DS-14-1631Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-216751 Permit Number: DS -7-14-1631
Scheduled Inspection Date: December 18, 2014
Inspector: Rodriguez, Jorge
Owner: FABRICIO M DE FREITAS, MARCIA H
on0210
Job Address: 80 NW 92 Street
Miami Shores, FL 33150 -
Project: <NONE>
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number
1131010160090
Contractor: ESR FLORIDA CONSTRUCTION INC Phone: (305)812-2716
tsunamg Ivepartment comments
NEW DRIVEWAY CONCRETE
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
December 17, 2014 For Inspections please call: (305)762-4949 Page 8 of 29
Miami Shores Village
,Building Department
16050 N.E.2rid Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type:
JOB ADDRESS:
BUILDING
LBY:JUL 2 9 2914
FBC 20 1 C
Permit No.
Master Permit NoD !�!KC
ROOFING
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11—:!) 1 n`_ p It _®0'q0
Is the Building Historically Designated: Yes NO U Flood Zone:
OWNER: Name (Fee Simple Titleholder): Q f bkok (X)R(1S Phone#: 00?) 9 - 6-91
Address: MW qa n1
City: ItA f KP State: '5-b
Tenant/Ussee Name: -�� Phone#:
Email:
CONTRACTOR: Cany Name: Jp�/��N ���✓� Phone# O i 1
Address: 1.-
City: State: O Y�
Qualifier Name: l!S
� Ph'o�n
State Certification rR'traon #: �cy #
Certificate :
Contact Phone# S rp�/
�2 z
�.�
DESIGNER. Architect/Engineer: Phone#-�1 2% dZ
7�7vlG-c Z 7—
Value
Value of Wolk for this Permit: $_t (j� Squar ear Footage of Work: i (!U
p Tie of Work. DAdditio ❑Alteration ew ORepair/Replace Werrpyon
+ DescriptionOf�Work -- !'�tl $T/�✓�nf 6IZ7" 1�ki VrwA/,AZ%
Color thru tile:
Submittal Fee $� (� Permit Fee $ V 30 ` _ CCF $ 0 CO/CC $
Scanning Fee $ Radon Fee $ �- �-� DBPR $ 2— •'-5 Bond $ _'000, GO
Notary $_ ��11 Training/Education Fee $ f - Technology Fee $
Double Fee $ bfJ Structural Review $
TOTAL FEE NOW DUE $ t �2-3 ° I Q
623 -t 0
3
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 44 e4' Signature.
Owner or Agent Contractor
The foregoing iinspwent was acknowledged before me this
day of &z1_4 , 20/ -L/ -,by ��G1 GL A02r9_e ,
who is personally known to me or who has produced
As identification and who did take an oath.
The forego' g instrument was acknowledged before me this
day of li ; 20Tor
by &"Aim �
who is pe sonally known to who has produced L
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLI
Sign: Sign:
Print: ��d6wom Print:
M Commissioa7pilres Notary Public, State of FloridaY My Commission p' X.
>`Zt
Commission t7 EE 198163 ,.. . � ��� ,,, •
res May 14, 2016 EX
My comm. epi
asa-oA
;7;,
11
APPROVED BY Plans ExaminerZoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)