DS-14-2043Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-219960 Permit Number: DS -9-14-2043
Scheduled Inspection Date: October 09, 2014
Inspector: Rodriguez, Jorge
Owner: BOWARD, DAVID
Job Address: 55 NE 97 Street
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: CHAMPION CONCRETE
rswiaing uepanment comments
CONCRETE DRIVEWAY
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (305)968-2445
Parcel Number 1132060130990
INSPECTOR COMMENTS False
Phone: (305)252-8055
October 08, 2014 For Inspections please call: (305)762-4949 Page 18 of 40
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
October 08, 2014 For Inspections please call: (305)762-4949 Page 18 of 40
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
SEP"�"VEJ
18 201
FBC 20 L�
BUILDING Master Permit No IL -i " `-lo-�>
PERMIT APPLICATION Sub Permit No.
ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
F-IPLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
JOB ADDRESS:
CONTRACTOR
DRAWINGS
Folio/Parcel#: Is the Building Historically Designated: Yes NO -
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): D V41W Phone#:
Address: `; /y
City:State: Zip:J�/'
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Phone#:
Address:to City:
Qualifier Name:
State Certification or Registration #: Certificate of Competency #:7
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work: 0 22 fkAll�
Type of Work: ❑ Addition
Description of Work:
❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ �' Permit Fee $ 12-1,5'Co CCF $ "2-, �4 ® CO/CC $ 92
Scanning Fee $ Radon Fee $ DBP�R�$ Notary $ CO
Technology Fee $ ° �� Training/Education Fee $ C) , 80 Double Fee $
Structural Reviews $ Bond $ 54?, ,
TOTAL FEE NOW DUE $ �9 " 0
(Revised02/24/2014)
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 must be posted at the job site
for the first ir�pection which occurs seven (7) days after the building permit is issued. in the absence of sui posted notice, the
inspection will of be approved and a,reinspection fee will be charged. �/
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 20 Py by
A)Ay k C) , who is personally known to
me or who has produced C-(— as
identification and who did take an oath.
NOTARY PUBLIC:
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The foregoing instrument was acknowledged before me this
day of , 20 �`� by
011 e)- (Z– x'25, who i personally know to
me or who has produced
identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print:
Seal:
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APPROVED BY �o Plans Examiner �� Zoning
Structural Review Clerk
(Revisedo2/24/2014)
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)lAve-0A hereinafter referred to as the owner of
the following described property (address): :,5� e -f 7—
Legal Description Lot Block Subdivision
Folio # o/` 3W6 — 0 a 0'? L')
Requests permission to install (describe work):_ 6 �" ALI�'
Within the public right of way of (address) A
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 Rem(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 day of , 201 Li
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(Owner's Signature )
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APPROVED
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ZONING DEPT
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BLDG DEPT
SUBJECT TO COMPLIANCE WITH ALL 1`44R 3AL
STATE AND COUNTY RULES AND REGULATIONS
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