RC-05-1106BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Tenant/Lessee Name
$ Value of Work For this Permit
(Continued on opposite side)
Contractor's Company Name 0 � oC
Contractor's Address 0-5 c,e(""
City lr t S State .
Architect/Engineer's Name (if applicable)
Total Fee Now Due $ 438 • ED
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit NQ. _ 06
M ster Permit No.
Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Q.„, w 11 Phone # len 5 3 10 Z4-S LE-3
Owner's Address 6f1 9 i C. I o 5 "(' *_'T
CityMt. .-t State 9- Lot O4 Zip I3 TS"
Phone #
Job Address (where the work is being done) r1 L as ik'bo v,
City Miami Shores Village County Miami- de Zip
Is Building Historically Designated YES NO
Phone # CA-Sue
Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No. �-
Phone #
Square Footage Of Work: / o a 31,0
Type of Work: ['Addition Alteration []New 0 Repair/Replace 0 Demolition
Describe Work: CpPr da 6 c- ? -' o ,,, t1/4.40 @ car-®. 1.)0A, ` C °`.
****************************F
Submittal Fee $ Permit Fee $ (2J �/ ' CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Df�
`
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date: 02/13/2006
Inspector: Inspector, Default
Owner: HUMBLES, ROBERT
Job Address: 69 103 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Friday, February 10, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
P(. ne: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Patio
Phone Number
Parcel Number 1121360130970
Lot:
Page 1 of 2
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) C t
Mortgage Lender's Address Q L-o (9
City La -c,b, ti S State O t
Owner or Agent
The foregoing instrument was acknowledged before me this
day of(l V. ,2
who is personally known to me or who has produced
NOT
Si �1 /�
Print:k S Peft ,
APPLICATION APPROVED BY:
chc 05/13/03
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 AlN'1+'IDAVIT: 1 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
by i.}.Aotes ,
As identification and who did take an oath.
Zip
Gilda P@Y2 .NOTARY PUBLIC:
,44:114,„ 73065
Signature
Zip /4-322- 4 °—
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 by
who is personally known to me or who has produced
as identification and who did take an oath.
r ; z; ; 1 uw uaatvu Tr �.� Sign:
;o" Etptres_ Dec. 7, ?3004 Print:
My Conunission Expires:
My Commission
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *j ** IK ** * ** 5 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Plans Examiner
Engineer
Zoning
'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, H�w.�Ol� S , does hereby attest that the
(property owner) •
attached survey, performed by G € N q•-t4.• sa tLL V t c s G ea
(name of surveyor's company)
•
performed on 0 7 / 7/r 3 , is an accurate representation of the existing conditions and
(dafe 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 this or other permits..
Further, Affiant sayeth naught.
Witness(sign and print) ) p ,_ Witness(sign and print) yw erce d es
SWORN TO AND SUBSCRIBED before me this - D,:r4 day of Pei
Affiant is _ persona11y known to me, produced
„.` Y 1, Glide Pereda
'a ' .. '• : 6 : Commission # DD273065
5 . .1�•.:0 Expires: Dec. 7, 2007
I ,,9 hn 1-800-350-Aaron
.800.350 -5
Thiarni SIjor Vi!ag,
A�an t/Property owner
Notary
tification.
Issue Date: 12/19/2005
Owner's Name: ROBERT HUMBLES
Permit Type: Residential Construction
Work Classification: Patio
Job Address: 69 103 Street NE
Comments:
CONCRETE PATIO AROUND POOL
Additional Information
Miami Shores Village, FL 33138-
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 12/05/2006
Contractor(s)
HOME OWNER
Phone
Primary Contractor
Yes
Type of Construction: CONCRETE PATIO A
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted:
Certificate Date: 12/5/2005
Occupancy:
Exterior.
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
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
Miscellaneous Fee
Permit Fee - Additions /Alterations
Scanning Fee
Technology Fee
Total:
Amount
$300.00
$1.20
$0.40
$25.00
$100.00
$9.00
$3.20
$438.80
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: RC -12-05 -1106
Phone:
1121360130970
Lot:
PB:
Total Square Feet:
Total Valuation:
Required Inspections
1000
$ 1,200.00
Slab
Final
Invoice Number
RC - 12 - 05 - 23146
Total:
DEC 19 PAID
GK -44- 1043
Amt Due
$438.80
Amt Paid
4 38.110
r0
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.
JOB ADDRESS:
6 ? M 1
APPLICANT:
ZONING CRITIQUE SHEET
APPLICATION:
lL„ 2_ Po.0
DAT COMMENTS Q ` INITIALS
6, ■ ,A" 67 7/). P.t., t„x1.4.2-e-i '244: 0 4
T
r ta:AQ_ 0_ < ft, 4lim 4 :J -P S GJ..le.
;So , . , z _ L r f - o z l � f 3 it 4 I . ' ' 4
PERMIT # ) kJ Ce
_e'�SK ITCH OF SURVEY
(BOUNDARY SURVEY)
PIP g
0w d
15.00
ALLEY
SCALE: 1"
LOT 20
BLOCK 123
•
= 20:•
•
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•• • • • • • • • •• • • • • •
• • • . •PF:DPERT`a: •
ADDRESS G9 NE 103rd 5T. MIAMI.
FL. 33138
• • • • • • • • •
••• • •••
• • • • �1 • J r11SbN ;' AMENDED PLAT OF SECTION NO. 5 OF MIAMI SHORES • • • • • • • • • • •
• • • • • X47 _ • • • • • • • •
• • • • • • • •ACCORDING �'O THE PLAT THEREOF AS RECORDED IN PLAT BOOK AT PAGE • • • •
• . . .
OF THE RECORDS OF MIAMI -DADE COUNTY. FLORIDA. •4 �•� •
••• • • • • • ••
• . •
• •
•• • •• • • • • • ••
n-- .nom- n— ••n —n- ^0'a - ten — n
20.05'
26.35'
30.05'
• LOT 2(2 AND THE EAST 1/2 OF LOT 19
LOT 21
BLOCK 123
4.90'
0
"
123.15'
ONE STORY
RESIDENCE
N° G9
37.35'
wIrY CONC.
LO OT 11
L
x BLOCK 123
�X�— X— .X�.— Y— .— X�X�X. —X� •
123.10' x
0
REMA1D19t OF
LOT 19
BLOCK 123
38.00
LEGAL DESCRIPTION
10.10'
25.01'
PIP
OYIt
(N0 ID)
7.50'
• • ••• • • • •••
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ALARMS TO ®E PROVIDED ON
ALL DOORS AND WNDOWS WITH
DI}�GT ACCESS TO POOL DECK
'1$102
N.W. 103 STREET
All = PI Ats.I
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