DS-13-2602 a
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-203191 Permit Number: DS-11-13-2602
Scheduled Inspection Date: November 27, 2013 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: SENA, CATHY Work Classification: Repair
Job Address: 1301 NE 104 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1122320300040
Project: <NONE>
Contractor: NIEBLAS AND SONS PAVING ENGINEERING INC Phone: (305)253-5354
Building Department Comments
RE-SURFACE EXISTING ASHPALT 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.
November 26,2013 For Inspections please call: (305)762-4949 Page 9 of 23
Miami Shores Village
Building Department BY.
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
F13C 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.)
Permit Type: WELDING ROOFING
JOB ADDRESS: 1301 hie.- 10L 5+-
City: Miami Shores County: Miami Dade Zip: 33152
Folio/Parcel#: 0�" Z.�1i►3 7.r 8 3�"" 00 0
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): CQ{41 Y1! Phone#: 305, I A,
Address: 1101 A)e_ I 0 LA 5+-
City: 1 VI i*Y < Sh oI'te.S State: 'F L zip: 3313 8
TenandUssee Name: Phone#:
Email:
CONTRACTOR:Company Name:h93,1rt S g QiAv'w�a �b�a QioB ��l�irT hone#: 305.153. 54?5"f
Address: 1011-10 Sy1 C*'
City: 4411", State: '1~1_ Zip:.
Qualifier Name: 361f- 1.., Al 1'G b 195 Phone#: 303---, .2.
State Certification or Registration#: Certificate of Competency* Cggl yQ0
Contact Phone#: Email Address: Sa Its &i go c1_y tY►S. co✓H
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ i 1 L40® Square/Linear Footage of Work: 2-150 S,F,
Type of Work: DAddition OAlteration ONew Ofepair/Replace ODemolition
Description of Work: ?*45U- A0j C.0- e 6 S4 i3
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$
I
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
MPROVEMENTS 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issue In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature Signature
er or Agent Contractor
The foregoing instrument was acknowledged me this The foregoing instrument was acknowledged before me this
day of W� ,20 iI,by CT•'q Se day of J110✓$Wl�J�t/',20�,by���5+�_�. �i�lolv5 ,
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. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: BLE Sign CAUBLE
Print: NOTARY PUBLIC Print: r. NOTARY PUBLIC
DA FLORIDA
My Commission Expires: 3 Iq r�� %C%MRComm#DD985494 My Commission Expires: ���/ Comm#DD965494
Expires 3/9/2014 �� Expires 3wo14
APPROVED BY `/ Plans Examiner Zoning
Structural Review Clerk
(Revised 3/1212012)(Revised 07/10/07)(Revised 06110/2009)(Revised 3/15/09)
ASH � Miami shores Village
a..," Building Department
10050 N.E.2nd Avenue
Miami Shares, Florida 33138
tpR1UA Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner)_C! _111 V S e_no� hereinafter referred to as the owner of
the following described property(address): 1301 Alf 104 S+-
AA A wi( PL 3313 fj
Legal Description Lot--��-`�Block 1 Subdivision AIV+E 9r
Folio#
Requests permission to install(describe work): A oh 1T �-�- / 1 cEf r/VGw�i.► 9,OA S
Vv
Within the public right of way of(address) A3d l &9
IN CONSIDERATION of the approval of this permit by the Village,the owner agrees as follows:
1. To maintain and repair,when necessary,the above-mentioned item(s)installed within the dedicated right of
way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any
and all liability,which may rise by virtue of permitting the installation of these items within the public right of way.
1
ti
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s)
to be removed and a lien being placed on the property and/or assessed against the Owner for all costs
incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land
and shall remain in full force and effect and be binding on the undersigned,their heirs and assigns, until
such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village(or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this / day of i ov. 2013
(Owner's Signature)
SIGNED,SEALED,AND DELIVERED in the presence of:
JEREMY CAUBLE
NOTARY PUBLIC
STATE OF FLORIDA
Comm#DD965494
Expires 3/9)2014
2
R
' ... p.. Miami shores Village
Building Department
ZOR1 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. X COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. X COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. X COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D..x COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL 33138
■■■■■■■■■■■■■■■■■■■■■■r■■■■■■■■COMPLETECONTRACTOR'SINFORMATION••••••••••••••■•••••••••••••••
BUSINESS NAME: Nieblas & Sons Paving Engineering Inc. d/b/a Rodwins Paving
BUSINESS ADDRESS: 19270 SW 185th Ct. CITyMiami
STATE FI ZIP CODE 33187
BUSINESS PHONE: 3( 05 ) 253-5354 FAX NUMBER 3( 05 ) 233-8831
CELL PHONE 7( 86 ) 298-1684 QUALIFIER'S NAME: Jose L. Nieblas
QUALIFIER'S LIC NUMBER: E941400
E-MAIL ADDRESS OF APPLICABLE): sales @rodwins.com
Created on MOM BY MLDV I RV 312M MLDV
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D. PARKING AREA,SIDEWALK PAVING AND REPAVING
Dept.Miami Shares Village
Building
10050 NE 2nd Ave.
II
Miami Shares,FI 33138
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Construcf3on Trades Qyk►g Bid
sBU81NESS CERTIFICATE OF COMPETENCY
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AW&M PAYINS EW0190t=WC
B.A►.:R0DWINS PAVING
NIEBLAS JOSE 1.
Is certified under the WwWm of Chapter to Cary
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QUALIFYIWG TRADE(S)
0007 PAVING ENGINEERING
1009 EXCAU&GRADING ENG
Curbs ORMW P.E.
S-WWV ofUm BOW
Local Business Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOT A BILL-DO NOT PAY LBT
3176179
BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES
RODWINS PAVING RENWA1. SEPTEMBER 300 2014
19270 SW 185 CT 3312245 Must be displayed at place of business
MIAMI,FL 33170 Pursuant to County Code
Chapter SA—Art,9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT.RECEIVED
NIEBLAS&SONS PAVING ENGR INC 196 SPECIALTY ENGINEERING BY TAX COLLECTOR
CONTRACT
.QO Q9 18
75 / /2 013
Worker(s) 1 E941400 0227-13-001501
This Local Business Tax Receipt only eon Ihms payment of the Local Business Tau.The Racelpt is not a License.
permit,or a certification of the hoidor's qualifications,to do business.Holder must comply with say governmental
or nongovernmental reguistory,Ism and requirements which apply to the bmhmm
The RECEIPT NO.above mast be displayed on all commercial vehicles—Nami—Dade Code See 88—M
a Far more inImmotian,visit
Municipal Contractor's Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOT A BILL-DO NOT PAY M C
CC NO. E941400
BUSINESS NAMEMOCATION RECEIPT NO. EXPIRES
RODWLNS PAVING NEW BUSINESS 3EPTEMEER 30, 2014
19274 SW 185 Cr 7437414
MIAMI,FL 33170 Must be displayed at place of business
Pursuant to County Code
Chapter BA-Art.8&10
OWNER TYPE OF BUSINESS
NIEBLAS&SONS PAVING ENGR INC SPECIALTY ENGINEERING PAYMENT RECEIVED
CONTRACTOR BY TAX COLLECTOR
200.00 09/18/2013
0227-13-001501
M For more information,visit wymmlembladtamftmil
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