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DS-13-1889 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-200381 Permit Number: DS-8-13-1889 Scheduled Inspection Date: October 11,2013 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: LAURORE,JEAN &BERTHA Work Classification: Addition/Alteration Job Address:11120 NW 6 Avenue Miami Shores, FL 33138-0000 Phone Number Parcel Number 3021360210520 Project: <NONE> Contractor: BEVERLY HILLS DESIGNS CONCRETE Phone: 305-826-1001 Building Department Comments PLAIN CONCRETE DRIVEWAY AND APPROACH Infractio Passed Comments INSTALLATION INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-200014. CREATED AS REINSPECTION FOR INSP-197608. Sod both sides of driveway Sod both sides of driveway Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 11,2013 For Inspections please call: (305)762-4949 Page 12 of 26 Miami Shores Village g Building Department • 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 7 U" Tel:(305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 U BUILDING Permit No. 10 PERMIT APPLICATION Master Permit No. Permit Type: BUILDING ROOFING _JOIE ADDRESS_ &'q % City: Miami Shores County: Miami Dade Zip: _�3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):: %J iLr ifs 2 lokur_49r° Phone#: 79-.3 le, "Z Address: &J22Q ,,V_/,0 61K !` le-_ City: s6 m,' 5horeS State: All Zip: 53 AZ J? Tenant/Lessee Name: Z Z ��'JC�i�1� ��[1 Phone#: X. )Email: CONTRACTOR:Company Name: L C s Phone#: j Address City: g State: Zip: -P�45,e Qualifier Name 4 m Phone#•.50 State Certification or Registration#: Certificate of C mpetency#: 61=7, Contact Phone#: �n a fr'`'d 3 Email Address: _.�e!57 e�cl DESIGNER:Architect/Engineer: Phone#. Value of Work for this Permit:$ 6)&3 e ®4-'�2 Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Re lace ❑Demolition Description of Work: �� 1'12e__"s Color thru tile: 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, ' t , r 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 .�� &,er!) - Signature O v�ner or Agent -Con-tractor, p The foregoing instrument was acknowledged before me this!:J&k The foregoing instrument was acknowledged before me this day of ai , 120 ,by A3eA2XA � [ , day of ,20 L::::�by , who' pers nally kno o me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY P IC: NWTARYP IC: Sign: Sign: Print: Print: NUTARY PUBLIC-STATE OF FLO My Commission Expir ;•" Audy Alvarez My Commission Expires: 7:� :F ij,Xo� ! Commission#DD977972 '%�0 f9 ,---:Expires: APR.01,2014 %'��0 R I D NONDxD U nTT nrrrlc B0nING c0.,1Nr— iii APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 1 :v w (E-""5• �x FIRST-CLASS U.S.POSTAGE ? ti PAID hr MIAMI,FL THIS IS NOT A BILL—DO NOT pqy PERMIT NO.231 RECEIPT No. 30-4269742 CC NO: E99200 BUSINESS NAME/LOCATION BEVERLY HILLS DESIGN CONCRETE INC RECEIPT HOLDER MAY Do 840 fill 51 PL BUSINESS AS A CONTRACTOR OWNER :BEVERLY HILLS DESIGN CONCRETE INC asSPEcIDHERCxv AELISTCOFONONEPARTIGIPATING SPECIALTY ENGINEERING CONTRACT MUNICIPALITIES Receipt Nader must DO NOT FORWARD register in the city where work Is to be BEVERLY HILLS DESIGN CONCRETE INC done. ANGEL CORPAS PRES 840 W 51 PL PAYMENT preE HIALEAH FL 33010 WLLN 012 02220002002 000175.00 PERMIT# CONTRACTOR: YK SUBMITTAL DATE: 101113 ADDRESS: NAME: RESUBMITAL DATES: PROJECT E: ZONING ' �. IRE STRUCTURAL IMPACT FEES ELECTRICAL HRS/DERM PLUMBING NOC MECHANICAL BLDG ANAMI EIADE COUNTY 2012 LOCAL BUSINESS TAX RECEIPT 2013,, FIRST-CLASS TAX COLt.ECTOR MIAMI-DAVE COUNTY-'STATE OF FLORIDA' U.S.POSTAGE 40 W,F:AOLER ST.' EXPIRES SEPT 30,2015 PAID ist FI ff2i (a 13is4�LAVP?yqf PEE QF$U$1#dESS MIAMI,FL }t91AIlA1, L33134 P. AID?C( E .iNTYDOpE;C $4=A , ll ?3 PERMIT NO.231 408984-3 THIS IS NOT A BILL—DO NOT PAY RENEWAL BUSNESS NAME 1 LOCATION RECEIPT NO. 426974-2 BEVERLY HILLS DESIGN CONCRETE INC CC # E99200 840 W 51 PL 33010 HIALEAH ,. AJt R BEVERLY HILLS DESIGN CONCRETE IN �f WORKER/S "'i4g�SPECIALTY ENGINEERING CONTRACT 1 -T-3.Rc ;1PI VIOLA- -:YA • DO NOT FORWARD - =rE_nncT ?HE BEVERLY HILLS DESIGN CONCRETE INC r- ANGEL CORPAS PRES 840 W 51 PL = HIALEAH FL 33010 10/09/2012 02220002001 000049.50 }F71 F}!J�} y{Ff{!l PII F}!FIlI!!FlitFft�jl31lP�ltldlt!} �3 _.;-FE OTHER SJDE 4' .JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS`COMPENSATION CERTIFICATE OF ELECIION TO BE EXEMPT FROM FLORIDA WORKERS`COMPENSATION LAW` CONSTRUCTION INDUSTRY EXEMPTION 1 r:is certifies that to individual listed below Mas elected to be pxen)pt`rom Flonda Vdorkers'Compersnt o€1 Iav, EFFECTIVE DATE: 5;1552013 EXPIRATION DATE: q 15120 53 PERSOW CCFRPAS ANGFL FEIN: 650903W8 BUSINESS NAME AND ADDRESS: SE VERLY•HILLS DESIGN CON 84s tn1 N1 PLACE HI,ALEAH FL 33,0 2 SCOPES OF BUSINESS OR TRADE: C3ONL RETE OR CEMENT 1AICORK-FLOO € >;is t[-r t dkt'i -id 9 O s Yti.i rF ties Sit..4 Y ts:5 w.t nt Et •a 3 -a 7 &-Yi-.<#e� ¢ - it e'SK s!ti s .`. ..,m. C...'�# ::GS'ij)E an., t=:.',rt,t's:... 3 i-. r sF.i +. f ti.sY?€f w dF n5{.! t f eth'+ ^a { Irr Cft ?' x3 tt. Ay t€y'3."a a ?.• ra. as #u'�,aa €a.atf d4.-'�`3r ;yt.c 3c.cti 1 ...€.x ztL.Issi ffi ar.'. .>- ..�Y�+ t``im.a �1 for i.,,,u,Y".L'n Ltt 3..Ciii i„BYs� Tt'en is:;."I l.tb.S„t?04!".d..Ki.a [,'iis,.c.- 'A any tillr., ..,,'FIa t*G'3t f .�{.'.{"!SI(i €. 5'..,c': .t• ,.<.A{A.7..,.5'.....-J:.S":ItLStt 13E.Lh:v'P.-. _ . 07/18/2013 3:44PM FAX 3055564354 ALL INSURANCE 1A 000 1/000 1 DATE IMM/D D/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07,18113 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC kTE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED I Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If th9 cerwcate holder it.an ADDITIONAL INSURED,the poucy(res)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may requlro an endorsement. A statement on this certificate does not Confer rights t the certificate holder in lieu of such endorserll"s). PRODUCER CONTACT All Insurance Services PHONE �F 1548 W.37 St. MAIL (305)822-4472 Na; (305)556-4354 _ ifemandakQaisrv.00m Hialeah,FL 33012 INSURER(S)AFFORDING COVERAGE NAIL# Phone (305)822-4472 Fax (305)5584354 INSURER A: GRANADA INSURANCE COMPANY INSURED WSURER 13.. CASTLEPOINT FLORIDA Beverly Hills Desigri'Concrete "" "°' • ,INSURER 6 840 W 51 Place _INSURER D., Hialeah,FL 33012 (305)885-6601 INSURER E. - INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMB R• 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 RESPEC TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$SUBJECT TO AL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. QTR TYPE OF INSURANCE ADOLSUBRI POLICY NUMBER 1 ICY EFF MlD1YPY GENERAL LIABILITY D UMrr3 J EACH OCCURRENCE $ 500 000.00 ® COMMERCIAL GENERAL LIABILITY 0 E TO RENTED EJ MISES Ea eeeu g) $ 100,000.00 A ❑ CLAmiss- r4DE [j occuR 0185FL00032936 011152013 01/15/2014 MEDEXP Any One pare A 4 5,000.00 _ PERSONAL&ADV INJU Y $ 500,000.00 ❑ GENERALAGGRE©A7 1 1,000,000.00 OEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ 500,000.00 El POLICY I.J .r,`car ❑ LOC g AUTOMOBILE LIABILITY EeMEWED 81NGLE LBA u ANYAUTO BODILY INJURY(Per pa on) $ ❑ AUTOOS OWNED E] AAU�H S BODILY INJURY(Par aci ❑ HIREDAUTOS ❑ �gSWNHD OPERA DAMAGE $ ❑ UMBRELLA LIAR �]OCCUR [� E EACH OCCURRENCE EXCESS LIAR $ ❑CLAMS-MADE AGGREGATE $ DED ❑ RETENTI S $ WORKERS COMPENSATION — ❑WC STA� El EMPLOYER$'LIABILITY Y/N ANY PROPRIETOWPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) It descr)ba under E.L.DISEASE.EA EMP $ O RIPTION OF OPERATIONS belay E.L.DISEASE-POLICY IMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Rvffmft schedule,N Mary space Is required) CERTIFICATE HOLDER _ CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES I 1E CANCELLED BEFORE MIAMI SHORES VILLAGES T149 EXPIRATION DATE THEREOF,NOTICE WILL BE C ELIVIERED IN BULDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS- 10050 NE 2 AVE AUTHOR220 REPRESENTATIVE MIAMI FL 33138 ACORD 26(2010105)QF Q)1908 2010 ACORD CORPO N. All rights reserved. The ACORD name and loqq4m g tar®d marks of ACORD • v J s � i SCOPE OF WORK NEW DRIVEWAY AND GATE - - SITE INFORMATION EXISTING PROPERTY LEDAL D€SM-20 FENCE UNE EXISTING IL E I FENCE ` LOT 1 N LOC A M P&42 PQ tb DAM COUNTY ROMA EXISTING IS TING SOD AREA ' PROPERTY Z EXISTING UNE I STING /// SOD AREA _ I SOO AREA - LJJ 7 �� ERTY -- - - -- --- � OA � WW lr' j 0 0 NEW DRIVEWAY \ 1 Lu DRIVEWAY W d 1 L-EXISTING EXISTING ~ C9 SOD AREA TREE (IJ EXISTI NG PROPERTY G z FENCE PRO FENCE 0. _ 8 S' CONC. SIDEWALK t;(oil �011vl _ GAATE r - � S 3 PERMIT : Miami Shores Village N.W. 6 AVENUE -- — — — — — — -- — BY DATc�E EXISTING SITE PLAN G DEPT ell t 3 DEPT SUBJECT TO CCMPLtA.NCE MATH ALL FED RAL STATE ANO CCUNTi Y RULES AND REGULATIONS a A-1 .o a .. � � 6