DSC-12-2102Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 182094 Permit Number: DS -11 -12 -2102
Scheduled Inspection Date: November 29, 2012
Inspector: Bruhn, Norman
Owner: WEEKS, JEAN FLASKER
Job Address: 560 NW 112 Street
Miami Shores, FL 33138 -0000
Project: <NONE>
Contractor: R&M DESIGN CONCRETE CORP
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 3021360210630
Building Department Comments
CONCRETE APPROACH INSTALLATION FOR EXISTING
DRIVEWAY
Infractlo
Passed Comments
INSPECTOR
MMENTS
False
Passed
//29-71__
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- 181275. Grade and sod
disturbed areas. NB
C6-
November 28, 2012
For Inspections please call: (305)762 -4949
Page 17 of 25
PERMIT # GS 1 L 7^-110 •
.R4 Oe&1t9Y-
CONTRACTOR:
ZO 1
SUBMITTAL DATE: ON-k.. (P I
ADDRESS: .0L.) NILO
1IS4
NAME: W UJ-eJk.' -
RESUBMITAL DATES:
PROJE T TYPE: 1 ' , I1t
/// f
ZONING
ARE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
B G J (4 1 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
BUILDING
PERMIT APPLICATION
10JMUMEWIEiri
la NGV002012
BYao m.9sovovm�em000 mom
FBC 20
Permit No. M
Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS:
6® ,V4) /04R, 4.
City: Miami Shores County: Miami Dade Zip: 33 /(p
Folio/Parcel #: " Pi a& ''o Q(p
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 3-6Afrvi Wit° EX Phone #: 3 ® 7JwV 71x3
Address: 56 ® 494,4.1 //a).. 44.
City: H., A r I/ 674D rat State: . Zip: 3 3 /av
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: --7‹ ? Al • G- • C ° Phone :��J) 7e,t,6 ),62
Address: 0?-47/ -Cu)1
City: •41/4 State: FL •
Qualifier Name: �� 40 a / 12 ( 0 � �b Phone #:
State Certification or Registration #: Certificate of Competency #: 6:77(:: ✓ /cPO4
®c
Contact Phone #: 3Cti 7 ?6, 3 7g, )_ Email Address: —1JnG4P - i / • e
DESIGNER: Architect/Engineer: Phone #:
Zip: 3'B /EC
Value of Work for this Permit: $ r 00 CO ear Footage of Work: C:P°
Type of Work: Addition ❑Alteration Gd1Qew ❑Repair/Replace ❑Demolition
Description of Work: #47:�� 4 Che ' w 7X e_. 0,5 0¢
/4 /A. Slice-el .
Color thru tile:
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * **** Fees************* * * * * * * * * * * * * * * ** * * * * * * * * * * * * * **
era
Submittal Fee $ Permit Fee $ dd CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ 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 e NOTICE OF
TWICE MAY RESULT IN YOUR � PAYING WICE 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 approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this ?Iu The foregoing instrument was acknowledged before me this �,
day of ® , 20 /.L,, by ‘//�.S1 0 G/ /ice , day of � ant , 20 (Lby%4. (e.0 1� � c
who is . ovally known o a or who has produced C_ who is p tronally known a or who has produced
CIO ` e) As ideation and who di . e an oath. ' �' \ identificatiF :, � ho did take an oath.
NOTARY PUB
My Commission Expires:
APPROVED BY
// rj— Plans Examiner
Sign.
Print:
My Co .'c:. "sion Expire
Structural Review Clerk
(Revised 5 /2/2012XRevised 3 /12/2012)(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiant, . i A4 on/664S , does hereby attest that
(Property owner)
The attached survey, performed by A115,04:76- 0.5-e.eva el ?
(Name of surveyor's company)
For address: 5240 4) // M
Performed on /0l00,0" (date of survey) 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 Village 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 may affect final inspections as applicable to this or other permits.
rher, Affiant say eth naught.
Prop Owner Signature Property Owner Print Name
SWORN TO AND SUBS a ,•re me is day of e9 .4)-o, 2
Affiant i_�erson -';�� produced
Revised on 5/2212009/ Revised on 6/12/09
.J 4 ./ Weeks-
as identification.
Miami Shores Village
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) J ;4 10 • S°
r
hereinafter referred to as the owner of
(address): following described property //0/--
i
dF 04
Legal Description
Lot I Block 7 Subdivision al's/ ASS
Folio # 11 ' a1 ,-0 P.1 • 0(03
Requests permission to install (describe work):
Within the public right of way of (address)
l /12 e
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 Miami 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 lien 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 facilities 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 and /or 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).
Signature
wner or Agent
0
The foregoing instrument was acknowledged before me this day of _� 20 _, by
o me or who has produced As identification and who did take
My Commission Expires:
2
wrrefir-tosi!..4
t!iv'ed -51
BOUNDARY SURVEY
NW 112 STREET
50.00' TOTAL R/W 20' ASPHALT
12— _
E
FIR 1/2-
133' TO w-
NO2.1D. S89'56110nW
BLOCK 57.99'(M) RP 1
CORNER 58.00r) NO
SCALE: 1"= 20'
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COVERED
ENTRY
&O.
31.65'
57=A
ONE STORY CBS
RESIDENCE
#560
LOT 4, BLOCK 4
5.90'
41.30'
CONCRETE
STEPS
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3.65'
1-
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7.27'
10.94
METAL CONCRETE \ 6'
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N89'28'48 W in 4.6 '
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LOT 17 c.i
BLOCK 4
5' UTILITY
EASEMENT
FENCE ON 1.9'
LOT 16
BLOCK 4
FILE NUMBER JE.6
WWW.ALLSTATESURVEYORS.COM
PAGE 2 OF 2
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE Al',10 COUNTY RULES AND fl[GU AT