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DS-17-2119Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)7954204 Fax: (305)758-8972 Inspection Number: INSP-28831 7 Permit Number: DS -8-17-2119 Scheduled Inspection Date: January 30, 2018 Permit Type: Driveways/Sidewalks/Slabs Inspector. Alvarez, Manny Angel Inspection Type: Final Owner. PETERSEN, CARSTEN Work Classification: Addition/Alteration Job Address: 1209 NE 98 Street Miami Shores, FL 33138-2562 Project <NONE> Contrattor. ARTISTIC CONCRETE GROUP iC Phone Number (305)807-2221 Parcel Number 1132050090230 Phone: (305)888-9095 Building Department Comments PLAIN CONCRETE POOL DECK (EXISTING POOL) Infraciio Passed Comment INSPECTOR COMMENTS False Passed d Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid Inspector Comments January 29, 2018 For it (305)762.4949 Peas 5 of 59 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. DS -8-17-2119 PerrnPermit pewsISidewalks/Slabs dition/Alteration Permit Status: APPROVED Issue Date: 8124/2017 Expiration: 02/20/2018 Parcel Number Applicant 1209 NE 98 Street Miami Shores, FL 33138-2562 1132050090230 Block: Lot: CARSTEN PETERSEN Owner Information Address 1209 NE 98 Street MIAMI SHORES FL 33138- 1209 NE 98 Street MIAMI SHORES FL 33138- Phone Cel I Contractor(s) Phone ARTISTIC CONCRETE GROUP INC (305)888-9095 Cell Phone Valuation: $ 18,880.00 Total Sq Feet: 2100 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Work: PLAIN CONCRETE POOL DECK (EXISTINC Bond Return : Scanning: 3 Additional Info: PLAIN CONCRETE POOL DECK (EX Classification: Residential Fees Due Bond Type - Contractors Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $500.00 $11.40 $3.00 $3.00 $3.80 $200.00 $9.00 $15.20 Total: $745.40 Pay Date Pay Type Invoice # DS -8-17-64952 08/24/2017 Credit Card 08/22/2017 Credit Card Bond #: 3496 Amt Paid Amt Due $ 695.40 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Foundation Review Planning Review Planning Review Building Review Building 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 and zoning. n hermore, I authorize the above-named contractor to do the work stated. Auth rized ' . nature: Owner / Applicant Building Department Copy August 24, 2017 / Contractor / Agent Date August 24, 2017 1 BUILDING PERMIT APPLICATION BUILDING ❑PLUMBING JOB ADDRESS: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 —CSC FBC20(4� Master Permit No .—17S a' d -I (9 ❑ ELECTRIC ❑ ROOFING ❑ REVISION Sub Permit No. ❑ MECHANICAL EPUBLIC WORKS ❑ CHANGE OF CONTRACTOR p-0 9 NE ens- 0 City: Miami Shores ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): City:Jvl;fAA; 61oizES Address: 1209 Tenant/Lessee Name: Email: State: RScN FL Phone#: Phone#: Zip: 3)3g CONTRACTOR: Company Nime: Address: O/c - City: /IAM i Qualifier Name: T'=CTC1 w CQ CRATE ,3 Eg Gam . Phone#: 3 888-409S riv/�12P State: TL Phone#: Zip: ) State Certification or Registration #: Certificate of Competency #: t 9OCic7 p7% DESIGNER: Architect/Engineer: Phone#: Address: City: State: ,Zip: Value of Work for this Permit: $ l � 51�_ % Square/Linear Footage of Work: 1-t 1°0 '�" Zi Type of Work: ❑ Addition Alteration ❑ New Description of Work: �p N CpA,1tt2-f 7cCL Encepair/Replace ❑ Demolition Dtgc<EXivJ Specify color of color thru tile: Submittal Fee $ Permit Fee $ AOC). • 03 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE$ 0CtS •ldtP * 41 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 of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature �" / Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 'el day of4 ilos-1. , 20 t) , by day of (/�t1g4' , 20 r? , by hA ( er, *IV cser. , who is personally known to 4edc'( Rxpe co— , who is .ersonally kno to me or who has produced L D Z as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: 4.31„—Comm# 0.1PRy,4s John Rogues rNOTARY PUBLIC STATE OF FLORIDA FF946106 . v �Expires 4/17/2020 ,,•�_ ` K ;yes * * * * * * * * * * * * * * * * * * * * * * * * * * * * * APPROVED BY (Revised02/24/2014) me or who has produced identification and who did take an oath. NOTARY PUBLIC: John Rogues 0 NOTARY PUBLIC STATE OF FLORIDA Sign: 4,� �� Comm# FF946106 �S4'CE 191 Expiies 4/17/2020 Print: Voir Krz-.)gijj Seal: as * ******************************************************************** ZY �� Plans Examiner Structural Review i/02-6/// ning Clerk Property Search Application - Miami -Dade County OFFICE 0, E PROPERTY APP A SERr Page 1 of 2 Summary Report Property Information Folio: 11-3205-009-0230 Property Address: 1209 NE 98 ST Miami Shores, FL 33138-2562 Owner CARSTEN PETERSEN Mailing Address 1209 NE 98 ST MIAMI SHORES, FL 33138 USA PA Primary Zone 1400 SGL FAMILY - 3001-3250 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3/2 / 0 Floors 1 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 3,693 Sq.Ft Lot Size 14,442.5 Sq.Ft Year Built 1950 Assessment Information Year 2017 2016 2015 Land Value $520,369 $484,315 $440,000 Building Value $207,219 $207,315 $127,500 XF Value $21,186 $21,484 $0 Market Value $748,774 $713,114 $567,500 Assessed Value $390,546 $382,514 $567,500 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $358,228 04/01/1985 $140,000 Portability Assessment Reduction $50,000 $330,600 $0 Homestead Exemption $25,000 $25,000 $567,500 Second Homestead Exemption $25,000 $25,000 Exemption Value Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description 5 53 42 EARLETON SHORES PB 43-80 LOT 11 & W1/2 LOT 12 BLK 2 & E2OFT LOT 10 LOT SIZE 132.500 X 109 Generated On : 8/22/2017 Taxable Value Information Previous Sale Price OR Book -Page Qualification Description 2017' 2016' 2015 County Qual by exam of deed 04/01/1985 $140,000 Exemption Value Sales which are qualified $50,000 $50,000 $0 Taxable Value I $340,546 $332,514 $567,500 School Board Exemption Value $25,000 $25,000 $0 Taxable Value $365,546 $357,514 $567,500 City Exemption Value i $50,000 $50,000 $0 Taxable Value $340,546 $332,514 $567,500 Regional Exemption Value $50,000 $50,000 $0 ' Taxable Value$340,546 $332,514 $567,500 Sales Information Previous Sale Price OR Book -Page Qualification Description 08/18/2014 $669,000 29286-3368 Qual by exam of deed 04/01/1985 $140,000 12483-0801 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser http://www.miamidade.gov/propertysearch/ 8/22/2017 STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Village Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, PRs =/" irtizstA! • does hereby attest that (Property owner) The attached survey, performed by AIvAreel AiutsVivcs r 4 Ass.c res 11‘,. c (Name of sure yor's company) For address: 110 9 AJ- ?641 �- I4 I 61101-zC5,. Performed on r 8-201(f (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 a - Ina) inspect) ns as applicable to this or other permits. Further, A Cp iTe!J 2ETE f\) Prope y Owner Signat Property Owner Print Name SWORN TO AND SUBSCRIBED before me this `' day of 1 I3USf 200 . Affiant is personally known to me, ✓'produced C-71 D(._ as identification. Revised on 5/22/2009/ Revised on 6/12/09 n. pl RY,gs John Rogues . NOTARY PUBLIC ESTATE OF FLORIDA Comm# FF946106 Expires 4/17/2020 Notary c= Jot Seoyoc i7L.MG EXI`s- i 5-toIJ c otJ P N� L -- x "ocL DECK W;11\10LJENrcl" Florida Health Miami -Dade County O.S.T.D.S..& Wei,I,9_,Qrogram�� Application o.: �—i� to-[,,�,� FENlcate: • -b,9 , Sigliature , , 13230 x x x x x 1)(5 3a tNof vf� • , fICNEs N T ►cam. coo C¢t-'re- z4-- fizoir)J Ste" �1CTuR� • F\\\\ -< I�tt�k Re:v4 1- • . 4'WIRE -- F.I.P. 1 /2"¢ FENCE 1'05.14' 0.20'CL co 4'WIRE FENCE L.P. S"St{6•..k 5'LAE REMAINDER LOT -10 BLOCK -2 2.53'CL *-x x 37.50' 0.20'CL 4'WIRE FE CE ASPHALT DRIVEWAY STEPS (TY LINE R=25' A=44.87' A 7 LOTYP T LINE Nor 07/, J&) l coe ��.. .yiNG DLPT fly BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STAKE AND COUNTY RULES AND REGULATIC:JS -DSP-2i19 .. • . • •.• •.. .• . • • •• • • • d . • • •. • . • ._ ... • • • .. . • .• •. •. •'• eiddeti * REMAINDEf LOT -12 BLOCK -2 L THE WEST H. OF LOT 1: •. • • • • •�. • • • • • • • • • •• •• • • HIM UTIUTY EASEMENT (PER ORB.13423. PG. 209) LOT -9 BLOCK -2 F.I.P. 1/2-0 LOT -8 BLOCK -2 (WIRE FENCE — — —T-13230 4'WIRE FENCE d 0 0 LOT -7 BLOCK -2 105.14' F.I.P. 1/2.0 37.50' 0.20'CL 0.20'CL UTIUTY • EASEMENT F.I. REMAINDER LOT -10 BLOCK -2 (WIRE FENCE F 1.92'CL 2.53'CL F (TYP) LOT UNE R=25' A=44.87' Tat1=31.34' 4=102'50'10• 126.71' 6o 1 REMAINDER LOT -12 BLOCK -2 LS'U� -.111) (5'U.0 o 1 THE WEST HALF OF LOT 12 LOT -13 BLOCK -2 LOT UNE P.C. F.I.P. 1/2'11 g 37.50' 132.50' 19.50' PARKWAY F.I.P. 1/2"0 This property described as: The East 20 feet of Lot 10, all of Lot 11 and the West 1/2 of Lot 12, Block 2, EARLETON SHORES, according to the Plat thereof as recorded in Plat Book 43, Page 80, of the Public Records of Miami -Dade County, Florida. Certified to: Carsten Petersen Columbus Capital Lending, LLC its successors and/or assigns, ATIMA Joseph R. Colletti, P.A. Old Republic National Title Insurance Company Address: 1209 N.E. 98th Street, Miami Shores, FL 33138 NOTES: - West side of the Subject Property Asphalt Driveway, Wood fence, Pavers and Pool falls into 10 feet Utility Easement - North side of the Subject Property Wire fence falls into the S feet Utility Easement - No visible Encroachments in th Is Lot $. ID 0 21". ASPHALT PAVEMENT 11\_.FOUND. NAIL Bearing, if any, shown based on N.E, 96th STREET N/A (reference) N/A rEVISIONS: FLOOD ZONE X COMM. No. 120652 NIS SURVEY DECLARATION 13 MAD! ON THE FIELD TE INDICATED, TO THE OWNERS) LISTED. IT 13 NOT SF!RABL! TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS.' BOUNDARY SURVEY. ru'1 g HEREBY CERTIFY: that this survey meets the .a_ -';min mum technical standards as set forth by the i.ORIDA BOARD OF .: • - - • 10 • SURVEYORS D MAPPERS I ap rJ 17 F a Administrative Code, pursuant to - ., n 4 Florida Statutes. STAYF r't1F PANEL No. 0306 SUFFIX: L F.I.R.M.DATE 09/11/09 F.I.R.M.INDEX 09/11/09 BASE ELEV. + WA N.G.V.D. ELEVATION NOTE: (IF APPLICABLE) L.F.EIev.- N/A (lowest habitable floor e Elevation shown hereon refer to N.G.V.D. 19 Lowest adjacent grade elevation= _WEL. '• BM • WA Elay.=/A :' Garage Eley N/A Erp Ma REN • AI —41.7-77 S 08/12/14 PROF SIONAL SURVEYOR AND MAPPER No. 4327. State of Florida. LEGEND A . • Arc ASPH •Asphalt BIA • Bench Mark BRG • Boeing CATV • Cable TV CB • Catch tram CBS • Camrata Block Structure CH • Chord Chatter Chattahoochee F . Canter Line CLF • Cham Link Fars CL • Claw CONC.. Caesar o • Delta • • otemeler DH • trill Hole DME • Drainage & Maintenance Easement E.B. • EI.c is Box Enc • Encroachment F.F. • Finish Floor • Fit • Fire Hydrant F.I.R. • Fouts Iran Reber FPL • Florida Paver & Light F.I.P. • Founts Iron Ftp. F.N. • Found Nell LP. • Dght Pole M •Maamed MF. •Mstat Fence MN. •Manhole !1 • Monument Ike MON. • Monument NIA • Not App(cads NO • Naga Disc NTS -Nab Sale 0/S • offset O.U.L • Overhead Utility Lina OH • Overhang P • Plat PB • Plat Book PC • Point of Curveltmo P.C.C. • Point of Comports Curvature 'PCP'•: Permanent Control Pont nl• . • Page p.h . g Point a Interyl lon a . • Property Line . 'A 1 Planter P.O.B.• Point ottairil ,P.O.a. • Point oiComneneement P.P. 6 Power lie P.a. Permerrnt1'r4i•ncs • ••• Mmumka••• y Mc.} P0011 if it y• a !i id $ Pr• • Point ofTaghnog Curv! tr5 • • Radice 1 f RR•. Rall ;Masi ti •'g g B a SSM• • Proh.ejysi Crvetw a i - l i i i 1See. ' Salm a•� •C : • •• • M lil t•E. • U®ly F/sergnr • F. • Waud i•,M • i 4 j tMA.•.wtterllletr• ••• o AV. •lvatxdLye 1 .14 tagt a� g 5 • y •Denotes Spot zt�SSIgr /Elevaaon.Taken is : %: c•a• ••• .• • Alvarez, �llguesyi�/e9agd Ast• oclates, JP Surveys, Mdppers an Land11Planners• 5701 S.W. 107th Avenue #204, Miami, FL 33173 Phone 305.385.0385 Fax 305.385.0623 L.B. No. 6 i Eafnail: ftsttur y( atictm • • • ••• • • Field Date Ecalat • New, bl• 'Dm* •Ne. • 08/08/14 •;Is=a0t •:R.• • •:14-1a351: 14RD® CERTIFICATE OF LIABILITY INSURANCE v DATE(MM/DD/YYY) 8/23/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER TriGen Insurance Solutions, Inc. 315 SE Mizner Blvd Suite 213 Boca Raton FL 33432 CONTACT PHON: (A/CNNo.Ext): (877) 987-4436 FAX (954) 252-4426 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Technology Insurance Company, 42376 INSURED (866) 286-2747 Oasis Outsourcing, Inc. Alt. Emplr: ARTISTIC CONCRETE GROUP INC. 2054 Vista Parkway Suite 300 West Palm Beach FL 33411 INSURERS: INSURERC: INSURER D: $ INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 21981 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTRINCILWVD TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENT. AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION,PER AND EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A TWC3640315 6/1/2017 6/1/2018 STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1, 000, 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage is provided for all leased employees but not subcontractors or non -leased employees of ARTISTIC CONCRETE GROUP INC. Location coverage effective 6/1/2017. CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE e ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 of 1