DS-11-2329Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 167973 Permit Number: DS -12 -11 -2329
Scheduled Inspection Date: March 26, 2012
Inspector: Bruhn, Norman
Owner: FEINBERG, HOWARD
Job Address: 1410 NE 103 Street
Miami Shores, FL
Project: <NONE>
Contractor: CHAMPION CONCRETE
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)754 -4000
Parcel Number 1132050310020
Phone: (305)252 -8055
Building Department Comments
DRIVEWAY PAVER
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 23, 2012
For Inspections please call: (305)762 -4949
Page 11 of 37
[11110 11111111111111111111111111111111111111
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. ) i 3—
C FL/
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
CFN 2012R0043033
OR BI; 27968 F`q 2023; (1139)
r2 2
RECORDED Ui.�_�lr ?il;, 12:45:52
HARVEY RUV'INr CLERK OF COURT
MIAMI-DADE COUNTY? FLORIDA
LAST PAGE
`rlli'�,, (r't.•'�sie� f � Sery i.•- :4�J -r_
Ar;2
THE UNDERSIGNED hereby gives notice that improvements will be made to,co%ta►nrlF,;
property, and in accordance with Chapter 713, Florida Statutes, the followinainformation
is provided in this Notice of Commencement.
1. Legal description of property and street/address: I i' ) PE /OS-
hr
"L.r D.G.
Sp1ce above reserved for use of recording office
2. Description of improvement DAL' 11/D WAY r j i1 /=
3. Owner(s) name and address: 4\1-). FT: /Zit P 45
Interest in property: 0 wit,./6 1p q
Name and address of fee simple titleholder. 5 I(7 m t
4. Contractor's name, address and phone number. (1'1A-piep 1O))C Y7ye
1 / 0 Oj ij ►ld ?1'3 5.),1-e- (A) tA -- 332 ?a
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 1, 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
Prepared By
Print Name 61.4./
Title/Office C5(--' x r(
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The foregoing instrument wass,ac owledged of q e me this day of
By 4+ ,o > J , / !.s
ividually, or ❑ as for
Personally known, or ❑ produced the following type of identification:
Signature of Notary Public:
• /' s) or Own= 1 A ,1 • zed Officer/Director/Partner/Manager
►st�la�51�1% rte. Prepared By .141h'1 ∎ /�� 40,1//, 0
/' ' C Print Name JA- b•�- `7/�'70""'
Tltle /Office
Print Name:
(SEAL)
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 /Manager who signed above:
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123.01-52 PAGE 3 3/10
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BUILDING
PERMIT APPLICATION
Fsc 20
Miami Shores Village l
Building Department
RE C E IVE
DEC 16 2091
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholde
Address: /410 M E 103
City: Y A1 . ) jA 4 3414/1421 State:
Tenant/Lessee Name:
Permit No 1 1 5D- Ai
Master Permit No.
ROOFING 4
+I
Phone #: )
1
Email: 11 J� Fe. ej a h 0 L . C .y rr,
JOB ADDRESS:
Zip: 3 ) 1
Phone #: -7 1-7
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO V Flood Zone:
CONTRACTOR: Company Name: (/f.J ?4 6(:1 ) "6; ' "'' Phone #:
Address: 11 JO tti j) 3 `A a:3 -7 -71-' ;g()
y3O�i 1 C State: Zip:
Cit ` ._jj -7(
Qualifier Name: 9-}' — hk5,(1,41)
State Certification or Registration #: Certificate of Competency #: � 7,_-)1.)(2) �
Contact Phone #: Email Address: ✓ Y:fly, c A "� ' �` '1G 1k
DESIGNER: Architect/Engineer: Phone #:
Phone #:
Value of Work for this Permit: $ k;eal `" Square/Linear Footage of Work: fOZ'
Type of Work: ❑Addition ❑Alteration
Description of Work: PA
y P���i'G' �',.•i
New ❑Repair/Replace ❑Demolition
:°x°xx:x° **** *** * ** ** :°x°x:x **** *** * *** * ****** Fees** ** * * ******* ****** ** **** x *** *°x°xx°°x:x*********
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
S29C/
CCF $ CO /CC $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
,1
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 del'vered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must b posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the ' bsence ouch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent 1 Contractor
The foregoing instrument was acknowledged before me this t The foregoing ins i ent was acknowledged before me this ± f
day of , 20 I t , by } day of - i y,/ j e -.1+-r- ,
b
who isg>frsonally known tom o has produced who s personally known to . e or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
#DD910671
Expires: AUG. 08, 2013
BONDED TBRt AT" • RONDDGCO.,INC,
NOTARY PUBLIC:
Sign:
Print: ti0Ta.:1- L,.J.,,'. TATS OFFLORIDA
E V. Goldman
Ge;-1rr, ? =;i.; . #DD910671
'„, Expu es AUG. 08, 2013
BONDED TIM 47 , NT- " 30*DLN0 00., INC
APPROVED BY 4::;i" ���6 l� Plans Examiner JI / /64 Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
The undersigned Affiant, HOWAPtlb 6' "' -46-`" , does hereby attest that
(Property owner)
The attached survey, performed by b 'A a fb'
(Name of surveyor's company)
For address: /'ilk Aft Es /0;14--- St
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Performed on t` It7 (date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Fu ffiant sa; eth naught.
1"..,/9 /zb it /week 6
Prop "rty Owner Signature Property Owner Print Name
SWORN TO A%D SUBSCRIBED before me this / 5 day of '_ ol-e'1
Affiant is _personally known to me, produced as identification.
Revised on 5/22/2009/ Revised on 6/12/09
NOTAR IATE OF FLORIDA
b: L.
Goldman
I c�r�a�i�i ^.n #DD910671
'•- ' ' � Expir;. AUG. 08, 2013
anrv7?ivAiIflt.- i:.,..,,, :,oNDLNGCO.,DC
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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
Permit NO. DS -12 -11 -2329
Issued
Permit Type: Driveways /Sidewalks /Slabs
Work Classification: Addition /Alteration
Expires:NOt Issued
Folio Number:1132050310020
Owner's Name: HOWARD FEINBERG Owner's Phone: (305)754 -4000
Job Address: 1410 103 Street Total Square Feet: 1800
Miami Shores, FL Total Job Valuation: $ 10,000.00
Contractor(s)
CHAMPION CONCRETE
Phone
(305)252 -8055
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 12/16/2011: Yes
Comments:
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) HO1..✓A; I> Ft-Jr-41 t I ( hereinafter referred to as the owner of
the following described property (address): ni / G�� )✓C /0 3 `� r n ' 3 h 6 4 j
ph
Legal Description Lot / r Block Subdivision -- A7frA
Folio# %_3 -d0 3/- Ua' x; 7
Requests permission to install (describe work): PAV A 2',r)41 c 1")
Within the public right of way of (address)
/v /0 pc, /0 7
/li% 11'1, P 11,;r��Cr
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).
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this day of , 20 L L , by4
who is personally known to me or who has produced As identification and who did take
an oath.
NOTARY PUBLIC:
Sign:
b -
Print:
My Commission Expires:
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R°VIED 7"F ?, •
. FLORIDA
oldman
e DD910671
-∎ G. 08, 2013
`'DLtiGCO.,INC
My Home
miami ade. ov.
Show Me:
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• Property Appraiser Tax Estimator
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Summary Details:
Folio No.: -3205-03 -
C T1VE ro OL: S•ELE
Property: 410 NE 103 ST
Mailing OWARD J FEINBERG &W
Address: CES
410 NE 103ST MIAMI
HORES FL
138-2626
P • - information:
= Zone: 300 ONE FAMILY
• • • 1 RESIDENTIAL -
INGLE FAMILY
• s/Baths: '.6
oors: •••
"ng Units:
1 Sq Footage:
Size:
ear Built:
,524
2,995 SO FT
958
-PLAT OF TR C MIAMI
HORES BAY PARK
STS PB 64-97 LOT 11
LK 5 LOT SEE 115.000
113 OR 13385-1409
1 OR 13385-1409
700
egal Description:
Assessment information:
itetctar4eitik4EM
\fear:
axable Value information:
2011 2010
Taxing
Authonly:
Regional:
County:
City:
School
Board:
Applied Applied
Exemption/ Exemption/
Taxable Value: Taxable Value:
,19
$50,000/$479,015450,000/$471,19
,19
$25,000/$504,015125,000/$496,19
Sale Information:
Aerial Photography - 2009
0 112 ft
MY Home 1 Property Information 1 Property Taxes
I My Neighborhood I Property Appraiser
Home 1 Using Our Site 1 Phone Directory 1 privacy I Disclaimer
If you experience ter.hnical difficulties with the Property Information application,
or wish to send us your comments, questions or suggestions
please email us at Webmaster.
Web Site
@ 2002 Miami-Dade County.
All rights reserved.
Legend
Property
Boundary
Selected
• Property
Street
=r,
drze Highway
=Avg Miami-Dade
County
Water
PERMIT #:
Miami Shores Viiiage
Building Department
RECEIPT
DATE: 0'
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Contractor
❑ Owner
❑ Architect
Picke u 2 sets of laps a
P and ther ��: /� -► �. k3
Address: I f�C 1 OI
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that th- plans need to be brought back to Miami
Shores Village Building Departmen to conti4permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
i
RESUBMITTED DATE:
PERMIT CLERK INITIAL: �`
rikAII '.-50■01.6
Permit No: 11 -2329
Job Name:
December 21, 2011
Miami Shores Village
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
qiLl%)t \10\c/%0
FLORIDA DEPARTMENT OF
HEALT
Rick Scott
Governor
H. Frank Farmer, Jr., M.D., Ph.D.
State Surgeon General
January 09, 2012
Rolanda Arrieta (Glasshammer, Inc)
19341 Sterling Dr
Cutler Ridge, FL 33157
RE: Contingency Letter
Application Document No: AP1057221
Centrax Permit Number: 13 -SC- 1385703
OSTDS Number:
1410 NE 103 St
Miami, FL 33138
Lot:11 Block:5 Subdivision: Miami Shores Bay Park Estates
Dear Applicant:
This will acknowledge receipt of an application dated 01/04/2012 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
From a review of your completed application, it has been determined that your existing system
is adequate for the proposed use (Driveway extension and replacement of asphalt by new
pavers).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Sincerely,
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 AP -
PART II - SITE PLAN Pg. 1 of 1
ocale: tacn D
OCK represents 7.5 feet and 1 inch
= 30 feet. .
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Notes: Asphalted driveway, walkway & double approach.
Exis- =Blackwater sys. 1 & 2 located at Northeast & Southwest side of the SFR w/ 750 & 600 gal. conc. tank, 150 & 75 sf
-ting: j ancient concrete block drainfields arrange as a multi - trench with 75 & 38 sf unobstru::ted reserve area respectively.
Scope! New semi - circular replacement brick paver drive walkway an approaches on the front North
of work: !side of the property, enough away from th xist - . lc systems 1 & 2 described above.
01 / 02 / 12 CEHP 0964
Site Plan submitted by:
RolaRtd'o Arne
Plan Approved Not ,Approved
Date
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS-H Form 4016 w hich may be used)
Page 2 of 4
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