DS-11-541Ir
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 164240
Scheduled Inspection Date: September 12, 2011
Inspector: Bruhn, Norman
Owner: FADELY, CHARLES
Job Address: 280 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ARROW ASPHALT & ENGINERING INC
Permit Number: DS -3 -11 -541
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060190410
Phone: (305)556 -5702
Building Department Comments
REMOVE AND REPLACE EXISTING CEMENT RIBBONS
AND CEMENT WALKWAY. INSTALL ASPHALT SWALE
WITH 6" LIMEROCK AND 1 1/2" HOT ASPHALT.
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 157702. Sidewalk must be
repaired /replaced
Replace sod in disturbed areas. NB
September 09, 2011
For Inspections please call: (305)762 -4949
Page 24 of 35
(etm Shores Village
Building-Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Y:
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Permit No. D51 ( -54 if
PERMIT APPLICATION
FBC 20
M MAR 2 (:-) 2011
Master Permit No.
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholder): h A 5 F17 1/ Phone#: 30.57- 796- g37:
Address: ,-,230 N E 97 -
City: M /9 iv State: AVORM04 Zip: 33/3
Tenant/Lessee Name:
Phone#:
JOB ADDRESS: 0 Al ,E W
City: Miami Shores County: Miami Dade Zip: 33 12g
Folio/Parcel#: //- 3,,,?‘96) -0/9 -011/0
Is the Building Historically Designated: Yes NO
X
Flood Zone:
CONTRACTOR: Company Name: A ROW /4,6,41/ Phone#: 305-681 -g65.26
Address: 36,---2:L_____ J.,0 a ? s 7i.
city: (7,0/4 /0cA,i9 State: F io k; f D efl Zip: 2,Z aCtill
Qualifier Name: SA419,17/f/ 0 ?Oa / Phone#: 95'/.6 */
State Certification or Registration #: Certificate of Competency #: 9,7 - 4:2,06
Email Address: 4./ZRO tz-,i9SPh 47 gad4
Contact Phone#: 30.5-6 9 'Y'- g‘ 2. 6,
DESIGNER Architect/Engineer: Phone#:
Value of Work for this Permit: $ 17/ 92.67 °° Square/Linear Footage of Work: ic2,(::0 As pAA hii
Type of Work: ClAddress DRepair/Replace CIDemolition
Description of Work: E iR 1
A, s 4-fi41 b de-ptie,u-f
DAlteration CINew
ptP 64-1
/
• COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
***************************************F ********************************************
Submittal Fee $ Permit Fee $ C� $ CO/CC $
CFP- efi'
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review .$
TOTAL FEE NOW DUE $ (15i
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 co . cement and construction lien law brochure will be delivered to the person
t. Also, a certi
whose property is subject to a
for the Lion Bich
spec
copy of the recorded notice of commencement must be posted at the job site
fter the building permit is issued In the absence of such posted notice, the
ill be charged
Owner or Agent
The foregoing instrument was a • i owledged before me
2I
day of rnarCh . MIL by . aile5
who is personally known to me or who has produced C. Di—
As identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY
Contractor
The forego', i g instrument was acknowledged before me this 224
day of
fho is personally known to m)or who has produced .
as identification and who did take an oath.
NOTARY PUBLIC:
by 511A0k 0ITok
Plans Examiner
Structural Review
(Revised 07/10/07 )(Revised 06/10/2009)(Revised 3/15/09 »rev6 /4/10)
4,/ JAW GARCIA
r MY COMMISSION # DD 842418
I EXPIRES: December 14, 2012
Bonded Thru Notary Public Underwriters
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) h / ��� hereinafter referred to as the owner of
, 8O A 6 E 9/ s1.ez-/
the following described property (address):
Legal Description
Folio #
Requests permission to install (describe work):
(c // /i t- EROCA g v
Lot Block Subdivision R ie_ B�
Within the public right of way of (address)
AO . I s /0h/9 /7 5ek) /9 A— �/ /h
Asph4 /'/
28O V E 9/ . `AEA -'
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above - mentioned item(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 shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any
and all liability, which may rise by virtue of permitting the installation of these items within the public right of way.
1
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s)
to be removed and a lien being placed on the property and /or 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 assigns, until
such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this
SIGN Z, SEALED, AND DELIVERED in the presence of:
2
'STATE OF FLORIDA
DEPARTMENT OF HEALTH
/APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PEtRMIT
JJO
Permit Application Number
_"71-
- - PART II. - SITEPLAN
Scale:- Each -bR ck represents 10 feet and 1 inch = 40 feet.
SO
le
l v ►
Notes:
Site Plan submitted by:
Plan Approved
gnature
Not Approved
c
Title
Date 5
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form. 4016 which may be used)
(Stock Number: 5744-002-4015-6)
a
, cal; WALL •
•( .A.MF
c"" ( . I. Ci.e4474.
Li, E. 7
LCCA1101',)
GAL
This property dettrf.
Lot 5, Block 3,
EL PORTAL, •
according to the PI
thereof, as recoede
Plat Book 9, Page'
• of the Publ ic Recor:
Dade, County, Florida
Arnt0161)
p to plot5.y*,
Date.. e\i-o 1%,
. Nuoti-Dadeco■Illti
iieattb:Dte
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oxiCRE're • Arbbo/us
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itroile ,„
Mitnj j,yo4 6's4'
PPM " ;V-h 7397e
5-3 AVM /
••,-*j4-
I hereby certify that the-
attached .sketch represents
a recent survey made under t
• my • direct Ion, and s• true-
and correct tp the best Of
my knooledie and belief, -1
and that there are • no en--
croachatents on said land •-
othext.h:n shzin here-
on, •. •• .„,4,•-•to
Fia. Re9. Surveyor No. ,001
pm. Reg, Engineer No.;
LANNES and GARCIA,
ENGINEERS- LAND SURVEYORS - LAN
P 0. Box 661131 It
Miami. Florida. 33156
•hiE RS
DATE
14-a--77
SCALE
lw= '
DRAWN BY .•,i. •
— ,,
•(""-"•U''':..
oftWG,-.N0,:
j 1-.77-452'
Miami Shores Villa e
APPROVED
ZONING DEPT
BLDG DEPT
StIOAVTIOCOMINCIIVICAMMOVII•
STATE MOCCOMIVIVAISANDRESUUM01.
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•
ARROW ASPHALT & ENGINEERING, INC.
3051 NW 129 ST
OPALOCKA, FL 33054
990004611
.
..UNTIL SEPTEMBER 30, 2011
FORCE NOTE THIS MEN
• •OCCUPATION SPECIFIED H
CITY OF OPA-LOCKA
IS HE
PLEASE DETACH AT PERFORATION
City of Opa-locka
Department of Business and Licensing
Occupational License
ARROW ASPHALT & ENGINEERING, INC.
3051 NW 129 ST
OPALOCKA, FL 33054
UCENSE FEE $150.00
SED TO ENGAGE IN THE BUSINESS, PROFESSION OR OCCUPATION OF
RENT OFFICE OR SPACE FOR BUSINESS NOT
F OPA-LOCKA, WITH THE AOWING REST TIONS:
11( 1' 0
BY:
CITY MANAGER
DISPLAY AS REQUIRED BY LAW
2011
NV( REGULATIONS NOW IN
THE BUSINESS OR
ai,A49.4411c)
LICENSECLERK
. . . . •
RD CERTIFICATE OF LIABILITY INSURANCE
OP 1D Q6
DATE (MM!DDIYYYY)
03/02/11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
-R EPRESENTATIVE OR PRGIAIGER, -AND -- THE CERTIFICATE HOLDER..
`ORTANT: If the certificate- holder is an ADDITIONAL INSURED, the policy(ies) must be endotsLd. If SUBROGATION IS WAIVED, subject to
terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
BROWN & BROWN OF FLORIDA INC
14900 NW 79th Court Suite #200
Miami Lakes FL 33016 -5869
Phone: 305 - 364 - 780 0' Fax:305- 822 -5687
(.UN I AL1
NAME:
PHONE
A/C, No, Ext):
E-MAIL
ADDRESS:
FAX
(A/C, No):
PRODUCER
CUSTOMER ID #: ARROW -4
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
Arrow Asphalt & Engineering
Inc.
Shawn O'Toole
3051 NW 129th Street
Opa Locka FL 33054
INSURER A: National Trust Insurance Co.
20141
INSURER B: FCCI Commercial Insurance Co
33472
INSURER C : FCCI Insurance Company
10178
INSURER D :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
AUUL
INSR
SUBI
WVD
POLICY NUMBER
�E�pFFp
(MM/D� DDY/YYYY)
FOLIC
(MM/DDIYYYY)
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL
LIABILITY
OCCUR
GL00099592
02/28/11
02/28/12
EACH OCCURRENCE
$ 1,000,000
X
PREMISES (Eatoccurrence)
$ 100,000
CLAIMS -MADE
X
MED EXP (Any one person)
$ 5,000
PERSONAL 8 ADV INJURY
$ 1,0 0 0 , 000
GENERAL AGGREGATE
$ 2,000,000
GEM_ AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2,000,000
POLICY PRC LOC
JECT
$
[' JTO
X
ANY AUTO MOBILE LIABILITY
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CA00154332
02/28/11
02/28/12
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
B
x
UMBRELLA LIAB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
UMB00103021
02/28/11
02/28/12
EACH OCCURRENCE
$2,000,000
AGGREGATE
$ 2,000,000
DEDUCTIBLE
RETENTION $ 10,000
$
X
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIV
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS
Y / N
N / A
001 -WC11A -63765
02/28/11
02/28/12
WCSTATU- X OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
below
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
CERTIFICATE HOLDER.
CIT3138
CANCELLATION -
SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE '
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ITY-: =OF MIAMI SHORES
-100507=14E- -2ND AVENUE
-141.411 "SHORES FL 33138
AUTHOR.IaD REPRESENTATIVE
ACORD 25,(2009109)
The ACORD name and logo ar
01988 -2009 ACORD
marks ofACORD
41Hit _ text...4_0(
Pia eig 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:1132060190410
Owner's Name: CHARLES FADELY
Job Address: 280 91 Street
Miami Shores, FL 33138-
Total Square Feet: 220
Total Job Valuation: $ 2,495.00
Contractor(s)
ARROW ASPHALT & ENGINERING INC
Phone
(305)556 -5702
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 3/29/2011
Comments: PLEASE REDRAW THE DRIVEWAY SO THAT IT IS LOCATED NO CLOSER THAN 4 FEET TO THE
EXTENSION OF THE SIDE YARD LOT LINE THROUGH THE SWALE (NORMALLY A 5 FOOT SETBACK IS REQUIRED).
FLARE CAN NOT BE GREATER THAN 2 FT x 2 FT.
04/06/2011 10:10 FAX 1 800 685 7530
DATA SCAN FIELD SERVICES
eon
TRANSMISSION OK
TX /RX NO
RECIPIENT ADDRESS
DESTINATION ID
ST. TIME
TIME USE
PAGES SENT
RESULT
* * * * * * * * ** * * * * * * * * * **
* ** TX REPORT * **
* * * * * * * * * * * * * * * * * * * **
1248
93056888484
04/06 10:10
00'21
1
OK
41ilti
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
PJ< 2 —(erY try
Permit NO. DS -3 -11 -541
Issue Date: Not Issued
Expires:Not Issued
Folio Nurnber:1132060190410
Owner's Name: CHARLES FADELY
Job Address: 280 91 Street
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 220
Total Job Valuation: $ 2,495.00
Contractor(s)
Phone
Primary Contractor
ARROW ASPHALT & ENGINERING INC
(305)556 -5702
Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 3/29/2011
Comments: PLEASE REDRAW THE DRIVEWAY SO THAT IT IS LOCATED NO CLOSER THAN 4 FEET TO THE
EXTENSION OF THE SIDE YARD LOT LINE THROUGH THE SWALE (NORMALLY A 5 FOOT SETBACK IS REQUIRED).
FLARE CAN NOT BE GREATER THAN 2 FT x 2 FT.
Permit No: 11 -5`'/
Job Name
G(
, 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
3 -66i-
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
Cnr:Aouc1ion Trades Qualifying tioa,d
cif r�5 CERTIFICATE.. OF COMPETENCY
E 7200
ARROW ASPHALT & ENGIN ERiri3G IP'C
D.B.A..
O'TOvl SHAWL !
ss c rtificd - s:nder the previ;:ion$ ca! C