DS-18-3150Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: DS-10-18-3150
A
[9
Permit Type: Driveways/Sidewalks/Slabs m nA Work Closs cation: Addition/Alteration
Permit Status: Approved
Issue Date: 11/19/2018'1 Expiration:05/20/2019
Location Address Parcel Number
1055 NE 105TH ST, Miami Shores, FL 33138 1122320280810
Contacts
HOME OWNER Owner CONCRETE SERVICES PUMP & FINISH INC Contractor
HOME OWNER HECTOR LUIS ROMAN
10061 SW 44 ST, MIAMI, FL 33165
Description: INSTALL NEW PLAIN CONCRETE DRIVEWAY IN Valuation: $ 10,000.00 Inspection Requests:
SECTIONS OF 12'X6' 4" DEEP + 3000 PSI. APPROACHES 6" DEEP 305-762-4949
+3000 PSI PLAIN CONCRETE. Total Sq Feet: 2,100.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$6.00
Concrete/asphalt/pavers, slabs, dways,
$150.00
swalks
DBPR Fee
$3.00
DCA Fee
$2.00
Education Surcharge
$2.00
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$5.00
Total:
$262.00
Payments
Date Paid Amt Paid
Total Fees
$262.00
Check # 1888
10/12/2018 $50.00
Credit Card
11/19/2018 $212.00
Amount Due:
$0.00
Building Department Copy
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. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Sioature: Owner / Applicant / Contractor / Agent
Date
November 19, 2018 Page 2 of 2
Miami Shores Village
Building Department CT 122018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 —!1
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. I -31.Sa
PERMIT APPLICATION
(BUILDING ❑ ELECTRIC ❑ ROOFING
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1055 AI e- to S _sJrtkI
City: Miami Shores County: Miami Dade Zip: 33! 3
Folio/Parcel#: i I— 22 2 2-- US 10 Is the Building Historically Designated: Yes NO
r
Occupancy Type: 1 ad: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1E i
Address: )OSS IJe- ) 0 5 sfYf.G'�
City: yyuayY1i Shot f State:
Tenant/Lessee Name: AM%=
Email:
] 1- `MQ_( - -7 d" 4- D
33/3e
h S. A21-17 01
CONTRACTOR: Company Name:, lWri�4/G/�,Q STAII C'jU t.�� P d F--ii CI 1 Phone#: ��-� M/9•oO?
Address: 1 V0`F J 1 qW 4' S±
n I,,
City: r ����I L State: '✓� Ziip: ' 131 b5
Qualifier Name: 'He V L. ' ✓ CA Phone#:3� _j Iifi'_1qL1h_?
State Certification or Registration #:
6.96 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ V / �• Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:,
Submittal Fee $ Permit Fee $ 2 CO ` CA-) CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $ '_00 03
TOTAL FEE NOW DUE W
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 recorcifd notice of commencement must be posted at the job site
for the first #?spVction which occurs seven (7) days after the building permit is issued. /n the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. n /
Signature 14,t,V/ " Signature Ui✓
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
8 i"tis
20by
personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PU4LIC:
Print:
Seal: �` T;
=•� �•: MY COMMISSON # FF927989
EXPIRES October 1S. 2019
APPROVED BY
Th 6oregoing
instrumen w s acknowledged before me this
day of dook 20 _ I �_, by
who is personally known to
me or who has produced
identificatiPB
d who id to a oath.
NOTARtP:1) /
•' MY COMMISSION # Fn2791
Seal: a EXPIRES October 15, 2019
;7W17 Plans Examiner /7�l Zoning
(Revised02/24/2014)
Structural Review
Clerk
1; �
_AL
Notice to Owner - Workers' Com
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
on Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations. ,.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature: ��
Owner
State of Florida
County of Miami -Dade ,
The foreg ' I before me this � day of RL14 20 l
By n who is personally known to me or has produced
I 1 as identification.
Notary:
EZ
SEAL: :�'LISVEr COMMISSION
N # FF9
MY COMMISSION � FF927989
•',,u �„ EXPIRES October 15.20t9
I
Survey Date: 04/07/2017
Job Number: 17-2014
Revision:
National Flood Insurance
Community Panel: 12086 C 0306 L
Flood Zone: AE
Base Flood Elevation: 8'
Firm Date: 09/11/2009
Certified to:
Nokul Jathor
Law Office of Rafael de Araujo
Old Republic Notional Title Insurance Company
American Internet Mortgage, Inc. ISAOA/ATIMA
SURVEYORS NOTES
-This s a Boundary survey. Ho io +/2 Plpe
-Legal description used for this survey was provided by others.
-This Survey has been prepared for the exclusive use of the entities named hereon and do note c
-No title policy, title commitment, abstract, or certificate of title was available; therefore easeme is and other
record may not be reflected in this survey. Obtain current title work and verify
-Bearings. if any, shown hereon are based on Plat Book 101, Poge 31 Broword Coun Within the swale, each
-All dimensions and directions shown hereon are in substantial agreement with recur ec
-Due to vorying construction standards, house dimensions are approximate. concrete slab will be
-All ties to property line are perpendicular to it, unless otherwise noted. 6" deep
-In all cases dimensions shall control location over scaled positions.
-Elevations, if shown, are basi]I1'ed of NAVD 88.
-Benchmark No. Elevation: feet, located at ;JUVV r�
-This survey does not dete"ne•c• wnply ownership. • •• /1_r�,�
-Underground improvemelits and util•ies•weia not lec.:d. • • /1�1t�.-H-C�
-Not vo
l id without the sig�nnature & reised4swol of a•Floodo•lice•sed surveyor and mapper.
I HEREBY CERTIFY THAT THS SURVRY•RERREilENTfLD MERKJN• AS RECENTLY SURVEYED AND
DRAWN UNDER MY SUPERVISIaN, MEETS THE ♦AIN•tUA. TF*HNICAL STR.NDAROS AS SET FORTH
IN CHAPTER 61017-6 OF iTIiE FL6P" ADWWSTRAJIVE GODFo FW•THE BOARD OF PROFESSIONAL
SURVEYORS AND MAPPERS PURSUANT TO SECTION 472.027 OF THE FLORIDA STATUES.
No port ^ of this drawing may be •_^ ^^ ^--pying. recording or by any other means, or stored, Processed or tra sn
^ n permission of R. Minguell Land Surveyo�opies of this pan without
sig ; .`k�0 J. MIN '• '-ol an
4 .`SSE NU'•.. ;t; • • • • •
�. "�;P R. Minguell, Inc.
No. 6402 • • •
: 4t -• • • • • • land Surveyors 8 Planners
LB.7272
dd, STATE OF �c.• • • 954-298-8935
FLORIDA Q`; c6vd J. ingueu Fax 954-302-5060
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3(�yENOR ` Regisle. d Lend Su yor & Hepper Nit<v2841 Loatvideo Avenue
.. 9402, 9tete �r YlorfAn Coo City. Florida 33026
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SURVEY
MAPS �
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20'
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LOT 11
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6.DD'
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at Book 4�,I Po9e 58
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LOT 10 BLOCK 5
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0.3 Acres t
10912.6 SQ.ft.f
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Ja.80
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Single Story
N
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Residence
1055 N.E. 105 Street
lliw Shores, Florida
u
2279.1 Sg.ft.t
f t.85
8.85 - t080 8.t5.
rt�
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�9.50
16 x 6 ft
tfix6ll t6x6ft
16 z6ft apete
16x6n 16x6n
16x6n 16x6R Grass
G"s' 16x6n x6ft
16x6ft 16x6ft
r�i00
Inside the property
i6 x 6 n
12 X 6 n
line, each concrete
lsxsn
12X6ft
slate 11e4"deep
104.77'
szsft
zx6n
Grass
-� 3v oO Ps /
,d parties. 16x6ft
rs of
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Center Dne
N.T.8 Not to ik-
BeR eraeerd temty Recrrde
] R Yiami-Dade Counts Beeerde
,r 8,tletlry ate+eeon
L �
LOT 11
1055 N.E. 105 Street
Miami Shores, Florida F_ 1/2 Pipe
�No ID
Leal Des�cri tin
Lo 1t 0. Block 5 of MMIAMI SHORES ESTATES, accordingg the the plot thereof, as recorded
in Plot Book 47, Page 58 of the Public Records of Miami -Dade County. Florida.
LOT 9
Survey Date: 04/07/2017
Job Number: 17-2014
Revision:
National Flood Insurance Certified to:
Community Panel: 17086 C 0306 L Nakul Jothar
Flood Zone: AE Law Office of Rafael de Aroujo
Base Flood Elevation: 8' Old Republic National Title Insurance Company
Firm Date: 09/11/2009 American Internet Mortgage, Inc. ISAOA/ATIMA
i
LOT 10 BLOCK 5
' s
1
0.3 Acree 3
1
1091Z6 Sq.R.t
1
SURVEYORS NOTES
-This is a Boundary survey. no 1.1dl1/2 F,
-Legal description used for this survey was provided by others.
-This Survey has been prepared for the exclusive use of the entities named hereon and do not eftelo any und
-No title policy, title commitment, abstract, or certificate of title was available; therefore easements and other 4ol
record may not be reflected in this survey. Obtain current title work and verify easements before constructirm
-Bearings, if any, shown hereon are based on Plot Book 101, Page 31 Broward County. Florida.
-All dimensions and directions shown hereon are in substantial agreement with record values unless otherwise noed
-Due to varying construction standards, house dimensions ore approximate.
-All ties to property line are perpendicular to it, unless otherwise noted.
-In all coses dimensions shall control location over scaled positions.
-Elevotions, if shown, are based of NAVD 88. T i
-Benchmark No. Elevation: feet, located at /
-This survey does not det.r•ineev ernpTIy o•nersill • • Ill
-Underground improveme•ts and utiWiesil rat lecoWd. • III,
Not valid without the s1'1 •4ture & �ised•s•al •f c•FlcgidoiI ic�sed surveyor and mapper.
I HEREBY CERTIFY THAT THQ SURVrbY•RE8RE5EN TIED jiEP*" AS DECENTLY SURVEYED AND
DRAWN UNDER MY SUPERVISIW. MEETS 44E IAIN&1U* TGPH14CAL STjANDAROS AS SET FORTH
IN CHAPTER 61G17-6 OF•TWE FLORjgA ADIIJIWSTRA&T1VE `ODfp Fr"THE BOARD OF PROFESSIONAL
SURVEYORS AND MAPPERS PURSUANT TO SECTION 472.027 OF THE FLORIDA STATUES.
No part of this drawing may be ^^pying, recording or by any other means, or stored, rocessed or tra sm
an,- -- -rl rfr pJ`-' -""ems In permission of R. Minguell Land Surveyors. oples o is pion without
Sig �•�PQD J. M/,V or,
�IS NU
: N :9 : R. Minguell, Inc.
z No. 8402 p' • r • • f lend Surreyon k Plmnere
5� .,•• • • • • • • LB.7272
�
rn STATE OF �` • • 964-Y98-8935
FLORIDA :' O Fez 954-392-50W
'•..........: • p2� Richard J. Yingaell 111ngueB•b.U.. th-1,
:" SI/RVEYOft `P.ee/rtered Lord Surveyor & Yepper 2841 Montrideo Avenue
N. eu 2. score of Florida Cooper City, Florida 33026
• • • • • • • f
••• • • • ••• • •
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parties.
of
SURVEY MAP
Frond 1/2
No Ia
130.00'
i
T
it
T
t
i.
. j�16.40
•�—
Single Story
Residence
11.e5
11155 N.E. 105 Street
Yllml Shorn, Florida
k
°O
2279.1 Sq.ft.f
IanGr "'o .15
1e.w
�•
Q�e
h^h
104.77'
�'—
1,LE: 1 "= 20'
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Legend ehan Nat hna
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Zproperty Line
Center Line
N.T. Nat to Sce4
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Yppit Ylami-bade Ceun(r Recprde
Sdetloe 91evaYen