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DS-15-57Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226369 Permit Number: DS -1-15-57 Scheduled Inspection Date: April 30, 2015 Inspector: Rodriguez, Jorge Owner: WILLIAMS, JOYCE Job Address: 246 NW 93 Street Miami Shores, FL 33150 - Project: <NONE> Permit Type: Driveways/Sidewalks/Slabs Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1131010331100 Contractor: MIAMICRETE INC Phone: (305)790-4850 duuaing uepanment comments INSTALL NEW DRIVEWAY APPROACH AND PARKING SLAB BRICK PAVERS INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. April 29, 2015 ' For Inspections please call: (305)762-4949 Page 3 of 29 ,$ Miami Shores Village 10050 N.E. 2nd Avenue NW ••'• Miami Shores, FL 33138-0000 Phone: (305)795-2204 OR Project Address Parcel Number Applicant 246 NW 93 Street 1131010331100 JOYCE WILLIAMS Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell JOYCE WILLIAMS 246 NW 93 Street MIAMI FL 33150-2236 Contractor(s) Phone Cell Phone MIAMICRETE INC (305)790-4850 In Review Approved:: In Review Denied: of Work: INSTALL NEW DRIVEWAY APPROACH At, Additional Info: Return : Classification: Residential ning: 3 Fees Due Amount Bond Type - Contractors Bond $500.00 CCF $3.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $1.20 Miscellaneous Fee $1.00 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $648.60 Valuation: $ 5,783.00 Total Sq Feet: 932 Pay Date Pay Type Amt Paid Amt Due Invoice # DS -1-15-54116 03/13/2015 Check #: 3312 $ 98.60 $ 550.00 01/12/2015 Check #: 3221 $ 50.00 $ 500.00 03/13/2015 Check #: 3312 $ 500.00 $ 0.00 Bond #: 2638 AVallaDle Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the abov�"amqd contractor to do the work stated. March 13, 2015 Authorized Signature: Owner / Applicant / Co`k tractor / Agent Building Department Copy March 13, 2015 1 Miami Shores Village Building Department 10050 N.E.2nd 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: BUILDING JAN 12 M FBC 2010 Permit No. Master Permit ROOFING JOB ADDRESS: 4_16 A&CZ /3:�,;f . 2 City: Miami Shores County: Miami Dade Zip: Folio/Parcelt ,_.o�- 3z� - 0 33 --e'ct9 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): =0eZ7 &11111*5,1 rj Phone#: _!.?-0S - ?!5�p ` ye r0 Address: Z Y(r tiLt/ `! 3 :5 T City: 14K�131 State: % Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: A'/�%/i�,5 Phone#: L3,oT- 'VV - / ?.5-0 Address: City: a��� State: Zip: Qualifier Name: (/ Phone#: 90 -- r,0 State Certification or Registrt tion #: Certificate of Competency #: 0. ,8,5 001!�- 5-3 Contact Phone#: 5- %��%- VX rQ Email Address: /Ivy DESIGNER: Architect/Engineer: Phone#: �a Value of Work for this Permit: $�,� , �� Square/Linear Footage of Work: Type of Work: ❑Addition OAlteration❑New ORepair/Replace e . - - a Description of Work: Submittal Fee Scanning Fee $ Notary $ Color thru tile: Permit Fee $ Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ LlGP 14c) -?Uy ❑Demolition CCF $ CO/CC $ DBPR $ Bond $ TC -1) , Ck) Technology Fee $ TOTAL FEE NOW DUE $ 10 ` -)- 0_5 V3AZ) Bonding Company's Name (if applicable) BrOing 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 roust 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 pos ed at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of suchsted notiNhe inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before I this / , day of �, 20 by �_X /%`� G!/! yJ ,®•�Z� day of -,20/Y, by I�J2,6 f .P /[J who is personally known to me or who has produced who is personally known to me or who has roduced As identifi and who did take an oath. o did take an oath. ,''... rP.e RONOTARYP RI IGO ALVAREZ NOTA ALVAREZ =* MY C ISSION #EE884004 MMISSION #EE884004 '........ ,; ° ES March 14 , 2017 9�� oPaQr PIKES March 14, 2017 (407) 39"1 Sign: Sign: 53 Fla ryS9rvlce.com Print: Print: My Commission Expires: My Commission Expires: APPROVED BY S Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) MIAMINC-01 SAEZM .a►`vRv' CERTIFICATE OF LIABILITY INSURANCE DATE(MYYII) 1/26/420120115 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 WAIVED, 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 lieu of such endorsement(s). PRODUCER EagleAmericanInsurance g 1 Longwood, FL 32750 CONTACT NAME: Shelia Serrano 407 7�-3000( ) A/C°ON o Ext : ( (FAX No : 407 788-7933 ���: Shelia.Serrano@ioause.com INSURERS AFFORDING COVERAGE MAIC P INSURER A: Star Insurance Company 18023 INSURED INSURER B INSURER C: Miamicrete Inc INSURER D: 7910 SW 16th St Miami, FL 33155 INSURER E : WSURERF: PERSONAL & ADV INJURY $ COVERAGES CERTIFICATE N"MRFR- RFVI_CIr1N NIIMamo. 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. ILNTSRR OF INSURANCE L ADDTYPE SUBR POLICY NUMBER MMN EFF MIMIDPOLID EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: RLOCPOLICY ❑ PRO- ❑ JECT OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON-OWNEDPROPERTY AUTOS COMB NED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ DAMAGE $ Per accident UMBRELLA LIAS EXCESS LWB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBEREXCLUDED? (Mandatory In NH) IT yes, describe under DESCRIPTION OF OPERATIONS below N/A WC079762800 080112014 08/29/2015 X PER OTH- STATUTE ER E.LEACH ACCIDENT $ 1,000,00 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached N more epee is required) RE: Concrete or brick pavers driveways Miami Shores Village Building Department 10050 NE 2 Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE , /2o 5Y' THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED, 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 lieu of such endorsement(s). PRODUCER NORTHEAST AGENCIES INC/PHS CONTACT NAME: PHONE ,Exl): (866) 467-8730 (, ,No): (888) 443-6112 210204 P:(866) 467-8730 F: (888) 443-6112 ADDRESS: 301 WOODS PARK DRIVE INSURER(S) AFFORDING COVERAGE NAICH CLINTON NY 13323 INSURER A: Hartford Casualty Ins CO 29424 INSURED INSURER B: INSURER C: MIAMICRETE INC INSURER D: 7910 SW 16TH ST INSURER E: MIAMI FL 33155 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. /NSR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER = EFF P=7 POLICYEYP Limns COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000 CLAIMS-MADEa PREMISES (Ea=n.) DAMAGE TO RENTED nce) 5 3 0 0, 0 0 0 MED EXP (Any one person) $10,000 A X General Liab 01 SBM AN2271 08/25/2014 08/25/2015 PERSONAL & ADV INJURY $1,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 POLICYE 0.❑ LOC PRODUCTS - COMP/OP AGG s2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Ea accident) BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOSAUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) HIRED AUTOS NON -OWNED AUTOS $ UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR [ CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE YM OFFICERIMEMBER EXCLUDED? (Mandatory In NH) El E.L. DISEASE- EA EMPLOYEE $ E.L. If yes, describe under DESCRIPTION OF OPERATIONS below $ E.L. DISEASE -POLICY LIMIT I PP DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Addrdonal Remarks Schedule, may be attached K more space Is required) Those usual to the Insured's Operations. Brickpavers and concrete driveways. CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village g BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A UTHORMED REPRESENTATIVE Building Department 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD STATE OF (FLORIDA) COUNTY OF (DADE) Miami shores Village Building Department SURVEY AFFIDAVIT ej The undersigned Affiant,.) A • t1✓, does hereby attest that (Property owner) The attached survey, performed by For address: Performed on (Name of sure yor's 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Further, Affiant say eth naught. .ft. - A--- - %A 2 1 -:jo me A Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this : day of Affiant is personally known to me, produced as identifiesion. RODPICO ALVAREZ MY CO W SSIOI`j #EE884004 Revised on 5/2212009/ Revised on 6112109 For those documents not prodding theems° ed_ space on the first page, this cover page must be attached. It must describe the document in sufficient &tail to prohibit its transference to another document. An additional recording fee for this page must be remitted, I � 1i� i 1 it111 itttt d9il Itis litl ISI �tt� OR Bk 29438 Fs5 4177 — 41791 {3F95) RECORDED 12/22/2014. 14:09:01 HARVEY RUVINe CLERK OF COURT MIAMI—DARE •COUNTYP FLORIDA �cjs��sa�eer�ss�sfm•oi�e,�e�l Document Me: f� ,b712.41 �Qn VQ't 01 A lei T a� (Mortgage, Deed, ConstructionLien, Etc.) Executing Pam Leo Description: (If Applicable) As more fully descax'betl. in above described docwnent Return Document To / Prepared Dr. F.S. 695°26 Requirements for recording instrammts afteciing real property— (Relevant excerpts of Mute) (1) No instrument by which the We to, real property or any interest therein is conveyed, assigned, encumbered, or otherwise disposed of shall be recorded by the clerk of the circuit court unless: (e) A 3 -inch 1y 3 -inch space at the top right-hand comer on the first page and a 1 -inch by 3 -inch space at the top right-hand corner on each subsequent page are reserved for use by the clerk of the court... CWCT 166 Rev. 04111 r F� �'10 COUpry - CLERK CO\ N cut; VVE iuusr o� �F cou�r 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) +byLd hereinafter referred to as the owner of the following described property (address): 49.3 9 ` Legal Description • •y ". �aRa Lbt Block /-35 Subdivision 256� '641!5 Folio Requests permission to install (describe work77 l_ 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. OR BK 29438 PG 4179 LAST PAGE 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 items) 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 201 �b �4 ° LU)' ( &, ature ) SIGNED, SEALED, AND DELIVERED in the presence of: ROD IG * ALVAREZ y;or MY COM I ION #EE884004 'R M6rch 14.2017 PA d b�- ��� 0 see . j .....� a .... 'p - _ - 6� ,o�•�•Z add ...�. 00 0 • ,V C O 1l FEB 2 5 2015 .v s- o BY: - .yv �•X�.1 �j p H C., � O ' OFFgvi IVa 17 iV9iami Shores Vinage APPROVED BY DATE `J' • epT.zoT3 ' Aguno- ap G� 2 15 ;o spaooag D-rTgna auk o O�:+Is�G ®SPT l ' 6 abaa ' o * 'O£ 4aYa T pap�coaax se ';oaaagq 9LDG DEPT � � '4eTa au"4 o-4, BuTplooae ' . I '9 NOlsDSS sauONS lwvj ; g °;! IflJFCTTO COMPLIANCE WITH ALL FEDERAL ;ET, £T )foaTlr€ 'S 407 ;0 { 58',3 auy pue L �o°I /-in Cnl INTY RULFS AND RFrULATIONS � se pagtaosap X-4aadoad s'Ftl;f, ys .. 0.000. 6'X6' CONC. EDGE CURB PERVIOUS BRICK PAYERS OVER 2' SAND FILL 6' LAYER OF WELL . COMPACTED LIMEROGK BRICK PAYER DETAIL • . . ...... .. .. ...... •0e•so e •goes• 0000 . • e•e.•. •..• • 0000. •.ogee • • 00:000 6 Goes* so ...eo• • • • • . • • 6996•9 0000•• 00 o 6'X6' CONC. EDGE CURB PERVIOUS BRICK PAYERS OVER 2' SAND FILL 6' LAYER OF WELL . COMPACTED LIMEROGK BRICK PAYER DETAIL