BP-04-1503as 1 \\ 1 a Miami Shores Village
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
t`
Owner's Name (Fee Simple Titleholder) ) I{ S 3 l {,'t l 0 t$ Phone #
Owner's Address 6� t • °' . \ \ \ ST->
Ci ty M A /41k J 40 e3 State e L, Zip 33 t ‘,X
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 07D 1 C ( L
City Miami Shores Village County Miami Dade Zip 336
Is Building Historically Designated YES NO
Contractor's Company
Contractor's A
City
Qualifier 1c;a -c
Submittal Fee $
Total Fee Now Due $
(Continued on opposite side)
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. — 1503
Master Permit No.
Notary $ —
Scanning $ et
Code Enforcement $
r 1 , iZ V-f Phone # Rs 4- - -
State
Type of Work: ❑Addition DAlteration
Describe Work: n € ()C
ONew
Zip 3
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit Square Footage Of Work: CJCO
❑ Repair/Replace 0 Demolition
* * * * * * * * * * * * * *** * * * * * *** * * **F * * * ** * * * * * ** *its * * * * ** * * *** * * **
.0C) Permit Fee $ / 7 0 CCF $ 58 C
Training/Education Fee S 1 , 0 Technology Fee $ 3, 7 C
Radon $ Bond $ '3 00
Structural Plan Review. $
c1
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 t� 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 FT FCTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONIImONERS, 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 no e approved anal a reinspecdon fee will be charged •
Signature
..r/ t
Od�her or Agent
The foregoing instrument was acknowledged before me this tj As identification and who .. take an oath.
NOT ' Yr i i : � r /
Sign: , .iF;1
Print. IL% Ma t ! e ' "i
day of _AIDAL___, 200 , by =,�', :91 Pi
who is personally known to me or who has produced
Si
Contractor
The foregoing instrument was acknowledged before me this 15
day of 20 by � /ID eJc
who is personallvicnown to me or who has produced
as identification and who did take an oath.
Martha L. HeiY PUBLI (•
Commission # DD353557 Sign: i * ■
- M g, 2048
Bonded T6ra
. , n, nn Print:
g Co., Inc.
My Co ' u'on Expires:
n„
My Commission Expires: /7/ F a '
* * * **** . : * * * ** * * * * * * * *` * * ** * *** *** ** ** * * * * *, ************* * * ** * * * * ** * * * * * **•* * * ** * * ** * * **
(Certificate j of Competency Holder)
State Certificate or Registration No.C3 Lro ."3 `� �5 Certificate of Competency No.
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc 10/14/03
�9G_ i7 ,/d �y
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
NOV 17 2004
Plans Examiner
Engineer
Zoning
1 .4 r • 'I. ..7
A. stie lli 0 ff
..4"S T/13‘1 4 : 4
•ilo RID?.
STATE OF FLORIDA)
COUNTY OF DADE) .•
The undersigned Affiant, Mit6 S116).-1
• • • AFFIDAVIT
\• 1 &Ifni .._)h.oreJ Vitt/age
. „
locations of all structures on the property as of this date.
• . •
(property owner)
• •
. • :
does hereby attest that the
attached survey, performed by LA14146 A- gill26
(name ofsury • ' Company)
• t is an accurate represtntaticm of the existing conditions apd
of survey)
. •
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 naughi
Witnesgsign and print)
operty
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me thisi_a_day of AkAl
Affiant is personally known to me, -•"" produced b • L '
. • :
as identification.
("ee A alfte-L''
•wner
Martha L. Hernandez
IR ...t Commission # DD353$57
1:1'. ;41Expirer. SEP, 08, 2001
-74e.
Bnaded ran
Aa. •• ,•,_ c __,...
....u.a.DI .
• .
Miami SIiorp /�ag
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, p
��aG � l Dt-4)14 , hereinafter referred to as the owner of the
(owner)
following described property:
Legal description/folio #: € alao CYcnt)
Lot A Block Subdivision IVO JIM
Tax Folio #:
requests permission to install:
[ J Asphalt, concrete, brick pavers
[ J Landscaping
[) Other SIM c 4Cfc
within the public road right of way of ) t u k It
SIGNED. SEALED AND DELIVERED in the presence of:
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (3051756 -8972
p� L4
� PPg o4Cti.
Gcs:
3316 L
(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).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this day of
en; Martha L Herad
-.' `4A. Commission # DD333387
�o; Expires: SEP. 08, 2008
",0 41° Bo Than
Atlantic Bonding Co., Ice,
• .
•
7't
••.:
4'
. A • • . .. • ..
• •I • '
•'• •.! •
,
Not valid unless embossed
with Surveyor's .Seal.
T2 i.... Block
,:IL
Thiglroperty,desoribedas:
tot ,
NEW /AMVSHORES.E$TATES,
accordingHto the'Plat . •
thereof, as recordOd in
Plat..Hook%51, PageF80
of -Public Records of
Dadej%County;' ' .
••:; I • ..t ...b . : . '
NOTE tt...UndergrOundllncroachments,
ifipy: not locatet
; :.. -:''.. . •
. •,,.. ,. , .... 1;
:. . , 4.•. ., • - .: • „LI" • '• '..... •
Certified First
MOrgage'Corporatibn, Home Title
Compapy,:and AoUrirand Marie
Simeon and Ed011itid!Charles.:
• • i.73,0: i • . , .
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. , : "1: • ;, • • 4 s . M Pl•
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.:.' - .-446/ dr ../ I
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4 • o> c. , e , ... , ,e - , . .# ' '' 7 l'.? .... . . ..
; 4 nOUNInhiav • SURVEY .
I hereby certify that the survey repre.
tented hereon meets the minimum
technical standards set' forth by the
Board of Land Surveyors pursuant to
Section 472.027, Ha. Statutes. There are
no enuoachrrtents,overlaps. easements
appearing on the Piet, other than as
showr hereto. . • •
• ft CtA.u..94.
Fa Beg. Land Surveyor No.....
sk/C23 tt b *W bc:14,4.t0.1-
1/' 7P 7-&-
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6 .../..aed,770N. -'5674
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PROPERTY.!0 EinteoraEoland Marie * nd charlea`, . Edouard, 255 N . W. 1 1 rth Street
•
DRWG. NO
187-5197
LANN •avid feiA ah
IN
•
ENGINEERS LAND SURVEYORS - LAND PLANNERS :I
s
Office address: 4080 S.W. 84th Avenue, Miami, Florida 33155
....Mailing address: P.O. Box 561131, Miami, Florida 33156
NOTICE OF COMMENCEMENT
A RECORDED COPY MIST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOUO NO, II 1 h Cb I C6
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that Improvements will be made to certain real
property, 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: LOT }1 6L-0C4
Mt 1\ a1 Sr1ste3
6d. 111 Ste'• fkMI r� I E1.
2. Description of Improvement: / 1' �� t-E 'K' °A /
3. Owner(s) name and address: Merk 1 .S I M 60i
Interest in property: r S . �• �•
Name and address of fee simple titleholder. •
4. Contractor's naj a and address:
lie
5. Surety: (Payment bond required by own - r from contractor, i ., , OF FLORIDA. COUNTY OF DADE
Name and address: •
Amount of bond $ ►�'P.
6. Lender's name and address: wirnF t My hair( .1 d 2 , 4 0111 c
ri. �nve it and Couniy Courts
7. Persons within the state of Florida designated by Owner upon
provided by Secgon 713.13(1)07., Florida Statutes,
Name and address:
8. In addition to himself, Owners designates the following person(s) to reoelve a copy of the Uenor's Notice as provid
In Section 713.13(1)(b), Florida Statutes.
Name•and address:
9. Expiratl
differe / e Ifi
ate of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless
Notary Public -
Print Notary's. N
My commission expires:
125.0142 P? E 4 WO2
• •S gnature of Owner
.Print Owner's Name
Sworn to and subscribed before me
6/ Oct— 15o3
1�(
1 kffriE_3Y CERTIFY that this pyofthe
IMI11lIlII•11111I11
FN 2004-R1026645
D.
Bk 22835 Ps 11096 tips)
RECORDED 11/18/2004 14:39 :03
HARVEY RUVIH, CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
LAST PAGE
D.C.
notices or other documents may be served a!
Prepared by 5;6044 (Z
IS day of )41,)t) 2Q _C_
H
Commissioa # DD33t1 9ress.
.iiiExplres: SEP. 08, 2008
jaea no
Bonding .o., ha.
44 Martha L. ernandez g j ,,.� ni
Arecthl
a
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 11 /30/2004
Applicant: MARIE
Owner: SIMEON
JOB ADDRESS: 255
Contractor BEAUTIFUL CONCRETE
Local Phone: 954- 693 -7777
Parcel # 1121360010690
NW 111
Signed: (INSPECTOR)
Building Permit
Permit Number: BP2004 -1503
SIMEON
MARIE
ST
Contractor's Address: 1868 N . UNIVERSITY DR. #100
Legal Description: NEW MIAMI SHORES ESTS PB 51 - 80 LOT 21
Permit Status: APPROVED Permit Expiration: 5/15/2005 Construction Value: $6,000.00
Work: INSTALLATION OF STAMPED CONCRETE DRIVEWAY
Page 1 of 1
BLK 3 LOT SIZE 75.000 X
Fees:
FEE2004 -11806
FEE2004 -11807
FEE2004 -11808
FEE2004 -11809
FEE2004 -11810
FEE2004 -11811
FEE2004 -11812
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Builders Bond
Submittal Fee
Total Fees:
Amount
$150.00
$3.60
$1.20
$3.75
$9.00
$300.00
($50.00)
$417.55
Total Fees: $417.55
Total Receipts: $0.00
00°
DEC 13 PAID
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:
8/15/2006
To: Current Owner
255 NW 111 Street
Miami Shores Village, FL 33138-
Dear Sir or Madam
Mabel Vargas
Administrative Assistant
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 • Fax; (305)756 -8972
Permit: BP2004 -1503
Address:255 NW 111 Street Miami Shores Village FL33138-
Date Expired: 6/21/2005
In order for us to serve you better, we need to keep our files up to date. Our records
indicate that the above reference Permit has expired.
The Building Department has determined that the work applied for has been completed
with out the required inspections and it has been more than 180 days since your last
approved inspection and thus your permit has expired as per Sec. 104.5.of the Florida
Building Code. You are required to renew your permit and schedule all required
inspections.
In the event you do not comply with the requirements herein, the Building Department
will file a complaint with Miami -Dade County Building Code Compliance Office for
possible disciplinary action against your licensed contractor And/or if permit was
obtained by the home owner the requirements of the Unsafe Structure Code of Miami
Dade County Sec. 8 -5. (3) will apply. "The building shall be presumed and deemed
unsafe and a permit shall be obtained to demolish the structure or bring the building in to
compliance with applicable codes as provided herein."
Please contact the Building Department, immediately upon receipt of this letter.