DS-14-2811Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-225831 Permit Number: DS -12-14-2811
Scheduled Inspection Date: January 27, 2015 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez, Jorge
Owner: MEVERS, ROY AND MARGARET
Job Address: 122 NE 105 Street
Miami Shores, FL 33138-2033
Project: <NONE>
Inspection Type. Final
Work Classification: Addition/Alteration
Phone Number (305)756-0156
Parcel Number 1121360130680
Contractor: STAR ISLAND CONCRETE DESIGN CORP Phone: 305-253-5151
Building Department Comments
REPLACE DRIVEWAY AND SIDEWALK
INSPECTOR COMMENTS False
January 26, 2015 For Inspections please call: (305)762-4949 Page 11 of 29
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
January 26, 2015 For Inspections please call: (305)762-4949 Page 11 of 29
Miami Shores Village
BuildingDepartment
p DEC 29 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201
BUILDING Master Permit No.�
PERMIT APPLICATION Sub Permit No.
E]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[:]PLUMBING E:] MECHANICAL ❑PUBLIC WORKS E] CHANGE OF ❑ CANCELLATION ❑ SHOP
!�CONTRACTOR DRAWINGS
JOB ADDRESS: 1 1
City: Miami Shores County: Miami Dade Zip:3�`
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ( lit wev-^— Phone#: f3V S
Address..
City: M. tom. State: Zip: S3) IS
Tenant/Lessee Name:
Email
r
"� '! c h , �c r s4� i L'
CONTRACTOR: Company Name: `7 ry� - z L L {_� C 1,22 Vii'Phone#: 3 -' + ,
r tit
Address:. Y
City: /\/ Y a State: l' `r Zip
Qualifier Name: Phone#: �c C j a ?.
State Certification or Registration #: Llcl
/ -J Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: A City: State: Zip:
Value of Work for this Permit: $ t� Square/Linear Footage of Work: 3—
Type of Work: ❑ Addition ❑ Alteration _ ❑ New air/Replace ❑ Demolition
Specify
Specify color of color thru tile:
Submittal Fee $ SO • W Permit Fee O� CCF $ CO/CC $
Scanning Fee $
Radon Fee $
DBPR $
Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $t 1
(RevisedO2/24/2014)
Z: 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. 1 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 ' f the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to att c ment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first ins ection which c r .. seven (7) days after the building permit is ►ss M the absence of such posted notice, the
inspection w#J *t * approved. n ca r (inspection fee will be charged.
�i
Signature
i 1 41,` N or AGENT
The foregoing instrumer6as acknowledged before me this
Y7 lb
_ day of- 'k'lz 1�, t / 20 by
who is,,�ersonall kno ''to
me or who has produced
identification and who did take an oath.
as
The forego ng instrument w s acknowledg6d before me this
/ day of +'c`'CS✓ 20 /tl' by
who is personally known to
me or who has produced FL- t L as
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: )'„� Sign:
Print. 1 �Y,E J ` / r ; 1 %7 Print:w11 _ G -. j v, -1r
Seal: &Bonded
DANAMASHOURN Seal:
MY COMMISSION #EE97518
EXPIRES: MAY 26,2015 tluough 1st State Insurance
************* ************************
APPROVED BY 5 Plans Examiner
Structural Review
(RevisedO2/24/2014)
CARLOS 6. WAR= JN
NOMY Pvbk • SM of Awift
my Com. bom Jul is. 2018
COeMule'li0 0 FF 1 tWU
14t Zoning
Clerk
Miami shores Village
Building Department
10050 N.E.2nd Aveirwe
Miami Shores. Florida 33138
Tel: (305) 795 2204
Fax: (305) 756 8972
Notice to Owner —Workers' Compensation Insurance Exemption
Florida Law requires %`orkers' Comricrtsation ilisuratim 4o%cra9c andcr Chaptcr440 of the Florida Statutes. Fla. Star ,
allows corporate officem to the constriction mdukiry to exenipi thernse Ive- from this requirement for any construcwn
prior to obtaining a building perinit- Pursuant to the Florida Mvision of Workers' Compensation Employer F' is Brocharr-
Art icniplo-yer in the imnstruciion -industry whe employs one or more pall -time 01 full-timit
employees,. including the OWlxr, MUM t*ttain workers"' compensation coverage Corporate
officers or members of a limited Itabilirt company ILLC) in the constrwfi*n mdV&*y may
elect to be exempt it
I . The officer owns at least 10 Mcent of the stock of the corporation, or in the case
of an I,I,C. a statement alitestin,,, to the mininitim 10 percria ownershipl-
2- The officer is listed as an officer of the corporation in the rvtords of the Florida
Department of Static. Division (4 Corporations. and
2t. I he corporation is registered and listed as active with the Florida Department of
State. Division OfCorporation.",
No more than three corporate officers per corporducin or hinitod liability company members
are allowed to be exempt Construction exemptions we valid for a period of two year's or until
a voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption. In these circumtances, Miami Shores % jllrp,
does not require verification of workers' compensation insurance coverage from The contractor's company. Th Vol; n1av be
_ws ttetmit� lease beck lith oar
2MMWIV W&C for AS M—Tkcr iWu-r' P c Y,
insurance sorrier since most property insurance policies, DO NOT cover this type of liability.
By SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE REAL) TMS NOTICE AND UNDERSTAND I I
CONTENTS.
Print
Signa
State of Florida
Comity of Mami-Dade
Sworii to and ' subAcri'bed before
daY of114_CL".L'_i'_.,21
Print
staf of FlWWIa ) I I
Co&ty of Nliatm-Dadc
Sworn d b nbed before me this C9
IVTZ 5U
dav of �O
By,
By B1A0N_?#d97 18
AL) Y §120
IXPIRE&MAY26 _ ",o (St
AL)
CAIRL0116-KRRIO" 1
a of HOW&,
comm. EtilMaa x.30111
0 FF I IGM
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) Q� o, rnz 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)
Ste,
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 or
SIG D, }SEALED j�ND DEL V RED in the presence of:
C.-
2
DANAMASHWRN
€' MY COMMISSION#EE97518
EXPIRES: MAY 26, 2015
Bonded through 1st State Insurance
BOUNDARY S UR VE Y
SCALE:1 "= 20'
' ¢
LEGEND:
105.19 '(R&M) •�:
=MONUMENT UNE
NGVD
=NATIONAL GEODETIC VERTICAL DATUM
N/D
=NAIL & DISC
N.T.S
=NOT TO SCALE
/-N0.
=NUMBER
0/S
=OFFSET
OH.
=OVERHEAD
O.•R.B.
=OFFICIAL RECORD' BOOK
PL.
=PLANTER
' ¢
=PROPERrr trNE
105.19 '(R&M) •�:
PCC.
=POINT OF COMPOUND CURVATURE
.::
;
'
P.0
=POINT OF CURVE
+
P. T.
P.O.0
=POINT 01% TANGENCY
=POINT OF COMMENCEMENT
F.I.P1120
F.LP1/20
P.O.B.
-POINT OF BEGINNING
( NO ID)
(NO 10)
PRC
=POINT OF REVERSE CURVATURE
P.P. . -POWER POLE
P.C.P. =PERMANENT CONTROL POINT
P.B. =PLAT BOOK
PG =PAGE
PW =PARKWAY
P.R.M. =PERMANENT REFERENCE MONUMENT
P.L..S =PROFESSIONAL LAND SURVEYOR
(R) =RECORDED DISTANCE
RR =RAILROAD
R/W =RIGHT-OF-WAY
R =RADIUS
RCE. =RANGE
SEC =SECTION
STY. =STORY
SWIG -SIDEWALK
SLP. =SET IRON PIPE
SLR. =SET IRON ROD
T =TANGENT
TOP. =TOWNSHIP
U.E. =UTILITY EASEMENT
U.P. =UTILITY POLE
WM. =WATER METER
D =INTERIOR ANGLE
q =CENTERLINE
U.H. =UTIurY HOUSE
P.P.
A/C =AIR CON0I710NER PAD
ASPH. =ASPHALT
BLDG =BUILDING
B.M. =BENCH MARK
C8. =CATCH BASIN
CB.S =CONCRETE BLOCK STRUCTURE
C.L.F. =CHAIN LINK FENCE
CONC. =CONCRETE
DW =DRIVEWAY
DIST. =DISTANCE
EL. =ELEVATION
F.H. =FIRE HYDRANT
FUP. -FOUND IRON PIPE
F.I.R. -FOUND IRON ROD
F.B. =FIELD BOOK
F.F. =FINISH FLOOR ELEVATION
FD. =FOUND
U.0 =UNDER' CONSTRUCTION
FT. -FEET
F.B.0 =FOUND BLOCK CORNER
F.N.D. =FOUND NAIL & DISC
F.O.I. =FOUND DRKL HOLE
F.'N.=FOUND NAIL
IL EL.
GA=GARAGE ELEVATION
W.P. =WOOD POLE
L.P. =LIGHT POLE
L =LENGTH
(M) =MEASURED
mom =MONUMENT
O.H.W -OVERHEAD WIRE
(®) =BASIS OF BEARINGS
=SANITARY SEWER MAN -HOLE
wwvMv
® =CATCH BASIN I� =WATER VALVE
M3 -UTILITY POLE --C =UTILITY POLE ANCHOR
-=.-=- =WOOD FENCE "y=CONCRETE
=FIRE HYDRANT =CHAIN LINK FENCE,
OA =ELEVATION CRS WALL
909 =TILE
1.50'
CONC.
WALK
6:' W.F
0.25'
F.I.P 1/20
(NO /D)
_ _NE 105th ST.
..... :•::- ::-
.....
......:::::::::::.::::::::::::: .
5-
23' PARKWAY
e -n . .
17-
5.100.00' R&M).-........ - :
��• _;I ' ` l-EPLO�e Aip4l •'
4
O
-5,.
17.00 .40'
1, ll. b0 Nj
I STORY
RES. # 122
-3 N
A/C o
42.30'
- 5' o
. 50'3.00
UTILITY
15.00' 11.00' SHED
b LEGAL DESCRIPTION.-
LOTS
ESCRIPTION:LOTS 11 AND 12 BLOCK 121' 'AMENDED PLAT OF SECTION
a NO.8 OF 'MIAMI SHORES"A SUBDIVISION, ACCORDING TO THE
o PLAT THEREOF AS RECORDED IN PLAT BOOK 10, PAGE 47,
PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
PROPERTY ADDRESS:
F.I.P 1/2m
(NO /D) C S. 122 NE 105th ST. MIAMI SHORES FL 33138
CERTIFIED TO:
RENATO PEREZ, ESQ. & LAW OFFICES OF PEREZ
c_ opy ROY E. MEVERS, IV
MARGARET HOOD MEVERS
WASHINGTON MUTUAL BANK, FA
ATTORNEYS' TITLE INSURANCE FUND., INC.
4' WIRE
FENCE
0.40'
0 0 0 100.00'(R&M) y(NO l 2m
o h � o�
r
-ASPHALT I HEREBY CERTIFY• THAT THE BOUNDARY SURVEY OF THE ABOVE DESCRIBED PROPERTY IS TRUE 1 L
AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AS RECENTLY SURVEYED UNDER MY PROFESSIONAL LAND SURVEYOR & MAPPER
=GRASS DIRECTION. IT IS ALSO MY PROFESSIONAL OPINION THAT TMS SURVEY MEETS THE MINIMUM TECHNICAL CERTIFICATE No 5571
STANDARDS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS IN STA TI: OF FLORIDA
CHAPTER 61 G-17-6 OF THE FLORIDA ADMINISTRATIVE CODE PURSUANT TO SEC710N 472-027 OF THE THE SURVEY SHOWN HEREON IS NOT VALID WITHOUT THE SIGNATURE AND
FLORIDA STATUTES ORIGINAL RAISED SEAL OF A FLORIDA SURVEYOR AND MAPPER
CARIBBEAN BUILDING INSPECTI NNS &,1S EY
LB 7362
7911 NW 72nd AVE., SUITE 105 MEDLEY, FL 33166
JOB # E-122 DRA WN: J. T REV- N.A.
MIAMI DADE,/MONROE BROWARD
(305) 889-1100 (954) 435-0220
FAX (305) 889-2900 FAX (954) 438-7272
PALM BEACH MARTIN/ST. LUCIE/INDIAN RIVER
(561) 741-4260 (772) 398-6.5.3.3_ .
'AX_ (561) 741-4259 FAX (772)'398-6532
WESTCOAST OPERATIONSS
COLLIER/LEE (239) 549-5911/FAX: (239) 549-5811
TOLL FREE STATE WIDE 1-866-261-CBIC
WWW. CBICCORP. COM
SURVEYORS NOTES:
1–OWNERSHIP IS SUBJECT TO.OPINION OF TITLE
2–EXAMIN47ION OF THE ABSTRACT OF TITLE V1/4L •
C
'9
O
HAVE TO BE MADE TO DETERMINE RECORDED • . • • • • ,
INSTRUMENTS, IF ANY, AFFECTING Ttl1S.PROPER'IY •
®
F
3–NO UNDERGROUND IMPROVEMENT9'WERE LO `�i0 • °
ARE REFERRED TO MA7lQNAL GEbDE7IC • •
,4
cn4–ELEVATIONS
28.90'
19.20
C
¢
VERTICAL DATUM OF 1929 (UNLESS'AMAfED). • ,
013
>
5–THERE MAY BE ADD177ONAL RESTNI�%BW NOF 311QWN „•.
c�j
p
y
®
IN THIS SURVEY THAT MAY BE FOUNbeAl THE COUIyV
PUBLIC RECORDS ":": + •
Lu
• g,
�'•
N
6–LEGAL DESCRIP77ON PROVIDED BY'CL I NT
7–UNLESS OTHERWISE NOTED RECO�'bWAND MEASURED
,C'
DATA ARE IN SUBSTAN71AL AGREEMEAUS. ' goose*
—'
p2 z
8–BEFORE ANY CONSTRUCTION THE ,SET• RACKS ' • +�'+
W
W
~
U Q
MUST BE CHECKED " ��•"
• • •
>
G
W
p
9– THIS SURVEY IS FOR USE AS PER REOUEST
6' W.F
CL
0
Z
-
0
c~j z
AN. D NOT F°OR' ANY• OTHER PURPOSE.
10–FLOOD ZONE X BASE N/A PANEL 0033
F
L11O
M
R �
11– DATE OF FIELD WORK : 0810.3
DEC AUN
4' WIRE
FENCE
0.40'
0 0 0 100.00'(R&M) y(NO l 2m
o h � o�
r
-ASPHALT I HEREBY CERTIFY• THAT THE BOUNDARY SURVEY OF THE ABOVE DESCRIBED PROPERTY IS TRUE 1 L
AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AS RECENTLY SURVEYED UNDER MY PROFESSIONAL LAND SURVEYOR & MAPPER
=GRASS DIRECTION. IT IS ALSO MY PROFESSIONAL OPINION THAT TMS SURVEY MEETS THE MINIMUM TECHNICAL CERTIFICATE No 5571
STANDARDS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS IN STA TI: OF FLORIDA
CHAPTER 61 G-17-6 OF THE FLORIDA ADMINISTRATIVE CODE PURSUANT TO SEC710N 472-027 OF THE THE SURVEY SHOWN HEREON IS NOT VALID WITHOUT THE SIGNATURE AND
FLORIDA STATUTES ORIGINAL RAISED SEAL OF A FLORIDA SURVEYOR AND MAPPER
CARIBBEAN BUILDING INSPECTI NNS &,1S EY
LB 7362
7911 NW 72nd AVE., SUITE 105 MEDLEY, FL 33166
JOB # E-122 DRA WN: J. T REV- N.A.
MIAMI DADE,/MONROE BROWARD
(305) 889-1100 (954) 435-0220
FAX (305) 889-2900 FAX (954) 438-7272
PALM BEACH MARTIN/ST. LUCIE/INDIAN RIVER
(561) 741-4260 (772) 398-6.5.3.3_ .
'AX_ (561) 741-4259 FAX (772)'398-6532
WESTCOAST OPERATIONSS
COLLIER/LEE (239) 549-5911/FAX: (239) 549-5811
TOLL FREE STATE WIDE 1-866-261-CBIC
WWW. CBICCORP. COM