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DS-11-1052Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 160789 Permit Number: DS -6 -11 -1052 Scheduled Inspection Date: June 23, 2011 Inspector: Bruhn, Norman Owner: Job Address: 118 NW 97 Street Miami. Shores, FL 33150- Project: <NONE> Contractor: RODWINS PAVING Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)978 -4715 Parcel Number 1131010250070 Phone: (305)253 -5354 Building Department Comments CONSTRUCT ASPHLAT DRIVEWAY APPROACH Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 22, 2011 For Inspections please call: (305)762 -4949 Page 14 of 32 Miami. Shores Village Building Department 10 050 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 JUN 0 REC'DA Permit No. �JV ` ) Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): 5E Ali R � 'i 1 - 1 oue56 t V 1.1- Phone#:. c"' 7v9 -Iva 7 (9'47 Address: l3 W!) b✓1eldo an. City: A4'1411117 I State: PL zip: 33) S 1 Tenant/Lessee Name: Phone#: FrnaiF JOB ADDRESS: // f N t/ 97 Si-- City: Miami Shores County: Miami Dade Zip: 3' 315-0 Folio/Parcel #: � � ' stn- C9Is- 007 8 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: /Ii�P,6�aS 4544 PQ✓m/y a/d /4 RO ,JWIiiS Rvie✓c Phone#:30C. 25S-535`t Address: l 12"% 0 -CIA/ as' C1- City: eA lam.✓► Qualifier Name: _ICI L.a A) r-G btu, C State Certification or Registration #: Contact Phone#: DESIGNER: Architect/Engineer: state: F L Zip; 3l / fi' 7 Phone #: SI S- 2y�J S"3 S" Certificate of Competency #: t ?W !0® �`S3 °S3�y Email Address: J0,2 L redo,lS, Cow, /Jer iyd rDlk../; ns . c Phone#: Value of Work for this Permit: $ goo Square/Linear Footage of Work: 2 g 2— 5, P4 Type of Work: DAddition OAlteration Description of Work: ®New DRepair/Replace ODemolition ******** * * * * * * * * * * * * * * * * * * * * ** * * * ** * * ** Fees************* * * * * * * * * * * * * * * * * * * * * *** * * * * * * ** Submittal Fee $ Permit Fee $ JU c Scanning Fee $ ° Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ 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 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 COMMENCEMENTS" 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 r such posted notice, the inspection will not be approved and cajreinspection fee will be charged. Signature Signature Owner or Agent Co tractor re), The foregoing instrument was acknowledged before me this 3 The foregoing instrument was acknowledged before me this sii day of � °,"1. , 20 tl , by s°fivi 12(4i1e7 , day of o?.nn -2. , 20 Yi , by -Jose. L. Ala- 1bi.Q.7 , who is personally known to me or who has produced DL... who is personally knownto me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sig Print: ersevt" c u e My Commission Expires: 3N (zo t APPROVED BY JEREMY CAUBLE oC, NOTARY PUBLIC STATE OF FLORIDA Comm# DD965494 CE 19�" Expires 3/9/2014 Plans Examiner NOTARY PUBLIC: S 'f,....- •T et t O� My Co f r�iS�' , -` �� ' 1 t 0+ (-y Comm# DD965494 44VE 10 � Expires 3/9/2014 // Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06/10/2009XRevised 3/15/09) 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 -1052 Issue Date: Not Issued Expires:NOt Issued Folio Number:1131010250070 Owner's Name: Job Address: 118 97 Street Miami Shores, FL 33150- Owner's Phone: Total Square Feet: Total Job Valuation: (305)978 -4715 232 $ 2,400.00 Contractor(s) RODWINS PAVING Phone (305)253 -5354 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 6/9/2011: Yes Comments: 2 FT FLARES MAX. FIP 0 ix 81.15' (kVA) .21PCL SVC. 111 „r. 7rael ••••••••• vi _111011.1, ■01■41~ OMNI( : .009:5= sec.a.etr NORTH R/W LINE ; 4 SNOLLY1f103EI ONV ointi kimoo ONV 31VIS 'MAW TV I-WM 3ONVIldIA100 01 1.3A11111S )P42/ -9 Sfil 1d30 001g 119 ay v , 1.d30 DNINOZ ii• d/ , 03A0licidV oit ME 06e1HA sax:14S !Wegfq , .21PCL SVC. 111 „r. 7rael ••••••••• vi _111011.1, ■01■41~ OMNI( : .009:5= sec.a.etr NORTH R/W LINE ; 4 10 CFN: 20110370522 BOOK 27713 PAGE 3136 DATE:C16/07/2011 03:09:45 PM HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY Miami Shores Village Building Department 10050 AL-E2N-Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF •CONSTRUCTION WITHIN RIGHT OF WAY Whereas, towneraLatilaa......._veg+s14431 iv a2-. hereinafter referred to as the owner of the following described property memo: — Legal DescriptionP0- .4240 Lot 1 Block 3 Subdivision op4,4444- Folio# 0 0 Requests permission to install (cleerie mr10: 17A i+ ThAlvitivy. mach (1 Within the publio right of way of eackiressi • IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as followe: 11. To maintain and repair,. when necessary, the above-mentioned. iterri(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 shaft be paid by the Owner or Shan constitute a Hen against the abovedesdribed property until paid. 2. Theowner does 'hereby agree to .indemnify end hOidlolarniShores orDade County harmless from any and all Ilabilfty, which may rise by virtue of .permitting the installation. of these items wittin.ffie public right of way.. 1 CFN: 20110370522 BOOK 27713 PAGE 3137 The. Owner does hereby..agnse to remove orrelocatetheir %dillies at their own erApense,. within SO days notice by the Village to do so. Failure to comply with this notice wilt result-in the Village causing the itern(s) to be removed and a lien being placed on the property ander 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 aseigna, untff such time as this obligations has .been canceled by an affidavit filed in the Public Records of Dade County. Florida by the krtllage Manager of lei Shores. Village (or his hilly authorized-representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this day of ,2oti SiGNED, SEALE DELIVERED in the presence of; 2 02,,ie, (Owner's Signature) JEREMY GALINA NOTARY PUBLIC STATE OF FLORIDA Corms% DD965494 Expires 3/9/2014 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR IF CONTRACTOR IS:AFJ FLORIDA STATE CERTIFIED CONTRACTOR) A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CgRTIFICA E HOLDER TO BE MIAMI plows VIl,LA,GEBLAGDEM D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT1 D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 R 4,.6R *3.S'!g fi.6.1Ff1!► A Aug-. NI 4l.P ikA !t�'lmiA egit lFf IFA■ �:!'I, i f■;tfl11Flflt.�i •L:1_�.i.A'.S`111-11.•111.110•11k11110.11111.*** Cb11PL "ET1= CON1tA�'IOIZ"5 INtt=f)13MAf1�T BUSINESS NAME: ) A�. �L�� � Sc i,s ea l 1 /i PCCU lV10 BUSINESS ADDRESS: 6 Cale' e � l � I L r ' CITY ILs 1,d '1lr1 STATE FL- ZIP CODE BUSINESS PHONE: ( ) ZVI FAX NUMBER (36S) 2.35 c)s� L . (�bIC�L -S CELL PHONE . QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: e L1 Y E -MAIL ADDRESS (IF APPLICABLE): �- , L d fl , 101LOVrsv es CERTIFICATE OF LIABILITY INSURANCE T . . . ' R le IMMO AS MATTER CP INFORMATION O N L Y , "' T NO ROM t i'N T1 CNOMMATE DOES NOTAPPIRAVOAIEI.Y OR ANOATIVELY AMC, UTE= OR ALTER THE COMMIE WORM BYTl1E THIS CNINIVCATE OP INSIMANCE 00E8 NOT C01STR1 TEA CONTRACT BETWEEN THE IMMO manteata, AM REPREVE4TATIVE Ilk PRODUCER, AND THE CERTIFICATE Ham. RONNITNItt Otte oettlieste WeertaaarACIONIONA. KM= the polkytiesi taut Ise mane& VINERCOATIOR H NAM Addeo to ths Watt lgte MOMS Oft PO* Conlin PoOINot IttIolte + ett vis otettneete doses oto atotettlfe tote. Nome EgLro8 Assooktes :329 Cotal Way Mien, FL MN Phone MO MOOD IMOD NNW* $. Smoky ennIneolo OM m 19270 sw Int eUat ,A 33167 MOM t AJ, 1 Fix fie) 2G711®7 ' Y .... t;t op'tr-rt 7, 1 . meg L$$U D't'Ol .:-r7 . �. :': ! { `Pi's . ' ''; INnWf i6rA4 *NY NT. Tom C N 0? ANY- CST OR O'11 Y ITN tQ 1 ' E MAY M IININD O R NMI PERI M,THE VSVRANC9 APFINCED w TPO POIAXIO IXSORNIED MIEN N MIMI TO ALVIN TWA& cletteXteS 1ND0014CITONS C =CH ruling& WM stoWN HAY MAW VEEN MUM St PAC OIMAA. MIAMI SHORES VILLAGE BLDG DEPT. 1 10050 NE 2ND AVE. MIAMI SHORES, FL 33138 CIANCELLID WORE iN ACSM powwow 01 The MORO OCNONNIATON. AS lift% awed. 88M and fog *t ACORD Jun.0S.2011 10:10 AM South Florida's Paving So 3052535233 PAGE. 1/ 1 04 -21 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO SE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: 04/21/2011 NIEBLAS FEIN: 650844246 BUSINESS NAME AND ADDRESS: PODWINS PAVING INC 19270 SW 18STH CT MIAMI FL 33187 SCOPES OF BUSINESS OR TRADE: 1- PAVING /ASPHALT EXPIRATION DATE: 04/20/2013 JOSE L se IMPORTANT; Pursuant to Chapter 440 , 00114), F.S„ on officer of a corporeiien who elects exemption from this chapter by filing a certificate el election under this section may not recover benvlits or compensation under Ibis chapter. Pursuant 10 Chaplet 440.00,412), F.g., Certificates of election to be exempt... apply only within the se0pa of the business or trade listed on the ilotice of election t0 be exempt. Pursuant t0 Chapter 140.00(19), F.S., Notices of election t0 be exempt and certificates pI election to be exempt short be subject to revocation 11. et any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certllicale. The department shall revoke a certificate at any lime for lativro of iIi parson named on the certificate to meet the requirements of this section. QUESTIONS? 18501 413 -1609 DWC -262 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE. REFERENCE STATE OF FLORIDA DEPARTMENT OP FINANCIAL SERVICES DIVISION OP WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 04 /21/2011 EXPIRATION DATE: 04/20/2013 PERSON: 'JOSE L NIEBLAS FEIN 860844248 BUSINESS NAME AND ADDRESS: RODWINS PAVING INC 19270 SW 185TH CT MIAMI. FL 33197 SCOPE OF BUSINESS OR TRADE: 1- PAVING/ASPNALT IMPORTANT 0 Pursuant to Chapter 440.05114). F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this Section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.061121, F.S., Certificates of election to be exempt_ apply only within the scope of the business or trade listed on Rthe notice of election to be exempt E Pursuant to Chapter 440.051134 F.S.. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11