DS-11-1028Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 160666 Permit Number: DS -6 -11 -1028
Scheduled Inspection Date: June 29, 2011 Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Owner: DE LUCA, BEATRIZ Work Classification: Addition /Alteration
Inspector: Bruhn, Norman
Job Address: 150 NE 100 Street
Miami Shores, FL
Project: <NONE>
Contractor: PAVERS AND BRICKS SERVICES CORP
Phone Number
Parcel Number 1132060132140
Phone: (305)986 -2544
Building Department Comments
NEW DRIVEWAY WITH CHICAGO BRICK ON SAND BASE
AND PATIO WITH CHICAGO BRICK.
Inspector Comments
Passed
r 4
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
June 28, 2011
For Inspections please call: (305)762 -4949
Page 17 of 38
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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ((����ROOFING C
OWNER: Name (Fee Simple Titleholder): 13eAT li 2.. tx L u ciS Phone #:
Pe 't No.
Master ' ermit No. D5 6- ((- i O 7es2
12,6v OA/
Address: t S 0 la.i t 4 0 0 S't
City: ) A A M t sttotrzEs State: F
Zip:
Tenant/Lessee Name: 1 - Phone #:
Email:
JOB ADDRESS: /5-C) /J L 00 St-
City: Miami Shores County: Miami Dade Zip: Y3 1 3 '
Folio/Parcel #:
Is the Building Historically Designated: Yes ci.isc Flood Zone:
CONTRACTOR: Company Name: PA 1/6 r2 kC.jS 12U_ (/C D) #tt2,)$hone #:
Address: '39 WW /56 V-
City: A4 r/4/M1 1 State: (ri L Zip: , ;/64/.
Qualifier Name: ¶ AU L 4h , Ff} GU N D c 2 Phone #: '986 Y Y 3 ?,
State Certification or Registration #: Certificate of Competency #: 06 650 06 ?-O
Contact Phone #: Email Address: PIA (d & R A/14O$ 126 A .e %iO /t/i4 i e. 6044
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $
600
Type of Work: Addition DAlteration
Description of Work: Ac-1DD
Phone #:
Square/Linear Footage of Work: 'Z'43®5:Z
&c ew
❑Repair/Replace
❑Demolition
* * * * * * * ** * ** * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * *** * * * * * * * * * **
Submittal Fee $
Scanning Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Permit Fee $ CCF $ CO /CC $
Radon Fee $ DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State
MIFF
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will ' e approved and reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this J 5
day of , 20 11 , by De Al `t 2 I)c LUC/15
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLI
Sign:
Print: SINPin
NOTARY PUBLIC -STATE OF FLORIDA
"" " '., Shantell Ruthiely lopes Cordeiro
= = Commission # EE019117
,,,,; Expires: NOV 15, 2011
BC THRT CBOND CO, I.. C.
et
My Commission Expires: Ij ®v - 5
Signature
Contractor
The foregoing instrument was acknowledged before e this I S
day of , 20 ) ( , bcRi'w D. G0 >1 _ .
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBL
OTARY PUBLIC -STATE OF FLORIDA
"' ShantellRuthielyLopes[ordeiro
mmission # EE019117
Expires. NOV..15, 2011
0000 •:r 1 • Y • VII • •
My Commission Expires:
/UOV•J5,o2J -$L�
oY*** **d:9: *9c9:****** ** t*** ** Y4rY *9rY****oY**** *** Y9:** ** **** *o` * ** * * * * * ** Peck *** *R4e9e*Fe*oY:F**ke ***::** ** ***oY*** Y * **
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09)
Plans Examiner
Structural Review
Zoning
Clerk
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit NO. DS -6 -11 -1028
Permit Ty Pa. Driveways /S1 e' a it s /$labs
Work Class st tion ArlditiotlffAtter tlo�
Issue Date: 6/14/2011
,1
Expires:6 /14/2011
Folio Number:1132060132140
Owner's Name: BEATRIZ DE LUCA
Job Address: 150 100 Street
Miami Shores, FL
Owner's Phone:
Total Square Feet: 750
Total Job Valuation: $ 2,400.00
Contractor(s)
PAVERS AND BRICKS SERVICES CORP
Phone
(305)986 -2544
Primary Contractor
Yes
1
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/17/2011: Yes
Comments: PLEASE MODIFY PERMIT TO REFLECT ALL WORK.
6/17/11
OK
aVVIiYru*1 YY�s��•
SCALE =r =201
SUBJECT TO COMPLIANCE tli1TH ALL FEDE l•
STATE AND COUNTY RULES AND REGULATIONS
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
JUN 0 k REEC1
Permit No. DS O�
Master Permit No.
Permit Type (circle): Building Roofing
Owner's Name (Fee Simple Titlehold OA Z' LWS
Owner's Address /TO Al /00 3T
City All 1 Wp ir-2-- Zip ''-, I
Tenant/Lessee Name Phone #
lob Address (where the work is being done) I S ci N L [ O 0 5t
City Miami Shores Village County Miami -Dade Zip 3313:
FOLIO / PARCEL #
Ls Building Historically Designated YES NO
1
Contractor's Company Name PA (1 Elam- ) iv C. S Sc flV ( one #
Contractor's Address Ci 9 N, (" / J`- e S#
City A1 a ,q✓-f i State F Z Zip '- 3 l 6
Qualifier Name 'RA u L ) F.4 6 Li A' PC Z Phone # q 66 ° Y li 3 . 31,0'3
406 13S co 6 - ®,'.
30r-, ga-i 913
State Certificate or Registration No.
Certificate of Competency No.
Architect/Engineer's Name (if ,applicable) Phone #
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Work: N C-1A✓
iA ' V 0
❑Alteration
Square / Linear Footage Of Work: > Q .D-17; L/ j
[ew
vi 1'4-14 c
❑ Repair/Replace
b ,cl=
❑ Demolition
6
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ I Permit Fee $ /LL,,r°4" CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side -)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
ss° e
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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 rot be approved and a reinspection fee will be charged.
The foregoing instrument was acknowledged before me this
5
day of ‘641e- ,20 l (,by 136-AThi2 D,c LVCA,
who is personally known to me or who has produced
Signature
/s9 Aisvc
" , wContractor
pil-0 L. C-e)/J Z
e foregoing instrument was acknowledged before me this 3
day of , 207 ( , by � V L �/�6(WPC
2
who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
NOTARY PUBLIC -STATE OF FLORIDA
;ow" Shantell Ruthiely Lopes Cordeiro
•5 Commission # EE019117
„��.. Expires: NOV. . 15, 2011
TA � M TBRC AT'I\.DTI^3Q DIN ,.-..,utc.
My Commission Expires: 100u - 5 , 0 .1
APPLICATION APPROVED BY:
(Revised 07/10/07)
NOTARY PUB
Sign:
Print:
C• NOTARY PUBLIC-ST IE OF FLORIDA
p••' " "`''•, Shantell F,uthmely Lopes Cordeiro
Commission # EE019117
/ Expires: NOV. 15, 2011
rir
%.,,
Al, Do
h Fort e r +Vt'
TSRUA j;C BONDING ' INC.
- 1� [fir.
My Commission Expires: ,V GO ,1 f , a ®l i
Plans Examiner
Engineer
Zoning
130611 12:37
PAVERS AND BRICKS SERVICE 305 - 759 -3165 p.1
YV)
CERTIFICATE OF LIABILITY INSURANCE LDAJI17/1 1
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
ALTER THE.COVERAGE AFFORDED BY THE POLICIES BELOW)
PRODUCER Accurate
8300 West Flagler Suite 114
Miami, FL 33144
Phone (305)226 -8727 _— — Fax (305)226 -8767
INSURED Pavers And Bricks Services Corp,
99 NW 156 Street
Miami, FI 33169
INSURERS AFFORDING COVERAGE I NAIC # —
INSURER A: Lloyd's Of London
INSURER B: SUA
INSURER C: —
INSURER D:__
INSURER E:
COVERAGES I INSURER F:
THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. •
INSR AMYL POLICY EFFECTIVE
• LTR : INSRD TYPE OF INSURANCE POLICY NUMBER DATE {ra►troun Y).
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY .ARTE009373 -2
IM CLAIMS MADE [ OCCUR
GENT. AGGREGATE LIMIT APPLIES PERT
❑ POLICY E PROJECT ❑ LOC
A!
❑
AUTOMOBILE LIABILITY
• ANY AUTO
• ALL OWNED AUTOS
❑ SCHEDULED AUTOS
• HIRED AUTOS
• NON OWNED AUTOS
—1
GARAGE LIABILITY
ANY AUTO
EXCESS/UMBRELLA LIABILITY
- OCCUR ❑ CLAIMS MADE
DEDUCTIBLE
- RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
B ' ANY PROPRIETOR/ PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED?
if yes, describe under
SPECIAL PROVISIONS below
OTHER
WSAU IEC 11596902
01/12/11
01/26/11
POLICY EXPIRATION
DATE I141/41IDDIYY) _
01112/12
LIMITS
EACH OCCURRENCE _
- DAMAGE TO RENTED
_PREMISES (Ea occurenee) -
MED EXP (Anyone person)
PERSONAL& ADV INJURY —
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per ardent)
PROPERTY DAMAGE
(Per ccident)
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
EACH OCCURRENCE
AGGREGATE - - --
- - f,000.000
50,000
- " -__ 5,000
1,000,000
_
2,000,000
1,000,000
01/26/12 TORy.uf s _D .E
EL EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Miami Beach is named as additional insured with regards to the following project:
Project Name: Elizabeth Potter
Project Address: 4554 Adams Ave
Project Description: Driveway Approach
Duration of construction activity: 1 Month
CERTIFICATE HOLDER
City of Miami Shores
10050 NE 2 Ave
Miami Shores, Florida
. 1
ACORD 25 (2001 /08) CIF'
CANCELLATION
100,000
500,000.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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 IMPOSE NO OBLIGATION OR LIABILITY •
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Lucia Estrella
OACORD CORPORATION 1988
Miami Shores Viiiage
Building Department
RECEIPT
PERMIT #: �� l - Z—Sr
Au RAA-6.4
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: b C i 3b1
ntractor
❑ Owner
o A _ hiteet-
Picked up 2 sets of plans and (other) uic_N-TLL
Address f ® A/6 too 51
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE: CO 4, '
1 n
PERMIT CLERK INITIAL: Y //�
1
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit NO. DS -6 -11 -1028
Issue Date: Not Issued
Expires:
or'
Folio Number:1132060132140
Owner's Name: BEATRIZ DE LUCA
Job Address: 150 100 Street
Miami Shores, FL
Owner's Phone:
Total Square Feet: 750
Total Job Valuation: $ 2,400.00
Contractor(s)
PAVERS AND BRICKS SERVICES CORP
Phone
(305)986 -2544
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/9/2011: Yes
Comments: PLEASE MODIFY PERMIT TO REFLECT ALL WORK.
•
+J 1 •••• v I 1 1
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax (3051756- 8972..
WHEREAS,
f}PPSotrC -t
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Riot 7, b - Lick—
following described property:
Legal description/foliok:
Lot
(owner)
Tax Folio 4:
, hereinafter referred to as the Owner of the
Block /N Subdivision /t'/444, ,S71,0ner.0
requests permission to install:
[ ] Asphalt, concret
[] Landscaping
[ ] Other
within the public road right of way of
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this 3 day of /t..'AJ 20((
is 2 IBC 2c/GA
. (0
SIGNED, SEALED AND DELIVERED in the presence of:
NOTARY PUBLIC -STATE OF FLORIDA
00""4, Shantell Ruthiely Lope's Cordeiro
Commission # EE019117
y.,;, fl,,,.' NOV. Expires: NO 15, 2011
BONDID THRU ATLANTIC BONDING COO=
n
4LJ"'e-
•
OVVIIILIP@IDI VV••vim.•
SCALE s 1. • 10'
{
S111l,IFCT TO COMPLIANCE WITH ALL FEDERAL
AND COUNTY RULES AND REGULATIONS
THIS PLAN OF SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMED
HEREON. THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY.
THE SURVEYOR MAKES NO.GU
AGENT SHOULD BE CONTACTED
LAND TO BE SITUA1ED IN ZONE
HASE FLOOD ELEVA1IoN .
APPROVED
0 HE H REI
M'
CERTIFIED TO. BEATRIZ D: �O�Y1NG DEPT
LEOPOLD,KORN 8 LEOPO ��gffial
FIRST AMERICAN TITLE IN - BANK OF AMERICA N.A., IT � � m . �: ... s
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
HIS "E G'1
JOB AT 11 E Gr
INSPECTION
E.M A
DESCRIBE
1995
FLORIDA DEPARTMENT OF
HEALT
Rick Scott
Governor
H. Frank Farmer, Jr., M.D., Ph.D.
State Surgeon General
April 25, 2011
Orville Evans
743 NW 111 St
Miami, FL 33168
RE: Contingency Letter
Application Document No: API002593
Centrax Permit Number: 13 -SC- 1314355
OSTDS Number:
150 NE 100 St
Miami, FL 33138
Lot:8 -9 Block: 16 Subdivision: Miami Shores
Dear Applicant:
This will acknowledge receipt of an application dated 04/21/2011 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
From a review of your completed application, it has been determined that your existing system
is adequate for the proposed use (brick patio installation).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Sincerely,
Joseph Pi er ; - f � •r e ' • - - ist I I
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com
TELEPHONE (305) 264 -2660
FAX (305) 264-0229 -
LAND SURVEYORS
DRAWN BY' • LIL Y
U b4 C 444. s.s 4. •Vif.P .v♦%4111.•
SHEET No. • 2 OF
BOUNDARY SURVEY
SCALE =1' = 20'
• -
F.IP 112° F.I.P 112°
NO CAP NO CAP