DS-12-1507Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 178845
Permit Number: DS -8 -12 -1507
Scheduled Inspection Date: September 25, 2012
Inspector: Bruhn, Norman
Owner: LOPEZ, GUSTAVO & SHEILA
Job Address: 575 NE 95 Street
Miami Shores, FL
Project: <NONE>
Contractor: AJIL CONSTRUCTION INC
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Feunttation
Work Classification: Addition /Alteration
Phone Number 305/757 -8118
Parcel Number 1132060140760
Phone: (305)207 -9416
Building Department Comments
REPLACE EXISTING PAVER AROUND POOL WITH
FLAGSTONE
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
0
CREATED AS REINSPECTION FOR INSP- 177133. Not ready. NB
i.i..,
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
September 24, 2012
For Inspections please call: (305)762 -4949
Page 23 of 30
Sheila Lopez
Sales Representative T +1.800.633.7610 x1476
C. +1.786.797.8118
slopez41@its.jnj.com
wvvw. depuy. com
Codman & Shurtleff, Inc.
325 Paramount Dr.
Raynham, MA 02767
Codman
never stop moving goe:..,,�„r,,,,„, _ .
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
BUIL ING
PERMIT APPLICATION
Permit Type: is o •
JOB ADDRESS: 575 Or % g '"� •
ECEIVE
AUG A 8 nu
FBC 2010
Permit No.D51 2-1574-
Master Permit No.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes . ..Ns.-- Flood Zone:
OWNER: Name (Fee Simple Titleholder): - "i / /-a Phone #: 9V6- 7e7 7° ? '
Address. 575 //' ' &
City: /No State: Zip:
Tenant/Lessee Name:
Email:
Phone #:
CONTRACTOR: Company Name: A J 1 L C-0 n 5+,rU C7b o n, 7r-.� e• Phone #: 306 2O1-q41(.°
Address: 55 0 3 l 3 8 C-1-
City: G'I 1 o vw+ State: Zip: 3-51/5
Qualifier Name: Pedro L • Fi o I.0s Phone #: g (" 5 41- Z/ g
State Certification or Registration #: G 1615 49 Certificate of Competency #:
Contact Phone #: Email Address: aJ c �� s%ru c -Pro n @ a ��
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 4.O 4?-0 Square/Linear Footage of Work:
Type of Work: C Address UAlteration
Descripti n of Wo k: / — /
c -'?o' 5 o" / %'7
UNew
tgRepair/Replace ❑Demolition
C. YL
tfJ/ I e'2 OA/ 5''At ® SEALL s ate'
Submittal Fee $ °` 'I, . � Permit Fee $ J CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
a�
CDouble Fee $ / %0 �- Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City , . State Zip
Mortgage Lender's Name` (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days afier 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
Owner or Agent
The foregoing instrument was acknowledged before me this v7
day of vS ,20 ,by S \ 0`C1194—
R ®personally known to me or who has produced
As identification and who did take an oath.
Sign
Print:
My Commission Ex its:
APPROVED BY
1ACKELINE DOMOND
*e" r : nssicn # EE 180176
• June 5,2016
Signature
Contractor
The foregoing instrument was acknowledged before me this -
dayof 41l71V+ ,20 12,by ea co L. korc., '
who is personally 1sno into me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
(Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09)
Plans Examiner
Structural Review
Sign:
Print:
Av -edto '67ccrh,e r5
My Commi
i}>ALIA ROCANEGRA
MY COMMISSION if DD9019S2
1ova' EXIRES: Septanbec 21201c3
1soo.3.sornty n.aae� 'nt ,a
'117413
* * * * * * * * * ** *fie * * * **
9-
Zoning
Clerk
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: D 'SI7.7-1 DATE: flit Li 1 7A)12._
I, ® r1. e C
G
Contractor
❑ Owner
❑ Architect
Picked up 2 sets of plans and (other) 'H' ° `#21C24--)
Address: Sl 5 L cl
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 D`• ent to cohinue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL: V'
Permit No: 12 -1507
Job Name:
.20, 2012
Miami Shores Vivage
Building Department
Building Critique Sheet 2nd
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
2) Provide a separate permit for the new barbeque /outdoor kitchen structure being built
without permits.
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
Permit No: 12 -1507
Job Name:
August 20, 2012
Miami Shores Viiiage
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 approval from Miami Dade County Health Dept. (DOH /HRS)
2) Provide details of construction.
3) Provide a separate permit for the new barbeque /outdoorkitchen structure being built
without permits.
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
1
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:1132060140760
Owner's Name: GUSTAVO & SHEILA LOPEZ
Job Address: 575 95 Street
Miami Shores, FL
Owner's Phone: 305/757 -8118
Total Square Feet: 1000
Total Job Valuation: $ 2,450.00
Contractor(s)
AJIL CONSTRUCTION INC
Phone
(305)207 -9416
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 8/9/2012
Comments: DECKS CAN NOT BE LOCATED CLOSER THAN 10 FEET TO SIDE PLOT LINE
Rick Scott
Govemor
John H. Armstrong, MD, FACS, FCCP
State Surgeon General
September 10, 2012
(Statewide)
p.o. box 3865
Hollywood, FL 33083
RE: Contingency Letter
Application Document No: API081994
Centrax Permit Number: 13 -SC- 1428042
OSTDS Number:
575 NE 95 St
Miami, FL 33138
Lot:22, 23 Block:54 Subdivision: Miami Shores Sec 2
Dear Applicant:
This will acknowledge receipt of an application dated 08/31/2012 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 your existing system is
adequate for the proposed use (pool patio construction).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645. http: / /www.MyFlorid2F.H.com
SPECIAL PURPOSE SUS LOCATION OF EXI
g Asphalt
75.00' W.P.P. 15'ALLEY W.M.
■
•
�...RECE
AUG 0 $tif:
1'
FND1.P.112°
(NO ID)
FNDJJ'iI?
(NO ID)
c
,S.y■f1 2o, G2- -'
J
U -
III Remainder L
BUC 14
ONE STORY CBS
0.0'
'p11BJECrrQQCNIPUANCE WITH
;STATE AND CCUPii f RULES AND RE U
M64M1— DADS - COUNT? t aALTH DEPARTMEN
PERMIT is
AE:—
FND.I.R.1(r
•ID
MOO'
8
ci
SCALE: 1 " =20'
RECENtD
AUG 8
x;11`: =F) -1
SPECIAL PURPOSE SURVEY LOCATION OF EXISTING POOL
Asphalt
75,00' W P p 15' ALLEY
W.M.
FND.I.P.1/2°
(NO ID)
LOT 21
BLK 54
.In+ chores Village
3' CBS Waif On/PL
FND.I.P.1/2°
(NO ID) A
LO
C
tab
V
Lt.
R
3 0
"
c
z
7.00`
'LOT23
10.20'
20.$30'
Condrete
ONE STORY CBS
RESIDENCE # 675
0.30'
• er Lot 23
K54
12.90'
Conc.
E \M frl ALL FEDERAL
(;I iLATiONS
FND.I.R.1/2°
NO ID
5' Conc.Walk
75.00'
li 79.38'
H.E. 6th AVENUE
(IBC
FND.I.P.1 /2"
____(NO ID)
25' Parkway
Asphalt Driveway
25.00'
22.00'
20' Asphalt
N.E. 95th STREET
80.00' Total RIW
FOR SHELIA LOPEZ
PROP. ADD: 575 NE 95 STREET, MIAMI SHORES, FL 33138
CERTIFIED TO:
SHELIA LOPEZ
JOB N0: 0212 -028A
FIELD DATE 07 -24 -2012
LEGAL DESCRIPTION: MIAMI SHORES
LOT: 22, W 1/2 OF 23 BLOCK: 54 SUBDIVISION: SECTION No 2
PLAT BOOK: 10 PAGE 37 OR MIAMI -DADE COUNTY, FLORIDA.
SURVEYOR'S NOTES:
1.) THE SURVEY OF THE PROPERTY SHOWN HEREON IS IN ACCORDANCE WITH THE
DESCRIPTION FURNISHED BY CLIENT.
2.) UNLESS A COMPARISON IS SHOWN, ALL BEARING, ANGLES AND DISTANCES SHOWld
ARE THE SAME AS PLAT VALUES.
3.) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER
RECORDED ENCUMBERANCES NOT SHOWN ON THE PLAT AND THE SAME, IF ANY MAY
NOT BE SHOWN ON THE SKETCH.
4.) UNDERGRAUND PORTIONS OF FOOTINGS, FUNDATIONS OR OTHER IMPROVEMENT
WERE NOT LOCATED.
5.) FENCES TIES ARE TO THE CENTER LINE OF THE SAME.
6.) WALL TIES TO THE FACE OF THE SAME.
7. ELEVATION WHEN SHOWN ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM
)1929) UNLESS OTHERWISE NOTED.
8.) THERE NO ABOVE GROUND ENCROACHMENTS OTHER THAN THOSE SHOWN.
(FLOOD ZONE INFORMATION)
ZONE: X COMM: 120652 PANEL:12086C0306SUFFIX: L DATE•9- 11- 2009BASE• N/A
NOTE: DETERMINATION OF FLOOD ZONE LINES WERE BASED ON SCALING OF FEMA MAP LISTED ABOVE
NOTE; ALL BEARING HEREON ARE BASED TO THE PLAT BEARING OF
ON THE CENTER LINE OF PROPERTY LINE.
EASEMENT VIOLATION& O YES X NO
APPARENT VISIBLE ENCROACHMENTS! ❑ YES a NO
COMENT&
ABBREVIATIONS;
SWK= Sidewalk, CBS= Concrete Block Structure, CLF= Chain Link Fence,
PL= Properly Line, DUE= Drainage Utility Easement, IP= Iron Pipe,
A/C= Air Conditioner Pad, P /C= Property Comer, DM= Drilled Hole,
WMF= Wood Fence, RES= Residence, CL= Clear IR= Iron Reber, UE= Utiity
Easement, CONC= Conc. Slab, R/W= Right of Way, DE= Drainage Easement,
CA.= Center Line, 0= Diameter, TYP= Typical M= Measured, R= Recorded,
ENCR= Encroachment, COMP= Computer, AS�PH= Asphalt, N/D= Nall & Disc.,
S= Set, FFE= Finish Floor Elevation, 0/5= Offset, P/P= Power Pole,
01-IP= Overhead Powerline, WM= Water Meter, WPP= Wood Power Pole,
E.M =Electric Meter, M.F =Metal Fence, P.F. =Plastic Fence, D.M.E =Drainage
Maintenence Easement, C.M.E. =Canal Maintenence Easement, LM.E. =Lake
Maintenence Easement, M.E= Maintenence Easement, B.C. BlockComer,
P ( =Pnint of C;urvatura FNFr= nund N() Ir Nn Idantiiirrtinn
Gb?hSIONS INC.
ci
Land Surveying Services
OFFICE:
14770 SW 43rd WAY,
MIAMI, FL 33185.
PHONE: (305) 512 -4225
FAX: (305) 512 -1914
I HEREBY CERTIFY:
That eta dashed °BOUNDARY SURVEY' ofete tends sMom ha!eon M tow and correct
to the hit of my �etd be9ef es tecpNy awveyed and drum under my
supeMeton,nd dbect1 n. etavey complies �e Minimum Technhei
Ste eds adopted bydte Ftodde ° Boed of P , p etd Mxppets
as2.027a,ed i Cllr 5J-77, Fk', aAdndNsbedve Code, (o Chester
472.027, Raids SMhdes. s�
DAVID L. FUTCK
REGISTERED LAND SURVEYOR # 4843
STATE OF FLORIDA
LB # 0008874
Note: Not Valid Unless
Signed and Sealed.
SHEET 1 OF 1