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DS-09-1753Miami Shores Village Building Department 10050 N.E;2nd Avenue, Miami Shores, Florida. 33138. Tel: (305) 795:2204 Fax: (305) 756.8972 INSPECTION'S PRONE NUMBER: (305) 762A949 BUILDING PERMIT APPLICATION Permit T FB°C 20 BIJILJING ROOFING Permit No. 4 S —07-/7,c3 Mast Permit No. Owner's. Name (Fee Simple. Titleholder) 'O2I fietz- 4.44w J 2 Phone # 3'5 7 g8 $ A 7 7 . Owner's Address City dv e . -)-ri . / State 0 4 C . zip ej j fcf 7 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 'Z' ,y . 1/7 S 7Xe e 7" City M hores is x►i S Village Co m -D ylia ade Zip `'7 �j is s FOLIO / PARCEL # _ /_.2 - G o 7, Is Building Historically Designated YES NO X Flood Zone Contractor's Company Name / 7- Contractor's Address City i / i . / • C State ,[y Zip -7 7 z 7 f 55' Qualifier Name cam' �� .7 14 Phone # ' 0 5 9c/ 4/ ( State Certificate or Registration No . 6 - 0 : To 0-74r g Certificate of Competency No Contact Phone C o 5 (/e?q 'e ors E -mail AZ to 2 , ),,,„1 4ov ; C© .- Architect/Engineer's Name if applicable) ( Phone # - Value of Work For this Permit $ Type of Work: DAddition Describe Work! Submittal Fee $ Permit Fee $ 150 IN .c er ° Phone # 34 q 9e/ cic# Square / Linear Footage Of Work: QAlteration QNew 0 .' Repair/Replace 0 Demolition e '. ze 1 /cen ;7" 5 1t9 ec / - 7 3 CCF•S CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ aCC) : Radon $ DPBR $ Bond $ Double Fee $ Violation date: ✓✓yy Structural Review, $ Total Fee Nov Due $ ebb-) See Reverse side ---> Signature rsonally.known NOTARY PUB (Revised 07110 /07XRevised 06/10/2009) ersonally kno Sign : �' Print: / t: ° � �zt v"Zie`'t My Commission Exp s�t�" � tuCinsiwrn►va 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 pennit to do the work and installations as indicated. I certify that no work or installation has commenced prior tci the issuance of a permit and that all work will be performed . to meet the . standards of all laws regulating u construction in this j 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 FNANCING,: 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 applic mt 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 rei eation fee will be charged. Owner or Agent The foregoing instrument was acknowledged before methis 2- day of ' v(o , 20(2(2, c , by i-c tQ / ,2'+ ," 1"i who is . • me or who has. produced As identification and who did take an oath, C: Sign: Print: My Commission Expires: ,, 4 Vi P � •• LUCIA SANTANA a1 Y is =.• !_ -� ;+: MY COMMISSION #05932659 EXPIRES: October 13, 2013 Y Bonded Thru Notary Public Underwriters re 4 APPROVED $Y mac) . Contractor The foregoing instrument was acknowledged before me this:Z.a day of r7cov , 20 , by - j t C&e `� �. who ' _ ; to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: so ▪ MY COMMISSION # D1 932659 ..- �,., EXPIRES: October 13.2013 c "•' Bonded Thru Notary Public Underwriters r .: ***** 3r*9r9r9Y3r, ti**Re*3e4ik4r :tr9FkyFde9r3air3cFar4c*:h Plans Examiner Zoning Engineer Clerk checked Inspection Number: INSP- 127756 Permit Number: DS -10 -09 -1753 Scheduled Inspection Date: August 24, 2010 Inspector: Bruhn, Norman Owner: Job Address: 52 NW 111 Street Project <NONE> Miami Shores, FL 33168 -4322 Contractor: True Stamped Concrete LLC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Stamped concrete driveway and approaches. Passedli��� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 23, 2010 For Inspections please call: (305)762 -4949 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360030370 Phone: (305)494-4465 Page 2 of 35 MOM Min MOM MEI woman O w r3 a e3 malt 0� 4 a worm emewal MINIM mommell aMR m wwwww T.4 original f ofiict on nand and Of.'iel � i r RK, of Ctresltf and Coalty Courts WITNES Sy This Instrument Pr pared By: Name e6.466 Address v2.. // c q- r Permit No. STATE OF COUNTY OF NOTICE OF COMMENCEMENT 6. Lender a. Name and address: b. Phone number: C. ,u 0 C THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of 1. Description of property: (legal description of property, and street addresi if available) .i 2 avu� i// 5 T ` r . j S 4D4, i° s ,r . 2. General description of improvement: S l- e7.e.1 . G O' " e Oic. / c.et4,, 3. Owner information a. Name and address: A of /C-e„..,e-/r -. E.eZ /OC/c'O 4/4/ '27. b. Interest in property: ®a/pt.r,Z.. c. Name and address of fee simple titleholder (if other than owner): 4. Contractor: a. Name and address: b. Phone number: ' ®5 v9e( Cif J' 6 5. Surety C{ a. Name and address: b. Amount of bond $ c. Phone number: 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: a. Name and address: /w b. Phone number: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienors Notice as provided In Section 7.13.13(1)(b), Florida Statutes: a. Name and address: b. Phone number: 9. Expiration date of notice of commencement (the expiration date is 1 year from 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 YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF t;0MMENCEMENT. WILLIAM TRUtb, MY•COMMISSION #DD834b FIRES: OCT 27 2012 Banded through 1st State Insurance The foregoing instr acknowledged before me this e/L/�1 _ __(name of person) as authority, ...e.g. officer, trustee, attorney In fact) for behalf of whom Ins twas - exbcuted), STATE OF FLORIDA, COUNTY OF DADS 9 vN y iHEREBYCERi`IIF'Y 1 6 : opy � �• e 1t K 0' ✓,,r :� Under penalties of per(uury, I declare that I have read th4 foreg knowledge and belief. Tax Folio No, 1 I d 1 R6 1 03 Signature of Owner Owner's Authorized O Partner /Manager Signatory's Title /Office /) day of /v t.' year) by (lyre of (name of party on Slgrtature of Notary Public -State of Florida Print, Type, or Stamp - Commissioned Name of Notary Public Commission Number Personally Known' or Produced identification Verification Pursuant to Section 92.625. Florida Statutes In It are true to the besr of my end that the fags sta Signature of lu al Person Signing Abo APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: Nelly Fernandez AGENT: True Stamped Concrete MAILING ADDRESS: 4211 SW 99 Ave Miami, FL 33165 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)0) OR 489.552, FLORIDA 3TArurES. IT IS THE APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. LOT: 5 SUBDIVISION: Miami Shores PROPERTY ID #: 11- 2136 -003 -0370 PROPERTY SIZE: 0.20 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM [X] Existing System [ ] Abandonment IS SEWER AVAILABLE AS PER 381.0065, FS? PROPERTY ADDRESS: 52 NW 111 St Miami, FL 33165 DIRECTIONS TO PROPERTY: East on Coral Way take Palmetto N to 103 St take 103 St go East to Na 2 Ave turn left Dr to 11 1 St turn right look for 52 BUILDING INFORMATION: [X] RESIDENTIAL Type of Establishment [ ] Floor /Equipment Drains SIGNATURE: DH 4015, 09/2006 (Previous Editions May Be Used) v 1.0.0 ACRES WATER SUPPLY: [ ]PRIVATE [ Y 4 N 1 No. of Bedrooms 3 [ ] Other (Specify) BLOCK: 220 PLATTED: 01/01/1949 ZONING: AP942008 [ ] Holding Tank [ ] Temporary [ ] COMMERCIAL Building Area Ft 1884 PERMIT #: DATE: APP DOC #: AP942008 PERMIT #: 13-SC-1077565 DATE PAID: 11/09/2009 FEE PAID: RECEIPT #: 13 -PID- 120268 [ ] Innovative [ ] TELEPHONE: 1 (305) 494 -4465 I/M OR EQUIVALENT: [ DISTANCE TO SEWER: 81131077565 OcA # Persons Served For This Unit 6 [ ]< =2000GPD [X] >2000GPD Total Design Flow AP R OED MIAMI-DADE COUNTY HEALTH DEPARTMENT q (2b9 DATE: 11/09/2009 Page 1 of 4 FT 300 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM Additional Notes and Comments: County Notes Fields: County Process #: County Permit #: Storage Box #: General Comments: This permit is ted. -.'a new stamped concrete driveway only. Does not have any impact on the existing OSTDS. o O.. pine Engine � r ED MIAMI-D COUNTY t F1G - v 1.0.0 AP9 42008 51D1077565 APP DOC #: AP942008 PERMIT NO. 13- SC-1077565 DATE PAID: 11/09/2009 FEE PAID: 70.00 RECEIPT #: 13 -PID- 1202688 STATE OF FLORIDA COUNTY OF DADE Further, Affiant sayeth naught. ass (sign and print) Miami Shores Village 10050 Northeast Second Avenue Miami Shores, Florida 33138 -2382 Telephone: (305) 795 -2207 Fax: (305) 756 -8972 www.miamishoresvillage.com The undersigned Affiant, • Cnti owl does here by attest that the attached survey, performed by eV 2 v 4 - e" .5 /'. C - performed on Q6- C(_ 2 fie(! , is an accurate represenation of the existing conditions and locations of all Structures on the property as of this date. 1,3 AFFIDAVIT The purpose of the 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 may now 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 effect final inspections as applicable to this or other permits. 4 f/A 1 M---— 4144 4 Affil operliOwne va Witnes (sign and print) SWORN TO AND SUBSCRIBED before me this 2 g•( day of 0 t t ( 2 Do Affiant is personally known to me, produced F(, l ' 0 I F as S 0 as identification. Miami Shores Village 10050 Northeast Second Avenue Miami Shores, Florida 33138-2382 Telephone: (305) 795 -2207 Fax: (305) 756 -8972 www.miamishoresvillage.com COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, ° L . i _ i_ • � , hereinafter referred to as the Owner of the following owner) c-Z 4/6- �//7 y .ef «- / 5e dit- f �L Legal description/folio#. KekitP,2 e / i/ 4 0 0 3 0 3' 7 0 Lot described property: Block 2 0 Subdivision 11/44/ �7 Tax Folio #: // 2y / ti D 0 3O 370 Requests permission to install: X Asphalt, concrete, brick pavers ❑ Landscaping ❑ Other Within the public road right of way of A1' //l 57, € e (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 includng 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 dsposal 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 (or his fully authorized representative). SIGNED, SEALED, AND DELIVERED in the presence of: SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this n fr WILLIAM TRUEBA MY COMMISSION #DD834517 EXPIRES: OCT 27, 2012 Bonded through 1st Statednsurance IW LJ ' 1-1,1g V .ZZ • • • • • • • • • • • • • V • • • • • • • • • • An ow It-/l d1J 1p Jo • • • • • • • •• •• • • •• __••• • 1-.0 • • • ___• • ••• • • • • • • 1 • OZZ • >130143 17101 • • • • 710 mg I 41.1. ON IMINS 1.. _ .ON ARAMS 1 L .1-1441 Oz elms A3ALUIS ALIVCIN1108 - SHOA3AIMS ONT1 Mit 0.111fiattlitii ilitiliq ZIO 014 Or/Cell j -ro 12' I To - rD i ro OZZ >0019 - 101 Sit 6\ A 0 R . D 1Vi S M ■ vi,Jeted 2-i Pic4A% 1401„,ii4 irk/ tooto-tla(sow:xu • 4LlidleZ (SOO aNCHe1131. 9ZIAte VW:VW %mom zoom= lamas 8S PER M 1 l #: 5- l - 11_5 Pvliami Shores Village APPROVED BY DATE ZONING DEPT 1 14 0 BLClr DEPT ' - 'IL /, 4, _J C :, T= . ' FEDERAL • • • • • • • • • • • • • • •••• • •• • • •••• • • • • •• • •••• • • • • •• • •••• •••• • • • • •• •• •• • • • • • • • •••• • • • • • • •••• • • • • • • . •• • • •• • • • •••• `.4; BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Roofing Owner's Name (Fee Simple Titleholder) Owner's Address / 0 (--/ CI ® , •%(4./ Value of Work For this Permit $ CT Usi Miami Sho - s Village Building Department f0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 / Alt PermitNo.0S_10 Master Permit No. City , 19 /1 ( State Zip Tenant/Lessee Name Phone # /Job Address (where the work is being done) 5 /1/(.(/ / S 7" City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # // 0 0 3 0" 10 �� I I I I • ` ' Is Building Historically Designated YES NO ' l - �n n,S1 Contractor's Company Name � �-..c., ec ✓l,.e/r – Phone # (..! D j) ( / &y P 6( Q Contractor's Address g 3 Z o G 3 r c, 77 l Cit %h / 1- ,,✓/ / State o' G Zip 3 /STS Qualifier Name &,/ /G - ► 7,2_ � i, Phone # C.27 �� ��� C/ b State Certificate or Registration No. f "n 7 QQ 7 (-(y Certificate of Competency No. 6O TO 0 7 Architect/Engineer's Name (if applicable) lei( L 6f/ 7;" Phone # ( o -) l� wig- /goo' Square / Linear Footage Of Work: Trainina//Education Fee $ • 69 0 Technoloav Fee $ * Type of Work: ❑Addition ['Alteration !Li New ❑ Repair/Replace ❑ Demolition Describe Work: 7 -4a0 r 0 t c e ("e., ojgt a/c mi l/ „9,1,41 ** * * ** * * *�� **********************F ** , * ** **,t**,t***, ***F ** * * ******** ** * * * **** ** ** ** ************* * ** Submittal Fee $ U U L Permit Fee $ B U CCF $ 1 V CO /CC Notary $ u. 2 Lo 45 109, (n(0 Bonding Company's Name (if applicable) ilL'(� Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) (AL 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 wil be charged Signature Owner or A t Contractor The foregoing instrument was acknowledged before me this (' The foregoing instrument was acknowledged before me this day of 0 e.7` , 20 ®q, by , day of OC 7 , 20 4by 44 0-,-- ( I& me or who has produced who is ersonally known me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: As identification and who did take an oath. WIWAM TRUEBA MY COMMISSION #DD834517 My Commission Expires: 6 7 ( 2.(2/2-- APPLICATION APPROVED BY: Signature NOTARY PUBLIC: Sign: / Print: 4.6 ;6 My Commission Expires: o e 7 2.0 ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ,W= �4 Y P4 • ILLJA 1 RU EBA a' Gn MY COMMISSION #0 D83 4 517 EXPIRES: OCr 27, 2012 n ist State Insurance a ///) Plans Examiner Engineer Zoning Permit No: 09 -/ Job Name: /O of . , 2009 Building Critique Sheet am. e hies/z9n11 i)eez,e:,-,e01 Norman Bruhn CBO 305 - 795 -2204 M iami Shores Vuiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings.