CC-14-97Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 205897
Scheduled Inspection Date: March 18, 2014
Inspector: Rodriguez, Jorge
Owner: MIAMI, ARCHDIOCESE OF
Job Address: 9401 BISCAYNE Boulevard
Miami Shores, FL
Project: <NONE>
Contractor:
Ai I nenF nRIVFwAv MAIAITFIJAKIrF
Building Department comments
SEALCOAT AND RE- STRIPE EXISTING PARKING LOT
(NO LAYOUT CHANGE) CONCRETE CURB REPAIR
ASPHALT
Permit Number: CC- 1 -14 -97
Permit Type: Commercial Construction
Inspection Type: Final
Work Classification: Repair
Phone Number (305)762 -1033
Parcel Number 1132060490010
INSPECTOR COMMENTS False
Phone: (305)836 -8678
March 17, 2014 For Inspections please call: (305)762 -4949 Page 13 of 35
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid
March 17, 2014 For Inspections please call: (305)762 -4949 Page 13 of 35
Miami Shores Village
Building Department
I10050 N.E.2nd Avenue, Miami Shores, Florida 33138
F Tel: (305) 795.2204 Fax: (305) 756.8972
(} J INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
Permit No.
JAN: 2120%
FBC 20
Master Permit No. (1,r I LA Q
ROOFING
JOB ADDRESS: 9401 Biscayne Blvd.
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel #: 11- 3206 - 049 -0010
Is the Building Historically Designated: Yes
NO no Flood Zone:
OWNER: Name (Fee Simple Titleholder): EDWARD A MCCARTHY ARCHBISHOP Phone #:
Address: 9401 BISCAYNE BLVD MIAMI FL 33138 -2970
City: Miami
Tenant/I.essee Name:
Email:
State: FL Zip: 33138
CONTRACTOR: Company Name: All Dade Driveway Maintenance Phone #:
Address: 1100 NW 73rd St.
City: Miami State: FL Zip: 33150
Qualifier Name: Ray C. Applebaum Phone#: 786- 457 -6915
State Certification or Registration #: Certificate of Competency #: E -136
Contact Phone#: 786- 457 -6915 Email Address: Permits @driveway.net
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 20,068.00 Square/Linear Footage of Work: 72,000 sq. ft.
Type of Work: OAddition OAlteration DNew JRepair/Replace DDemolition
Description of Work: Sealcoat and re -stripe existing parking lot (no layout change) concrete curb repair asphalt patch.
Color thru tile:
Submittal Fee $ . DO Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
10191
Ong Company's Name (if applicable)'
Bonding Company's Ads
City State zip
Meftagg Lender's Name (if applicable)
Mortgage Lender's Address
City State zip
Application is hereby wade to obtain a permit to do the work and installations as infiaated: I certify that no work or installation has
commenced prig to to issuance of a permit and that all work will be perfmwd to MM the standards of all laws regulating
construction in this jmUdichom I aid that a separate permit must be secured for ELEMUCAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDrI m ms. 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 replaft won and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COM&ENCEMENT MAY RESULT IN YOUR PAYING TRUCE FOR
EM PROYEMENTS TO YOUR PROPERTY. ]OF YOU INTEND TO OBTAIN
FINANCING, CONSULT WI1`H YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Appdieunt; As a condidon to the issuance of a brsilding permit wkh an estimated value aweeding $2540, the applicant must
promise in good faida that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
Whose Properly is sulrfect to attachment. Alm a cer 'Died copy of the recorded notice of cammencem m must be posted at the fob site
for the Jim kWecdoft which omurr seven (7) days after the buNmg permit Is issued In the absence of such posted notice, the
InsPection will not be approved and a rekipecdon fee will be charged /l le-)
air.0 1
NOTARY PUBLIC:
UK LaalaRA:
fr- c+ 1
i
contractor,
The ping fitmnerit was acknowledged before = this rO
day C.. . 20 by, (te- •r ' . -4 2ikb
who is personally knows to me or who has produced
as Weatification and who did take an oath.
APPRQVED BY it LEI t 1 Plus Examiner
Strucnuai Review
(Revised =M12)(Revised annewjRevisea mnmiwatevised, mmm
NOTARY
Sign:
L
`I
MY C.a tundssion Expires: 6 • d � � � Q� o� �• ``
r. 1
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That the most Reverend Thomas Wenski, as Archbishop of the Archdiocese of Miami, his
successors in office, a corporation sole, has made, constituted and appointed, and by these
presents does hereby make, constitute and appoint Sister Elizabeth A. Worley, C.O.O., his true
and- lawful attorney for him and in his name, place, and stead.
Giving and granting unto Sister Elizabeth A. Worley, C.O.O., his said attorney full power and
authority to do and perform all and every act and thing whatsoever requisite and necessary to be
done in and about the premises as fully, to all intents and purposes, as be might or could do if
finally present, with full power of substitution and revocation, hereby ratifying and
confirming all that Sister Elizabeth A. Worley, C.O.O., his said attorney or his substitute shall
lawfully do or cause to be done by virtue hereof.
In Witness Whereof, I have hereunto set my hand and scel this 15 day of August, A.D., 2013.
Signed, sealed and delivered in the presence of
Witness: /
W4 6iess Signature -
�"arr►e-�-
Printed Name
"Witness Si gnature
naralm
Printdd Name
STATE OF FLORIDA )
SS:
COUNTY OF DADE )
The Most Reverend Thomas Wenski
As Archbishop of the Archdiocese of
Miami his successors in office, a
corporation sole
I hereby certify that on this day, before me, an officer duly authorized to administer oaths and
take acknowledgements, personally appeared The Most Reverend Thomas Wenski, as
Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, known to
me to be the person described in and who executed the forgoing instrument, who acknowledged
before me that he executed the forgoing instrument, who acknowledged before me that he
executed the same, and an oath was not taken. Said person is personally known to me
Said person provided the following type of identification:
Witness my hand and official seal in the County and S e last aforesaid this 15 day of August,
A.D., 2013.
My Commission Expires: gAYRA ttE MM
No" PWftsWO Mtea
.� ca
my t" at ff. M5
APPL&AS -01 STIIVIGGS
"' CERTIFICATE OF LIABILITY INSURANCE °12012014
1/20/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR 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 policy(les) must be endorsed. If SUBROGATION IS WANED, 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
certificate holder In lieu of such endorsement(s).
PRODUCER
Collinsworth, Alter, Fowler 81 French, LLC
8000 Governors Square Blvd
Suite 301
Miami Lakes, FL 33016
CONTACT
PHONE
AICONNo : (305) 822-78 Af, C305) -4
L
ADDRESS:
INSURERS) AFFORDING COVERAGE
NAIC #
A
INSURERA:Amerlsure Insurance CO
ISM
INSURED
INSURER B
7/1/2013
All Dade Driveway Maintenance Co
P O Box 430350
South Miami, FL 332434360
INSURER C:
$ 1,000,000.
INSURER D:
PREMISES Es occurrence
INSURER E
MED EXP (Any one person)
INSURER F:
PERSONAL& ADV INJURY
"rmm 11F11 -® 1 F NI Iisrim I o
1 \G rh71 V1\ 1/Y IIIIOCR:
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 CONTRACTOR 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LINTER
TYPE OF INSURANCE
POLICY NUMBER
POLI U F
P� Y EXP
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE K OCCUR
CPP2062887030013
7/1/2013
711/2014
EACH OCCURRENCE
$ 1,000,000.
X
PREMISES Es occurrence
$ 300,00
MED EXP (Any one person)
$ 10,00
PERSONAL& ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
JECT F1 POLICY X PRO LOC
PRODUCTS - COMP /OP AGG
$ 2,000,00
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS X NON -OWNED
CA 20628600303
71112013
71112014
Ee accident L
$ 1,000,00
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
R PERTY DAMAGE
Per accident
$
A
A
A
X
UMBRELLA LIAB
Excess LIAB
X
OCCUR
CLAIMS -MADE
NIA
CU20628610303
0206606004
CPP2062887030013
71112013
1/1/2014
71112013
71112014
11112016
71112014
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED X RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS LIABILITY
ANY PROPRIEfOR/PARTNER/EXECUTNE YIN
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory inNH)
If describe under
DESCRIPTION OF OPERATIONS below
Leased/Rented
WC STATU- OTH-
X TORY LIMITS ER
$
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00
w/$2500 DED 150,00
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Paving Contractor
Miami Shores Village
150 NE 2nd Ave.
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
-4w
v 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Q RUL00. so*
136.
A+£'P� -.esAu # F, AM L ids
Q yi ' f�Rt ft�tFiAlY "rit�t!Lrei -t
8 A U M �,C
003224
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
35-593
BUSINESS NAMMOCATION
ALL DADE DRIVEWAY MAINTENANCE CO
1184 t SIM 57 CT
Cof.AL GABLES FL 33156
LBT
RECEIPT NO. EXPIRES
E 413 SEPTEMBER 30, 2014
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
J SEC. TYPE OF BUSINESS
OWNER ENT RECEIVED
AFPLEBAUM & ASSOC SOUTH INC MMC SPECIALTY ENGINEERING CONTRAx COLLECTOR
El 36 $175.00 09/18/2013
Category(s) I FPPU11 -13- 004582
This Local Business Tax Receipt only aoafirms ment of the Local Business Tax. The Receipt is not a license , or
Permit, or a certification of the bolder s gaafifi aas, re do bt business comply vthlt am governmental
noa�vernmental regulatory haws and requirements which apply to the
The RECEIPT N0. above must be displayed on all commercial vehicles- Mlami -Dade Code Sec sa-M
For more information, visit
y�v miarrddggp �Ruteopectoc
000090
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
351593
BUSINESS NAMEILOCATION
ALL DADE DRIVEWAY MAINTENANCE CO
11841 SW 57 CT
CORAL GABLES FL 33156
LBT
RECEIPT NO. EXPIRES
RENEWAL SEPTEMBER 30, 2014
351693 Must be displayed at piece of business
Pursuant to County Code
Chapter BA - Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED
APPLEBAUM 8 ASSOC SOUTH INC 196 SPECIALTY ENGINEERING CONTRACT BY TAX COLLECTOR
Worker(s) 10 E136 $45.00 09/18/2013
FPPU11 -13- 004582
This Local Business Tax Receipt only c" firm payment of the Looal stoniness Tex The Receipt a not a license,
permit, or a certification of the holders qualifications, to do business. Holder must comply witb any govemmamal or
neogawemmamai regulatory laws and rsquaeme+ds which apply to the business.
The RECEIPT N0. above must be displayed on all commercial vehicles - Miami -Bade Code Sac M -276.
Far more information, visit �w°'iaade gg�/tsxcollector
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