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DS-12-2067am Miami Shores Village Building Department OCT �01ti 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 No. PERMIT APPLICATION Master Permit No.' e FBC 20 1Q Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): Adl4m Phonek Address: l?y i IV !� /3 -4,-g City: lymetfi !�il& 2 -r State: Zip: 3,41-3d' Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: gzioi A5 13 City: Miami Shores County: Miami Dade Zip: -3!5 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: �-0-M 1AWU &- 4PQir-7'e Phonek Address: //00 AJAJ �3 5;i City:State: A P' Qualifier Name -,'Ary -dr—, &ieeo, P-) Phone#: 3 30'r State Certification or Registration #: Certificate of Competency #:C-0 :5 6.5, a0jg! ;S_ Contact Phonek Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ (f400l � Square/Linear Footage of Work: &60 151-• Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: Cptjae7 AdV*pz ! 3 :Fe �:�d:x:x�:�:��x�x���::x:x�:x�����:x:�x�x�x���:�:��x�:�:�::��:����x��:x� Submittal Fee $C' Permit Fee $ m�CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 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 that a copy of the notice of commencement and construction lien law brochure will bjadeliv ed to the person whose property is subject to attachment. Als ; a certified copy of the recorded notice of commencement musedatthejob site for the first inspection which occurs endays after the building permit is issued. In the ab ence oosted notice, the inspection will no)o roved a reinspection fee will be charged. 1v (pwner or Agent The fore ping instrument was acknowledged before me this day of , 20by w s person�knowna or who has produced �'-- As identification and who did take an oath. NOTARY PUBIS MY COMMISSION # EE032278 2014 53 Contractor The foreg ing instrument was acknowledged before me this99 day of f , 20 �, byai7� who is personally known to me or who has �� identification and who did take an oath. NOTARY P14 VARI A GROppER f E:Q``/f COMMISSION # EE032278 Commission Expires: IVCommission Expires: APPROVED BY C�'%J Plans Examiner 32�� Z Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. I TAX FOLIO NO. ( 7 3 �� �-1 �14G STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be property; and in accordance with Chapter 713, Florida Statutes, the is provided in this Notice of Commencement. 1. Legal description of property and streetladdress: 2. Description of 3.Owner(s) name and address: Interest In property: Name and address of fee simple titleholder. 4. Contractor's name, address and phone number. 0 ltllll ltlll lttlt !Illi lltlf lull lilt ltll lltl OR 8k 28330 Ps 1810; QP9) RECORDED 10/26/2012 09:10301 HARVEY RUVIN? CLERK OF COURT MIAMI—DADE COUNTYr FLORIDA LAST PAGE STATE OF FLORI COUNT OF OAM rife I HEREBY CERTIFY thts 4 e trued day �i ortgmet lino in tDia )ce ° 1LQ OMitffli&t�� Ad Qui 'et Seel. rlAavEY RU a�c��rcowts O.C. ey TANASHI ARNOLD 1144 Space above reserved for um of recording office 5. Surety: (Payment bond required by owner from contractor, If any) Name, address and phone number Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number: B. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a different date Is specmea) 7/— WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of er(s' u#�oriz�d"Officer/Director/Partner/Manager Prepared By Prepared By .1 1 0/ Print Name Print Name Title/Office Title/Office STATE OF FLORIDA COUNTY OF MIAMI-DADE /�jamn The for oing Instrument was acknowledged before me this day of—Ig �// Z By ❑ Ind -dally, or ❑ as for 11L.Kersonally known, or ❑ produced the following type of Identill on: Signature of Notary Public: Print Name: (SFS ;*: .* MY COMMIS EXPIRES October 05, 2014 _VERIFICATION PUFISUANT TO SF�CTION 92625 FLOF3IDA STAGE '• ' , =- - — _ . Naervtae.mm_ _ _ _ — -- _ -- Under penalties of perjury, i declare that I have read the foregoing and (401) ase �"53 F10 that the facts stated In it are true, to the best of my knowledge and belief. Signature(s) of Owners) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: By By 123.01-62 PAGE 3 3H 0 Permit No: 12-2067 Job Name: November 5, 2012 Building Critique Sheet 2"d Provide HRS/DOH approval. NB Planning Critique PROVIDE PLAN THAT IS TO SCALE AND PROPERLY DIMENSIONED. Page 1 of 1 MAKE SURE THAT NOT MORE THAN 50% OF FRONT YARD IS COVERED BY HARD SURFACE. NO PART OF DRIVEWAY MAY BE LOCATED WITHIN 10 FEET OF SIDE PLOT LINES. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. Norman Bruhn CBO 305-762-4859 STATE OF (FLORIDA) COUNTY OF (DADE) Miami shores Vitlage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tet: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT The undersigned Affiant ! �H • . does hereby aftest that (Property owner) The attached survey, performed by 1714A�wj (Name of surveyor's company) For address: 3V3 Performed on O3= G 3-/2 (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 exlet on the property which are not permuted or which may violate zoning or building cede regulations. The Affiant further understands that the existence of any such structures may affect final inions as applicable to this or other permits. Fu ant say eth naught. _ P wr>er Signature Property Owner Mame SWORN TO AND SU ore me this -day of / Affiant is krrown fo me roduced as identification. J/ Robed ons/22/2 9/ReWsm!onOM20 MYCOMMI IFCCV�cr- �&°`. r-xpiRES ctober 05, 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)_ AO -An G/l D,P .C. hereinafter referred to as the owner of the following described property (address): Ci q �f /vim �� •9'V p e&4I kv�TV-> /-/- 3 3>�� Legal Description ��r7nv ylZcjmot 3 Block _ Subdivision Folio # H- 3ZOS- 00 -r— 0 Lta'Q Requests permission to install (describe work): (oN4ie7C. �. Within the public right of way of (address) 4YO/ NE 113A u,� 110)y33i�-- 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 resrilt 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 Signature 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). r or Agent The foregoing instrument was acknowledged before me this --a,-day of 20LZ=, by &"-- Zme— who is personally known to me or who has produced As identification and who did take an oath. KART A GROPPER NOTARY PUBLIC: °`t MY COMMISSION # EE032278 '? u,._,• EXPIRES October 05, 2014 Sign: Com 2 IYllssl<bn: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. (Jamie Basilio Corp) 11001 NW 83 Street 103 Miami, FL 33178 Melon : To be the Healthiest State in the Nation RE: Contingency Letter Application Document No: AP1091875 Centrax Permit Number: 13 -SC -1445763 OSTDS Number: 9901 NE 13 Ave Miami, FL 33138 Lot:3 Block:4 Dear Applicant: March 14, 2013 Subdivision: Earleton Shores Rlck Scott Governor. John H. Armstrong, MD, FACS State Surgeon General & Secretary This will acknowledge receipt of an application dated 12/18/2012 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. The drainfield is on the South side of the building. This permit is for the certification of a driveway on the West side of the property. If you have any questions on this matter, please call our office at (305) 623-3500. Sincerely, Joseph Enclosures cc: Specialist II Florida Department of Health www.FloridasHealth.com in DADE COUNTY TWITTER:HealthyFLA 1725 NW 167 St, Opa Locka, FL 33056 FACEBOOK:FLDepartmentofHealth PHONE: (305) 623-3500. FAX: (305) 623-3645 1 YOUTUBE: fidoh (,:� I ,, f ES .M1) RSG loa = o L :e1bOS !2/lms -710 011V141 �•.-� .Ll'LOZ rn •� Cr1 .1� i'3 4 MAK-DADS COUNTY " A a h PERMIT :ars; �:___�m��• � �? ��..___�. ! 7 GJ 11t.OL V" C. Q),�, 031ON 3SIM?J3H10 SS3lNn 3anSV3W (INV 02J0036 321V N032J3H NMOHS S30NV1SIQ ONV S0Nl?JV39llb dd` IN ONb• dOA3AMS 3SN3 V 10lV3S 03SI` ?J 1VN19 3H ONV 3dn1H 3H11noHwm OnVA 1014 S, SIHl MOI d lV3S OIN 0313 031V0I1N3Hj Nb 3drlLVN91S 01NOM-DEN3HLnb NVV (O ZM On lON YQlb01d d0 t' +: J(J15 '�N14'S'd tiO.NI 3 4w. l�2lld 313L)d lA F3N71C 1.J11)<Ijb''YQJ,IOId'11, o,zit' (.)1 J O11NvnS mi 300):7 A1iflLu�tmwaY '0,70 Id '9 L1 119 i131d� H, NI 3 t'W ON!' C'dOA3A21n1 'I 'qo tiS39021d do aliY08 VC[MOld d0 31F' L 3 A H.LVOJ 131 SY 'sOZJYG.. 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