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DS-11-1433Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162957 Permit Number: DS -8 -11 -1433 Scheduled Inspection Date: September 13, 2011 Inspector: Bruhn, Norman Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 415 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: HIGH TECH STRIPING INC Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)758 -0539 Parcel Number 1122310430010 Phone: (305)884 -0166 Building Department Comments SEAL COAT AND RESTRIPPING EXISTING PARKING LOT TO CURRENT CONFIGURATION Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 12, 2011 For Inspections please call: (305)762 -4949 Page 6 of 14 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 RECEIVED AUG 082011 BY Permit No A✓ 1 I" I 1 3 2 Master Permit No. OWNER: Name (Fee Simple Titleholder): .J A 0 4 tv C../4. /0/4..444, Phone #: Address: 41 S A I OS— 51"" City: wt. `licttM1. S10 ✓Q. S State: c L Tenant/Lessee Name: Email: "leg Si-/e JOB ADDRESS: WS-- .sgc.SChol • e'vwj 4//m /Os' 5)1- City: Miami Shores County: Folio/Parcel #: 1 t ` 221 k 043-') t) Is the Building Historically Designated: Yes NO K_ Zip: 3 313 Phone#: `jnS D5-37 Miami Dade Zip: 3313? Flood Zone: 4/1) CONTRACTOR: Company Name: 49" )'. at ci.�.,..+. °.�... T., . "" 2hc'S�S?�/ n/�iG,'lr, Address: 777 c 'VW '� 3 11 City: 11/tAbk, State: Pc Qualifier Name: &.v U Pill Ll State Certification or Registration #: . ?-14 Z bo Contact Phone #: 7 ?( ' 2-2o - I4 1 Ua Email Addresis: ��/ DESIGNER: Architect/Engineer: �1.. Z. ri t�)Vte 11 f GS DC.''�' .L,It+� J Phone #: 3(�c,- ` 3 2 (0 6 Phone#: Certificate of Competency #: h ,&3y-5516(0 Value of Work for this Permit: $ 15, DUO Square/Linear Footage of Work: 1 ZZ, 000 ¢ Type of Work: ❑Addition °Alteration UNew °Repair/Replace °Demolition Description of Work: , 5.e.,/ rocti p fi,ei(104. p) vrre g. o., t� OL1 ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees********************* *****a:** ******* * ******* Submittal Fee $ ' Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO/CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ • m 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 FT.RCTRICAL 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 not be a rein , • ction fee will be charged. Signatur Or 1 41 Owner or Agen The foregoing instrument was acknowledged bef jK me this - ` 9 2011_, byS'e 4 wn. ✓S t-' 6y 1.E , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: day of Sign: Print: My Commission Expires: 4 (0/2-(p/t2 NESTO D. DIAZ s` *****7*** ** Commission 41DD801249 Vit APPROVED BY L ;��7d'y4 " '!� "a ' My Commission E i4A finer The foregoing instrument was acknowle l ed/before me this _5 day of ' t U f , 201L, by �1lee4 -Cf�e iQ1l who is personally known to me or who has produced 'i Pi as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: (P /ZCv /I ERNESTO D. DIAZ y x orie wto of Florld8 Commission #0D801249 My Comn ng os Jun. 28, 201" Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOTICE OF COMMENCEMENT A RECORDED COPY NNST BBEEPOSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO.� \) 1 15 TAX FOuO NO.' I-243 N '43— bo l o STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain meal property, and in accordance with Chapter 713, •Florida Statutes, the following information is provided in this Notice of Commencement. ! 111111 I I Ii 11111 11111 11111 11111 11111 1111 1111 CFN 201 1 R0 536838 DR Bk 27789 Ps 0120-i tips} RECORDED 08/11/2011 11252:04 HARVEY RUVIUr CLERK OF COURT MIAF1I -DADE COUNTY, FLORIDA LAST PAGE Space above reserved for use iof recording office 1. Legal description of property and streeUaddress: G'�is xo e /0s. .5 0i f,i Ln, h s Q'.r pc, Description of improvemegt• Sexs,L Cam- f lees knrsorr•,y CA's Sell Ic4-445, !Qi 16 eurv.et .1- ci e$vraalA ttw �L� 3. Owner(s) name and address: Vick 1l c - d r... Interest in property: tits dl,L /as Name and address of fee.simpie titleholder: — 4. ontra 's nom` ddress and phone �l `X101 b a O IG? 5. Surety: (P , ent bond required by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1Xa)7., Florida Statutes, Name, address and phone number: 7 W 7.1e4' 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor s Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement (the expiration date Is 1 year from the date of recording unless a different date is spedfted) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE€XPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) or Owner(s)' Authorized Officer /Director/Partner/Manager Prepared By Prepared By Print Name Print Name Title/Office Title/Office STATE OF FLORIDA COUNTY OF -DADE The faregoi � ���. � j �., ?. gad before me , - s 11 day of BY Individ ••` ly, or ❑ as f$9f'I ,3 tT�'i`�L� for ❑ Person Iy known, or O prod following • of identifi Signature of Notary Public: Print Name: (SEA-) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director /Partner By 123.01-52 PAGE 3 9110 STATE OF PLONDA, C DACE I HEREBY CERTIFY Met this is a true copy of the original filed in this office on day of WIT K re9D.20 • I Deal. fl , my Courts .C.