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DS-11-461Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163703 Permit Number: DS- 3- 11-461 Scheduled Inspection Date: November 07, 2011 Inspector: Bruhn, Norman Owner: FRANCIS, BERNARD Job Address: 9338 NW 2 Court Miami Shores, FL 33150- Project: <NONE> Contractor: AMDI USA INC Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1131010150120 Phone: (305)200 -4778 Building Department Comments CONCRETE DRIVEWAY INSTALLATION ON EXISTING LAYOUT Passemay i /( 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- 163639. CREATED AS REINSPECTION FOR INSP- 157270. NO PERMIT NO PLANS, RE SOD NORTH SIDE. NB Same comments NB November 04, 2011 For Inspections please call: (305)762 -4949 Page 15 of 42 111 Miami Shores Village Building Department Hifutc44-- 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 pczawisl ; i• on 1.5 1011 N. BUILDING Permit NoPS 1 PERMIT APPLICATION FBC 20 .. ...a.e ,.1 we veer. • Master Permit No. Permit Type: BUILDING ROOFING /�- / �+�i OWNER: Name (Fee Simple Titleholder): 8er/74/ Fr4h4/$ Phone#: J �©L iJ v�" Address: ' 33e AM 2 t%_ City: W i440t; S'hDt#4 State: FL Zip: 33 ! 6 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: J3 ( NV Z G/ T City: Miami Shores County: Miami Dade Zip: a3%c7 -o Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: , ' iq[-%.. OS/ Z- V. Phone4( 1') Z o) - 4 )% 12 Address: 01/41/AL30 AVe, City: 4.i— Lixkt . _State: FL Zip: Qualifier Name: /GYreZ 1 1 j., State Certification or Registration #: 646 "160944 9 Certificate of Competency #: Contact Phone#: �j�Email Addr ess: DESIGNER: Architect/Engineer: 6B124.1r6 Value of Work for this Permit: $ jJ i ) 6 Square/Linear Footage of Work: Type of Work: DAddition iiiAlteration l]Nevv ORepair/Replace e Phone #: 33059 Phone#( Description of Work: e * * * * * * * * * *Mi* ***** ** *** * * ** ********** * *AF ** ********* ******** * ******* * *+ *** ** * *** *FYI), Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ /soeb 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 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. 1 understand that a separate permit must be secured for ELECTRTCAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S A]N'H'IWAVIT: 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a rejppection fee will be charged. Signature Z Signature Owner or Agent ent was acknowledged before me this 3 20 , by 644.0 40 co; tractor The foreg i g insttrum cdg The foregoing instrument was acknowledged before me this day of rt4rt ,20�[,,by I4/A � 1.4412..e1 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY P s LIC: allyiovwnto-nne —,who has produced , As identification and who did take an oath. CHUG: APPROVED BY y 2 e '_— Plans Examiner Structural Review (Revised 07/10107)(Revised 06 /1012009)(Revised 3/15/09) Sign: Print: MARIELA MEDiNA `i AMY COMMISSION It D0820200 EXPIRES September 04, 2012 1 ( 407) 398-0153 FtnrWallotarySerme,com My Commission Expires: * * * *1/ * * * **** * * * * ** Zoning Clerk 00 NOT FOAWARD ANDI USA INC ALEX A OROZCO PRES 1411 N 69 AVE HOLLYWOOD FL 33024 to�f88 f dA I#n NADI MA INC 13050 NW 30 AVENUE OPA -LOA FL 33054 license you beccvne one ol the newly one million Floridians et t Depatimerd of Business twat Regulation. Our praise end businesses range from ardiftects to yacht brokers, from boxers to barbecue restaurants, and they keep FkstKts'ss economy strong. Every day we wait to Improve the way we do business in ceder to serve you better. For information about o r antes, pleased onto w Cen$e.c ont. There you can that impact you, e eb our and the that to department newsletters and tem more about the Department's Our mission at the Department le: License Efficiently, Regulate Fairly. We constantly strive: to wave you better so that can serve your customers - Thank you for doleg business in Florida, and conipeduktions c n your new license! DETACH HERE 08/04/2011 14:59 FAX 3058630519 10K INSURANCE SERVICES IJ001/001 A-C-CliMull CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 8/4/ 011 PRODUCER 1OK INSURANCE 11500 NW S River Dr #5 Medley, FL 33178 (305) 863 -6283 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. INSURERS AFFORDING COVERAGE NAICS INSURED AMDX USA INC 1411 NW 69 AVE HOLLYWOOD, FL 33024 INSURER A: MADISON INSURANCE COMPANY • INSURER B: ACCIDENT INSURANCE COMP GENERAL INSURER C: AGL9001720 INSURER D: 09/23/11 INSURER E $ 1,000 , 000 6 100,000 $ 5.000 COVERAGES 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR Mai. IG■ • la_ ;_ POUCYNUMBER POLI Y EFFECTIVE P_ L1,,ALIPU1 POL, YEXP1RATION DA I.I0, LIMITS • B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY AGL9001720 .y_ 09/23/10 09/23/11 EACH OCCURRENCE $ 1,000 , 000 6 100,000 $ 5.000 PRMAGE TO RENTED PREMISES (Ea aaaserroa) CLAIMS MADE X OCCUR MEDEXP (Any one person) PERSONAL & ADV INJURY $ 1,0001000 $ 1,000,000 $ 1.000 , 000 GENERAL AGGREGATE GEML AGGREGATE LIMIT APPLIES PER POLICY n J 17 LOC PRODUCTS - COMP/OP AGO 7 A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS AUTOS NON-OWNED AUTOS FULL PIP MIC28014061J0 04/06/11 04/06/12 (Ea SINGLE LIAR $ 300,000 BODILY INJURY (Par I) $ X BODRYBJJURY (Par e^I) $ _HIRED — X PROPERTY DAMAGE (Petac dent) $ X 10/21.000 UM GARAGE LIABILITY ANYAUTO AUTO ONLY- EAACCIDENT $ OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY -I EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ 6 WORKERSCOMPENSATIONAND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXE THE orMWveeEnleeR ExcuioEV ► If yak describe under SPECIAL PROVISIONS below 1 TWCSTAT - I I TH E L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE S • E.L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION MIAMI SHORE VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL S TO MAIL, DAYS WRITTEN NOTICE TO THE CERTIFICATE/HOLDER NAMED - •► ALLURE TO DO SO SHALL IMPOSE NO OBLIGATION OR ATION Or u;, +, THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD2S(2001 /08) •ACORD CORPORATION 1988 Aug. 4. 2011_ 3:OOPM Emmanuel Insurance No. 1290 P. 1 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID 19 AMDIAMI DATE(MWMPIYYYY) 08/04/11 TYPE OP INSURANCE PRODUCER Emmanuel Insurance Agency Sarai Medina 2370 E 8 Ave Hialeah FL 33013 Phone: 305- 693 -0003 Fax:305 -691 -4381 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAM 4 INSURED 4WD1 UM INC 13850 W 30DA 054 7�0 INSURER A: ERIDGEFIELD EMPLOYERS INS 10701 INSURER B: INSURER C: EACH OCCURRENCE INSURER O: INSURER E: IJgMAtit I U HtN I tU PREMISES (Ea occufence) 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THI& CERTIFICATE MAY SE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DE8CRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED HY PAID CLAIMS. I.TR NERD TYPE OP INSURANCE POLICY NUMBER DATE MMIDDIYYE DATE M IDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY IJgMAtit I U HtN I tU PREMISES (Ea occufence) $ I CLAIMS MADE ❑ OCCUR MED ExP (Any one pereon) 1 PERSONAL 8 ADV INJURY 1 GENERAL AGGREGATE $ GEM% —1 AGGREGATE LIMIT APPLIES PER POLICY n 218, n LOC PRODUCTS - COMP/OP AGO $ AUTOMOBILE LIAWLITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE LINT (Ea $ — — BODILY INJuRY (Per wean) $ BODILYINJURY (Per accident) $ — — PROPERTY DAMAGE (Per acctdenq $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EAACCIDENT $ 0ER THAN EA ACC 1 AV'O ONLY AGO $ EXCESS/UMBRELLA LIA Rimy OCCUR Er CLAIM$ MADE RETENTION $ EACH OCCURRENCE $ AGGREGATE 1 $ RDEDUCTIBLE $ S A WORKERS COMPENSATION AND EMPLOYERS'L1AbILIW ANY PROPRIETOR/PARTNER/EXECUTIVSE E OFFICERIMEMBEREXCLUOED7 8 yes, SPEC/AL describe PROVISIONS BPEClAL PROVISIONS �e1ow 12051 00 S 07 /28/11 1 ap 1 X ITORY$uA1114 I I OER 07/28/12 E.L.EACHACCIDENT $1,000,000 $1,000,000 E.L DISEASE .EAEMPLOYEE E.L OISEASE- POLICYUMIT S1,000,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS concrete contractor CANCELLATION Miami Shore village Building Department Fax: 305.795.2207 10050 NE 2nd Ave, Miami Shore FL 33138, ACORD 26 (2001108) SHOULD ANY OF THE ABOVE DESCRB DATE THEREOP, THE ISSuIHG INSURER NOTICE TO THE CERTIFICAT HOLDER IMPOSE NO OBLIGATION 0 LIABILITY 0 REPRESENTATIVES. AUTHORIZED REPREBENTA Sarai Medina POLICIES BB CANCELLED BEFORE THE EXPIRATION ENDEAVOR TO MAIL 10 DAYS WRITTEN TO THE LEFT. BUT FAILURE TO DO $O SHALL 1 NY KIND UPON THE INSURER, ITS AGENTS OR (gl ACORD CORPORATION 1988 FLORIDA DEPARTMENT OF HEALT Rick Scott Governor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General July 21, 2011 (AMDI USA INC) 13050 NW 30 Ave Opa Locka, FL 33054 RE: Contingency Letter Application Document No: AP1041795 Centrax Permit Number: 13 -SC- 1360016 OSTDS Number: 9338 NW 2 Ct Miami, FL 33150 Lot:4 Block:2 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 07/18/2011 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced Proposed Driveway at front of the house, septic system located at the back yard. There is not increase in sewage flow, change sewage characteristic, or compromise the integrity or function of the system 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.MyFloridaEH.com 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) (CYn4rd l r4y, t!iS' hereinafter referred to as the owner of the following described property (address): 3/1/w2 Hi�tvni ..St-). (es, FL L'R 3I3"O Legal Description 1/44i4(,h et.. . Lot Block Subdivision Folio # ,- Requests permission to install (describe work): A. e01l ore ie I r% VBw4 . Within the public right of way of (address) 4837 NO 2 Cr 1 hetni; Shore fL 33JS'D 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 A( day of // 44it&) , 201i SIGNED, SEALED, AND DE 2 ERED in the presence of: VIARIELA iMEDINA ';' .. -' MY COMMISSION # 00820200 °'may 'T - EXPIRES September 04, 2012 "':,',',,,, Servsce.com (407) 398 - 035`!. 1'londaNlota (Owner's Signature ) IVIiam, Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT iti5 H kib 1 DATE: 7411 •l, -70 Y6 "1.-z Contractor ❑`Owner ❑ Architect `��► Picked up 2 sets of plans and (other) 3 v kg P P ( � Address: 4 -t,`c 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: RESUBMITTED DATE: PERMIT CLERK INITIAL: goon punt/Tars .Jxr .1 r. LAND SURVEY BOU/ iz4fty URVEY • 2 of APPROVED Pennit no. '-1- 1 04119 Date: �:21il li , Miatni cve C uatyi Health Department NO LOT -3 a 23&lr • NO CAP • • • it • • ••• • • • • • • • • • •• saRVSPDR�%roral. • Vote map be Enemata recorded bzNis Puldielloccodo not *boss •n thin 8mvey. 4 • • • • • • • • • • • • • • • •• • • • • ••• • ••• • • • • ••• • • • • • • • • • • • • • • • • • • • • • •• v• • • • •• •• ••• • • • ••• • • • • • • -e i 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:1131010150120 Owner's Name: BERNARD FRANCIS Job Address: 9338 2 Court Miami Shores, FL 33150- Owner's Phone: Total Square Feet: 250 Total Job Valuation: $ 1,800.00 Contractor(s) Phone Primary Contractor AMDI USA INC (305)200 -4778 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 3/24/2011: Yes Comments: PLAN IS OK PROVIDED THE DRIVEWAY IS LOCATED NOT LESS THAN 10 FEET FROM SIDE LOT LINE ANC IS NOT WIDER THAN 18 FEET WITH 2x2 FOOT FLARES WHERE THE DRIVEWAY MEETS THE ROAD ASPHALT. 03/21/2011 12:25 FAX 1 800 885 7530 DATA SCAN FIELD SERVICES l j 001 $$$ TX REPORT $$$ TRANSMISSION OK TX /R% NO 1194 RECIPIENT ADDRESS 93053971001 DESTINATION ID ST. TIME 03/21 12:22 TIME USE 02'30 PAGES SENT 5 RESULT OK Permit No: 11- «'7 Job Name A , 2011 Miami Shores Vivage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Bui . ing Critique Sheet e' ��L.tLArs>i� A a�6m � 'TT � ( ESN €N4N -f O Cf�t�IS"C2.�x.■"1-1(J J W) at{ N fi2A9KT o - u te" `, Miami Shores ViIiage Building Department Permit No: 11- q- / Job Name 7cf., , 2011 Bui ing Critique Sheet /,e9c},W �f Ur 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 CON] CNA NCI P CoN S-Te.a.7-Cl W r T H r - 0 LAJ 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