DS-07-109Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Date: 08/21/2007
Inspector: Grande, Claudio
Owner: FABRICANT, MICHAEL & LORETTA
Job Address: 622 97 Street NE
Miami Shores, FL 33138-2471
Project: <NONE>
Contractor: CHAMPION CONCRETE
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: New
Block:
Phone Number
Parcel Number 1132060171670
Lot:
Phone: (305)252-8055
Building Department Comments
OLD CHICAGO BRICKS
0 Z Z
Passed Co., tiq
Inspector Comments
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled
re-inspection fee is paid .
until
Monday, August 20, 2007
Page 2 of 2
Miami Shores Village ��1
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING M O M ET Permit No.
PERMIT APPLICATION J; N 2 2 200? aster Permit No.
FBC 2004 B Y.
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple i - ' o ` s er
MILtT
Owner's Address j 622- t4 - r
City j( S(4O State rt-CIP-ArOPt
Tenant/Lessee Name
Phone #
Zip 3319,,8
Phone #
Job Address (where the work is being done)
City Miami Shores Village
6ZtiNe��
County Miami -Dade
FOLIO / PARCEL # R11U 4 s 6
Zip 331'18"
Is Building Historically Designated YES NO
Contractor's Company Name Cilicitir I OA) £t-e'7 Phone # 3tJ5 2S2- e2J f
Contractor's Address - /k "7-004A.
.
City 11-0 State Zip 3 31 en
Qualifier Name J L 0 Phone # 3‘.6. c re-1-3
State Certificate or Registration No. Certificate of Competency No. C> e› 815
Architect/Engineer's Name (if applicable)
Phone #
Value of Work For this Permit $ 3,6'0
Type of Work: DAddition
Describe Work:
❑Alteration
4
Square / Linear Footage Of Work: i 7 / v../ar
❑New
❑ Repair/Replace ❑ Demolition
* * **** **4ir, *** **.t** ** *qtr ** ** * ** *Fees :*** * ** pie* **,t** ****** **** *** *i ** *** * * *** *** *sip
Submittal Fee $ • Permit Fee $
Notary $ Training/Education Fee $ C�
CCF $ CO /CC
Technology Fee $ J 2-
Scanning $ , I' ` Radon $ DPBR $ Zoning $
Bond $ Zeode Enforcement $ Double Fee $
a
Structural Review. $ Total Fee Now Due $ 4-31 3 2
See Reverse side
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 1 ust be posted at the job-site
for the first inspection which occurs seven (7) days after the building permit is issued In the abse ' of such posted notice, the
inspection will not be ap'roved and a reinspection fee will be charged
Signature
k:v
Owner or Agen
The foregoing instrument was acknowledged before me this (�
day of rA 20 a by IA% CViN�Lr21(i� ,
who is personal! known to me or who has produced
fl(92' I2rA0As identification and who did take an oath.
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of —.)V-4/0047 , 200) , by 41'"f i'Ve- 615744
who is personally knownppo me or who has produced /Dt,
6 140 -'f?f L3,,gentification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC STATE OF FLORIDA N
Gisela Basilic)
Commissltn # DD491643
ExpiNgl NM 17, 2009
e_\ Print:
My Commission Expires: ill tip I t!!) 'i
Sign:
Print
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. It" 32O b -Or - t�`�E}
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that impro
property, and in accordance with Chapter 71
is provided in this Notice of Commencem
111111i111111111111111111101
(: FN 200780 0071 n91
OR 2k 25296 Ps 1302; [fps)
RECORDED 01/22/2007 14:36 :09
HARVEY RUVIN? CLERK OF COURT
MIAMI -DADE COUNTY? FLORIDA
LAST F'AGE
STATE Of FLORIDA, COUNTY OF DADE
t
oIFY that this i > f copy of
n nalfiled ;m00%
HERE o �►_
orida Statuteaq s'Ramie s i '
By _..
1. Legal description of property and street/address:
MIkwt 9.1-017 -S SEX-- M n tS 1 K
LOr t' 4 wit 4F 3- .-w- IQ()
2. Description of improvement: e,OA/iV�f
3. Owner(s) name and address: l2 2-2_ Re 011ru 5n
WaftA _ E tC". 1 MtAM.i SIkEQE %L 35158
Interest in property: �n
Name and address of fee simple titleholder: MtC(fikl✓L ZJ-
62-2 1 S•112 r AktAivq f �2.. sl t s P
4. Contractor's name and address:JA/ -le- ��ji 0 /J)g,4-. CW $i t %,1 i e 'o
1,5&3D stwo 11-f r Ta a_ 1,444 33,
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 daepe ified)
Anat e of Owner
Print Owner's Name X t f t ill }-4612-10(4f<
Sworn to and subscribed before me this L day of t., set , 20
Notary Public
Print Notary's Name
My commission expires:
123.01-52 PAGE 4 8(02
e e.-k RtFUBI ` `TOTE OF FLORIIJA
t k I 1 72 l '1 U i G i3 dx8 Basilic)
Commission # DD491643
Expires: NOV 11L2009
gdittied Mt i! 11& figiiiiiiiii sgasi i
Prepared by- Al At t._ 445/LI
Address: 15 Q Jai 1 d'7e
A vvo -5-3)q.6
• flhami SIwr iLLac�e
STATE OF FLORIDA)
COUNTY OF DADE)
f,I1 G 3 (The undersigned Affiant, , does hereby attest that the
attached survey, performed by
(property owner)
IQ f riNikKici ,. stA140 \oxs , IR1 G�
(name of surveyor's company)
performed on 6 I Q0 , is an accurate representation of the existing conditions and
(date of i
e3')
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.
Wi ess( gn and prin
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this 1 el day of • 6106'7
Affiant is personally known to me, produced 1)1,0 f (92." } -'7-g .2.66-0 as identification.
NOTARY PUBL'C STATE OF FLORIDA
Gs�^1a Basilio
Commission # DD491643
Expires: Ndg O � 9 Bonded T rA ntleBeninE
Yl'Qiarni SIiorc$ Elay=
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138-2382
Telephone: (3O5j 795 -2207.
Fax: (3051756.- 8972......:
irgortcrt
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, lA t(,4@- C ikeit24 G , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio #: 11— 324 (9-017 ' 1 0
Lot 5 A Y or Block 0 0 Subdivision M *AA StAaoz sQ `( /(+® /4'11
Tax Folio #: 1 1-320(0 -0l}- l6
requests permission to install:
halt, concrete, brick pavers
ndscaping
[ ] Other
within the public road right of way of
(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'tiie 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, S, S§SIAR,preikCsIfg136,11946FKNOWLEDGE on this 1: d of JAN %.1 ?-`1 21-
Gisela Basilio
Commission # DD491643
Expires: NOV. 17, 2009
Bonded Thru Atlantic Bonding Co., Inc.
SIGNED. SEALED AND DELIVERED in the presence of
n
LL
)
ni
•
5/8" LR.
CAP /5390
SW CORNER
OF LOT 13
BLOCK 101
75.00' P.
75.84' M.
O
cat,
NW 97TH STREET
75' R/W
(IMPROVED)
Legal Description
Lot 8, Block 100, AMENDED PLAT
OF MIAMI SNORES SEC71ON NO. 4,
according to the plat thereof, as
recorded in Plot Book 15, Page 14,
of the Public Records of Dade
County, Florida
Community Number. 120852
Panes: 0093
Suffix J F.I.R.M. Date: 3/2/1994
Flood Zone: X
Field Work: •5 /2004 Completed:
5/10/2004 • •
• • • ••• • ••
:•Glertll?ed To: ••••
• • •
• •
• 12cee to Fabrf t ; %tichael
ifabricant; Coconut Grove Title.
Obrnpany, Low Offices of PIMP €! •
•.•Kowr°wesh, P.A..b AttOmeys' jiile • •
Asura ce Fut14 MO Wash m t
• 1Lfud/ Bank, .A., IPs suc
•dhd)'elr asslgg &• • i •••• • •
• •Pribrve ty Address:
• 622 lortheost 97th Street •
• •Miami• Shores, Florida 33139
•
•Survey Number 0112971d •••.
•••• • •
• •
• •
gCALC. PT.
BOUNDARY SURVEY
0 15 30
30 21.6;i1M16;11111111.11111.111.
GRAPHIC SCALE (In Feet)
AV1L» 1 inch = 30 ft.
1 II COUNINKE WITH PL ASTARESE1G118 t1ff IP LOCATION OF
EASEMENTSORWOHTOP4VAYOPRECOMOINERTHANTINEWORRECOW
PLAT, 1AWA TIONARL3TBE TO
NEST 25'
OF LOT 9
BLOCK 10
0.77'
25.0'
FD.
5/8' I.R.
Property Address:
622 Northeast 97th Street
Miami Shores, Florida 33136
Survey Number 0- 129710
12
BLOCK 100
GENERAL NOTES:
1) LEOALOEICRPTIONTWOWIWOYOTHERIL
4 714161•1181000111EREONWERENOTAISTRACTEDFOREASEMOM3
ONr17TN WICUMBRANCESNOT ONINEMAT:
8) PORTKESOFFOOTIUO4FTO TION8WP01TIER
OPROVEMIKTOWERENOTLCCATWI
4 WALL 1ESAREJG7HEPAIA:OF71LEWMLAA8
AAWNWTOOEWWED =WOW LEER
4) NOTVALIDOWORMT1HEIWWATIWERawmALRANDSE4LCIFAFLORMA
LICINIEDEURVEMANDIEAPPEIL
6) OVLYVISSLEISKROACIWEIRSLOCATEL
7) 11O97BRIi A7ICIVFOA1WOWPAl R7YG 14 B Yt
8) SROVRI YIWPLATAAWIWs180 1ED0Mf'88OTWOOWIE87TOWIt
• FEKOEOSSINSIVISOTOEITIMINEO.
10 les•VA1WNSF ARE9AW•LLIYN.6 V..o. ADTEDt
11) IWNITIMERERTROXIWTOLMENOTEDRIL
1
TWESIEWEYDEPICRWIRREFTWWIACLIXEDGEOHEIRWIW1URE
9e MA I I N I W O . D v v u m , 4 D f r * r w I M O T A I AMU,*
75.00' P.
75.40' M.
1
BL
LEGEND
04200
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item ERERETICHANW
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