DS-11-635Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 158256
Scheduled Inspection Date: August 18, 2011
Inspector: Devaney, Michael
Owner: EUGENE, KERMITH & LOUIS
Job Address: 524 NW 113 Street
Miami Shores, FL 33168-
Permit Number: DS -4 -11 -635
Project: <NONE>
Contractor: JOHN DALTON LLC
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 3021360210860
Phone: (561)394 -2619
Building Department Comments
CONCRETE DRIVEWAY ON THE FRONT OF THE HOUSE
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 17, 2011
For Inspections please call: (305)762 -4949
Page 6 of 46
4141 —3041\1 D'ruiLsN'
011 -71W) Building 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 Ptofr\
3 Permit Type:
OWNER: Name (Fee Simple Titleholder):
Address:
City: /2947//a, /2947//a, ,,te�rr State: /_
MRWIE
APR a t.201H
Yo
Permit No. O S 1 1 (Q
Master Permit No.
ca , / CIGait &
�. /,
Phone #: 77ra .Q27c 0‘ffz,
Zip: < ?/ See
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: -:".) N (A)
d
City: ipti9i11L Miami Shores
Folio/Parcel #:
County: Miami Dade
Zip: ..a?f
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: J 0 l°! PI, 44062-t00 /L C, Phone #: 3519 — G /9
Address: /5-2/ 503 (71- `f t(
City: IS , C itit, nn (�a- C,�,,.. _ State: Ft- ` Zip:
Qualifier Name: 11. (-1 l� ��t-(� Phone #: /� el.
State Certification c�egistration #: Certificate of Competency #: 6 L9-C al
Contact Phone #: 3- z q / 0 Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 2:00D Square/Linear Footage of Work:
Type of Work: Address ❑Alteration
Description of Work: ®
❑Ne
❑Repair/Replace
❑Demolition
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
******* ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *,Fees * ***** *** *** * * ** * * **** ** ** ** * ** * * * ***** * * **
Submittal Fee $ Permit Fee $ /J227 a
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
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 will Q. be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The fore ; oing jnstrument was a owle , ed b: fore me this
day of / , 20 il , by
A F
son 1 e or who has produced
l II �'��intification and who did take an oath.
NOTAR ,.. yUBLIC:
Sign:
Print:
My Commission Expires:
Signature
41E>.-2 tCYYL
Contractor
The foregoing instrument was acknowledged before me this 1/ ?-t)
day of A PA , 20t/ , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC: J 163.5. /?9 f &' -a
APPROVED BY
f� see
61 ��Q1ti Vi s\iisy 4 .
P•
0
49-6(r---Fe/
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10)
Plans Examiner
Structural Review
Sign:
Print:
My Co
!► z;t EUN
*SION 4 DD 749/48
S. Ma 1 2012
Gondnd Pine Watcry Public Underwriters
* * * * * * * * )V * * * * *, * * * * * * * **
Zoning
Clerk
Rick Scott
Governor
H. Frank Farmer, Jr., M.D., Ph.D.
State Surgeon General
April 29, 2011
Louis Eugene
285 NE 82 St
Miami, FL 33138
RE: Contingency Letter
Application Document No: API002892
Centrax Permit Number: 13 -SC- 1314808
OSTDS Number:
524 NW 113 St
Miami, FL 33138
Lot:8 Block:5 Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 04/25/2011 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
Proposed two driveways at front of the house.
There is not increase in sewage flow, change sewage characteristic, or any alteration that
change the conditions under which the system was approved.
From a review of your completed application, it has been determined your existing system is
adequate for the proposed use.
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaF,H.com
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: (< ^-035 DATE: r 1
o�Contractor
❑ Owner
❑ Architect
Picked up 2 sets of plans and (other) i'(2.4%-_.
Address: 5? i
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:
CLERK INITIAL:
RESUBMITTED DATE: ' r ( 1
PERMIT CLERK INITIAL:
Permit No: 11-‘,F5-
Job Name
dflo
, 2011
WS-
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
Building Critique Sheet
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
Folio Number:3021360210860
Owner's Name: KERMITH & LOUIS EUGENE
Job Address: 524 113 Street
Miami Shores, FL 33168-
Owner's Phone:
Total Square Feet:
Total Job Valuation:
0
$ 1,000.00
Contractor(s)
JOHN DALTON LLC
Phone
(561)394 -2619
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 4/22/2011: Yes
Comments: PROPERTY IS IN THE ANNEXED AREA AND IS SUBJECT TO MIAMI -DADE ZONING REGULATIONS.