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RC-10-402Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 173486 Permit Number: RC- 3- 10-402 Scheduled Inspection Date: July 12, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN9tL CHANGE-OF CONTRACTOR IS DONE IN EL PERMIT. PkWitiiiqiiiiiiinents REALEASE MC PERMIT CREATED AS REINSPECTION FOR INSP- 137783. All required inspections 2,7 ././_012._ � � must be approved prior to final >NB Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. cL July 11, 2012 For Inspections please call: (305)762 -4949 Page 9 of 23 Miami Shores Village 10050 NE 2 Ave, Miami Shores FI, 33138 Tel: 305- 795 -2204 Fax: 305- 756 -8972 Building Inspection Department This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: Square Footage Description of Work NONE Date Issued Occupancy R -3 Load Occupancy 1,334.52 SQ FT Type 540 GRAND) CONCOI1RSF Miami Shores FL 33138 - Location Not Transferable POST IN A CONSPICUOUS PLACE 514t-k Miami Shores Village Building Department 90050 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 Cpl RECEIVED APR 27212 Permit No. Master Permit No. /0--1-10 Permit Ty + e: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): �� J evo -w4r- Phone #: -S — ?Si -e) Address: City: /VV✓‘ 47‘444Z &V.■+A State: Tenant/Lessee Name: Phone #: CSACIntrerk t0. CC 'h 816- f N Email: JOB ADDRESS: City: Zip: 37" i3 Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Phone #: Address: � - . City: w( State: Si Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 6 14"-t e-i- nare/Linear Footage of Work: Type of Work: °Addition °Alteration UNew C]Repair/Replace °Demolition Description of Work: *+x********* * * * ** x**+ x**a:: ***** *+ x*+ r****** Fees**x: ******* *+ x******* ******:x **** **** **** *** *** Submittal Fee $ il Permit Fee $ 07b CCF $ CO /CC $ Scanning Fee $ IL, OD Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE$ ;: 03 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, BOTT ERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S Ai'EIDAVIT: 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 w 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. Signature Signature Owner or Agent Contractor / The foregoing instrument was acknowledged before me this G' �y The foregoi g instrument was acknowledged before me this day of AM L , 201 , by Drlt2- Lae A(( , day of , 20 _, by who is personally 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 identification and who did take an oath. NOTARY PUBLIC: ```��j1111tttttt� " NOTARY PUBLIC: 2 *G �xx� �xa�x� �x+x *�x x �s �x a �xx� �x+x� *.n +x+xma x�x:11/1"/ItaiS�it*IN* x"°+ xx� *�x�:a��x�x�x�x**** *+xa�**4" : x:+ xx�* �k�x+ ��xx��x+��x *�x�x�n�xx:x��x�x *+x +xx�+x*** **** Sign: Print: My Commission Expires: Sign: Print: My Commission Expires: APPROVED BY �`r /M— Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: Y' �j'Y t &V1 DATE: Lib -7 // ADDRESS: 5110 Cfr,rid. CCA^%eGur . Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new fdrm states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial N c 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. Initial Initial ��k� 6. I understand that] may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is,my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. 1, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I wit abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that 1 may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.mvfloridalicense.com /dbpr /pro /cilb /index.html Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner- builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of I �- , 20 12_ Produced there License or who was personally known to me or who has cv) as identification. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR 1 ARCHITECT Permit N. lo Owner's Name (Fee Simple Title Holder): \-)ettlisK. S einCtAir- Owner's Address: SLf0 C— 1 C � City: IVIL Skope S State : Phone #: 7,51-,k0-7 Zip Code: ` 3 Job Address (Of where work is being done): S.-17 0 , 4J_ 64Jrafist City: Miami Shores State: Florida Zip Code: 33l S� Contractor's Company Name: YC. Vc, Phone #: Address: City: State: Zip Code: Qualifier's Name : Lic. Number: Architect/ Engineer of Record Name: Sa - Phone #: Address: City: State: Zip Code: Describe Work: I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Mia j ' Shores harmless for all legal involvement. er or Agent The foregoi ' strument was aknowledged before me this21 day of AIL (-- 20 ,by` &Zrek. 11-12' Who is personally known to me or who has produced as indentification. \ \ \ \ \ \` 1111111 I1 Vo �1/,,,! Notary Publi Sign: Seal: Signature Contractor or Architect The foregoing instrument was aknowledged before me this day of , 20 by who is personally known to me or who has produced as indentification. Notary Public: Sign: Seal: March 12, 2012 Keith Johnston Construction, LLC 9740 SW 16th Street Pembroke Pines, FL 33025 RE: 540 Grand Concourse Miami Shores, FL 33138 Keith, Please be advised that the intent of this letter is to inform you that you will no longer be the contractor on record for the property located at 540 Grand Concourse Miami Shores, FL 33138. Thank you for your time and cooperation concerning this matter. Regards, Darik Smart COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the maiipiece, or on the front if space permits. ❑ Agent ddressee 1. Article Addressed to: 7L s4) ) 6,11'• ST. N t—A b IP! VI SS rt 3 30.)--s- 2. Article Number (Transfer from service labep PS Form 3811, February 2004 B. Received by (Printed Name) of Delivery D. Is delivery address different from item 1? ❑ Yes if YES, enter delivery address below: ❑ No ce Type Certified Mall ❑ Express Mall ❑ = • !stared ❑ Return Receipt for Merchandise ❑ Insured Mall ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) 7010 2780 0002 0036 1177 ❑ Yes Domestic Retum Receipt 102595 -02 -M -1540 4 • NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 11)_ a TAX FOLIO NO. Sao6— On— ) 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. 111111111111111111111111111111111111111111111 CF1hhi 2010Ri a310726 0R Bk 27278 Ps 1813; Ups:, RECORDED 05/10/2010 11:10 =19 HARVEY RUVII'dp CLERK OF COURT MIAMI-DADE COUNTYp FLORIDA LAST F'AGE 1. Legal description of property and street/address: % S 3 to-- i\ t d &i,xerts Sec 14 rt ".} PB 1 r-111 Let F L4' J.5- .7 ZDT + i6e u. n.. CO I-4 6C 1\)-- pft - A) • L t3 ©I - (. 2a-tt SwL i3 d C-stetia e cur {e zk ^�; (( 3 3 i3 g Ck.a� ( N 1 c f FC 331.q: 2. Description of improvement: 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder: 4. Con actor's name and address: (IC 5. Surety: (Payment bond required by owner from contractor, if ar.ATE OF FLORIDA, CO I HEREBY CERTIFY that this origin& fi Name and address: Amount of bond $ 6. Lender's name and address: DADE pyofthe hand and 0 iciai .C. 7. Persons within the state of Florida designated by Owner upon "' • • i, • `'• , • o —' ens ay be serv- • as provided by Section 713.13(1)(a)7., Florida Statutes, 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: C Camesc ftea44.1 ShciY,c f 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date ism - d) Print Owner's N �wornit `(-- ..41 and subscnbed before m i•� . '•t�ay.' .1 �'i , 2016 p .' 49fi v`luti1) ••. • t Ua . MO 0, /,,I,ili11111111� .gyp d Prepared by Notary Public Print Notary's Name My commission expires: 123.01 -52 PAGE4 8/02 Address: -016 G-4 Ctoucturtt VA V4•4i S41 rI 1313$ Miami Shores Village polgEWED Building Department MAR 3 0 2010 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 . `�.- ...., Tel: (305) 795.2204 Fax: (305) 756.8972 BY: " " "" INSPECTION'S PHONE NUMBER: (305) 762.4949 j j� Permit No. 1 \ J 4O2. Master ,Permit No. BUILDING PERMIT APPLICATION FBC 20 c Permit Type: Owner's Name (Fee Sit leTitleholder) _ dirt K , 6 Owner's Address t� &fc ,, CrAtoccuric City it t SIBS State R Phone # 36,g" 7 S-1[ Zip Tenant/Lessee Name Phone # Email CLAP VIVrf. I �. CrOwtCcf.,St , Pe Job Address (where the work is being done) SltO i 1 C City Miami Shores Village County Miami -Dade Zip 33 (3 FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone /" a Contractor's Company Name e607, )O a /'?r Z-Ze Phone # S S- 573 Contractor's Address l ® J.) / " -Cl City t6G7,g/i6 f lot9-? State fig' Zip 5'3 °Z Qualifier Name / /�// 774L,fr V6 - Phone # ZeT 39Q - 3 State Certificate or Registration No. C6C /5/21,2 Certificate of Competency No. Contact Phone 20,( 3 70 d.577&% E -mail e/%� 2 f2 ) e 407 Architect/Engineer's Name (if applicable) --3—i'vvk S not t14. Phone # Value of Work For this Permit $ Type of Work: Describe Work: / r` '-_ Square / Linear Footage Of Work: 1 38, dition ❑Alteration ONew ID Repair/Replace emolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** I� et/6706 !. nJ Submittal Fee $ r..� l _,I 1>>i Permit Fee $ e/67 CCF $ CC $ 5� Notary $ Training/Education Fee $ � � 0 Technology Fee $ I 11 .t., 0 Scanning $ Radon $ Co DPBR $ �'" (S Band $ ROO Violation date: Structural Review. $ mp 6-0 l'4° Total Fee Now Due $ 41°141 •W • Double Fee $ See Reverse side -* 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�.wgrli or installation has commenced prior to the issuance of a permit and that all work will be performed to ehe standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for EL Gel`- €?RICAL 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 ap r. .. nd a reinspection fee will be charged. Owner or Agent The foreg g instrument was acknowl ged be re me 's day o &(°`,20)0,by 1'i 5 who i personally known to me or who has produced who is pe identification and who did take an oath. 11 Contractor The foreg • g instrument was acknowledged bef�r me day o , 20 10 , by / J *7 sonally known to me or who has produced ification and who did take an oath. TARY ' UBLIC: NO Sign: Print: My Commission Expires: ARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY .V3040. ,50r1"'`' Plans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked PERMIT # CONTRACTOR: SUBMITTAL DATE: 1'i( vfC ADDRESS: 540 r yi NAME: M\G,i Ja1C1; MID RESUBMITAL DATES: ZONING FIRE 3/i6/0 -2// 3,(3 /r® 3 ST UCTURA Ott-Aft tee ritreOP ELECTRICAL '<— 9(c - 313ilk, PLUMBIN6* p3C.f. MECHANICAL IMPACT FEES 4 HRS /DERM NOC BLDG 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 Permit No. 7i \ 0- 1-0g, Master Permit No. BUILDING" PERMIT APPLICATION FBC 20 Permit T e BUILDING ROOFING tiTACM,Wq MAR 1 1 2010 B Y : - . - — - ' Owner's Name a eholder) �G('i 1L # MflirtAcri ) Smot-12-1 'Phon�# 30) L 12-.7 Owner's Address '',t4 0 Cmrei", a. C mac.[.- 4- -r'S∎c'� City i� `rA v DL LS State - • Zip 3"a VYZ Tenant/Lessee Name Y\ 0 ►' \ IL... Phone # Email (mwr '--4-h L-49' C C C.tS"fi 10J - -- Job Address (where the work is being done) S-H 0 ' G ( r1, - c- S ( 1 g ) City Miami Shores Village County Miami de Zip 33 : ��,. FOLIO / PARCEL # 1� 3 act-e- D1,1- I ti Is Building Historically Designated YES Contractor's Company Name 1401/1/r- Contractor's Address City Qualifier Name State Certificate or Reiistration No. Contact Phone Architect/Engin er's Tame (if applic . ble) Value of Work For Type of Work: Describe Work: s Permit $ ddition Ow C 5 DAlteration 0 i7 '1 c(CQ( 4 61bCX cT1 Fib 5 , \�} Flood Zone f hone # Zip Phone # care of Competency No. h Pho e # 3(6J -cve Square / Linear Footage Of Work: 13 Z e s (New ❑ Repair/Replace ❑ Demolition escri a or . r _ 1— * ** * * *** * * * * * * * * * * * * * * * * * * * * * * * * * ** , Fees************** * * * * ** *,* * ** ** * * * * * * * * * ** * * **** U �Sra CC/*' Submittal Fee $ - Permit Fee $ CCF $ CO /CC $ Notary $ Training/Education Fee $ . Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ 6 0 a A� �I 1_ Total Fee Now Due $ See Reverse side -* 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 PLUM BING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AN'F1DAVIT: 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 o rs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app oved a reinspection fee will be charged. 1 \ Signature Owner or Agent The foreginstrument was ac day o N;20 0bY who is p.-rsonajy_ known :e wledged befor this ) or who has produced fication and who did take an oath. NOT Sign: Print: My Commission Expires: ,°� b'��4' **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this day of ,20_,by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: ************************************** * ** * * * * * * * * * * * ** * * * * * * * * * * * * * ** 01) 3,1X0 Zoning Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME. -ACk 4C-- `M4 ✓(en■ S ,St 144 DATE: 3'I t ADDRESS: ( c5 �r�, .-�.�` Cc c Inn kSho re_S Do hereby petition the Village age of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And 1 have read and understood the following disclosure statement, which entitles me to work as my own contractor, I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied fora permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must _ supervise the construction yourself. You may build or improve a one - family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a bu have built yourself within one year after the construction is complete, the law will presume that you built for sale o ease, whi a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the peopl mployed by you have licenses required by state law and by county or municipal licensing ordinances. Any person wo ng on your buil ! who is not licensed must work under your supervision and must be employed by you, which means that you mu deduct F.LC.A . with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your onstru 'on must comply all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 understand that state law requires co r tructlon t permit under an exemption from the Ia*r The exem contractor with certain restrictions even though 1 do n 2. I understand that building construction a < is not hiri r and hive applied for an owner- builder owner of the property listed, may act as my own uired to be by a property owner unless he or she is respo le for the or to assu • nit>itity. 3. 1 understand that, 1. an owner from potential finan ial risk by hi name. I also unde nd that the permits and contracts Initial nsible party of record on a permit. I understand that 1 may protect myself contractor and having the permit filed in his or her n = ins t:,,.((.jj•�� my own fired by law to be licensed in Florida and to list his or FL: hers on Initial 4. 1 understand that I may ild or improve a on =milt' or two-family residence or a farm outbuilding. I may also build or improve a commercial building if , : costs do not exceed $75,000. The building or residence must be for my use or occupan t may not be built or substanti . improved for sale or lease. If a building or residence that I have built or subs tially s .ved elf is sold or leased `', in 1 year after the construction is complete, the law will presume that I built „ s Ily oved it for sale or leas which violates the exemption. Initial 5. I understand the as the own r- builder, I must provide direct, onsite supervision of the construction. ealp Intal 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law unty or municipal ordinance. 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner- builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I gm willfully r as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licerwed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be.employed by me, which °means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial ,tiwv 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by ail l . ble laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand I -► contact the Florida Construction Industry Licensing Board at 850.487.1395 or htto:/ /wwrw.mvfloridalicense.com/dbor /p 1 Initia 11. I am aware of and consent to; an owner- builder building permit applied for in my name and understands that 1 am the party legally and financially responsible for the proposed construction activity at the following address: 5&C G t fit. ac c c �✓►.i ∎071 LC rte, Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this I 1 day of 4;irC-S4 , 2010 BY015tw(AniS SmC+yl Produced �-'nse or 71 who was personally known to me or who has 1C.Q��O Q�.2 ..90 dentification. N, h In NOTARY � 14. 9IN- 1 o�p „ae, C� lu e t vat. DEVELOPMENT ORDER File Number: PZ- 10 -09- 2009163 Property Address: 540 Grand Concourse Property Owner /Applicant: Darik Smart Address: 540 Grand Concourse, Miami Shores 33138 Agent: Address: James Smith 11633 NE 11th Place, Biscayne Park FL 33161 Whereas, the applicant Darik Smart (Owner), has filed an application for site plan review before the Planning Board on the above property. The applicant sought approval as follows: Special Approvals, Sections 600 & 523: Site Plan Approval, Second story and first flood addition.. Whereas, a public hearing was held on November 12,2009 and the Board, after having considered the application and after hearing testimony and reviewing the evidence entered, finds: 1. The application was made in a manner consistent with the requirements of the Land Development Code of Miami Shores Village. 2. The conditions on the property and the representations made at the hearing merit consideration and are consistent with the requirements of the Land Development Code. The Board requires that all further development of the property shall be performed in a manner consistent with the site plan, drawings, and the conditions agreed upon at the hearing: 1) Applicant to secure necessary DERM or Department of Health approval for the septic system prior to the issuance of a village building permit. 2) Applicant to meet all applicable code provisions at the time of permitting. 3) This zoning permit will lapse and become invalid unless the work for which it was approved is started within one (1) year of the signing of the development Page 1 of 2 DO PZ- 10 -09- 2009163 Smart order by the board chair, or if the work authorized by it is suspended or abandoned for a period of at least one (1) year. 4) Approval is for additions to the residence, approval does not include the cabana. Additionally, the applicant must, satisfy all applicable Miami Shores Village Codes, Miami -Dade County Codes, the applicable building and life safety codes required for development, and provide a copy of the development order to the Building Dept. The application with conditions was passed and adopted this 12th day of November, 2009 by the Planning and Zoning Board as follows: Mr. Abramitis Yes Mr. Busta Yes Mr. Reese Yes Mr. Madsen Yes Chairman Fernandez Yes Date Richard M. Fernandez Chairman, Planning Board Page 2 of 2 DO PZ- 10 -09- 2009163 Smart 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:1132060171411 Owner's Name: DARIK & MARLENIS SMART Job Address: 540 GRAND CONCOURSE Miami Shores, FL 33138- Owner's Phone: (305)751 -8127 Total Square Feet: 528 Total Job Valuation: $ 73,000.00 Contractor(s) HOME OWNER Phone Primary Contractor Yes 1 Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 3/15/2010: Yes Comments: Permit No: 10-402 Job Name: March 25, 2010 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 1) Provide receipt from Miami Dade planning and Zoning for impact fees. 2) Provide permit applications for all subs (Electric, plumbing, mechanical, roofing, all site work including fences and flat work) 3) A demolition permit application is required. 4) Corrections for mechanical, plumbing, electrical and structural must be completed. 5) Provide energy calculations per FBC R 2007 -09 6) The footing schedule does not have all footings shown on plan. 7) Provide a soil boring report and a soil bearing capacity certificate. 8) Provide a note for corner bars in foundation and beams. 9) The minimum depth to the top of the footing is 8" provide a note showing depth to top from grade. 10) Provide a filled cell minimum at the door at stair. 11) Provide a detail for the change in elevation at the beam. 12) Plans specify that beams are arched and that arches are of wood. Please clarify. Note: all portions of exterior walls must be of masonry or concrete. 13) Provide a special inspector form. 14) Provide truss plans for the floor and roof. 15) The detail of the fascia does not provide the required diaphragm boundary and does not match the sheathing detail. 16) The sheathing detail shows 8d ring shank at joints and 10d at joints. Sheathing detail requires blocking, identify location of blocking. 17) Provide design wind loads for all exterior openings that are new or altered. 18) Provide a detail showing bucks and waterproofing at openings. 19) PA for Single Hung have been submitted but plans show Horizontal Roller. 20) The product approval for the doors does not match the specified PA on the plans. 21) Show means of escape from the sleeping rooms. 22) Provide a detail for the stairs and guard rails /handrails. 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 v IVIlami Shores Village .Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 0 — 40 2 Job Name 5-177 ai- Date 3726 //e STRUCTURAL CRITIQUE SHEET Pie. 9 td e 4 Ch Lail dal/6 Pla d C tt iv er-r-arc. Place C-12)frh4leli k 11C' fe ott 147' e 5 fen l r■ C-f ie V el 6 PERMIT #: C 10 ' 47 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT DATE:da'Wl (oo o Contractor yti Owner o Architect Address: 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: 3731c2-010 PERMIT CLERK INITIAL: U ''-- -� March 27, 2010 Miami Shores Village Building Dept. Plan Correction Comments Re.: Job Address: 540 Grand Concourse Permit No. RC 10-402 Critique Response Building Critique: #1 Item 1, 2, & 3 by owner. #2 Item 4, Corrections have been completed. #3 Item 5, Energy calc. are being provided. #4 Item 6, Footing schedule was corrected. #5 Item 7, Soil note added to plans. #6 Item 8, Detail of corner bars was (is) on S-4. #7 Item 9, Depth of footing is corrected. #8 Item 10, New masonry shows two on each side #9 Item 11, The engineer informed me there is no beam that has a change of elevation. #10 Item 12, All Arched beams are poured concrete as detailed, the note was for interior arches that are at the opening between the existing structure and the addition. #11 Item 13, Special inspector form is provided. #12 Item 14, Truss shop drawings will be provided, #13 Item 15, Fascia detail was corrected to match structural. #14 Item 16, Nail note has been corrected. #15 Item 17, Wind loads for openings are on S -5 #16 Item 18, Detail added to A-4. F #17 Item 19, PA for Single hung windows was in error. Added Horizontal roller PA. #18 Item 20, the number for the doors PA was corrected on the schedule. #19 Item 21, Means of egress was added to exist. bedrooms. #20 Item 22, Stair detail is on S -3, Railing will be provided with shop drawings. Structural Critique #1 Item 2, Conflict with lines and notes has been corrected. #2 Item3, Chimney structure has been clarified Plumbing Critique #1 Item 1, HRS stamp was provided on A -1 & the back of P -2. #2 Items 2, Layout for hot and cold water supply has been added to plan. #3 Items 3, Size & location of service and the unit fixture count is added to plan P -1. #4 Items 4, Exist. W/H is Gas tank -less type by `Rinnai', noted on plans. Electrical Critique #1 Load calculations has been added to plans. #2 Added additional smoke / carbon monoxide detectors. #3 Corrected bath breaker to 20 amp. #4 Floor receptacle added to second floor. Mechanical Critique #1 Energy Calculations will be provide as FBC R 2007 -09. March 27, 2010 Miami Shores Village Building Dept. Plan Correction Comments Re.: Job Address: 540 Grand Concourse Permit No. RC 10-402 Critique Response Buildinv,Critiaue: #1 Item 1, 2, & 3 by owner. #2 Item 4, Corrections have been completed. #3 Item 5, Energy calc. are being provided. #4 Item 6, Footing schedule was corrected. #5 Item 7, Soil note added to plans. #6 Item 8, Detail of corner bars was (is) on S-4. #7 Item 9, Depth of footing is corrected. #8 Item 10, New masonry shows two on each side #9 Item 11, The engineer informed me there is no beam that has a change of elevation. #10 Item 12, All Arched beams are poured concrete as detailed, the note was for interior arches that are at the opening between the existing structure and the addition. #11 Item 13, Special inspector form is provided. #12 Item 14, Truss shop drawings will be provided, #13 Item 15, Fascia detail was corrected to match structural. #14 Item 16, Nail note has been corrected. #15 Item 17, Wind loads for openings are on S -5 #16 Item 18, Detail added to A-4. Permit No: 10 -402 Job Name: April 12, 2010 Miami Shores 'iIIage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) Provide receipt from Miami Dade planning and Zoning for impact fees. 2) Provide a soil bearing capacity certificate. 3) Provide a detail for the change in elevation at the beam. The upturn beam at the balcony is a change in elevation. 4) Provide truss plans for the floor and roof. 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 Fmt co 9 Miami Shores Vipiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: I � 1 � - DATE: 141(LI 1 2.f-1 h \ SVv\ ❑ Contractor r Owner ❑ Architect Picked up 2 sets of plans and (other)�� VAS Co`� %M.2 Address: v`&( (0-6,") Cc (\s 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 .ermitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 149592 Permit Number: RC- 3- 10-402 Scheduled Inspection Date: August 03, 2010 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Slab Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA Inspector Comments Passe d r-/� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. August 02, 2010 For Inspections please call: (305)762 -4949 Page 25 of 31 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 149584 Permit Number: RC- 3- 10-402 Scheduled Inspection Date: August 03, 2010 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Footing Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 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- 144950. CREATED AS REINSPECTION FOR INSP- 137758. Provide soil bearing capacity certificate. NB Not Ready NB August 02, 2010 For Inspections please call: (305)762 -4949 Page 24 of 31 TRULY NOLEN Of CA, INC. 4474 NW 12$ ST. OPALOCKA FL 33054 Notice of Preventative Treatment for Termites (as required by Florida Building code (FBC) 104.2.6) 540 Grand Concourse Miami Shores Fl 33138 Address of Treatment or Lot /block of Treatment 07/28/2010 Date Premise 75 Product used 10:30 a.m. Alfredo Brown Time Applicator Imidacloprid 60 Chemical used (Active Ingredient) Number of gallons applied 0.5 600 94 feet Percent Concentration Area Treated (square feet) Lineal Feet treated Stage of treatment (horizontal, vertical), adjoining slab, retreat of disturbed area) As per 104.2.6 — if soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. If this notice is for the final exterior treatment, initial and date this lane 07/28/2010 TRULY NOLEN OF AMERICA. 4474 N.W. 128"' ST, FL, 33054. 305 - 685 -7411. F 305 - 685 -7416 TRULYNOLEN.COM US South Engineering & Testing Laboratory, Inc. 14345 Commerce Way, Miami, FL 3301 6 Phone: 305.558.2588 1 Fa x: 305.362.4669 DATE: 7/26/2010 REPORT OF FIELD DENSITY TEST (SOIL COMPACTION) CLIENT: Derrick 861 bEgdittotto& , , , , , '' ' ' 1 ' PROJECT: Residential Home ■ , ,ciiiiiitiiiiiMoisture (o70) ' ' 13242 540 Grand Concourse 110.7 12.2 540 Grand Concourse 1 Center of dining room under the slab Miami Shores, FL 33138 13242 Miami Shores, FL 109.4 TOR .4419 : i,.,, gi,,„ ii';;:, ;6■ ,‘ 44.;,64,,,:;;'..'',', 861 bEgdittotto& , , , , , '' ' ' 1 ' ,.. . .VALUE - .. .m. ,...14- s .1D-,-, -.0,1ifol).r,, ,-• Max. 17 . ens' g '''s ■ , ,ciiiiiitiiiiiMoisture (o70) ' ' 13242 Brown Sand With Traces of Rock 110.7 12.2 lellELD DENSITY TEST ACCORDING TO ASTIVI METHOD D-2922-71 TEST No. : i,.,, gi,,„ ii';;:, ;6■ ,‘ 44.;,64,,,:;;'..'',', :,.'. ;2 n*''•',17;'.,' ', 1XI ,;'•1' DS0(,, . Y00, / , J e‘'.• 0J"„. ' 0 d..„ , 4 " ,. A,.vEgt I 1 Center of dining room under the slab 13242 FINAL 109.4 5.2 98.8 PASS 2 Center of family room under the slab 13242 FINAL 106.2 7.5 95.9 PASS 3 Center of dining porch under the slab 13242 FINAL 108.5 6.5 98.0 PASS 4 Center of covered porch under the slab 13242 FINAL 107.3 7.8 96.9 PASS 1 ' ' '', tniAt#,I*47 1* . ,:. , (!, : ' ' '' , '.''' ' . ',. . , ''' ':.';',•''',;', P= PASS F=FAIL FT=FOOTING SG=SUB-GRADE BC=BASE COURSE MH=MAN HOLE Respectfully submitted, Ghasem Khavanin, P.E. 7 Florida Registration # 41955 CESAR A. GRANADOS, P.E. April 17, 2010 Building Inspector Miami Shores Village Building Depai tnnent 10050 N.E. 2' Avenue Miami Shores, Florida 33138 RE: Smarts Residence 540 Grand Concourse Miami Shores, Fl. 33138 Dear Building Official: I, having performed a . visual inspection as required, and verified the existing soil condition consist of Sand, silty sand, and silty gravel, hereby attest that the site was observed, and the foundation conditions are similar to those upon which the design is based, With a Soil Bearing Capacity of 2,000 psi as it was established in the soil statement in sheet S -1 of the structural plans and following Table 1804.2 of the F.B.C. 2007. This document is being prepared in accordance with the requirements of the Florida Building Code and must be submitted to the Miami Shores Village Building Department for the above referenced structure. Should you have any questions or need any additional information, please do not hesitate to contact me.: Sincerely, --)-4tJ Cesar Granados, P.E. P.E. No. 64221 �- /"j® 9510 S.W. 6th Court, Pembroke Pines, Florida 33025 Phone : 954 -638 -0318 Phone : 954 - 593 -8871 Fax : 206 - 339 -2616 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 137765 Permit Number: RC- 3- 10-402 Inspection Date: September 08, 2010 Inspector: Dacquisto, David Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Spot Survey Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA Inspector Comments 1313a k. 11.0:1^ � c 5. Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 September 08, 2010 Page 1 of 1 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Importa eed the instructions on pages 1 -9. OMB No. 1660 -0008 Expires March 31, 2012 1. Building Owner's Name 1iARTTi cwreum Al n MART ITT e 0 646 Policy Number SMART A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 540 GRAND CONCOURSE Company. NAIG:Ngmbe brae SHORES SECTION A - PROPERTY INFORMATION For insurance +Company, FLORIBre 331:ijde A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 4 E 15' OF LOT 5 & PO_.TION OF BLOT' 3 BLOCK 97 P.B. 15 PAGE .14 MIAMI -D A4. Building Use (e.g., Residential Non - Residential, Addition, Accessory, etc.) RESIDENTIAL / CONSTRUCTION A5. Latitude /Longitude: Lat. N25 d 51' 58" L W80°1 11 10" A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. Horizontal Datum:. ID NAD 1927 A7. Building Diagram Number 8 ,, A8. For a building with a crawispace or enclosure (s): (s ) a) Square footage of crawlspace or enclosure A9. For. a building with an attached garage: 960 sq ft a) Square footage of attached garage 320 sq ft b) No. of permanent flood openings in the crawispace or enclosure(s) b) No. of permanent flood openings in the attac garage es) within 1.0 foot above adjacent grade 8 within 1.0 foot above adjacent grade e4 A c) Total net area of flood openings in A8.b 960 sq in c) Total net area of flood openings.in A9.b N/A sq in d) Engineered flood openings? Yes No q ❑ ® d) Engineered flood openings? ❑Yes ®No X NAD 1983 SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION• B1. NFIP Community Name & Community Number B4. MaptPanel Number 12086C0306 B5. Suffix L . B6. FIRM Index • Date 9/11/09 B7. FIRM' Panel Effective /Revised Date -9/11/09 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile IN FIRM Community Determined ❑ Other (Describe) B8. Flood Zone(s) X B11. Indicate elevation datum used for BFE in Item B9: NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date ❑ CBRS ❑ OPA X .B9: Base Flood Elevation(s) (Zone • AO, use base flood depth) N/A [1] Yes ®No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ® Building Under Construction* U Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones Al A30, AE, AI-I, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO. Complete Items C2.a -h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized F-603-1 Vertical Datum NGVD Conversion /Comments N/A a) b) c) d) e) f) 9) h) Top of bottom floor (including basement, crawlspace, or enclosure floor) Top of the next higher floor Bottom of the lowest horizontal structural member (V Zones only) Attached garage (top of slab) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 11 -95 feet ll �2 feet X X X feet 9 .40 ® feet 9 .95 ® feet 9 40 ® feet 9 .9-5-® feet N/A X feet ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. El Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? © Yes ❑ No Certiifier's Name License Number ADIS N. NUNEZ 5924 Title REGISTERED LAND SURVEYOR Address 555 SORE Signatu BLANCUNsURVEYORS, BEACH F-EM. -F- rimy- 8-1 -31 -, Mar-09 INC. State ZIP Code FLORIDA 33141 Telephone (305.) .8.65 -1 200 - -See reverse side for continuation IMPORTANT: In these spaces, copy the corresponding information from Section A. ,-Building,StreetAd ressir(inOuding Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. o bi AiTD' CONCOUEtSE Ci MIAMI SHORES oc InsuranceCompany Use FLabA 33138ZIP Code i ripariy NAIL., N umber SECTION D - SURVE OR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments C2. e) A/C SLAB ELEVATION, DCBM #N -603 -R LOCATOR#3250SW ELEVATION8LONGITUDE OBTAINED BY GOOGLE. ROAD ELEVATION: @ CENTERLINE ON CENTER OF THE ROAD. 9/2/10 SECTION E = BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZON A Check here if BFE) attachments (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. Et Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade.(LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure ) is b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑feet ❑meters ❑above or ❑below the HAG. E2. For Building Diagrams 6 -9 with permanent flood openings provided in Sectio4 Items 8 a❑nd /or 9 (see oa es 8❑-9of Instructions) tithe next higher floor (elevation C2.b in the diagrams) of the building E3. Attached garage (top of slab is g is • -=- feet 11 meters above or below the• HAG. . . ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO oral : If no flood depth number is available, is the top of the bottom floor elevdted in accordance•with the community's floodplain management ordinance? Lj Yes ❑ No. ❑Unknown. The Local official must certify this information in Sectioa.,G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA - issued°or community - issued BFE) or Zone AO must sign here. The statements In Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address Signature City State ZIP Code Comments Date Telephone ❑ Check her if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (ot E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. G1. ❑ The information in Section C was taken from other.d©cunentation that has been signed and sealed by a licensed surveyor, engineer, or architect who G2. ❑Is authorized by law to certify elevation information. ;(Indicate the source and date of the elevation data in the Comments area below.)• A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3. ❑ The followin g information (Items G4-G9) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance /Occupancy .issued - G7. This permit has been issued foc ❑ New Construction G8. Elevation of as -built lowest floor (including basement) of the build* Substantial Improvement G9. BFE or (in Zone AO) depth of flooding at the building site G10. Community's design flood elevation Local Official's Name Community Name Signature ❑ feet ❑ meters (PR) Datum ❑ feet ❑ meters (PR) Datum ❑ feet ❑ meters (PR) Datum Title - Telephorie Comments Date EEMA_FoTin -5 -73-1. Mac O9 Check here if attachments, z= 0 O 0 '130.00' ( R & M ) ‘1„\-1 '111111111MAtell z= a LOCATION SKETCH SCALE: NTS s 1.60' C z- 0 :0 4r 6 p '� W -1 FOUNTAIN CO O r - � - - lc, 0 130.07'(R&M) 7 :z O NOT VALID UNLESS EMBOSSED WITH SURVEYOR'S SEAL ABBREVIATIONS: SWK= SIDEWALK CBS = CONCRETE BLOCK STRUCTURE, CLF =CHAIN UNK FENCE, PL =PROPERTY LINE, DUE =DRAINAGE UTILITY EASEM ENT, IP =IRON PI 2E, F =FOUND, NC =AIR CONDn'IONER PAD, P /C= PROPERTY CORNER, D/H= DRILLED HOLE, V'F =WOODEN FENCE, RES= RESIDENCE, CL- CLEAR, RB= REBAR, UE= UTILITY EASEMENT, CONC= CONCRETE SLAB, R/VIARIGHT OF %GAY, DE= DRAINAGE EASEMENT, C/L= CENTER LINE, 0= DIAMTER, TYP =TYPIC IL, M= MEASURED, R= RECORDED, ENCR =ENCROACHMENT, COMP =COMPUTER, ASH = ASPHALT, N/D =NAIL & DISC, S =SET, FEE = FINISH FLOOR ELEVATION, 0 /S= OFFSET, PIP =POWER POLE, OHP= OVERHEAD POV9ERLINE, WM =W4 TER METER WOOD FENCE= MASONRY NALL =1 I I I I I I I I 1 ELEVATION BASED ON LOC. # 3250 SW CONCRETE= CBM# N-6O3 —R ELV 1' MAIM 'ENANCE&DRAINAGEEASEMENT= M &D.E. ' . g,1TYPE OF SURVEY: BOUNDAF :'SURVEY SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATUFE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED•HERE IS NC-T COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5) UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODET C VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITJON,1.1. RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 9) CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BEMADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB PAGE REVISED: C Fri SURVEY FOR: DARIK SMART, 540 GRAND CONCOURSE, MIAMI SHORES, FLORIDA 33138. LEGAL DESCRIPTION: Lot 4 and the Easterly 15 feet of Lot 5 and the following described portion of Lot 3, all in Block 97, AMENDED PLAT OF MIIAMMI SRORES SECTION FOUR, according to the plat thereof, as recorded in Plat Book 15, at Page 14, of the Public Records of MIAMI -DADS COUNTY, Florida: Begin at the moat Westerly corner of Lot 3, Block 97, of the Amended Plat of Miami Shores Section Four, Plat Book 15, Page 14, of the Public Records of Miami -Dade County, Florida, thence Northeasterly along the Northwesterly boundary of said Lot 3 and along a circular curve having a radius of 1849.79 feet through a central angle of 0 °11134" for an arc distance of 6.22 feet to. a point, thence Southeasterly for a distance of 130.07 feet to a point 'on'the Southeasterly boundary of said Lot 3, said point being located on 10 feet Northeasterly from, as measured along the Southwesterly boundary line of the moat Southerly corner of said Lot 3, thence Southwesterly along the Southeasterly boundary of said Lot 3-and along a circular; curve having a radius of 1719.79 feet through a central angle of 0 °19459" for an arc diutanae of 10 feet to the most Southerly corner, of said Lot 3, thence Northwesterly along the Southwesterly boundary of said Lot 3, for a distance of 130 feet to the Point of Beginning (the "Property"). i HEREBY CERTIFY That the survey represented thereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. ADIS N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 SINCE 1987 BLANGO SURVEYORS INC. Engineers • Land Surveyors • Planners • LB # 0007059 555 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 (305) 865 -1200 Email: biancosurveyorsInc@yahoo.com Fax: (305) 865 -7810 FLOOD ZONE: PANEL: 0306 SCALE: 1 " =20' SUFFIX: L DATE 9/11/09 BASE:N /A' COMMUNITY# 120652 JOB Nn 10 -646 DWN. BY: F. Blanco may. L. LV I U t. V71 In A a CERTIFICATE OF LIABILITY INSURANCE (1O, J/44 r. I/ I DATEIMM/DDIYYYY) 05/1212010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to , the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Admin Insurance Group, Inc. 780 Dalton Blvd. Suite 201 Deltona, FL 32725 -7128 INSURED Keith Johnston Construction, LLC 9740 SW 15th Street Pembroke Pines, FL COVERAGES CONTACT V. Ureeth PHONE 366. 860.1016 (A/C, NO EktL En ADDRESS: jursethaiyahoo.com FAx 386.860.1051 fAIC. Nol: PRODUCER CUSTOMER [Di. INSURER(5) AFFORDING COVERAGE INSURERA: Southern Eagle Insurance Co NAIL f/ INSURER B : INSURER C : INSURER o: INSURER E c INSURER F : CERTIFICATE NUMBER- • THIS INDICATED. CERTIFICATE EXCLUSIONS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 'THE IN$UREO NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUC 4 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. mot LTR TYPE OF INSURANCE AUDL IN8N SUER WVD ,, POLICY NUMBER POUCY EFF (MMIDD/YWY) IMM/OWYYYY) UNITS GENERAL _— UABILI1Y COMMERCIAL GENERAL UABIUTY OCCUR ❑ EACH OCCURRENCE $ DAMAGETORbNTb0 PREMISES (Ea occurtenmL 3 I CLAIMS•MADE MED EXP (Any one person) S PERSONAL & ADV INJURY 3 GENERAL AGGREGATE $ GEML AGGREGATE LiMIIT APPLIES PER: POLICY n JECT fl LOC PRODUCTS • COMP/OP AGO $ n S —� AUTOMOEILEUABILITY `I ims ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-0wNEO AUTOS ❑ ❑ COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY (Per person) S BODILY INJURY (Per Satinets) 3 (Per den) DAMAGE S S r S uMSRELtA LWB EXCESS LIAR OCCUR CLAIMS-MADE EACH OCCURRENCE S AGGREGATE �S f� DEDUCTIBLE RETENTION S If S WORKERS COMPENSATION ANO EMPLOYERS' LABILITY Y I e ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEWMEMBER excu an (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N f A ❑ 2010-09107-000 05/10/2010 05/10/2011 / I WC STATU- n 0TH- DIY I,)�IT.ZI Fp E.L. EACH ACCIDENT S 100,000 E.L. DISEASE. EA EMPLOYEES 1 00,000 E.L. DISEASE - POUCY LIMIT S 600,000 DESCRIPTION OF OPERATIONS f LOCATORS J VEHICLES (Attach ACOR0101, Addidedel Romance Schedule, if more space is required) CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 Fax#: 305.756.8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTAT! ACORD 25 (2009/09) ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web software. www,FoemeBoee.com; ® Iapresalee Publishing 800.208.1877 Sep 01 10 02:18p Assurance Associates Of M 3052272263 p.1 A� oRO® CERTIFICATE OF LIABILITY INSURANCE DA 8 /31/1DDIY") PRODUCER Assurance Associates of Miami B90 S.W. 87th Ave. #16 Miami, FL 33174 Phone (305)227 -1121 Fax (305)227 -2263 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 I NAIC # INSURED keith jhonston Construction LLC i 4201 SW 33rd Street I West Park, FL 33023- 1 (786) 837 -3284 INSURERA: NATIONAL GROUP INSURER B: INSURER 0: INSURER E: INSURER E: COVERAGES INSURER F; THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT R OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES D SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCI BY PAID CLAIMS. INSR 67$ A _ ADD'L IFI.SRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YYJ POLICY E4/1X1YeN DATE IMM!DDIW) LIMITS ❑ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 02L0001038 i 01/15/10 01/15/11 EACH OCCURRENCE $1,000,0001 DAMAGE TO RENTED 50,000 PREMISES (Ea occurence) ❑.! CLAIMS MADE ❑ OCCUR ❑ MED EXP (Any one person) 10,000/1000 PERSONAL & ADV INJURY 1,000,0001 ❑ GENERAL AGGREGATE ! 1,000,000 GEN'L AGGREGATE UNITY APPLIES PER:, ❑ POLICY 0 PROJECT • LOC PRODUCTS - COMP/OP AGG i 1,000,000 AUTOMOBILE LIABILITY ❑ ANY AUTO • ALL OWNED AUTOS COMBINED SINGLE LIMIT • (Ea accident) BODILY INJURY (Per person) ❑ SCHEDULED AUTOS El HIRED AUTOS [1 NON OWNED AUTOS BODILY (Per accident) (Per acddent) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT r❑^-� I...L • GARAGE LIABILITY • ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESS/UMBRELLA UABIUTY ❑ OCCUR • CLAIMS MADE L. DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE • B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR 1 PARTNER 1 EXECUTIVE OFFICER IMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E WC STATU- t] OTH- TORY LIMITS______._. E8 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY UMfT OTHER DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES 1 EXCI IICrnun ennnn nv FAInnOCCnnouT / cocr1a1 OCAVICI MVO CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHOREVILLAGE 10050 NE2NDAVE MIAMISHORES,FL 33138 305- 7952204 ACORD 25 (2001/081 QF SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSU NTS •.- REPRE j TATIVES. AUTHORIZED REPRES Salvador Garci ORPORATION.1988 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 174791 Permit Number: RC- 3- 10-402 Inspection Date: July 09, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: F. Special Inspector Letter Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN —IL �9 OR IS DONE IN R MC PERMIT CHANGE eel. I9Fspector Comments PLEASE DO NOT t V i elf \--) NA C titi CIS -ABC _C C . 1\() S(' A, \i \ ) CCc - H tt � EL PERMIT. ,ffC) Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 July 09, 2012 Page 1 of 1 JUL 0d CESAR A GRANAEOS, P.E. June 24th, 2011 Building Official Miami Shores Village Building Department 10050 Northeast 211 Avenue Miami Shores, Florida 33138 RE: 540 Grand Concourse, Miami Shores, Florida 33138 Permit # RC -10 -402 Dear Building Official: I have inspected the entire engineered unit masonry including but not limited to: Mortar, horizontal reinforcement, filled cells, columns, beams, lintels, reinforcing steel, concrete pour, etc., and have found them in compliance with the approved plans and the Florida Building Code. Should you have any questions or need any additional information, please do not hesitate to contact me. Sincerely, Cesar A. Granados P.E. # 64221 6 South Valencia Dr., Davie, Florida 33324 Phone : 954 - 200 -4462 Phone : 954 -591 -8126 Fax Y54 -2O'0 -8835 te, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 153247 Permit Number: RC- 3- 10-402 Inspection Date: January 01, 2999 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Columns Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN CAE �I OR IS DONE IN : a '� MC PERMIT - • L PER NGE IT. 9 pector Comments Rii R EEtID /INSPECTION FOR INSP- 152807. CREATED AS REINSPECTION FOR INSP- 152730. Provide final engineer letter NB No paper in permit box. NB Letter attached. NB Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 July 10, 2012 Page 1 of 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 153248 Permit Number: RC- 3- 10-402 Inspection Date: July 10, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Tie Beam Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN OR IS DONE IN ; MC PERMIT - - L PER NGE IT. 15Fspector Comments FORMEEIDACREINSPECTION FOR INSP- 152808. CREATED AS REINSPECTION FOR INSP- 151432. CREATED AS REINSPECTION FOR INSP- 151357. Provide final special inspector letter NB No plans or permit in box. NB Letter attached. NB Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 July 10, 2012 Page 1 of 1 Q� MAY 22Z612 BY:_o' CESAR A. GRANADOS, P.E. r " 0 COMPLIANCE LETTER June 24th, 2011 Building Official Miami Shores Villae Building Department 10050 Northeast 2fla Avenue Miami Shores, Florida 33138 RE: 540 Grand Concourse, Miami Shores, Florida 33138 Dear Building Official: I, having performed the required structural inspection, hereby attest that to the best of my knowledge, belief and professional judgment, the designed structure satisfies the requirements of the Florida Building Code (FBC 2007 w/2009 amendments), envelope components of the inspected items for the above referenced structure are in compliance with the FBC 2007. Should you have any questions or need any additional information, please do not hesitate to contact me. Sincerely, -a-440AS Cesar A. Granados P.E. # 64221 6 South Valencia Dr., Davie, Florida 33324 Phone : 954 -200 -4462 Phone : 954 -591 -8126 Fax : 954 - 200 -8835 } lSL c15-( _Loo Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 75C%.8972 CERTIFICATE OF OCCUPANCY /COMPLETION CHECK LIST slikildiRtipamait card. .� }Las built - Required Items: Elevations of buildings showing all intended netivesimstaialgoperty lines and other existing structures. Ingress± Egress, required parking tops, stripping, and all paving to exterior. n — (Sealed by surveyor). Expiration date required on the form. ��,h6\ Certificate of Insulation. 1- ment (Final treatment - original)\ \1� ITE PROTECTION: "This Building has received a complete treatment ,� mention of subterranean termites. Treatment is in accordance with the rules and w•ee-established by the Florida Department of Agriculture and Consumer Services . oliiatitIkBepeflivosat4pproval Letter (On septic or private water). 410 is on septic tank, approval letter is required from Health Dpt. nsity report is required) Final certification letter from the Engineer /Architect (on masonry, trusses, special structure, etc) tweillia to Re wired on commercial projects only) PLEASE NOTE THAT THE SAME ITEMS ARE REQUIRED FOR TEMPORARY CO • Emergency CO (Without 24 Hrs Processing) Additional fee is $80.00. • Temporary CO (Up to 90 days max) $75.00. • Residential CO fee is $150.00 • Commercial CO is $200.00 ‘tIc5 t Per-vv.-A) REV (2/18/72010) 5L m.►et..tt gent 1,c fL . ,, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 172859 Permit Number: RC- 3- 10-402 Inspection Date: April 30, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: F. Elevation Certificate Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN �OR IS DONE IN MC PERMIT - - L PER NGEspector IT. Comments PLEASE DO NOT Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 30, 2012 Page 1 of 1 e IMPORTANT: In these spaces, copy the corresponding information from Section A. - Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 540 'GRAND 'CONCOURSE MIAMI SHORES FLaDA 33138ZIP Code For Insurance CorimpanyIJs Policy Num ;CompariyNAIC: Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments C2.e) A/C SLAB ELEVATION, DCBM(�N -603 —R LOCATOR��3250SW ELEVATION: AND LONGITUDE OBTAINED BY GOOGLE. Signature 'CROWN OF THE ROAD ELEVATION; 10.27' @ CENTERLINE ON CENTER OF THE ROAD. 11/9011 ❑ Check here if attachments SEC I! N E _ BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the erevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade.(LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑feet ❑meters ❑above or ❑below the HAG. Ofeet E2. For Building Diagrams 6 -9 with permanent flood openings provided in Sectio A Items 8 and /or 9 (see • a es 8-9 of Instruction❑s), the next higher floor (elevation C2.b in the diagrams) of the building is . ❑ feet 11 meters ❑ above or 11 below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4.-` Top of platform of machinery and /or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated In accordance•with the community's floodplain maprn ageent ordinance? ❑ Yes ❑ No. ❑ Unknown. The local official must certify this information in Section: G. • . ' SECTION F - PROPERTY OWNER (OR OWNER'S- REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA- issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, 8, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address Signature City State ZIP Code Commerits Date Telephone ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who G2. ❑is authorized by law to certify elevation information. ;(Indicate the source and date of the elevation data in the Comments area below.) A community official completed Section E fora building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3. El The following information (Items G4-G9) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance /Occupancy Issued G7. This permit has been issued for ❑ New Construction ❑ Substantial Improvement GB. Elevation of as -built lowest floor (including basement) of the building G9. BFE or (in Zone AO) depth of flooding at the building site G10. Community's design flood elevation Local Official's Name Community Name Signature ❑ feet ❑ meters (PR). Datum - 0 feet ❑ meters (PR) Datum ❑ feet ❑ meters (PR) Datum Title Telephone Comments Date EEMA Form 81-31,.-Mar-09 ❑ Check here -if attachments U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE Federal Emergency Management Agency National Flood Insurance Program Important Read the instructions on pages 1 -9. OMB No. 1660 -0006 Expires March 31, 2012 Al. Building Owner's Name SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Ap , Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.6 t 540 GRAND CONCOURSE MIA1+ily SHORES FLORIBre A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 4 E 15' OF LOT 5 & PO_.T1.ON OF LOT'S BLOCK 97 P.B. 15. PAGE 14 MIAMI -D, iE For Insurance Company Use: 331iiiode A4. Building Use (e.g., Residential Non - Residential, Additio',ogAccessory, etc.) r RESIDENTIAL /NEW CONSTRUCTION A5. Latitude /Longitude: Lat. N25'51 58" W80 e 11 10 ° A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade • c) Total net area of flood openings in A8.b d) Engineered flood openings? n Yes No 960 sq ft 8 960 sq in Horizontal Datum:. ❑ NAD 1927 X NAD 1983 A9. For. a building with an attached garage: a) Square footage of attached garage 320 sq ft b) No. of permanent flood openings in the attacheq garage within 1.0 foot above adjacent grade N/. c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? [ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State B4. Map/Panel Number B5. Suffix 12086C0306 L B6. FIRM Index • Date 9/11/09 B7. FIRM Panel Effective /Revised Date 9/11/09 BI0. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89. ❑ FRS Profile ® FIRM Community Determined ❑ Other (Describe) B11. Indicate:elevafion datum used for BFE in Item B9: X NGVD 1929 ❑ NAVD 1988 Q Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? fl Yes . ®No Designation Date [] CBRS P OPA B8. Flood Zone(s) . X .139: Base Flood Elevation(s) (Zone • AO, use base flood depth) N/A SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* [1 Building Under Construction* NJ *A new Elevation Certificate will be required when construction of the building is complete. Finished Construction C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO. Complete Items C2.a -h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized N-603-I3 Vertical Datum NGVD Conversion /Comments N/A Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 1 1 95 © feet b) Top of the next higher floor Ir© fefeet et c) Bottom of the lowest horizontal structural member (V Zones only) .4.0 ® ._.© feet d) Attached garage (top of slab) 9 e) Lowest elevation of machinery or equipment servicing the building 9 .95 IT feet (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 9 40 ® feet g) Highest adjacent (finished) grade next to building (HAG) 9 95 feet h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/4 X feet structural support ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) meters (Puerto Rico only) ❑ meters (Puerto Rico only) meters (Puerto Rico only) 0 meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? El Yes 0 No Certifier's Name ADIS N. NUNEZ Title REGISTERED LAND SURVEYOR Address 555 NO Signature SHORE DRIVE FEMA Fin 81 1, Mar 09 5924 Number BoLANCUNSURVEYORS, INC. ZIP Code City State BEACH FLORIDA 33141 11 Data Telephone (305)865 -1200 1 /2811'7: PLS# 5924 See reverse side for continuation. R arska -• ,r..,it Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 inspection Number: INSP- 172864 Permit Number: RC- 3 -10 -402 Inspection Date: April 30, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Soil Compaction Letter Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN OR IS DONE IN ; TA PERMIT - L PER NGE IT. biFpector Comments PLEASE DO NOT Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 30, 2012 Page 1 of 1 CESAR A. GRANADOS, P.E. April 17, 2010 Building Inspector Miami Shores Village Building Department 10050 N.E. 2' Avenue Miami Shores, Florida 33138 RE: Smarts Residence 540 Grand Concourse Miami Shores, Fl. 33138 Dear Building Official: I, having performed a visual inspection as required, and verified the existing soil condition consist of Sand, silty sand, and silty gravel, hereby attest that the site was observed, and the foundation conditions are similar to those upon which the design is based, With a Soil Bearing Capacity of 2,000 psi as it was established in the soil statement in sheet S -1 of the structural plans and following Table 1804.2 of the F.B.C. 2007. This document is being prepared in accordance with the requirements of the Florida Building Code and must be submitted to the Miami Shores Village Building Department for the above referenced structure. Should you have any questions or need any additional information, please do not hesitate to contact me. Sincerely, Cesar Granados, P.E. P.E. No. 64221 9510 S.W. 6th Court, Pembroke Pines, Florida 33025 Phone : 954 - 638 -0318 Phone : 954 - 593 -8871 Fax : 206 - 339 -2616 US South Engineering 8 Testing Laboratory, Inc. 14345 Commerce Way, Miami, Ft- 33016 Phone: 305.558.2583 l Fax: 305.362.4669 Date Tested: 05.28.10 REPORT OF FIELD DENSITY TEST (SOIL COMPACTION) CLIENT: Smart Residence 540 Grand Concourse Miami Shores, FL 33138 PROJECT: • Residential Home Addition 540 Grand Concourse Miami Shores, FL 33138 FIELD DENSITY TEST ACCORDING TO ASTM METHOD D- 2922 -71 �l ! dYJ 'i' �M1 � ' ..%p y V : !Y.iV t 4 ry �{�f "'''�'f� 'ir^,s. t'S' }�� . Xi c tit A ky n 'ran! !fit 4) P ;. r 1 f 3i yiLl Y :{' ,E r D : f;f `y _.. 3 .X t. 1 NORTHEAST CORNER OF FOOTING 13593 FT 121.2 7.2 98.1 PASS 2 CENTER OF FOOTING 13593 FT 124.3 7.0 100.6 PASS 3 NORTHWEST CORNER OF FOOTING 13593 FT 120.8 6.9 97.7 PASS 4 SOUTHEAST CORNER OF FOOTING 13593 FT 122.6 7.5 99.2 PASS 5 SOUTHWEST CORNER OF FOOTING 13593 FT 120.3 7.9 97.3 PASS 'd } y# S'Y�u. ��i {�yf� k,��'�A!ii�� 'CA' � +N! Pr'F ! A °y bfi .. ,w.t 1 i �l }.,iu! �"'!S .� '' "i'�� r.w }�y �' J e Z�'iG�4? �7i' ry r � ® {�h rM ��i : :, r @ICU �� 0 iY L . . W�'. yf n$ ii �.G., b 4raru _Et2 P= PASS F =FAIL FT= FOOTING Respectfully submitted, Ghasem Khavanin, P.E. „> 1e9.. /to Florida Registration # 41955 SG= SUB -GRADE Page 1 of 1 BC =BASE COURSE MH =MAN HOLE 136 135 134 133 132 131 130 129 128 127 126 125 124 123 122 121 120 119 118 117 116 115 114 113 112 U.S.SOUTH ENGINEERING & TESTING LAB., INC. Date: 05.28.10 Project Name: Smart Residence Project Location: 540 Grand Concourse Project City & State: Miami Shores, FL Sample Method: D -1557 Proctor No.: 13593 Max. Dry Density: 123.6 PSF Optimum Moisture: 7.6 Natural Moisture: Soil Description: limerock w /some sand 111 110 109 108 107 106 105 104 103 102 101 100 99 98 97 96 95 94 93 92 91 90 Respectfully submitted, ' Ghasem Khavanin, P.E. 57c9' / id7 Florida Registration # 41955 89 88 87 86 85 84 83 82 81 80 79 78 77 76 N N V 14345 Commerce Way Miami, FL 33016 Phone (305) 558-2588 Fax (305) 362-4669 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 137780 Permit Number: RC- 3- 10-402 Inspection Date: April 30, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Final PE Certification Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN —IL OR IS DONE IN EL E MC PERMIT CHANGE J---c: 6IPpector Comments PLEASE DO NOT � PERMIT. Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 30, 2012 Page 1 of 1 ores Village :. 21411. Ave. Shores, Fl. 33138 Letter of Compliance ' esidence Miami S Please be info ed, a1%r a complete inspection of the residence of Mr. &i Mrs. Smart, upon the l request by the owner, Derick Smart. I have found that the remodeling project appears to be in compli with the permitted set of plans, completed by my office and appipved by the Village ami Shores. /#404774,74 1119 a+es G. ti.aa Smith & Smith Design Corp., Inc. A FloridaCorp. Since 1986 11633 N.E. 11th PIA PHONE (305) 89f-966R • FAX (305) 893- BISCAYNE PARK, FLORIDA 33161 • CELL (305) 710-0161* E -MAIL srthIthdgr}®Crol com Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 137784 Permit Number: RC- 3- 10-402 I Inspection Date: April 30, 2012 Inspector: Dacquisto, David Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Declaration of Use Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN OR IS DONE IN � MC PERMIT IL CH NGEs IT. pector Comments PLEASE DO NOT L PER Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 30, 2012 Page 1 of 1 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. (1 111111111111111111111111111111111111111111111 C FH 2012R0018157 OR Bk 27956 Pss 2306 - 2307; (sass) RECORDED 01/10/2012 11:0:53 HARVEY RUiVINlp CLERK OF COURT MIAMI-GLADE C:L!JNTYp FLORIDA (Space above this line reserved for recording office use) Document Title: ,- r (Mortgage, Deed, Construction Lien, Etc.) Executing Party: a Y-1 Mar Legal Description: (If Applicable) 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 circuit 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 comer on each subsequent page are reserved for use by the clerk of the court... CLK/CT 155 Rev. 04/11 ti PREPARED BY: DECLARATION OF USE OR B k 27956 PG 2307 LAST PAGE Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 KNOW ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned S V 6..c r t is /are the fee simple owners) of the following described property (Property) situated and being in Miami Shores Village, Florida: Lot(s) G 5 34 a . Block -S ec. 1 of t k. m i SIVai 1-46i' (Subdivision), according to the plat thereof, as recorded in the Plat Book t Page / 4 of the Public Records of Miami -Dade County, Florida, (address) ' -(d %'r ci i! cPjC.C.Orce. and WHEREAS, the undersigned owners) have sought certain development approval from Miami Shores and are providing this document in consideration thereof and to induce the Village to grant same: NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which is acknowledged, the undersigned do(es) hereby declare and agree: 1. That the Property will not be used in violation of any ordinance of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. 2. That the property will be used for a single family residence only. 3. That he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant concerning the use, enjoyment and title to the above Property and shall constitute a covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its successors, in accordance with the codes, rules and regulations of said Village then in effect. IN WITNESS WHEREOF, the undersigned has/have caused hand(s) and seal(s) to be affixed hereto on this 200_ . WITNESS i Signature and Print gnature d Print STATE OF FLORIDA COUNTY OF MIAMI -DADE ) day of Signature and Print and-, od II 1 I HEREBY CERTIFY that on this day personally appeared before me a 9A.A.cm who is personally known to me or (type of identification) as identification and he/she acknowledge that he/she executed the foregoing, freely and purposes therein expressed. SWORN TO AND SUBSCRIBED before me on this 9 day of My commission e) 4 I pir •,� CLAUDIA V. CUBILLOS ft Notary Public - State of Florida [•, • My Comm. Expires Sep 23, 2015 it Commission * EE 128810 '' + n n0 Bonded Through National Notary Assn. NOTARY PUBLIC, STATE OF FLORIDA Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172860 Permit Number: RC- 3- 10-402 1 Inspection Date: April 30, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: F. Insulation Certificate Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN —IL OR IS DONE IN FE �t A'�SE MC PERM T EL CHPNGEspector Comments LEASE DO NOT PERMIT. Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 30, 2012 Page 1 of 1 S O L U T I O N S , N C. April 27, 2012 Permit No: RC -3 -10 -402 540 Grand Concourse Miami Shores, FL 33138 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 Certificate of Insulation To Whom It May Concern: Please be informed that after review and inspection of the insulation for the property located at 540 Grand Concourse Miami Shores, FL 33138, it complies with the approved architectural plans and the Florida Building Code. The use of R -30 Batt insulation in the attic, R -21 Batt Insulation for the spacing between the first and second floor trusses and interior walls, and Fl FOIL AA -2 R-42 Reflective Paper Insulation for the outside walls. Regards, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172861 Permit Number: RC -3- 10-402 I Inspection Date: April 30, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: F. Termite Letter Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA. ALL PERMITS ON HOLD UN —IL rETOR IS DONE IN EL MC PERMIT CH!.NGEspector l'il Comments PLEASE DO NOT PERMIT. Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 30, 2012 Page 1 of 1 Tun,' NO 4474 OPAL. 3054 Notice of Preventative Treatment for Termites (as required by Florida Building code (FBC) 104.2.6) 540 Grand Concourse Miami Shores Fl 33138 Address of Treatment or Lot/black of Treatment 07/28/2010 Date Premise 75 Product used 10:30 a.m. Alfredo Brown Time Applicator Imidacloprid 60 Chemical used (Active Ingredient) Number of gallons appled 0.5 600 94 feet Percent Concentration Area Treated (square feet) Lineal Feet treated Stage of treatment (horizontal, vortical), adjoining slab, retreat of disturbed area) As per 104.2.6 - if soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. If this notice is for the final exterior treatment, initial and date this lane 07/28/2010 Building has received a complete treatment for the prevention of subterranean termites. Treatment is in acc“rdance with the rules and laws as established by the Florida Department of Agriculture and Consumer Services. TRULY NOLEN OF AMERICA. 4474 N.W. 128th ST, FL, 33054. 305-685-7411. FAX 305-685-7416 TRULYNOLEN.COM Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 172858 Permit Number: RC- 3- 10-402 I Inspection Date: April 30, 2012 Inspector: Bruhn, Norman Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: Survey Final Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE ARRIOLA ® I�1-/(30//-2 ALL PERMITS ON HOLD UN �OR IS DONE IN MC PERMIT 1spector Comments PLEASE DO NOT NG E IT. Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 April 30, 2012 Page 1 of 1 r s - - (. :„..,.,� ., , .. _ ,J�'�Y. _ fib;. � _ !S.. t 4e ,fir` U fi - - +1 SU34"-,e l Y ` ._4 � t ( . �a` LOCATION SKETCH SCALE: NTS 0 z 0 0 130.00'(R &M) z- o? m I R 6Y :m aummajamell11111111M1 ! APR3� �tV c cn 1.80' C SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COtINT1( RULES AND REGULATIONS SURVEY FOR: DARIK SMART, 540 GRAND CONCOURSE, MIAMI to z N Woe z 130.07'(R &M) 0 �11 z= o:a o NOT VALID UNLESS EMBOSSED WITH SURVEYOR'S SEAL ABBREVIATIONS: SWK =SIDEWALK, CBS= CONCRETE BLOCK STRUCTURE, CLF =CHAIN LINK FENCE, PL =PROPERTY LINE, DUE =DRAINAGE UTILITY EASEMENT, IP =IRON PI'S, F= FOUND, NC=AIR CONDITIONER PAD, P/C= PROPERTY CORNER. DIH= DRILLED HOLE, W/F =WOODEN FENCE, RES= RESIDENCE, CL -CLEAR RB =REB' R, UE= UTILTY EASEMENT, CONC =CONCRETE SLAB. RIV+=RIGHT OF WAY, DE =DRAINAGE EASEMENT, C/L= CENTER LINE, O =DIAMTER, TYP =TYPIC L, M= MEASURED, R= RECORDED, ENCR =ENCROACHMENT, COMP= COMPUTER, ASH = ASPHALT, N/D =NAIL & DISC, S =SET, FEE = FINISH FLOOR ELEVATIoN, O/S =OFFSET, P/P =POWER POLE, OHP= OVERHEAD POWERLINE, IANI =WATER METER WOOD FENCE= MASONRY WALL =l I 1 I I 1 I _ ELEVATION BASED ON LOC. # 3250 SW MAINTENANCE•& DRAINAGE EASEMENT=M&D.E• i CBM #N -603 —R ELV. 8.11 TYPE OF SURVEY: BOUNDAFY SURVEY SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATUFE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NCT COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5) UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODET C VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITION,.L RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 3) CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONII ■ G INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BEMADE TO DETERMINE RECORDS D INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY. BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB PAGE 1 SHORES, FLORIDA 33138. LEGAL DESCRIPTION: Lot 4 and the Easterly 15 feet of Lot 5 and the following described portion of Lot 3, all in Block 97, AMENDED PLAT OF MIAMI SHORES SECTION FOUR, according to the plat thereof, as recorded in Plat Book 1.5, at Page 14, of the Public Records of MIP.MI -DADS COUNTY, Florida: Begin at the most Westerly corner of Lot 3, Block 97, of the Amended Plat of Miami Shores Section Four, Plat Book 15, Page 14, of the Public Records of Miami -Dade County, Florida, thence Northeasterly along the Northwesterly boundary of said Lot 3 and along a circular curve having a radius of 1849.79 feet through a central angle of 0 °11'34" for an arc distance of 6.22 feet to a point, thence Southeasterly for a distance of 130.07 feet to a point on•the Southeasterly boundary of said Lot 3, said point being located on 10 feet Northeasterly from, as measured along the Southwesterly boundary line of the most Southerly comer of said Lot 3, thence Southwesterly along the Southeasterly boundary of said Lot 3 and along a circular curve having a radius of 1'719.79 feet through a central angle of 0 °19'59" for an arc distance of 10 feet to the most Southerly Corner of said Lot 3, thence Northwesterly along the Southwesterly boundary of said Lot 3, for a distance of 130 feet to the Point of Beginning (the !'Property"). REVISED: i HEREBY CERTIFY That the survey represented thereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. ADIS N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 SINCE 1987 BL.ANGO SURVEYORS ING. Engineers • Land Surveyors • Planners • LB # 0007059 555 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 (305) 865 -1200 Email: blancosurveyorsInc@yahoo.com Fax: (305) 865 -7810 SUFFIX: L DATE 9/11/09 BASE:N /A COMMUNITY# 120652 JOB 10 -646 FLOOD ZONE: PANEL: 0306 SCALE: 1 " =20' DWN. BY: F. Blanco Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 172862 Permit Number: RC- 3- 10-402 I Inspection Date: April 30, 2012 Inspector: Hernandez, Rafael Owner: SMART, DARIK & MARLENIS Job Address: 540 GRAND CONCOURSE Street Miami Shores, FL 33138- Project: <NONE> Contractor: KEITH JOHNSTON CONSTRUCTION Permit Type: Residential Construction Inspection Type: HRS Approval Work Classification: Addition Phone Number (305)751 -8127 Parcel Number 1132060171411 Phone: (305)370 -5731 Building Department Comments ADDITION OF A SECOND STORY OVER EXISTING DINING ROOM. PROPOSED ADDITION INCLUDES: BEDROOM, BATHROOM, STUDY, PLAYROOM AND SITING AREA 1/21/2011 - ELECTRICAL PERMIT ON HOLD. INSPECTIONS TO BE REQUEST IN PERSON BY JORGE AIRRIOLA. ALL PERMITS ON HOLD UN �OR IS DONE IN MC PERMIT - - L PER NGE IT. t9p pector Comments PLEASE DO NOT Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 30, 2012 Page 1 of 1 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: /11' PERMIT NO ti DATE PAID' FEE PAID' RECEIPT #' .0 AGENT: -- `�. *`� -..t- = •t �`� -� s ..-.:c L PROPERTY ADDRESS: LOT:-..ELL t BLOCK: SUBDIVISION: PROPERTY ID #' CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [01] TANK SIZE [1]) 2 6 a [2] [02] TANK MATERIALC4'•- -k=r..4 [03] OUTLET DEVICE [04] MULTI - CHAMBERED N) [05] OUTLET FILTER - `' [06] LEGEND i 3 ° CJ i _. [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID' �. DRAINFIELD INSTALLATION [10] AREA [1] [2] (IC / 5SQFT [11] DISTRIBUTION BOX HEADER [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION - y [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABO ELOVV it °a `73' [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE [20] AGGREGATE -EXCESSIVE FINES [21] AGGREGATE DEPTH FILL / EXCAVATION MATERIAL ] [221 ] (23) 1 [24] ] [25] 1 [26] FILL AMOUNT 7.2 FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ [ 1 [ 1 CONSTRUCG [APPROVED ISAPPROVED] ( —1* FINAL SYST Y :PPROVE1- /DISAPPROVED]• 6e...6"1,"4/ ..,. " O_ rtel / .l SETBACKS [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES � FT [33] BUILDING FOUNDATION e, FT [34] PROPERTY LINES � FT [35] OTHER FT FILLED MOUND SYSTEM [36], DRAINFIELD COVER [37]i SHOOLDERS [38] SLOPE [39] , STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] ` MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING'_., a. [47] CONTRACTOR [48] OTHER ABANDONMENT [49] . TANK PUMPED "/ [50] TANK CRUSHED & FILLED C / )c/ DH 4016 (Page 2), 1 = revious Editions May Be Used) Stock Number. 5744-002-4016-4 CHD DATE' '- $ CHD DATE'(- PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department Page 2 of 3 Reeald Pupa