DS-10-1940Inspection Number: INSP- 157626 Permit Number: DS -11 -10 -1940
Scheduled Inspection Date: March 28, 2011
Inspector: Bruhn, Norman
Owner: LEANDER, CLIFFORD
Job Address: 525 NE 90 Street
Project: <NONE>
Miami Shores, FL
Contractor: ARTISTIC CONCRETE USA INC
Building Department Comments
March 25, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
U mwome Phone Number
Parcel Number 1132060400030
Phone: 305 - 888 -4565
STAMP CONCRETE DRIVEWAY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 24 of 27
Ckr
r1 S6 - 3
BUILDING
PERMIT APPLICATION
FBC 20
Miami Shores Village
uilding Department
50 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (3 05) 762.4949
Permit Type: BUILDING ROOFIN
' e Owt►er s l+ (Fee Simple Titleholder) 0[1 �t?�c� �. C.. anr Phone
Owner''. , ; dress` S a L3 ) S
City ( Sta
Tenant/Lessee Name . In
Email
Job Address (where the work is being done) S k) e ci ( S I
City ;Miami. Village County Miami-Dade Zip
FOLIO / PARCEL # j 13.20 Co u=C1 cc
Is Building Historically Designated YES
Contractor's Company Name r `$ c' NC'
Contrac.r'. Address :69' 1 S3 r
City (O State
Qualifier Name ' ! t c 7
U r
State Certificate or Registration No,
Contact Phone 6 30G - ()C.C
Architect/Engineer's Name (if applicable)
00
Value of Work For this Permit $ ' (.CO 6
Type of Work: It ddi o [Alteration
heh be Wo k:
❑New
Submittal Fee $
Permit Fee $
Training/Education Fee $
DPBR $
Zip 3 f T
Phone #
Phone #
Bond $
Si MAR l G 2011
Flood Zone
.5` S- ?Oc
Square /Liniearr Footage Of Work: 'OO [
Permit No. `- t 10 )9q(
Mat Permit No
Zip 1( C,-6
Phone #
Certificate of Competency No. E 0 C 4 1 0 ('.") p 9
II Repair/Replace a Demolition
* * * * * * * * * * * * * * * *** * * * * * * **
CCF $ CO /CC $
Technology Fee $
Notary $
Scanning $ Radon $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ G g • (X)
See Reverse side --->
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 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 approved and a reinspection fee will be charged.
Signature
NOTARY PUBLIC:
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
Owner or Agent
The fo e:oing in trument was acknowledged # efore me this
day of
As identification and who did take an oath.
Plans Examiner
Engineer
Signature
Notary Public - State of Florida
.^ My Comm. Expires Aug 20, 2013
°c Commission # DD 918432
.
°'• °F Pc."' Bonded Through National Notary Assn.
Sign:
44'1 Contractor
The fore oing ins meet was aclarowl - aged
;r day of ,20 (,by
efore me this iC
who isonally known to r who has produced who ' onaily" o to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
l e a State of Florida
•I My Comfit. res Aug 20, 2013
Of Commission # DD 918432
Bonded Through National Notary Assn.
* *** * ** *
f P,
***** * * * * * * * * * * * **
Zoning
Clerk checked
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APPROVE! .. 'o
WWI -DALE COUNTY l i r ALTH t?ci AR7N 1f
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M'ami Shores Village
/ APPROVED i Y
!, F' Ea, t * 1, ', ` '° W F j / - '';cr % ' �.! I :ZONING DEPT - .1�((
. te, . � 1,�.1� CH •G. '. ia V 1'E.1fil , tR 1
T + f y : UvtTt t FEDERAL . ' B DEPT • •
;-- s ,' V. ° -� ' i` tt . Fi i} t • 9N0 A SUBJECT TO COMPUANCE WITH ALL FEDERA1: ,
�
w tw ,y. ,; � d� , � V t;� STATE AND CO t) TV RULES,RND'REGV ATIONS '
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BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING
City: JL[ kCA
Tenant/Lessee
Email:
JOB ADDRESS: C e)- c t ( S
City: Miami Shores County:
Value of Work for this Permit: $
Type of Work: DAddress
Description of Work:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 � Q Q
Permit NoD JO l 4 0
Master Permit No.
OWNER: Name (Fee Simple Titleholder): I( friA Lez:bt. Phone #: - - 7 5( lin
Address:
t90 9 c) cf-
State: I" Zip: 1'
Phone #:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO • Flood Zone:
e #: C -- 8 g FC -'-'( p 4'�
CONTRACTOR: Company Name: A � ^ 1 � Co " �/1 0 11� �'� .�
Addres • S
City: CQ- .., a.. State: F Zip: b b
Qualifier Name: / ( T J) : c) lc' (-G Phone #: /y /�
fate Certification or Registration #: Certi cate of Competency #: ; +� 000
CC f oo C ntact Phone #: - e mail Address: Cl l l C `e'C t — t tyr o Q 3
DESIGNER: Architect/Engineer: Phone #:
O,.
UAlteration New DR air/Replace DDemolition
/O LC®
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
*************************************** F*********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ / /. CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
Miami Dade
Square/Linear Footage of Work:
TOTAL FEE NOW DUE $
5 E(
NOV 0 2 2010
zip: 33(3
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 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 approved and a reinspection fee will be charged.
a
Signature e Signature
ner or Agent Contractor o
The foregoing instru was acknowled ed befor- me t his The foregoing nstrument was acknowledged before met i
day of ., dpi , 20 by 0._(, a IL ray of ® , 2010 , by `-P a1'' (toImo
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10)
- —AL IL.
• •
o,,°�vPUe Notary Public - State of Florida
• My Comm. Expires Aug 20, 2013
Commission # DD 918432
' ''i ± "NP Bonded Through National Notary Assn.
************
Plans Examiner
Structural Review
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Com
, '10 Li
ugpver.":„611YPOP411010#114'
awymp !i:7.fg9.
11.! •
o
•
Notary Public - State of Florida
• E. My Comm. Expires Aug 20, 2013
Commission # DD 918432
Bonded Through National Notary Assn.
14
00-- //V /l6 Zonin
Clerk
SURVEY AFFIDAVIT
STATE OF (FLORIDA)
COUNTY OF (DADE)
The undersigned Affiant, ( f d croid Lett .gyres hereby attest that
(Property owner)
The attached survey, performed by
c t
(Name of su eyor's company)
For address: SD-S C
Property Owner Signature
Affiant is
Revised on 5/22/2009/ Revised on 6/12109
personally known to me, t. produced
M iami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Performed on (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 affect final inspections as applicable to this or other permits.
C1,14,4
Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this 6 day of ( h ,. oro
as identificati
MARIA DE BRUZOs
- c,,,
„� s Notary Public - State of Florida
�•; My Comm. Expire: • jS 20, 2013
,, mrmission ' 'i ot8432
:' :ar i Assn.
THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS
POLICIES. AGGREGATE OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INDICATED. NOTWITHSTANDING
MAY BE ISSUED OR
AND CONDITIONS OF SUCH
LIMITS
MISR
lift
A
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
nATF mm mn/vv)
POLICY EXPIRATION
nomp mmunnmr)
GENERALUABILITY
X
COMMERCIAL GENERAL LIABILITY
FLG2089114
10/06/2010
10/06/2011
EACH OCCURRENCE
$ 1000000
FIRE DAMAGE (Any One Fire)
$ 100000
CLAIMS MADE X OCCUR
MED EXP (Any one person)
$ 5000
PERSONAL &ADVINJURY
$ 1000000
GENERALAGGREGATE
$ 2000000
GEN'L AGGREGATE UMIT APPUES PER:
fl POLICY r 71 9-,.. Ii LOC
$ 2000000
PRODUCTS - COMP /OP AGG
AUTOMOBILE
—
—
UABILITY
ANY AUTO
AU. OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
-
COMBINED SINGLE UMIT
(Ea sodden))
$
BODILY INJURY
(Per person)
$
BODILY INURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
R ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA Acc
$
AUTO ONLY: AGG
$
EXCESS
LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
—
DEDUCTIBLE
RETENTION $
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LUU3ILITY
WC77779991701
04/01/2010
04/01/2011
X 1414Pi A 1 Pa
EL EACH ACCIDENT
$ 1000000
E.L DISEASE - EAEMPLOYEE
$ 1000000
EL DISEASE - POLICY UMIT
$ 1000000
OTHER
R
UMITS
$
UMITS
$
DESCRIPTION OF OPERATIONS ILOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
1. This certificate remains in effect, provided the client's account is in good standing with AMS.
Coverage is not provided for any employee for which the client is not reporting wages to AMS.
Applies to 100% of the employees of AMS leased to ARTISTIC CONCRETE GROUP INC, effective 04/01/2010
MIAMI SHORES VILLAGE,
P: (305) 795 -2204 F: (305)
ATTN: PERMIT DEPARTMENT
10050 NE 2 AVE
MIAMI , FL 33138
756 -8972
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
RI IMPOSE NO OBLIGATION OR UABTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORQ, CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Highpoint Risk Services LLD
14160 Dallas Parkway #500
Dallas, TX 75254
(800) 632 -5096 (972) 715 -0959
INSURED: AMS 1 /c /f:
ARTISTIC CONCRETE GROUP INC
6945 NW 53RD TERR
MIAMI, FL 33166
(305) 888 -1967 Fax: (305) 888 -4366
CERTIFICATE NO. / DATE
AC10- 13800183- 927650
09/21/2010 02:37 PM
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
I_ •
INSURERS AFFORDING COVERAGE
INSURERA Companion Property and Casualty Insurance C
INSURER B: Companion Property and Casualty Insurance C
INSURER C:
INSURER D:
INSURER E
COVERAGES
CERTIFJCATE HOLDER I I ADDmONAL.INSURED' INSURER LETTER:
ACORD 25-S (7/97)
® ACORD CORPORATION 1988
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and In accordance with Chapter 713, Florida Statutes, the following information
is provided In this Notice of Commencement.
1. Legal description of property and street/address:
2. Description of improvement:
3. Owner(s) name and address:
c ;
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address:
1111111111111 1111111 1111111111111111111111111
CFN 2010R0744049
OR 8k 27476 Ps 0393; ►.ip9)
RECORDED 11x°02 /201O 15:00:5;
HARVEY RUVIFdr CLERK OF COURT
MIAMI-DADE COUNTYr FLORIDA
LAST PAGE
5. Surety: (Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
Signature 8f Owner T 1 2 0rJ Print Owner's Name. C (1 Lam e r'
Sworn to and subscribed before me this i day of J „,,to - 20 tt,
Notary Public
Print Notary's Name
My commission expire
123.01 -52 PAGE 4 5/02
."i�'!!�'�4, :►+;� y a
y i► y p y n�4 of Florida
Egtw° +y omm. Expires up 20, 2013
Bono -J Through National Notary Assn.
Address:
t CA,
STATE OF FLORIDA, COUNTY OF DADE
I HEREBY CERTIFY that this a3 Oaf covey °€
original Red In thls A D20
1MTMESS my hand and
HARVEY RUVIN,
BY
Prepared by 4 4 1 ov, �7
Ca1pis
D.C.
S34 rr
L. 33 (c C.
JA Nip 08 201
t
APP RON/
MAD COUNT' HEALTH DEPARTMENT
noun* 44
004es
•
-- am Shores Village
SUE11FCT 4,0 COMPUANCE WITH ALL FEDERAL
4TATE AND COUNTY RULES AND REGULATIONS
,1
;t I 1'A r7 • etc r_ a
:.;nt ,. . T.c 3.111 . 471 ; F.. T . )
fr ➢ , • t'ie? : 3'11 r
. •
FLORIDA DEPARTMENT OF
HE
(Artistic Concrete)
6945 NW 53 Ter
Miami, FL 33175
RE: Contingency Letter
Application Document No: AP990508
Centrax Permit Number: 13 -SC- 1296228
OSTDS Number:
525 NE 90 St
Miami, FL 33175
Lot:3 Block:1 Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 01/18/2011 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
From a review of your completed application, it has been determined your existing system is
adequate for the proposed use.
This permit is granted for the construction of three (3) driveways. There will be no increase in
sewage flow or characteristics and no impact on the unobstructed area.
* * * * * * * * * * * * * *** * * ** * APPROVED * * * * ***** * *** * * * * * * **
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500
Astrid Edwards, Engineer Specialist II
Rick Scott
Governor