Loading...
DEMO-15-486Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229518 Permit Number: DEMO -3-15-486 Scheduled Inspection Date: March 18, 2015 Inspector: Rodriguez, Jorge Owner: DIXON, PATRICK Job Address: 10317 NE 2 Avenue Miami Shores, FL 33138-2056 Project: <NONE> Contractor: ARCO CONSTRUCTION suiming uepartment comments REMOVE 2 CONCRETE SLABS ON OUTSIDE OF EXISTING RESIDENCE. REMOVE ALUMINUM SCREENED ENCLOSURE Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1121360130380 INSPECTOR COMMENTS False Inspector Comments Passed _VP Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: 305-892-6507 March 17, 2016 For Inspections please call: (305)762-4949 Page 20 of 34 Miami Shores Village 1.., Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION KfUILDING ❑ ELECTRIC ❑ ROOFING FBC 20 l0 Master Permit No. 1 z�ko ' is - Sub s - Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11:7 N U z,4 City: Miami Shores Countv: Miami Dade Zia: —'41AV-Zi Folio/Parcel#: Is the Building Historically Designated: Yes NO %_. Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): Construction Type: Flood Zone: BFE: FFE: Address: -�,,, tl ®A !Q T `'-ans LZ City:�. � �2 �1a� Stater Zip: o "LS' Tenant/Lessee Name: Phone#: °'3®05 Email: CONTRACTOR: Company Name: PQAQC,1 I� t 9f',1rt,�te �JQ Phone#: Address: City: Stater 1 Zip: 3 - Qualifier Name: L_l=e ��j��1� Phone#:011 State Certification or Registration M �� X15—3Certificate of Competency #: DESIGNER: Architect/Engineer: b*A (1-4- Phone#: Value of Work for this Permit: Type of Work: ❑ Addition City: State: Square/Linear Footage of Work: 10 00 ❑ Alteration ❑ New Zip: ❑ Repair/Replace [Demolition Specify color of color thru able: Submittal Fee Permit Fee $ ,� C.0 CCF $ CO/CC $ Scanning Fee $ Technology Fee Structural Reviews $ (Revisedo2/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ��CJ • J�� Bonding'Company's Nam, e''((f applicable) Bonding Company's Address City State tits. Mortgage Lender's Name ('if applicable) Mortgage Lender's Address Zip City 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 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 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. Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of MAN.:1 , 20 `E , by TA10ZMAND.A (Sb45;I0F4m. , who is personally known to me or who has produced ,#L-,Mlwg— Wg��as identification and who did take an oath. NOTARY PUB Sign: `yd' Print: Notary Public State of RoMa Seal:Sindia Alvarez 6+� My Commission FF 158750 �1IV Expires 08!0312018 Signature C T OR The foregoing instrument was acknowledged before me this day of Maw , 20 1S . by u FS-Cep—a wsll l- l . who is personally known to me or who has produced7-NMW uzoslz� as identification and who did take an oath. NOTARY PU IC: Sign: Print: � Notary Public State of Florida Seal ;F +.' Sbuiia Alvarez My Canmiss�n FF 158750 orn E*M, 08/03/2018 ############################### #######n################################################################### APPROVED BY 3 7 I Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami -Dade County Clerk - County Recorder's Official Record Search CFN Details W 0 Itern(s) In Basket Homo Online Services About us Page 1 of 2 Eqn.17-71M17 County Recorder's Official Record Search CFN Details CFN #2014 R 66596, Group ID #1 First Party (Code): DIXON PATRICK A (R) Second Party: GARDINER PATREMANDA Subdivision Name: Legal Description: CJerk's File No: l2014 R 65595 Pages In Document: Rec Date: DI/28/2014 Group ID: Doc Date: Doc Type: CP Entry Date: )1/28/2014 Rec Book: 9006 535 Block No: Orig. CFN No: Section: OrIg. BooklPage: Township: Plat BookfPage: Range: Misc Reference: 14000026CP02 WILL I Folio No: Folio No: BACK TO SEARCH RESULTS MODIFY THIS SEARCH First Party (Code): GARDINER PATREMANDA (D) Second Party: DIXON PATRICK A Subdivision Name: Legal Description: Clerk's File No: 014 R 65595 Pages In Document: Rec Data: )1/28/2014 Group ID: Doc Date: Doc Ty : CP Entry Date: )1128/2014 Roe Book: 9006/535 Block No: Orig. CFN No. Section: Orig. BookfPage: Township: Plat Book/Page: Ran e: Mlse Reference- 14000026CP02 WILL Folio No: BACK TO SEARCH RESULTS MODIFY THIS SEARCH First Party (Code)- DIXON KENNETH D (D) Second Party: DIXON PATRICK A Subdivision Name: Legal Description: 5Jerk's File No: 12014 R 65595 Pa es In Document: Rec Date: )1/28/2014 Group ID: 1 Doc Date: Doc Type: CP Entry Date: )1/28/2014 Roe Book: 9006 t 535 Block No: Orig. CFN No: Section: Orla. BookfPage: I Township: Plat Book/Page: I Range:- Misc Reference: 114000026CP02 WILL Folio No: BACK TO SEARCH RESULTS First Party (Code): DOLCHIN STEVEN B (R) Second Party: GARDINER PATREMANDA Subdivision Name: Legal Description: ClorWs File No:t014 R 65595 Pages In Document: Rec Date: 1/28/2014 Group I MODIFY THIS SEARCH https://www2.miami-dadeclerk.com/officialrecords/Search.aspx 3/6/2015 ' Miami -Dade County Clerk - County Recorder's Official Record Search CFN Details Page 2 of 2 Doc Date: Doc T CP Entry Date: 1/28/2014 Rec Book: 29006 t 535 Block No: Orl . CFN No: Section: Orig. Book/Page: Townshi : Plat Book/Page: Range: Misc Reference: M4000026CP02 WILL Folio No: BACK TO SEARCH RESULTS MODIFY THIS SEARCH Official Records Search Home I Official Record Information I Hein I Email I Loo Home I Privacy SMterrmt IIO sclaiI C�oqtad U€ I About Us 2008 Clerk of the Court. All Rights reserved. 50142977 https://www2.miami-dadeclerk.com/officialrecords/Search.aspx 3/6/2015 OFFICE of VITAL. STATISTICS CERTIFICATION OF DEATH STATE FILE NUMBER: 2013139669 DATE ISSUED: October 17, 2013 DECEDENT INFORMATION STATEFILE DATE: October 16, 2013 NAME: PATRICK A DIXON AKA: PARTICK A DIXON DATE OF DEATH: October 3, 2013 SEX: MALE AGE: 071 YEARS DATE OF BIRTH: January 24, 1942 SSN: 36440-2732 BIRTHPLACE: MIAMI, FLORIDA, UNITED STATES PLACE WHERE DEATH OCCURRED: DECEDENT'S HOME FACILITY NAME OR STREET ADDRESS: 10317 NORTHEAST 2ND AVENUE LOCATION OF DEATH: MIAMI SHORES, MIAMI-DADE COUNTY SURVIVING SPOUSE, DECEDENT'S RESIDENCE AND HISTORY INFORMATION MARITAL STATUS: MARRIED SPOUSE (IF FEMALE, MAIDEN NAME): PATREMANDA GARDINER RESIDENCE: 10317 NORTHEAST 2ND AVENUE, MIAMI SHORES, FLORIDA 33138, UNITED STATES COUNTY: MIAMI-DADE OCCUPATION, INDUSTRY: PSYCHOLOGIST, CLINICAL PSYCHOLOGY RACE: WhRe (Black or African American Asian Indian' _Chinese _Filipino _Native Hawaiian American Indian or Alaskan Native—Trig: _Japanese _Korean= Vietnamese _Guamian or Chamorro Samoan _Other Pacific Isl: _Other Asian: _Other. _Unknown HISPANIC OR HAITIAN ORIGIN? YES, PUERTO RICAN EDUCATION: DOCTORATE DEGREE (E.G., PHD, EDD) EVER IN U.S. ARMED FORCES?YES PARENTS AND INFORMANT INFORMATION FATHER: JAMES DIXON MOTHER: MERLEAN UNKNWON INFORMANT: PATREMANDA GARDINER RELATIONSHIP TO DECEDENT: WIFE INFORMANTS ADDRESS: 10317 NORTHEAST 2ND AVENUE, MIAMI SNORES, FLORIDA 33138, UNITED STATES PLACE OF DISPOSITION AND FUNERAL FACILITY INFORMATION PLACE OF DISPOSITION: GOLD COAST CREMATORY FORT LAUDERDALE, FLORIDA METHOD OF DISPOSITION: CREMATION FUNERAL DIRECTOR/LICENSE NUMBER: GEORGE N. SCOTT, F044266 FUNERAL FACILITY: NEPTUNE SOCIETY -POMPANO BEACH F064804 3404 N ANDREWS AVE, POMPANO BEACH, FLORIDA 33064 CERTIFIER INFORMATION TYPE OF CERTIFIER: CERTIFYING PHYSICIAN MEDICAL EXAMINER CASE NUMBER: NOT APPLICABLE TIME OF DEATH (24 hr): 0633 CERTIFIER'S NAME: NEIL F FURMAN CERTIFIER'S LICENSE NUMBER: OS8703 NAME OF ATTENDING PHYSICIAN (If other than Certifier): NOT ENTERED THE ABOVE SIGNATURE CERTIFIES THA'TYf9IS IS A TRU2'A1CL7'GUF(RECT'COPY OF THE OFFICIAL RECORD ON FILE IN THIS OFFICE. THIS DOCUMENT IS PRINTED OR PHOTOCOPIED ON SECURITY PAPER WITH WATERMARKS OF THE GREAT WARNING: SEAL OF THE STATE OF FLORIDA. DO NOT ACCEPT WITHOUT VERIFYING THE PRESENCE OF THE WATER- MARKS. THE DOCUMENT FACE CONTAINS A MULTICOLORED BACKGROUND, GOLD EMBOSSED SEAL, AND THERMOCHROMIC FL. THE BACK CONTAINS SPECIAL LINES WITH TEXT. THE DOCUMENT WILL NOT PRODUCE A COLOR COPY. II�P IY����11DH FORM 1946 (04-10)01 go] ATI REQ: 2014272472 Notice to Owner - Workers' Com Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if - 1 . f: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years 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 and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signatur� Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 00 day of UPVW., 2015 . By il(Q who is personally known to me or has produced Cn 46'49- �FYQ- 0 as identification. -Del Uez Notary: SEAL: r Notary putgtc state of MOO ,p Sbift Alvarez My CM04991on FF 158750 . 09103/2018 • • Arco Construction Corporation March 5, 2015 State of Florida County of Miami Dade Before me this day personally appeared Lester Jensen who, being duly sworn, deposes and says: All work to be performed by Lester Jensen or licensed and insured subcontractors. Sworn to (or affirmed) and subscribed before me this a� day of 20 t5 .by Personally know Or Produced Identifications, Ct Type of Identification Produced RZ*2A i 1CA ._ 1www7 Print, Type omp `Ime of Notary Notary Public state or Flora . . . 81ndia Alvarez My COlntal8slon FF 156750 Expires 0312018 General Contractors/CGCI50516311665 N.E. 137* TerraceM. Miam4 FL 33181 305.892-6507 W. DIXIE W . r .�-6 - 4_ Rspha� Pa ve m e M+gsc p l .4 75 0o id . 0 LT. ORK F4 9 t Zi +X S o1 zs.�2 RES #10317 1 STORY CBS C3 Ar, C 133 N D o n '0 m In al g —moi f 3 cn M0 O� << N / W ct? m LTJ m ),;1 ara -A a dl a �ivA 3=22" NC" �► '� 0 ?