DS-12-502Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 173071 Permit Number: DS -3 -12 -502
Scheduled Inspection Date: May 07, 2012
Inspector: Bruhn, Norman
Owner: KOTALIK, KENNY
Job Address: 950 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: BRICK PAVER GROUP INC
Permit Type: Driveways /Sidewalks /Slabs
r Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060340200
Building Department Comments
PAVER DRIVEWAY
PassedG%
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- 172815. CREATED AS
REINSPECTION FOR INSP- 171419. Pavers are unsupported /sinking at
edges. NB
5/3 -SAME CONDITION EAST END.JR
May 04, 2012
For Inspections please call: (305)762 -4949
Page 38 of 50
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 n
B IL ING Permit No I22°
PERMIT APPLICATION Master Permit No.
P iAR
FBC 20
Permit Type: BUILDING
ROOFING r�-Q�
OWNER: Name (Fee Simple Ti ,holder): \(e it. \� � ```�- Phone# �� ��Ui ��
Address: �o' ).r il,
City: 1r State: �'re zip: 331 %
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
Tso
City: Miami Shores County: Miami Dade Zip: 33/3g
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: 1r \(IO W' 1°1
Address: Cj) W �(,6.�\ kn`
City: '\\.tk \ \ State:t
Qualifier Name: \ 0�1� Y�U,+1` cam•
State Certification or Registration #:
Contact Phone #: ` —WOO Email Address:
Phone #C),t. -7)
Zip: 177 Ys
Phone #: ( 4\5*. VM
Certificate of Competency #: &cD® \5
DESIGNER: Architect/Engineer:
Phone #:
Value of Work for this Permit: $
Type of Work: OAddi • OKilteration
Description of Work: CM/ VD)
Square/Linear Footage of Work: `� o
100
ew ORepair/Replace ODemolition
**** **** a:+ xx: *** ** **m*****+x ********* *** Fees****** �xx��x�x�x* �x****M a��x* ***�x�xx� ****�x�x *�x�x�:�x*****
Submittal Fee $ Permit Fee 00a CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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. 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 comme cement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued absence of such posted notice, the
inspection will nj! be approved an a rein.ypection fee will be charged.
Signature
.14
0 er or Agent
The foregoing instrum -nt was acknowledged before me this V
dayof/i'('? e ,20 / by He -4 y %Co 'a1" ,
who is psonally cTnown e or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: 4 12 )'7
Print:
My Commission Expires:
Y;/i P NA vot " o
•2G Yi n P. NavaITo
a(.�� lWN #EE030439
•,,as
Xis EXPIRES: SEP.. 28, 2014
• +4y° fl;; www.A RONNOTAItrcom
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of/M%ivi e4 , 20 /2 , by �� 'e re/7 77 d'„ d $�
who ers wnnne or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
l ilan i Kam
`�r.,� ¢ COMMISSION#EE030439
t•;I/WIRES: EXPIRES: SEP. 28, 2014
* * * * * ** * ** * * **** ** * * ***O*' 5************************************** ***a* *** * * * * ** ** ** * ***** *** ** ** * Y s
APPROVED BY
4/1-- Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
/2 Zoning
Clerk
NOTICE OF COMMENCEMENT
A RECORDEDOOPY M$ BE POND 044 THUDS SIR A.T/TIME OF f18ST ICI
f N O. TAX'S NO 11 20
STATE CF FLORIDA:
COUNTY OF MIAMI -DADS
THE INDERSIGNED ice► gives noticettet improvements ad be made to certain real
property, ard'maeoorriarreew Clavier 713,( Statutes, the following!! el i
is provided in this Naked Commencement
1. Legal description of proparty and street/address: q50 f10g,1��
in me" -7101 4 sis
111111111111111111111111111111111111111111111
CFN. 2012R0185697
OR ek 28034 Ps 3429; (111o)
RECORDED 03/14/2012 14:30:47
HARVEY RUVIN, CLERK OF COURT
IIIAIII -DACE COUNTY, FLORIDA
LAST PAGE .
2. Description of movement: -hi-1 C 1 /"t ae- & 1
3.O9er{s aname ► i c\ 5D a ' pD
thiaivl 1 glwv> 5'2 I%
Interest in property:
Name and address of fee simple titleholder.
4. Contractor's name and address:. -- <.
41) Per cA" e r S /7 a-
5. Surety: (Payment bond required by owner from contractor, if any)
Name and address:
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(1X47.. FloridaStahRes,
Name and address:
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 and address
9. Expiration date of this Notice of Commencement (the expitallon date is 1 year from the date of recording unless a
prent date Is
Signature of
Print • s Nature t"► P )/ 1'C o a /% f'( Prepared by
Swom to and subscribed before me this S' day of,/ti1Qn eh , 20 LI
Address:
Notary Public � 2-7a-t.a..vz-o
Print Notary's Name Y /Q % Ara yeti-1)z e
My commtssicxr e
OH-
1-13_01-313 004 PAGES
iTATE OF FLORIDA. COUNTY OF DADE
I HEREBY CERTIFY that This is a due copy of the
day of
11:1AM ii Y4 L , A D 20
WITNESS my hand and 1:I Sea
IAA
County Courts
D.C.
114.1a'o Ylan R Navarro
=?' tw` COM!ON #EE030439
21%.. .Z. q. • a
•
tamAt° WWW.AARONNOTARCooIn
1 CC`t4Y/
MAR 2 2 ?S
• °."
15' ALLEY
150.00'
APPRO ■yED
ZON!N �E� r
R,ILDG DEPT
BY
APPROVED
NrmitTeo. Ap- to 6 5C2-'v
Date: O'31IGll
lM_ij: tni Da;ie O.`.%un' k \
Health Depart-me Jf
EXISTING
SEPTIC TANK
TO BE ABANDONED
SUBJECT 10 COI\ AF LIANCE 1M rl-I ALL
STATE /'!IJC1 1_,N fHLLE
FEDERAL
INDEX
COVER SHEET
C-1 SITE PLAN
ARCHITECTURAL
13-1 EKISTINO DEMO FLOOR PLAN d'
A-1 PROPOSED FLOOR PLAN F'..
A-2 PROPOSED ELEVATIONS
STRUCTURAL
8-1 STRUCTURAL NOTES
8.2 FOUNDATION PLAN
8.3 ROOF FRAMING PLAN
S4 SECTIONS
8-5 SECTIONS
MECHANICAL
15-1 MECHANICAL PIAN
M-2 NOTES, SCHEDULES 6 DETAILS
ELECTRICAL
E-1 ELECTRICAL FLOOR PLAN/
Ed NOTES,SCHEDULES
PLUMBING
P -1 PLUMBING FLOOR PLAPSI
P.2 NOTEB,SCHEDULES
P4 SANITARY ISOMETRIC
P4 WATER ISOMETRIC
P4 GAS ISOMETRIC
EXISTING
ONE STORY
RESIDENCE
NEW
DRAIN
FIELD
667 SF
reArfz
23.60'
SEPTIC TANK 1050 GAL
p""",14.65'
--7
ASPHALT
DRIVE
N.E. 100 th STREET
12
11
10
9
e
\\\ 4
�\
\\ \
3
2
1
` 13
14
15
18
17
18
19 20
21
22
23
24
N.E. 99 TH ST
LOCATION SKETCH
LEGAL DESCRIPTION
LOT 5, 6 AND 7, BLOCK 170, SECTION NO. 8 OF MIAMI SHORES,
ACCORDING TO THE THEREOF. AS RECORDED IN PLAT BOOK 14,
PAGE 33 OF THE PUBUC RECORDS OF DADE COUNTY. FLORIDA.
150.00' WATER
METER
APPLICABLE CODES:
FLORIDA BUILDING CODE — RESIDENTIAL. 2007 EDITION
NFPA 101 — LIFE SAFETY CODE. 2006 EDITION
NEC -2008 EDITION
141 t1/41.
— — — —
SITE PLAN
SCALE I/8• =1.4r
N.E 10
NOTE:
AREAS:
THERE ARE NO PERTINENT FEATURE
ACROSS THE STREET OR ADJACENT
TO PROPERTY THAT MAY AFFECT
SYSTEM INSTALLATION
EXISTING HOUSE: 2,631 S.F.
NEW ADDITION: 887 S.F.
TOTAL: 3,318 S.F.
FLORIDA DEPARTMENT OF
HEALT
Rick Scott
Governor
H. Frank Farmer, Jr., M.D., Ph.D.
State Surgeon General
March 19, 2012
Jose Fernandez
350 W Park Rm 101
Miami, FL 33172
RE: Contingency Letter
Application Document No: API065628
Centrax Permit Number: 13 -SC- 1399078
OSTDS Number:
950 NE 100 St
Miami, FL 33138
Lot:5 -7 Block:170 Subdivision: Miami Shores
Dear Applicant:
This will acknowledge receipt of an application dated 03/15/2012 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
Proposed circular driveway.
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
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
STATE OF (FLORIDA)
COUNTY OF (DADE)
The undersigned Affiant, bal , does hereby attest that
Pr owner
( �ttY
The attached survey, performed by \ Wne \�N\i.e
(� t (Name of surveyor's company)
For address: —150 1t. \dOFier
Performed on 1 (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 Tess 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
struc res may affect final inspections as applicable to this or other permits.
Fu ntsay rth na
j Z •,
/6',y/iI,&
Property Own r Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this ' day of /ua n � `i g9 , 0/
Affiant is personally know to me, produced as identification.
Yilan P. Navarro
COMMISSION # EE030439 ;407,
, at
EXPIRES: SEP.28,2014
''•t i,: °•• www.AARONNOTARY.cam Notary
Revised on 5/22/2009/ Revised on 6/12/09
DOCUMENT COVER PAGE
For those documents not providing the required
space on the first page, this cover page must be attached.
It must describe the document in sufficient detail to
prohibit its transference to another document.
An additional recording fee for this page must be remitted.
Document Tide: ye'fJ% 71
(Mortgage, Deed, Construction ' n, Etc.)
Executing Party: d ', `J,
Legal Description:
(If Applicable)
1111111 11111 11111 11111 1111111111 11111 11111111
CFN ?O 12RO 1 S5 98
OR Bk 28034 Fss 3630 - 3632; (3vas)
RECORDED 03/14/2012 14 :30:47
HARVEY RUV'INr CLERK OF COURT
t1IAt1I -DAI E COUNTY, FLORIDA
(space above this line reserved for recording office use)
As more fully described in above described document.
Return Document To / Prepared By:
F.S. 695.26 Requirements for recording instruments affecting real property—
(Relevant excerpts of statute)
(1) No Instrument by which the title to real property or any interest therein Is
conveyed, assigned, encumbered, or otherwise disposed of shall be recorded by the
clerk of the dreult court unless:
(e) A 3 -inch by 3 -inch space at the top right -hand corner on the first' page
and a 1 -inch by 3 -inch space at the top right -hand corner on each subsequent page
are reserved for use by the clerk of the court...
CLK/CT 155 Rev. 04/11
4
Miami Shores Viiiage
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)' OV �� \O I1 hereinafter referred to as the owner of
the following described property (address): q50 rE Os\-reet
Legal Description 101`x11 mot 6 ) 7 Block 17o o Subdivision P ' Mtn) ) (A itT
J
Folio#
Requests permission to install (describe work): �\".f5 Qt
Within the public right of way of (address) NI I
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
1
until paid,
2. The owner, does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any
and all Iiability;'which may rise by virtue of permitting the Install Lion of these items within the public right of way.
OR B1'',. 23s e34 IF'1 3832
EAST PAGE
,,,�,,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
1,
..4112Z".
Ow- er or Agent
r,En,�y
The foregoing instrument was acknowledged before me this day of-11/'c-.4' , 20/2 , by Kea, ./ Y /to & Of
who is,personally know b me or who has produced As identification and who did take
an oath.
NOTARY PUBLIC:
Sign:
Print: i:,/Q.7,7 /V va-7172 v
My Commission Expires: S e j g -- -% 0/ V
2
,k0;;; PG° °y Yilan P. Navarro
COMMISSION #EE030439
;9���`or�'c EXPIRES: SEP. 28, 2014
WW W.AAR0NN0TARY.(m
STATE OF FLORIDA, COUNTY OF DADE
1 HEREBY CERTIFY that this is a true copy of the
original filed in tins office on / day of
wA D 20
WIT