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DS-13-1154Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 192099 Permit Number: DS -5 -13 -1154 Scheduled Inspection Date: June 13, 2013 Inspector: Rodriguez, Jorge Owner: SIMS, DALE Job Address: 152 NW 110 Street Miami Shores, FL 33168 -4321 Project: <NONE> Contractor: CHAMBERS CONTRUCTION COMPANY Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360030130 Phone: (954)610 -5325 Building Department Comments REPAIR ASPHALT DRIVE IN ALLEY 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 PERMIT IN BACK DOOR ON HOUSE. NO FENCE NO DOG. June 12, 2013 For Inspections please call: (305)762 -4949 Page 17 of 36 .ER.R. X413- I 1 �z CONTRACTOR: oh / fl Corqfirzi41-)eion7 SUBMITTAL DATE: y- /3 �.. ADDRESS: /3dA NAME: vOle lei Sew RESUBMITAL DATES: STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM `LUMBING NOC 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 MAY 2 11 3 2fli3 ..: BYooaoosm000ma00000000 'BiC201© Permit No. ) 1) Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: 16a !ANN/. 1 I 0131' S" 1 P EET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 212(, ©3 0I3a Is the Building historically Designated: Yes NO *- Flood Zone: OWNER: Name (Fee Simple Titleholder): DALE M • S I ti S Phone#: (WS) 315' °14 I Address: 2 3) 0 N. E .194 STREW City: ■00114 MIAMI GEAGH State: ROAM* zip: 331 SO Tenant/Lessee Name: t4/4. Phone#: ]mail CONTRACTOR: Company Name• MSi=iQS_L" 51hQCf Qt4 T Phone#: C9 s4) 410. 5525 Address: (022 0 S. Vi . 1 SI:1/ STREET City: Fth1eROkE Pit4ES State: Row:A - Zip: 33025 Qualifier Name: G— 2L TtN G'-iz4N4L Phone#: L9s+) WO. 5325 State Certification or Registration te-a C 056=64,1 Certificate of Competency #: Contact Phone#:CG194) Cog). 9325 Email Address: CAP fFvnCM4W ( bef Isourl-h. n df- DESIGNER: Architect/Engineer: N%l► Phone#: Valve of Work for this Permit: $ 1 OO- oa Square/Linear Footage of Work: 1 1 OS.'E- Type of Work: ❑AdditiTo�n `�,,' DAlteration ONew ®Repair/Replace DDemolition Description of Work: - t— ►wsJ1Z ASPHALT E)211E 1 M AU.E-f Color thru tile: ********* *** * * ** * * * * ** ** ** ** * * * * * ******F * * *** *** * ******* ** ***** **** * **** *may * * ******* MC./ ppi�a Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ m ,� TOTAL ME NOW DUE $ Y 0 Bonding Company's Name (if applicable) 46c Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 14/A. Application is hereby m de 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 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 3CLd atiae Ownee or Agent The foregoing instrument was acknowledged before me this 17 The forego day of t'7A r , 201 , by M'. �..- f (5 , day of who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * ** 4NAWL NOTARY PUBLIC STATE OF FLORIDA Commit EEE50743 ail#00 41=06*******: new ***** ** *** ** * * ** ** ** *** * * * ** s ** ** **** ** *** ** 4 f • .r NOT 'Y Sign: Print: to me or who has produced 1 1.3 LIC: on and who did take an oath. ` 49 L 4 •��.M� r ,:�IOS (lL.:�. 11.eOid�A` sep Honda °d • a; Gomm Expires Sep 23, ' commissron Assn. Bonder' Through National Notary My Commission APPROVED BY J X*..1" Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk This property described Lot 13, Block 219,'° MIAMI SHORES EXT7ENSION,; according to the Plat thereof, as recorded in OSEVIC w;:t232013 Plat Book 43, Page 40 SY' m • oomm000m of the Public Records of ' Dade County, Florida. FLOOD LONE: X. NOTE: Underground encroachments,' if any, not located. Certified Td: American Southern Mortgage Corporation its Successors and /or assigns as their interests may appear and Commonwealth Land Title Insurance Company•. r' V=1 P„, -For" -FAN e�e ^„ 254475' -.-•- 1 a. ,t.8 asp x, Miami Sh ore Village r • l,+u • Rive .st; , • r eaal :V' v /a \ \ /0d. ea. 7S' • /5 H. \. // /4.c� .I• 75 °' / .`` ° '' BSc ,g7. /2 \ :JQ,a.5 O /7 • + /0UGC%• , N 75. / N 1.0. b 2c /v i ,/ 75' 9)1r. 7,a/, /0,970 sr L49C.477424✓ A /,Q," • ; /// • PROPERTY 'OF. Sims, JF • • 0+ :oar Q'.,. • z 7A OD' 1 • • N , 5,5' 1 ele 0.70' a o 70' /' 7 )rp • G. /u' vi 1 J ,140 gip►' • t;) • /e. ds /a /6.• As E44LT a RLAI' a eFAce 7S OO'• Ori ty 152 N.W. 110th Street Miami Shores Florida. Not valid unteis =e:rr+ossed with SurveyQrr's, Sel.' ;:: 1++ A BOUNDARY SURVEY I hereby certify that the survey repre- sented hereon meets the minimum technical standards set forth by the Board nt Lind Surveyors/pursuant to Section 472.tlp, Fla. Slat es. There are no emu' tMnents.ove +pc,easement% appear R on the P t: other than d' shos hereto 4 - • 11 . Reg i< ti Xurvevot tiu d % .a leize LANNES and GARCIA, INC. ENGINEERS - LAND SURVEYORS - LAND PLANNERS Office address: 4080 S.W. 84th Avenue, Miami, Florida 33155":4" Mailing address: P.O. Box 561131, Miami, Florida 33156 •a' DATE. SCALE DRAWN BY Go 2A' /G 2.. G" =. G,�, DRWG. Nb 1.7 -82