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DS-13-658Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 188503 Permit Number: DS -4 -13 -658 Scheduled Inspection Date: April 25, 2013 Inspector: Rodriguez, Jorge Owner: Job Address: 790 NE 91 Street Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: J&R STRIPING CORP Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)757 -1018 Parcel Number 1132060390010 Phone: (786)556 -6406 Building Department Comments ASPHALT OVERLAY AND RE STRIPE PARKING AREA 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 April 25, 2013 For Inspections please call: (305)762 -4949 Page 11 of 49 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 ®, .i__ BUI DING PERMIT APPLICATION JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: -3 3 i3 8 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: /Vi- Permit No. Master Permit No. ?/ + yL. 0 3 2.63 FBC 20 1.5--(P‘t ROOFING OWNER: Name (Fee Simple Titleholder): 7, o co-De !-.✓ C Phone #: 7 g 6 .ri *0 6 Address: 7 0 AJ S%/( -f= f5-r- # / City: H State: /-=-1:— Zip: 3 3 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name `gyp� ' ® ? r '� . Ph, 4 e Address: \ \S Lk City: ° ®Pkx—X 1 ��)\—, State: Qualifier Name: Y:11'°Z3Z CONrtIv 10.-1=0"■.) O 5- State Certification or Registration #: Contact Phone#. ®� (P Email Address: ' Pt 44:\\-1 LA-1-3 3 CS DESIGNER: Architect/Engineer: Phone#: �� Certificate of Competency #: €./a.3 (72) C> 'JO- S O-\ Value of Work for this Permit: $ C> t> Square/Linear Footage of Work: ° Pb e"°%° f".1: • Type of Work: ❑Addition DAlteration ONew Description of Work: 4 S /3 1 " '" d ✓ e-r- / taRepair/Replace ODemolition Color thru tile: *********** * * * * * * * * * * * * * * * * * * * * * * *^^** * * * *,j3 Fees************* ** ** * * * * * * * * * * * * * * * * * * * ** * * * * ** Submittal Fee $ Permit Fee $ Q') • V l� CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1l 61 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 XV C caner or Ag Contractor The foregoing instrument was acknowledged before me this Z S The foregoing instrument was acknowledged before me this // day of , 20/ 3 , by Z/,L-G / Hfj-iLZG y . j7 —' day of 'hat-C.41 , 20 13 , by 9'0* / 6eageliQnsa. who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: v Print: %,t S DEDRIA S. WEBB ' Public, State of Florida Comm. Expires March 23, 2013 No. DD864910 Bonded thru Arthur J. Gallagher & Co. *************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** * * * * * ** P e' :fling My Commission Expires: as identification and who did take an oath. NOTAR Sign. Print: My Co PUBLIC: i , .,4 11 !n ..�,. ": '�. � � d9'J 1 • " `��7��� '1'1976 APPROVED BY /., 4/407/ 3. Plans Examiner Structural Review (Revised 5 /2 /2012XRevised 3/12/2012) )(Revised 06 /10 /2009)(Revised 3 /15 /09XRevised 7/10/2007) Clerk '�c 3. CERTIFICATE OF LIABILITY INSURANCE 3/12% 013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER EAGLE INSURANCE AGENCY 390 NE 167th Street North Miami Beach, FL 33162 CONTACT PN ONE FAX A/c.No.Ext): (305) 653 -3344 (A/C, No): (305) 651 -9443 A-MAIL leinsa en ahoo.com ADDRESS: ea g g cY�Y INSURER(S) AFFORDING COVERAGE NAILS INSURER A : Penn - Amreican Insurance LIABILITY COMMERCIAL GENERAL LIABILITY INSURED J & R Striping Corporation 103 NE 154 Street North Miami Beach , FL 33162 786- 282 -0256 INSURER 8 : SCP0929283 INSURER C : 01/30/14 INSURER D : $ 1,000,000 INSURER E : $ 100 ,000 INSURER F : $ 5,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILSSR TYPE OF INSURANCE ADDL INSR =BR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY SCP0929283 01/30/13 01/30/14 EACH OCCURRENCE $ 1,000,000 GE PREMISES O(Eatoccurrence) $ 100 ,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE _ $ 2 , 000 , 000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE UMIT APPLIES 1 POLICY —I JECT T I PER: LOC $ AUTOMOBILE — — LIABILITY ANYAUTO ALL OWNED AUTOS HIRED AUTOS —. SCHEDULED NON -OWNED AUTOS COMBINED B) accident) UMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y® OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA - WC STATU- TORY LIMITS OTH- ER E.L EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Paints Parking Lots and Asphalt Work LLATION I MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2 AVE MIAMI SHORES, EL, 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD25(2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo stered marks of ACORD £ Y��333i�}i(r €ti(�iNifIti ifiilfili !tilifilf1 {i}rlfi €iIfli {i1fff Z91££ 1J IWVIW IS VSI 3N 201 S3Nd 3AON9 l3(lbV2f d2103 ONIdI?LLS 8 V r OUVMHOd ION 00 13VSINO3 SNId33NISN3 A11VI33dS 'N031:13H 031d103dS SV H010VIIINO3 V S1f SS3NISf19 00 AVW 13010H id1303H 'ON 11W83d 14 IWVIW OIVd V1SOd'STi 1V'13-1Sk1Id 00'SL1000 1OOL1002ZZ0 21OZ /SZ /10 • :UOlO31100 XY1 Ammo 3OYOEIWYIW 03AI30a.1N3INAVd veep eq O} 81 )IJOM wJet M /IlI0 81,1} UI JejsIGoJ }sew Jeplo4 ldleoe S3IIIlVdI3INfW 9NIIVdI3IISVd -NON JO 1SI1 V SOJ 1413338 JO )13V1 33S d2103 9NIdISIS S 8 r: S3NMO IS £91 3N OS, d2103 JNIdI211S b V r 00£Z3 s ON 33 8ZSI6£9 001 / 3WbN SS3NISf18 £ 'ON 1d1303H AVd lON QO - TliS V .LON St SIHl 612855 -7 THIS IS NOT A BILL - DO NOT PAY RENEWAL BUTTS OIA�Ef.i�� N CORP 450 NE 163 ST 33162 UNIN DADE COUNTY ®� R STRIPING CORP FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 CC 1 ECElS 639152 -8 UU Sec1r4gelP TY ENGINEERING CONTRACT WORKER/S IS ONLY A LOCAL !ESS TAX RECEIPT. IT NOT PERMIT THE ER TO VIOLATE ANY ING REGULATORY OR G LAWS OF THE DO NOT FORWARD TY OR CITIES. NOR - 4 IT EXEMPT THE ER FROM ANY OTHER R OR LICENSE IRED SY LAW. THIS IS It CERTIFICATION OF IOLDER'S OUALIFICA- ENT RECEIVED .DADE COUNTY TAX ECTOR: 09/13/2012 60020000165 000075.00 SEE OTHER SIDE J & R STRIPING CORP RAQUEL GROVE PRES 103 NE 154 ST MIAMI FL 33162 jf} �lfl itlf!!! itl�}l ffifi�t�lifl f}fifll�3}Fa {iff}fiiFi�til}� }}� 59 PERMIT # ! l.,0 J le CONTRACTOR: 3i,g 4firi.ne- SUBMITTAL DATE: 4' 5 1,5 / ADDRESS: �k rV r "/ (i 1 a NAME: RESUBMITAL DATES: PROJECT TYPE: IMO �` 441 STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL BLDG — 4 ORIGINAL PROPERTY LINE 50' RIGHT- OF—WAY (BY PLAT) 24'..± ASPHALT PAVEMENT N.E. 91st STREET LOCATION SKETCH SCALE: NTS F F.NA /L N.E. SYlat STREET 148:001. (R&M). 1........... I.... 1.. 1 1..I .. f.. #RE r SPA S} 1 1 Y SCALE: 1 " =20' REMA W.P.P. 12.4 a: .............. F.I.P. 1/2" NO /.D.) STAIRS IIIIIII 9.09 %\ li O 95.70' TWO STORY CBS BUILDING # 790 116.50' 11 80' 0 0 N 0 N It) 19.01' v ' ON 19.18' F.LP. 1/2" .—`- (No /.D.) NOT VALID UNLESS EMBOSSED WITH SURVEYOR'S SEAL A/C ON CONC. (3'X4) A /C. ON CONC. (3'X3) W/ HEATER 148.00' (R &M) LOT 3 A /C—_/ h ON CONC. (4'X4) 0- 8975,00" ABBREVIATIONS: • SWC =SIDEVWl4LK• CBS = CONCRETE BLOCK STRUCTURE. CLF =CHAIN LINK FENCE, PL =PROPERTY LINE, DUE = DRAINAGE UTILITY EASEM ENT, IP =IRON PIPE, F =FOUND, A/C =AIR CONDITIONER PAD, P /C= PROPERTY CORNER, D/H =DRILLED HOLE, WF =WOODEN FENCE, RES= RESIDENCE, CL- CLEAR. RB =REBAR, UE =UTILITY EASEMENT. CONC= CONCRETE SLAB. R/W =RIGHT OF WAY, DE= DRAINAGE EASEMENT C/L= CENTER LINE, O= D!AMTER, TYP =TYPICAL, M= MEASURED. R= RECORDED, ENCR = ENCROACHMENT, COMP =COMPUTER, ASH = ASPHALT• N/D =NAIL & DISC, S =SET, FEE = FINISH FLOOR ELEVATION. 0/S= OFFSET PIP =POWER POLE, OHP= OVERHEAD POWERLINE, VVM =VW TER METER MOD FENCE= MASONRY MLL= I 1 1 1 1 1 1 1 11 ELEVATION BASED ON LOC. # CONCRETE =, MAINTENANCE& DRAINAGE EASEMENT= M & D.E. CBI# ELV. TYPE OF SURVEY: BOUNDARY SURVEY SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5) UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODET+C VERTICAL DATUM OF 1929.._.7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE_.ADDITIONAL. RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDSOF TI IS COUNTY. 9)' CONTACT. THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED ....I, 1,•.0„ :IA*. •a ;.•.••:;•:.•:::.I REVISED: INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY. Additions or deletions to survey maps or reports by other without written consent of the signing party or parties. BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE .OF SAID PS PAGE F.I.P. 1/2" (NO 1,D.) 0 o) 1< Q ° F.I.P. 1/2" • (NO 1. D. {, 1 • 25.00' APR 0 3 2013 At YTl3 : • r 7.0M NG DEPT /� BLDG DEPT .�t 4 4 AY. SUBJECT TO COMPLIANCE WITH ALL FEDERAL 1 STATE AND COt INTY RULES AND REGUI_ATirms Property Address: 790 N.E. 91 St., Miami Shores, FL. 33138. Legal Description: The East 148 feet of Lot 4, less the North 12 feet thereof, of ASBURY PARK, according to the plat thereof, recorded in Plat Book 4, page 110 of the Public Records of Miami -Dade County, Florida. HEREBY CERTIFY That the survey represented thereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. z ADIS N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 SINCE 1987 BL.ANCO SURVEYORS INC. Engineers • Land Surveyors • Planners • LB # 0007059 555 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 Email: blancosurveyorsinc@ayahoo.com Fax: (305) 865 -7810 (305) 865 -1200 FLOOD ZONE: AE PANEL: 0306 DATE: 3/26/1.3 SUFFIX: L SCALE: 1 " =20' COMMUNITY # DWN. BY: F. Bianco DATE: 9 120652 09 BASE:8 JOB No 13_272 Miami Shores Viliage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 April 4, 2013 Permit No: DS13 -658 Planning Critique 1. MODIFY PLANS TO PROVIDE ACCESS TO EASTERLY PARKING SPACE OR ELIMINATE FROM PLAN. David Daquisto 305 - 762 -4864 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 V Building Department RECEIPT PERMIT #: / 3'— 6 5- , DATE: / / 1 vv ❑ Contractor ❑ Owner ❑ Architect 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 A Picked up 2 sets of plans and (other) L CLate...-1 Address: 7 5 ( A) l� g / �S, 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 continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: