDARY
Fla. Reg. Land Surveyor
/00.00'
r
SURVEY
I hereby certify that the survey repre-
sented hereon meets the minimum
technical standards set forth by the
Board of Land Surveyors pursuant to
Section 472.027, Fla. Statutes. There are
no encroachments, overlaps, easements
appearing . the Plat, othe than as
shown her t• /
If l • '
9f(,
/9.OD•
us :J' :' q
Nju •
X11
�tt
-
z- 050•
9.0
vi
nr 'r
,, Certified To: American
4" Southern Mortgage
Corporation is Successors
and /or assigns as their
interests may appear.
O,US•
Bellows, 134 N.E. 102nd Street, Miami Shores, Florida.
DATE SCALE
4 -9 - PG 7" = 20'
GOCA7 /04/ M'AI'
SCA G E',' /" = /50'
.
DRAWN BY
L.
LANNES and GARCIA, INC.
ENGINEERS - LAND SURVEYORS - LAND PLANNERS
Office address: 4080 S.W. 84th Avenue, Miami, Florida 33155
Mailing address: P.O.. Box 561131, Miami, Florida 33156
DRWG. NO
186 -465