DS-16-1525 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-260699 Permit Number: DS-6-16-1525
Scheduled Inspection Date:June 10,2016 Permit Type: DrivewayslSidewalks/Slabs
Inspector: Porta Jr,Jose
Inspection Type: Final
Owner: WHALEN JR, MICHAEL PATRICK Work Classification: New
Job Address:10414 N MIAMI Avenue
Miami Shores, FL 33150- Phone Number
Parcel Number 1121360131150
Project <NONE>
Contractor: HOME OWNER
Building Department Comments
PLACE BRICKS ON EXISTING CONCRETE Infractio Passed Comments
INSPECTOR COMMENTS False
TO REPLACE PERMIT#DS-5-15-1209
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-260149.
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-Inspection fee is paid
June 09,2016 For Inspections please call: (305)762-4949 Page 27 of 33
Miami Shores Village
10050 N.E.2nd Avenue N '
Miami Shores,FL 33138-0000
YL
Phone: (305)795-2204
° Expiration: 1112 2016
Project Address Parcel Number Applicant
10414 N MIAMI Avenue 1121360131150
Miami Shores, FL 33150- Block: Lot: MICHAEL PATRICK WHALEN JF
Owner Information Address Phone Cell
MICHAEL PATRICK WHALEN JR 10414 N MIAMI Avenue
MIAMI SHORES FL 33150-
10414 N MIAMI Avenue
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 500.00 T
HOME OWNER
IN Total Sq Feet: 450
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:NEW PERMIT FEE Additional Info: Review Planning
Bond Retum: Classification:Residential Review Building
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# DS-6-16-60016
DBPR Fee $2.00 06/02/2016 Credit Card $119.60 $0.00
DCA Fee $2.00
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $119.60
1111111
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit 1 ssume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ,AL PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OW RS AF IDA V T• I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
stru n d g. F thermore,1 77
the above-named contractor to do the work stated.
June 02,2018
ature: r / Applicant / Contractor / Agent Date
Building Department Copy
June 02,2016 1
r Miami Shores Village 0.22016
Building Department BY: =-
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2004
BUILDING Master Permit No.-DE JQ — a�
PERMIT APPLICATION Sub Permit No.
( UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
1
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION F-1 SHOP
(� CON CTOR DRAWINGS
1 U �d t
JOB ADDRESS: ll \ �� � z
City: Miami Shores County: Miami Dade z1a:
Folio/Parcel#: Is the Building Historically Designated:Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
I
OWNER: m (Fee Simple Titlgholder): �`�� �` /� ( r bhone#: ( L-63"
I
Address:
City: / 1 ^ �� State: �� Zip:
Tenant/Lessee Nam`e: Phone#-
Email:�(1,°�l^ : i^k CID Vj JV C�L�ti IJL
CONTRACTOR:Company Name: nt mum, Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: 1 Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition M Alteration ❑ New ❑ Repair/Replace , ❑ Demolition
Description of Work: L
S (G
Specify color o color thru tile:
Submittal Fee$ Permit Fee$(N3 •�-�.TT
! CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$ �
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 11q , 60
(Reviseda2/24/2014)
1
V
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
talose-property-i"wbject-to-affachment:-Also,-a-certified copy Lfthe recorded notice of cammencemenrmu postL-rarfh-e-fo"ite _
for the first inspection which occurs seven (7) days after the building permit is issued in the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
-
Signature / Signature
4 OWNER or AGENT CONTRACTOR
The foregoing instrument as acknowledged before me this The foregoing instrument was acknowledged before me this
fir,► r
-02- --day of p ��, -yam 20 06 by day of .20 by
VYt�c� U(\) tSSis personally,known to who is personally known to
me or who has produced'EQ--W ff�L'C'E' s me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
4Sign Sign:
Print: S` � -P"QXX-4 Print:
� ,A14-
Seal:
. 4-Seal: f
ro�Y vue� Notary Pi:t;iic State of r='nrda +;' Seal:
o
Smdia Aivarez
My Commission FF 156*7?0
'moi OF Exp res 0 910 3/2 01 8
Gr
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
gs Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
OWNER BUILDER DISCL SURE STATEM AIT
NAME: l'1DATE•
_ I '
r
ADDRESS:
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,F.S 489.103(7).And I have
read and understood the following disclosure statement,which entitles me to work as my own contractor;I further understand that I as the owner
must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption
allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must supervise the
construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a
cost of$25,000.00 or less(The new form states 75,000).The building must be for your own use and occupancy.it may not be built for sale or
lease.If you sell or tease a building you have built yourself within one year after the construction is complete,the law will presume that you built
for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make
sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on
your building who is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and
with-holdings tax and provide workers'compensation for that employee,all as prescribed by law.Your construction must comply with all
applicable laws,ordinances,buildings codes and zoning regulations.
Please read and initial each paragraph.
1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an
exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain
restrictions even though I do not have a license.
2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Initials
3. I understand that,as an owner builder,l am the responsible party of record on a permit.I understand that I\may protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name.I also understand that the
contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts.
Initial ,\
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve a commercial
building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy.It may not be built or substantially
improved for sale or lease.If a building or residence that I have built or substantially improved myself is sold or,leased within 1 year after the
construction is complete,the law will presume that I built or substantially Improved it for sale or lease,which A lates the exemption.
Initial
5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction.
Initial
6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence.It
is my responsibility to ensure that the persons whom i employ have the license required by law and by county or municipal ordinance.
Initial
7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that erroneously
implies that the property owner is providing his or her own labor and materials.I,as an owner-builder,may be held liable and subjected to
serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property.My homeowner's
Insurance may not provide coverage for those injuries. I am willfully acting as an owner-builder and am aware of the limits of my insurance
coverage for injuries to workers on my property.
Initial
8. 1 understand that 1 may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the
work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by
me,which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the
Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employee.I understand that my failure to follow
these may subject to serious financial risk.
Initial\�
9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all applicable laws and
requirement that govern owner-builders as well as employers.I also understand that the
Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations.
Initial
10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,the United States
Small Business Administration,and the Florida Department of Revenues.I also understand that I may contact the Florida Construction Industry
Licensing Board at 850.487.1395 or http://www.mvfloridalicense.com/dbor/pro/cilblindex.htmi
Initial
11. 1 am aware of,and consent to;an owner-builder buildir)g permit applied for in my name and understands that I am the parry
legally no 7nclally resp risible for,the proposed constructio"ttivity at the following address:
Initial
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the Information that I have provided on
this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who does not have a license,the
Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial
loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or
employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder
permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of
the contractor's workers compensation coverage.
Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local
permitting agency responsible for issuing the permit.A copy of the property owner's driver license,the notarized signature of the property
owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued.
Was acknowledged before me this 89 day of �U� , 20 �
13YA10 ACL A 7t e( V12—
��` ho as personally known to me or who has
uced there License or t= as identification.
I �Y n� Notary .$rate of Florida
OWNER NOTARY �� " Smtlra Alvarez
.a My r01r.mtissiol7 FF 156750
iFOFFy �xpi9s0910312018
P+�°4m
Miami Shores Village
Building Department MAY 201
l`y 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 L
` ---
FBC 20 It
BUILDING Master Permit No. �2V
PERMIT APPLICATION Sub Permit No.
�YBIILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION SHOP
b� � q k CONT CTOR DRAWINGS
1 4
JOB ADDRESS: < Q le
City Miami Shores County: Miami Dade Zip: �"� S�
Folio/Parcel#: Is the Building Historically Designated:Yes NO ,V
Occupancy Type: Load: Construction Type: Fllo7�Phone#:
BFE: FFE:
OWNER:Name(Fee Simple Titleholder): V �� ® Vl
Address: 0 L111
�-
City: / State- Zip:
Tenant/L Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ .s--Oe� Square/Linear Footage of Work: �W_
Type of Work: ❑ Addit'on Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: n Ul
4
.s1 ice-
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ ji44
(Revised02/24/2014)
Bonding Company's Name(if applicable) a
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 w 'ch occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspectio ►ll not ap ro ed and a reinspection fee will be charged.
Signatur Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this`
y of E! 20 ,by day of 20 .by
ot� L 1�1 FLM
is personally known to ,who is personally known to
me or who has produced F `/ J me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal: �`Opv I% Notary Public State of Florida Seal:
Sindia Alvarez
MyCommisaion FF 156750
F)cpires 09!0312018
1
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
,gam s Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
NER BUILDER INSCLOSURE STATEMENT-
NAME: L)"r\( DATE: IZI
ADDRESS: Lo
i 1 9
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,F.S 489.103(7).And I have
read and understood the following disclosure statement,which entities me to work as my own contractor;I further understand that I as the owner
must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption
allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must supervise the
construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a
cost of$25,000.00 or less(The new form states 75,000).The building must be for your own use and occupancy.It may not be built for sale or
lease.If you sell or lease a building you have built yourself within one year after the construction is complete,the law will presume that you built
for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make
sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on
your building who Is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and
with-holdings tax and provide workers'compensation for that employee,all as prescribed by law.Your construction must comply with all
applicable laws,ordinances,buildings codes and zoning regulations.
Please read and initial each paragraph.
1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an
exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain
restrictions even though I do not have a license. /(,
Initial V SIC
Nj
2. I understand that building permits are not required to be signed by a property owner unless he or sheds responsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Initial_
3. I understand that,as an owner builder,I am the responsible party of record on a permit.I understand that l may protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name.I also understand that the
contractor is required by law to be licensed in Florida and to list his or license numbers on permits and con acts.
Initial
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve a commercial
building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy. It may not be built or substantially
Improved for sale or lease.If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the
construction is complete,the law will presume that I built or substantially improved it for sale or lease, hich violates the exemption.
Initial
S. I understand that,as the owner-builder,I must provide direct,onsite supervision of the constructio .
Initial
6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence.It
Is my responsibility to ensure that the persons whom I employ have the license required by law and by c ty or municipal ordinance.
Initial
q
7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that erroneously
implies that the property owner Is providing his or her own labor and materials.I,as an owner-builder,may be held liable and subjected to
serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property.My homeowner's
insurance may not provide coverage for those injuries. I am willfully acting as an owner-builder and am aware of the limits of my insurance
coverage for injuries to workers on my property. AA
Initial_�P1��
8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the
work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by
me,which means that I must comply with taws requiring the withholding of federal income tax and social security contributions under the
Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employee.t understand that my failure to follow
these may subject to serious financial risk.
Initial__
9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all applicable laws and
requirement that govern owner-builders as well as employers.I also understand that the
Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations.
Initial_IU�
10. 1 understand that 1 may obtain more information regarding my obligations as an employer from the Internal Revenue Service,the United States
Small Business Administration,and the Florida Department of Revenues.I also understand that I may contact the Florida Construction Industry
Licensing Board at 850.487.1395 or htto://www.mvforidalicense.com/dbpr/aro/cilb/index.html
Initial
11. 1 am aware of,and consent to;an owner-builder b9ding permit applied for in my name and understands that I am the parry
legally/and financial`y re ns a for the proposed c struction activity at the following address:
Initial
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the formation that I have provided on
this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who does not have a license,the
Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial
loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or
employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder
permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of
the contractor's workers compensation coverage.
Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local
permitting agency responsible for issuing the permit.A copy of the property owner's driver license,the notarized signature of the property
owner,or other type of verification acceptable to the local permitting agency Is required when the permit is issued.
Was acknowledged before me this day of AH 20
I`�
By �� 1ZIWQLTN 1 vho was personally known to me or who has
Produced there License or-�L-Mkk-C as identification.
OWNER OTARY �,. Notary PuWIo g�of F1orMa
;A Sindia Alvarez
y� My Commission FF 158750
'�Ap�= Expires 0910312018
Miami Shores Village
Building Department
10050 N.E. 2nd Avenue
Miami Shores, FI 33138
Tel: 305-795-2204
Fax: 305-756-8972
11/24/2015
10414 N. Miami Avenue
Miami Shores FL 33150
RE: Process No.DS-5-15-1209
Address: 10414 N Miami Avenue
Dear Owner,
Our records indicate that the above referenced permit has expired without obtaining the
proper permit approval. In order to serve you better,we need to keep our files up to date.
As per section 105.3.2 of the Florida Building Code, "An application for a permit for any
proposed work shall be deemed to have been abandoned 180 days after the date of filling, unless
such application has been pursued in good faith or a permit has been issued."
Please be advised that open permits will hinder your ability to refinance or sell this property.
Please contact the Building Department,within 15 days of receipt of this letter in order to
take care of this matter.
Sincerely,
Ismael Naranjo, C80
Building Department Official
305-795-2204
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) hereinafter referred to as the
owner of the following described property(address):
Legal Description Lot Block Subdivision
Folio#
Requests permission to install (describe work):
Within the public right of way of(address)
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 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
Owner or Agent
The foregoing instrument was acknowledged before me this day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
PERMIT II' �� l
CONTRACTOR: U- j-�-
SUBMITTAL DATE: I I
ADDRESS: rn I
NAME:
RESUBMITAL DATES:
PROJECT E: �J
ZONING / FIRE
STRUCTURAL IMPACT FEES
ELECTRICAL HRSIDERM
PLUMBING NOC
R� r
MECHANICAL BL h
• IAT-23Lar-6
BLOCK-123 t BLOCK-125
i d
,�y+ r.i�s}i {�!N•'AS•�,i• `t�,+`"`:�Ly��:`•+ .4»:" :aF.'4✓a � .
3.P 1/Z" NO CAP
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NO REVIEW REQUI I `
Florida Health Miami-Dade Coun ' e
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O.S.T.D.S. &Well Program I=-3 BL=-2125
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Application No.:
Date: > > 1� rocks on 40P °
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PJti.ie'ei Shores Village
APPROVED BY DATE
DEPT f r
ass M
�1 1
1 I;C r.1--PT
T
TO(-ONIPUANCE WITH ALL FEDERAL
���!�f-1T'r{ll ILl= Mln RFOU ATInNS
suimeyoB'SNom ----
Thm may be Basements recoraed in the Public Becords not shown on this Survey.
The pwrpose of this Survey is far use in obtsiaiug Title Insuxance and Financing and should not be used for Construeldoa purposes.
Bonding Company's Name(if applicable)
Bonding Company's Address
C
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 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 such posted notice, the
inspection will not be ap oved an reins ction fee will be charged.
Signature Signature
Ower or Agent Contractor
The foregoing instrument was acknowledged before me this 13 The foregoing instrument was acknowledged before me this
day of NyV '2011 ,by M14iP L WAALA,0 , day of .20_,by ,
who is personally known to me or who has produced e l Q who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: �au��see►tN����,/
��� �v�ca ,,� NOTARY PUBLIC:
Sign: _-.®? w }� ..�®�' = Sign:
, '.!REPrint: = �� %� 5`°5°� = Print:
1
My Commission Expires: �°�`. .. My Commission Expires:
n►nn
APPROVED BY (f t Plans Examiner t I E Zoning
Structural Review Clerk
(Revised 5/2/2012XRevised 3/12/2012)XRevised 06/10/2009XRmised 3/15/09XRevised 7/10/2007)
Miami Shores Village
Building Department INGV
1*3 W3 �.
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
1, v INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 201 L
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
DRESS: 10 L1 `LA 1�•1y V& y� ,�J A-
JOB AD �e�
City: Miami Shores County: Miami Dade Zip: 1 S
Foho/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Njune(Fee Simple Titleholder): ` e A1,XPhone#: -36s-- Ito
Address: it) �1 • cam- J L
City: 6 l ( r t S State: L Zip: 9 3 1 5
Tenant/I.es`seeee Name: 4 Phone#: T4,5--
Email:
4,5-"Email:
CONTRACTOR:Company Name: /yr� Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#•
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: Alkddition ❑Alteration ONew ORepair/Replace ODemolition
ption of Work: 0 77a
Color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
L
TOTAL FEE NOW DUE$