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DS-15-2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-241005 Permit Number: DS-8-15-2005 Scheduled Inspection Date: October 06, 2015 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: RICHARDSON,VICKIE Work Classification: New Job Address: 126 NW 108 Street Miami Shores, FL 33168-4313 Phone Number Parcel Number 1121360100030 Project: <NONE> Contractor: CHAMPION CONCRETE Phone: (305)252-8055 Building Department Comments STAMPED CONCRETE WALKWAY APPROACH. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed <JTI Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 05,2015 For Inspections please call: (305)762-4949 Page 13 of 39 n 'BOUNDARY SURVEY . 1 108 STREET v�►�vp N as*5-r Msr w (/ 1. 5'Conc MLkk- - -—75 0t3 M&M-) BC - YE -1 r • , ' FND.1 P.1J2' 153M' (No)a) AAC � /�� - " �� 11.85.E i-: Pore" ?9.70' F GNOn ONE STOP V CBS c" RESIDENC_»926 is r.i - -- C N c c G ul YAI Ti vim-• � - ; > �� rte` �- ._'./:.:-_ T - f- At N ti _ r_ n t' LL. CDnc. ��- N > z L ' i f7l Tl cr _ i �I1•i - - - • .- - • r-• _ —� L'j t 3V ,ij L'7 i t T rSIN 0 1 9nvr 7) f 9.6!" C., 1 m t o. 1 2.09 L- ' 1 S FNDJ.P.1.' i�O 1G' - - &W5214 . .1P' Dat Wo 10) Miami Shores Village AUG Building Department i 2. 15 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Lip(- �` 46 Tel:(305)795-2204 Fax:(305)756-8972 T� INSPECTION LINE PHONE NUMBER:(305)762-4949 T_f FBC 20 !q BUILDING Master Permit No. � PE IT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL F-IPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ,2-(, 0 W 1 Uey;— 2 y City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: V3&—010` 03/0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): U 44e— ,� ,O._14 J Phone#: Address: a City: A-AMn 5'11-1Q bg!G� State: — Zip: 3516r Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: a All— Phone#: Address: I10to Me5 City: State: ..N Zip: �r��7�1 Qualifier Name: .- �SZJ.d t)- Phone#: -`ice State Certification or Registration#: Certificate of Competency#: cc_C5 DESIGNER:Architect/Engineer: Phone#: Address: —City: p i : State: Zip: Value of Work for this Permit: f Square/Linear Foota a of Work: /r �'S Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: to Specify color of color thru tile:'; Submittal Fee$ Permit Fee$ 115) ' (5� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ ` za TOTAL FEE NOW DUE$ ' 3 C) (Revised02/24/2014) (a , Bonding Company's Name(if applicable) Bonding Company's Address I _ 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 brochurf 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 abstnce of uch posted notice, the inspection will not be approv nd a reinspection fee will be charged. i Signature Signature t- OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this /��t0 day of �vJST 20 1 by �� day of �6v�� 20 IS by C N'1*'r.xJ3 SM:A/C= who is personally known to P"e 13d3/it O who is personally known to me or who has produced / 3C)-/ TD—5�/'2?p2-0me or who has produced w�4�� as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: MYCl/Ty�0 Sign: Sign. r}, EXpI /SSI F1 xF z,.. � • t ��wrr• .._ ryAT 'ry udry8Print: Print: vU019 "?019 ,kw!rV, RUTH LEDESMA Seal: t FF 172019, MY COMMISSION Seal: lmoNWuewlk ly �uNE AtXPIP1p72019eoneeaPc undrrsSS�ohde^rh. 2 Notary p, � n f APPROVED BY Plans Examiner I Zoning Structural Review Clerk (Revised02/24/2014) S&ORES !_ VC.1933 G� Miami shores Village soon Building Department 10050 N.E.2nd Avenue Aires it, � Miami Shores, Florida 33138 �XORIDA Tel: (305) 795.2204 Fax: 305 756.8972 SURVEY AFFIDAVIT STATE OF(FLORIDA) •••••• •• •••••• COUNTY OF(DADE) "•`•• • f •f J f•• f•fffJ f•s• fJ•tJ" The undersigned Affiant, t-*Aafl3 -� �� does hereby attest that '••' ••••;• J . (Property owner) •••••• The attached survey, performed by��' �`'�� `G� •""• (Name of surveyor's company) • For address: [?moi NW It V`'�,IA�vf 5►'l� �f_ �3/6�' Performed on Z (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 i ht. roperty Owner Signature Pribperty Owner Print Name SWORN TO AND SUBSCRIBED before me this day of C?-6 -"S' Affiant is personally known to me,to"I produced as identification. MY co RILED SM *_ ION#FF Nota pf., �EEXPIRES:Janua 1719 Notary Revised on 5/22/2009/Revised on 6/12/09 •d TAN Notarypa.18�ers 5t�OR Miami shores Village l ,,,,, Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 RipA Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner)IoCYN p__ Ulir61v bc. hereinafter referred to as the owner of the following described property(address): 0 GL/Y JET Legal Description Lot Block Subdivision Folio# lI-Zl,?zh— lel0 - X31 Requests permission to install (describe work): Within the public right of way of(address) nU �3,� 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 harmlessof 4 any • • • i• • , i • i•i• and all liability,which may rise by virtue of permitting the installation of these items witlp the publicrri m of way*,* • •i••r• i••i•: • i••• • 1 • i• • I 3. The Owner does hereby agree to remove or relocate their facilities at their own ex�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). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this to day of Gv51 201 r wner's Signature) AILED, DELIVERED in the presence of: • co' UTHLEDESJ17201d99M r p •7 +? MY MMISSION#EXPIRES:Januaryf; bonded Thro VWery Pun f • • • t f • •••••• •00.00 • • • •••• eggs • 000• ' 0 ••04,00 egoo go 0 e 4,04. • •• IN am Sir Miami Shores Village 10050 N.E.2nd Avenue NW Miami Shores,FL 33138-0000 i tiF—mss Phone: (305)795-2204 �� r• t"oRtvA Expiration: 02l20/2016 r Project Address Parcel Number Applicant 126 NW 108 Street 1121360100030 Miami Shores, FL 33168-4313 Block: Lot: VICKIE RICHARDSON Owner Information Address Phone Cell VICKIE RICHARDSON 126 NW 108 Street MIAMI SHORES FL 33168-4313 Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 CHAMPION CONCRETE (305)252-8055 (786)402-4802 __ .. . Total Sq Feet: 1000 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final Date Denied: Foundation Type of Work:STAMPED CONCRETE WALKWAY APPRC Additional Info: Review Planning Bond Return: Classification:Residential Review Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# DS-8-15-56659 CCF $1.80 DBPR Fee $2.25 08/24/2015 Credit Card $618.30 $50.00 DCA Fee $2.25 08/10/2015 Check#: 1971 $50.00 $0.00 Education Surcharge $0.60 Bond#:2815 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $668.30 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 cert that - foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z _ r , thorizwthe above-named contractor to do the work stated. August 24, 2015 Authorize i at e:Owner / Applicant / Contractor / Agent Date Building Department Copy August 24,2015 1