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DS-11-2033Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 167940 Permit Number: DS -11 -11 -2033 Scheduled Inspection Date: March 19, 2012 Inspector: Bruhn, Norman Owner: AGOSTA, MARY Job Address: 200 GRAND Concourse Miami Shores, FL 33138 -2834 Project: <NONE> Contractor: PAVERS AND BRICKS SERVICES CORP Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132060133540 Phone: (305)986 -2544 Building Department Comments REPLACE EXISTING ASPHALT DRIVEWAY WITH BRICK PAVERS ON SAND BASE 11/22/11 - ON HOLD FOR BOUNCED BOND CHECK #677. 12/13/2011 - BOUNCE CHECK PAID. Passed 431f/g-/oc Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 166169. work exceeds permit provide revision. NB Cc March 16, 2012 For Inspections please call: (305)762 -4949 Page 6 of 19 119,d12- Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): ,/-t/ A-6057* Phone #: ruvi o D conic-0u f2.Scr • Address: City: /A / /MI Tenant/Lessee Name: Email: JAN -203 S /1od'ec5 State: FL Zip: 3 s / 3? Phone #: JOB ADDRESS: 2 0. 6/2.4 + 1 CO ", -' c V i �C City: Miami Shores County: Miami Dade Zip: 331 3,,f - Folio/Parcel #: Is the Building Historically Designated: Yes Flood Zone: CONTRACTOR: Company Name: )111/41E)2 -S t cCS - e1ZNi'c:c > / P A/✓/.Phone #: 2675 - ? ?G 'f c/3) /o Address: ° C /t/w / ,5, 5 f . City: ,/Vt Men i State: Zip: 3:31 Qualifier Name: NA- V L i>. FA-(y 'A-'D Phone #: 3°5- ? *'‘ . 7 cl 3 ((-) 72- State Certification or Registration #: �' " Certificate of Competency #: O( 13--S Contact Phone #: 11-S6 Lf ke 3 /-4,- " :4 Email Address: DESIGNER: Architect/Enginier Phone #: Value of Work for, this Pernut: - < Q 4) — Square/Linear Footage of Work :. 2 6 z (tom a" �4 ) 4 g Type of Work lAdaht "n UAlteration dNew URepair/Replace ❑Demolition Description f %Vor c: C . / W Al... K. ■/.{ -�( Acv :D ,kk 7 ,` 0 L-v'i -. 6 YL c- k P./i v& yt 5 o ******** * * * * * * * * * * * * * * * * * * * * * * * * * * *x * ** Fees************* *x * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ ,]-71.1: d CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 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. Signature Owner or Agent The foregoing instrument was acknowledged before me this / day of , 20 l 1 , by MA- r l II- 6 QSTA day of Signature 7&-ec-!---.4- Contractor The foregoing instrument was acknowledged before me this 3 , 2011 , by Y is -Af e who is personally known to me or who has produced who is personally known to me or who has produced As identifi kcan o '1 L ; tit ccoliSSION Fa(pIREs tiovembet 15,2015 as identificatioV,and w . NOTARY P e MY COMMISS10N # EI:135305 ' ` * EXPIRES: November 15, 2015 Banded ltou Budget N Y Sobs My Commission Expires: J, J Q U< -J 5 s c) 5 APPROVED BY fti L Plans Examiner (Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) My Commission Expires: Oti - J } A S �S1J � /may /Z zoning Structural Review Clerk IVI iami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #:�II .9° b3 DATE: 0 pb 0) 7-- 1, 'PAL) L.10 Mtic'�' ❑ Contractor ❑ Owner ❑ Arc ckkeed up 2 sets of plans and (othe Address: From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: • RESUBMITTED DATE: PERMIT CLERK INITIAL: Permit No: 11 -2033 REVISION Job Name: January 21, 2012 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Building Critique Sheet 1) Provide approval from Miami Dade County Health Dept. (DOH /HRS) 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. Norman Bruhn CBO 305 - 762 -4859 ACS CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 03/15/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Accurate 8300 West Flagler Suite 114 Miami, FL 33144 Phone (305)226 -8727 INSURED Pavers and Bricks Services Corp 99 NW 156 Street Miami, FL 33169- Fax (305)226 -8767 COVERAGES CONTACT NAME: PHONE AIC, No, E) ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : Lucia Estrella (305)226 -8727 luciaestrella ©bellsouth. net INSURER(S) AFFORDING COVERAGE American United Insurance Company SUA FAX No): (305)226 -8767 NAIC # CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF INSR TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ JERT- ❑ LOC AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS ❑ AUTOS UTOS NON -OWNED El HIRED AUTOS ❑ AUTOS ❑ ❑ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE ❑ DED ❑ RETENTION$ ADD SUBR POLICY EXP POLICY NUMBER (MMIDDIYYYI) (MMIDDIYYYY) CIBA00045787 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? I NIA (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below WC00487878 UNITS EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED ! 100,000.00 PREMISES (Ea occurrence) $ MED EXP (My one person) $ 5,000.00 03/15/2012 03/15/2013 PERSONAL BADVINJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 COMBINED tSINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) i EACH OCCURRENCE $ AGGREGATE i $ $ k TORYTLIMITS ❑ ERH 03/15/2012 03/15/2013 E.L. EACH ACCIDENT $ 100,000.00 E.L. DISEASE - EA EMPLOYEE $ 100,000.00 E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) CERTIFICATE HOLDER r Miami Shores Village 10050 NE 2ND AVE Miami Shores, FL 33138 305 756 8972 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESE d Lucia Estrella i/ © 1988-2010 CORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF The ACORD name and logo are registered marks of ACORD L t L i; ...., , -I LI:. -...:...-..,,....., - z. • .. ' -, T ,,?,_ ...- 51, ; . - % L-. •:'., •A 0 M?;.,A.,!-il A L.:i.-: C...;,,;:: LEP.4,(11,,12:4 ■ I1-',E-. ;;:ilil ■ I P:_ e i 0 '_,. 3 --i 4. 1 1 i DATE 1 : 1 a / 7.........v • NOV 0 1 2511 z wItj CA uil itillE OF ji &ReElv Aftz, 12,■Eihi XTp..A ( 3 x 3 ---4-kC L-04 1-0-7- 5(10/11.5 53/ Fe e Lc' , O 6wc 'FA uLo Rov1442$ P,Avc--ps t31-z‘• c c.C.:15 r-'C Crq ()? C6 - APPROVED Miami Shores Village DATE ZONING DEPT BLDG DEPT SUBJECT CO CCMPIJANCE WI 111 ALL FEDERAL STATE AND CCIJN riLLES AND REGULATIONS Rick Scott Governor H. Drank Fanner, Jr., M.D., Ph.D. State Surgeon General March 06, 2012 9S (Pavers Bricks Services) 200 Grand Consourse Miami, FL 33138 RE: Contingency Letter Application Document No: API063949 Centrax Permit Number: 13 -SC- 1396415 OSTDS Number: 200 Grand Concourse Miami, FL 33138 Lot:910 Block:26 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 03/01 /2012 for a permit to uti,e an existing onsite sewage treatment and disposal system located on the above refereiced property. From a review of your completed application, it has been determined that your existing system is adequate for the proposed use (installation of brick pavers on patio). If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Sincerely, Joseph gineer Specialist II Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITEPLAN Scale: Each block re resents 10 feet and 1 inch = 40 feet. _�. Site Plan submitted by: roved By 4 .. c 4_ - t� CHANGES M ST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT ....Signature Title Date . . Not Approved County Health Department DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used) (Stock Number 5744- 002 - 4015 -6) Page 2 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATgON FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number `Scale: Each block re IIMEMII p�. PART II - SITEPLAN resents 10 feet and 1 inch = 40 feet. Notes: Site Plan submitted by: n Approved t! 77, By y /// #: .Sigriature Not Approved Title Date County Health Department L CHANGES Mf S- BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used) (Stock Number: 5744- 0024015 -6) 11 t. • • G, • • S�pa�G 1ANt(. , �1 i �✓ Vr l'L!) 1rkgI/J A6 _. - 12xFkii ?;o," C: X TiZA 10` 5 BE OH LE OF .s-r/4 5K© /E$ - 3313s 2G FEC-'. T to'r t 10 £3 c,C . D.. "1476 L(ci 341-07 • $C Miami Shores Village DATE ja SUBJECT la CCIMIANCE WITH ALL FEDERAL STATE ANL) CUNT? RULES AND REGULATIONS Nov 0.i 1, l ` ?uLv VMS ?eve rz 5 ' C3+2<< K.4 SE rev: ce.S I Nc C : 2 , 3 : ce- - t& t t t t t: t t t t t t t t t t t t MIAMI -DADE COUNTY TAX COLLECTOR 140 W. Flagler Street Miami, Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 11/7/2011 1300 /228 /001SAKENI 0109 -0001 Last Seq.# :0002 WI LBT #:30 605805 -1 Local Business Tax $175.00 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT 2011 -2012 MUNICIPAL RACTOR TAX Local Business Tax #:30605805 -1 State /CC# :068500670 Issued to: PAVERS AND BRICKS SERVICES CORP Type of Business: SPECIALTY BUILDING CONTRACTOR SEE BACK OF OFFICIAL RECEIPT FOR NONPARTICIPATING MUNICIPALITIES THIS RECEIPT IS ISSUED AS EVIDENCE OF. PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami -Dade County Tax Collector 0c0etkC ?QNik (- 11/7/2011 1300/228/001SAKENI 0109 -0002 Last Seq. #:0002 WI LBT #:00 605805 -1 Local Business Tax $86.25 CA $300.00 CHANGE $38.75 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT 2011 -2012 LOCAL BUSINESS TAX Local Business Tax #:00605805 -1 State /CC #:06BS00670 Issued to: PAVERS AND BRICKS SERVICES CORP Type of Business: SPECIALTY BUILDING CONTRACTOR THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami -Dade County Tax Collector 1 111111111111111111111111111111111111 11111111 NOTICE OF COMMENCEMENT A RECORDED COPY MUST RE POSTED OK THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO, STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby elves nodes that.Improvements w[!! be made.to certain real property, and In accordance withChapt•r 713, Florida Statutes, the following inforrnation Is provided in'this Notice of ConsnencernenL ' FN 21 ;11R07. 0.615 Bk 27386 Ps 0766; CC19s RECORDED 11/07/2011 14:28:06 HARVEY RIJVIN, CLERK OF COURT P1IAPII -C'AG'E COUNTY! FLORIDA LAST PAGE ,• 1. Legal description of property and street/address: `Z, 6n1i l J) (0r4"eoyrz e /14 1,444 ,-Ica . FL 991 53 ' La-r L E,5S 20 Y O.T ANI7 Lu T / o lock 2 ( SeC7;Q/d Pt '( to e o/ PA# "© l 2. Description of improvement r2,6190\-c4--- l- �St�i'i4 -7" Z12t ✓6 k/1 -� W t '- �'/ (C% 194(-161z_ )511 3 Owner(s) name and add oS re interest In property. 'RO PENTi /- Name and address of fee simple titleholder: 4. Contractofs name and address: 6r- C.0 v,NCvc4?- l• i; iLS to rc S - uic63 q'9 /..m/ /56 Sr 6. Surety: Payment bond raqulmd by owner from contractor, Name and address: Amount of bond $ - 8. Lender's name and address: Of FLORIDA, cout4re of DADS efegd'Y CERTIFY that this is a true copy of the v{ T GL`1.I11 �il�J 7. Persona within the state of Florida designated by Owner ups or other documents y: provided by Section 713.13(1)(a)7.. Florida S • Name and address;: served as 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Nctra as provided In Section 713.13(1)(b), Florida Statut • Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a diff L nt date {s sp o Print OHmer's Name H.° f �% 0 S 5 • l Sworn to and subscribed before me thls 2� Notary PubUO Print Notary's Name My oamrrlisston expires: 121.01 -I12 Mali vat /4—o-os Prepared by P day of Cc 11/6EYe , 20 NOTARY PUBLIC -STATE OF FLORIDA 9 W /S—‘51 Shantell Ruthiely Lopes Cordeiro Addme: Commi .'on # EE019117 ItArate2r47 Mid JP n /C3 J • Q e5. o..,1 � _ Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 200 GRAND Concourse Miami Shores, FL 33138 -2834 1132060133540 Block: Lot: MARY AGOSTA Owner Information Address Phone CeII MARY AGOSTA 200 GRAND CONC MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone PAVERS AND BRICKS SERVICES COI (305)986 -2544 (786)443 -7107 Valuation: Total Sq Feet: $ 4,500.00 1300 Approved: Yes Comments: Date Approved: 11/2/2011: Yes Date Denied: Type of Work: DRIVEWAY Bond Retum : Scanning: 3 Additional Info: PAVERS Classification: Residential Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $3.00 $2.25 $2.25 $1.00 $150.00 $9.00 $4.00 $671.50 Pay Date Pay Type Amt Paid Amt Due Invoice # DS -11 -11 -42450 11/09/2011 Check #: 677 $ 500.00 $ 171.50 11/09/2011 Cash $ 171.50 $ 0.00 Bond #: 2079 Available Inspections: Inspection Type: Final Foundation 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. November 09, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date November 09, 2011 1 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Na DS -11 -11 -2033 Issue Date: 11/7/2011 Expires:1 1 /7/201 1 Folio Number:1132060133540 Owner's Name: MARY AGOSTA Job Address: 200 GRAND Concourse Miami Shores, FL 33138 -2834 Owner's Phone: Total Square Feet: 1300 Total Job Valuation: $ 4,500.00 Contractor(s) Phone Primary Contractor PAVERS AND BRICKS SERVICES CORP (305)986 -2544 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 11/2/2011: Yes Comments: 1/20/12 REVISED PLAN OK Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 NOV 0 1 60 3 aA ' BU L ING Permit No. 11—.94)b3 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING � "ROOFING OWNER: Name (Fee Simple Titleholder): 1 , A- 'Z. j (2. - A Cos -TA • Phone #: Address: ZOO 12..p/ti) GoNCourz City: M I A M I KKR- €S State: P Z- Zip: 3.3 133 Tenant/Lessee Name: Phone #: '48G i `(3 '1‘3 4' Email: JOB ADDRESS: 2.9 a GAP anr cQ /R5c% City: Miami Shores County: Miami Dade Zip: 33/3g Folio/Parcel #: } Is the Building Historically Designated: l 1 Flood Zone: �p ((( — t u e. 01/9/40,(,p CONTRACTOR: Company Name: 1A`-■ tVL5 r;V2_Zc14:2S 5Erl i i ce$ Phone #: 35_ 75q 3/6.5- Address: 99 N w 1 5 b 5 City: M I A-M , ) State: ' L Zip: 53 i e Qualifier Name: � L) L- D. V A 6 V N O2 2 Phone #: ' - '$ Y t(3 4 ( 0 State Certification or Registration #: Certificate of Competency #: BP S o c7 6 U Contact Phone #: �ig ° ( q 3't (' 'I 1 Email Address: 6)AL/ LC PA/1405 Yeko g `t O A/i1/ DESIGNER: Architect/Engineer: --e- Phone #: Value of Work for this Permit: $ 4)Sa/ "00 Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration tw URepair/Replace ❑Demolition Description of Work: 12,E Pik CC e ,K ∎s-i ; /� A5f/ L T D t,=-,' v e- vvAi (o- i 'i k b ; c-K 'PAL, L, E'(1-5 0 6V A £ p ,i ******* * * * * * * * *** * * * * * * * * * * * * * * * * * * * ** *Fee ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Q Qd CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ I TOTAL FEE NOW DUE $ Q -11 ' 'SO 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 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. Signature Contractor The foregoing instrument was acknowledged before me this 2 7- The foregoing instrument was acknowledged before me this Z day of 007-487, 20 1( , by ('41 V2-3 12 . A 005%4 , day of (T 4yz , 2011 , by F qu Z. D. (,a jots ,Pf z. who i�own to me or who has produced O waally -known to me or who has produced As identification and w ®FLORIDA N� " "•g4Shanteii Ruthiell lopes tordeiro s: NOV.1512011 8OIiI)8D THRt7 ATLANTIC BONDING Cp,]1iC. NOTARY PUBLIC: Sign: Print: S h My Commission Expires: NO U • S 5 APPROVED BY c ' 1/ ii,4 // Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) as identification an NOTARY PUBLIC: who did take an oath. L'BLIC -STATE OF FLORIDA ntell Ruthiely Lopes Cordeiro nil I + EE019117 f:? • . V 15, 2011 TLA,TIC BONDING CO. INC. Sign: Print. My Commission Expires: /VDU . Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) YL R. _ Acy(25f-A • hereinafter referred to as the owner of the following described property (address): 2a0 612A/V2 CP NCoora 9 � M j 44 f Legal Description Lot /C' Block 2‘ Subdivision �C-c j 2 A/ ® ( Folio # Requests permission to install (describe work): Pt P(A G6 S i i N� ,P60.64/7 y��� l/E /N ;�ti rd � �k?f Dim A MN Y SE . Within the public right of way of (address) Q 2 5t - 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. 1 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 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, EXECUTED AND ACKNOWLEDGE on this 2:3— day of 0 C7u %ETZ— , 201 ( SIGNED, SEALED, AND DE IVERED in the presence of: NOTARY PUBLIC -STATE OF FLORIDA .•••""'ti., Shantell Ruthiely Lopes Cordeiro Commission # EE019117 Expires: NOV. 15, 2011 BONDED THRU ATLANTIC BONDING CO, INC. 2 (Owner's 5 ifjnature ) GToll -2033 (Miami Shores is i,? ire SUBJECT TO OMPLIANCE WITH ALL FEDER -AL !:STATE AND 1,•. LINTY RULES AND'1E1l7LnT'n�;:z / /K� IFICX1E7, la NOV 0 � �a� BY: . i w �� //// ` f I sS / \\, i. V _rte - .., ..� _..) 44-2 0 Jf • • • • • .. • • ... • f •••e • • • • • • • Nt f} r- V t A605 -rA 2°0 Gre#1,JD cov,cO(JtZ 44749/0, 51.to/LFS FL 55I; to z_(=ss 20 Fee i Z-07 A,v,D ALL 2,0-1- (0 at7c1c- 2 Mim4; .Citorzts 5e c ri* A/L 1 A/A'M 1 D /D6 Cow/ -r LLo V2$ PAvers • t3i'ztcxs cis i Nc . `f86 LI Y3 0?. c _ - . 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Issue Date: Not Issued dthenommilb Expires:Not Issued Folio Number:1132060133540 Owner's Name: MARY AGOSTA Owner's Phone: Job Address: 200 GRAND Concourse Total Square Feet: 1300 1 Miami Shores, FL 33138 -2834 Total Job Valuation: $ 4,500.00 Contractor(s) PAVERS AND BRICKS SERVICES CORP Phone Primary Contractor (305)986 -2544 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 11/2/2011: Yes Comments: