DS-12-2324Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 182691 Permit Number: DS -12 -12 -2324
Scheduled Inspection Date: February 21, 2013
Inspector: Bruhn, Norman
Owner: MAIDBREY, JESSE
Job Address: 1130 NE 100 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 1132050190440
Phone: (305)252 -8055
Building Department Comments
PAVER DRIVEWAY
Infractlo 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
February 20, 2013
For Inspections please call: (305)762 -4949
Page 8 of 23
PERMIT # t (d‘, " 21
CONTRACTOR: Cl PI (3N l.sLDNC-1-
SUBMITTAL DATE: l D I 1 0 1 .KN D.
ADDRESS: 1 1-30 2�-- 1 03 ST
NAME: f'} t D 13�
RESUBMITAL DATES:
PROJECT TYPE: -W1►
FIRE
ZONING "
IMPACT FEES
STRUCTURAL
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
BLDG / ` '%
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
FBC 20
Permit No. `D3��° e P9
Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: / 1 SZ E (0 0 1.)r
City: Miami Shores County: Miami Dade Zip: 3 3 /3
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): -7 -11 /4- /JOILr7' Phone#:
Address: // 3 0 ye /00 sr
City: f l k . �e5
State:
Zip: 3 13 �.
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: e'/i_I 1t-✓1 /()A) COiu4dj.-ex Phone #: 3 u5 252 55
Address: ( /00/ iw) f ..w17-e_. /U5
City: 0 004,e_ State: Zip: 3 317 f"
Qualifier Name: J oe /-2'r- 15 I �' td Phone#: 3c6 q.701-- 433 ..
State Certification or Registration #: Certificate of Competency #: 4-c 05.5-5®®d'I5
Contact Phone #: Email Address: N/ -/h' - C/7 4/// 2. y '7s '- ,
DESIGNER: Architect/Engineer: Phone #:
Value of Wotk for this Permit: $ .7, Square/Linear Footage of Work: iyc'
Type of Work: DAddition DAlteration New DRepair/Replace ODemolition
Description of Work: .O2AU-P.t.0*-Nf / tif..
Color thru tile:
*************************************** F�*********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ . Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training,/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ \ A 2
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 CONDmONERS, 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 % e delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement ` t be posted at the job site
for the fir. ' .ection which occurs seven (7) days after the building permit is issued. In the absen of such posted notice, the
inspectio be approv a a rei spection fee will be charged.
Owner or Agent
The foregoing instrument was aciowledged befo
day of ri C , 20 11--; by Ste— !°I'14 'DSI
who is personally known to me or who has produced ()
As identification and who did take an oath.
NOTARY PUBLIC•
Sign:
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Print: 4n o, a do " • w
BOO �./Ls ' ....
tt��,�l /!f I f I 0\\
APPROVED BY .' /212 Plans Examiner
My Commission Expires:
Signature
Contractor
The foregoing instrument was
`(day of D2 L , 20
who is p
acknowledged before me this I
or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
=�mo
-(A cn 9" E` : O-
N ' f�)o e..... LV
�k�k�k+ i<**** �k�xa� >k�x>k**** *+!<�x+xa�+i,�x*** ********************************************
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r,.., 1111Itit11�
Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Viiiage
Building Department
SURVEY AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiant,J r' 16k`l , does hereby attest that
(Property owner)
The attached survey, performed by Mi troViAril
(Name of surveyor's company)
For address: 03 0 1O r 511A-4-02-%
Performed on ee®11 ®L? J (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
ures may : ect fna`t i .pe s as applicable to this or other permits.
Affia
�esc cALV
P . perty Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me, _produced e-- ( as identification.
``u
' Aet S 8/
„
_ • � Vii► ►.
Nory : ''DIARY PUBLIC
m CEF j3U5n � / e
Revised on 5/22/2009/ Revised on 6/12/09
Miami Shores Vniage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel (305) 7952204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) J ti44A 6Aey hereinafter referred to as the owner of
the following described property (address): ti 3 0 NZ' ( X
b rho $ a 9)34
Legal Description Lot Block Subdivision
Folio# I —32-05 c,(4 L11-t1)
Requests permission to install (describe work): p /weep 5
Within the public right of way of (address) U �, 1190 .51 -°
I1i-A j 3 in
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).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on thi
SIGNED, SEAL
•`\e \S Sill/a l/I
2
(144 p�e'sefve of:
2016
URIC:
Commission # ,r
u' ∎ °•..EE113059..
411 - film
ilt {11{ {�`
,201 .—
(Owner's Signature )
575818 -1
BUSINESS NAME/ LOCATION
CHAMPION CONCRETE
11001 NW 83 ST
33178 DORAL
OWNER
JAMIE BASILIO CORP
Sec. Type of Business
196 SPECIALTY
THIS IS ONLY A LOCAL
BUSINESS TAX RECEIPT. IT
•DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY OR
ZONING LAWS OF THE
COUNTY OR CITIES. NOR
DOES IT EXEMPT THE
• HOLDER FROM ANY OTHER
PERMIT OR LICENSE
REQUIRED BY LAW. THIS IS
• NOT A CERTIFICATION OF
THE HOLDER'S QUALIFICA-
TIONS.
•
PAYMENT RECEIVED
. MIAMI -DADE COUNTY TAX
COLLECTOR:
09/18/2012
02280036001
000045.00
SEE OTHER SIDE
FIRST -CLASS
U.S. POSTAGE 1
PAID
MIAMI, FL
PERMIT NO. 231
THIS IS NOT A BILL - DO NOT PAY
RENEWAL
RECEIPT NO. 597435 -8
CC B 05BS00815
103
BUILDING CONTRACTOR
WORKER /S
1
DO NOT FORWARD
CHAMPION CONCRETE
JAIME A BASILIO PRES
11001 NW 83 ST 103
DORAL FL 33178
hati1IJ7tl7)Iiiffl Iii /Imili}i}Tiihli}1,,hliukJJlji1
THIS IS NOT A BILL — DO NOT PAY
RECEIPT NO. 30- 5974358 CC NO:
BUSINESS NAME / LOCATION
CHAMPION CONCRETE
11001 NW 83 ST
OWNER :JAMIE BASILIO CORP
SEE BACK OF RECEIPT FOR
A LIST OF NON- PARTICIPATING
MUNICIPALITIES
Receipt holder must
register in the city
where work is to be
done.
PAYMENT Rte. NED
MIAMI•DADE COUNTY TAX
- alt4718/2012
02280036002
000200.00
05BSQ0815
FIRST -CLASS
U.S. POSTAGE 1
PAID
MIAMI, FL
PERMIT NO. 231
RECEIPT HOLDER MAY DO
BUSINESS AS A CONTRACTOR
AS SPECIFIED HEREON.
SPECIALTY BUILDING CONTRACTOR
DO NOT FORWARD
CHAMPION CONCRETE
JAIME A BASILIO PRES
11001 NW 83 "ST 103
DORAL FL 33178
ii:JJu i1h ,Jflii:ihib n Ii11}IlifltlJJJt:
CTQB
Construction Trades Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
05BS0081 5
JAMIE BASILIO CORP
D.B.A.:CHAMPION CONC
BASIL JAIME A
is certified under the provisions of Chapter 10 of Miami -Dade County
IVI iami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: OSV-742 t 24' DATE: ) J)2
1:x 1, 5,45/LA
Contractor
Owner
Architect
Address:
ther)
0.30 IWZ-1"
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 Department to c• ntinue pei ng process.
Acknowledged b
g y yr-
PERMIT CLERK INITIAL:
RESUBMITTED DATE:`
PERMIT CLERK INITIAL: _______th___
Miami Shores Vivage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
December 12, 2012
Permit No: DS12 -2324
1) Provide HRS /DOH approval
Norman Bruhn CBO
305 - 762 -4859
Building Critique
Zoning Critique
1) SEC. 521 MAX WIDTH 24 FT, 20 FT DRIVEWAY 2 FT FLARES
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.
Miami Shores Vivage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
December 12, 2012
Permit No: DS12 -2324
1) Provide HRS /DOH approval
Norman Bruhn CBO
305 - 762 -4859
Building Critique
Zoning Critique
1) SEC. 521 MAX WIDTH 24 FT, 20 FT DRIVEWAY 2 FT FLARES
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.
Rick Scott
Governor
John H. Armstrong, MD, FACS
State Surgeon General
January 02, 2013
(Jamie Basilio Corp)
11001 NW 83 Street
Miami, FL 33178
RE: Contingency Letter
Application Document No: AP 1091880
Centrax Permit Number: 13- SC- 1445769
OSTDS Number:
1130 NE 100 St
Miami, FL 33138
Lot:8 Block:178 Subdivision: Miami Shores Sec 8 Rev
Dear Applicant:
This will acknowledge receipt of an application dated 12/18/2012 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 in the North side of property).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Sincerely,
Joseph P'j, °'rg -;r, Engin - pecialist II
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaFH.com
s
,*
220.04'
USA MAIDBREY, his wife
MATTHEW B. WEALCATCH, P.A.
FIRST AMERUCAN TITLE INSURANCE COMPANY
?L�uNa LV
?Q? v'W'
K'S -ua.tta C id fW 6�
%OiaL. 44o, )0c-ft
N
411 LOT 9
BLOCK 178
BEARING
IEASURED
LES
/2 O I�
FND 1/2 IP
NO ID
COVERED '•_
— PORCH
M Atv11 -LADE COUNT RHEA
Ll'H DEPF,R1
tOsi 18 O
MIENT
SCREENED
•. PATIO _
ONV c'NV 31d1S
1 -1d 1-1.11M 3D14,11•1c11N 0:., 0.1 10r9ns
FND 1/2 IP
NO ID
DATE OF ORIGINAL FIELDWORK 2110/1G
GENERAL NOTES:
(1) THIS SURVEY IS BASED UPON RECORDED INFORMATION AS PROVIDED BY CLIENT. NO SPECIFIC
(2) SEARCH OF THE PUBLIC RECORD HAS BEEN MADE BY THIS OFFICE.
(3) UNDERGROUND IMPROVEMENTS HAVE NOT BEEN LOCATED EXCEPT AS SPECIFICALLY SHOWN.
(4) ELEVATION ARE BASED UPON NATIONAL GEODETIC VERTICAL DATUM 1929 (N.G.V.D. 1929).
(5) IN SOME CASES, GRAPHIC REPRESENTATIONS HAVE BEEN EXAGGERATED FOR CLEARER
ILLUSTRATION. MEASURED RELATIONSHIP SHALL HAVE PRECEDENCE OVER SCALE POSITIONS.
(8) ALL DIMENSIONS SHOWN ARE FIELD MEASURED AND CORRESPOND TO RECORD INFORMATION
UNLESS SPECIFICALLY NOTED OTHERWISE.
(7) UNLESS OTHERWISE SPECIFIED, THIS SURVEY IS NOT TO BE USED FOR CONSTRUCTION
PURPOSES.
(8) WELL - IDENTIFIED FEATURES IN THIS SURVEY AND MAP HAVE BEEN MEASURED TO AN
ESTIMATED HORIZONTAL POSITIONAL ACCURACY OF 0.10 (FT)
(9) NOTE: "I HEREBY CERTIFY" IS UNDERSTOOD TO BE AN EXPRESSION OF PROFESSIONAL OPINION
BY THE SURVEYOR AND MAPPER BASED ON THE SURVEYOR AND MAPPER'S KNOWLEDGE AND
INFORMATION, AND IT IS NOT A GUARANTEE OR WARRANTY EXPRESSED OR IMPLIED.
ATTENTION IS DIRECTED TO THE FACT THAT THIS SURVEY MAY HAVE BEEN REDUCED OR
ENLARGED IN SIZE DUE TO REPRODUCTION THIS SHOULD BE TAKEN INTO CONSIDERATION WHEN
OBTAINING SCALED DATA.
SURVEYORS CERTIFICATION:
I HEREBY CERTIFY THAT THIS _BOUNDARY & PATJAL
TOPOGRAPHIC SURVEY MEETS THE MINIMUM
TECHNICAL STANDARDS FOR SURVEYS, AS SET FORTH BY
THE FLORIDA BOARD OF SURVEYORS AND MAPPERS IN
CHAPTER 61G17-6 OF THE FLO' DAADMINIS1RATWE CODE,
PURSUANT T• • ION 47 FLORIDA STATUES.
Pr
GINO 0, PRO '�'.IONAL SURVEYOR & MAPPER
FLOR I• ° REGISTRA )r• NO. 5044
(NOT AUD WITH • ' SIGNATURE AND ORIGINAL RAISED
SEAL OF THE FLOR 'A LICENSED SURVEYOR AND MAPPER
SHOWN ABOVE)
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. id\ -QS Li TAX FOLIO NO.
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.
1. Legal description of property and street/address:
2. Description of improvement
3. Owner(s) name and address:
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name, address and phone number: CfrleipipW Copuckso-e,
flOg /Ad tr-3 t3
5. Surety: (Payment bond required by owner from contractor, If any)
Name, address and phone number:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provide
Section 713.13(1)(a)7., Florida Statutes,
Name, address and phone number:
1111111 11111 11111 11111 1111111111 11111 1111101
F1,41 2012R0922190
OR Bk 28411 P9 3445; (1p9)
RECORDED 12/21/2012 11:31g02
HARVEY RUVIMp CLERK OF COURT
MIAMI—DADE COUNTY, FLORIDA
LAST PAGE
Space above reserved for use of recording office
lowLit 19YrS V513
Ns) 40,4.)et poi d ea5
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Se
713.13(1)(b), Florida Statutes.
Name, address and phone number:
9. Expiration date of this Notice of Commencement:
ltj
84'2
(the expiration date is 1 year from the date of recording unless a different date is spec
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NO110E OF COMMENCEMENT ARE CONSIDER D
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING Tat R
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE ITIE
FIRST INSPECTION. IF YOU INTEND • OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCIW@VgeK
OR RECORDIN - NOTICE OF OMMENC 9 ENT.
' • zlls u/(0.44///Director/Partner/Manager
Air Prepared By .-.1.4-PWCAA6,1-4
'ilginOtir Print Name
Title/Office
Signature(s) of 0
Prepared By
Print Name
Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoing instrument was acknowledged before me this
By ss
laandividually, or 1-.3 as for
la Personally known, or Xproduced the following type of identification:
Signature of Notary Public:
Print Name:
(SEAL)
VERIFICATION FURS ANWTO SECTION 92.525. FLORIDA_STATUTES
Under penalties of pe ry, I declare that I have read the foregoing and
th ts stated n it are true, t the best of my knowledge and belief.
day of
. Com •
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By