DS-15-2007 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-241013 Permit Number: DS-8-15-2007
Scheduled Inspection Date: September 16, 2015 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: SALYER, THOMAS Work Classification: Addition/Alteration
Job Address:311 NE 94 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060136100
Project: <NONE>
Contractor: CHAMPION CONCRETE Phone: (305)252-8055
Building Department Comments
REPLACE EXISTING DRIVEWAY WITH CONCRETE Infractio Passed Comments
PAVERS INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 15, 2015 For Inspections please call: (305)762-4949 Page 11 of 16
Y ByrdD 6
��sHO1�so, Miami Shores Village
10050 N.E.2nd Avenue NE r<14,00ffa6�n3c*bin/Aitatiorf '{
Miami Shores, FL 33138-0000
_._ r : ' Pelttai# ia� APPROVER.:.,;
ti Fryy Phone: (305)795-2204 ,
FLORIDA Ry'Ej u/i 3 f '
Expiration: 02/21/2018
Project Address Parcel Number Applicant
311 NE 94 Street 1132060136100
Miami Shores, FL 33138- Block: Lot: THOMAS SALYER
Owner Information Address Phone Cell
THOMAS SALYER 311 NE 94 ST
I MIAMI SHORES FL 33138-2831
Contractor(s) Phone Cell Phone Valuation: $ 6,500.00
CHAMPION CONCRETE (305)252-8055 (786)402-4802
Total Sq Feet: 1100
Approved: In Review Available Inspections:
Comments: Inspection Type:
Date Approved: : In Review Final
Date Denied: Foundation
Type of Work: REPLACE EXISTING DRIVEWAY WITH CC Additional Info: Review Planning
Bond Return: Classification: Residential Review Building
Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00
Invoice# DS-8-15-56661
CCF $4.20 08/10/2015 Check#: 1971 $50.00 $624.70
DBPR Fee $2.25
DCA Fee $2.25 08/25/2015 Credit Card $624.70 $0.00
Education Surcharge $1.40 Bond#:2817
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $674.70
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: 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. Futhermore, thorize the above-named contractor to do the work stated.
August 25, 2015
Authorize ignature:Owner / Apl ant / Contractor / Agent Date
Building Department Copy
August 25, 2015 1
Miami Shores Village g AUG z015
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949C,
FBC 20 ( �
BUILDING Master Permit No.� ( �
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
^fCONTRACTOR DRAWINGS
JOB ADDRESS: �� " `'L ' ITLt- S-r
City: Miami Shores pp Countv: Miami Dade zip: 3!�r3 S
Folio/Parcel#: SOTS lo��J p�G1� $ Is the Building Historically Designated:Yes NO_X'
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): _�� �� (/� >S o4.�-.YL=i2_ Phone#:
Address01=r
:q,�
City: �'r'`tel 1' � .r� State: L__ Zip.
Tenant/Lessee Name: Phone#:
Email:
(�✓� Tit-•�E R.. r C�►t�
CONTRACTOR:Company Name: �i7�1 /"�Ej/v ��G �'[ Phone#:
Address: i �� �VQ RA w
City: tate: Zip.
./ �S`(�
Qualifier Name: Phone#: -?(!rb`q0L `l +Z
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer:. Phone#:
Address: / City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: Z;/o D -57,x,
Type of Work: ❑ Addition p❑, Alteration ❑ New �epair/Replace ❑ Demolition
Description of Work:
L�L�2 Ez-L�
Specify color of color thru the
Submittal Fee$ Permit Fee$ CCF$ CO/CC$ v
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ � t
TOTAL FEE NOW DUE$
(RPvkPdn,)/')d/Jn1dl
R s
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 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of ch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT C NTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day ofyn� 201 by 10 day of �tJt6df� 20 by
who is personalllyl known to I� �Ig+l�'1'1 6d51�� o who is personally known to
me or who has produced r �. S��d 2�Z 1�F14s�U me or who has produced as
identification and who did take an oath. lSS I®OOL�TUU identification and who did take an oath.
NOTARY PUBLIC: 111 D�11 NOTARY PUBLIC:
Sign: Sign:
Print: Pu Print: RUTHLEDESMA
I0"I FF tow ;*;' LM MY COMMISSION N FF 172019
Seal: *1 OOIIMII§*M MY,19,2O19 Seal: •.• ` EXPIRES:January 18,2019
Bonded Thru Notary Public Underwriters
APPROVED BY Plans Examiner �� Zoning
Structural Review Clerk
♦SH0Res Li
�c Miami Shores Village
Building Department
10050 N.E.2nd Avenue
FNres„�8� Miami Shores, Florida 33138
�zORiDp' Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
. . .... ......
COUNTY OF(DADE) '
...... .. . ......
The undersigned Affiant, 76mss &("ks"S+ereby attest that ••• •
.... . .....
(Property owner) '
...... .... .....
The attached survey, performed by " 9690 06••••
(Name of surveyor's company) • • • • ••••••
For address:
3« n} .is . �� s-r ►h� ►� Sri ,. �•. ... 3$
....
•• •
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.
Further Affiant say eth naught.
Property Owner Signature Property Owner Print Name 1
SWORN TO AND SUBSCRIBED before me this J day of v W
Affiant is personally known to me, produced
Sd�o 3 G uUDIANA L RODRIGUEZ
Notary Public,State of Fiorlda
Ocmmlae W FF 209430 t� *1 01M
-� daBl13�e1 ,
Notary
Revised on 5/22/2009/Revised on 6/12/09
5ORs
t . ' Miami Shores Village
unit" Building Department
10050 N.E.2nd Avenue
x�yd Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) TFb W40fQ W • s .`c l�`�--- hereinafter referred to as the
owner of the following described property (address): I I T S S,yo29S/9L,
Legal Description Lot A0—If Block vS Subdivision
Folio # LA___f 0106k-- 104
Requests permission to insta (describe work): JJArk)8'✓ZQ-AUL
Within the public right of way of (address) .3l/ --r-
IN CONSIDERATION of the approval of this permit by the Village, the owner agreeA asf'bllows:....
1. To maintain and repair, when necessary, the above-mentioned itern(69.}instaled*wlthin the-:.
dedicated right of way. If it becomes necessary for Miami Shores "fitite or Dade Cou+�ty•:
to make repairs or maintain said items within public right of way i6�jyding jestoration*.af..
street by reason of the Owner's failure to do so, such expense sha&lpepaid by." OwM4••9
or shall constitute a lien against the above described property until-patd. 00.0:0
2. The owner does hereby agree to indemnify and hold Miami Sl6W:Village99r DagjP.;:0
County harmless from any and all liability, which may rise by virtue. of pdrHfttng 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 owTf e*ense,
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).
Signature W '
Owner or Agent �10
The foregoing instrument was acknowledged before me this day of �O , 20 , by
JNW'(�U� j U U tj, who is personally known to me or who has produceAl� _ L1t a�L� �,_A t U�,(j
as identification and who did take an oath. � � � �
N UB
Sign:
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MOM
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tz
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a ye/\ �''ra,!� °`' \�41sr �P Legal Description
�,�x'({�y _,✓ ' -''fir'` ° �'�„ �8 s 3 r.3�Or>E:;2HEr111� e� ��h
�� �Q� �� �s• `�''�-'� L.tra , ��a Lots 10 and 11,Block 45, ofAN"EJ
.o. )� °�' rs ' 2 �5 SHORES SECTION NO. 1,according
b " )O. a* recorded in Plat Book 10, Page 70,of r
Dade County,Florida.
Date of field work: 3115194
Completion date: 3116194
Flood zone: X
Panel: 0093
Survey number: G-3912
'f�1�✓� ' � ."!� 4 i�J� ' 'Cel ct�c�. �, t, CertiJled to:
Thomas W Salyer and Kathleen M. Sal
tvY-1/ I
Q Services,Inc.;First American 17tle Ins
Z BancBoston Mortgage Corporation, its
Jam- y l� asz t,.v�a�( i assigns
s� '�
' roperty address:
' b —� R :U I R E DI1 N.E. 94 Street
-* =- a t ) e CountyMiand,FL 33138
,, -�►. � ,.;&W II Program
Application o.
Date: oil oZfl1
l NOTESI First
/ R EITHER ASSUMED
I 1) BEARI�Mqj !1 E
CE fHb I BOUNDARY SURVEY MEETS THE MINIMUM TECHNICAL STAND DS AS SET z) LEGAL�281. loN PROVIDED BY OTHERS. Financial
Ip RD OF PROFESSIONAL LAND SURVEYORS IN CHAPTER 21H FLORIDA 3) THE LAND BROWN HEREON WERE NOT ABSTRACTED FOR EASEMENT
TIV" p, DANT TO SECTION 472.027,FLORIDA STATUTES. OR OTHER RECORDED ENCUMBRANCES NOT SHOWN ON THE PLAT.
d) UNDERGROUND PORTIONS OF F40TINGS,FOUNDATIONS OR OTHER
IMPROVEMENT WERE NOT LOCATTED.
5) ELEVATIONS ARE BASED ON NATIONAL GEODETIC DATUM.
RALP: ERDL F 8) FENCE OWNERSHIP NOT DETERMINED.
REGISTERED LAND SURVEYOR NO.3411 7) WALL TIES ARE TO THE FACE OF"rHE WALL.
CTATr-nF R f)RinA 8) NOT VAUD UNLESS SEA).ED WITH AN EMBOSSED SURVEYORS SEAL. ,�� nwn .•-Vr-f% A 1t•