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DS-12-1617Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 inspection Number: INSP- 178932 Permit Number: DS -8 -12 -1617 Inspection Date: September 28, 2012 Inspector: Bruhn, Norman Owner: GREEN, PENNY SUE Job Address: 73 NE 99 Street Miami Shores, FL Project: <NONE> Contractor: CHAMPION CONCRETE Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132060131310 Phone: (305)252 -8055 Building Department Comments DRIVEWAY PAVERS Infractio Passed Comments INSPECTOR COMMENTS True Passed `-/c7i_ Inspector Comments CREATED AS REINSPECTION FOR INSP- 177902. Walk must be 3' wide maximum. NB Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until September 28, 2012 For Inspections please call: (305)762 -4949 Page 1 of 1 9IS�IL �e�t MSa 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: (345) 762 4949 BUILDING PERMIT APPLICATION F,-B�C 20 Permit No. �� 1 Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: 1 3 D J 6 qg City: Miami Shores County: Miami Dade Zip: 37/3" Folio/Parcel#: //' 3 z06.- O/ - /3/0 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simile Titleholder): ' ' JJ PAP/ 6V Phone#: Address: 73 N `� �� City: WO ', i State: Zip: '5 5/F) Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: C/ i 'e Phone#: 3 O 252 YE T Address: //00i City: State: rt Zip: 3/7" Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #:'�� Contact Phone# Email Address: I�'�111 ° DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ 5 X - Square/Linear Footage of Work: I Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Deniolition Description of Work: 449944.147" Color thru tile: al * *** ees Submittal Fee $ Permit Fee $ /ref CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ 'fraining/Education $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ J .-O 10 PERMIT # CONTRACTOR: CO Prm 9 0 t' C JC,a& -7 It-- SUBMITTAL DATE: 9 J'' 6 0:m0 2. ADDRESS: NAME: RESUBMITAL DATES: PROJECT TYPE: b y Z�� v..4,05--C � -.'6 b A G ✓ ``��� . •i'+.L `' omit' ,./ `/ j FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL BL LI* Bonding Company's Name (if applicable) 3 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 perfbrnxd 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 acanate 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 goad faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose properly is subject to attachment. Also, a cert fed copy of the recorded notice of commencement must , ', , sted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the ab a of h posted notice, the inspection - <, ., a approved and a reinspection fee will be charged Signature Signature or Agent The foregoing instrument was acknowledged before me this The fore day of 40 ' -T-, 20 t(- -by (W—CANI who is personally known to me or who has produced e--J As identification and who did take an oath. NOTARY PUBLIC: I \\`\```0uinnr Sign: Print My Commission Expires: day of who is If Contractor instrauvant was acknowledged before me this 20 aby m i l Ci O to me or who has produced as identification and who did take an oath. a.. oW a` ice. /,,,,1/4101r1111111\0\`'\ NOTARY PUBLIC: 1 Sign: elk ,,.. �9r Print ;p 106��p1%`,.': My Commission Expires: _ . Um �t�1�n A Structural Review (Revised 3 /12/2012XRevised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk NOTICE OF COMMENCEMENT. A RECORDER COPY MUST BE (POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. CS- — 1 to I -1 TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 111111111111111111111111111111111111111111111 CF14 201.2R0622894 OR Bk 28255 Ps 1047; (1s) RECORDED 09104/2012.09:37:53 HARVEY RUVIN, CLERK OF COURT i1IAPII -DARE COUNTYr FLORIDA LAST PAGE THEDNDERSIGNEDIereby.givesnotice .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. 1. Legal description of • roperty and stye{ address: 2. Description of improvement: - . rim L wle „D4 \>— /_ 3: Owner(s) name and address: • � � 6491 L 1k - 6iC9, 73 'cg' q' Win-- ll 97-' -X7/3 Interest in property: Name and address of fee simple titleholder. 4. Contractor's name and addr 5.- Surety: (Payment-bond- required by owner from contractor, OF FLORIDA, (�(�At� ®F DADE Name and bond $ I HEREBY C ER77FYthat this a true T Amount of bond $ � 6. Lender's name and address: or nal fif WITNESS 7. Persons-within-the state of- Florida- designated by -Own be served as provided by Section 713.13(1)(a)7., Florida Name and address:. • rid ob ,Mite �1 err..:: 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 recor,' g u ..s a different date is specified) Signature of Owner Print Owner's Name Sworn to ,and subscribed Notary Pub( Print Notary's Name My Commission expires: efore me this 011"llllp ) }Omit OretAILf ) 37thtitultY PUBIIC Commission # This instrument prepared DM'', r • O �•ress: 1Q. A t40 J Miami -Dade My Home My Home Show Me: Fm pertylrifbm>ion Search By: Select ter Text only 1, 1,0 Property Appraiser Tax Estimator Property Appraiser Tax Comparison Portability S.O.H. Calculator Summary Details: 8/27/12 2:01 PM ACTI Legend Property Boundary Selected Property be,f Street dobt Highway Miami -Dade County Water Property Information: Floors: egal Description: LAMI SHORES SEC 1 D PB 10 -70 LOTS 22 23 BLK 9 LOT SIZE RREGULAR OR 13637- 381 1087 1 OR 13637- 381 1087 00 Assessment Information: jay Exem • tion information: Taxable Value Information: < < ear: 2012 2011 Applied Exemption/ Taxable Value: APPfied Exemption/ Taxable Value: 0 000/$122,2 Aerial Photography - 2009 0 112 ft My Horne 1 Property Information 1 Property Taxes 1 My Neighborhood [ Property Appraiser Home 1 Usino Our Site J Phone Directory [ Privacy l Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. http: / / gisims2_ miamidade _gov /myhome /propmap_asp Web Site 2002 Miami-Dade County. All rights reserved. Page 1 of 2 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) � 9neep/ I ^ 9 hereinafter referred to as the owner of the following described property (address) 73 / & Qf r n i'i i 5 � .33/9r Legal Description Lot Block Subdivision Folio # /1— 62-06 -- c-Q/3 \ ,f-31 0, Requests permission to install (describe work): ./9110 /97p0 /t '1 - Within the public right of way of (address) 73 r5f- 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 tbJ,s -� r day of 41-e-1-"L)) , 201 2 SIGNED, SERB,, A kf(IV the • since of: 2 AFFIDAVIT 'STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiimt PtWf S does hereby attest that the (property owner) attached survey, performed hy / 4:1" A- 5)4't5. tik,6 (name of surveyor's company) perforrned on / qg , is an accurate representation oftheexisting conditions and (date of survey) locations of all structues on the property as of this date. The purpose Of this Affidavit is to induce Miami Shores Village to issue a building permit forthe 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 net 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) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this day of Affiant is pets:many known to me, produced owintini1/4 d I (Y0 tuaishi.144„, ter lee • 0' • to - z.- es efe •cc = 1 49 api • ........ 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 NO. DS -8 -12 -1617 Issue Date: Not Issued Expires:Not Issued Folio Number:1132060131310 Owner's Name: PENNY SUE GREEN Job Address: 73 99 Street Miami Shores, FL Owner's Phone: Total Square Feet: Total Job Valuation: 820 $ 5,200.00 Contractor(s) CHAMPION CONCRETE Phone (305)252 -8055 Primary Contractor Yes Planning and Zoning Criteria and Comments • Approved: Yes Date Approved: 8/28/2012 : Yes Comments: