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DS-13-563PERMIT # C ,/' CONTRACTOR: SUBMITTAL DATE: ")10 13 ADDRESS: Int c1'T NAME: RESUBMITAL DATES: PROJECT TYPE: Vell ZONING F, : a FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC �- MECHANICAL 7 *' * / /�,- / -, BL 6 G ,` 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 B I;&-i BUNG PERMIT APPLICATION Permit No. clp ":7717 � 9 lYp �,iA 6Y: m �-~m_ ------- _e Master Permit No. ao n� �l �C.J Permit Type: BUILDING ROOFING JOB ADDRESS: r 15 ) J 6t2 City: Miami Shores County: Miami Dade Zip: 3a3er- Folio/Parcel #: %/ — 3705 5 ® 02-7 - (N Q Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): OW-0,56 / d//Ii Phone #dO5 75 / -P6'60 Address: //5 q� � City: ,H` ) State: ® Zip: 3 WI/ Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: Cfr /out r . y 9 Phone #:.� Address: 0001 i /03 City: Dp6 State: % Zip: 3 3 /7 Qualifier Name: ‘A,/ i Phone #: State Certification or Registration #: Certificate of Competency #: 16.2565 /I Contact Phone #: 4 VOZ Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: tZ® . Type of Work: UAddition DAlteration Description of Work: 0 , A/ ONew ORepair/Replace ODemolition Color thru tile: a as p ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ees************* * * * **** * * * * * * * * * * * * * * * * * * * * * * ** a Submittal Fee $ 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 $ 1 2 I ( 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 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 th t a copy of the n c, of commencement and construction lien law brochure will be delivered to the person whose property is subj: ct to attachment. Al i, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs eve (7) days a r the building permit is issued. In the absence of such posted notice, the inspection will not . e approved and re spection fee / 1 be charged. Signature 0r� Owner or Agent ent was a .1 owle g 2 V , by , `.Agri _ The forego dayo As identificatio NOTARY P LIC: 11 /./. d eb fore me Sign: Print: Signature Contractor The forego R. of ent was ackn 20 .ducet who did take an oath. EPIPIPArlfre#;Pai 1114 -ad My Commis ion Ex APPROVED BY �. ver CUBILLOS y om Exs Sep 23, 2015 Commission es4%„ F " ..... " Bonded Through # EE 128810 gh National Notary Assn. o Florida wh Plans Examiner Structural Review e y edged 1 or who has produced entification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission (Revised 5/2 /2012)(Revised 3/12/2012) )(Revised 06 /10 /2009)(Revised 3 /15 /09)(Revised 7/10/2007) Zoning Clerk Miami-Dade My Home My Home Show Me: Property Information Search By: Selectlem ; Text only Property Appraiser Tax Estimator Property Appraiser Tax Comparison IA Portability S.O.H. Calculator Summary Details: Folio No.: 3/18/13 5:53 AM ACTIVE TOOL: SELECT 4tiv2W:- -4- OWARD E WILLINGHAM 1158 NE 92 ST MIAMI HORES FL 33138-2935 LUC: AY LURE PB 44-63 OTS 5 & 6 BLK 3 LOT IZE IRREGULAR OR 18023-0660 0298 4 OR 8023-0660 0298 01 Assessment Information: Land Value: Exem • bon Information: Taxable Value Information: ear: < iTaxing ;Authority 2012 Applied Exemption/ Taxable Value: 2011 Applied Exemption/ Taxable Value: Re • Iona!: oun ,000/$270, 1011 ,000/$270, 0,000/ 1, 1 0A0/$261,315 ,M01$261,31 Aerial Photography - 2012 0 116 ft My Horne I Property Information! Property Taxes 1 My Neighborhood 'Property Appraiser Horne I Using Our Site !Phone Directory 1 Privacy, 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.goy/myliome/propmap.asp Web Site © 2002 Miarri-Dade County. Alt rights reserved. Legend Property Boundary Selected 404e Property -ter Street Highway Miami-Dade County Water Page 1 of 2 STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Village Building Department SURVEY AFFIDAVIT, 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 The undersigned Affiant, Hiotow 01/hiJ6 1 oes hereby attest that (Property owner) The attached survey, performed by (Name of surveyor's company) For address: iL 612, ti i 1 7 .i 3/Sr Performed on (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 obt -'n permits for -ny structures which now may exist on the property which are t permitted or which may viola t / oning or b ' •' g code regulations. The Affiant further understands that t (existence of any such structur may affect inspectio, s as applicable to this or other permits. Furt r, Affi n:,. e naeht. Property Owner Signatur;' Property Owner Print SWORN TO AND SUBSCRIBED before me this g0 da of Affiant is personally known to me, produced identification. Revised on 5/22/2009/ Revised on 6/12109 CLAUDIA V. CUBQLLOS _ Notary Public - State of Florida g �k+ My Comm. Expires Sep 23, 2015 Commission # EE 128810 f.� " Bonded Through National Notary Assn. Notary Miami Shores. V,iiage 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 hereinafter referred to as the owner of the following described property (address): //5( /re- 42_5'r 4 33 / 3z). Legal Description Lot Block Subdivision Folio # // 32,05°0-17- cLL(Q Requests permission to install (describe work): Miett Within the public right of way of (address) 1/5 iteAPRA r) 33/ 375 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 fot 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 < uthorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this day •f Il Lit /, 4 1 2 , 201 Signatu ;4'713.N ..'NQH3...v1:' hs. no, .Ntloo:• -. ridligol.02: .. .....1:;..';.' .4' ''' • " ..* ■,!. '1P4.-." .. '..,:.,.:1 .7 ;:;r::.•!•e, , ' .,-; ..,,. :**'...',""`. .. ..'.', •-• • *,•`" .:A. - ; ,- _ • - , ,t;...-;-1,1- • .- 7f..":" ' t , ..,.,, ,:. ,,,,h„ ';:i:•• , •;:. v• • '.••••.:.. -......: - I ' ":,-..1....": 7,...• .,,t....:4,'. i.;,4„...;:..-,,r.. • . . iii. ' : ' 4 , 1 ' ' ' ** ' • •'•,,,•'". , ..1:-.',...; ' • :. - .;:Aii: .:- :ty....i.. 3A ,.. %'''':* - C.111. A Sa4.14S1141 I. ... , • ..-. •••., .c , . ,• . • :.; ., • .. • ' i ;4'713.N STATE O FLORID& COUNTY Y OF LADE I HEREBY CERTIFY that fitt is y, copy f tft� original fwd !n tlrie WITNESS VI HARVEY RUM, CL.IE is I I��III ��II Nil 11111 IIIII IIIII 1111 CF14 - 201:M4326612 OR Bk 28568 Ps 1569 Ups) RECORDED 04/08/2013 12:10:00 Courts -' ' ` HARVEY R1IVIHp CLERK OF COURT MIAMI -DADE COMM FLORIDA CE OF COMMENCEMENT) ASE NO NOTICE OF COMMENCEMENT MUST BE FILED IF THE JOB VALUATION OF $ 2,500.00 AND/OR MORE IN LABOR AND MATERIAL. PLEASE FILE AT 22 NW 1ST STREET, 1ST FLOOR, MIAMI, FLORIDA (305) 275 -1155 - (A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION) Permit Number: (J -5(.03 Tax folio Number: State of Florida County of Dade THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statute, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: /15 iVz ef/X 2. Description of improvement: Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: BOA) 613mIkere .1 5. Surety. (Payment bond required by owner from contractor) Name and address: Amount of Bond: $ 6_ Lender's name and. address: 7. Persons with the State of Florida designed by Owner upon whom notices or other documents may be served as provided by Section 713.13(1). (a) 7, Florida Statute: Name and address: 8. in a provided in Name an o himself/herself, Owner designates the following permit(s) to receive a copy of a Lienor's Notice as 713.1. (1) (b), Florida Statute: ddress: 9. differ mencernent: (the expirations date is one (1) year from the date of recording unless a ignature of Owner) • before me this ,2O . Personally Know, or Produced Identffication Oath taken Prepared by. irt/l'e-- D Address: (JO t' t ems'&) e351— wit 3 Notary Public: • Print Notary's Name: Commission Expires: CLAUDIA V. CU8 LLOS Notary Public - State of Florida My Comm. Expires Sep 23. 2015 3 Commission # EE 128810 Bonded Through National Notary Assn.