DS-13-1936Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 197964 Permit Number: DS -8 -13 -1936
Scheduled Inspection Date: January 30, 2014
Inspector: Rodriguez, Jorge
Owner: BLANCO, CHRISTIAN
Job Address: 1360 NE 103 Street
Miami Shores, FL 33138-
Project <NONE>
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (754)214 -2875
Parcel Number 1132050300070
Contractor: IMAGES & CONCEPTS DEVELOPMENT INC Phone: (305)232 -5184
comments
REMOVE PAVERS FROM APPROACH AS SHOWN ON I " " "_ -_
SURVEY AND INSTALL ON STEPS IN FRONT OF INSPECTOR COMMENTS False
RESIDENCE
January 29, 2014 For Inspections please call: (305)7624949 Page 3 of 18
Inspector Comments
Passed
Failed El
Correction
Needed
Re- inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid
January 29, 2014 For Inspections please call: (305)7624949 Page 3 of 18
�- ` Miami Shores village
4 w �
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
BUILDING
PERMIT APPLICATION
AU6�6213
FBC ZO LO
Permit No. 193 (o
Master Permit N .
Permit Type: BUILDING ROOFING
JOB ADDRESS: 1 ® P�6 to-3 :5; 1 City: Miami Shores County: Miami Dade Zip:
FolicMarce10: I 1 32- ®S ^ ' 0040
Is the Building Historically De iguated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder):
Address: 13 (00 PC- 103 S'
City: At 4-,,mi SVioaAE55 -State: 4::�- Zip:?P31-N
TenantiLessee Name: Phone#: I,
Email:
CONTRACTOR: Company Name:. �✓��� �',J�?C���s 26"72 Phone# --30j� �,S
Address: 5 A/ A. � e4-A-"-
City: /V,- ,�t/'a ®' State:. zip.
Qualifier Name: XL/A N LA L L A P- Phone#: 7.710
State Certification or Registration #: G frC. ® 4 T 6, .32' Certificate of Competency #:
Contact Phone#. •�l A Email Address:
DESIGNER: Architect/Engineer. Phone#:
Value of Work for this Permit: $j 2 0 0
Type of Work: OAddition DAlteration
413 ftairAbplace
Submittal Fee $�01 do Permit Fee $ CCF $ CO /CC $
Scanning Fee $ _ RoedOt $ DBPR $ Bond $
Notar Train!n ucadon Fee $ Technology Fee $
........... TOTAL FEE NOW DUE $
W&
ODemolition
, I? 2lJc-v
Bonding Company's Name (if applicable) MW V
Bonding Company's Address d
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure ill be delivered to the person
whose properly is subject o attachment. Also, a ' ed copy of the recorded notice of commence us be posted at the job site
for the first inspection h ch occurs sev days after the building permit is issued. In the a e e such posted notice, the
inspection will note p ved and areolpection fee will be charged. �f
er or Agent
The foregoing ins`tlrume was acknowledged before me this 23
day of , 20 ��, byR.s
rs personall own to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
APPROVED BY
My Comm. Expires Nov 27, 2013
Commission # DD 912225
Contractor
The �regoing instrument was acknowledged before me this 0 �/ t-
day of hV/ as . 20 -Z-3, by •7 04*J V0
who is personally known to me or who has produced
as identification and who did take an oath.
"Plans Examiner
Structural Review
(Revised 3 /1212012)(ReAsed 07 110 /07)(Revised 06/10120090evised 3/15/09)
NOTARY PUBLIC:
Sign:
Prim • f f'1 �%
My Expires:, '. vu •`'r. . • Notaiv ° it :.n a ot'ry ,,ytla
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08/23/2013 09:15 3052325184 JUAN VILLAR PAGE 01/05
CERTIFICATE OF LIABILITY INSURANCE immmm�"'
THIS CERTIFICATE I$ ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ON 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 pollcy(les) must be endorsed. N 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
CoMfieate holder In lieu of such endoraeme s .
PRODUCER ALL CITY INSURANCE INC - ACI C0NTAH JAVIE=R GUTIERREZ
276 FONTAINEBLEAU BLVD. PHONE (305) 463 -8431 P (3f) 436.6797
SUITE 180 Ejn JGUTIERREZ@ALLCITYINS.COM
MIAMI FL 33172 °-- •-- -• -- --
IMAGES & CONCEPTS DEVELOPMENT INC
15041 SW 186 TERRACE
MIAMI FL 33181-
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDINO ANY REQUIREMENT NTT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TW INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TMM,
EXCLUSIONS AND CONDMONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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MIAMI SHORES VILLAGE THE EXPIRATION DATE THr!RKW, KCMCE WILL BE DELIVERED IN
10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS,
MIAMI SHORES FL 93136- AuTebRePxesewramrE :I' :: =
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