DS-12-2001Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 180546
Scheduled Inspection Date: October 31, 2012
Inspector: Rodriguez, Jorge
Owner: WELYCZKOWSKI, JORGE & MARIA
Job Address: 1453 NE 104 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: INTERIOR DESIGN & DEVELOPMENT
Permit Number: DS -10 -12 -2001
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122320320080
Phone: (786)333 -2300
Building Department Comments
INSTALLATION OF PAVERS (GREY) WALKWAY & FRONT
PORCH
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
PAVERS OVER EXISTING CONCRETE
October 30, 2012
For Inspections please call: (305)762 -4949
Page 30 of 44
PERMIT # IlijS )2_ 2001
CONTRACTOR:
SUBMITTAL DATE: ItAk
ADDRESS: '453 iiiii.
NAME:
RESUBMITAL DATES:
PROJECT TYPE: 1u'
va
fa /Olir/ (L
ZONING
FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
='- itili
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
l bl'UQ 112 I CA's Fes`- C
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: Li 5 3 F 1011 S f it e
City: Miami Shores
County:
BY: _' amm --
FBC 20
Permit No. ) ---
Master Permit No.
ROOFING
Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO )° Flood Zone:
OWNER: Name (Fee Simple Titleholder): f1 ' IL) e-- 7 C 2 s-/ Z Phone #:
Address: /453
City: /V / 4 ii / S/-7L/2 %ee s State: J� — zip: 3 3 / 3 6
Tenant/L,essee Name: Phone #:
Email•
CONTRACTOR: Company Name: _„147Fc IL. bF _k1 at OF rtir dPit' Phone #: "1-Y6 3 33 Z 3 o
Address: A Z (a c1 f e P0., G' R art 6
city: f l i r=% ri i f� ra c f-j state: C zip: 3 3
Qualifier Name: rt C i\ F L 3 F j 6 M 0 1A Phone #: Y‘ 3 x 3 2
State Certification or Registration #: Certificate of Competency #: ( CJt)41 P
Contact Phone#: -1( 333 23 o c. Email Address:.1 OG T i1t` A t1 I (O 6 17A r 1
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ / /gc;� Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration °New Repair/Replace
P%
°Demolition
Description of Work:
Color thru tile:
********* ** **** **** ************a******* Fees* * *** * * *** * * * ** *** *** ** * *** ***** *** * *** * *** oA
Submittal Fee $ Permit Fee $ 10t CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ 10(Qi ' . /
TOTAL FEE NOW DUE $
s
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDTTIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in complianne 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 certif fled 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 2'1 The fo fit I g ' I k .I ent wass acknow ' ged befor
day of 007 , 20 J.by 1 ®14 t1 L J aIfri .5 y of 1 1%L , 20 r (/fib
who is personally known to me or who has produced .I/�---- 1 /i who is • • nally own to me or who has produc
As identification and who did take an oath. 3*' " 6 G '(Old identification and who did take an oath.
NOTARY PUBLIC N I TARY PUBLIC; .
Sign:
do
-
//o„ �o J Print: :/90 ' 1 '
y
My Commission Expires: - o� �/
NI a* ** *' * * ** *** ** **** * * * * * ** ** * ** * ** ? tt k anaa **** **** *** * *** *** **************************114*********
APPROVED BY Plans Examiner
Sign.
Print:
My Co
'
••�P -. MM om so.
es Com Mou9hW iaoa"Notary as
�C�• g Aed
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009XRevised 3115/09)
/�Z Zoning
Clerk
10- 24- 12;08:08AM;
�.__ -- CERTIFICATE OF LIABILITY INSURANCE
DATE(MWDDIYYYY)
10/24/12
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
HOLDER, THIS
POLICIES
IMPORTANT; I1the certificate holder le an ADDITIONAL INSURED, the pollcy(tes) must be endorsed. 11 SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on thin certificate does not confer rights to the
certificate holder In lieu of such endomement(s).
PRODUCER
Smdy's Group Corporation
10126 W. Flagler St,QRFSs,
Miami. FL 33174
Phone (305) 485.0116 Fax (305) 485-0633
CONTACT
M
. N a. Ego. (305) 485.0116 A/C. Not: (305) 485.0633
sardyGbellsouth.net
INSURER1SI AFFORDING COVERAGE
NAIC it
INSURER A: Federated National Insurance Co.
_
INSURED
Interior Design & Development LLC
1210 Cleveland Rd
Miami Beach, FL 33141 305
COVERAGES ce ot-re,rarc uu.rn.e.•..
INSURER 6 :
09/28/2012
INSURER 0:
EACH OCCURRENCE
INSURER D I
PREMISESJES eceufrence)
INSURER E S
0 II CLAIMS.MADE 2 OCCUR
INSURER F:
S 5.000.00
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THe INSURED NAMED ABOVE FOR THE POUOY 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 SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN R
TYPE OF INSURANCE
ACCIUSUBE4
INSR
'►ti
POLICY NUM6LR
pppp��ppyy�
al
t NUDD
MD
LILGI'1S
A
GENERAL LIABILITY
II��
L.J COMMERCIAL GENERAL LIABILITY
_
GL- 0000013890 -00
09/28/2012
09/28/2013
EACH OCCURRENCE
8 1,000,000.00
PREMISESJES eceufrence)
3 100.000.00
0 II CLAIMS.MADE 2 OCCUR
MED EXP (Any one Parson
S 5.000.00
..
PERSONAL &ADVINJURY
S 1,000,000.00
❑
GENERAL AGGREGATE
S 2,000,000.00
GE��IMI. AGGREGATE LIMITAPPLIESp p,
Z PouCY ❑ ligt ❑ LOC
PRODUCTS .COMP/OPAGG
5 2,000,000.00
$
AUTOMOBILE, LIASIUTY
a a O ITGCEUM)T
^ s
IN ANY AUTO
ALL OWNED ASCUHTEDULED
I� AUTOS n NONBWNED
BODILY INJURY (Par perms)
5
BODPL JURYgoer eopdent
$
LJ HIRED AUTOS quips
P g' ongAMAGE
Mg' 1
[1 n
a
1-1 UMBRELLA LAB • 000UR
-
EACH OCCURRENCE
$
n EXCESS L.IAB n CLAIMS -MADE
AGGREGATE
3
n DEO El RantoleN $
S
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y r N
D7ECIAIV6
O�FFICEH,V
NIA
WC 5T ��
EA YORY U TS El ER'
E.L. EACH ACCIDENT
S
DCREX0LUD
(Mandatory NN
DESCRIPTION OF OPERATORS hdaer
E.L. DISEASE . EA EMPLOYE
3
E.4• DISEASE • POLCY LIMIT
S
DESORPTION OF OPERA1IDNS / LOCATIONS f VEHICLES (Attach
1110 and marble In6t&1atlon
CERTIFm /TR urn nko
ACORD tot, Add Uonal Remarks Schedule, If more apace ts required) - -
- _. ---- . ___ --
Miami Shores Village
10090 NE 2nd Ave.
Miami Shores, P1.33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHOROED REPR
ACORD 2542010/05) QF
® 19882010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SKETCH OF BOUNDARY SURVEY
SCALE: 1 = 20'
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Water
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S
Io cap
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2-21.
Miami Shores ViUage �l
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BSI EN4 I
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SUBJECT TO COMPLIANCE WITH ALL FEDERAL
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••• .............
OCT IMCIEE
2 :; 2012
1 04th
AEj EVIATION OF ANY APPUED)
A = CURVE
A/C = AIR CONDITIONING UNIT
ASPH. = ASPHALT
B.M. = BENCH MARK
Blk /Cam.= BLOCK CORNER
CALC.(C) = CALCULATED
CB = CATCH BASIN
C.B.S. = CONCRETE BLOCK STRUCTURE
CL = CLEAR
CONC. = CONCRETE
D.M.E. = DRAINAGE MAINT. EASEMENT
0 = DIAMETER
EASMT. = EASEMENT
ELEV. = ELEVATION
ENC. = ENCROACHMENT
F.D/H = FOUND DRILL HOLE
F.H. = FIRE HYDRANT
F.N /D = FOUND NAIL AND DISC
F.I.P. = FOUND IRON PIPE
F.S. = FOUND SPIKE
L.P. = LIGHT POLE
MEAS.(M) = MEASURED
MH = MANHOLE
M = MONUMENT
= MONUMENT LINE
NTS = NOT TO SCALE
P/W = PARKWAY
P.O.B. = POINT OF BEGINNING
P.O.C. = POINT OF COMMENCEMENT
P.C. = POINT OF CURVATURE
P.1. = POINT OF INTERSECTION
P = PROPERTY LINE
P.P. = POWER POLE
P.R M -= PERMANENT REFERENCE
MONUMENT
P. T. = POINT OF TANGENCY
RAD. = RADIAL
REC. (R) = RECORDED
RES. = RESIDENCE
R/W = RIGHT OF WAY
SEC. = SECTION
LOCATION MAP
SCALE: NTS
S.D /H = SET DRILL HOLE
S.N /0 = SET NAIL AND DISC
S.I.P. = SET IRON PIPE
S.R.B. = SET REBAR
STY = STORY
SWK. = SIDEWALK
T.O.P. = TOP OF SANK
U.E. = UTIL. EASEMENT
W.P. = WOODEN POLE
= SECTION UNE
2
4
5
7
B
10
11
3
13
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17
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FLOOD ZONE INFORMATION
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JORGE AND MARIA WELYCZKOWSKI
VAZQUEZ AND ASSOCIATES
OLD REPUBUC NATIONAL TITLE INSURANCE CO.
FBC MORTGAGE, U_C. DBA HOME LOANS TODAY, ITS SUCCESSORS AND /OR ASSINGS,
A.T.I.M.A.
LEGAL DESCRIPTION;
LOT 9, BLOCK 3. OF RIVER BAY PARK ADDITION SUBDIVISION, ACCORDING TO THE PLAT THEREOF AS
RECORDED IN PLAT BOOK 40 AT PAGE 72, OF THE PUBUC RECORDS OF MIAMI —DADE COUNTY. FLORIDA.
1 HEREBY CERTIFY THAT THE ATTACHED SKETCH OF "BOUNDARY SURVEY AND THE SURVEY MAP RESULTING THEREFROM OF THE ABOVE
DESCRIBED PROPERTY IS A TRUE AND CORRECT REPRESENTATION OF A FIELD SURVEY MADE UNDER MY DIRECTION AND MEETS THE INTENT OF
THE APPUCABLE PROVISIONS OF THE "MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYING IN THE STATE OF FLORIDA" PURSUANT TO RULE
5J-17 OF THE FLORIDA ADMINISTRATIVE CODE AND ITS IMPLEMENTED LAW, CHAPTER 472.027. OF THE FLORIDA STATUTES
SITE ADDRESS:
JOB NUMBER:
1453 N.E. 104th STREET, MIAMI FL 33138
12 -102
DATE OF SURVEY
DEC. 22, 2011
SURVEYOR'S NOTES:
- LEGAL DESCRIPTION WAS FURNISHED BY CLIENT
-SHOWN ELEVATIONS ARE REFERENCED TO THE NATIONAL GEODETIC VERTICAL DATUM (N.G.V.D.) AND ARE BASED ON
MIAMI DADE COUNTY RICH MARK No.B -26RA, ELEVATION 17.23 FEET.
- EXAMINATIONS OF THE ABSTRACT OR TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY
AFFECTING THIS PROPERTY NO UNDERGROUND UTILITIES OR IMPROVEMENTS HAVE BEEN LOCATED, EXCEPT AS NOTED.
-THERE ARE NO VISIBLE ENCROACHMENTS OTHER THAN THOSE SHOWN.
-THE PRECISION OF THIS BOUNDARY SURVEY IS ONE PART IN 7,500
- THIS SURVEY WAS DONE FOR MORTGAGE TRANSACTION ONLY.
- IN SOME CASES GRAPHIC REPRESENTATION HAVE MEN EXAGERATED TO MORE CLEARLY ILLUSTRATE A PARTICULAR AREA WHERE
DIMMENSIONS SHALL HAVE PREFERENCE OVER GRAPHIC LOCATION.
- BEARINGS SHOWN HEREON OF ANY) ARE BASED IN AN ASSUMED MERIDIAN OF N•0'09'05'Yj FOR THE CENTER LINE OF N.E. .
American Services of Miami, Corp.
LB 6683
Consulting Engineers . Planners . Surveyors
9360 S.W. 72nd Street, Suite 200
Miami, Florida, 33173
PH: (305) 598 -5101
FAX (305) 595 -8627
Email: Ed®aaomiami.com
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NOT VAUD WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA UCENSED SURVEYOR AND MAPPER
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3
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FLOOD ZONE INFORMATION
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JORGE AND MARIA WELYCZKOWSKI
VAZQUEZ AND ASSOCIATES
OLD REPUBUC NATIONAL TITLE INSURANCE CO.
FBC MORTGAGE, U_C. DBA HOME LOANS TODAY, ITS SUCCESSORS AND /OR ASSINGS,
A.T.I.M.A.
LEGAL DESCRIPTION;
LOT 9, BLOCK 3. OF RIVER BAY PARK ADDITION SUBDIVISION, ACCORDING TO THE PLAT THEREOF AS
RECORDED IN PLAT BOOK 40 AT PAGE 72, OF THE PUBUC RECORDS OF MIAMI —DADE COUNTY. FLORIDA.
1 HEREBY CERTIFY THAT THE ATTACHED SKETCH OF "BOUNDARY SURVEY AND THE SURVEY MAP RESULTING THEREFROM OF THE ABOVE
DESCRIBED PROPERTY IS A TRUE AND CORRECT REPRESENTATION OF A FIELD SURVEY MADE UNDER MY DIRECTION AND MEETS THE INTENT OF
THE APPUCABLE PROVISIONS OF THE "MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYING IN THE STATE OF FLORIDA" PURSUANT TO RULE
5J-17 OF THE FLORIDA ADMINISTRATIVE CODE AND ITS IMPLEMENTED LAW, CHAPTER 472.027. OF THE FLORIDA STATUTES
SITE ADDRESS:
JOB NUMBER:
1453 N.E. 104th STREET, MIAMI FL 33138
12 -102
DATE OF SURVEY
DEC. 22, 2011
SURVEYOR'S NOTES:
- LEGAL DESCRIPTION WAS FURNISHED BY CLIENT
-SHOWN ELEVATIONS ARE REFERENCED TO THE NATIONAL GEODETIC VERTICAL DATUM (N.G.V.D.) AND ARE BASED ON
MIAMI DADE COUNTY RICH MARK No.B -26RA, ELEVATION 17.23 FEET.
- EXAMINATIONS OF THE ABSTRACT OR TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY
AFFECTING THIS PROPERTY NO UNDERGROUND UTILITIES OR IMPROVEMENTS HAVE BEEN LOCATED, EXCEPT AS NOTED.
-THERE ARE NO VISIBLE ENCROACHMENTS OTHER THAN THOSE SHOWN.
-THE PRECISION OF THIS BOUNDARY SURVEY IS ONE PART IN 7,500
- THIS SURVEY WAS DONE FOR MORTGAGE TRANSACTION ONLY.
- IN SOME CASES GRAPHIC REPRESENTATION HAVE MEN EXAGERATED TO MORE CLEARLY ILLUSTRATE A PARTICULAR AREA WHERE
DIMMENSIONS SHALL HAVE PREFERENCE OVER GRAPHIC LOCATION.
- BEARINGS SHOWN HEREON OF ANY) ARE BASED IN AN ASSUMED MERIDIAN OF N•0'09'05'Yj FOR THE CENTER LINE OF N.E. .
American Services of Miami, Corp.
LB 6683
Consulting Engineers . Planners . Surveyors
9360 S.W. 72nd Street, Suite 200
Miami, Florida, 33173
PH: (305) 598 -5101
FAX (305) 595 -8627
Email: Ed®aaomiami.com
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trr arlielb sr fa fi�as�l, m ood �lra41,=ea, 4i .d,rr..rfoarr ✓«r to.e 4 44faar4 G10.
NOT VAUD WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA UCENSED SURVEYOR AND MAPPER