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DS-13-919Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 190421 Permit Number: DS -5 -13 -919 Scheduled Inspection Date: June 24, 2013 Inspector: Bruhn, Norman Owner: JEAN, DOLINA & GIEBNER Job Address: 550 NW 113 Street Miami Shores, FL 33168 -3321 Project <NONE> Contractor: ASTERISK SOLUTIONS INC Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360210840 Phone: (305)300 -4026 Building Department Comments INSTALLATION OF A NEW CONCRETE DRIVEWAY Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 21, 2013 For Inspections please call: (305)762 -4949 Page 14 of 37 PERMIT # y -- 6 1 01 SUBMITTAL DATE: ADDRESS: NAME: Dxfo 3 rte, Il�t RESUBMITAL DATES: STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING MECHANICAL 93 V3 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit Type: BUILDING JOB ADDRESS: CCU ,l/ LJ //1/4.3 imqygIME MAY 0 1 HI? promo ®mmmmm cameclOOGIC20010i70 Permit No. 2-9/19 Master Permit No. ROOFING City: Miami Shores County: Miami Dade Zip: Z33) 6 g Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 2 o )i Ai Pr �I �` / Phone#:(7�6> 3 o/ — Address: S C) /(114.i jf/c,S City: M �1LO 4 ve'4 State: 74-10 2 f ')4- Zip: 33/4"k Tenant/Lessee Name: Phone #: Email: C. 3T 0 CONTRACTOR: Company Name: /eYe "�i/t ®1ld %(� %7 S Phone #: Address: 0(b ® ) Met et ob i 2(' CA-- City: 1k.) - ( ' State: 41`Z4 D 4 Zip: .3 30 eag Qualifier Name: A40 1St' O S Phone #: State Certification or Registration #: C_&-C- tsi 9 2-23 Certificate of Competency #: Contact Phone#:,.3 OS 3o 0 — t . f o 3-L, Email Address: , O Ct lite vvia L.5 E two, ogre? DESIGNER: Architect/Engineer: 1hone#: Value of Work for this Permit: $ I j ®D d Square/Linear Footage of Work: 560 sP Type of Work: XAddition g, °Alteration °4-3-1.e...1 New DRepair/Replace °Demolition Description oI Work: k fill ' 1Y __ Color thru tile: *********** *** * *** **** ***** ***** * * *** * *Fees************ *** *** * ********* ** * *** * ** ****** Submittal Fee $ Permit Fee $ /re CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE$ Ito 10 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 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 ®,� Te 6941/ Owner or Agent The foregoing instrument was acknowledged before me this a0 CO day of /PYl ( ,20`3,by I o1141A-"3 'J , who is personally kno too me oar who ha; produced re) d t ,o -3 ! As identii�ication and who did take an oath. NOTARY PUBLIC: �, It Signature Contractor The foregoing instrument was acknowledged before me this c 044' day of ' r _ , 20 a, by A40 "re. l u, who is Wally known me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ********* *********+x********** * ********* **+ x********* ***x: *+ x+ x*x= *** *+ x************** ** * * ** **** ****** **** **** x*** APPROVED BY Plans Examiner /� \ \O Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 323 99 - 07 83 TELUS , ISE X ASTERISK W SOLUTIONS INC 1605 COVE LAKE ROAD NORTE LAUDERDALE FL 33 0 68 Congrabilalionsi With this ficense you become one of the nearly one =Von FloridansTicensed by the Department of Business and Professional Regulation. Our porfessiMmis and businesses range from arrielects to yacht baters from boxers to barbeque restaurants. and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better For illfulnialruir about our services, please log onto wouramdlorideliasese.com. Thee you can find more informer= about our rrivisionsand the regulations that hnpact you, subscribe to department newsletters and learn more about the Department's Matives. Our mission at the Depalment is: License Braderaty, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new Hensel (860) 487-1395 nFTACH HFRF SLATE OF FLORIDA AC# 62E12 MO DEPartsgarr OF BUSINESS AND PROFESSARMiREGBLATION 02C3319223, 1E1412 agr 4,445444aro ariE6-7.:, 2•; • TEEM, 4t 24STERISE 128049344 TS CERT102311) 1331dteX the previsions of c.489 FS expbmziest date: AUG 310 2014 142002202705 AC#6292260 TH:S DOCJET COLORED BACKGROUND - T NTED PAPER STATE OF FLORIDA DEPUTMIT OF BUSINESS alio PROFESSIONAL REGULATION CONSTRUCTION INEMSTRY LICENSING BOARD MI:W=2082M1O5 08/22/2012 1i8049344 IcGc151922 . The • =NEM Named below IS CERTIFIED Under the provisions o Chap Expiration date: AUG 31, 201*-11: TIMM NOISE X ASTERISK, • SOLUTIONS INC ". 6809.•NIUMON PLACE • Nom LAUDERDALE FL 33068 • RICE :SCOTT GOVERNOR REQUIRED BY LAW NEN LAWSON SECRET:ART' 1 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301 -1895 — 954-831-4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Business Name' ASTERISK SOLUTIONS INC Owner Name: MOISE X TELUS Business Location: 1603 NE 3 AVE FT LAUDERDALE Business Phone: 954-397-5123 Rooms Employees Receipt it: 1$ coNTRACTOR (G Business Type:coNTRACTOR) Business Opened:o3 /10/2011 State /County /Cert/Reg:CGC151922 3 Exemption Code: "Machines `• Professionals For Vending Business Only Number of Machines: Vending Tvue: Tax Amount Transfer Fee NSF Fee: Penalty.. Prku Yes Colectlon Cost Total Paid 27.00 0.00 '`0.00 0. 00 '0.00'' 0.00 27.00 WHE HIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS ECOMES A TAX RECEIPT VALIDATED Malli Address: MOIS 1140 NORT 3306 X TELUS SUSSEX AVE APT 1406 LAUDERDALE, FL This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business Is legal or that it is in compliance with State or local laws and regulations. 2012 - 2013 Receipt #035 -12- 00000005 Paid 10/01/203.2 27.00 09/28/2012 Effective Date ACORD. CERTIFICATE OF LIABILITY INSURANCE ERCEOCER JIM W INSURANCE 7879 PINES BLVD. #101 PEMBROSE PINES FLORIDA 33024 TEL: 554- 963 -1208 JFA% 963 -1211 :MSWIEMSARTROUGCMANAGE I4AICS [ p4'23t20t' 13 THIS ONL� CONFERS �zl HOLDER. THIS CEPMRCATE DOM NOT ACID, ' MEND . ALTER THE COVES AFFORDED SY THE POLICIES BELOW - Asterisk Solutions INC 6809 Marion Place North Lauderdale Fl.. 33068 tteMiMk Granada Ins Co. MONISM C trz 719E FOWLES OF INSURANCE LISTF33 HEM ANY REDUMEMEN: "Ham OR CONDDIDM H A V E S E E N ISSUED TO 1HE EttiatRED NAMED AsovEFORTHEPOUCYP OF ANY COMTRACi' OR OTHER DOCUMENT VAIN 8Y1HEPOLICIES DESCRIBED Him is sF ECrTOAU.THETERAMs. HAVE REDUCED Y8 W1404 INDCATIEI: NORMINSTANDING MSS CRATE MAY SE ISSN OR £ND SIONS AND CotenaftS OF SUCH uNDS RESPECT G.tf i MAY PE iTAUU. THE AtISURARCE AFFORDED NUCLEI ASGRESAYEL52TSSMLStit tii,AY Y 1411 i'..:i1: /� �yt y�C�P �� ` '. �R01JyI ��+� to sY 0185FL00041742 r �? -22- 12.12 -22 -13 I k ? z r is 1t ,000,000 At , ,� is • 100,000 • Xco., t4.1,; ,1, • tt LA S. �, } 'S • 5,000 la i,000,c n • SSS C$ 2, 000, 000 F --- ' L#tTTAP'PU ESPtik ; PRODUC1S- COMPAPAL; i $ 1 ' AU[Ott3 Eta ii1! v ,BOW is i . s ANYAUtO ` , - �. • . ALL AtiLOS ' ' /. Yi NAI.- tJ i_ tYeDA TOS j ( . hc.4.0vius3AU:CS SCOLYVADRY z$ fsrstetssM `& • ' GAt7ataut*flaiyy • z• AUTOO$Y -EAA Ii f_S ANYMIT* DIMM:fOS't 5001X; 5 AUTOO ROO • S IMNUIT 1 t .1 .EACHOCCURFIBCE , $ Otui L 1 t MADE ASIENEWE • S S 7WW1= s Is 1 i 1°2-1 Ot Ci rAtet YE'I.TAS S P/ I �y�s,,� I ISSW_ h y t ELEAStit I S Es.t •t 5 ELO ISFASS.PPOt.iCYL St ' S • C1ifER • r I ` CERTIF.A. ..R CITY OF MIAMI SHORES VILLAGE ATT: BUILDING DEPT. 10050 N.E. 2nd AVE MIAMI SHORES, FL 33138 ACORD25{:I CANCELLAITON MOS 12111180E. Tt 15f MUSES Olt. MUMS 10458. DM wawret NOMS810116OREMFEXISHOLOSKSANSOSOWE WM, tnrrta ro ottilso stmt. IMPOSE tIO OR OP Off i p us At oft �Af f. O Acof D c0RPORAT IoN 11aa8 CERTIFICATE OF LIABILITY INSURANCE Data 4/29/2013 Producer: Lion Insurance Company 2739. U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 This Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries_ 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer A: Lion Insurance Company 11075 Insurer 8: Insurer C: Insurer D: I Insurer E: Coverages The policies of insurerrs listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement, term or condition of any contact or other document with respect to wtnch this certificate maybe issued or may pertain, the insurance afforded by the policies described herein is subject to all= terms, exclusions, and conditions of such polices. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL NSRD Type of Insurance Policy Number Policy Effective Date ( MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits GENERAL 1: General J UABIUTY Commercial General Liability Claims Made ® Occur Each Occurrence $ Darnage to rented premises (EA ^ce) $ Med Exp $ Personal Adv Injury $ aggregate limit applies per Policy Project LOC General Aggregate $ Products - Comp/Op Agg $ AUTOMOBILE LIABILITY ArryAirto At Owed Autos Scheduled Autos Hired Autos Non -Oared Autos Combined Single Limit (EA Accident) $ Bdity Njtsy (Per Person) $ Bodry TrtityY (Per Accident) $ Property Damage (Per Accident) $ EXCESS/UMBRELLA LIABILITY ROccur Claims Made Each Occurrence Aggregate A Workers Compensation and Employers' Liability proprietor/partner/executive Any proprietor/partner/executive of8cer/member excluded? NO If Yes, describe under special provisions below. WC 71949 01/01/2013 01/01/2014 X I WC Statu- tory Limits I 1OTH- ER E.L. E.L. Disease - Ea Employee $1,000,000 E.L. Disease - Policy Limits $1,000.000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations /LocationsNehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 84-65-128 Coverage only applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company": Asterisk Solutions, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Begin Date: 3/28/2011 CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES VILLAGE ATT: BUILDING DEPT. 10050 N.E. 2nd Avenue MIAMI SHORES, FL 33138 Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurerwlll endeavor to mail 30 days written notice to the certificate holder named to the lett, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. �s E1 )11P ? (AC) 01 144 11► '' WY-74°P iif 4 'AV I LA . is 11 I M am -F acletes �4ervlces, lnc. BOUNDARY SURVEY LW Survey= it Debars 880 East 49111 Street HIALEAH, FL 33013 PHONE:(305) 953 -2800 a - /".I 0<is Of S oac P-Wratittt j'0 , lit el- 11 X1, h0 proq d-da,' d pi►v NjD./NI fp,.1 g wa? a9 iii Fix,0€ ... ............................... (50' TOTAL R/W BY PLAT .....................•• ...... ............................... PAGE 2 OF 2 NOT VALID WITHOUT PAGE 1 OF 2 JOB No. 13- 0326178 Drawn by: ART w z w _L r (0 z a 4 a x.00 BLOCK CORNER LOT 4 BLOCK 5 4' C.L.F. 4' C.L.F. 0.60'CL 1 0.30'CL x— x —x —x —x c.L:F7' -- 58:09' (R-BLM)- LOT 17 BLOCK 5 L. E AND A8BREVIAl1013 .70 - ELEVATION DRWY. - DRNEWAY U.P. - UTIUTY POLE B.O.B. - BASIS OF BEARINGS AC - AIR CONDITIONING PAD A -.ARC DISTANCE BLDG. - BUILDING C.B. - CATCH BASIN C.B.S. - CONCRETE BLOCK STRUCTURE D.E - DRAINAGE EASEMENT CL - CLEAR ' ,• • - CENTER UNE CONC. - CONCRETE E.O.W. - EDGE OF WATER LOT 16 BLOCK 5 1!. - METAL FDWE C. & G. - CURB &GUTTER SJ R - SET IRON ROD P.O.C. - POINT OF COMMEN- CEMENT F.N. - FOUND NAIL P.T. - POOR OF TANGENCY EN.C. - FJL , - FOB: HYDRANT FJ.P. ,:- FOUND IRON PIPE F.I.R. ° - FOUND DEBAR LF.E - LOWEST FLOOR ELEVATION LP. UGHT POLE (M) - MEASURED (R & M) - RECORD & MEASURED --e-- PJ. P.R.0 P.C. FAD. P.C.C. U.B. N.G.V.D. 0.E. P.B. P.C.P. P.O. P.O.B. N.T.S. - MEGL FENCE - POINT OF INTERSECTEN ▪ POINT OF REVERSE CURVE - POINT OF CURVATURE - FOUND NAIL/DISK - POINT OF COMPOUND CURVE - UTILITY BOX - NATIONAL GEODETIC VERTICAL. DATUM - OVERHEAD ELECTRIC LINE - PLAT BOOK - PERMANENT CONTROL POW - PAGE - POINT OF BEGINNING ▪ PROPERTY UNE - NOT TO SCALE - CENTRAL ANGLE D. & M. E. L I.E. —X- UZI -/ B/C R RAD. RES. R/W SEC. S.I.P. STY SWK UE. DRNNAGE & MAINTENANCE EASEMENT - LAKE MAINTENANCE EASEMENT - WOOD FENCE (NP HIGH) -CHAIN UNK FENCE (4' HIGH) - C.B.S. WALL -BLOC( CORNER - RADIUS - RADIO. - RESIDENCE - RKBiP OP WAY - SECTION - SET IRON PIPE - STORY - SIDEWALK - UTIUTY EASEMENT 'AVILA soclates err/Ices, Inc. 880 East 49th Street HIALEAH, FL 33013 PHONE:(305) 9532600 BOUNDARY SURVEY PAGE 1 OF 2 NOT VAUD WITHOUT PAGE 2 OF 2 JOB No. 13- 0326178 Drawn by: ART SW 37th TERRACE •— O J N 0 —I ce) F- 0 'tt 0 —I tO / O / CO 0 —I O J CO 0 J co 0 J LOT 10 /A LOT 16 0 _(0 .4. T2 IT 1 )T ' )T ° 1_ 1_ )T ' ' )T 0 0 SW 38th TERRACE JOB No. 13- 0326178 CLIENT: DOLINA JEAN & GIEBNER JEAN PROPERTY ADDRESS 550 NW 113 ST, MIAMI FL 33168 LEGAL 'DESCRIPTION: (FURNISHED BY CLIENT) LOT 5, BLOCK 5 SUBDMSION WEST SHORES ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 42 OF THE PUBUC RECORDS OF MIAMI —DADE COUNTY, FLORIDA. AT PAGE 18 SUBJECT TO ALL RESTRICTIONS, RESERVATIONS, EASEMENTS AND RIGHT —OF —WAY OF RECORD, UNDERGROUND ENCROACHMENTS IF ANY, NOT LOCATED. LEGAL NOTES THE SURVEY OF THE PROPERTY SHOWN HEREON IS IN ACCORDANCE WITH THE DESCRIPTION FURNISHED BY CLIENT NO SEARCH OR PUBUC RECORDS HAS BEEN MADE BY THIS OFFICE FOR ACCURACY OR OMISSIONS. SUBJECT TO OPINION TITLE. I HEREBY CERTIFY: THAT THE ATTACHED BOUNDARY SURVEY OF THE ABOVE DESCRIBED PROPERTY IS TO THE BEST OF MY KNOWLEDGE AND BELIEF AS RECENTLY SURVEYED PLATTED UNDER MY DIRECTION; ALSO THAT THERE ARE NO ABOVE GROUND ENCROACHMENTS OTHER THAN THOSE SHOWN, AND THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL STANDARDS SET BY THE FLORIDA BOARD OF LAND SURVEYORS AS SET FORTH IN 472.027 (F.S) AND CHAPTER 5J -17 F.A.C. (FLORIDA ADMINISTRATIVE CODE). ELEVATIONS REFER TO: NGVD DATUM 1929 B.M. USED L -11 —R ELEVATIONS 11.51 FEET B.M. LOCATED NW 119 ST NW 7 AVE ELEVATION AFOFMATIONt BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY DATED OR REVISED ON 09/11/09THE HEREIN DESCRIBED PROPERTY IS SITUATED WITHIN ZONE X BASE FLOOD ELEVATION N/A COMMUNITY 120652 PANEL NUMBER 0139 SUFFIX L SURVEYOR NOTE: BEFORE ANY CONSTRUCTION THE SET BACKS MUST BE CHECKED THE' CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY. NOTES: CERiF� TOt DOLINA JEAN & GIEBNER JEAN BY: SURVEY DATE: 03/12/13 'AVILA soclates sCervIces, Inc. Surveyors & Engineers CERTIFICATE OF AUTHORIZATION NO. 29056 CERTIFICATE OF AUTHORIZATION NO. 7538 680 East 49th Street HIALEAH, FL 33013 PHONE:(305) 953 -2600 FRANCISCO A. AG IRRE, P.E., P.S.M. CERTIFICATE No.LS.-3354. P.E. -35457 STATE OF FLORIDA `NOT VAUD WITHOUT THE SIGNATURE, DATE AND THE ORIGINAL RAISED SEAL OF A FLORIDA UCENSED SURVEYOR AND MAPPER.'