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DS-12-1458Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176730 Permit Number: DS -8 -12 -1458 Scheduled Inspection Date: September 25, 2012 Inspector: Bruhn, Norman Owner: JESKE, CRAIG Job Address: 116 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: CHAMPION CONCRETE Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132060132560 Phone: (305)252 -8055 Building Department Comments PAVERS AT RIGHT AWAY Inspector Comments Passed G W Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 24, 2012 For Inspections please call: (305)762 -4949 Page 13 of 30 DING PERMIT APPLICATION Permit Type: BUILDING ROOFING JOB ADDRESS: /76 NE q7 5r City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Buildi� Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): _ /1 °N ' 4 Phone#: Address: J/ C NE q7$j- city: 1-1474011 4 5 state: Tenant/Lessee Name: Phone#: Finail- Miami Shores village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (3( 5)) 762.4949 rrcFv. AUG 02 2012 p FBC20t0 Permit No. 05- l2. - 1 y 55 Master Permit No. CONTRACTOR: Company Name: Address: &lt7f-4 140 ( ®* r,C Phone#: 2 3-2 5 City: dd 0140...L State: Zip: 3 3/17 Qualifier Name: ,JF} fit'& 4/W4 j p,1 Phone#: State Certification or Registration #: Certificate of Competency #: e-0�6.�'6)c.3A>. r Contact Phone#: Email Address: DESIGNER Architect/Engineer: Phone#: Value of Work for this Permit: $ ,rSO4t9 ° Square/Linear Footage of Work .5120 Type of Work: OAddition ©Alteration UNew ORepair/Replac a ODemolition Description of Work /04)ai- ly; 1'.7— A /6 )1r- 4 0x r Submittal Fee $ 50 , 00 Permit Fee $ , (j CCF $ CO/CC $ Scanning Fes $ P R 1 D Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ `/� (�,/� TOTAL FEE NOW DUE $ I • * - t'V 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 T.ip 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 mast 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 deliv red to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be sted at the job site for the first inspection which occurs seven (7) days after the building permit is Issued In the ab e of v/ posted notice, the inspection will not be approved and a reinspection fee will be charged The f day o who is • oin. NOT trument was ,owledged be 1,, , 2 20 \, byi�J► VI �G ^,4 "° / y knortio me or who h. s produced • U 1 LA.slidentification and who did take an oath. 10 r LIC: Sign: l� ••l Print My Commission Expires: APPROVED BY WINNE IN Et CUBILLOS `t. 'o ary .u, , • • & Comm. Ex . ires Sep 23, 2015 o;: Commission # EE 1288 ' ° ,`,,, Bonded Through National Notary Assn. Al � ,a "ir •2 1 .111 Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009XRevised 3/15/09) NOT Sign: Print My 20 edged be • e li i wn to me or who has produced � identification and who did take an oath. PUBLIC: 1 HIM i„ ,.iv Commission # EE 128810 ♦ ...,�.? %%; ,ft ft,, °, Bonded Through National Notary Assn. duy� CLAUDIA V. CUBILLOS ;.-...,.......lit. ''• Notary Public - a e ' My Comm. Expires Sep 23, 2015 rn Zoning Clerk Miami Shores Viiiage 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) Cteifri G hereinafter referred to as the owner of the following described property (address): /16 Z)g 47 9P Legal Description Lot Block Subdivision Folio # Requests permission to install (describe work): 4rfi- , , Within the public right of way of (address) 116 a%"- / �T % r) — ?/.7 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 Gen 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 Winning 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 D. SEALED A 2 ■ R s I`1 e presence of: CLAUDIA V. CUBILLOS �•. Notary Public - St Sep 230 2015 • My Comm. Exp s„ o Commission # EE 128810 "48∎,; ;,, ?os Bonded Through National Notary Assn. , 20162., (Owner's Signature ) STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Village Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant,-i6 H , does hereby attest that (Property owner) The attached surrey, performed by CJt2 4601/IA Name of surveyor's company) For address: //b gT ,5T ot104A 7�% 74 �3i31. Performed on 7-9 ' (date of survey) is an accurate representation of the existing conditions and 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 seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the properly 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 ant W eth naught Property Owner Signature SWORN TO AND SUBSCRIBED before me this a day of Affiant is personally known to me, produced Revised on 5/22/2009/ Revised on 6112 07; P Owner Print Name PO as identification. CLAUDIA V. CUBILLOS Notary Public -State of Florida . . e My Comm. Expires Sep 23, 2015 o;= Commission # EE 128810 ''' '''' Bonded Through National Notary Assn. • Notary • BOUNDARY SUR SCALE: 1" _ °' FEB 6 2L:2 BY- c? sr C75'770744 Wm) AL 0 PROPERTY ADDRESS. //!v NE 977-W 5T, /, /a144/0-,Cor24" ; GL LEGAL DESCRIPTION LOT BOCK /9 SUBDMSION 41/ IJ VPE S FeAraeAkAA4/50.0e.es ACCORDING TO THE PLAT THEREOF AS RECORDED COUP, FLORIDA IN PLAT AT PAGE 7 ) OF THE PUBLIC a DS OF .0 t ! DATE O OCMPIWJCE WT ,J c c!,rdr rl`r ES AND RE D C DEPT 3T 1 ALL FEDERAL 33 AND r :, U`_ATI0NS %It AUG O 2 ZU1Z aO A/E 97' / 2 p lD 9 A 7 to id Ei 123 BSI` L'i'I I Ie a s �7 li H /+/G "Co' "' •ST • D LOCATION SKETCH SCALE: 1" al :I, 1 1. e• p ;01.41 E Fe I ` I "11 1 hj 1 I� iIt1II' co z 0 w> co } Ll1 cc 0 N LL z W W J 9 3. trOt gg r3iS0Ei.a h 5 •,: NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF RRST INSPECTION PERMIT NO. 1 2 l 7 S TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1111111111111111111111111111111111111111 d`_FN 2012R01581091 991 OR Bk 28232 Fla 3463', Ups) RECORDED 08/17/2012 14:08:57 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE Space above reserved for use of recording office 1. Legal description of property and sireetladdress: 2. Description of improvement ,j4fl/tW flyAi�j 3. Owner(s) name and address: >e,4v 4d �./ei Interest in property: Ph Al 97,7 �14 a4 5 / > I, Name and address of fee simple titleholder. 4. Contractor's name, address and phone number. / /Ca/, °� ri e_- /D3 C ; j • 5. Surety: (Payment bond required by owner from contractor, it any) Name, address and phone number: 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 p Section 713.13(1x47., Florida Statutes, •'`ATE OF FLORIDA, COUNTY OF CIAO Name, address and phone number: CERTIFY that Ph; It:�tam Y if if in this cO ca C I J clay or 8. In addition to himself, Owners designates the following person(s} to rece 713.13(1)(b), Florida Statutes. Name, address and phone number: WrNESS NARVE Rv and Mold Seal. Flit, of Circuit and C as prove unty COu t$ D.C. _az,D Jed; 9. Expiration date of this Notice of Commencement the expiration date is 1 year from the date of reconding unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE SY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, 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 COMMENCEMENT. Signature(s) of Own s) o Owner(s)' Authorized Officer /Director/Partner/Manager Prepared By of Print Name Gr�,� J Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The f By Individ • , I' r ❑ as for ❑ Personally known, or produced the following type of identifl Prepared By Print Name Tftle/Oftice Signature of Notary Public: Print Name: (SEAL) - iFt21 I I lad 111 171111/421MMItri! VERIFICATION PURSUANT TO SECTION 92.525 FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer /Director/Partner /Manager By 12301 -52 PAGE 3 3110 ,,,,, CLAUDIA V. CUBILLOS IP °e`�'• Notary Public - State of Florida '~• °" ires Sep 23, 2015 .- My Comm. Exp' Commission # EE 128810 Bonded Through National Notary Assn. �liI IIII• k By