DS-14-1074. INSPECTION ION RECORD
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)758-8972
Permit NO.DS-5-14-1074
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IssueDate: 6/9/2014
. 1 Expires: 12/06/2014
INSPECTION REQUESTS: (305)762-4949 or Log on at https:ilbldg.miamishoresvillage.comicap
REQUESTS ARE ACCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY.
Requests must be received by 3 pm for following day Inspections.
Driveways/Sidewalks/Slabs Parcel #A 122320320260
Owner's Name: BEATRICE & JOSE IGLESIAS Owner's Phone:
Job Address: 1384 NE 104 Street Total Square; Feet: 860
Miami Shores, FL 33138-
Bond Number: 2395 Total Job Valuation: $ 4,800.00
Contractor(s) Phone Primary Contractor
CHAMPION CONCRETE (305)252-8055 Yes
WORK IS ALLOWED MONDAY THROUGH SATURDAY,
7:30AM - 6:00PM. NO WORK IS ALLOWED ON SUNDAY
OR HOLIDAYS.
BUILDING INSPECTIONS ARE DONE MONDAY
THROUGH THURSDAY. ROOFING INSPECTIONS ARE
DONE MONDAY THROUGH FRIDAY. NO BUILDING
INSPECTIONS DONE ON FRIDAY._
ami SHORES VILLAGE
For Driveways and/or Sidewatlks,
before final Inspection and bond can be
approved for refund; all sod and yard work
must be completed.
NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS
THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER
THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO
YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
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BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
c FBC 2 0
Master Permit No. V ./�� �'i� 1
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION E] RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: (Sem ! 0`� ) OA s)
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO -
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
11P A
OWNER: Name (Fee Simpple� Titleholder): � Phone#:4
Address: Oeik � V C-7 10 A
�l r
City: hiAPLA iY10/1 Y5 State:
Tenant/Lessee Name:
Email
KJ .
CONTRACTOR: Company Name: �h 606)C i y;`i _2 Phone#: 305
Address: (1001 pi o e3 5-r
City: 0 044&= Stater- Zip: 1
Qualifier Name: �!`�1��-� 16-47:�Z t- Phone#: ��,�cc
State Certification or Registration #: Certificate of Competency Mc-c-05?�J ly
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ A14 -0i) Square/Linear Footage of Work:
Type of Work: ❑ Addition [:]Alteration [TN//ew ❑ Repair/Replace ❑ Demolition
Description of Work: C011'Y-7'_ J,4/l`i �Cft i
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $
Notary
Double Fee $
Bond $ �JL
TOTAL FEE NOW DUE $ l D M
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 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 mus be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence If such posted notice, the
inspection will not be approved and a reinspection fee will be charged. If
Signatur
OWNER &orAGENT
The foregoing instrument was acknowledged before me this
day of m �C . 20 by
') (I,e' ICO- COA7,C4a . who is personally known to
rrlCor' who hasp dui � �(—►��� as
identification and who did take an oath.
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of l . 20 . by
who is personally known to
me who has produce as
identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Z\1 Is
Sign:D
i �°i� ''% Sign
0310612-
Print:
Print:
— Print:
_ _
Seal:
; commissiPUSL/C :' seal:
EE 1730
%�lF '••...FF..... •fid \\\`.
APPROVED BY
Plans Examiner
Structural Review
(Revised02/24/2014)
Clerk
a
Miami Shores Village
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) 'g1c& i hereinafter referred to as the owner of
the following described property (address): l� N e- Pit S
Legal Description Lot Block Subdivision
Folio #
Requests permission to install (describe work): i i /J co oira tz, ?o..
Within the public right of way of (address) � � f ik S' J
t74.," ��� ._ -3 313 Y
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.
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 ?a�) day of �n , 201
(Owner's Signature)
SIGNE SEALE AND DEL IV �it�(C���sence of:
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STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
The undersigned Affiant, k-e—does hereby attest that
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
(Property owner)
The attached survey, performed by i-&-" f1
(Name of surveyor's company)
For address: _ � � m mr- tam !tc �► G � -A.
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 obtain permits for any structures which now may exist on the property which are not 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.
Furt er, Affiant say ght.
roperty Owner Signature rr��
SWORN TO AND SUBSCRIBED before me this �J day of VR
Property Owner Print Name .
Affiant is personally known to me, produced —zoe" �—� Ar/n �''%�,s identificati
Notary
Revised on 5@2/20091 Revised on 6112/09��
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Ttii.s property described as:
Lot 5, Block 4,
RTVRR-BAY PARK ADDITION,
according to the Plat
thereof, as recorded in
Plat Book 40, Page 72
of the Public Records of
Dade County, Florida.
Note: Underground encroachments
utilities, if any, not l.oc:ated.
.fence ownership by visual means
legal owncrsh.i p not-- determined.
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FLOOD INFORMATTON:
Community No.: 1.25038
Panel No.: 93
Suffix: F
Date of FIRM: 1I-4-87
Base Elevation: +9.00
N.G.V.D.
Certified To: M and
M Title Services, Inc.,
Commonwealth Land
Title Insurance Company,
Iglesias, Jose A. and
Garcia, Beatrice E. and
Pointe Federal. Savings and
Loan Bank, its successors
and/or assigns as their.
interests may appear.
74`