DS-12-1106Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 174874
Permit Number: DS -6 -12 -1106
Scheduled Inspection Date: July 19, 2012
Inspector: Bruhn, Norman
Owner: MAE, FANNIE
Job Address: 175 NW 101 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: LEVY FATHER & SON
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1131010230160
Phone: (305)458 -7134
Building Department Comments
CONCRETE DRIVEWAY INSTALLATION
Passe
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
July 18, 2012
For Inspections please call: (305)762 -4949
Page 16 of 27
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'BIIIL�I�1�1G
-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 APPLICATION
Permit Type: BUILDING
JOB ADDRESS: /76- AAt) 101 54 .
20
Permit No. }
Master Permit No.
ROOFING
City: Miami Shores
Folio/Parcel #: ) , ° 3 (O —
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder):
Address: 1Q b
City: Cam, Pi
County: Miami Dade
OZ Qt (a0
Zip:
NO Flood Zone:
d' <i• T % Phone #: 305° 1461 -'7/ 3 t%
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: 1 t V7 PArigeK . Phone #:
Address: 3 AI, / -r7
city: 41/44 /
Qualifier Name:
State Certification or Registration #: CC- /2- 3 '17 Certificate of Comf0/74,.
tency #.
Contact Phone #: 79 ° 292 a r Email Address: to 1® Q
DESIGNER: Architect/Engineer: / Phone#:
8/M
State:
L�°P/ Phone #:
7c46 also - /2.3f
Zip: 33/2
745V-Ar3 2.410
CJ
Value of Work for this Permit: $ ./t7.1-2,/"°1 Square/Linear Footage of Work:
Type of Work: °Addition °Alter Lion
Description of Work: k _ ck-e_ e_ 1�3 Y r ve- J®''7 ://•
ew °Repair/Replace
°Demolition
Color thru tile: .2iki-,
ar+ x** ***** *****w ****** ****** ****** **+ x*** Fees***+ x*+ x**** *****+ n*** ************ *************
Submittal Fee $ Permit Fee $ iJ 06 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ E (0.1 C)
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 FT.F,CTRICAL 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 issue In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of fq , 20 LL, by •,414- t
who is personally known to me or who has produced V--- .
..e As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Signa
Contractor
e foregoing instrument was acknowledged before me this
day of hp ,20J,by
who is personally known to me or wh has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
STATE OF FLORIDA
STATE OF FLORIDA Comm* EE093866
ILENA CASTRO
UNA CASTRO NOTARY PUBLIC
NOTARY PUBLIC Bp'OIL
Comm# E ,.
**************************• ,., ..,: *x ix�x .xg m �x+ x�x�x�x�x�x **** * ***a��x�u�x+x�x� ***wax *** *** * * * * ** . x**A00ti14(1/445
'"xpres 6 15 / �i /
APPROVED BY Plans Examiner Y f CU �1 y Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
IVI iami Shores
Viiiage
Building Department
RECEIPT
PERMIT #: $ -11de DATE:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
N❑ ontractor
wner
❑ Architect
Picked up 2 sets of plans and (other)
Address:
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 Buildin • D rtment to continue permitting process.
Acknowledge
PERMIT CLERK NITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
PERMIT #: DS 6_t //o C.,
1)'.
I, gab 1ov)
Contractor
Owner
Architec
Pick-d p 2 sets of plans and ther)
Address: l�IXJ iUl' s
Miami Shores Viiiage
Building Department
RECEIPT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: 06.Z) a Zevz
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I and .tand that e plans need to be brought back to Miami
Shores Village Building :
pa j e i continue permitting process.
r''i LI
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE: 1°2-7
PERMIT CLERK INITIAL:
Permit No: 12 -1106
Job Name:
June 20, 2012
Miami Shores Vivage
Building Department
Building Critique Sheet
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
Page 1 of 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 762 -4859
MANUAL Proof of Payment for NEW MUNICIPAL CONTRACTORS Receipts
The 1/2 year Municipal Contractor Receipt expires September 30, 2012.
Contractor must have paid 2011 -2012 LBT in order to buy a 1/2 year
Municipal Contractor Receipt.
Give customer manual proof of payment for the contractors municipal
LBTR, see sample below.
This form is used during the cut off period: June 18 -30.
Write the information with red pen.
2011 -2012
MUNICIPAL CONTRACTOR TEMPORARY RECEIPT
LBTR # I -(B
State/ cc# 19 1O5 GCC0
Name L ��.� j � �-G�� V) fir' ec n ocr-
Municipal Contractor is restricted to do business in the municipality of .'-T t' /)(YI i 5k ore. -s .
Type of contractor:
orj,
are +e
Date Q '- ( —(901 Amount J c 7 5
This temporary receipt is issued as evidence of payment and is valid only until July 18,
2012.
Notice to the Municipality: Accept only original proof of payment, completed in red
ink. Do not accept a copy.
Rick Scott
Governor
VED
JUL 0 9 2012
(Ley Father & Son Corp)
3550 NW 15 St
Miami, FL 33125
RE: Contingency Letter
Application Document No:AP1075975
Centrax Permit Number: 13 -SC- 1417474
OSTDS Number:
175 NW 101 St
Miami, FL 33150
July 06, 2012
John H. Armstrong, MD
State Surgeon General
Lot:5 8 Block:2 Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 06/26/2012 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
From a review of your completed application, it has been determined that your existing system
is adequate for the proposed use (driveway construction).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Sincerely,
Jose Piverg
Enclosures
cc:
gineer Specialist II
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http:I /www.MyFloridaF,H.com
U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
federal Emergency Management Agency
Nation4IFlood Insurance Program
Important Read the instructions on pages 1-9.
OMB No. 1660-0008
Expires March 31, 2012
SECTION A - PROPERTY 1
• "
TION
Al. Building Owner's Name FANNIE MAE
A2. Building Street Address (inclucfing APL, Urul, Sue, and/or Bldg_ No.) or P.O.
175 NW 101th STREET
and Box
City MIAMI State FL BP Code 33150
A3. Property Description (Lot and Mod( Numbers, Tax Parcel Number, Legal Description, etc.)
16 AND THE EAST 25 FEET OF LOTS 5,6,7 & 8 IN BLOCK 2 OF BONMARK PARK, PLAT BOOK 24 AT PAGE 71.
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat 25°5705.31'N Long. 809704.82W Horizontal Datum: 0 NAD 1927
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number §
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? 0 Yes No
3,40 sq ft
7
705.60 sq in
A9.
NAD 1983
For a building with an attached garage:
a) Square footage of attached garage 220 sq ft
b) No. of permanent flood openings in the attached garage
within 1.0 foot above adjacent grade WA
c) Total net area of flood openings in A9.b
d) Engineered flood openings? 0 Yes
sq in
No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
UNINCORPORATED 120635
B2. County Narne
DADE-COUNTY
B3. State
FL
B4. Map/Panel Number
12086C0302
B5. Suffix
L
86. FIRM Index
Date
09-11-2009
B7. FIRM Panel
Effective/Revised Date
9-11-2009
138. Flood
Zone(s)
X
99. Base Flood Elevation(s) (Zone
AO, use base flood depth)
N/A
B10. Indicate the smite of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89.
0 F1S Profile FIRM 0 Community Determined 0 Other (Describe)
B11. Indicate elevation datum used for BFE in Item 89: NGVD 1929 0 NAVD 1988 0 Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes ;1'4 No
Designation Date N/A 0 CBRS 0 OPA
SECTION C - BUILDING ELEVATION I
• , ,
TION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings* Building Under Construction* 0 Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations -Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, APJAO. Complete Items C2.a-h
below according to the building diagram specified in Item A7. Use the same datum as the EIFE.
Benchmark Utilized gMV ertical Datum NGVD 1929
Conversion/Comments NA
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 10.25
b) Top of the next higher floor 12,16
c) Bottom of the lowest horizontal structural member (V Zones only) N/A.
d) Attached garage (top of slab) 10.76
e) Lowest elevation of machinery or equipment servicing the building N/A.
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 1§.25
g) Highest adjacent (finished) grade next to building (HAG) 10.2a
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A.
structural support
r..74
Check the measurement used.
feet 0 meters (Puerto Rico only)
feet 0 meters (Puerto Rico only)
feet 0 meters (Puerto Rico only)
feet ID meters (Puerto Rico onlY)
feet 0 meters (Puerto Rico only)
feet 0 meters (Puerto Rico only)
feet 0 meters (Puerto Rico only)
feet 0 meters (Puerto Rico only)
SECTION - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or archtect authorized by law to certify elevation
information. I certify that the information on this Ceilftate represents my best efforts to interpret the data available'
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? w Yes 0 No
Certifier's Name ARTURO TOIRAC License Number 3102
Title PROFESSIONAL LAND SURVEYOR AND MAPPER Company Name VIZCAYA LAND S. INC.
Address 13217 S.W. 46 LANE City MIAMI
State FL ZIP Code 33175
Signature
Date 11-11-2011 Telephone 305-223-6060
3 9 o
I I-11-11
IMPORTAIT: In these spaces, copy the
4
Building Street Address (fticluding Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
175 NW 101th STREET
City MIAMIState FL ZIP Code 33150
SECTION - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) chimer.
Comments THE LATITUDE/LONGflUDE IS PRN1DE BY 000GLE EARTH
CROWN ELEVATION = 10.90'
BM N 444 ELEVATION 10.79'
Signature
Date 11-11-2011
Check here if attachments
SECTION E - BUILDING ELEVATION INFO 710N (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 El -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
El. 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, crawispace, or enclosure) is . El feet 0 meters 0 above or 0 below the HAG.
b) Top of bottom floor (including basement crawlspace, or enclosure) is . 0 feet 0 meters 0 above or 0 below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor
(elevation C2.1, in the diagrams) of the building is . 0 feet 0 meters 0 above or 0 below the HAG.
E3. Attached garage (top of slab) is 0 feet 0 meters 0 above or 0 below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters 0 above or 0 below the FIAG.
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 management
ordinance? 0 Yes 0 No 0 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, B, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address
City
State ZIP Code
Signature
Date Telephone
Comments
fl 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 Certfficate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9.
01.0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
02.0 A community official completed Section E for a building located in Zone A (without a FEMA-Issued or community-issued BFE) or Zone AO.
03.0 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 0 New Construction 0 Substantial Improvement
G8. Elevation of as-buift lowest floor (including basement) of the building: . 0 feet 0 meters (PR) Datum _____
G9. BFE or (in Zone AO) depth of flooding at the building sae: . 0 feet 0 meters (PR) Datum
010. Conanunity's design flood elevation . 0 feet 0 meters (PR) Datum
Local Official's Name
Community Name
Signature
Comments
Title
Telephone
Date
fl Check here If attachments
13217 S.W. 46th Ln.
Raffle 33175
4 \
BLOCK 2 SUBDIMION. BONMAR PARK
CORDED N P1.AT BOOK 24 AT PAGE 7/
143ADE COUNTY, FLORIDA. SKETCH OF SURVEY
(Boundary Survay)
SCALE 1" = 20'
SUBJECT TO COMPLIANCE WITH 4 44 AL it
STATE AND COUNTY RULES ANWRECIULATIONSP
1\3
BLOCK- 2
LOT- 9
75. cry o) (w)
BLOCK- 2
LOT- 10
Pit
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wat-
t
BLOCK- 2
LOT- 16 $ E. 25 ft
of Lote 5, 6, 7 and 6
Conc. .5fail•
I t
IN
"t1
f3LOCK- 2
LOT- /5
BLOCK- 2
Remainder of
LOTs- 5, 6, 7 and
/
MIAMI-DADE COUNTY HEALTH DEPARTMENT
orio 751 75-
DATE:
t.
VISUAL .1 A- • "
LEGAL, NOTES
TVS SURVEY DOES NOT RERECr OR DETERMINE OLININISISP. MANAWATION Cr THE ABSTRACT OF
TITLE WILL HAVE TO SEAMEN TO OSNEWERE MORT= WSTRUSIENTEL ANY. AFFECING
FFIOPTV. MS SURVEY IS ESEUECT TO DECIMATION. WETMORE. REETWCTICWE RESEWOOKINE
OR EASEMENTS OF RECORDEL LEGN.DESCRIPOON PROVIDED ar cum. THE WOUTY OF MIS
suRvre S Lamp TO TRE cost cr THE SURVEY. UNDERGROWSUENCROACIWENTE. IF NW, ARE NOT
SNOW TiSS PD WIG NOT ATIERPTED TO LOCATE FOOTERS AMOR Foutoknore mom
UNDERGROUND IMPROVBEENTS OF ?MY NATIAIMP MUM BEARINGS ARE REFERRED RI PR
Assuino NEIMAN. IF MOM IIIEVATICEIE ARE REFERRED TO Kara OP METRE CLOSURE DOME
GARY SURVEY ABOVE I: VMS
DATE OF REID WPC Nov. 1 1, 20
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survey s valid foridertgages only
TVS...TYPICAL
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R *RADIUS
A ARC DISTANCE
CZ.= CATCH BASIN
S.C.* EILOCK CORNER
ENC. *ENROACHMENT
clus.coacarry BLOCK STRUCTURE
CONC.* CONCRETE
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LF. =IRON FENCE
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U.E. * MUTT EASEMENT
PIENNINENT CONTROL POINT)
ROA* POINT OF EMMEN°