DS-11-1605Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 163963
Scheduled Inspection Date: October 12, 2011
Inspector: Bruhn, Norman
Owner: MAYER, JEFFREY
Permit Number: DS -8 -11 -1605
Job Address: 1255 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: PAVERS AND BRICKS SERVICES CORP
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: tien-
Work Classification: New
Phone Number (954)547 -3357
Parcel Number 1132050270090
Phone: (305)986 -2544
Building Department Comments
NEW PATIO WITH PAVERS ON SAND BASE
Inspector Comments
Pass
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
October 11, 2011
For Inspections please call: (305)762 -4949
Page 14 of 28
1161111 PalAto .
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 812011
BY
Permit No.D5 J I (°()
Master Permit No.
OWNER: Name (Fee Simple Titleholder): ilefFilteY I MA7 tt. Phone #:
Address: 12. 55 Al 1, 3 Sy
City: A4 i,4 44 I cti aRe j State: irL
g " 335.
Zip: 33 / 3S
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: a 5 5 /v/= 613
City:
Folio/Parcel #:
Miami Shores
County: Miami Dade Zip: 3 3'/i2
Is the Building Historically Designated: Yes
Flood Zone:
CONTRACTOR: Company Name: R2 V &t V C i ° ; '/ ' Cal Phone #: g6 "0(3114)`3
Address: 9°6? ik, g f / 4 C S p
City: via State: !C�-
Qualifier Name: ` ! ie?i e cJ r
State Certification or Registration #: Certificate of Competency #: 06 es L7O Z®
Contact Phone #: * ' 1 Entail Address: , -- ' Ar "at _ ,, y
DESIGNER: Architect/Engineer: Phone #:
Zip: 3 / / 9
Phone #: $‘ 14 31. I .
Value of Work for this Permit: $ i. 6t7C' 012 Square/Linear Footage of Work:
Type of Work: Addition UAlteration
Description of Work: eA B �,
r 'New ❑Repair/Replace
r'o
❑Demolition
so A d4v' A- i 1) e' t
******** * ** * * * * * * * * * * * * * * ** * * * * * ** * * * ** Fees************* * * * * * * * * * * *** * * * * * * * * * ** * * * * * **
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
/0092
CCF $
CO /CC $
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
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved d a reinspection fee will be charged.
Signature
Signature
ent Contractor
p
The foregoing instrument was cknowledged before me this 11 The foregoing instrument was acknowledged before me this I O
day of , 20 r/( , by % F}2ei w . / e(IL , day of ikutQ ..s? , 20 U , by
who is pe onally known to me or who has produced t! who is personally known to me or who has produced
as identification and who did take an oath.
As iden
NOTARY PUBLIC:
Sign:
Print: 5
My Commission Expires: .'VD
NOTARY PUBLIC -STATE OF FLORIDA
tion and who did take an oath.
,.• °" Shantell Ruthiely lopes Cordes
'siio # EE019117
�� �EXP *��D%i
'arnV �
aONDEn THRU ATLANTIC BONDING
APPROVED BY
S:
o
/ Plans Examiner
(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)
My Commission Expires: /(J 0 v .
NOTARY PUBLIC -STATE OF FLORIDA
' "4•.,Shantell Ruthiely lopes Cordeiro
Commission # EE019117
pima„
aOND$D THR 'FIC BONDING CO. C.
1/ Zoning
Structural Review Clerk
Permit No: 11 -1605
Job Name:
August 31, 2011
Miami Shores Viiiage
Building Department
Building Critique Sheet
1) Provide approval from HRS /DOH.
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
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LEGAL DESCRIPTION AND CERTIFICATION
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FLORIDA DEPARTMENT OF
HEALT
Rick Scott
Governor
H. Frank Farmer, Jr., M.D., Ph.D.
State Surgeon General
August 31, 2011
(Pavers Bricks services)
99 NW 156 St
Miami, FL 33169
RE: Contingency Letter
Application Document No: API045902
Centrax Permit Number: 13 -SC- 1366790
OSTDS Number:
1255 NE 93 St
Miami, FL 33175
Lot:7 /8 Block: 1 Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 08/30/2011 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
From a review of your completed application, it has been determined that your existing system
is adequate for the proposed use (Patio with pavers on a sand base).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Miami -Dade County Health Department
17251 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SI WAGE °DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
- PART II - SITEPLAN
Scale: Each block re resents 10 feet and 1 inch = 40 feet: MEMMINIMMINIMMIMMEMEMEMEMM
MIMMEMMEMEWAMMMUNIREMEMMEMMINIMM
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Notes: ,.
Site Plan submitted b
Plan Approved`
By
•
Signature Tithe
Not Approved, Dateu �--.
ik t
County Health Department
- f .
ALL CHANGES MUST. BE ; iPPRd3VED BY THE OUNTY HEALTH DEF ARTMENT�
DH 4015, 10/96 {Replaces HRS-H Form 4016 which may be Used)
{Stock Number 5744-002-4015-6)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
- PART II - SITEPLAN -
Scale: Each block re •resents 10 feet and 1 inch = 40 feet.
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Notes:
Site Plan submitted b
Plan Approved
By
1
signature
Not Approved
Title
County Health Department
ALL CHANGES MUST BE APPROVED BY THE'C'OUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be Used)
(Stock Number. 5744- 002 - 4015 -6)
Page 2. of 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH.,
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ ] New System [ Existing System
[ ] Repair [ ] Abandonment
APPLICANT: CJ y Nyer
AGENT: (
MAILI
PERMIT NO. DD
DATE PAID:
FEE PAID:
RECEIPT #
[ ] Holding Tank [ ] Innovative
[ ] Temporary [ ]
tiers. ail ;c.k .vi cS /ado .p5 TELEPHOISE ?Se 0' 7(07
DDRESS: 943 /V lea® / 6 i„4/4/ 3/6
TO BE COMPLETED .`'"`APPLICANT R APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED P RSUATO 105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S
RESPONSIBILITY TO PRO DE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED
(MM /DD/YY) -IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT: BLOCK: � SUBDIVISION: J3A9 4'd MG
PLATTED:
g.2 3
PROPEFTY ID #: ‘‘ 5 - ®1, 0 ZONING: 1/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: /Al ACRES WATER SUPPLY:[ ] PRIVATE PUBLIC f < =2000GPD [ ] >2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y
PROPERTY ADDRESS:
DIRECTIONS TO PROPERTY:
cc).
5
DISTANCE TO SEWER: FT
A
,4P
BUILDING INFORMATION [ RESIDENTIAL
Unit Type -of Nd.'of t° E]uildin fP Corrxmercial /Ihstitutional Sytem Design
No Establishment Bedrooms Area Saft Table 1,,c ha ter 64E -6, FAO
1
!j
1
2
[ ] Floor /EquE pment
SIGNATURE:
DH 4015,10/97 Pege 1 (Pr- iou Editions E4ay Be Used)
Stock Number: �} 44 -001 01r -1
APPLICATION FOR:
APPLICANT:
AGENT:
TELEPHONE:
MAILING ADDRESS:
LOT, BLOCK,
SUBDIVISION:
DATE OF SUBDIVISION:
PROPERTY ID #:
ZONING:
PROPERTY SIZE:
WATER SUPPLY:
SEWER AVAILABILITY:
PROPERTY ADDRESS:
DIRECTIONS:
BUILDING INFORMATION:
TYPE ESTABLISHMENT:
NO. BEDROOMS:
BUILDING AREA:
BUSINESS ACTIVITY:
FIXTURES:
SIGNATURE / DATE:
Check type of permit, if "Other" specify type in blank.
Property owners full name.
Property owner's legally authorized representative.
Telephone number for applicant or agent.
P.O. box or street, city, state and zip code mailing address for applicant or agent.
Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a
recorded subdivision, a copy of the lot legal description or deed must be attached.
Official date of subdivision recorded in county plat books (month /day /year) or date lot originally
recorded. Dividing an approved lot into two or more parcels for; the purpose of conveying
ownership shall be considered a subdivision of the lot.
S u -
27 character number for property. CHD may require property appraiser ID # or
section /township /range /parcel number.
Specify zoning and whether or not property is in I/M zoning or equivalent usage.
Net usable area of property in acres (square footage divided. by' 43,560 square feet) exclusive of
all paved areas and prepared road beds within public rights -of Way or easements and exclusive
of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water.
Contiguous unpaved and non- compacted road rights -of -way and easements with no subsurface
obstructions may be included in calculating lot area.
Check private or public <= 2000 gallons per day or public > 2000 gallons;, per day.
Is sewer available as per 381.0065, Florida Statutes, and distance to sewer in feet.
Street address for property. For lots without an assigned street address, indicate street or road
and locale in county.
Provide detailed instructions to lot or attach an area map showing lot location.
Check residential or commercial.
List type of establishment from Table II, Chapter 64E-6, FAC. Examples: single family, single
wide mobile home, restaurant, doctor's office.
Count all rooms designed primarily for sleeping and those areas expected to routinely provide
sleeping accommodations for occupants.
Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport,
exterior storage shed, or open or fully screened patios or decks. ', Based on outside
measurements for each story of structure.
For commercial /institutional applications only. List number of employees, shifts, and hours of
operation, or other information required by Table 11, Chapter 64E-6, FAC.
Mark Floor/Equipment Drains or Others and specify item or "NA'` if not applicable.
Signature of applicant or agent. Date application submitted to the CHD with appropriate fees
and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings,
swimming pools, recorded easements, onsite sewage disposal system components and location, slope of property, any existing
or proposed wells, drainage features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage
disposal systems, surface waters, and other pertinent facilities or features on adjacent property, if the features are with 75 feet of
the applicant lot. Location of any public well within 200 feet of lot. For residences, a floor plan (residences) showing number of
bedrooms and building area of each unit. For nonresidential establishments, a floor plan showing the square footage of the
establishment, all plumbing drains and fixture types, and other features necessary to determine composition and quantity of
wastewater.