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DS-12-1489Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 177025 Permit Number: DS -8 -12 -1489 Scheduled Inspection Date: September 25, 2012 Inspector: Bruhn, Norman Owner: HALL, LORAN Job Address: 106 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: CHAMPION CONCRETE Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060132561 Phone: (305)252 -8055 Building Department Comments PAVER DRIVEWAY APPROACH AND WALKWAY Inspector Comments PassedL /��� 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 14 of 30 PERMIT # O o2—' 14J-i CONTRACTOR: C of SUBMITTAL DATE: to ADDRESS: 10(p W. - 6 I NAME: RESUBMITAL DATES: PROJECT TYPE:_ ta ZONINGy- " el > - �J FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL B 1 e gliiip;��iBnvG 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: /I2 4E- '9 7 es% City: Miami Shores County: Folio/Parcel#: 1f _ Oh -- 0/3 56/ Is the Building Historically Designated: Yes NO RE_ AUG 0 6 2012 Y: 05.1g.-1.407) FBC200 Permit No. Master Permit No. ROOFING Miami Dade Zip: 3 3/3& Flood Zone: X OWNER: Name (Fee Simple Titleholder): a/i/L) /2/4LL Address: /06 fie- S7 City: /Vi,n i / Slib//ES State: 9V9 73°Z -19d,/ Zip: .33/3r Phone#: Tenant/Lessee Name: Email: CONTRACTOR Company Name: �pC #4ffl O i`� C© /JC- -1i— Phone#: 30 5 �c2 -Jo 5T Address: //'0 / N `! 2 �7 J ',T /l' 3 City: itto,f4L Stale: " "z" zip: 3 3 / 7or Qualifier Name: ..J p(IY'e' G a/ LA 6� State Certification or Registration #: Certificate of Competency #: 0,5R3 00075 Contact Phone#: 30 5:?- la 55 Email Address: DESIGNER: Architect/Engineer. Phone#: Phone#: Value of Work for this Permit $ ...5)C0600 Square/Linear Footage of Work: a J 4V_Jl ./ Type of Work: OAddition DAlteration C]New C]Repair/Replace ODemolition Description of Work: ieVieX /r /ffV— �i✓V , 4 /! ,4J) 64/s h � 'Zlshrn i7 %p• e Submittal Fee $ Permit Fee $ / J c 4tY3 CC $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ r I TOTAL FEE NOW DUE $ `eZ • 90 Bonding Company's Name (if applicable) Al* Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Ny4 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 r livered to the person whose property is subject to attachment. Aim, a certified copy of the recorded notice of commencement must q' posted at the job site for the first inspection hick occurs seven (7) days after the building permit is issued. In the < , e �, `such posted notice, the inspection will t be l' proved and a reinspectton f, ; !. be charged /. Owner or Agent Y Contractor The f • ._ ping ins nt was acknowledged before me 1 The �'� t g '4 <<, was ackno ' ledged befo day of 20 by XI e) �2.. f 7/ , / 4A & , day of 1, 20 12, by o IS a i . y known to me or who has produced a 1 y 1 gqknno�own to Inc or who has produced TA ,1�/2 A it': As identification and who did rake an oath. 10 1 '2 � '2Q3 i eentification and who did take an oath. NOTARY PUBI IC: Signature Signature Sign: �����►%Ihu IIii,/ Print ��� .•• " "� �UpSs My Commission# Jut). re 3.7V7 irs,*11 V we> o a d,**,b*,SS+R+R*** APPROVED BY si> ;OF OPW" 23728 S. DIXIE F;. "/ HOMESTEAD, FL 3 i 3('5- 245 -73GO LIC: Sign: Print: My Commissi c. MY Commission # EE 128810 ,0.` Bonded Into ugh National tdotary Assn. '. ,� O! d Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10107)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) Z'q4-)') 60 the following described property (address): �i a 4-Y / ,.5' /1 /L a /`L-°' 33/ ;cr Legal Description Lot At Block r 9 Subdivision "'PT/ ' S ' ', `> Folio# /1-3c)-176 —O/3-926/ Requests permission to install (describe work): hereinafter referred to as the owner of /06 tr Within the public right of way of (address) /06 S 41711/ (9/t5 33/3 IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Nam' Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a Gen against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 1 3. The Owner does hereby agree to remove or relocate their fact ities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property andlor assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this 2 RED in the presence of: ®i� r.,,sT��, F � • •■ 4e a) •y'v 43;456 II N1 ;P\oI'\\\`\\\ d' day of ' °�� is Signature ) Miami Shores Viiiage Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 STATE OF (FLORIDA) COUNTY OF (DADE) The undersigned Affiant, /0424-?-i ' iM dbes hereby attest that (Property owner) The attached survey, performed by /< / £ J /A 6 Co &/' For address: (N7--of surveyors company) /off �e Cif ,, sjJ, 33/3, Performed on 11-417" /' (date of surrey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Vilage to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures m ,, affect final inspecti i _ y , plicable to this or other permits. Furth r_. tsa eth nau zoirrh Property Owner Sign. ` Property Owner Print Name SWORN TO AND SUBSCRIBED before me this Affiant is personally known to me, oowiriorskt ••�yCoors SL°• *Q 4• r . *.+ •� 4 os• ®,� � .. Revised on 5)22f2009/ Revis ► 2f LiS orritritm000 • " 1■^1 2 28 S. f..VJE HA''• Fk.) ES ,I y, FL 33033 3O5-245-73c „ n 4 NE 97th STREET Total Right of Way = 75° 21' Pavement 22' Parkway 31.04' LtJrNu SURVEY NOTES FN&D Found Nail and Diski Beatings and coordinates r recorded Plat or NAD83. 2 legal Desaiption provided others. 3 The lands shovm hereon, w abstracted for easement or encumbrances not shown 4 Underground portions of f. foundations or other imp-i were not located. 5 Elevations are based on Na Geodetic Vertical Datum 1 6 Fence ownership not deter 7 Wall ties are to the face of 8 Not valid unless sealed wit embossed surveyor's seal. 9 No identification found on property corners unless nos 10 Only visible encmachmet located. 11 The survey depicted here covered by professional li Overhang Electric insurance, liability limited cost of the smvey. Metal Fence 12 This survey is intended fo Elevation NGVD29 by those to whom it is Ct. and foronebuildingpert estate closing only. 13The attached survey mater original work product of and are subject to the cop3 of the USA. Infringement this same survey is re-use closing or biulding pmmit occurs if a government bc dish:tinge it in any form. At)MIE ■110)4=11.-friG, Fi 7.8 4 Concrete Asphalt o Property Comer (R) Recorded (M) Field Measured Centerline " Found Iron Pipe FIP 1/2 Y2" diameter Covered Area Utility Pole Fire Hydrant Catch Basin Water Meter —"-- Wood Fence —x— Chain Link Fence 1><1 x41. ..• .•.• • .• • • .• • • • • • .• • • ..• . • '.*."..'. .. • • .• .• • • es1 One Story # 106 12.2' 9.55' Ei en14.0' ■ FIP 1/2" FIP 1/2" FIP 1/2 LOCATI1ON SKETCH Community number: 120i VILLAGE OF MIAMI ST. Panel: 12086 C 0302 Suffix: L -11-200 -11-2001 rk: 07-26 lebon te-07-27-2 cA144 elevation: N/A Di\ Finished floor elevation:1 Lowest adjacent grade:9. Highest adjacent gmde:9. Crown ofroad:10.11' Garage:10.01' Latitude: 25°51' 51" N Longitude: 80°11'43" W RECEIVED AUG 0 6 2092 BY: Description: t 14, Block 19, MIAMI SHORES SECTIt according to the Plat thereof, as recon k 10, Page 70 of the Public Records of ...Dade County, Florida. NO F; ..;:;:113T1 bilft 1-'11711Z1 S'Ir ISM APPRCA/ED ZONING DEPT DL DG DEPT frEiMi rifT71- ) " ii":77'.41hirip.171 ,i 41.11,1: :ri.:;17t. • UR Certifv to: SUBJECL Witatt-1 ALL FEDERAL STATE ANIj CC,U41.7 -_FS AND REGULATIONS Property Address: 106 NE 97th Street Miami FL 33138 Folio No.: 11-3206-013-2561 GRAPHIC SCALE 10 20 20 mber. MEC12/dwg/106dwg ••• 14 fg■ • ,",/ •••• • • tre—ro• wan.. •• • o• n • 1 I MIAMI ENGINEERING CORP. I ( IN FEET ) 1 inch = 20 ft. JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 04 -13 -2012 * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 04/13/2012 EXPIRATION DATE 04/13/2014 BASILIO JAIME A 201817735 BUSINESS NAME AND ADDRESS: JAMIE BASILIO CORP 11001 N.M. 83 ST. #103 DORAL FL 33178 SCOPES OF BUSINESS OR TRADE 1- PAVING (5221) 2- CONCRETE WORK * IMPORTANT: Pursuant to Chapter 440. 05(14). F.S., an officer of a corporation who elects exemption from this chapter by Wing a certificate of election andar this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(121 F.S., Certificates of election to he exempt— apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE QUESTIONS? (8501 413 -1609 CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW EFFECTIVE 04/13/2012 EXPIRATION DATE: PERSON JAIME A BASILIO FEIN: 201817735 BUSINESS NAME AND ADDRESS: JAMIE BASILIO CORP 11001 N.W. 83 ST. 3103 DORAL, FL 33178 SCOPE OF BUSINESS OR TRADE 1- PAVING (5221) 2- CONCRETE WORK 04/13/2014 IMPORTANT F Pursuant to Chapter 440.05(141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt. E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 NOTICE OF COMMENCEMENT A RECORDED COPY ,q, T BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. / _2° /01Y Y TAX FOLIO NO. // -3 ' ‘ - a/3 -0256/ 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. 1111111111111111111111111111111111111111111 CFN 2:=o 12R.0c81 o m9re OR Bk 28232 Ps 3462; Ups) RECORDED 08 /17/2012 14:08:57 HARVEY RUVIN? CLERK OF COURT MIAMI -DADE COUNTY? FLORIDA LAST PAGE �/ �// Space above reserved for use of recording office 1. Legal description of property and street/address: 1(27- /T ` C/< t l R /:3t / 5/,14)/to s�e�jori 19-14/0 P6 /o P* 7o /06 N - 97 57" ni4rni Sim 5 - FL - 3 3/3d" 2. Description of improvement J/=� h A(//v8.--a/1-7 4-`J I ALKI4%4 3. Owner(s) name and address: 20/ . 1-394...(--- /D& /4--- 97 Sr A 'k f i71-aa , 1--Z. _43/4, Interest in property: C24-4NC7e -- Name and address of fee simple titleholder. 000 6"),/0/1/-4.---, 4. Contractor's name, address and phone number. Cr/-4t- 2 ors -/ C v ti'C/f L 7-L- i/ 001 PG) d'35-2--- • 5a [7-L- J03 iDo 1-L, Al 33/7X [ • Jo 5 - °14-') - 49.06E OF FLOci117A, COUNTY DADE OF DA ' b , 5. Surety: (Payment bond required by owner from contractor, if any) i HEREBY Ci;RTO that this !s a flu® copy of Ms . Name, address and phone number , is olti'e asp � 7 de o ,'; Amount of bond $ ' ' � A.r�. y u� ? it 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon wh � • I T 'y ma be sere ( )(� 8y + Circuit D.C. Courts dos ccir�Tf, &VO�`'' Section 713.131 7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lieftor's Notice as provided in Section Name, 713.13(1)(b), ess aFlorida Statutes. 4305/ /71't LC..., 70.6 /tic. 97.5/ ,� •41 / SY6'f 5 FL- Name, address d phone number: J ?S- 9. Expiration date of this Notice of Commencement the expiration date is 1 year from the date of recordng unless a afferent date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of • 111,;-, ,: •rgwner )' uth•rized Officer/Director/Partner /Manager Prepared By / ' % Prepared By Print Name 2 1// f Print Name Title/Office Titie/Oftice STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument as acknowledged before me this B / el /4,9>d ee• ,# Individually, or ❑ as BiLI"'7✓ ❑ ❑❑ Personally known, or ❑ produced the following type of identification: Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts ted in it are true, to the best of my knowledge and belief. Signatusff�n?ner s) or OwrIr(s)'s Au fized Of /Direcior/Par1per /M 1/ day of for 2 d/ . By 123.01 -62 PAGE 3 3/10 By • 2 • ..rte C,1/I /oo sw », HU?hES7E?AD, FL 3:023 305-245 -77:T'y