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DS-14-1269Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-214290 Permit Number: DS -6-14-1269 Scheduled Inspection Date: February 03, 2015 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez, Jorge Inspection Type: Final Owner: LUBINSKI, STEVEN Work Classification: Addition/Alteration Job Address: 100 NE 95 Street Miami Shores, FL Phone Number (305)345-4629 Parcel Number 1132060132860 Project: <NONE> Contractor: CHAMPION CONCRETE Phone: (305)252-8055 Building Department Comments DRIVEWAY PAVERS INSPECTOR COMMENTS False February 02, 2015 For Inspections please call: (305)762-4949 Page 7 of 41 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 02, 2015 For Inspections please call: (305)762-4949 Page 7 of 41 I�,� -z_(0 9 ALCM& CERTIFICATE OF LIABILITY INSURANCE DATE01/26/15YY) THIS CERTIFICATE IS 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 an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, subjectto 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 lieu of such endorsement(s). PRODUCER Accurate 8300 West Flagler Suite 114 CONTACT Lucia Estrella NAME: PHONE : (305)226-8727 AI No: (305)226-8767 ADD L luciaestrella@bellsouth.net INSURER(S) AFFORDING COVERAGE MAIC# Miami, FL 33144 INSURER A: Granada insurance Company Phone (305)226-8727 Fax (305)226-8767 INSURED INSURER 9: Normandy Harbor Insurance INSURER C: Jamie Basilio Corp dba Champion Concrete INSURER 0: 11001 NW 83 Street Suite 103 PRODUCTS - COMP/OP AGG $ 1,000,000.00 Doral, FL 33178- (305) 252-8055 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED 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. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MMMDY EFF MMIDD EXP LIMITS A GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE W OCCUR 0185FL00055712 01/28/2015 01/28/2016 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000.00 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: 0 POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ Ee acccidentSINGLE LIMIT $ BODILY INJURY (Perperson) $ BODILY INJURY (Per accident $ PROPERTY DAMAGE $ Per accident $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORMARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?N (Mandatory In NH) Y❑ If yes, describe unde DESCRIPTION OF OPERATIONS below / A NHFL141506 06/26/0214 06/26/2015 W WC STATU- ❑ E E.L. EACH ACCIDENT $ 100,000.00 E.L. DISEASE - EA EMPL_0YEE $ 100,000.00 E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Concrete & Pavers Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE NCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF 0 E D N DIN 10050 NE 2nd Ave ACCORDANCE WITH THE POLI P SIO Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE 305-756-8972 Lucia Estrella � UJU ©1988-2010 ACNORMIC61RATION. All riahts reserved. ACORD 25 (2010/05) OF The ACORD name and logo are registered marks of ACORD Miami Shores Village��� Building Department ` JUN 17 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 'd Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 /L*)4 ' BUILDING Master Permit No. D-5 PERMIT APPLICATION Sub Permit No. UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 4110 &y Phone#* 3Qs Address: 00 lUE 475 -,gr- City: ,gr- City: tll-Ak/i�%i` State l'�/r Zip: 313 / Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Phone#: 305 Address: % 0 �% 10 �S `5`-e_ 103 City: State: Zip: 2��_ y3QL Qualifier Name: -e- C� Phone#: 7�1�"' M- Wte State Certification or Registration #: Certificate of Competency #: ek:05 L5S �® DESIGNER: Architect/Engineer: Phone#: Ad State: Zip: Value of Work for this Permit: oeO7o. Square/Linear Footage of Work: / i0®, Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: s Specify color of color thru. tile: Submittal Fee $ -0-CS Permit Fee $ a � � CCF $ CO/CC $ Scanning Fee $ � 0-3 Radon Fee $ DBPR $ Notary $ ° Technology Fee $ Z Training/Education Fee $ 1 ( D Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ F� 9 (Revised02/24/2014) 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 f, 1* 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 b0fiosted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In theabsgnce of ch posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature d . 4jj'.', c OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of )u -n -�_ , 20 , by --1-6—day of �we , 20 —�. , by 15iZe� who is personally known to J 12;W 6' Ga g2 y _-2 , who is personally known to me or who has produced as me or who has produced identification and who did take an oath. NOTARY PUBLIC: 5 ._ Joanna M Felidano Seal my Commies FF 052753 o Exresovlzrzole�.�,. identification and who did take an oath. NOTARY PUBLIC: Sign: Notary Public State of Florida Seal Joanna M Feliciano My Coromission FF 082753 W'ao Expires 01/12=18 APPROVED BY _ y Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk r 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) hereinafter referred to as the owner of the following described property (address): Legal Description Lot Block Subdivision Folio # Requests permission to install (describe Within the public right of way of (address) tLV Vr 4 ?9-5' -9T. HiAr 5&T�� 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 day of J uy\ e , 201 SIGNED, SEALED, AND DELIVERED ir}rthe presence of: 11 a Notary Public State of FloridaJoanna M Feliciano 00 My commission FF 092783 Expirde 01!12/2019 2 (Owner's Signature) A1 s i.. Mission: Rick Scott To, protect, prrlmote & improve the health Governor of all people in Florida through integrated John H. Armstrong, MD, FACS state, county & community efforts. "IH State Surgeon General & Secretary Vision: To be the Healthiest State in the Nation November 19, 2014 Steve Libinski 100 NE 95 Street Miami, FL 33138 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: API 165466 Centrax Perriiit Number: 13 -SC -1569728 100 NE 95 Street Miami, FL 33138 Lot: 1314 Block: 21 Subdivision: Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 11/07/2014 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. No Objection. Reviewed by Y.Martin on 11/19/2014 for concrete pavers 10 feet setback from the septic system. 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 attestto 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 aril questions, please call our office at (305) rtin Engin erin Specialist II Department of Health in Dade County Florida Department of Health www.floridahoulth.gov in Dade County - - , Florida TWITTER:HealthyFLA PHONE: (305) 623-3500 FACEBOOK:FLDepartmentofHeafth YOUTUBE:fldoh . 1 1.2 n7/61 ,7YYGo1, 0---,) qgd� .4'716- . , b --�. g �NSIi Gr �� ti's 6,e ' ..) eli c0Mi k" -7e !�! pip � g.--�..m s a ` pezi. 4Amami. t to % 14 o b NO C3JE ION •;LS and.96 �t►rida Health Miami -Dade Coun wc,ya�r t7�iicrsd ,fi D.S•.. a rogram Application No.: ArP. it (pc;4��Lj Signature Sv0*- �� �s1GE AEGv��o .,gyp -a v If OC7G n7/61 ,7YYGo1, 0---,) qgd� .4'716- . , b --�. g �NSIi Gr �� ti's 6,e ' ..) eli c0Mi k" -7e !�! pip � g.--�..m s a ` pezi. 4Amami. t to % 14 o b NO C3JE ION •;LS and.96 �t►rida Health Miami -Dade Coun wc,ya�r t7�iicrsd ,fi D.S•.. a rogram Application No.: ArP. it (pc;4��Lj Signature Sv0*- �� �s1GE AEGv��o .,gyp