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DS-13-2175Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 201955 Permit Number: DS -9 -13 -2175 Inspection Date: December 03, 2013 Permit Type: Driveways /Sidewalks(Slabs Inspector: Rodriguez, Jorge Owner: CROCKER, JOHN & BETTY Job Address: 10110 N MIAMI Avenue Miami Shores, FL 33150- Project: <NONE> Inspection Type. Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010210070 Contractor: ESPINOSA CONCRETE Phone: (786)346 -5579 Buildina Deoartment Comments PLAIN CONCRETE DRIVEWAY AND PATIO Infractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 199867. Replace sod on both sides of new work Failed El Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762-4949 December 03, 2013 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (30,5) 762,4949 BUILDING PERMIT .APPLICATION Permit Tw: BUILDING X--- SEP 8Y.o- --- PBC201O Permit No. MasterPerWt W `BG�3NG City: NOW shorn county. MjMW Do Zip: , Is the B4ft torlcaRy. ted 'yam Np .. Flood done: OWNER: Name (Fee Simple Titleholder): Z2 Ad� G. ® m...__.. A 4C— City: X,ll J -� Qualifier Name: Stec Certification or * tkt�kW+ P& tl+ k�A�kd�kd4k *�k+k ##kkk�k &F+k4Q&+ kip# 4b# �7�* B�k&* k+ I+ NkB* �k�Ak+ kk4k�ktii+ kkd� #�k+k#+Ad! *Rd+kkb *RkR* Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ — Notary $ Trainin&Wucatlon Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 w this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOIL W, HEATERS, TANKS and AIR CONDMONERS,�4=:. . 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: FOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TW�C FOR BIPROVEMENTS TO YOUR PROPERTY. IF VOU bftND TO DETAIN 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 abs such posted notice, the inspe wt t be approved and a reinspection fee will be charged Si Signature Owner or Agent �r ntractor The f ent was ackn��oydoged bp�re me this day of 20 l by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sig, Pr1n My APPROVED BY The fo t was ow gel mm this day of 200 by 61 who is personally known to me or o has produced as identification and who did take an oath. V /`, Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06110,009)(Revised 3/15/09) NOTARY Zoning Clerk Mlsslon: To protett, promote & improve the health of all people in Florida through integrated state, county & community efforts. Vision: To be the Healthiest State in the Nation September 17, 2013 Ylin Espinosa 15441 SW 160 Street Miami, FL 33187 RE: Contingency Letter Application Document No: AP1119476 Centrax Permit Number: 13 -SC- 1493569 OSTDS Number: 10110 N Miami Ave Miami, FL 33150 Lot:10 11 Block:1 Subdivision: Dear Applicant: Rick Scott Governor John H. Armstrong, MD, FACE State Surgeon General & Secretary This will acknowledge receipt of an application dated 09/06/2013 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. Proposed concrete driveway, concrete terrace and a 3' walkway adn the north side of the property. septic system is located at the south side. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. If you have any questions on this matter, please call our office at (786) 315 -4444. Enclosures cc: Florida Department of Health www.FloridasHoolth.com in DADE COUNTY TWITTER:HealthyFLA 1725 NW 167 St, Opa Locka, FL 33056 FACEBOOK:FLDepartmentofHealth PHONE: (305) 623 -3500. FAX: (305) 623 -3645 1 YOUTUBE: fldoh t 12.10' 2.40 1 N v ",m 2.0' tea.. SCALE:0 BLOCK CORNER FlP. 1 ft No I.D. FlP. 1 1;r LOT- B 1 A 5' CHAIN UNK FENCE O I CV I SEP BY0000 ®oo® FlP. 1 f 2° No I.D. . "' a S 89'291090 a' N FlP. 1 f 2° 8.1 ' __-- x x -- x x No I.D. ° 6' wow F Cc I 24.7' CD ^ N 26.90' Nf- cli A11EWAY, 13.7' 33.25' -.. 01, CI i 0 J 8.3 12.10' 2.40 1 N v ",m 2.0' O BLOCK CORNER FlP. 1 ft No I.D. FlP. 1 1;r 72.00' No I.D. to SEP BY0000 ®oo® m4ammoo ,� 8.3 12.10' 2.40 1 N CN N to 8.1 ' 2.40 5.70' ai ° CD ^ N Nf- cli 13.7' 33.25' .i}RiLt, °•:u{aj 01, �- 4 .7V 519 � - � 1iCK WALL o — 5' SI iEWAIX } �v 1 LD 23.7' P v Z® a -- otwn1;' t?313Gj 16 10/09/2013 03:05PM 7866213241 FLORIDA BANKERS PAGE 01/01 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDONY) 10109113 PRODUCER Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266 -6493 Fax (305)262 -0679 MIAMI - SHORES VILLAGE 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 ALTS THE COVERAGE AFFORDED BY THE POLIO ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED ESPINOSA CONCRETE INC 15441 SW 160 St MIAMI, FL 33187-• OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPROGONTATIVES. INSURER A: CONVINGTON SPECIALTY INSURER B: PROGRESSIVE EXPRESS INS. CO. INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATE,D. 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR AOrPL n TYPE OF INSURANCE POLICY NUMBER pOLICY•PFFECTIVE PATE MM/nnm POLICYFXPIRAMON DA[€(MMIbDIYtr� _ LIMITS A ❑ GENERAL LIABILITY COMG+iERC1AL GENERAL LIABILITY ❑❑ CLAIMS MADE © OCCUR ❑ GEN'L AGGREGATE LIMIT APPLIES PER, Q POLICY ❑ PROJECT ❑ LM VBA225002 04/18/13 .4 0/18/14 EACH OCCURRENCE 1,000.000.00 DAMAGE T PREMISES Ea occurencS 1 00.000.00 MED EXP (Anyone person) 5.000.04 PERSONAL 8 ADV INJURY 1,000.000.00 GENERALAGGREGATE 2,004.000.00 PROAUCT9 - COMP /OP AGO 1,000.000.00 $ AUTOMOBILE LIABILITY ❑ ANYAUTO ❑ ALL OWNED AUTOS © SCHEDULED AUTOS ❑ HIRED AUTOS El •NON OWNED AUTOS ❑ 01794$13 -1 0$117/13 08/17 /14 _ , _ , „ COMBINED SINGLE LIMIT gEa aeddeni " BODILY INJURY Per person 1.0,000.00 BODILYINJURY (Per acaldent) 20,000.00 PROPERTY DAMAGE (Per accident) 10,000.00 ❑ GARAGE LIAB4 ITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGO ❑ EXCESSIUMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ FAC,H OCCURRENCE AGGREGATE WORKERS COMPI+NSAi