DS-10-1508Inspection Number: INSP- 150317 Permit Number: DS -8 -10 -1508
Scheduled Inspection Date: September 28, 2010
Inspector: Bruhn, Norman
Owner:
Job Address: 52 NW 111 Street
Project: <NONE>
Miami Shores, FL 33168 -4322
Contractor: TRUE STAMP CONCRETE LLC
Building Department Comments
September 27, 2010
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
Phone Number
Parcel Number 1121360030370
Phone: (305)494 -4465
STAMP CONCRETE PATIO 25 X 15
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 7 of 22
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BALDEST .r ROOFING
Miami Shores Village f;
Building Department ;,
( tx
1 0 050 N.E.2nd A venue, Miami : i Shores, Florida 3313$'
Tel (305) 795.2204 Fax: (305) 736,8972
INSPECTION'S PHONE MASER: (305) 762.4949 BX :...
Job Address (where the work is being done) 5:2 /// 51 '
City Miami Shores Village County Miami = Dade„ ,,,_Zil
FOLIO/ PARCEL # /12/ 6_0 f , 7c
Architect/Engineer's Name (if applicable)
Contractor's Company Name
Contractor's Address 1 -, s ?l
City / ! ,% i'6
Contact Phone
* * * *�r * * *. * * * **x
�
Submittal Fee $,v
Permit Fee $,
Permit No. D I 1
Master Permit .No.
Owner's Name (Fee Simple Titleholder) r ) J- e � Q . . z
•. 1 e:, : Phone # der 7 9 ? /6 7
Owner's Address (0 c 1 41it-'6e, 0 /✓ i e r. �:-e
w
City m e i -r1 f State . C.. ' Zip' '7l 7
Tenant/Lessee Name
hone##
Email
Is Building Historically Designated YES NO Flood Zone:
Phone # c$ Si /' c/ 6-s`
e : :. _ Zip'
Qualifier Name __Zi':(44 --''7 T44c2 , {erg Fhone #
State Certificate or Registration No. ' s, 63 - 76.1.7, Certificate of Competency N'o.
'-r " U( c (Ci6:::. E-mail ..
Phone #
Value of Work For this Permit $:. 40 Square / Linear Footage Of Work: c-6o 0
Type of Work: °Addition [Alteration : evw :
. . : [ �.,..11epairlReplace : Demolition
Describe Work: �j'r' �' Cuat. f..L 7` ? X<®
* ** * * * *w * * * * * * * * * * * * * ** F ees **** ** r * * * ** * * * * ** * * * ***** * * * * * *, * * * ** *ire. * **
CCF $ . • NCO /Ce
Notary $ Training/Education Fee $ Technology Fee
Scan ill Radon $ DPBR $ Bond $
Double Fee . /f , '' `. Violation date:
ructua'a1 Review. $ Total Fee Now Due $
Set 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 WITII YOUR. LENDER OR AN ATTORNEY ` BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.”
• ;;r_ MY COMMISSION # DD 932659
?'q.r,�tirti EXPIRES: October 13, 2013
' hail Bonded Thni Notary Public Underwriters
Sign:
Print:
My Commission Expires:
(Revised 07 /10 /07XRevised 06/10 /2009)
Engineer Clerk checked
Signature
NOTARY P
APPROVED BY
Plans Examiner.
".'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 reins. ' ion fee will be charged
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 7 The foregoing instrument was acknowledged before me this2Z
i .s.
day of. , c1C) (o , 20 , by t3 4 t° ��t �Q , day of , 201_42, by 4.4.-272;t
who • personally known t me or who has produced who i • ersonaily known t. me or who has produced
As identification and who did take an oath.
as identification and who did take an oath.
NOTARY PUB C:
Sign:
Prink
My Commission Exp
:ik":PY LIJCIASANTANA
'A.1 •, MY COMMISSION # DD 932659.
A N ���:: EXPIRES: October 13, 2013
`',
Al.�+aBonded 'Wu Notary Public Underwriters
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APPLICATION FOR:
[ ] New System
[ ] Repair
APPLICANT: Jaime Fernandez
AGENT: True Stamped Concrete
MAILING ADDRESS: 4211 SW 99 Ave Miami, FL 33185
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY
A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA 3TATuTES. IT IS THE
APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED
(MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
LOT: 5
SUBDIVISION:
PROPERTY ID #: 11- 2136 - 003 -0370
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
[S] Existing System
[ ] Abandonment
PROPERTY SIZE: 0.20 ACRES
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y
PROPERTY ADDRESS: 52 NW 111 St Miami, FL 33175
DIRECTIONS TO PROPERTY.
BUILDING INFORMATION: [X] RESIDENTIAL
SIGNATURE:
v 1.0.0
[ ] Holding Tank
[ ] Temporary
BLOCK: 220
PLATTED: 01/01/1963
ZONING:
WATER SUPPLY: [ ]PRIVATE
Type of No. of
Establishment Bedrooms
[ ] Floor /Equipment Drains [ ] Other (Specify)
3
DH 4015, 08/09 (Obsoletes previous editions which may not be
Incorporated 64E- 6.001, FAC
AP976604
used)
TELEPHONE: 1 (305) 494 -4415
I/M OR EQUIVALENT: [ Y '1 - P
DISTANCE TO SEWER:
[ ] COMMERCIAL
°ATE:
51D1274638
APP DOC # AP976604
PERMIT # : 13 -SC- 1274638
DATE PAID 08/24/2010
FEE PAID: 70.00
RECEIPT #:13 -PID- 146189
[ ] Innovative
[]
[ ]<= 2000GPD [A] >2000GPD
Building # Persons Total Design Flow
Area Ft Served For This Unit
1884 6
iVi ED
A IFOIRIlinsno 4w1
n� . gym' 6
pestor is
DATE: 08/24/2010
Page 1 of 4
FT
300
APPLICATION FOR:
[ ] New System
[ ] Repair
APPLICANT: ) P'a'd✓ ?n
AGENT:
LOT:
2
3
4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
MAILING ADDRESS: 6/2- //
PROPERTY INFORMATION
BUILDING INFORMATION
Existing System
[ ] Abandonment
/. A can a° e
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S
RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED
(MM /DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
BLOCK: ° 2 SUBDIVISION:T/ PLATTED: C. s.
PROPERTY ID #: ,// 24 0 , 7t ZONING: I/M OR EQUIVALENT: [ Y / N
PROPERTY SIZE: 0 a ( WATER SUPPLY: [ ] PRIVATE
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /
PROPERTY ADDRESS: 2. 4;1,-, 1/ :
DIRECTIONS TO PROPERTY:
RESIDENTIAL
Unit Type of No. of Building
No Establishment Bedrooms Area Soft
1
DH 4015, 10/97 - Page 1 (Previous Editions May Be Used)
Stock Number: 5744 - 001 - 4015 -1
[ ] Holding Tank [
[ ] Temporary [ ]
[ ] COMMERCIAL
TELEPHONE:
PERMIT NO. KYA
DATE PAID: 0 4) —C) ®1,
- FEE PAID: - 0.9
RECEIPT #:
Innovative
PUBLIC [ ] <= 2000GPD [ ] >2000GPD
DISTANCE TO SEWER:
Commercial /Institutional System Design
Table 1, Chapter 64E -6, FAC
FT
[ ] Floor /Equipment Drr- ainns [ ] Other (Specify)
SIGNATURE: - DATE:
,.a
Page 1 or 4
APPLICATION FOR:
AGENT:
TELEPHONE:
MAILING ADDRESS:
LOT, BLOCK,
SUBDIVISION:
DATE OF SUBDIVISION:
PROPERTY ID#:
ZONING:
PROPERTY SIZE:
WATER SUPPLY:
SEWER AVAILABILITY:
PROPERTY ADDRESS:
DIRECTIONS:
BUILDING INFORMATION:
TYPE ESTABLISHMENT:
NO. BEDROOMS:
BUILDING AREA:
BUSINESS ACTIVITY:
FIXTURES:
SIGNATURE / DATE:
Check type of permit, if "Other" specify type in blank.
Property owners full name.
Property owner's legally authorized representative.
Telephone number for applicant or agent.
P.O. box or stree city, state and zip code mailing address for applicant or agent.
Lot, block, and subdivision for kd orunn*omrdedmubd��k�n\ If , '
recorded subdivision, a copy of the lot legal description or deed must be attached.
Official date of subdivision recorded in county plat books (rnonth/day/year) or date lot originally '
recorded. Dividing an approved lot into two or more parcels for the purpose of conveying
ownership shall be considered a subdivision of the lot.
27 character number for property. CHD may require property appraiser ID # or
section/township/range/parcel number.
Specify zoning and whether or not property is in I/M zoning or equivalent usage.
Net usable area of property in acres divided by 43,560 square feet) exclusive of
all paved areas and prepared road beds within public rights-of way or easements and exclusive
of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water.
Contiguous unpaved and non-compacted road rights-of-way and easements with no subsurface
obstructions may be included in calculating lot area.
Check private or public <=2OOO gallons per day cn public »2OOO gallons per day
Is sewe available as per 381.0065, Florida Statutes, and distance to sewer in feet.
Street address for property. For Iots without an assigned street address, indicate street or road
and Iocale in county.
Provide detailed instructions to lot or attach an area map showing lot location.
Check residential or commercial.
List type of establishment from Table II, Chapter G4E-6.FAC. Examples: single fonlily,oinoha
wide mobile homm, restaurant, doctor's office.
Count aU rooms designed primarily for sleeping and those area to routinely provide
sleeping accommodations for occupants.
Total square footage of enctosed habitable area of dwelling unit, excluding garage, carport,��
exterior storage shed or�penorfuUymcrm�nedoatoaord�ckm. Based
. patios
measurements for each story of structure.
For only. List number of em shifts, and hours of
operation, or other iriformation required by Table 11, Chapter 64E-6, FAC.
Mark Floor/Equipment Drains or Others and specify item or UNA if not applicable.
Signature of applicant or agent. Date application submitted to the CHD with appropriate fees
and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings,
swimming pools, recorded easements, onsite sewage disposal system components and location, slope of property, anyeomting
or proposed wells, drainage features, filled areas, obstructed areas, and surface water. Location of welis, onsite sewage
disposal systems, surface waters, and other pertinent facilities or features on adjacent property, if the features are with 75 feet of
the applicant Iot. Location of any public well within 200 feet of tot. For residences, a floor plan (residences) showing number of
bedrooms and building area of each unit. For nonresidential establishments, a floor plan showing the square footage of the
establishment, all plumbing drains and fixture types, and other features necessary to determine composition and quantity of
wastewater.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
Additional Notes and Comments:
County Notes Fields:
County Process #:
County Permit #:
Storage Box #:
Zone:
Permit Type:
County Status:
General Comments:
This permit is granted fo - r stallation a 4" stamped concrete terrace only.
Does not hha impact on th'- • sting OSTDS.
Pedro Ospina
Engineer II
v 1.0.0 AP976604 E1D1274636
APP DOC #:
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
AP976604
13- SC-1274638
08/24/2010
70.00
13- PID- 1461898