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29 NE 102 St (10)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 5 /3 Type Insp'n \`� C Permit No. 9 2z - J Name V ,�/� XCY 3 J C do 4� Address (UE ) O� CG- Company V Phone # Inspection Date Correction Re- Insp'n Fee tal Dat Type Insp'n f U &IOT(,i auskuo Permit No. 6P05- mS . Name I Address 42.--q NE La s--- Company Phone # Inspection Date ' 2t US MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bt}ildirlg Inspection Request Correction Re- Insp'n Fee Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 4/4/2005 Applicant: JUDITH Owner: ARMSTRONG JOB ADDRESS: 29 Contractor Local Phone: Parcel # 1132060131650 NE 102 Signed: (INSPECTOR) Building Permit Permit Number: BP2005 -385 ARMSTRONG JUDITH ST Contractor's Address: Permit Status: APPROVED Permit Expiration: 9/14/2005 Construction Value: $4,000.00 Work: INSTALL DRIVEWAY IN FRONT OF HOUSE, GARAGE AND WALKWAY Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 15 & LOT 16 BLK 12 LOT SIZE Fees: Description Amount FEE2005 -4165 Building Fee $100.00 FEE2005 -4166 CCF $2.40 FEE2005 -4167 Notary Fee $5.00 FEE2005 -4168 Training and Education Fee $0.80 FEE2005 -4169 Technology Fee $2.50 FEE2005 -4170 Scanning Fee $3.00 FEE2005 -4171 Builders Bond $300.00 FEE2005 -4172 Submittal Fee ($50.00) Total Fees: $363.70 Total Fees: $363.70 Total Receipts: $0.00 APR 0 8 2005 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: BUILDING PERMIT APPLIC FBC 2001 Permit Type (c Tenant/Lessee Name Job Address (where the work is being done) 9 1 �- 1 City Miami Shores Village Is Building Historically Designated YES NO x State Certificate or Registration No. Architect/Engineer's Name (if applicable) $ Value of Work For this Permit `8 400 , (D© Scanning $ 3 Radon $ Code Enforcement $ Totai Fee Now Due $ (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 n � is ;-="" &Permit No. 7 3) 4, 00-C - 3 k5 I` A°? 1 8 ast r Permit No. Electrical Plu ing Owner's Name (Fee Si .le Titleh • r)U P) (\ r (j 1 Phone # 05 - 715 - 17) V q Owner's Address a? A 0 City (' i = a V1\) t53 ho D State FL, Zip 3313g" County Miami -Dade Phone # Zi p X1 3 Contractor's Company Name Pho e # Contractor's Address City Qualifier • Structural Plan Review. $ Certificate of Competency No. Phone # Square Footage Of Work: Type of Work: EAddition ❑Alteration New ❑ Repair /Replace ❑ Demolition Describe Work: ` t '1L4 . GS 1 1 ct q uP» D nl.t in �rh rl�' tc,ta , Q r A ;() %%6( - I k LOck.l `r -V'r.1 - o h aU�SP� Oati * * / * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ �. � Permit Fee $ G ' CCF $ /2 1 q° CO /CC Notary $ Training /Education Fee $ Q, 5 Q Technology Fee $ Mechanical Roofing Zoning Bond $ 300 6'7 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 reinspection fee will be charged. -, •- ,•A •. I S ers nall k Owner or Agent by app r / D ** * * * * ** * * * * * ** N Signature The fo day of NOTARY PU Sign: Prin iukk My Commission Expires: 11 Contractor instrument was ac iii ' le• d b / 1 ore , - this ---The foregoing instrument was acknowledged before me this ...: � /L ' Ay of ,20,by 07 L_ has produced tO L_ is personally Icnown to me or who has produced as identification and who did take an oath. * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: chc 05/13/03 entification and who did take an oath. eCIIM FAMM ******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * Signature NOTARY PUBLIC: Ginny H. Gone' . ssion #DI5g4 Expires: May 2 . p O8 Bonded OF F�� Atlantic BondinQQC�o., My Commission Expires: ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning NOTICE OF COMMENCEMENT . A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO8f aoO5- TAX FOLIO NO 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 information is provided in this Notice of Commencement. 1. Legal description of property and street/address: J ; ty4e., q m ; 1 �G(pL cat)) >J - loasT Siam shore c/ ,3113? 2. Description of improvement: pa l9 P (\ do; (1 e u3ct 3. Owner(s) name and address: ) (Ad 14h f ' asf r6ii r g,c) ka�. 16�.s . m (am; h� nes ci _33 GR Interest in property: ha Me-OW net() 1 Name and address of fee simple titleholder: EL?( t omt �Of'�- q P. C Qripa Y)i P o. e)Gx al to) .l qck so,�u 11(°. �t ,3aaia, -� o� 1 4. Contractor's name and address: W- 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: n� Amount of bond $ 6. Lender's name and address: 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(1 (a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: AVAIt ature o 1 HEREBY RTIFV M. HARVEY R .y ile . , h,: of is p .•. ..t: Al rig,nal 9. Expiration date of this Notice of Commencement: (the e different date is specified) WITNESS Sig ) "Owner Print Owner's Name U414h Sworn to and sub crib Notary Pu Print Notary's Nart My commission expire: ,20 (' d County Courts D.C. Pol*K))1 A ddress :Q} fv i O l Prepared b ea+ Lory M Corbett +P • My Commission DD231272 1 4 a Expires July 13, 2007 111111111111111111111111111111111111111111111 CFN 20105R03 51325 OR Bk 23253 Ps 0331; (lag) RECORDED 04/08/2005 13:45:16 HARVEY RUVIN. CLERK OF COURT MIAMI -DADE COUNTY? FLORIDA LAST PAGE • @( 'STATE OF FLORIDA) COUNTY OF DADE) attached survey, performed by performed on 1 ( � �iurni SIior� Vi��uc�e The undersigned Affiant, J I At *a » 1 , does hereby attest that the (property owner) Bann -es aid Gc,rc'o.. 1c . (name of surveyor's comp 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. 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 SUBSCRIBED before me this L Q day of Affiant is personally known to me, produced I as identification. • Ginny H. Gonell Commission #DD323870 , V. Expires: May 26, 2008 %9;FOF 0:11;$ Bonded Thru ." Atlantic Bonding Co., Inc. ag-d Proof of ownership provided ( ) acknowledged before this VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE .STATEMENT being the legal property owner, for the property 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),And I have read and understand the following disclosure Statement, which entitles me to arork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT 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 525,000.00 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 Iicensing 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. initial of reviewing clerk. Tlie foregoing instrument as identification and who did take an oath. Ginny H. Gonell ;;�.•_ •.¢. 0otnmission #DD 32381 = .'a_ ExpirB 2008 Thin '1 ', n Atlantic Bonding Co., Inc, A BOUNDARY SURVEY I hereby certify that the survey repre- sented hereon meets the minimum technical standards 71 .•forth the bard of Land Surve rs pursud.s -so Section 472.Op„ Fla. tutes: Lk re are noencro F�r( erla p / eis ments ' appearf,6g't at .tber jean at show u Fla. Reg. land rveyor No .06/7/04C SCALE DRAWN BY DRWG. NO 1 8 Itr ?_c fu1� =►L 189 - 9956 This property described as: Lots 15 and 16, Block 12, AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1, • according tb the Plat thereof, as recorded in Plat Book 10, Page 70 of the Public Records of Dade County,, Florida. J WOOL 9 cxc 13 ' u gc� vi ZOnlrig App, oved rCi 5C .-- - -.) ,/o /o PROPERTY OF: Armstro Not valid unless embossed with Surveyor's Seal. q, Judy A:, P OL E 7 7 d ,e p,¢ /LL NcL� 4s' tIC (AO plod /o d q . cL. C c.) A sh 1 .\- - tiny T REET p i pe /0/o /o) Page 1 of 2 la 29 N.E. 102nd'Street, Miami Shores, 4-1 • rl t" 2 LANNES and 61 A, IMP L.B. #2098 - BEALE SMITH # C ENGINEERS - LAND SURVEYORS - LAND PLANNERS 3 za v alcu ° aria rflg Mailing address: P.O. Box 561131, Miami, Florida 33156 (305) 666 -7909 0 w 9 -24 -03 "Recertified", Names and Certified To revised and Flood 152245 9 -29 -03 Information and Zip Code added : pm/4/p A P S '/'1 52,'q P / Names revised.. f' � PERMIT NO. • ADDRESS: . MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT" SECTION - BY DATE ZONING ELECTRICAL MECHANICAL PLUMBING - FIRE PUBLIC We • 8 STRU RAL B ' ING OFFICIAL 1. Subject to compliance with alt Federal. State. County.VUtage lutes and regulations. Wage assumes no responstbpfty for accuracy of /or mutts from these plans. 2. This copy of plans mutt be available on building site of no tnspectlon will be conducted. JOB AODRESS .0Z`L /2 CRITIQUE SHEET APPLICANT PHONE tt APPLICATION , b4/1/ (1 44 V SHEET OF MISCELLANEOUS DATE ZONING ' COMMENTS INITIALS 3( y ;5— u 57 /, ' /Z)G s i b fl u : //t7; le •ee - no ,/,V CFN 2OO5RO3 5132 5 NOTICE OF COMMENCEMENT OR BI: 23253 Fs 0331; tips A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED 04/0EI2005 13:45:16 HARVEY RUVIN, CLERK OF COURT PERMIT NO&(C)oO5 MIACiI -DADE COUNTY, FLORIDA TAX FOLIO NO. LAST PAGE 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 information is provided in this Notice of Commencement. 1. Legal description of property and street/address: J �� R m i (U h Gm z_ d aci toE i oaasT i o m Shor 2. Description of improvement: eA19er Cent lie,UI9C0 3. Owner(s) name and address: V Ltd i-I-h f r f Gr Q/ r . �a �( ��j i e- j o T m (ofm GAG cP S- l W k Interest in property: home.aw nc(' 1(0)11e_ � n Name and address of fee simple titleholder: r l (t 1 „�� i OI P , (l()Yt') pQ A 1. PO. e)Gx a) lo`) Jack ►11t'. Ct . aaaAa, 4. Contractor's name and address: PA 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 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(1 (a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specifed) ot•APA 8. A A ' I ' A. ,.ice �.v - -- Notary's Na Sig of Owner Print Owner's Name �J U4 • irk\ Sworn to and sub.crib- efore me this ( Alp Notary Pu Print My commission exor- : „�a+ LoryM C ft • My Commission DD231272 1 , 0 Expires July 13, 2007 Prepared b 111111111111111111111111111111111111111111111 r Address:} 11)E /10Q--T CONTRACTOR Name / / . /7 C � C . / License No. / -Na e�V' fib r4I 1JOb Address 96 c.-/ Ce)e.17 C 4.2s4 e- 0r: i 7C- 3 /86 Telephone O1Yse- Fax 37?../ Fax S Qualifier Name .,---7 C � �O.�IV C- ✓ U PROPERTY OWNER New Construction Enclosure -Na e�V' fib r4I 1JOb Alteration Exterior ' Repair 1 � c. 10 a-'5Yl fer i ) 514 -te-E S. r-L ' 33) 3� Home Telephone 3os--_ 0 Business Telephone 31.1c --)t / Shell Only Fax Add'I Attachment TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other X Job Address: INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION � f e" /c9. s Folio Number Address Apt, City State escription of Work 1)/e/ U/ / Lot Block Subdivision PB PG Zoning Current Use of Property Square Feet Proposed Use of Property 5<Value of Work Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Poo Tax Assessed/Appraised alue Flood Zone PERMIT APPLICATION Master Permit No. Subsidiary Permit No. P' a Linear Feet Q a Floors Zip ldg Value Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. 1. A FFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STA I FLORIDA, C gnat VN ,Print Name Swo ._,, and subscribed before me this UNTY OF MI ,// 2) J (e-_ day of I -D 00 ce) f11 ht Name Sworn to and subscribed before me this Signature of Notary Public - State of Florida PERMIT APPLICATION STA 3F FLORIDA, CO_ Y OF MIAMI -DADE day of SEAL: 0 1 PRY PGA OFF ET COAL NOTARY s .. 15^ ,.rr ANGELA A4 BECKER 00MArlsnoH NUMBER <(` 0 �p CC 786697 OF f1.09. 11" COMMISSION Personally known dua31 f on Personally known OR, Produced Identification k i j 3 - 0 Type of Identification Produced: Type of Identification Produced: SEAL: ELECTRICAL TYPE Minimum Fee QTY. T1 IT Dryer QTl'. TYPE Outlet, Appliance QTY. 'rvi'i: Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch - Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent - Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPI. Minimum Fee QTY. TYPI. Condensate Drain QTY. TYPE Generator QTY. TVPF. Refrigeration, Tons Q'rY. A/C Central, Tons Q . i . V , Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of - Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof Q ' I ' Y TYl,l, Miscellaneous Fixture QTY. TvI'I; Soakage Pit Q . i . V , Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinlder Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 • PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION B Dt1TE 7//' Zoning ( /3,1 t Electrical Mechanical Plumbing Fire Public Works Structural Building Official P,l1 Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) O OTHER. (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ (pD %DO $ 5t0 DO $ a Le 0 ( x sq . = x/1000 $ $ (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ C rG ' ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX°(305) 756 -8972 • http : / /www.miamishoresvillage.com Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -1258 Printed: 7/30/2002 Applicant: JULIO Owner: REGALADO JOB ADDRESS: 61 Local Phone: Parcel # 1132060131670 NE 102 Contractor R & M DESIGN CONCRETE Building Permit REGALADO JULIO ST Page 1 of 1 !YI si'`..,.I Owner is Responsible for M: of Contractor's Address: All Village Sidewalks as per Village of Miami Shores Cii;? et Ordinances, Including ba'Jeway;, ,'yi; Caused 13y Current Ccnsirncf en :cti �' vi'ics. Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 19 & E1/2 OF LOT 18 BLK 12 LOT SIZE Fees: Description Amount FEE2002 -3943 Building Fee $87.50 FEE2002 -3944 CCF $2.40 FEE2002 -3945 Buildier's Bond $300.00 FEE2002 -3946 Notary Fee $5.00 Total Fees: $394.90 Total Fees: $394.90 Total Receipts: $0.00 Permit Expiration: 1/12/2003 Construction Value: $300.00 Permit Status: Approved Work: DRIVEWAY If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. � - - -- (INSPECTOR) Signed: BY: 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. (Contractor or Builder) BY: REG 6x01 080102 1450 MC #01 000066 CA5 WHEREA following described property: Legal description /folio #: Lot Block Subdivision Tax Folio #: requests permis ;ion to install: (own r Asphalt, concrete, brick pavers [ ] Landscaping [ ] Other within the public road right of way o fl?iami SIzorps Vd/cye 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (305)_756 -8972 � COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY ' � / I / �/O hereinafter referred to as the Owner of the pRtuECufiy PF o,4ctf 6( A/ r /a2 4447-12/ 6f4,1, (address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: 1. 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 ACKNOWLEDG on this day of SIGNED, SEALED AND DELIVERED in the presence STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affian attached survey, performed b Further, Affiant sayeth naught. Affiant is personally known to me, )oduced i' d' /iujni ore6 Waje OFFICIAL NOTARY S d> L Pt; YP U [tNOV.•R M BACKER 00;4.11w)4 miaow Ce.1a64397 k tr p MV c ,,,, N:tnvOH exPIRES o ry a Pltt�J. 16,2002 AFFIDAVIT W ela 2 1:i d es hereby at that the (property o ner) �C o surve • (name surveyor's company) . performed on is an accurate representation of the existing conditions and da of s ey) 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. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this � , day of S� 'IS— as as ident cation. A - ( / /�� R . :axu., «enlw.e °:..x° .4 o- c x «S �° :ex. ° <•a :e S x ::xa ox �za a xd :eta 8w vo :eve se °xa sa ae�jSxaAw •ss o z za. < e . •.. ,.� ....... :... : : :. x : ,..,>r a z w i' �• Ra? i >:r 4 A S /� - /� L> s: • 2 f6 % - A . 1 '. L�,, i; Q ,o�e � R 6 L � ( �/ ea• o >: •�' a• b ' ° ' <c°s a «< °�x� y �yx'�•s w DATE (MM/DD/yY) ti > : er i. :r, T.. • . 4 i ' zza�� ':- :y.....>:.Go :i: :J ::: :Ga:;:.� >� w�axa a ..... .�°': �.:.0 . �` . � ° •:. ...,. ..:.°. � � e .- , . n ...�$:....:ax° •.. , ... ... •>,.Z". PRODUCER AMERICAN CHOICE INSURANCE 7960 SW 8 ST. MIAMI, FLORIDA 33144 305- 264 -7333 FAX 305 - 264 -7492 . . •. . . gle S 0 7 / 2 6 / 0 2 x<>t�wx a C.°r :°,.•°�"x' :..�.K� ., >•��'R;i x`C THIS CERTIFICATE IS V ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A WESTERN WORLD INS. CO INSURED R & M DESING CONCRETE - " — X62'1 W CALUSA CLUB DRIVE MIAMI , FL 33186 1 COMPANY B COMPANY C ' ' • COMPANY D (410404— 5 L , ex , :.`�� itax�AL a�i' su� > � :y.< °v�yeq°roj,3`•s>e <�:� "w :� 'y`.f <. �x7e'wx.�`kx, x '1«L°i.`,w.ax:. ,x . ;«: r.>„•<. x,•<'.. a,.•,... �•..,..¢. x:«!. :.•� irgtf ' ��x, w x ,q�"K ��•�^• ;'KrA'yRxiy tidf THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE « >.D exa "u�a`�•yeaa�x'�e�iY�ls •ZF'RM•F1 9�'>P :o,�yey� s� �a :y'y�ci �� %,�ca,i ti�fro2'Y� Y Y-y>xe : ua°x ax awx «Ba i•xa>:a x v°% az<: �a: Le: �. cr, �::>.e �¢ xu�. mex: Lxx? s:¢ nx> v> ka> kx> t. Frncu ::�, :a .`c:.f'.��•,°�,'�'�a'� � .,' BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POLICY (. PliAl ION DATE (MM/DD/W) LIMITS GENBIAL X LIABILITY COMMERCIAL GENERAL. LIABILITY NPP754233 11/01/01 11/01/02 GENERAL AGGREGATE 0$ 600,000 . S 300,000 . S 300,000 . PRODUCTS - COMP /OP AGG CLAIMS MADE OCCUR PERSONAL & ADV INJURY — OWNER'S &CONTRACTOR'S EACH OCCURRENCE S 300 , 6 50,000. S S,000. FIRE DAMAGE /Any one fire) MED EXP (Any one person/ AUTOMOBILE — — --- — LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTO NON -OWNED AUTOS COMBINED SINGLE LIMIT s BODILY INJURY (Per person) 6 Bobo INJURY leer accident) PROPERTY DAMAGE 6 GAMIN LaBUJTY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: • ANY ... : : :,.','. „�, <.•..,.` .•,,`• ., EACH ACCIDENT 6 AGGREGATE 3 EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE s AGGREGATE 6 6 WORKERS COMPENSATION EMPLOYERS' UABILRY THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE: AND ^_ — INCL DCCL WC STATU TORY LIMITS OT FR `.. :i' f :i' : i 'r: i ; % : a' ;: :i: :: .'•.:.• % >..:.< :1:: : : > :. : ; .; EL EACH ACCIDENT s EL DISEASE - POLICY LIMIT 6 EL DISEASE - EA EMPLOYEE 6 OTFER DESCA(!PTJON OF OPERATIONS/LOCATIONS/VEHICLES /SPECIAL ITEMS CONCRETE DRIVEWAY 1 e•r4 �%S�fa `S 7` ` m:3a0;a�•Y.0 k Ire• eed e a' id> e s .'- u,a i,f ";t'f • ....S . .: l.. RF? l... RYZ •y:""l?i°i :!?C°.L'.�..i?xn'.^'l ":tl:ti °: 'x)�• �..! C°i. • 4 X g ,>�axb;i� . AIH w.,V s ass yep. : e:iiggi g i. k` MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES , FLA . 33138 •; ., :t I.e ;11 , •H aw , • o:I NV .. <� .ey4cx a .a F x :;;N .9� ,;;Ie..ne•• . ... .. .. ... W , W...i4/4.P L€_ .x ,a_ae,s" 6tl S e < x. r.. x :a2 ry , ry'• '� i _?itil�?3..L! :OLe_ ; '��,.. '° �".' 3° a..: ., :..n..,Y..�,.Ya >a• :> x,w > : <•ws c >. > : >.:. °.v w'wkee'a�tn xL� ,a J' ss: St :a�0•+r<. z-�.0 Fw>wii��l >kxe x °e axa:sxOr.O .. >.�. � qqeeyy..: x , yx R.1- x > • c ° t W: %ww•a° ri:q axa n� a�S I .; ...,.... .•. ......,.. ,.. . ... :4,.L°. e.< e,e:,o,O:iVFY. PY.'d1 K. SHODU) ANY OF THE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. : . .FAILURE TO MAIL sUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AU • - •• 0 REPRESENTATIVE 7,° o....e5 .,ewew xo:owx ?o a � <ia i .. ,,,,,r- ' �,,.. .. •>: e'S .tr• • i; 140 •tl•0 ,�'. : ` . :v e.' "k� :ttt7 'S.`` ' °. u:a, Sax )wx�xe :eRa :oxttK>4;o,�:� ?i,G .:r>J'.y:K.: �:>�. o .. -• ' Jul.26. 2002 12:22PM AMERICAN CHOICE 305- 266 -6321 No.7531 P. 1/1 x 19' d1[£4 TOU 0 a. 0 3 4°14 o 0.40 nee u/ /L o f 'OT /4 TO 4/D O. /4 'L L ti 32o Ola 6:7 /DEA/Az* C ot.JG 2 23' PA/2t WAY • SKETCH _ s it% . 4..k. 44*Atr n' •':49.4. • f e d • ;. . •. :,,; •..v 1111 ti E /6.35' h DA/6- - 570.QY £E5 + 6/ 2L8' • • ••• • • OI? • • • S • ••• •• SCALE • 1 " 10' ti Y . 1 1.F l04AAA4EJ' • ••• • • ••• • • • C •i •• • • • 6 • • • n• 22.95' /. 7 7.0' • /70' Its ti NE- /0Z 41 5/ T 1 rn , p / 900 L • .�. S ) ° 4' 4 • /3./5' 13. O5' /0.6' {/ /4ole.r • I VE Y • e •• A20/i/0 • • '"4' /P. N • tr) Ca / FOo A/D ' / 2 " v T.� ACCORDING ID THE N.F.I.P..'1HE SUBJECT PROPERTY 1 1LG WITHIN PLOOD SE �_ I TYNE: /2- z /993 LOCAT I ?if N • • JOB N 93 — o F.B. - PG. 6/- 72 N . T . S . • • ... • • • • 0.I- --- _ N E - /at ' 4/47 CERTIFY TO: Trans -State Title Insurance Corporation. 4 ). GUNTER GROUP LAND SURVEYING - LAND 9350 S.M. 22nd 'Terrace PHONE: 13 Nisei, Florida 333165. I HEREBY CERTIFY TO THE ABOVE NAMED FI 'f AND /CR PERSONS THAT THE OF BOUNDARY SURVEY" OF THE HEREIN DFSQtIBED PROPERTY IS TRUE AND 10 THE BEST CF CUR KNOWLEDGE AND BELIEF, AS RECENTLY SURVEYED AND UNDER CUR DIRECTION, ALSO THAT THERE ARE NO VISIBLE ENCROACRIENTS THAN THOSE SHOWN AND MEETS THE MINIMUM ITCNNICAL STANDARDS SET BY THE BOARD ar LAND SURVEYORS, PURSUANT TO Sf7C'TICN 472.027 AND CHAPTER OF THE FLORIDA ADFi1NIS VAT7VE CODE. SURVE'YOR'S NOTES: * This is a Boundary Survey. * Legal Description sea furnished by client. * Domination of the Abstract of Tltle will have to be made to de recorded instruments, if any affecting the property. * Legal Description subject to eny dedications, limitations, restr reservations or easements of record. * Scale as shown. NOT VALID UNLESS SEALED WITH AN EMBOSSED E•YtP.' S SEAL. SKETCH N° S6 /2 • • • DRAWN BY: ✓' D/or CMCKED BY: ,¢D I�+� A P PROPERTY At=FESS• 61 N.E. 102nd Street, Miami Shores, Florida 33161. LEGAL DESCRIPTION: Lot 19 and the East 1 of Lot 18, Block 12, "AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1", according to the plat thereof, as recorded in Plat Book 10, at Page 70, of the Public Records of Dade County, Florida. FOR: Julio Regalado Jr. - Great Western Bank Insurance Services. Attorneys' Title Insurance Fund, Inc. Julio Regalado Jr. ,INC. LANNING 05) 220 -0073 SKETCH CIRRI= PLATED calm FTLJRMA 21 -1*16 ABL EVATIONS: CL.. Clear. C.L.F.• Chain Link Pone. I.P.• Iron Pipe. WM. Mater Meter. D /H• Will Male. C/L• Center Line. N /D- Mail 9 Disc. CT3hC.. Concrete. M.P.• Mod Pole. M.F.. Mxd Fens. F/H. Fire Hydrant et1C.- Encroach. M/R. Man Bole. Alto Kressent Line. P/L• Property Lune (M1. Measure. C.P.. Qmcretn Pole. (1)- Ilsoesd. C.B.S. - mnieta Kock 1 Stu000. _SY: • • CRTIA. numgr XAL EAND SURVEYOR N' 4312 S"lA7E OF FI RIDA. REVISION: ,r ....., . . '/ f ...' .. � V Z2 /G /7 Z.% • .4> II/ ZU L I TYNE: /2- z /993 LOCAT I ?if N • • JOB N 93 — o F.B. - PG. 6/- 72 N . T . S . • • ... • • • • 0.I- --- _ N E - /at ' 4/47 CERTIFY TO: Trans -State Title Insurance Corporation. 4 ). GUNTER GROUP LAND SURVEYING - LAND 9350 S.M. 22nd 'Terrace PHONE: 13 Nisei, Florida 333165. I HEREBY CERTIFY TO THE ABOVE NAMED FI 'f AND /CR PERSONS THAT THE OF BOUNDARY SURVEY" OF THE HEREIN DFSQtIBED PROPERTY IS TRUE AND 10 THE BEST CF CUR KNOWLEDGE AND BELIEF, AS RECENTLY SURVEYED AND UNDER CUR DIRECTION, ALSO THAT THERE ARE NO VISIBLE ENCROACRIENTS THAN THOSE SHOWN AND MEETS THE MINIMUM ITCNNICAL STANDARDS SET BY THE BOARD ar LAND SURVEYORS, PURSUANT TO Sf7C'TICN 472.027 AND CHAPTER OF THE FLORIDA ADFi1NIS VAT7VE CODE. SURVE'YOR'S NOTES: * This is a Boundary Survey. * Legal Description sea furnished by client. * Domination of the Abstract of Tltle will have to be made to de recorded instruments, if any affecting the property. * Legal Description subject to eny dedications, limitations, restr reservations or easements of record. * Scale as shown. NOT VALID UNLESS SEALED WITH AN EMBOSSED E•YtP.' S SEAL. SKETCH N° S6 /2 • • • DRAWN BY: ✓' D/or CMCKED BY: ,¢D I�+� A P PROPERTY At=FESS• 61 N.E. 102nd Street, Miami Shores, Florida 33161. LEGAL DESCRIPTION: Lot 19 and the East 1 of Lot 18, Block 12, "AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1", according to the plat thereof, as recorded in Plat Book 10, at Page 70, of the Public Records of Dade County, Florida. FOR: Julio Regalado Jr. - Great Western Bank Insurance Services. Attorneys' Title Insurance Fund, Inc. Julio Regalado Jr. ,INC. LANNING 05) 220 -0073 SKETCH CIRRI= PLATED calm FTLJRMA 21 -1*16 ABL EVATIONS: CL.. Clear. C.L.F.• Chain Link Pone. I.P.• Iron Pipe. WM. Mater Meter. D /H• Will Male. C/L• Center Line. N /D- Mail 9 Disc. CT3hC.. Concrete. M.P.• Mod Pole. M.F.. Mxd Fens. F/H. Fire Hydrant et1C.- Encroach. M/R. Man Bole. Alto Kressent Line. P/L• Property Lune (M1. Measure. C.P.. Qmcretn Pole. (1)- Ilsoesd. C.B.S. - mnieta Kock 1 Stu000. _SY: • • CRTIA. numgr XAL EAND SURVEYOR N' 4312 S"lA7E OF FI RIDA. REVISION: ORGAN DONOR The Sunshine State LICENSE WMBER J520420-47-418-0 RODOLFO JUNCO 9621 WEST CALUSA DR MIAMI, FL 33186-0000 BIRTH DATE SEX .. HOT. REST. ENDORSE. • 11-18-47 M 6 ISSUED ' EXPIRES IXIPUCATE 06-25-00 11-18-06 00-00-00 Operation of a motor vehicle constitutes consent to any sobriety test required by law SAFE DRIVER