DS-14-612Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 209811 Permit Number: DS -3 -14 -612
Scheduled Inspection Date: May 01, 2014
Inspector: Rodriguez, Jorge
Owner: C/O PHELAN HALLINAN PLC,
I0Ue%0ftw f`UAQ= QAKIV AI w
Job Address: 162 NE 107 Street
Miami Shores, FL 33161 -7032
Project: <NONE>
Permit Type: Driveways /Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number
1121360070190
Contractor: D DEVELOPMENT INC Phone: (305)510 -8164
tsunaing oeparltment comments
INSTALLATION OF PAVER POOL DECK
INSPECTOR COMMENTS False
Passed
Inspector Comments
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 30, 2014 For Inspections please call: (305)762.4949 Page 10 of 24
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Permit Type: BUILDING
JOB ADDRESS: { t C.% 1l'
City: Mid Shores
Folio/Parcel #: > `
b the Building Hlstorkstly Designated:
OWNER: Nam; (Fee
City: AA A
Tenantlf.essee Name:
Email:
CONTRACTOR: Company Name:
Address: foo 07ox 1A
Value of Work for this ` i
Type of Work: UAddition
Description of Work: "
Jami Shores Village
uilding Department
! N.E 2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
CTION'S PHONE NUMBER: (37 762.4949
MAR 2 7 2014
BY: i
FRC 20b:;'
Permit No. c
Master Permit No. u Li
. a I
ho-7
County: Miami Dade
1Pi4a
NO Flood Zone:
mss' Zip:
of Competency #:
Address:
_5quare/Linear Footage of Work:
DNew ORepair/Replace t7Demotition
Cola r dwu tilaE:
Submittal Fee $ Perm t Fee $ CCF $ CO/Cc $
Scanning Fee $ Rada i Fee $ DBPR $ Bond $
Notary $ Trak Ing/Education Fee $ Technology Fee $
Double Fee $ Struc tural Review $ ---�
TOTAL FEE NOW D. UE $
j
PERMIT # - cz) 1 4 ® (o t 2
CONTRACTOR:
SUBMITTAL DATE:
ADDRESS:
NAME:
RESUBMITAL DATES:
PRO3ECT TYPE:
_ AFIRE
STRUCTURAL IMPACT FEES
ELECTRICAL JHRS/DEP
PLUMBING
MECHANICAL
r �
R
l 0oft Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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 Hurst
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 whiclt 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_��
Owner or Agent
The foregoing instrument was acknowledged before me this=
dayofD1fLP--,204 by��
who is personally known to me or who has produced
Alta T> L— As identification and who did take an oath.
NOTARY PUBLIC:
Sign:.-.. I
Print: Rrndrb* DtlflN.dn
My Commission Expires:
APPROVED BY
wiau as
The regoi g instrument w c owledged before me this - 1
day o 0 by Yy 5� V V 15
who is personally known to me or who has produced 2a t r-::)
as identification and who��rr oath
NOTARY PUBLI `A �4 3I V S,
Sign: Z
-6 .
BRODRICK DUNCAN
Notary Public, State of Texas
My Commission Expires
Apr1122, 2014
/, V —/Plans Examiner
Structural Review
(Revised 3/122012XRevised 07/10anmevised o6noRm o vised 3/15/()9)
Print:
My Commission Expires:
:21J�/Zo�ng
Clerk
Performed on -7 - (i
locat" of all structures on the p
The purpose of this Aft
wbout first providing a survey le
re" or obtain permits for any
may uiotate zoning or building c
structures may affect final insert
Further, Afflant say eth naught
e�
is _--persorlally
Revwd,on 5Q2r2M RevW on 6M20
Miami shores Village
Building Dent
10050 N.E.2nd Avenue
Miami Shores, Floirda 33138
Tel: (305) 795.2204
Fax: (305) 755.8972
SURVEY AFFIDAVIT
hereby attest that
(Name of surveyor's company)
ate of survey) is an accurate representation of the existing conditions and
xperty as of this date.
3vit is to induce Miami Shores Village to issue a building permit for the property
than seven (7) years old old. The Afflant, as property owner, further agrees to
ups which now may exist on the property whit are not permed or which
3 regulations. The Afflant further understands that the existence of any such
as apple to this or other permits.
P BRODRICK DUNCAN
°par vuB'.
:a °`•' `'� Notary Public, State of Texas
, My Commissio�Zn01xpires
..c April 22.
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