DS-13-464Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 186985 Permit Number: DS- 3- 13-464
Scheduled Inspection Date: April 29, 2014 Permit Type: Driveways /Sidewalks /Slabs
Inspector: Rodriguez, Jorge Inspection Type: Final
Owner: HART, NEIL Work Classification: New
Job Address: 295 GRAND CONCOURSE
Miami Shores, FL 33138- Phone Number (305)962 4547
Parcel Number 1132060133600
Project <NONE>
Contractor: ROSS SERVICES Phone: (954)401 -2013
comments
ADD 500SQ FT F MIAMI PAVERS TO MATCH EXISTING I AS PER PLANS INSPECTOR COMMENTS False
April 28, 2014 For Inspections please call: (305)762.4949 Page 2 of 25
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 28, 2014 For Inspections please call: (305)762.4949 Page 2 of 25
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MAR 14 Building Department
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10060 N-Und Avenue
Miami ShOm, Florida 33138
TIC; (3o5) m,?W4
Foo (305) 75&w72
CHANGE OF CONTRACTOR / ARCHITECT
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Zip Code. 04
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Amhk%cV BOW of Record
Address:
M341
Describe VVb&-
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I hereby certify that the work has been abandoned andfor the contractodwchited is
unable or umWolng to complete the contract, I hold the Building Official and the
Mlon! Shores harmless for all ISO lnvolvwnft
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My COMMISSION #FF01
Miami Shores 'pillage
Building Department
10050 N.E.2nd Avenue, Miami ShOM Floxida 3313$
Tel: (305) 795.2204 Fast. (305) 756.8972
INSPECTIONS PHONE NUMBER: (gam 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUMDING
JOB ADDREW.- C> t (._goC
citr- 11+11emi SIx Comty:
FOlio/Parcel#:
b Me Building MAarlcaily Designated.. Yes
OWNER; Name (Fee
IVXVZ# Ai
CONTRACTOR:
FBC ZU
PermkNo.
Mier Permit No.
ROOMG
zow:
state:
-
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DESIGNER: ArcltiiteW aginew
Value of Work for this Pertnit: $ a�
Square/iinear Footage of Warkw
T"e of Work: DAddi&m DAlter on ONe
Description of Work: 1`l� . ll�L• =- �, n f.''7
color
SabmhW Fee S Permit Fee $ CCF $ COICC $
Scanning Fee $ Radon Fee S . DBPR $ Bond $
NotalY $ Trai hWEdacatiion Fft $ TechuMogf Fee $
Double Fee $ Structural Revlew S ____
TOTAL FEE NOW DUE $_�
Bending Company's Name (if applicable)
Bonding Company's Address l C1 �!2✓
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 alt laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUWM, SICsNS,
WELLS, POOLS, FURNACES, BOII ERS, 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 applkwd 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
inspecdon will not be approved and a reinspecdon fee will be charged
Signature ! ~
L
Owner or Agent
The faregoing instrument was acknowledged before me this
day of -ftZO, by
who is personally known to me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
APPROVED BY
signature
Contra
The foregoing instrument was aclmowledged befse me.tb _•
day of 20 L 'by T"n 1/'/', o e ";
who is pertly known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
(Revised 5PI1Z012)(Rv4i=d 3/121 112 ) = XRevissd otilll )( Reviwd 3n W9XRevisW 7110=7)
zo
Clerk
■ Complete Hems 1, 2, anti 3. A complete
s ►e+�
Nem 4N 1loteci De
X Ltlol
• Nnt your name and add on reverse
Addressee
so that we can return the lard to you.
Attach Oft card to the back of the maltplece,
g; by fp, )
—��
C. natg of Delivery
or on the front N space permits.
t. Artist® to:
D. (s de6ve�y address r,9:"n Item 1? O Yes
If YES, enter �� 0 No
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Service TAM
O Pa&bmd ® Rdwn Pmelpt for Mwdmdm
0 Insured Mao 0 C.O.D.
4. Pm&ktad Delivery? (60a Fee) O Yes
2. Article Number
R►msfar*o , wMw ts} 7013 2630 0000 3369 3431
PS Form 3811, February 2W4 Owestic Return Remot
Miami Shores village
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
C 20
Permit No. L 1
Master Permit No. %% --
Permit Type: ILDING ROOFING
JOB ADDRESS:-925'
DDRESS: 9 25'
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO _ Flood Zone: 011fe
A
OWNER: (Fee
Address: • 9411
City: M/AlIkv,
Tenant&zssee Name:
Email:
CONTRACTOR: Company Name: IL � � � ��C�J C'. �° Phone#: 30 5" 01%� — 3 74 2
Address: 16 Tl S W /3 0 V 9
City: h /
Qualifier Name: L
State Certification or Registration #:
Contact Phone#:" G
DESIGNER: Architect/Engineer: _
2]
`?' ?/
of Competency #: // POO
Value of Work for this Permit: $ '(70o t a'° Square/Linear Footage of Work: . s1�7
Type of Work: OAddition hp" n n h
Description o W,
Submittal Fee $ Permit Fee $
ONee /w
Scanning Fee $ Radon Fee $
Notary $ Trahung/Education Fee $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE ��
.J
. '
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site,
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature Signature
Owner or Agent Con 4G
The foregoing instrument was acknowledged before me this
day of l t` , 20 a by
who i ersonally known to me r who has produced
As identi
The foregoing instrument was acknowl ed before i e
day of 20Lby,
who is personally known to in or who h6s r_p oduced
as identification and mhe adid take an oath.
L4,
Notary Pubuc State of Florida
NOTARY PUBLIC: �e11 shorn NOTARY PUBL
My Commission EE 18250a
Expires 04/27/2016
Sign Sign:
Print: VJ1 r 14 i� Print:
d Nalsry Fuolic State of Florida
Abet Jesus Vener+eo
My Commission Expires: y.- r —024/ �/ My Commissio
v My Commission EE036321
�aa� Expires 12128!2014
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APPROVED BY `! %��" / /� Plans Examiner _
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /102009)(Revised 3/15/09)
Zoning
Clerk
10/18/2012 17:09 3052656246 OBREGON INS PAGE 02/02
' " '� CERTIFICATE OF LIABILITY INSURANCE OA7E(MRIIOnIWYY)
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THIS WRTIFIWE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 90 RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMAWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the ceilffir to holler IS an ADDITIONAL INSURED, the pollWlea) must he endorsed, If SUBROGATION IS WANED, subjed to
the terms and oond)pons of the policy, eertaln policies may require an endDmment A statelnent On this Certificate does not CoMa► flghts to the
certificate holder In lieu of such endorsemenge}
PRODUCER 0W QA YOANA G13REGON
Obre •- Y w
n Insurance Nam — ._._..
0p PA�.NeEle._�)• (805) 265.8226 Not ($05) 265 -f3248
1740 SW 57 Ave 'MAIL obre ®oninsurenc®yn�i400m
.Op,RF,S3:
Miami, FL 33155 1NSURERr81 AFFORDING COVERAOG NAIC 0
Phone (30$) 2656226 Fax (305) 265 -6246 INSURER A: • GRANADA INSURANCE COMPANY
INSURED
INSURER 13;
RM DESIONS CONCRETE CORP INSURER 0:
10251 SW 130TH AVE 1NSURERD,,�_
MIAMI, FL 33186 INSURFJi E: ^_
_
COVERAGES CE INSURER F RTIFICATIS IULIMFIPP- QCtlle:l/1W til11AADDD•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE: FOR THE! POLICY PERIOD
INDICATED. NOTVNTHSTANDINO ANY REQUIREMENT, TERMS OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUOIES. LIMITS SHOWN MAY HAVE BEEN REDUCCO BBppYppPAID C�LppAJM��S..
INS
TYPEOF INSURANCE
yip
POLICY NUMBER
"MMIUDrIlYYYY
MIVIIDD/YYYY I
LIMITS _ --
A
OENERAI. LIABILITY
[] COMMERCIAL GENERAL LIABILITY
❑ ❑ CLAIMSMADS ❑ OCCUR
❑
❑
GENLAGCRMATEUNT APPLIES PER;
❑ Poucy EI PRO' ❑ LOC
0165F L00039718
10/02!2012
10/02/2013
EACH COMENCE
$ 500 000.00
RENTED
R ISES [Ea tsccurrance]
$ 100,000.00
MED W (Any one ICI an
S 5,000.00
PERSONAL A ADV !•N�+URY
S 5,000,000,00
GENGRALAGGREGATE
s 5,00D,000.00
PRO DUCTS, COMPIOP A00
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C�OMESNED 31NLaLE LibaT
AUTOMOBILE LIABILITY
❑ ANY AUTO
❑ AULT09�� ❑ SC14®UL513
❑ HIRED AUTOS ❑ A�UTNOgVYNEb
BODILY INJURY (Pew pm-an)
9
$
$
BODILY INJURY (PeraadderM
LgPGRTY AMAG
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EACH OCCURRENCE
5
❑ UMBRELLA UAE ❑ OCCUR
❑ F.YCESS LIAR ❑ CLAIMS.MADE
AGGREGATE
$
❑ OED ❑ RETENTION$ _
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$
WOR11011SCOMPENBATION
AND EMPLOYERS* LIABILITY YIN
OFFIG�ERIMEMi ER OCCIUD UTiV
(Mandatory In NH)
DRIFT ON dP�AnoNe Imt�
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❑ OTOT R LAIpTAIxS �.
E.L. EACH ACCIDENT $ ....--
E.L. DISEASE - EA EMPLOYS $ _
R.L. DISEASE - POUCY LIMIT _ S —
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DESCRIPTION OF OPERATIONS 1 LOCATIONS f VENICE RS (AlQoA ACORD 707, Additionef Remern Schedule, M mare mpae:e ha n qulMd)
CERTIFICATE HOLDER
CITY OP MIAMI SHORES
10060 NE 2 AVENUE
MIAMI, FL 33138
ACORD 25 (20101115) QF
CANCELLATION
SHOULD ANY OP THE ABOVE DESCRIBED POLICIES
THE EXPIRATION DATE THEREOF. NOTICE WILL BE
ACCORDANCE WITH THE POLICY PROVISIONS.
BEFORE;
01988 2010 ACORD CORPORATM All rights reserved.
The ACORR name and logo are registered marks of ACORD
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Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shcres, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756-8972
Permit NO. DS -3 -1 3— jP4 1
Issue Date: 3/21/2013 Expires: 09/17/2013
INSPECTION REQUESTS: (305)762 -4949 or Log on at https : /Ibldg.miamishoresvillage.com /cap
REQUESTS ARE ACCEPTED DURING 8:30AM - 3.30PM FOR THE FOLLOWING BUSINESS DAY.
Requests must be received by 3 pm for following day inspections.
Driveways /Sidewalks /Slabs Parcel #:1132060133600
Owner's Name: NEIL HART Owner's Phone: (305)962 -4547
Job Address: 295 GRAND CONCOURSE Total Square Feet:
Bond Number: Miami Shc,res FL 33138 -
Total Job Valuation:
500
$ 4,700.00
WORK IS ALLOWED MONDAY THROUGH SATURDAY,
7:30AM - 6:0013M. NO WORK IS ALLOWED ON SUNDAY
Contractor(s) Phone Primary Contractor OR HOLIDAYS.
R &M DESIGN CONCRETE CORP Yes
BUILDING INSPECTIONS ARE DONE MONDAY
THROUGH THURSDAY. ROOFING INSPECTIONS ARE
DONE MONDAY THROUGH FRIDAY. NO BUILDING
INSPECTIONS DONE ON FRIDAY.
NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS
THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER
THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO
YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
- OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.