DS-15-2938 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-248212 Permit Number: DS-11-15-2938
Scheduled Inspection Date: January 21,2016 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: LOUIS,ALIX& MARIE Work Classification: New
Job Address: 161 NW 108 Street
Miami Shores, FL 33168-4312 Phone Number
Parcel Number 1121360100270
Project: <NONE>
Contractor: CHAMPION CONCRETE Phone: (305)252-8055
Building Department Comments
CONCRETE DRIVEWAY. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
January 20,2016 For Inspections please call: (305)762-4949 Page 15 of 32
Miami Shores Village M Pwntt= ,yj e.Dtivipways'S1'r"al s/ (>abs
10050 N.E.2nd Avenue NW l�lorkC/asifoathN]>
Miami Shores,FL 33138-0000 �€::. ':.
Phone: (305)795 2204 /e w Status.:AP`PRO�D
�'toRtvA
Iue Date
12/21/2016 Expiration: 06/18/21
Project Address Parcel Number Applicant
161 NW 108 Street 1121360100270
Miami Shores, FL 33168-4312 Block: Lot: ALIX&MARIE LOUIS
Owner Information Address Phone Cell
ALIX&MARIE LOUIS 840 AZALEA Place
WESTON FL 33327-
Contractor(s) Phone Cell Phone $ 2,400.00
CHAMPION CONCRETE 305 252-8055 Valuation:
( ) (786)402-4802
- _ Total Sq Feet: 600
f
i"
Approved:In Review Available Inspections:
Comments:
Date Approved::In Review
Inspection Type:
Date Denied:
Final
Foundation
Type of Work:CONCRETE DRIVEWAY. Additional Info: Review Planning
Bond Return: Classification:Residential Review Planning
Scanning:3 Review Building
Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00
CCF Invoice# DS-11-15-57839
$1.80 11/20/2015 Check#: 126 $50.00
DBPR Fee $2.00
$597.80
DCA Fee $2.00 12/21/2015 Credit Card $597.80 $0.00
Education Surcharge $0.60 Bond#:2931
Notary Fee $5.00
Permit Fee $125.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $647.80
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing4nformation is carats and that all work will be done in compliance with all applicable laws regulating
construction and zoning. rmore,I_authorize the abov - eat contractor to do the work stated.
December 21,2015
Authori atu e:Owner / / Agent Date
Building Departmen;!�ractor
December 21,2015 1
d
Miami Shores Village
Building Department raov
4 J`\ `` 10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 'r
FBC 20(�
BUILDING Master Permit No.)S 15— 39
PERMIT APPLICATION Sub Permit No.
ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/�g��l CONTRACTOR DRAWINGS
JOB ADDRESS: it/it) �(
City: Miami Shores, d County: Miami Dade zip:
Folio/Parcel#:��6 --0 -&O Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction/Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): ��tee/ , Phone#:
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:
Company Name: / ' Phone#;,,a ✓
Address:
City: - > State: r Zip:
Qualifier Name: N'L m�1��� Phone#: ivl �
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 24 !(06 Square/Linear Footage of Work: 66,07E
7E
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Re lace
p ❑ Demolition
Description of Work: �IF
Specify color o(f�color thru tile:
Submittal Fee$°—"' .cg-� Permit Fee$ ` �! CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ s ,-
TOTAL FEE NOW DUE$ I�
(Revised02/24/2014) S9-4 ,
y ,
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 mut be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence f such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
1
Signatur Signature
OWN or AGE NTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 !`� , by day of ,20 (�,by
�(S ,who is personally known to �� ,who is personally known to
me or who has produced \r2 UQ_7 NS3,,_as me or who has produced EL-t:>Zc VEP U�Ck
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLI
4
Sign: Sign:
Print: e Print:
o Q Notary Public State of Florida
Seal: �' Sandia Alvarez Seal: oa± ose` Notary Public State of Florida
�'� My Commission FF 156750 = Sandia Alvarez
®R Expires 09103/
910 312 01 8 og My Commission FF 156750
Expires 09/03/2018
APPROVED BY 1, �� Plans Examiner t� l ����/� Zoning
Structural Review Clerk
(Revised02/24/2014)
6
SNORES
Miami Shores Village
oMIN Building Department
10050 N.E.2nd Avenue
lORA o Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) A& "j Z_&u A hereinaftgr f rre to as the
owner of the following escribed property (address):
Legal Description Lotc Block Subdivision
Folio # I—V ;��_,�� r� � L
Requestsperm bion to install (describe work):
Within the public right of way of(addres )
IN CONSIDERATION of the approval of this permit 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 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).
A
Signature
Owner ge
The foregoing instrument was acknowledged before me this day of , 20 (& by
puk (W I r who is personally known to me or who has produced n_
as identification and who did take an oath.
NOTARY PU C:
Sign:
Print: S
My Commission Expires: 1 (�
0% Per,
aye Notary PubliEStateof a
Sindia AlvCommisExpires 091
QS( -
7,U7/7,- -7
. t
i
II I r ✓n,i Al i rr Di ren
L C
warzl� lip
i
Ilk'
NOV 2
kX
IL
p.
J
.8f4Util I,
``
to
eb
•••• • •• 0.4106
.. •0.•410.• 0000 •••0• .
• • •
4141 4141 41410• e•••:41 ,
MOM9
• •
, • • • • •41••0•,
l 4141 • • 4141• - •;p 'moi
i • • p
7�r
C.e..too
C
a.t 00