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DS-14-194Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 206614 Scheduled Inspection Date: April 01, 2014 Inspector: Rodriguez, Jorge Owner: BRENNER, JUSTIN Job Address: 334 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ROSS SERVICES auiming Department comments BRICK PAVER PATIO Permit Number: DS -1 -14 -194 Permit Type: Driveways /Sidewalks/Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number INSPECTOR COMMENTS False 1132060135450 Phone: (954 )401 -2013 March 31, 2014 For Inspections please call: (305)762.4949 Page 12 of 50 Inspector Comments Passed bR Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 31, 2014 For Inspections please call: (305)762.4949 Page 12 of 50 Miami Shores Village Building Department JAN a 1 2014 ?0050 N.E.2nd Avenue, Miami Shores, Florida 33138 % I� Tel: (305) 795.2204 Fax: (305) 756.8972 f J INSPECTION'S PHONE NUMBER: MID 762.4949 3( `�� FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit NoZ.5 1, �A Permit Type: BUILDING ROOFING JOB ADDRESS: �_ M E 10® :fi City: Miami Shores County: Miami Dade Zip: 3z Folio/Parcel#: i ' (a ® t 3-5_V50 Is the Building Historically Designated: Yes OWNER: Name (Fee Simple NO Flood Zone: City: �U tom\ 1 State: 1 zip: 11�� (� Tenant/Lessee Name: Phone#: +a a ; CONTRACTOR: yn i u �\ ► i ' 7_ city: COCC s1� n Qualifier Name: " Q Z5 t t Phone State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ q- ► DM , 0 Q Sgaare/Linear Footage of Work: Type of Work: OAddition OAlteration ONew ORepair/Replace ODemolition Description of Work.. ;(°'-P, A--,Luzf C Zj4a .i' , ! COIOT thm ii%: ea�g��ese�sas�esa�a��as�e+ �e���a�s�a► sa►* �F�sa��ee�e�a�e�e�e +�s�aa�ae *a�ex�a�va�s�e�s�a�sse Submittal Fee $ _ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ TraininglEducation Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ !1 4 , PERMIT 16,� CONTRACTOR: Se e SUBMITTAL DATE: /-c-1 ADDRESS: NAME: 7 u-s it e_- S. RESUBMITAL DATES: PROJECT TYPE: ZONING FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSfDERM PLUMBING NOC A 1MECHANICAL BLDG � 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 IlVIPROVEMENTS 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 Si Signature,, A!2AA A _.pea Owner or Agent V Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me thiO� day o _, 20L, by �� day of 20 14 by &OOLZ who is personalb4mown 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: P Sip: ly(Y F Print: r A EXPMES MAY 14, my commission IN FtaWW t.T8.1 E APPROVED BY vt Plans Examiner Structural Review (ReviAed 3112=12)(Revbed OT/lQW)(Reviwd 06AW009)(ReviW 3/15/09) '�� ,:p. ■ter n !lr My Commission Expires: I btI & Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 am none so mesons a am now a am as am a a a Samoan man monsoons a no one ease man mono a am no a a a a a an a NON an Nam on a Sao COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: BUSINESS ADDRESS: '�R?U I�Lti 0 ����� CITY( (Ci 1 STATE ZIP CODE33D BUSINESS PHONE: ) t4n 1 ` 7 (� FAX NUMBER CELL PHONE (_) QUALIFIER'S NAME:. "Cr QUALIFIER'S LIC NUMBER: r-C� 15 ()°-7 GaZZ Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS ONNOV., LOCAL BMIMW 'A RECEIPT City of Coral springs other information: Business Tax Office An 9 Am 551 West Sample Road ' '¢ Coral Spriags, BL 33065 -3800 a`"`p Phone (�54) 344-5958/(954)344-5963 `: ?> Local Business Tax For: a , '0 T., S . Is hereby Allowed to Engage Business or Occupation ofs ROSS MANAGEMENT BRIAN POVLOW 5325 NW 109 LANE CORAL SPRINGS FL SERVICES, INC. 33076 Payment Date : 7/31/13 Amount Paid : 126.00 Susiaess Tax #: 14- 00062226 Expires on 9/30/14 ** DETACH AND POST THIS BUSINESS TAN R19CNXPT IN A CONSPICUOUS PLACE ** ISSUED: 42/0412013 SEQ # L1312040001236 DISPLAY AS REQUIRED BY LAW JAN-31 -2014 B8:51 AM P.01 iWATWATIR ' OW RRAWAL MYM " STA"fROIL.FLORMA WAIkTW.NT OF FINANCIAL. SERVICES pIYaum OF WORKERS' COMPlINSAVION ' • CERTIFICATE OF GUCTION TO $I. EALIFT PROM FLORIDA WORKERS' GOMPFINSATION LAW" GQN11maro m INDUSTRY EXOMPTION Tale o dfd" mot"O dvl" Hied below Oda Ooftd to be exbmpt (matt Florltle laW. 9"IECTIVE PAM ' 9 /26014 EXPIRATION DATE! Insi2ni6 PARwN, t3RIIsPSR ' s BARRY emit 2OW2977 MEIN NAW AND SSr R f flI:AiT.SWIV,26 INC ,• . Was $mVIOks $325 NW 109 LANE t SRt�I{!ItdS FL 3so7e Scam-OF I LIOINM OR TRAPIg: OHTRACTOR V 13� -f�- 0126$ GER4IFNGA7� OF �LERT{DN 7o t� i'�fEIdP'T Iffi�8@,D 97.12 4UE67i0Pid7 db60}a1!•4899 i SEP -27 -2013 14:17 FROM:ROSS FFER•.!ICES `�43 -? :,6694 TO, 1. L%33t31@9 BROWARD COUNTY LOCAL BUSINESS TALC RECEIPT 115 S. Andre" Ave., Rm, A -100, Ft. 1.3uderdsle, FL 33301.1595 — 954. 931 -4000 VALID OCTOIDER 1, 3013 THROUGH SEPTSIVISER 30, 2.014g VA TRACTOR Remipt #,, a tt2Ax. C N:'RAL�GR Busin "s Name: ROSS MANAGEMENT MV. INC ausiness Type: owner Name: BARRY GUBPER Business Opened:1.2 /02/2010 Btwiness LOxttion: 5325 NN 109 LXM ° statslC*unty /CotVRog:CaG1S07523 CORAL SS+R_NOS Exemption Code: 8usinen Phone, PA O" a++t# Bmprol/ees iNBGhlrs�ll Prrdt l0pels 1 Number of Vachtnest Tax Amourd I Transfer Fes NSF ra Cailectlon Cost Tow Papa 27.Q0 O,Oq A.t}� 0.00 9.Ot1 4.00 27.00 i THIS RECEIPT MUST BE POSTSD CONSPICUOUSLY IN YOUR PLAtrz OF SUSINESill THIS BLCOMES A TAX RECEIPT This tax is levied for trA priuNsge Of dcirtg tKmnass *ithin 9rowurd County and is nor-reguistory In nature. You rt+ttat pteet all County ondlor Municipality planning I WHBId VALIDATED and zoning ro4 irerr+onts. This Susinoss Tact Rwelpt Musi G81:rattsl`Orw when i the business is sold, business risme has changed or you have moved the i business iocation. This receipt does not indicAte that 0% 0uainoss is legal or that i it is in Compliancs With State Or 10081 fawn and regulations. f Mailing Address: ; { iY GRI1EgSRsipt �pSA•1.7.00014ti7b it 5325 NW 209 LANE said 07/©9/2013 a^.00 CORAT, SPRINGS, Fr,. - 730-6 i U.S.A. I I I 2013 -2014 _��i 01/31/2014 13:06 9549560555 COVER ALL INSURANCE PAGE 01/01 ACsflRD,- CERTIFICATE OF LIA. BILIW INSURANCE DATE(N=DW W) PROOUCEs 101131/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION COVER ALL INSURANCI: ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE 5800 W. ATLANTIC BLVp, ALTER D p BY THepNLICIES BLOW MARGATE FL 33083 PH (954) 8 0008 FX 54 95B -OSiS INSURERS AFFORDING COVERAGE NAIC 1I MMURED ROSS MANAGEMENT SERVICES INC DSA ROSS SERVICES INSURER A. OLD REPUBLICS RETY COMPANY 5325 NW 108 LANE CORAL SPRINGS FL ;{3878 INSURER C: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERRA 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 LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A wonall GE*IERAL LIABILTY ° u A X C MWRCIALGENE MlLITY L1440009532 07/1812013 07110 014 CLAIMS MADE M OCCUR LyEW AGGREGATE Limrr APP41Fs$ PER: ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS AGE LIABILITY ANY AUTO OCCUR CLAIMS MADE DEDUmus RETENTION S WORKENS CCIMPENBATION AND EMpLOYER3' LIABILITY ANY PROPRIETORlPA�'�NERrFJIECUTNE OFFlCERlMEM9ER EXCI UDED7 S tlemwf0e under be Eur OTHER B BOND OFL - 0595152 0410812013 10411062014 DE90RIpTION DR OPERATIONS r LacaTIpNS! VEHICLES / EXCLUSIONS ADDED BY RNDORllMENr! SPEcuU_ pp0VWON9 SALESMAN 1 HOME IMPROVEMENT MIAMI SHORES BUILDING BE" 10050 NE 2nd Ave ffmiM Shores, FL 33138 DATE TNERROP, NOTICE TO THE I IMPOSE ND O RePRE AWnfORIZEp (E9 M INGLH U kV S BDDLY INJURY � ReoYrinel�ittl� b (p 80P GE AUTO ONLY, EA IDRNT S OTHER THAN EAACC AUTO ONLY: I �+ - lg -rvwu7 L=ji BOND LIMIT $100,000 IN9IJ R WILL ItTO enAU. 10 DAYS WRITTEN to RR TO 01080 SHALL w f U THE INSURER, IM AGENTS OR � � Y O� t Ss" e F_ qwqpbw. sweet.. a "A Northeast 140th -Streee�- �°� :: . =lam ;ate Pia i : :; ::i . .......... � � � •...... CTION i i i i for a Health Miami -Dade County ;^°` ;=P° • :__ ` �" i S.T.D.S. & Well �gqrarp. rwimy { Appli tian Q r �� \.. Date C " y• O v LU a zz t Ss" e F_ qwqpbw. sweet.. a "A Northeast 140th -Streee�- �°� :: . =lam ;ate Pia i : :; ::i . .......... � � � •...... CTION i i i i for a Health Miami -Dade County ;^°` ;=P° • :__ ` �" i S.T.D.S. & Well �gqrarp. rwimy { Appli tian Q r �� \.. Date ONE STORY CBS I HOUSE sM fW4 C " y• I A ONE STORY CBS I HOUSE sM fW4 _ Noa 5 3 i►sse i�evemeiii •: l ................................................ fty As Per Pe 0-70 Vhw*Dade Ca. FL*- e :................................... ............................... X1140 C JOB #: 12 -365 DATE 07 -13 -2012 IPB 10-70 1 sm—wi"Nopm Sw4yishmpim , Ed, a 1of2 q=bofT P-w IMosy: a Taw Dffim o7 0012 0zmp1MdAWd &ffW note MJ-0J2 AFA&COMMMOMIX80AM 1*dcTMw4 M Ld V, ft&40 a mak l5�;,} caa ,wow ............................ ........... I ................ ............................ ....................... Ld 1% Back 4D CO3 C " _ Noa 5 3 i►sse i�evemeiii •: l ................................................ fty As Per Pe 0-70 Vhw*Dade Ca. FL*- e :................................... ............................... X1140 C JOB #: 12 -365 DATE 07 -13 -2012 IPB 10-70 1 sm—wi"Nopm Sw4yishmpim , Ed, a 1of2 q=bofT P-w IMosy: a Taw Dffim o7 0012 0zmp1MdAWd &ffW note MJ-0J2 AFA&COMMMOMIX80AM 1*dcTMw4 M Ld V, ft&40 a mak l5�;,} caa ,wow ............................ ........... I ................ ............................ ....................... Ld 1% Back 4D CO3 I Northeast 4th Avenue Northeast 3rd Avenue ::.:: 1w o 14 Jill, I a Sak t i I W Jd ]--too � � s�A la. 4--4 I I- A ZVI 110 \ E ti��R\ Northeast 3rd Avenue ::.:: 1w o 14 Jill, I a Sak t i I W Jd ]--too � � s�A la. 4--4 I I- A ZVI Mission: Rick Scott To protect, prornote & improve the health y Governor cef all people.ln Florida through integrated state, county & community efforts. John H. Armstrong, MD, FAGS HEALTHState Surgeon General & Secretary Vision: To be the Healthiest Spate in the Nation March 12, 2014 Lily Medrano 334 NE 100 Street Miami, FL 33138 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: API 137986 Centrax Permit Number: 13- SC- 1524598 334 NE 100 Street Miami, FL 33138 Lot: 8 Block: 40 Subdivision: Miami Shores Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 03104/2014 for the use of the existing onsite sewage treatment and disposal system located on the above refe a ced property. No objection issued by Betsy Olmino for the construction of a.d4veway. C_ This office has reviewed and verified the floor plan and site plan you submitted, for the proposed remodeling addition or modification to your single - family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessment, or modification, replacement,. or upgrade authorization is required. Because an inspection or evaluation of the existing septic system was not conducted, the Department cannot attest to the existing system's current condition, size, or.adequacy to serve the proposed use. You may request a voluntary inspection and assessment of your system from a licensed septic tank contractor or plumber, or a person certified under section 381.0101, Florida Statutes. If you have any questions, please call our office at (305) 623 -3500. Sincerely, Betsy Olmino Engineering Specialist II Department of Health in Dade County Florida Department of Health www.FloridasHealth.com In Dade County - • , Florida TWrTTER:HealthyFLA PHONE: (305) 623 -3500 FACEBOOK:FLDepartmentofHealth YOUTUBE: fldoh Miami Shores Village Building Department RECEIPT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT #: 325 I�A — j 9 LJ DATE: ?- ^ )3— 1 �-.l (NAME) Contractor • Owner • Architect Picked up 2 sets of plans and (other) Address: ?23q Q E 1 M S-t From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: ► (Signature) PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: