DS-16-1407 3 �
Miami Shores Village lOP
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204 0 � �
Expiration: 01/08/2017
VM, .
Project Address Parcel Number Applicant
1501 NE 103 Street 1132050310200
Miami Shores, FL Block: Lot: MARTIN AND ROXANNA MEDIN,
Owner Information Address Phone Cell
MARTIN AND ROXANNA MEDINA 1501 NE 103 ST (305)759-9148
MIAMI SHORES FL 33138-2627
Contractor(s) Phone Cell Phone Valuation: $ 7,200.00
CHAMPION CONCRETE (305)252-8055 (786)402-4802
_ m ._.,,._.. _. .. .... _ _ Total Sq Feet: 1240
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:DRIVEWAY PAVER 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-Contractors Bond $500.00 Invoice# DS-5-16-59883
CCF $4,gp
DBPR Fee $2.25 07!12/2016 Check*2240 $626.30 $50.00
DCA Fee $P.25 05/23/2016 Credit Card $50.00 $0.00
Education Surcharge $1.60 Bond#:3139
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $6.40
Total: $676.30
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,statementsr specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either my if, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS, OOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information ' accur and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-name tra o work stated.
July 12,2016
Authorized Signature:Owner / Applicant / CVntractor / Agent Date
Building Department Copy
July 12,2016 1
Miami Shores VillageRECPAVMV
Building Department mAy 2 , 2616
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014 s�
BUILDING Master Permit No. �c51 i;P --
PE IT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1'50/ m:'� 10:7 t�1�
City: Miami Shores J Countv: Miami Dade Zip: wkiy
Folio/Parcel#: ��-��(�®�jJ—��� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 1`U�4eTIAJ 6A&Aly is Phone#: .
Address: , 101 NE 10-3 5r
City: 0re.s State: Zip:
Tenant/Lessee Name: Phone#:
Email: /
CONTRACTOR:Company Name:�I c�4��n� Phone#_3�
Address:J o Lf_3c-) Nk) / SL_g/je .
City: -JQ0"/_ State: 4-(, Zip: 3 3)
Qualifier Name: -JA/z f f� C 5/(,� Phone#:
State Certification or Registration#: Certificate of Competency#: GC�_9_3 00�y
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 7Z0� Square/Linear Footage of Work: 7 V s�
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Alf ;e �e4 A
Specify color of color thru tile: K
Submittal Fee$S!%� Permit Fee$ t�'� •�y CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ 5g� •//��
TOTAL FEE NOW DUE$ 6 2_ P•23 0
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lenders 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 on 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 uch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
�i f,
Signature ,/ Signature
OWNER or AGENT CO TRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
M day of,�,/ 20 by �_day of �" �20 by
h � 1 a("4 who is personally known to I'Y1:2 13 A-S t ho is personally known to
me or who has produced T1", as me or who has produced &S or 44, as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign Sign:
Print: Print:
,., * MY COMMISSION H FF 172119 `'�4
Seal: EXPIRES:January 18,2019 Seal: `* t MYCOA ��sMA
',RPS t°��, Bonded Thru Notary Public Un4enurkeB P?�' EXPIRES ISSION1�yFF fT2�tg
Pf Fha` Bonded TMu k�N Putd1,101 2DIO e
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
t 51�os G
•�• nn. Miami Shores Village
Building Department
IORIDA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT#:,l JS (�" `I Dom- DATE: 3Y
(Name)
ol6ontractor
❑Owner
❑Architect
Picked up 2 sets of plans and (other)
Address: /�O/ /UN-7- la-3
From the building department on this date in order to have corrections done to plans
And/or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to ntinue pe itting process.
Signature:
I NATURE)
PERMIT CLERK INITIAL:
RESUBMITTED DATE: `T 7"
PERMIT CLERK INITIAL:
5/2/2016 Property Search Application-Miami-Dade County
v
f
a
IMPORTANT MESSAGE The Property Appraiser does not send tax bills and does not set or collect taxes. Please visit the Tax Collector's
website directly for additional information.
Address Owner Name Folio
SEARCH:
1501 NE 103 ST Suite U
PROPERTY INFORMATION
Folio:11-3205.031-0200
Sub-Division:
MIAMI SHORES BAY PARK EST REPLAT OF TR C
Property Address
1501 NE 103 ST
Miami Shores, FL 33138-2627
Owner
MARTIN MEDINA&W ROXANNA
Mailing Address
1501 NE 103 ST
MIAMI SHORES,FL 33138-2627
Primary Zone
1100 SGL FAMILY-2301-2500 SO
Primary Land Use
0101 RESIDENTIAL-SINGLE FAMILY: 1 UNIT
Beds/Baths/Half 4/2/0
hnp://www.miamiclade.gov/pmp"search/`#/ 1/8
OR
Miami Shores Village
I nil Building Department OR BK 30082 Pg 1895 (Pgs)
10050 N.E.2nd Avenue i=i:ORH
L"fYt i
1A f '( s:: ;;,i j.E;g CLERK OF{ n COURT
�LORmA Miami Shores, Florida 33138 sy ; _ . r.,...,;_' ,
_11J h1L�
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CON$TRUCTIO14 WITHIN RIGHT OF WAY
Whereas, (owner) Aa7iAI IVP-
hereinafter referred to as the owner of the following described
property (address): (501 IV 0 /Q-s 5r.-
Legal Description: Lot Block Subdivision
Folio #
Requests permission to install (describe work): A S
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 Shore ' ge
(or his fully authorized representative). STATE OF FLORIDA,COUNTY OF DADE P�,o COUNry
j
I HEREBY CERTIFY that this is a true copy of the � �CIf P. C'OG
�/ original filed in this office on day of
Signature r �L7inl / eJ;Nle!
D zo
✓v THE s my hand and Official seal. win - Muv OQ`
Owner or Agent H U IN, n c gyres �<oq
.C. �ECOU��
State of Florida S ALL 8 8
County of Miami Dade G
The foregoing instrument was acknowledged before me this C -( day of N f' , 20 / , by
f h Yk who is personally known to me or who has produced
r�n as identif4ation.
er,'• RUTH I, �MA
NOTAR UB 'r4 MY COMMISSION 0 FF 17410
Sign: EXPIRES JJanuq 1Q,2919
p'" "'' layn�@trders
Print:
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