DS-13-1435 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-194208 Permit Number: DS-6-13-1435
Scheduled Inspection Date: October 24,2013 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address:79 NW 92 Street
Miami Shores, FL Phone Number
Parcel Number 1131010170150
Project: <NONE>
Contractor: ONE WAY BRICK OF FLORIDA CORP Phone: (786)333-4620
Building Department Comments
Infn4ctlo Passed Comments
CONCRETE APPROACH INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 23,2013 For Inspections please call: (305)762-4949 Page 6 of 30
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Miami Shores Village
Building Department P JUN 2 4 2013
90050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20LD
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.Ds �J
Permit Type: BUILDING ROOFING
JOB ADDRESS: '7q IJ l O `,-) cep,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): , ,9c° ' Zz U�v'14t: -79 '513-
Address: UW
City: H1AUXA 0 State: E1 Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#: e7s 1
Address:
City: tate: Zip::
Qualifier Name: �. v1 '� Phone#: 70 6-33 4
State Certification or Registration#: Certificate of Competency#:
Contact Phone#:_ IJ'1"� � Email Address: M" t, a d
DESIGNER:Architect/Engineer: Ph
one#:
Value of Work for this Permit:$ ° ` Square/Linear Footage of Work: f b
Type of Work: ❑Addition ❑A teration IgNew ❑Repair/Replace ❑Demolition
Description of Work: 6 v� PD'
Color thru tile: .�1• T,D
Submittal Fee$ '�� Permit Fee$ �J CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ l
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 ��Y Signature let
Owner or Agent tractor
The foregoing instrument was acknowledged before me this 215-' The foregoing instrument was acknowledged before me this�.2 '
day of D�Ah ,2011,by 140 07 /A AWE t7 day of U 4— ,20�,by Nbse, �� d17�i�e,
who is personally known to me or who has produced who is ersonally known to me or who has produced QL
.. � identification and who did take an oath. as identification and who did take an oath.
NOTARY LIC: NOTA Y PUBLIC:
Sign Sign:
Print: a Print:
My Co i ids C MISSION#'14099483 My Coxp1LOAAO ,ARCIA
MY COMMISSION#EE099483
EXPIRES June 02,2015 r EXPIRES June 02,2015
385.0153 com •
3"53 FbddqNoWySw4m.com
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
PERMIT#
9 t
CONTRACTOR:
SUBMITTAL DATE:
6j-4�-
ADDRESS: `7 V
-W-64ceeia,
D
NAME:
RESUBMITAL DATES:
PROJECT TYPE:
/(3
ZONING FIRE
STRUCTURAL IMPACT FEES
ELECTRICAL HRSIDERM
PLUMBING NOC
MECHANICAL BLDG/
Power of Attorney for Finances (Limited Power
of -� 'LU appoint
s �
A0 rT, L^-al A�S y M to act in my place for the purposes of
1. � . � Ne�l
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This power of attorney akes a ''
y effect°n �'�o ( l and shall continue until terminated in writing
or until l{, 12 f2, 0106
5
whichever comes first.
I grant my attorney-in-fact full authority to act in any manner both proper and necessary to the exercise of the forego-
ing powers,and I ratify every act that my attorney-in-fact may lawfully perform in exercising those powers.
I agree that any third party who receives a copy of this document may act under it.Revocation of the power of attor-
ney is not effective as to a third party until the third party has actual knowledge of the revocation.I agree to indemnify
the third party for any claims that arise against the third party because of reliance on this power of attorney.
Signed:This day of 1,4
State of County of
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Signature: � Principal
Social Security number:—:- ;;(qj y
Witnesses
On the date written above,the principal declared to me that this instrument is his or her financiabwer of attorney
and that he or she willingly executed it as a free and voluntary act.The principal signed this instrument in my pres-
ence.
W' ness 1
Si ature
Printed Name ed ame
Street Address e tfAAdress
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City,State,Zip Cod4 ity-State,(Zip Code
LF240 Limited Power of Attorney 1-99
ftolarown www.nolo.com
Ccrtificata,of Acknowledgment of Notary Public
State of
County of ® � �°� ® , .
a notary
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On �°1p a ��°� �' who proved to me on the basis
public,personally appeared ®� i
of satisfactory evidence to be the person(s)whose name{s)
is/are subscribed to the with msu mnent and acknowl-
d ed to me that he/she/they executed the same in his/her/their authorized capacity(ies),and that by him red the
edged the entity upon behalf of which the Person
on the instrument the person(s), that the
instrument.I certify under PENAL'T'Y OF PERJURY under the laws of the State of
foregoing is true and correct.Witness my hand and official seal.
Signature
GRAq
�40TARY PUBIC�:r m
e
do No. 97694 a
.my Comm.Expire®:,9,,
�',Nov.23,2014.°&
,(( ent of Attorney-in-Fact
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B accepting or acnder the appointment,the attorney-in-fact assumes the fiduciary and other legal responsibili
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Name of Attorney-in-Fact:
Signature of Attorney-in-Fact:
VN ,c,„& Aniano J, Garcia, PLSM Ph
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