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DS-13-1871Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-197498 Permit Number: DS -8-13-1871 Scheduled Inspection Date: March 21, 2014 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez, Jorge Inspection Type: Final Owner: GARVER, EDUARD & PAULA Work Classification: New Job Address: 153 NW 100 Terrace Miami Shores, FL 33160- Phone Number 305-754-6070 Parcel Number 1131010230220 Project: <NONE> Contractor: ARM STRUCTURAL INC Phone: (305)669-4244 comments NEW DRIVEWAY AND APPROACH INSPECTOR COMMENTS False March 20, 2014 For Inspections please call: (305)762-4949 Page 1 of 22 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 20, 2014 For Inspections please call: (305)762-4949 Page 1 of 22 PERMIT # CONTRACTOR: SUBMITTAL DATE: 5 ' ADDRESS: NAME: RESUBMITAL DATES: PRO TYPE: FIRE / STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL LD ' Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: VS - �� l i.� I DATE: (NAME) o Owner o Architect -Picked up 2 sets of plans and other 1� Address: 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 Depa ie cO tine permitting process. Acknowledged by: PERMIT CLERK IN RESUBMITTED DATE: A alliC PERMIT CLERK INITIAL: M110don: To protect, promote & improve the health ,all people in Florida through integrated te, county & community efforts. Vision: To be the Healthiest State in the Nation September 16, 2013 Antony R. Martin 9000 SW 28 Street Miami, FL 33165 RE: Contingency Letter Application Document No: AP1119049 Centrax Permit Number: 13 -SC -1492860 OSTDS Number. 153 NW 100 Ter Miami, FL 33150 Lot: 13 Block:3 Subdivision: Bonmar Pk Dear Applicant: Rick Scott Governor John H. Armstrong, MD, FACS State Surgeon General & Secretary This will acknowledge receipt of an application dated 09/03/2013 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From.a review of your completed application, it has been determined your existing system is adequate for the proposed use. This permit is granted for the construction of a new driveway. There will be no increase in sewage flow or characteristics and no impact on the unobstructed area. *********************APPROVED********'"*"**«****** If you have any questions on this matter, please call our office at (305) 623-3500. Sincerely, Betsy Lange, Engineering Specialist II Enclosures cc: Florida Department of Health www.FloridasHealth.com In DADE COUNTY TWITTER:HealthyFLA 1725 NW 167 St, Opa Locka, FL 33056 FACEBOOKFLDepartmentotHealth PHONE: (305) 623-3500. FAX: (305) 623-3645 1 YOUTUBE: fldoh Miami Shores Village Building Department 10050 N.E.2nd Avenue, Viiami Shows, Florida 33139 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 7624%9 BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 6 C23 AIA) A00. City: Folio/Pamew. — N01 - �AUG 16 2013 --------------.- C 20 Permit No. 'b-- I �nl Master Permit No. ROOFING County: - Miami Dade rap; it A.- n,10ls- Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple City: cp OFTM-4 State: Tenant1essee Name: • Email: Citr. �A Qualifies Nance: State Certification or Registration #: JLWLe a /G Contact Monet Email Address: DESIGM:R: ArchitecVEng ur. Monet Value of Work for this Permit: $4 uarckkear F of Work: —q%, Type of Work: ClAddition� / OA motion ONew '/Replace ODemolition Dmrfpdon of Work:-. /JIRAJ �Yj/�, A Color duu %lie: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Stunning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Trainiag/Educatlon Fee $ _ Technology Fee $ Double Fee $ Structural Review $ _ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address city'. •e I , , 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, BO)LERS, HEATERS, TANKS and AIR CONDMONERS, 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 INYOUR *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. the absence of such posted notice, the inspection will not be proved and a reinspection fee will be charged. sig=n--)L,Sigrrrature ' Owner or Agent cT ntractor The foief �ing instrument was ac ledged b�refore me this day of --L4 20 ,bY ��lA who is persdnally known to me or.who has As identification arid who did take an" oath. The #bregoing instrument was ackn=141W1 me day of 20 .� by who is personally known to me or who haspro4edy _ as identification and who did take an oath. Structural Review Clerk (Revised 3n2012)MrAsed mnQVXRvWwd o6narlA )0tvwwd 3n5/w) US13-191) Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) �C��,L1CA CQCAiVelf- hereinafter referred to as the owner of the following described property (address): LU 10 D rn I S1 c) re e - I 0 Legal Description Lot Block Subdivision Folio # Requests permission to install (describe work): 1 Within the public right of way of (address) IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this y of Au0uL-:)+_, 201 (Owner's Signature) "'v�B • o1a�Y ?uh}t`;pii ".$eG 23,'U' 1 ' '•._ N Ex es t2ag 0 '.�: �.�;��°,. � htY �oR�miss�un # E.E otaty Assn• Ihrou9h National N 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 August 19, 2013 Permit No: DS13-1871 Planning Critique 1. Driveway must be separated from house by not less than 5 feet. David Daquisto 305-762-4864 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. .a Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 August 19, 2013 Permit No: DS13-1871 Building Critioue Review 1. Pending zoning approval Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. Miami Shores Village APPROVED BY DATE 70NI VG DEPT BLDG DEPT ALL FEDERAL STATE AND C OLINTYRULES AND RFGIUI ATIQNS 09/03/2013 TUE 13t50 FAX 305 441 6443 FIRST CLASS INSURANCE MA 2001/001 CERTIFICATE OF LIABILITY INSURANCE °"'0903/13 "' _ _ 08/03/13 THIS CERTIFICATE 1S 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 en ADDITIONAL INSURED, the policypes) 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 tleu of such endorsement(s). PRODUCER CONTACT First Class Insurance Market HO NAME: 4101 NW 9th Street AI o- Feu: (305)441-2997 M1 No . (306)441-644i— AIL ,lj,DDRESS- fdMCQa01.COm Miami, FL 33126 -�"- -- --- ••- INSURERS) AFFORDIRO COVERAGE MAIC tt Phone (305)441-2997 Fax 305)441-6443 INStIRERA: WESTERN HERrfAGE INS COMPANY INSURED _ -.- ARM STRUCTURAL INC 3616 SW 108 AVE MIAMI, FL 33165 COVERAGES- IIYJVRCR r: _ I _ CERTIFICATE NUMBER: REVISION NUMBER: THIS M TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED REAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L _ _ TYPE OF INSURANCE A=WaR GENERAL LIABILITY _ ® COMMERCIAL GENERAL LWBILITY A 0 ❑ CLAIMS -MADE Q OCCUR SCP0920880 ❑ _ GEML AGGREGATE LIMIT MPLILS PLR: ❑ POLICY ❑ i�OQ n LOC AUTOMOBILE LIABILITY ❑ ANYAUTO ❑ ALL SCHEDULED AUTOS El HIRED AUTOS NON -OWNED L�O ❑ UMBRELLA LIAB OCCUR ❑ EXCESS LIAR I-1 r1 A - WORKERS COMPENSATION - MN EMPLOYERS' LIABILITY Y ! N /A RCIY I GV Eaac $ 1 10/262012 10/26/2013 -MED EXP WnY one persons $ 1 PERSONAL & ADV INJURY S 1 $ BODILY INJURY (Per person) I S BODILY INJURY (Per accident $ P OP DAMAGE IFOLit .... _ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / iiE :LES (Attach ACORp 101, Additional Remoriaa Schedule, U more space Is roqulrod) CERTIFICATE MIAMI SHORES VILLAGE BULDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES, FL 33138 ACORD 25 (2010/05) QF POLICY CANCELLATION -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN +CCRDANCE WITH THE POLICY PROVISIONS. ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marls; of ACORD za . owME A R " 3TRUCTURAO LINC To [. 841HCRO WQR�IS A R M STRUCTURAL INC ANTHOW MARTIN PREt 366 1RR AVE MIAMI FL 33163 23 Our mi en at#m Depa*wjjjl Im Lkw",WWW*, R"Watq Fahiy., We cart at ntlYsWetoss�myou 'tt ' or- you mserveyour cu omers. $a oftmAishwast ftk, mid r kelp c ns on your n6w HoWtW,� ..................... ................... . . . . . . . . . . . . . . . . . . SVGA low, N A V Eii 08-09-2012 .TEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida. Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 08/09/2012 EXPIRATION DATE: 08/0912014 MARTIN ANTHONY R 850947218 BUSINESS NAME AND ADDRESS: A R N STRUCTURAL INC 3616 SN 108 AVE NIAl1I FL 33168 SCOPES OF BUSINESS OR TRADE: 11- LICENSED GENERAL CONTRACTOR IMPORTANT: Personal to Chapter 440 . 06114, F.S., an officer d a corporation who elects exemption team this chapter by filing a cenilicate of election ender ibis section may mm soma benefits or compensation ander this chapter. Parsoad to Chapter 440.051121. F.L. Canxftcates of election to be exempt... apply only within the sap$ of Ike business or trade tilted on the Delia d election to be esempl. Parsoant to Chapter 440.O5t131. F.S. Notices at election to be exempl and certificates of election to be exempt sbau be $abject to revaclow N. aI say time after me filing of the notice or the issaance d the to"pe"e. the person named on the notice or cardliate so loager mom the regoiremsots d tots sealop for Issuance of a certificate. The departmeal span revoke a certificate It say time for failure of the person 04=4 as the cenuleate to most the requirements of Ibis section. QUESTIONS 1850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKEIM COMPENSATION LAW I& EFFECTIVE 09/09/2012 EXPIRATION DATE: 08/08/2014 PERSON: ANTHONY R MARTIN FEIN: 680847218 BUSINESS NAME AND ADDRESS: A R b STRUCTURAL INC 3818 Sar 108 AVE rt1AMk Fl 33185 SCOPE OF BUSINESS OR TRADE r. LtCOMI) MERAL CONTRACTOR IMPORTANT F Pursuant to Chapter 440.051141. F.S., an officer of a corporation who 0 elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05112}, F.S.. Certificates of election to be H exempt-. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt. E Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person rutmed an the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to most the requirements of this section. CUT HERE QUESTIONS? {8501 413-1609 * Carry bottom portion on the job, keep upper portion for your records. OWC-2S2 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11