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DS-11-470Inspection Number: INSP - 157300 Scheduled Inspection Date: April 26, 2011 Inspector: Bruhn, Norman Owner: #1 LLC, 2260 HOLDINGS Job Address: 18 NW 106 Street Miami Shores, FL 33150- Project: <NONE> Contractor: ALL FLORIDA BRICK CORPORATION Building Department Comments INSTALL BRICK PAVERS DRIVEWAY AND WALKWAY Passed1,1 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ec, April 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 Number: DS- 3- 11-470 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360050180 Phone: (305)525 -1991 Page 8 of 19 BUILDING PERMIT APPLICATION FBC 20 Permit Typ Miami Shores Village Building Department JOB ADDRESS: EA OA' ( ©[2 51 Type of Work: ❑Addition Description of Work: Writ 4f. 11. C4.1t/ pa l RaIWW3n MAR 1. 5 2411 Lti 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 • CS 1 -4 Permit No. ROOFING City: Miami Shores County: Miami Dade Folio/Parcel #: 11 2X% DOS 01,80 Is the Building Historically Designated: Yes NO >0 Value of Work for this Permit: $ 2 Z©0 Square/Linear Footage of Work: ❑Alteration Master Permit No. OWNER: Name (Fee Simple Titleholder): 2,9 6 0 (40L-Po 1.1)& S* 1 r L _C Phone#: SOS S 25 C 5 Address: (8 Mx l bb sr ¢A( City: daft 4.. ( 5121-014/2_ State: ft, Zip: 33i 6 Tenant/Lessee Name: Phone #: Email: Flood Zone: Zip: 3; t - CONTRACTOR: Company Name: /4//?/ i d4 1,17, CO • Phone#: 3o s - jq 9/ Address: _ eu LI Ate City: )--b�fl�S4J9 P/ g `2 State: Zip: ia Z Qualifier Name: ,4grei Akt irt. 2 State Certification or Registration #: 06 49 5 ®® P/ Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Phone #: gar . `lqi It.F' New ❑Repair/Replace Demolition ********************** **********+ x****** F a****+ a********* *********+x**:n****•r **** Submittal Fee $ Permit Fee $ AD 0 a CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 MR 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. Owner or Agent The foregoing instrument was acknowledged b day of L , 20 it, by ore me this /6 who is personally known to me or who has produced As identi on and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: OF FLORIDA 0 Marrero ion # DD952610 Signature Sign: Print: My Commission Expires: **** ****** **********+ x*****+ x* ************* ***** ****************** APPROVED BY 3 .29 - 17 Plans Examiner Structural Review (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Contractor The foregoing instrument was acknowledged before me this day of , 20 JL, by who is personally known to me or who has produced as identificatio d who did,» e an oath. NOTARY PUB ATE OF FLORIDA 1 : * -dl Marrero 'on #DD952610 :1' 1 * ** ** ** ****************** Zoning Clerk Mar, 31. 2011 12:33PM Emmanuel Insurance No, 8935 P. 2 Ziidgefield Employers Insurance Company® Member of Liberty Mutual Group CERTIFICATE OF INSURANCE RE : 0830 -45812 ISSUED TO : Miami Shores Village 10050 NE Second Ave Miami Shores, FL 33138 This Is to certify that All Florida Brick Corporation, 20000 NW 83 CT HIALEAH, FL 33015 -5972, being subject to the provisions of the riorida VVOIR - Gompensatton Law, nas secured the payment of any workers' compensation benefits due by insuring their risk with the Bridgefield Employers Insurance Company. POLICY NUMKR: 0830 -45812 Statutory Limits — State of Florida EFFECTIVE DATE: August 16, 2010 EXPIRATION DATE: August 16, 2011 This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be construed as amending, extending, or altering coverage not afforded by the policy shown above or affording insurance to any insured not named above. The policy of insurance listed above has been issued to the named Insured for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document to which insurance certificate may pertain, the nsurance made available by the described policy in this certificate is subject to only the terms, exclusions and conditions of such policy. Paid claims may have reduced the shown limits. If the policy described above is cancelled before the expiration date indicated, the issuing company will endeavor to mail 30 days' written notice to the certificate holder named above, although if cancellation is for nonpayment of premium, then the issuing company will endeavor to mail 30 days' written notice to the certificate holder. In any event, the issuing company, Its agents, and representatives accept no obligation or liability of any kind for failure to mail such notice. Authorized Signature Southwest Region Alaimo*, A,komar, Lazdsiamy, MissUr ppl P.O. Box 80439 • Baton Rouge, LA 70898 -0439 (225) 926-3264 1-800-421-2944 Fax (225) 926 -4102 WC 0'-050 (Rev. 3108) WI COI 296152.1 1210 Employers Liability 1,000,000 (Each Accident) 1,000,000 (Disease- -Each Employee) 1,000,000 (Disease -- Policy Limit) Corporal® Office Flartda P.O. Box 988 • Lokaland, PL 33802.0988 (863) 665 - 6060.1- 800 -282 7648 Fax (863) 666 -1958 8ridgcfreld Employers Insurance Company is an affiliate of rind is managed by Summit. Summit Includes Sunrmlt CarisuWug Inc, and lis subaMlarlea. Rated A (Excellen0 by A.M. Best Company Producer : Sara! Medina Company : Emmanuel Insurance Agency, Inc. Address : 2370 E. 8th Avenue Hialeah. FL 33013 Phone : (305) 836 -3151 summiiholdings.com Date: March 31, 2011 Southeast Region Oeorgla, Kenracky, North Caroanm. Saudi Corot +nn, Tanasr,. P.O. Sox 600 • Gainesville, GA 30503 -0600 (678) 450 - 5825.1- 800 - 9712667 Fax (770) 531.1349 THE POLICIES OF INSURANCE LISTED BELOW HAW 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 MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOuCEO BY PAID CLAMS. 1NSH LTRINSRL Am] ' TYPE OF INSURANCE POLICY NUMBER POL CCyy EFFEC�T�I� yE DATE(MM/DOIYYI FPOL1 YEXPiRATf( l� I DATRIMMIOD/YV) "" LIMITS INSURED All Florid prick Corporation 20000 NW 83 Court Hialeah FL 33015 -5972 INSURERA BRIDGEFIELD EMPLOYERS INS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY INSURER C: EACH OCCURRENCE $ INSURER E: PREM KL 1 tU PREMISES �E aoocluen, re $ CLAIMS MADE OCCUR MED EXP (kw one person) 3 PERSONAL &ADVINJURY $ GENERAL AGGREGATE $ GENT. AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGO $ POLICY JEc ■ LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS • (Es COMBINED LIMIT _ BODILY INJURY (Per person) $ _ • BODILY INJURY (Paraccrdcn0 3 — PROPERTY DAMAGE (Per aoaldenl) S GARAGE LIAthLIIY ANY AUTO AUTO ONLY EA ACCIDENT S R OTHERTHAN EA ACC $ AUTO ONLY AGO $ EXOESSIUMBRELLALIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE 3 DEDUCTIBLE RETENTION $ $ 9. $ S A WORKERS COMPENSATION AND EMPLOYERS' IETOR / LrtY ANY PROPRIETOR/PARTNER/EXECUTNI? OFFICER/MEMBEREXCLUDEDT IT yyes, deD ille unde 3PECIAaL PROVISIONS below B30 -45812 08/16/10 08/16/11 X !TORY LIMITS I I E L. EACH ACCIDEN $1, 000, 000 E.L. DISEASE - EA EMPLOYEE 31,000,000 E.L. DISEASE - POLICY LIMIT , $ 1, 00 0 , 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Paver contractor Miami Shores Village fax: 305 -756 -8972 10050 NE Second Ave Miami Shores FL 33138 SHOULD ANY OF THE ABO E DE$ RIBED POLICIES ByrCArELLED DATE THEREOF. THE ISSU G INSURER WILL ENEMA /OR T 1AAIL NOTICE TO THE CERTIFIC re HOLDER NAMED TO LEFT, IMPOSE NO OBLIGATION R LIABILITY OF ANY KIND U ON TiJ REPRESENTATIVES, BEFORE THE EXPIRATION 10 DAYS WRITTEN BUT FAILURE TO DO SO SHALL L INSURER, ITS AGENTS OR AUTHORIZED REPRESENTA Sarai Medina THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLICIES INSURERS AFFORDING COVERAGE ivi ai , .l. — IL.32 dlllrrlanueI Insurance ACME!, CERTIFICATE OF LIABILITY 190, 077 INSURANCE OP ID 19 =41 -1 1 31/11 OR BELOW. PR ODUCER Emmanuel Insurance Agency Saran Medina 2370 E 8 Ave Hialeah FL 33013 Phone: 305 -693 -0003 Fax:305 -691 -4381 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLICIES INSURERS AFFORDING COVERAGE NAIC # INSURED All Florid prick Corporation 20000 NW 83 Court Hialeah FL 33015 -5972 INSURERA BRIDGEFIELD EMPLOYERS INS 10701 INSURER B: INSURER C: INSURER O: INSURER E: 2011 ou D COVERAGES CERTIFICATE HOLDER ACORD 25 (2001/08) CANCELLATION ® ACORD CORPORATION 1988 FLORIDA OF HEALT Juan Uribarri 11921 W Ridgeview Dr Fort Lauderdale, FL 33330 RE: Contingency Letter Application Document No: AP999348 Centrax Permit Number: 13 -SC- 1309381 OSTDS Number: 18NW106St Miami, FL 33175 Lot:2 Block:203 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 03/25/2011 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 (driveway). If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: March 28, 2011 Sincerely, Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645 Jos Piv er, En Specialist II Rick Scott Govemor F`" . rte Miami Shores I lage '. • ROVED BY DATELI 1 DEPT r I w D , DEPT e� ~l/ { a , 1 <� CT TO COMPLIANCE WITH ALL FEDERAL 1-� QIZ • VD C TY RULES AND REGULATIONS ILI 7210 .W. 126th. COURT, MIAMI, FLORIDA 33183 F.I.P. 01" ANIANO J. GAR CIA, PLSM. N52 °37'30'W 0.49' 9' ASPHALT PAVEMENT 0.93' uP 40E Iv78"07'16'W 15' WIDE ALLEY LAND SURVEYOR & PLANNER 16' ASPHALT PAVEMENT N.W. 106th. STREET (75' TOTAL R /W) — .F-p_ ._ PH. (305) 856 -4566 FAX. (305) 595 -1454 PROPERTY ADDRESS: 18 N.W. 106th. STREET, MIAMI SHORES, FLORIDA 33150 LEGAL DESCRIPTION: LOT 2, BLOCK 203, OF "DUNNING'S MIAMI SHORES EXTENSION NO. 1 ", ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 41, AT PAGE 51, OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA. PIZ opo 551> S ri pAu � D .vE v. 24' PARKWAY ALV. wh 1.30' RECORD SURVEY SCALE 1 "= ZO ` '� MAR 1 6 2011 LOT 3, BLOCK 203 w AA /A PERMIT #; r� 13 43 �I DATE OF FIELD WORK... n; - -2 4011 FOR: ( nnccn ON 2260 HOLDINGS NO. 1 LLC o n ED" F.I.P. ADE COUNTY HEALTH DEPARTMENT DATE: FF s V ISIAND /oR OTHER • INSTR MENTS ECTING THIS PROPERTY, "' RECORDED IN THE PUBLIC RECORDS NOT SHOWN ON THIS SURVEY. NOO°00'00"W 122.76' NOO°00'00"E 122.81' , 7210 S.W. 1*26th: COURT, MIAMI, FLORIDA 33183 ANIANO J. GAR CIA, PLSM. LAND SURVEYOR & PLANNER PH. (305) 856 -4566 FAX. (305) 595 -1454 0 N O 0 CO F.I.P. 01" A = ARC DISTANCE C A/C = AIR CONDITIONER PAD. C AE = ANCHOR EASEMENT. C ASPH. = ASPHALT. B/C = BLOCK CORNER. C BLDG. = BUILDING. C B.M. = BENCH MARK. B.O.B. = BASIS OF BEARINGS. C = CURVE C = CACATCH LCULA BASIN. TED DIMENSION. CONCRETE BLOCK RE' C.B.S.W = CONCRETE BLOCK CK WALL A ■ CENTRAL ANGLE = PROPOSED ELEVATION. 0„ N78 °07'16 "W 0.49' co N N_ w O o 0 10.01' --✓ < 'KK z �.y 10.03' OE SEPTIC TANK (IDENTIFIED AND LOCATED BY OWNER) m x14.5', H = CHORD DISTANCE H. B. = CHORD BEARING. L = CLEAR. C /L OR C = CENTER UNE .1.F. = CHAIN UNK FENCE. .M.E = CANAL MAINTENANCE EASEMENT. CONC. = CONCRETE. C . P. D =CONCRETE POST COLAB. 0.E DRAINA GE EA = DECREES. D.M.E. = DRAINAGE & MAINTENANCE EASEMENT. XODO = EXISTING ELEVATION. 15' WIDE ALLEY 9' ASPHALT PAVEMENT S89 °39'35 "E 75.00' LOT 2, BLOCK 203 \‘>:% �\ y / WOOD, �A DECK ., ��`�� /\17.4' 7' 'RESIDENCE #18 v/ 5' SIDEWALK S89 °41'50 "E 75.00' 24' PARKWAY 16' ASPHALT PAVEMENT (75' TOTAL R /W) DIST. = DISTANCE DR. = DRIVE. DR. W. = DRIVE WAY. E =EAST. ELEV. = ELEVATION. ENCR. = ENCROACHED. E.T.P. = ELECTRIC TRANSFORMER F.D.H. = FOUND DRILL HOLE F.F.E =FINISHED FL OOR ELEVA F.H. = FIRE HYDRANT . F.I.P. = FOUND IRON PIPE. F.I.R. = FOUND IRON ROD. F.N. = FOUND NAIL FT. = FEET. X—X = CHAIN LINK FENCE. z N.W. 106th. STREET N52 °37'30' W 0.93' Z O U z LEGAL NOTES 0.90' 2.8 UP 12.72' -- 8 R/ s 0 0 THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP. EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT TO DEDICATIONS, LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORDS. LEGAL DESCRIPTION PROVIDED BY CLIENT. THE LIABILITY OF THIS SURVEY IS LIMITED TO THE COST OF THE SURVEY UNDERGROUND ENCROACHMENTS, IF ANY, ARE NOT SHOWN FIRM HAS NOT ATTEMPTED TO LOCATE FOOTING AND /OR FOUNDATIONS AND /OR UNDERGROUND IMPROVEMENTS OF ANY NATUR IF SHOWN, BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN. IF SHOWN, ELEVATIONS ARE REFERRED TO N.G.V.D. OF 1929. DATE OF FIELD WORK 03- -2011 REVISED ON REVISED ON O AN N SED S P.L.S.M 5105 ,are THE � NATURE AND THE ORIGINAL F A FLO '' LICENSED SURVEYOR AND LEGEND IONS EGEND AND ABBREVIAT N. & EG. E = INGRESS & EGRESS EASEMENT. LB. = UCENSED BUSINESS. LF.E = LOWEST FLOOR ELEVATION L.M.E. = LAKE MAINTENANCE EASEMENT. LN. = LANE. LP. = UGHT POLE (M) = MEASURED DIMENSION. TI ON , = MINUTES. M/L OR Id = MONUMENT UNE MON. = MONUMENT. N = NORTH. N.A.P.0 = NOT A PART OF. = WOOD FENCE. ® = C.B.S WALL PROPERTY ADDRESS: 18 N.W. 106th. STREET, MIAMI SHORES, FLORIDA 33150 LEGAL DESCRIPTION: LOT 2, BLOCK 203, OF "DUNNING'S MIAMI SHORES EXTENSION NO. 1 ", ACCORDING TO THE PLAT THEREOF, 77-- AS RECORDED IN PLAT BOOK41, AT PAGE 51, OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA. ii I -1.30' W N N _ LOT 3, p BLOCK 203 0 O O O 0 Z F.I.R. RECORD SURVEY SCALE 1"= 20' S89'41'50 "E B.O.B. w tit 2 . Q co 9 450.18' _ T F.I.P. 01" (B /C) THERE MAY BE EASEMENTS AND /OR OTHER INSTRUMENTS AFFECTING THIS PROPERTY, RECORDED IN THE PUBLIC RECORDS NOT SHOWN ON THIS SURVEY. FOR: 2260 HOLDINGS NO. 1 LLC ORDER NO. 11 -0066 N.G.V.D. = NATIONAL GEODETIC PL = PUNTER OR PLACE R = VERTICAL DATUM. 5/1. = PROPERTY UNE. (8) N.T.S. = NOT TO SCALE. P.LS = PROFESSLORRL LAND SURVEYOR. E N0. OR a = NUMBER. PUN - PROFESSIONAL L RD AND RD. 0.E = OVERHEAD UTILITY ONES. SURVEYOR & MAPPEL 0.H. = OVER HANG. P.O.B. = POINT OF BEGINNING. ROE 0/S = OFF SET. P.O.C. = POINT OF COMMENCEMENT. R.LS O.R.B. = OFFICIAL RECORD BOOK. P.R.C. = POINT OF REVERSE CURVE. P8. = PLAT BOOK. P.R.M. = PERMANENT REFERENCE R.R. P.C. = PO O5 CURVATURE. M ONUMENT . P.C.C. = POINT OF COMPOUND PROP. COT. = PROPERTY CORNER. R/W CURIE P.T. = POINT OF TANGENCY. S = PINT. = PAVEMENT. PG. = PAGE PINY. = PARK -WAY. SEC. P.C.P. - PERMANENT CONTROL POINT. RADIUS. S.I.P. = SET IRON PIPE = RECORDED DIMENSION. WITH CAP P.LS 5105 = RADIAL S.P. = SCREENED PORCH. = ROAD. ST. = STREET. = RESIDENCE. STY. = STORY. RANGE S.W.K. = SIDE WALK . REGISTERED LAND T = TANGENT. SURVEYOR. TINS. = TOWNSHIP. RADIUS POINT. U.E - UTILITY EASEMENT. = RAIL ROAD. U.P. = 011.117 POLE = RIGHT OF WAY. SOUTH. SECONDS. SECTION. UTY. = U1TMY. W =WEST. W.F. = WOOD FENCE W.Y. WATER METER. W.V. = WATER VALVE