DS-13-1016Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 191178 Permit Number: DS -5 -13 -1016
Scheduled Inspection Date: June 06, 2013 Permit Type: Driveways /Sidewalks/Slabs
Inspector.'3AC \����� moo e_ Inspection Type: Final
Work Classification: New
Owner: RINEY, IRENE
Job Address: 157 NE 101 Street
Miami Shores, FL
Project: <NONE>
Contractor: CHAMPION CONCRETE
Phone Number
Parcel Number 1132060131951
Phone: (305)252 -8055
Building Department Comments
CONCRETE DRIVEWAY ON APPROACH
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
To(
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
June 06, 2013
For Inspections please call: (305)762 -4949
Page 15 of 38
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: 167 IN [ 0 l
City: Miami Shores County:
Folio/Parcel #: 1A a 3 2 06 ®CP/ 3 m qq/
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder):
Address: 1 ' OO / ct
A
City: t iD5
Permit No.
RECEIVED
MAY 2013
Master Permit No.
ROOFING
Miami Dade
Zip: 3? !3
NO Flood Zone:
lit* o-t7
Phone#: d
State:
Zip: 3 3a 37f
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: C. 4I NAJ (°.-0 AnYir ZrZ J'o$
Address: 11.00 f!* g
\/ /
City: ® State: °®- Zip:
Qualifier Name: ems" ' 'MAO
Phone,#:
State Certification or Registration #: Certificate of Competency #: O.5 eO ?S
Contact Phone#: 7�b° 4 Email Address: - o Nth <4
DESIGNER: Architect/Engineer: Phone #:
Value of Woik for this Permit: $ S
Type of Work: DAddition DAlteration
Description of Work: f � J A
vs�aa.,
q 14 footage oia°
k) .t. HMO mae&
fioimlli'sS j
Color thru tile:
Submittal Fee $ Permit Fee $ % 0 c1'+
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF$ CO /CC$
DBPR $ Bond $
Technology Fee $
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,
WFT,T,S, 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 $2500,
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be de
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be
for the first inspection which occurs seven (7) days after the building permit is issued. In the abs e of s
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this "% The fo go strument ackn wledged before
day of 1`kR � , 20 a, by Sc &At *O1 'R•.n4.1 , day of , 201 , b} 0 �
who is personally known to me or who has produced PAM/ who is
LA C.• As identification and who did take an oath.
NOTARY PUBLIC:
Signature
Imo'
>I
Iw_. 6
,Contractor
applicant must
d to the person
ed at the job site
posted notice, the
Print:
% 4
me or who has produced
as identification and who did take an oath.
UBLIC:
i
Sign: _ 14A►.1A1!11.. r
Print:- Notary Pub is 23.2015
Expires Sep
;v Commission # E Assn.
My Commissio oa h National Notary
e,F OF F�,,° Bonded Throug
Mar 3, 2017
My Commission Expires:
Mtrcti, 3, 20! ?
NOTARY
* * * * * * * * * * * * * * * * * * * * * * * * * ** *,> ******* * * * * * ** * * * * * * * * * * * * * ** ** * *** * ** * * ** * * ** * **** * * * * * * * * **> * * * * * * * * **
APPROVED BY
Plans Examines (() 7( //" Zoning
Structural Review Clerk
(Revised 3 /1212012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) -I/ %)e '24 Ai hereinafter referred to as the owner of
the following described property (address): 157 /000 /01 �r
- 4441- kt-im, ff- 3 3 i?-1
Legal Description _ Lot Z2, 23 Block Al Subdivision M ,5b70.5 7u-,
Folio #
Requests permission to install (describe work): Comm c$ tare- 41/W -e l) ° /
Within the public right of way of (address) /5.7 Ad17 . ° r`$
hi-Amt t-ci�
0
I to ,E NM toga eWIIO3
401 VIS 31 • ReieatmoWl
a1P"sr°-
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 i day of &Abby , 2013
SIGNED, S ED ND DELIVERED in the presence of:
12450 May 7, z1 �3
ESP•
2
(Owner's SignattTle )
-; or s-r
_I®t
TRUST AGREEMENT
' THIS TRUST AGREEMENT made this Jr- day of
May, 1987, by and between CHARLES KERTES FOX (FUCHS),
hereinafter called the Settlor, and CHARLES KERTES FOX
(FUCHS) and IRENE F. RINEY, hereinafter called the Trustees.
If IRENE F._RINEY should predecease the Settlor, or be
unable to act as Co- Trustee due to legal incapacity, then
her Husband, L.B. RINEY, JR., shall serve as substitute
Co- Trustee. If he also should predecease the Settlor or be
unable to act due to legal incapacity, then their daughter,
CATHERINE RINEY, shall serve as second substitute Co- Trustee.
SECTION I:. TRUST ASSETS
That the Settlor has delivered to the Trustees certain
assets listed on Schedule A attached hereto, the receipt of
which is hereby acknowledged. The Trustees agree to hold such
assets subject to the following terms and conditions. The
Settlor confirms and alleges that the assets which are being
funded into this Trust are the assets of the Settlor.
SECTION II: ADDITIONS TO TRUST
The Settlor or any other person may, at any time and
from time to time, designate the Trustees as ,.„beneficiaries
of life insurance policies and deliver to ;the Trustees a
other assets acceptable to them, all of which ,shall be held
under the terms of this Agreement. Such additions, whet4her
made by deed, assignment, bequest or deviseL maybe allotted
pE....51?>- 116
COrilt\I e
CONTRACTORC,hM 1C)
SUBMITTAL DATE:. -0C\ ;C)
ADDRESS: I S-1 13 E \C\
NAMEal ,
�&f\ e 1
RESUBMITAL DATES:
PROJECT TYPE:
•STRUCTURAL
FIRE
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
BLDG
'46
6
foregoing instrument as Settlor, this day personally appeared
before me and acknowledged that he executed the foregoing
instrument freely and voluntarily for the uses and purposes
therein expressed.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal on this S.,..444 day of May, 1987.
„
My mission Expi '--
BemdGd thru .Mavrtard Bonding. AGnc
My commission expires:
STATE OF FLORIDA )
SS
COUNTY OF DADE ) ,
I HEREBY CERTIFY that CHARLES KERTES FOX (FUCHS) and
IRENE F. RINEY, to me known to be the samepersons whose name
is subscribed to the foregoing instrument as Trustees, this
day personally appeared before me and acknowledged that they
executed the foregoing instrument freely and voluntarily for
the uses and purposes therein expressed.
IN WITNESS WHEREOF,, I have hereunto
on
My commision expires:
PIAV, Stste c ilnrci,ci
leT Commiss:at June
UOded ri Mid Corking
FIP 1/2"
9.84'
• PERMIT #7.•
• ;•:,•
• • - •
ES tcER
Miami Shores Village
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
-10\
STATE AND COJNef /DLES AND ULATIONS
25.16'
45.00'
perky Address: 157 NE 101 S
Miami Shores
Community number: 120652
Village of Miami Shores
Panel: 12086 C 0302
to Suffix: L
Date: 09-11-2009
Date Revised: 09-11-2009
Date of field work: 05-01-2013
Completion date: 05-01-2013
z Flood zone: X
Base flood elevation:N/A
Diagram: 8A
Finished floor elevation:13.03'
Lowest acliacent grade:10.73'
Highest adjacent grade:10.96'
Crown of road:10.62'
Garage:11.11'
HP 1/2" Latitude: 25°52'05" N
Longitude: 80°11'40" W
C SCALE
20
NE 101 th STRE
otal Right of Way =
FEET
1 itih = 20 ft.
SurVey.mun dW 1510h
i MEV tirinf'Y NAT YOS 00410A21 SURVEY METS 1141
SI,ANDAFtbS...AS BET FORTit 'mg FLORIDA BOARD 07,PRC
BiRS'YORS AND MAFPERON WAVIER 8,1147/01DAVADk
PURSUANT To:stcroN 474:027.ektOtoiket,*. 'ts:Girt
010414.
G11.81411Y t GAV
REGISTERED SURVEY
STATE ...DATE: