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DS-05-1046BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle):( Building J Electrical Owner's Name (Fee Simple Titleholder) Phone # Owner's s ddress 1 1 2' t E t t© -s'��9 k City �"` • `■sb (US State - Zip 3316 Tenant/Lessee Name Job Address (where the work is being done) 124- 110 City Miami Shores Village County Miami -Dade Zip ,s310 Is Building Historically Designated YES CIO Contractor's L U � O OS To -3X _414 Contractor's Address ntractor s Company Name Phone # t 10 i -.k1' 1 % 0:2 City ''E'er , J- c-`- C 2-- ‘ 0 c"'- State -S— Zip IS Qualifier (1 %./ Z r 5.,(:. e V State Certificate or Registration No. �� GO 3 2 J Certificate of Competency No. Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: ❑Addition Describe Work: Submittal Fee $ J .00 Permit Fee $ Notary $ Training/Education Fee $ Code Enforcement $ Total 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 r:DS t t©O" ❑Alteration New Aft en. EIMMI **** *** * * * * * *** * * * * *** * * * * ** F ees * * *** ** * *** * * * * * * * * * * *** *** * ** Scanning $ Radon $ Zoning Structural Plan Review. $ Phone # Permit No. ^ 1 1 " ls r Permit No. Phone # Square Footage Of Work: Mechanical Roofing c ) - f42T ❑ Repair/Replace n 4 0 ❑ Demolition CCF $ CO /CC Technology Fee $ Bond $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address 1 A 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 AINFIDAVIT: 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 comm cement and construction lien law brochure will be delivered to the person whose property is subject t- ttach , ent. Also, a certi ed copy of the recorded notice of comme • -ment must be posted at the job site for the first i 'ec on wh occu seven (7) day after the building permit is issued. In t �'bsence of such posted notice, the inspection wil not b appr ' . • and reinspection e will be charged. I ur 0 r A nt 7 , 4: 144. 1 7 0 oing instrument iacknolged efore Ne this J t by os o is s - onally As or who has pro nstific uced o did EZ as PEZ Signature The for day of NOT ARY Sign: Print: APPLICATION APPROVED BY: chc 05/13/03 oath. Contractor The fore oing instrument was acknowledigeil before day of to .; .! � , 20 who • o ally known t who has produced NOTARY PUBLIC: Sign: entification an •d take an oath. jo � i J► Commission E �n� ; _ PIRES: Feb. :ry 19, 2009 y Co 11 I " ' * 13 : - *` 19s i lit * N 1 19 * s'e * 2N l ice° * 9s ************** Bon. i dget Notary Services ** * * * * * * * ** * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning =STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, attached survey, performed by (name of surveyor's company) performed on , is an accurate representation of the existing conditions and (date of survey) 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 Affiant is Further, Affiant sayeth naught. Witness(sign and print) SWORN TO AND = SCRIBED before me this day of produced C (property owner) EXPIRES' Febru3q 1, . Bonded ihruBad9etN ^ " , does hereby attest that the iP Tij7- operty Witness(sign and print) other p as identification. Th iami Sh,oreJ 10050 N.E. SECOND AVE. MIAMI SHORES, FLORIDA 33138 -2382 Telephone: (305) 795 - 2207 Fax: (305175678972 COVENANT 6RF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, ,Y }3YZ , hereinafter referred to as the Owner of the Tax Folio #: (owner) following described property: Legal description/folio #: Lot Block Subdivision requests permission to install: Asphalt, concrete, [] Landscaping [ ] Other within the public road right of way of IN CONSIDERATION of the approval 1 2 € . I (® SA — (address) of this permit by the Village, the Owner agrees as follows: APPRo4c -t • 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 reco of Dade County Florida by the Village Manager of Miami Shores Village (or his fully autho • ed re tative). ���uI d SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE o ti SIGNED. SEALED AND DELIVERED in the presence of: 2 os . i PU 9 er FIDIAS J. LOPEZ * MY COMMISSION # OD 385028 EXPIRES: February 19, 2009 Bonded Tara Budget Notary Solon Issue Date: 12/1/2005 Owner's Name: LINA BERMUDEZ Permit Type: Driveways /Sidewalks /Slabs Work Classification: New Job Address: 124 110 Street NE Additional Information Miami Shores Village, FL 33161- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 08/24/2006 Contractor(s) RELIABLE CONCRETE CORP. Phone 305/229 -4945 Primary Contractor Yes Type of Work: PLAIN CONCRETE DRIVEW Additional Info: 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Bond Type - Owners Bond CCF Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $300.00 $1.26 $0.42 $123.50 $3.00 $2.50 $430.68 Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: DS -12 -05 -1046 Phone: (305)758 -1427 1121360040420 Lot: PB: Total Square Feet: 970 Total Valuation: $ 2,100.00 Required Inspections Foundation Sidewalk Landscaping Final Invoice Number Amt Due Amt Paid DS 12 05 1136 $430.68 $50.00 Total: ,,, c---g- Z 1 c�� a DEC 0 7 PAID 1 G 4-5 -t4r50. 6E3 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. .'9:i _ • Vs-i , _ k. • 4 11‘•1 144"4 BASED FLOOD ELEV.: • • •• •• • •• • • • • • T Y SC ..o.. • 1 • • • ••• • • • '�t " r • s �, • \s¢ ! t (7C-