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DS-11-5i A Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 154582 Permit Number: DS- 1 -11 -5 Scheduled Inspection Date: July 19, 2011 Inspector: Bruhn, Norman Owner: LEVROS, ARLETTE Job Address: 117 NW 103 Street Miami Shores, FL 33138- Project <NONE> Contractor: WPH CONSTRUCTION COMPANY Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360131570 Phone: (305)244 -2392 Building Department Comments DRIVEWAY CONCRETE 20 X 20 Inspector Comments Passed % Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 18, 2011 For Inspections please call: (305)762 -4949 Page 3of21 \A(6.11,011- gi /lett, L-r 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 NoD 5 4(1), S PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder : 1i VC Ciorr ; 1/E CS Address: 117 ii% 6) ,Q3 City: / f i q sit; —CA e,V€..k State: Zip: 3 iITO Tenant/Lessee Name: Phone #: Email: Phone #: D j5 l: /0 JOB ADDRESS: �! ,u.! / v 3 5if- City: Miami Shores Folio/Parcel #: it 2.134 01 3/s-16 Is the Building Historically Designated: Yes County: Miami Dade Zip: 3 3 C-7) NO Flood Zone: CONTRACTOR: Company Name: 1.,3 hi CO t2.S[ra t ca.e e v Address: DAlvt, , ,' i r/ AA, li,, kar, ,, / City: PId7/4 14 /.364 /Pj / oil o&� State: "-C. -- Zip: 37 / Qualifier Name: J 6 156rv.%. P f' g N(t, Phone #: 3 0-'" 21't fz Z, State Certification or Registration #: G.13 C i 2&' b L. Certificate of Competency #: Contact Phone #: 3340 .24'l 37 Z Email Address: DESIGNER: Architect/Engineer: Phone #: Phone #: A( ?[237Z Co ora Value of Work for this Permit: $ Z IS—Ob Square/Linear Footage of Work: #11 Act" Type of Work: ❑Address ❑Alteration UNew Ca Repair/Replace o z49 (NA Description of Work: J riY ❑Demolition COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: h ******** ** * * * * * * * * * * * * * * *** * * * * * *** * * ** Fees************* * *** * * * * * * * * * * * * * * * * * * * * * * * * * ** Permit Fee $ 1(6) CCF $ CO /CC $ Submittal Fee $ Scanning Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Radon Fee $ 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 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 wil not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of, . , , 20 �/, by VI Cc �� �C v pipj who is pers ly known to me or who has produced r#1 4 As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires. * * * * * * * * * * * * * * * * * ** APPROVED BY ERIK ROSARIO Notary Public, State of Florida y mins uao, 21, 2012 (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Signature C s tractor The foregoing instrument was acknowledged before me this day of , 20 It by (i\ l 1SO\.) 't1G who is personally known to me or who has produced I t....1 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ra iilelttot�f My Commission Expires: �: ® � •y�oo s Ca °OO�. k `� ,� ......... x,0 **************************** Plans Examiner Structural Review e./Zoning Clerk 111 It 33 IP C scale 1 " =20' LOT -4 BLOCK -I27 or ft LOT -3 BLOCK -127 ao --_ z 1 BL NO: ID. , A Pp fee LOT -20 BLOCK-I27 LOT -23 BLOCK -I2' .31' G. ItOMEWIE JAN 2011 FIP W2• NO I.O. �a eoam.. Miami ore!! ivitiotee APPROVED ZONING DEPT BLDG DEPT SUBJECT TO CO 1 F yi/ITFi A[ L FE UAL L E AND COU . TV RULES ANpli A Jci • Rick Scott Governor January 28, 2011 Wilson P Henry 117 NW 103 St Miami, FL 33155 RE: Contingency Letter Application Document No: AP991067 Centrax Permit Number: 13 -SC- 1297005 OSTDS Number: 117 NW 103 St Miami, FL 33155 Lot:22 Block:127 Subdivision: Miami Shores Dear Applicant: This will acknowledge receipt of an application dated 01/21/2011 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. 1. -There is no increase in sewage flow, change in characteristics compromising the integrity or function of the system installation. 2. -This project entails : " PROPOSED DRIVEWAY " From a review of your completed application, it has been determined that your existing system is adequate for the proposed use : " APPROVED ". G/P If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Sincerely, Jose erger eer Sp- ialist II Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 Permit No: 11- $ Job Name 02_5. , 2011 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 .tiq-0/)) Planning and 4oning 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- 1 -11 -5 Issue Date: Not Issued Explres:Not Issued Folio Number:1121360131570 Owner's Name: ARLETTE LEVROS Job Address: 117 103 Street Miami Shores, FL 33138- Owner's Phone: Total Square Feet: 400 Total Job Valuation: $ 2,500.00 Contractor(s) Phone Primary Contractor WPH CONSTRUCTION COMPANY (305)244 -2392 Yes 1 Planning and Zoning Criteria and Comments Approved: No Date Denied: 1/4/2011 Comments: DRIVEWAY MUST BE SET BACK NOT LESS THAN 10 FEET FROM SIDE LOT LINE. DRIVEWAY MUST BE SET BACK 5 FEET FROM HOUSE IF DRIVEWAY DOES NOT LEAD TO GARAGE. 2/10/11 PLEASE REDRAW PLANS TO SCALE SIDE YARD SETBACKSHOWS AS 10 FEET BUT DOES NOT WORK OUT BASED ON LOCATION OF DRIVEWAY ON PLANS. PERMIT #: contractor ❑ Owner ❑ Architect Miami Shores Vivage Building Department RECEIPT DATE: Q- 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Picked up 2 sets of plans and (other) Address: (l Imo\ '0 t3) 3 T 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: CA RESUBMITTED DATE: l0 PERMIT CLERK INITIAL: Il) - -tr3+Lv Permit No: 11 -5 Job Name: January 5, 2011 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 1) Plans must be approved by HRS for the septic system. 2) Provide zoning approval. 3) Provide construction details for the work. EX: product to be used, reinforcement, thickness ect. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 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-1-11-5 Issue Date: Not Issued Expires:Not Issued Folio Number:1121360131570 Owner's Name: ARLETTE LEVROS Job Address: 117 103 Street Miami Shores, FL 33138- Owner's Phone: Total Square Feet: 400 Total Job Valuation: $ 2,500.00 Contractor(s) Phone Primary Contractor WPH CONSTRUCTION COMPANY (305)244-2392 Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 1/4/2011 Comments: DRIVEWAY MUST BE SET BACK NOT LESS THAN 10 FEET FROM SIDE LOT LINE. DRIVEWAY MUST BE SET BACK 5 FEET FROM HOUSE IF DRIVEWAY DOES NOT LEAD TO GARAGE. ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE 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. 10 -22 -2010 EFFECTIVE DATE PERSON: HENRY FEIN: 204782503 BUSINESS NAME AND ADDRESS: WPH CONSTRUCTION COMPANY 15724 NE 12 AVE MIAMI FL 33162 10/22/2010 EXPIRATION DATE: 10/21/2012 WILSON P SCOPES OF BUSINESS OR TRADE 1- CERTIFIED BUILDING CONTRACTOR 2- CERTIFIED ROOFING CONTRACTOR * IMPORTANT: Pursuant to Chapter 440 . 0504), F.S., in officer of a corporation who elects exemption from this chapter by filing a certificate of election ander this section may not recover benefits or compenaatfen under chapter. Pursuant to Chapter 440.06(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed an the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation N, at any time after the filing of the notice or the issuance of the certificate, the person named a the entice or certificate no lager meets the requirements of this section for Issuance of a cettlicate. The department sham revoke a certificate at any time for failure of the person named on the certificate to meet the regairemems of this section. QUESTIONS? {850) 413 -1609 OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE .CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANcIAL SERVICES DMSiON OF WORKERS' CONWEdSATION COPSTRUCTION IfWUSTRY CERTIFICATE OF !EJECTION TO 05 EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 10/22/2010 EXPIRATION DATE: 10/21/2012 PERSON: WILSON P HOMY FEIN 204782503 BUSINESS. NAME AND ADDRESS: WPM CONSMRUCTtON COMPANY . 15724 NE 12 AYE MIAMI, FL 33182 SCOPE OF BUSINESS OR TRADE 1- CERTWED BUILDING CONTRACTOR 2- CERTMED ROOFa1G CONTRACTOR IMPORTANT F Pursuant to Chapter 440.03(14), F.S., all officer of a corporation who O elects exemption from this cu certificate ter by filing a of election I- tm der this section may not recover benefits or cordon tinder this D gter. Pursuant to Chigger 440.05(12), F.S., Certifiitates. of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt E Ptrstaatt to Chapter 440.05(13), 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 notices or certificate no longer meets the requirements of this section for isstaorce of a certificate. The deportment 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 e Carry bottom portion on the job, keep upper portion for your records.