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ACT-11-1565
Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 d 51 1 1-4440(1-1 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING UILDING Permit No. A l , 1 '151675 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOFING./ OWNER: Name (Fee Simple Titleholde}): €--"N^ s ��j V ' . -3' v,'' G=am Address: X70 NW 11-2- S 1 City: 1 "\ State: Zip: . ci Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 70 N 112 At- City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 1i - !-3G -0,21-40 (o20 Is the Building Historically Designated: Yes NO ' CONTRACTOR: Company Name: L Address: 1(Z1—. -C- Flood Zone: &-'1\ e. (0,Mphone #: -V3"03 3 City: --1--t-,421 State: FL- Qualifier Name: Phone #: Zip: .3 ®`2<31 State Certification or Registration #: Certificate of Competency #: C 6G 01 1 4 Contact Phone #: io5- 33 \ Email Address: DESIGNER: Architect/Engineer: 5600 Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: "'G go -t' Type of Work: ❑Addition ❑Alteration UNew ❑Repair/Replace ❑Demolition Description of Work: vA✓ aa �f'Gd o"o' `(-0.,.rrort- Submittal Fee $ Permit Fee $ i Eve.i CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $t_I • 4 , 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 not be approved and a reinspection fee will be charged. Signaturel U I Owner or Agent 4 The foregoing instrument was acknowledged before me this? day of.2S. 20 IL, by � �� —I who is personally known to nor who has produced As identification and who did take an oath. NOTARY PUB - C: Sign: Print: My Commission Expi EpµONTONER �� MY COMMISSION* DD 883081 r 4 K EXPIRES: Marc h 2013 ff, Bonded Thru Notary Public Underwriters Signature- _ `9 Contractor The foregoing instrument was acknowledged before me thisZ -�4 day of &' -1J , 20 by who is personally known to me®r who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission E ** ****ffi**+ k**** *****# ***** *, k****ffi****sk********* k********* ** **** * **** kM******** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. / COPY OF QUALIFIER'S STATE LIC CARD B. / COPY OF LOCAL BUSINESS TAX RECEIPT C. / COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. / COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION1 YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Li V I J c i7---ENNobEt BUSINESS ADDRESS: 121 -4& ScOLITI4 21 fSJ " ITY 4oU Y °C) STATE EA-- ZIP CODE 3302'0 BUSINESS PHONE: ri ) c:/0 FAX NUMBER rCkt ) CELL PHONE (30S-) 331 O°) %'g2 QUALIFIER'S NAME: -13::)/90Li QUALIFIER'S LIC NUMBER: COO-- 01 1 210 L f E- MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV 1 RV 3126109 MLDV *wAr, PAA# t, ,c1 „ .P gc# WAD- lc\ CITY OF HOLLYWOOD LOCAL BUSINESS TAX RECEIPT PRINT DATE: 9/20/10 THIS IS YOUR LOCAL BUSINESS TAX RECEIPT. PLEASE DETACH AND POST IN A CONSPICUOUS PLACE AT THE BUSINESS LOCATION. PLEASE DO NOT REMIT ANY PAYMENT THIS IS NOT A BILL. Business Name" Business Location: Business Class: Tax Basis: Receipt Number: Receipt Year: Expiration Date: LIVING EARTH REMODELER'S INC. 1121 S 21 AVE CONTRACTOR /GENERAL 2 - 4 WORKERS 11 00047143 10/01/10 09/30/11 NEW CHARGES" (Itemized Below) Base Fee Additional Charges: 251.00 251.00 TOTAL NEW CHARGES" Penalty Amount: Previous Balance Due: TOTAL AMOUNT PAID: 251.00 .00 .00 251.00 Comments: PURSUANT TO STATE LAW, THE LOCAL BUSINESS TAX IS LEVIED ON THE PRIVILEGE OF DOING BUSINESS WITHIN A CITY'S LIMITS, AND IS NON - REGULATORY IN NATURE. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT BY THE CITY OF HOLLYWOOD DOES NOT MEAN THAT THE CITY HAS DETERMINED THAT THE EXISTING OR PROPOSED USE OF A LOCATION IS LAWFUL. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT LEGALIZE OR CONDONE THE NATURE OF THE BUSINESS BEING CONDUCTED IF CONTRARY TO ANY LOCAL, STATE OR FEDERAL LAWS OR REGULATIONS. ACORD. CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NO.10AU Ac11.11$01222- 3036881 8/33/2011 12.57.4SW PRODUCER Higbpoint Risk Services sa.0 5507. ma vans YAY, BOrss 1200 Dallas, TX 75240 (800) 728 -0623 (972) 404 -0380 Ft= (972) 404 -0380 THIS CERTIFICATE= IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTF.R TFIP CM /FRAGEAEFORDFD RY THF PAI IMF", BPI AW,-,� INSURERS AFFORDING COVERAGE INSURED: ANS 1 /a /E: LIVING EARTH ADHODELES,S, INC. (ICA) 1121 -A SOWS 215T AVE HOLLYWOOD, FL 33020 (554) 925 -3350 Fax' (954) 925 -5325 INSURER A: INSURER s: • U • w •J. K• ! _ ,l : H . INSURER 0: INSURER O: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW ANY REQUIREMENT, TERN' CR CONDITION UTAY PERTAIN. THE INEORANCC AFFORD= POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN ISSUED TO THE INSURED OP ANY CONTRACT OR OTHER DOCUMENT NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR SUBJECT TO ALL THE TFRM6y CEIOLIJCIONS ANO OONDiTIV N9 OF OUCH BY YI411 POLJ8IN . DeSemema HEREIN A8 HAVE BEEN REDUCED BY PAID CLAMS. NM Ta TYPE OF INSURANCE POLICY NUMBER MAY EFFECTIVE d$'C LIONmn0In,I IRyu& EXPIRATIO5 nave iNameoa m LIMM8 EACH DCcURRFN C F. ... . S MORAL LIABILITY COMMERCIAL GENERAL LIAAIUYY FIRE DAMAGE pm Ono Elm) S CLAIMS MADE III OCCUR MED EXP (Any mw preen) $ PERSONAL a AM* IrLINNY o GENERAL AGGREGATE 5 Gum AGGREGATE LIMIT APPLIES PER 7 Fes,., f pzt n L PRODUCTS- COMP/OP AGG ^_ $ AUTOMOBILE — — — LUABU�T1l ANY AUTO ALL OWNED ANJTOS SCHEDULED AUTOS HIRED AUTOS wOI,F094Nomune3 _ CWA1S1NED SINGLE LIMIT (Eatwas% e BODILY INJURY (Per psn"+on) $ BODILY INLAY mu mere flU PROPERTY DAMAGE (Petacoldun0 $ GARAGE usually ANY AUTO AUTO ONLY. EA ACCID Nt $ - OYHP-N THAN EA ACC a •� AUTO ONLY: AGO S MESS LIASLITY OCCUR El wen UADE EACH OCCURRENCE $ AMC-WE $ $��-.. — O$GUOTIN.E RETENTION S i A ROMURSDOERDISAnONAND EMPLOYE >7 2262727400GO 04/0142011 04/01/3012 Y. MAIM, R.R' LIABILrtY E.L EACH ACCIDENT $ 1000000 EiL DISEASE- EAEMPLOYEE S 1000000 e..I. MOR Aa - POLICY LIMIT ® 1000000 OTHER U10T'.$ UNITS .a 1•• This o rtifioate emai.s Cov ra a ie t p dad for A, l Co 10 1; t the emplooeeh �44fOlf 011, ineured is attord policy fors 1pyees leased r +2LEASE SEE ACED EMPLOYEE in effea , provided the client's any e e for which the o ° 1eaneli I:n T.TVTN* Torkers Compensation free AMS. ROSTER.*** account client is not EARTH REMODNLEgg' & Zlaployers is in good standing with ANS. reporting wades to AMS. 9 . (icA) , ogEaceiwo liability as a co- employer under CERTIFICATE HOLDER 1 1 AUTIQIVALINSURED; WIURERLErrERI Miami Shona Village 10050 Northeast tad Avenue Miami Shores, 3'L 33338 ACORD 26-S (7/97) CANCELLATION SFIbULDANyoF lg-fwcvE etamaacpontwea CA4CEu_toBEFORrnievuNRA -no1J HATE THUMP, THE ISSUING I N$URFR WILL ENDEAVOR TO NAIL 30 DAYS warm NOTICg Y0 me CERTIFICATE NOLLIUN NAM= IU TKO LEFT, EIUT FAB.URE TO DO SO SHALL MP0$E NO OBLIGATION ON LLABUTY OF ANY KIND UPON THEINSUR<l$, ITSMENU OR REPRE$ENTATIY65. ANTIS RONMSENTATIVS ® ACORD CORPORATION 1988 08/2/2011 14:05 9549560555 COVER ALL INSURANCE PAGE 01/01 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (31131130/YVYY) 00123/2011 Thi r�- PRODUCER COVER ALL INSURANCE 5800 W. ATLANTIC BLVD. MARGATE FL, 33063 ..1M1054) 956.0006 FX _(954) 956 -0555 - THIS CERTIFICATE IS ISSUED AS A MATTER ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ALTER THE COVERAGE AFFORDED BY THE OF INFORMATION CERTIFICATE EXTEND OR POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED LIVING EARTH REMODELER'S INC 1121A SOUTH 21ST AVENUE HOLE:MOOD FL 33020 _ . �— - — INSURER A: MID - CONTINENT CASUALTY COMPANY LIABILITY coMMERCIAL GENERAL LIASILrry elms MADE U OCCUR INSURER a 12/1612010 INSURER C. , EACH OCCURRENCE INSURER D; X INSURER E _ .,_J THE ANY MAY POLICIES. IN —FR POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE[? NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND con :wows OF SUCH AGGREGATE LIMIT$ SHOWN MAY HAVE BEEN REDUCED EY PAID CLAIMS. ��►Dp m INRR�, ' TVPR flPJNRuwANaF _ POLICY NUM98A POLICY RFPECTNE BATE (MM1 plvY1 POLICY EXFIRAT1 N DATE (IRM Tn LIMITS A GENERAL LIABILITY coMMERCIAL GENERAL LIASILrry elms MADE U OCCUR 04GL00030$701 12/1612010 12/1612011 , EACH OCCURRENCE - $ 1,000,000 $ 100,000 X DAB QESO REHM „o, _ .,_J MED EXP (Anj mne person) $ EXCLUDED PERSONAL $ ADV INJURY ; 1,000,000 B 2.000,000 GENERAL AGGREGATE AGGREGATE L MIT APPLIES PER: -X7 PRODUCTS - COMP /OP AGO $ 2,000,000 AGE IN'L POLICY X FR ' 1 1 LOC B AUTOMOB►LB _ LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 0401000808701 12/1612010 1211612011 COMBINED SINGLE LIMIT (Ea acauent) $ 1,000,000 BOOBY INJURY (Per perm) 5 — X BODILY INJURY (Pro accident) $ X PROPERTY DAMAGE (Per axitlmd) S GARAGE LIABILITY ANY AIJTO AUTO ONLY- EA ACCIDENT j EA ACC OTHER THAN AUTO ONLY: AGG .-§-- 5 ER. CESSAJMBRELLA _ ] — LIABILITY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION 5 EACH OCCURRENCE $ AGGREGATE $ 3 $ $ _ , WORKERS COMPENSATION AND EMPLOYERS, LIABILITY ANY PROPRIETORMARTNERIEXFCUTjUS OyFr,aF C�ER#MEAI�IER OCCLUDED? SPECIAAL PRbe01 under N$ below _ I WGiVSTATIJ- I 0TH - TA I nulrrR F� �.�J 6.L EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE 5 EL. DISEASE • POLICY MIT 3 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS GENERAL CONTRACTOR CERTIFICATE HOLDER MIAMI SHORES BUILDING DEPT 10050 NE 2ND AVENUE MIAMI SHORES FL 33138 • FAX; 954-925.5325 ACORD 25 (2001108) CANCELLATION SMOuLDANYO E DATE THEREOF, NOTICE TO IMPOSE REPRES.E CANCELLED BEFORE THE RXP *AT=OM VOR TO MAIL 10 DAYS WRITTEN LEFT, BUT FAILURE TO 00 SO SHALL URER, ITS AGENTS OR AUTHORED REPRESENTATIVE ACORD CORPORATION 1988 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 169614 Scheduled Inspection Date: February 13, 2012 Inspector: Bruhn, Norman Owner: SMITHERMAN, DAVID Job Address: 570 NW 112 Street Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: LIVING EARTH REMODELERS INC Permit Number: ACT -8 -11 -1565 Permit Type: Awnings /Canopies/Tents Inspection Type: Final Work Classification: New Phone Number Parcel Number 3021360210620 Phone: (954)925 -5003 Building Department Comments INSULATED ALUMINUM ROOF /CARPORT Pa sse). 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- 163730. The anchors in the beam, angle, c channel are not per plans. All anchors must be spaced per approved details. NB February 10, 2012 For Inspections please call: (305)762 -4949 Page 13 of 19 81,2,c, % 1 1--, Permit No: 11 -1565 Job Name: August 29, 2011 Miami Shores Village Building Department Building Critique Sheet 1) Provide approval from HRS /DOH. 2) Show connection of panels to existing wall. 3) Transfer bars are required in foundation. 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 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 Issue Date: Not Issued Expires:NOt Issued Folio Number:3021360210620 Owner's Name: DAVID SMITHERMAN Job Address: 570 112 Street Miami Shores, FL 33138 -0000 Owner's Phone: Total Square Feet: 280 Total Job Valuation: $ 4,400.00 , Contractor(s) LIVING EARTH REMODELERS INC Phone (954)925 -5003 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 8/25/2011: Yes Comments: FALLS UNDER MIAMI -DADE REGULATIONS. RU2 DISTRICT 5.8 FT SIDE YARD SETBACK, 1 CAR PORT WITH METAL ROOF PERMITED IN SIDE YARD 10 -17 -11 PLANS OK 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 Expires: Permit NO. ACT -8 -11 -1565 Issue Date: Not __ fPF i 9 } 33r 3k ' Type t ni €' o Crar�o New Issued t ued Folio Number:3021360210620 Owner's Name: DAVID SMITHERMAN Job Address: 570 112 Street Miami Shores, FL 33138 -0000 Owner's Phone: Total Square Feet: 280 Total Job Valuation: $ 4,400.00 Contractor(s) LIVING EARTH REMODELERS INC Phone (954)925 -5003 Primary Contractor Yes 1 Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 8/25/2011: Yes Comments: FALLS UNDER MIAMI -DADE REGULATIONS. RU2 DISTRICT 5.8 FT SIDE YARD SETBACK, 1 CAR PORT WITH METAL ROOF PERMITED IN SIDE YARD 08/29/2011 11:17 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES eon * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /RX NO 1730 RECIPIENT ADDRESS 919549255325 DESTINATION ID ST. TIME 08/29 11:16 TIME USE 00'33 PAGES SENT 1 RESULT OK 8I,2,c / I I _ -rs-• Permit No: 11 -1565 Job Name: August 29, 2011 Miami Shores Viiiage Building Department Building Critique Sheet 1) Provide approval from HRS /DOH. 2) Show connection of panels to existing wall. 3) Transfer bars are required in foundation. 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 ct-ot-- 5 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 570 NW 112 Street Miami Shores, FL 33138 -0000 3021360210620 Block: Lot: DAVID SMITHERMAN Owner Information Address Phone Cell DAVID SMITHERMAN 570 112 Street MIAMI SHORES FL 33168- I Contractor(s) Phone Cell Phone LIVING EARTH REMODELERS INC (954)925 -5003 Valuation: Total Sq Feet: $ 4,400.00 280 1 Approved: Yes Comments: FALLS UNDER MIAMI -DADE REGULATIONS. RU2 DISTRICT 5.8 FT SIDE YARD SETBACK, 1 CAR Date Approved: 8/25/2011: Yes Date Denied: Type of Work: ALUMINUM CARPORT Classification: Residential Additional Info: Color Approved: In Review: Yes Code Comments: : FALLS UNDER MIAMI -DADE REGULA Code Approved: : Yes Code Denied: Scanning: 2 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.00 $2.25 $2.25 $1.00 $150.00 $6.00 $4.00 $168.50 Pay Date Pay Type Invoice # ACT -8 -11 -41841 08/24/2011 Credit Card 11/10/2011 Credit Card Amt Paid Amt Due $ 50.00 $ 118.50 $ 118.50 $0.00 Available Inspections: Inspection Type: Final Foundation In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. November 10, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date November 10, 2011 1 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. 17-21.35-402)- 0 3 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1 IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII CFN 201 1R0756957 OR Bk 27889 Ps 0676; (1ps)) RECORDED 11/09/2011 14:29:53 HARVEY RUVINr CLERK OF COURT I'1I AMI I -DADE COUNTY r FLORIDA LAST PACE ' ,Space above reserved, for use of recording office 1. Legal description of property and street /address: v "A�}e5� 4 red 42-1 2S L 1 -3 _ r .Tir) NO 12 r c7� 2. Description of improvement: re`"^�°� r C'. 3. Owner(s) name and address: r�3P ._T— Interest in property: Name and address of fee simple titleholder: j�,,^ A 4. Contractor's narrle, address and phone umber: � 6� `�`Olre 5. Surety: (Payment 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(1)(a)7., Florida Statutes, Name, address and phone number: 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 specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION 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 Ovymer(g)_or Prepared By.x (%,� -tfZ Print Name // PAV 1 Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instillment was acknowled By D4 Vas -AA (7 it 472- ❑ Individually, or ❑ as for ersonally known, or D produced the following type of identification: Signature of Notary Public: Authorized Officer /Director /Partner /Manager Prepared By Print Name Title /Office before me this L7 day of Print Name: .- " (SEAL) 1 °• 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( Owner(s) o caner, 's Authorized Officer /Director /Partner /Manager who signed above: By 'y"" By EAMON TONER :+ MY COMMISSION 8 00 863061 s;T EXPIRES: March 4, 2013 Bonded Thru Notary Public Undewrftere 1 STATE OF FLORIDA COUNTY OF DADE I HEREBY CERTIFY that o erg rya)+ of the urigrri blued ur toe on I C J 7 a /04/ A t3 29 (1 Wi TTVE'SS my hood and 08'telat ;ed, HARV 1 Rt. id, CLE ". G Courtly Cads D.C. 4. Rick Scott Governor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General October 05, 2011 (A Super Septic) 7701 W 18 Ln Hialeah, FL 33016 RE: Contingency Letter Application Document No: API 048605 Centrax Permit Number: 13 -SC- 1371543 OSTDS Number: 570 NW 112 St Miami, FL 33168 Lot:3 Block:4 Subdivision: West Shores Dear Applicant: This will acknowledge receipt of an application dated 09/30/2011 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced Proposed two concrete driveway at front of the house, septic system is at the back yard. 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.MyFloridaEH.com STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION. FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART 11- SITEPLAN resents 10 feet and 1 inch = 40 feet. Notes: o P. Cig )11,1" 7 l/`.exr- Yom/ t 71- Site Plan submitted by: Title Plan Approved Not Approved Date County Health Department 1/7/5-1-011 irk D / v, z iore Dr / v e Vi/ cey Signature ALL CHANGES MUST BE APPROVE }; BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS-H Fort 4016 which may be used) (Stock Number 5744 - 002 - 4015 -6) Page 2 of 4 F: \DRAWING \570 NW 112 STREET.dwg U3/22/2011 0— BLOCK CORNER FlP. 1/2" No I.D. SOY BOUNDARY SURVEY SCALE: 1" = 20' FlP. 1/2" No I.D. 133.00' 9.5' PARKWAY 5' SIDEWAU< 58.00' FlP. 1/Z' No I.D. IRON FENCE 89'55'52" 5' CB5 WAU 0.1 0.3 r LAND SURVEYORS, INC. PHONE: 305 - 822 -6062 * FAX: 305 - 827 -9669 6175 NW 153rd STREET SUITE 321 MIAMI LAKES FL 33014 24.65' i for 2.6'X3.6' 1 —STORY RES# 570 4- 7.32' 32.00' 5 1.1 o' aa= FlP. 1/2" 4' CHAIN UNK FENCE 0.2 II 10' UTILITY EASEMENT LOT 18, BLOCK 4 LEGEND off Overhead Wire Line /1 Wood Fence x Chain Link Fence ❑ Iron Fence — — — Monument Line Centerline Property Line EZ=M C.B.S. 9 = Extsting Elevations =Catch Basin ® =Water Meter ® = Electric Box 0 = Sanitary Manhole k =Sprinkler Pump cal =Wood Pole IN =Conc. Pole XX =Light Pole =Fire Hydrant A =Water Valve =Inlet =Florida Power Light Transformer ® =Coble Tv Box M1 = Electric hater Box 111:111 A /C=Air Conditioner Conc. =Concrete C.B.S. =Concrete Block & Stucco D.E. = Drainage Easement D.M.E.= Drainage Maintenance Easement F.F.E. = Finish Floor Elevation .I.P. =Found Iron Pipe /Pin F.I.R. =Found Iron Rebar F.N. =Found Nail F.N&D =Found Nail & Disc L.M.E. =Lake Maintenance Easement (M) = Measured (P) =Plotted (R) =Record Res. = Residence SIP /R =Set Iron Pin/Rebar U.E = Utility Easement 12 A =Arc BRG= Bearing CH =Chord A =Delta L= Length R= Radius T= Tangent Page 2 of 2 9 r'•, r C Gll1CCN G, C seketakmdoedorb LICENSE # 11955 1 OC! W. 76TH STREET, SUITE 311, HIALEAH, FLORIDA 33016 • TEL: 305.822.3141 ® FAX: 305.822.3161 P1306IECT: NAME: DATE: SHEET: OF 5"kac eD .ged z , LICENSE # 11955 2100 W.. 76TH STREET, SUITE 311, HIALEAH, FLORIDA 33016 TEL: 305.822.3141 FAX: 305.822.31 61 PROJECT: NAME: DATE: 'SHEET 5 • __ 1.__.. I . 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