DS-16-1477 15
,
Miami Shores Village 'W �iit�labs '
10050 N.E.2nd Avenue NE
X18 t7 id4d�# lattl<on
•"' Miami Shores,FL 33138-0000
IN
Phone: (305)795-2204 `
AN
` � g Expiration: 3/19/2017
Project Address Parcel Number Applicant
17 NE 109 Street 1121360040610
MATTHEW ANDERSON
Miami Shores, FL 33161-7039 Block: Lot:
Owner Information Address Phone Cell
MATTHEW ANDERSON 17 NE 109 Street (305)632-2288
miami shores FL 33161-
Contractor(s) Phone Cell Phone Valuation: $ 7,000.00
CHAMPION CONCRETE (305)252-8055 (786)402-4802
Total Sq Feet: 924
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:FRONT BRICK PAVER DRIVEWAY REAR Additional Info: Review Planning
Bond Retum: 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-5-16-59962
CCF $4.20 05/27/2016 Credit Card $50.00 $599.20
DBPR Fee $2.00
DCA Fee $2.00 09/20/2016 Credit Card $599.20 $0.00
Education Surcharge $1.40 Bond#:3214
Permit Fee $125.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $649.20
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 anc =. ?heore,I authorize the above-named contractor to do the work stated.
September 20,2016
Autrag
ed Signature Owner / Applicant / Contractor / Agent Date
Build i Department Copy
September 20,2016 1
Miami Shores Village M:OV
oti
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 20N �
BUILDING master Permit No. d Js I(o "
PERMIT APPLICATION sub Permit No.
OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ' ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 17 NE 109 STREET
City: Miami Shores County: Miami Dade Zia•
Folio/Parcel#: 11 2136 004 0610 Is the Building Historically Designated:Yes NO X
Occupancy Type: SFH Load: Construction Type: CBS Flood Zone: N BFE: FFE:
OWNER:Name(Fee Simple Titleholder):MATT ANDERSON/BETH BARTELETTI phone#:305 632 2288
Address: 17 NE 109 STREET
City. MIAMI SHORES State: FL Zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: CHAMPION CONCRETE Phone#: 305 252 8055
Address: 10430 NW 74 STREET#208
City: DORAL State: FL Zip: 33178
Qualifier Name: JAIME BASILIO Phone#: 305 978 4333
State Certification or Registration#: Certificate of Competency It: 05BS00815
DESIGNER:Architect/Engineer: SAME Phone#: SAME
Address:SAME City: State Zip:
Value of Work for this Permit:$7000 Square/Linear Footage of Work: 618 FRONT&306 REAR q 2 4
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition
Description of Work: FRONT- BRICK PAVER DRIVEWAY/ REAR POURED CONCRETE
PAVER STYLE CHICAGO 6X9 & 6X6
Specify color of color thru tile:
Submittal Fee$-50 Permit Fee$ (2� CCF$ CO/CC$
[[••]]
Scanning Fee$ —1 Radon Fee$ - Oo DBPR$ 2 os Notary$
Technology Fee$ `) . (DO Training/Education Fee$ .4o Double Fee$
Structural Reviews$ Bond$ (`1 O0
TOTAL FEE NOW DUE$ 9 9 LU
(Revised02/24/2014)
5 99 - 20
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 such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
—day of .00a, -.20 /6 by ��K• dayy of ��7 y 20 /4e by
, &,-j®,V7 who is personally known to �04'4*0e 64.4r1.,C'® who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
A -
Sign: Sign:
Print: Print:
Seal: Seal: �� .,� Notary Public State of Florida
MY C01aIM13S10N f FF 189170 Matthew B Anderson
•, s EXPIRES:March 31,2019 p�< EMy xpires 09111/2016 834294
'�, Bonded Thfu iVotmy Pu61M U»dae or w P'
APPROVED BY r Plans Examiner V J/7�i� Zoning
Structural Review Clerk
(Revised02/24/2014)
e Miami Shores Village
Building Department
10050 N.E.2nd Avenue
R004
y Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305)756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner)VA'f9Z9Ar>%9hJ A'441,464W bOrCLAV herein fter referred to as the
owner of the following described property(address): 17IW909 4TREEr, Mr'A+W javirS K. 33141
Legal Description Lot 3( Block Z, Subdivision
Folio #_II - Z134•®® -O 0 Tb NZ �� $
Requests permission to install (describe work): MeA 1?a10EQS
Within the public right of way of(address) l7 A1E' 1�1 nQEE1°+ r1ii� ®ltt±$ 0 t 3314A
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
_ 2?1AjdAW
Owner or Agent
.The foregoing instrument was acknowledged before me this 1® day of 4 LQV 20�, by
h�- - - +- ® 4 who is personally known to me or who has produced
as identification and who did take an oath.
JFW2#504 3A0ZrrXjW
NOTARY PUBLIC:
Sign:
Print: f f-s
My Commission Expires:
*. tC ml C0MWwMi#FF 1N270
ISorded mR�E3:Match 31,2019
1' Un
NOTE: PAGE 1 OF• 2 IS NOT
COMPLETE WITHOYT PAGE 2 OF 2
CF- WED o WITH CORRESPONDING SURVEY #.
MAY 2 7 201675
kv Zp
• • • bi26
.:....... . ' •...•....... sWDOp
�o Oi/J
F .S T p•S• GOy0.50, JEG
1 -4 i
..• � aa®
... n1.
, th0?
•. N \Aea &io
2 3
$
�t•"�
.. .... i o r'wo a
..... .. + ai�� �, \� Ali ` ati�o N - �
+
. . _ .` �0
.:... .... '•' : 1735
• bra co ,� t io�l,7 75<see* r/ nor
�vjsli `0 _ NE, 709 ra' -,7 — L.F, EI.EV, M03 LNOT65 Lti� uST
T�� �--p x liftjTABLZ f=R rUEVAnot1)
V
�5 t ,
U v 0
.. � � 0 - 1g29
Lt?W65T ARIACERIT d9AV9 e 11.20
RR` , z g N N.J s. B.M.tt >�-a& fir._ .to.7g
,� �E SHOE lYGE I GA1?PAE; 04E.�V. 11,23.
N !.3•j}3 �T3o This property described as: p� 10��
T � o.4y ra oso Lot 31 , Block 2
w COLLEGE HEIGHTS, A
n. 1r /¢'�d Tacluacal Standards for Land Surveying
�—� hereby certify that oft
according to the Plat surveyeoMomtstuttreMirdmum
4501 3/9� thereof, as recorded in in the Side of Florida,as outlined in
Rules SJ-17,Florida Administrall"
Plt
i��ro0 �_!2°� a � aBook 42 g8, Pae f
m x � Code).as adopted by the Department
o f the public Records of of Agriculture and Consumer services,
\ t ;yn•. '', •': :.;: w Board of Professional Surveyors and
,� Miami-Dade County, Florida. Mappers inSeptemberA981,asamended,.
GPjr/�L Jr� , ya �pter s7a�dr7Z:4 Florida tutulesxW ithe
CU
2' XO°7D's✓. y/qr to the best of my loge and belief.
w t=
w A() .; ? FLO A PROFESSIONAL PANDA
CS LL (�•
ER REGISTRATION NO���
Q 4d
° !
:..
75/00 � � ANDERSON & ELIZABETH R BARTELE
w /lv, ' ,a�XE✓ e � Y� a PROPERTY OF: MATTHEW B.
z ° �. _ � � 17 N.E. 109th Street, Miami Shores, Florida'
o
LID
_ t+V-10"THE SIGNATURE BO1�A_RY 33161
NOT VA
i- 0 _ FL uc X==M 111 111E ORIGINAL RAISEGI imay comfy that the sutxy relive- I.AiNNES AND GARC'IA, INC.
+�1 TAPPER. seated hereon meets the maMntum
r LI r �+ Qaj tedvucW standards set forth by the Board
CF n 1(�"° .O� LT lJ�t/ sf ?e X\f� - of {sad Slxveyors in chaps 61GV-6 PROFESSIONAL SURVEYING AND MAPPING
fiorida A ist►xive Looe piuu+ru to LL I.ANNES&GARCI'A,INC
q• w) Section 4rtiD.ffa Statutes Tlwe are no , L.B.#2098
overtaps. easemer+ts FRANCISCO F.FAJARDO PSM#4767(QUALIFIER)
appearing on the Plat. other than as 385 Alhambra Circle,Suite#C,Coral Gables,Florida 33134
PH(305)666-7909 FAX(305)442-2530
tannesgatciao0wahoo.c orn
,,,t1t� ssnrrnNn Z'�a6
FIELP DTE SCALE DRAWN BY DRWG.NO
RA1 i L7 e-A�-4 a,%14 bo lf��GUr •4.®. 111462
3/2-2o/4 RECERTIFIED. F ELD W
REVISED. le `7 255679