DS-14-1783Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-217954 Permit Number: DS -8-14-1783
Scheduled Inspection Date: September 24, 2014 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez, Jorge Inspection Type: Final
Owner: OJALA, JACK Work Classification: Addition/Alteration
Job Address: 28 NW 100 Street
Miami Shores, FL 33150- Phone Number (305)758-2987
Parcel Number 1131010180440
Project: <NONE>
Contractor: CHAMPION CONCRETE Phone: (305)252-8055
tiuttarng ueparltment comments
DRIVEWAY PAVERS
INSPECTOR COMMENTS
False
September 23, 2014 For Inspections please call: (305)762-4949 Page 5 of 25
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
September 23, 2014 For Inspections please call: (305)762-4949 Page 5 of 25
BUILDING
PERMIT APPLICATION
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
9526II'LDING ❑ ELECTRIC ❑ ROOFING
117�CEJVED
a AUG 14 014
FBC 20 LO
Master Permit No.��� l
Sub Permit No.'')siq— necf5
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION ❑ SHOP
DRAWINGS
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: r/FFE:
OWNER: Name (Fee Simple Titleholder): Phone#:
Address:
RR
City: 4 alm, h8t W2 State: 1--.2 Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:__ C Phone#: '.?or zjr
Address: Um
®,,��11� kw �s
City: —0 0&9' State: Zip:
Qualifier Name: _ —j -�%%'D�._ l s/iL I� Phone#: S'65 q?l 1(33
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: r City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work: 3f
lee -
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: A499ugU r
Specify color of color thru tile:
Submittal Fee $ tO .(30 Permit Fee $ ��-� �/� CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ q(0,
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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 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 musta posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absenceo such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
A A �,L
OWNER or AGENT
The foregoin trument was acknowledged beforememe this
Y day of 20 ' ` , by
t� , who is personally known to
r
me or who has produced as
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of ��'�-"' l 20 by
>rriYC, who i rsona no
me or who has produced \ as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
1111 IIII////,� ��gllllllll l///�°0i
Sign: "11105 'r Sign: � � • °�
Print: Print: _
Seal 9`0,�'Ile
4�,���� �= Seal: �'_
aX3 .....
INSK�k�� 7/:�
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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) c; r� hereinafter referred to as the owner of
the following described property (address):
Legal Description Lot Block Subdivision
Folio #
Requests permission to install (describe work): `fid 0
WithinJ,W Rublic rightpf way o[(address) A, ®n S� 1,
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 or
SIGNE , SEALE
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East 30' East 43'
of Lot 7 of Lot 6♦
Legal Description: 75.00' g
West 45 Feet of Lot 6 & East 30 Feet of Lot 7, Block
5,NAVARRO SUB, according to the Plat thereof, as
recorded in Plat Book 12, Page 59 of the Public
Records of Miami -Dade County, Florida.
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Property Address: 28 NW 100 STREET
Miami Shores FL 33150
Folio No.: 11-3101-018-0440
Certify to:
JOAN SUSAN OJALA JTRS JOYCE ANN OJALt
JTRS JACK RANDOLPH OJALA JTRS
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of Lot 7 of Lot 6♦
Legal Description: 75.00' g
West 45 Feet of Lot 6 & East 30 Feet of Lot 7, Block
5,NAVARRO SUB, according to the Plat thereof, as
recorded in Plat Book 12, Page 59 of the Public
Records of Miami -Dade County, Florida.
GRAPHIC SCALE
20 0 10 20 40
( IN FEET )
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Property Address: 28 NW 100 STREET
Miami Shores FL 33150
Folio No.: 11-3101-018-0440
Certify to:
JOAN SUSAN OJALA JTRS JOYCE ANN OJALt
JTRS JACK RANDOLPH OJALA JTRS