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
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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.