DS-15-1131 Miami Shores Village 2 \\ �+ r� SE
10117W,� S
10050 N.E.2nd Avenue NW ` � � �� �
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Miami Shores,FL 3313&0000
1 ,oJ � d 4 ' '47 OVER
4Fry Phone: (305)795-2204 - „,, ,,u�
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` ti1?6 Expiration: 12123/2015
Project Address Parcel Number ry Applicant
113 NW 108 Street 1121360100310
Miami Shores, FL 33168-4312 Block: Lot: ALEXANDER RUNDLET
_Owner Information Address Phone Cell
ALEXANDER RUNDLET 113 NW 108 Street
MIAMI SHORES FL 33168-4312
Contractor(s) Phone Cell Phone Valuation: $ 4,620.00
CHAMPION CONCRETE (305)252-8055 (786)402-4802
Total Sq Feet: 740
Approved: In Review Available Inspections:
Comments: Inspection Type:
Date Approved: :In Review Final
Date Denied: Foundation
Type of Work:STAMPED CONCRETE DRIVEWAY Additional Info: Review Building
Bond Return: Classification:Residential Review Building
Scanning:3 Review Building
Review Planning
Review Planning
Review Planning
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00
CCF Invoice# DS-5-15-55535
$ .00
DBPR Fee $22.00 05/13/2015 Credit Card $50.00 $596.00
DCA Fee $2.00 06/26/2015 Check#:916 $596.00 $0.00
Education Surcharge $1.00 Bond#:2767
Permit Fee $125.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $646.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS, DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: Icertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a o Fut rmore,I authorize the above-named contractor to do the work stated.
June 26, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 26,2015 1
Miami Shores Village r .T_' JV1FD
6 jj` S� Building Department MAY 13 2015
6 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972 BY'
INSPECTION'S PHONE NUMBER: (305)762.4949
FBC 20' 0
BUILDING Permit No. C)S f
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING'X ROOFING
JOB ADDRESS: I/ 3 ✓�� ��
City: Miami Shores County: Miami Dade Zip: '
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): /7'/� �s.1�7�'.�� Phone#:
Address:
City: n:�&W jff,0&!�2 State: — Zip: 3 ��
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:_ L �^'� 4,-,)Vl Phone#:3X15 2sL' a5�
Address: L1 0 i)/ I�VV0�3 '7T
City: J L'iM State: Zip: -4'�`ir/
Qualifier Name:_�Jf1 < ANA J Phone#:0"`d C?74•-tl j n
State Certification or Registration#: Certificate of Competency#: j�5 3!Ll �'/f
Contact Phone#: Email Address: I YAW 4.e4,
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ Y4 Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work:
Color thru tile:
Submittal Fee Permit Fee$ ` CCF$ CO/CC$��----
Scanning Fee$ Radon Fee$ DBPR$ Bond$ l_ • l J
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ H6 'oo
v- 1C . 00
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 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 muo be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absenc of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
�{
Signature ,�`��1. � � Signature
Owner or Agent ontractor
The fore oing instrument was ac awledged before his The for oing in trument was acknowledged befo e this
day of 201 5 ,by day of 20 I ,by f
who is personally known to me or who has produced who i ersonally know to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY LIC: NOT PUB IC:
Sig Si
Print: Print: v
My Commission Expires: to�'�:::;�QCE, AILYN RAVELO My Commission Expires: r°` :;�°�� AILYN RAVELO
* MY COMMISSION#FF 214548 + * MY COMMISSION#FF 214549
EXPIRES:March 29,2019 EXPIRES:March 29,2019
�004' Bw4ed TAN Budget No"SWiCeS J'�>E `�e Bpold Thn B t Np�yy
APPROVED BY i- Plans Examiner ( Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
, 1
gNoREs
Miami shores Village
soon �J ,.,.. Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
OR{pP Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Z"
Whereas, (owner) 4O10- /a'�,"�A1- hereinafter referred to as the owner of
the following described property(address): d3 '00, ;
Legal Description Lot Block Subdivision 11- Z43& -00-0310
Folio# _
Requests permission to install (describe work): ./C
74VA �VA�A'-',
Within the public right of way of(address) �a1 al 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.
1
r ,
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 �� da + 1`t 201
� v r
(Owner's Signature)
,54ED, ND DELIV�D in the prese ce of:
�J /S
AtLYN RAVELO
* MY COMMISSION I FF 214549
EXPIRES:March 29,2019
a'rFor v���Oe Bonded Thru Budget Notxy Seniea
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