DS-13-888Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 191779
Permit Number: DS -4 -13 -888
Scheduled Inspection Date: May 21, 2013
Inspector: Bruhn, Norman
Owner: MARY ELLEN BENTON, DOUGLAS
Job Address: 10108 NE 1 Avenue
Miami Shores, FL
Project <NONE>
Contractor: ARCO CONSTRUCTION
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060131560
Phone: 305 -892 -6507
Building Department Comments
4" TOPPING OF CONCRETE OVER EXISTING GARAGE
SLAB FLOOR INTERIOR.
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
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- 190191. No permit or plan
posted. No access. NB
May 20, 2013
For Inspections please call: (305)762 -4949
Page 16 of 20
mitsfoo- - "130
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
Permit Type: BUILDING
JOB ADDRESS: O i ,D g Ai 5- I evti
City: Miami Shores
Folio/Parcel #:
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder):
Address: 0 - , J J .
FBC 20 l
Permit No.
Master Permit No. t .
ROOFING
County:
Miami Dade
Zip:
NO
Flood Zone:
Phone #:
City: State: Zip:
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: A P.C°,C.) C3—t Phone #: � C 1-
Address: I24' t oti
City: a 1 ` State: Zip: '®
Qualifier Name: tt
State Certification or Registration #: t (. PS--0 VI 6 ---4> Certificate of Competency #:
Contact Phone#: Email Address:
Phone#:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $
Type of Work: OAddition
Description of Work:
er.Cri-Cyc
f1
OAlteration
Square/Linear Footage of Work:
ONew `" i' epair/Replace
o f e 0 ° 0 Vi 5-.1 ,edci, ?
Vow'
ODemolition
Color thru tile:
** ******* ***** **** *****************+x***F **** * *** x* **** ****** ************ ********+ * **
Submittal Fee $ ` C C3 Permit Fee $ 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 Al'FIDAVIT: 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 fore,oin_ instrument as ac pwledg' d al fore
day of �,�, , 201 , by . !
who is pe sonally kno t
r who ha produced
The foregoing instrument was acknowledged before me this 2 7
day of , 20 (3, by Gen (J2— Si; ,r--., ic-k,
whocisly onal y known tar who has produced
as identification and who did take an oath.
ation and who did take an oath
NOTA
Sign:
Print:
My Commis
on Expires:
NOTARY PUBLIC
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Sign: � � # Uo�s / y03 .'n
Print: _ �1190� _ . .ii.--
My Commission Expires: 910Z/90/e0
ca•..s
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** **** * ****+x+x+x ******** ******* **+ x***** *a, ��x% �x+ x�x**** �x�x+ x* x�x��xx�a��: �xx�+ x�xa: �x+ xx�x�***** * * *�x *�x+x�x+x****+x *�x�xa��x�x S kl�d�MA* *+x+x **** **
APPROVED BY `. , 2114 ° /� �/ -5e Plans Examiner Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/ 10/2009)(Revised 3/15/09)
Instrument Prepared By:
CHRISTOPHER P. KELLEY, Esquire
11098 Biscayne Boulevard, Suite 205
Miami, Florida 33161
Folio #11- 3206- 013 -1560
1 11111101111I1I 1 1111 I I NI 1111! I I I I Al l
CFN 2013R02144$4
OR Bit 28539 Pas 1737 - 17384 42sas!
RECORDED 03/20/2013 11430454
DEED DOC TAX 3v810.0
HARVEY RUVIH• CLERK OF COURT
MIAMI -DARE COUNTY, FLORIDA
WARRANTY DEED
THIS INDENTURE, Made this 10 day of Act/TA , 2013, Between GEORGE M.
ROMANIK, a single man, GRANTOR, and DOUGLAS M. BARNES and MARY ELLEN BENTON,
husband and wife, whose post office address Is 10108 NE 1 Avenue, Miami Shores. FL 33138,
GRANTEES,
WITNESSETH, That saki GRANTOR, for and in consideration of the sum of Ten and 00/100
Dollars, and other good and valuable considerations to said GRANTOR in hand paid by said
GRANTEES, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the
said GRANTEES, and GRANTEES' heirs and assigns forever, the following described land, situate,
lying and being in Weird-Dade County, Florida to-wit
The East IA of Lot 22 and all of Lot 23, Block 11, AMENDED PLAT OF
MIAMI SHORES SECTION NO. 1, according to the Plat thereof, as
recorded in Plat Book 10, at Page 70, of the Public Records of Miami -
Dade County, Florida.
SUBJECT TO: Applicable zoning and/or restrictions and prohibitions imposed by
governmental authority; Conditions, Restrictions limitations, reservations,
easements, and other matters appearing on records, if any Utility easements of
record, taxes for the year 2013 and subsequent years.
and said GRANTOR does hereby fully warrant the title to said land, and will defend the same
against the lawful claims of all persons whomsoever.
IN WITNESS WHEREOF, GRANTOR has hereunto set GRANTOR'S hand and seal the day
and year first above written.
Print
STATE OF FLORIDA )
COUNTY OF MIAMI -DADE )
I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State
aforesaid and in the County aforesaid to take acknowledgments, personally appeared GEORGE M.
ROMANIK, who produced F /) t as identification, and who executed
the foregoing instrument and acknowledged before me that he executed the same.
Witness my hand and official seal in the County = ' ' = = last o r f • _ id / day of
A n , 2013.
My commission expires:
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SUBJECT 10 CC-NIRLIPNCE WI H ALL 1 ERAL
STATE ANu COUN .11 HU__-_S.AND REGULATIONS
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Edward A.
SCALE:
DATE 7 j
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DRAWN BY erS1/
REVISED
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CONSUL
7850 NW 146 MEET. SUITE 50
1305423493$ • • MIAMI LAKES. FL 33016
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