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: