DS-15-823Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-232094 Permit Number: DS -4-15-823
Scheduled Inspection Date: May 08, 2015 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez, Jorge
Owner: GRIFFIN, FRANCIS
Job Address: 1576 NE 104 Street
Miami Shores, FL
Project: <NONE>
Contractor: RODWINS PAVING
Building Department Comments
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1122320320400
Phone: (305)253-5354
RESURFACING OF EXISTING ASPHALT DRIVEWAY- ----- -- -
INSPECTOR COMMENTS False
May 07, 2015 For Inspections please call: (305)762-4949 Page 12 of 33
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
May 07, 2015 For Inspections please call: (305)762-4949 Page 12 of 33
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 -°
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 20 l
BUILDING Master Permit No.,:D S 15' Y22>
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
Q p9 CONTRACTOR DRAWINGS
JOB ADDRESS: f -N� S I D `®®�� t' S
City: 9Miami Shores Countv: Miami Dade Zip:
Folio/Parcel#: I ( 2.7, 32 -03'-"' - 0gDD Is the Building Historically Designated: Yes NO V
Occupancy Type:, Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): FP-0--t7C-j'1& f4' 8A Phone#: 30r-7-274 -7'90 7
Address: 15-7 to /Ve" 104 5� -
City: % f lq-, /1 l 5 409CS State: r-2- Zip: 3313,9
Tenant/Lessee Name: Phone#:
Email:
/a lei -5 �5Mv 5 Pte,' FAV& &/V6 -1 n,1G
CONTRACTOR: Company Name: d1 b/: 961,U*nS /2%2 id9w' Phone#:��� Z��_✓
Address: /9;M «S- C�.
City: "I t State: Zip. 3313%
Qualifier Name: L iPhone#:°3®J'?-�3-5 3S-7/
State Certification or Registration #: Certificate of Competency #: eC74 / 46n
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ �,� �- �^ Square/Linear Footage of Work: ;2-000
Type of Work: ❑ Addiction El Alteration El New ❑ Repair/Replace El Demolition
Description of Work: y 1 L'oS�(-[.rf,&� etiAs or �Yi I✓P .t U
Specify color of color thru tile:
Submittal Fee $.Sc - 0- Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
Double Fee $
Bond $ 5 04' c
TOTAL FEE NOW DUE $ 04-6O
(0 + (;; 0
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
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 i In the absence of such posted notice, the
inspection will not be approved and a einspection fee will be charged.
Signature Signature
OWNER or AGENT
The foregoing instrum/entt was acknowledged before me this
�r day of �Uyl/OACA .20 15 , by
fmobs '4- P I4' m who is personally known to
me or who has produced ,52q I - - J 7 ff -® as
identification and who did take an oat .
>�121 UCR L4 C
NOTARY PUBLIC:
The fo"going instrument was acknowledged before me this
01 S� day of /va*CA , 20 % , by
To 5-e- C A-)/ —hlas , who is pto
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign:
Sign: a.
Print:
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* •_ Notary Publi -State of Florida
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Seal: ''2. °�_ Notary Public State of Florian
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APPROVED BYPlans Examiner FT- Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D.::]�CWOPY
'rPY OF LIABILITY INSURACE*
E. OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
........................................................................................
BUSINESS NAME: A)) e blfiS I SWs PkV;,n,; CrM • /YI C • 14 RoQ.f Il S hays* «
BUSINESS ADDRESS: 1197D lY S • •. CITY Y I4 -M l STATEZIP 7
BUSINESS PHONE:) 25"35 FAX NUMBER ) �7''" �d�%r�
CELL PHONE (-V(0) Z-1 W --1(00QUALIFIER'S NAME: /Ut �-b c&s
QUALIFIER'S LIC NUMBER: E94/
CTQB
Constriction Trades Quab" Board
(NESS CERTIFICATE OF COMPETENCY
Jk,
E941400
e
J
:A 7,77TRIAWSA.:RODWINS PAVING
N1 La
B) SJOSE L
Is cedffiad under the Provisions of Chapter 10 of Mlarnl-Dade Courdy
VA -1,10 POWtOWRACUNG Off"LOW30IMS
QUALIFYING TRADPS)
0007 PAVING ENGINEERING
0009 EXCAU & GRADING ENG
;� 14
iawycrewftwdii wwar
Municipal Contractor's Tax Receipt
Miami—Dade County, State of Florida
--THIS IS NOT A BILL - DO NOT PAY
CC NO: E941400
BUSINESS NAMEILOCATION
RODAWS PAVING
19270 SW 185 CT
MIAMI, FL 33170
MC
RECEIPT NO• EXPIRES
New susium SEpTEMBER 309 2015
7455SS3 Must be displayed at place of business
Pursuant to County Code
Chapter BA - Art. 9 & 10
TYPE OF BUSINESS pAyMENT RECEIVED
OWNER SPECIALTY By TAX CoLLECTOR
NIEBLAS & SONS PAVING ENGR INC CONTRACTOR INEERING 20000 09/29/2014
0221-14-005389
MM
MOFremare iNsttaatioa.eisii
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A BILL - 00 NOT PAY
3178179
BUSINESS NAmVLOCATION
RODWINS PAVING
19270 SW 185 CT
MIAMI, FL 33170
RECEIPT NO. EXPIRES
RENEWAL SEPTEMBER 30, 201 5
3312248 Must be displayed at place of business
Pursuant to County Code
Chapter BA - Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS PAYMONT RECEIVED
NIESLAS & SONS PAVING ENGR INC 196 SPECIALTY i9Y TAX COLLECTOR
ENGINEERING 73.00 09/2912014
Worker(s) 1 E94140D CONTRACT 0221-14-005369
This Local Business Tax Recalpt onlY centum 11111=0 of tba local Bass Tax. The Racelpt is act a ticease.
peen% or a cerdficadoc of due hakWS gUolit&adoas, to du busiae. Nobler MW CMVlY wide Bay 99moIncolal
or t regulatory laws sad requirement wN ch apply to tba bushom
The RECEIPT N0. abm mum he displayed an all coavuerciai vahias- Aliaud-Dade Code Sec Ba -M
aFar stere hdormadon. visit
ENDICATED. NOTWITHSTANDING ANY REGUIRS NT, 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAN&
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DRIVEWAY,PARKING AREA OR SIDEWALK PAVING OR REPAVING,
CONTRACTOR LICENSE NUMBER E941400
4
CERTMATE HOLDER
Miami Shores Village
100SO NE 2nd Ave.
Miami Shores, Fl 33138
ACORD 25 {2109MO) OF
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Miami, FI 33187
A ekbumd cm #ft awokwftdow ratca+det rhe to the
INDICATED N07 AMWANDING ANY REQUIIREMENT, TERM OR COAIDt7f W OF ANY CONTRACT OR OTHER DOCUMENT W TH RESPECT TO VffCM THN
CSRTRCATS MOW BE i8813M OR MAY PERTAM , •THE INSURANCE AFFORDED GY THE POLICIES DESCRIBED M M11418 $US= TO ALL THE TOM,
SONami OF SUCH POLICM •ttr U $140MMAYNAVENNIEDUCEDBYPAD"MAIMS,
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DRIVEWAY, PARKING AREA, SIDEWALK PAVING AND REPAVING
Contractor License Number E941400
Miami Shores Village INWAAAMOFTHEASMONCIUMPOUCMUN X-LMNSOM
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10050 NE 2nd Ave. ACQOftM=WffffTNpM=pRWMWft
Miami Shores, FI 33138
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AC01M 25 tom) Tta ACORID nawand bp ata n0dend meft of ACORD
CFN: 20150192472 BOOK 29550 PAGE 4925
DATE:03/25/2015 09:26:40 AM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner} �1wc/d '4. 4ollwlo%
owner of the following described property address : j
Legal Desai tion Lot /1 Block
Folio #
Requests permission to Instal (descxibe work): OUE
hereafter referred to as the
t l.33!
Subdivision 1u ' 134V
Within the public right of way of (address) 44910 5F
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
9. To maintain and repair, when necessary, the above-mentioned kern(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 (lability, 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 Ding 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 died in the Public Records of Dade County, Florida by the
ge Man of mi SF�res Village (or his fully authorized representative).
X111 �jj '
're ' �''"�� �T�GItZCi sr7 • �I7�-t-r
Owner or Agent
The foregoing instrument was acknowledged before me this V"2 day of 6AA9jj8. 20 by
anleis _ ; i� i N who is personally known to me or who has produced
as identil'Ication and
did take an oath.
NOTARY PUBLIC:'
� ds
F IWO
:. XM W-
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Village
Building Department
SURVEY AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiant, PMUC fs A • 6P,PN , does hereby attest that
(Property owner)
The attached survey, performed by % � L) ° GLV /'Uf
(Name of surveyor's company)
For address: 1 �-7% 1JC A 07�L S�467171 , R, 531;9
Performed on 6'i!�'� % (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 Ppal inspections as applicable to this or other permits.
oher, AfFian nau/ghht�. .
Property Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this V-6 day of U��
Affiant is personally known to me, produced G615-2-41-1I`t-PH- Das identification.
E141
t:
Notary Public State jFloridaNotary
Revised on 5/22/2009/ Revised on 6112109. My Co Aiwa►ezMy Comrrd�ionFF
Expires 09l03t2018
CFN: 20150192473 BOOK 29550 PAGE 4926
DATE:03/25/2015 09:26:40 AM
HARVEY RUVIN, CLERK OF COURT. MIA DADE CTY
NOTICE OF COMMENCEMENT
ARECORDED COPY WINT BE POSTED ON THE JOBSrrEAT TIE OF F0tST WspECTIOU
PEI`W NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED try gives ndice that imprmw eMs will be made to cWtain real
Mvpeq, aid In ao=danoe w0h Chepw 713, Ftorwa Stahrtes, Ere foawng information
Is provided in this Noke of Comrrnoi
I. Legal description of property and streeVaddress: 157iv NE IV II ;q- Zvi i)ftwj fir
.10:r lit O,.. 9 4
2. Description of improvement:
3.Owner(s) name 6d address: , e9 _ S r rl;W
Interest in pruperty:
Name and address of fee simple titleholder.
4. Contractor's ngje /and address: ki S Ul.' _J Iblej,
AIC I
5. Surety: (Paymed bond required by owner from contractor, N any)
Name and address:
Amount of bond $
B. Larder's name and address:
7. Persons within the state of Florida designated by Owner upon whom notices or outs• documents may
be served as provided by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's
Notice as provided in Section 713.13(1)(b), Florida Statutes
.Name and address:
If
9. Expira on date this Notice "of Commencement: (the expiration date Is 1 year from the date of
nless erent� s ed)
Si ure of Owner
Print Owner's Name i-jr�i(y,A (-i &!1
Swom to and s bed before 17 ts% day of Z 1- 20J•J_.
Notry Public weagrect
ttby
Print NoWs Nwe . Y i , JEREMY WWBIE Natrre +E4,t'lL Gu r'-
My CortsrMM 60W. In ftu1 Ne Address: a J�'IC '� i r Q7
my comm. Eras Mar 9, 2018
_d.._ Ca ossfun 0 FF 093trt19
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COMA. au►sn.,�"Pu& NtWO !D 7 7 - 5� 2 I
SORVEY OF ••••
•••. sees:*
LOT 4• --2 +� seeSUNIVISIONe
AC4�DING TO TRE PUT AS RECORDED 114 PIAT MW W- AT .• 7Z • • • • • • • i •
Pifd1.IC RECORDS OF f� COlEi1Y. €Y.ORYDA. • e • • • e ..
• :sees:
DATE.• .1.a!'+r ✓ FOR: �.. eee �
•
LOCATION SKETCH SCALE I"- % gc' f hereby re4tify that this sketch of e.e• •e0•e0
per„ yr..i.r survey of the above dlsci�eds aropsttye • • eggs*
to true and correct to Mie Wbt ai ®y ••e ••••••
+ knowledge and beliet as we�;y surveyed �•
r a lc ; 7 l f 1 i 7t g � t a= ( 30 and platted under my dlrect%itw Y • . •. ••: •
further certify that this survey flet '••
IUI�- � G € the minim= requf reareats• t4dp*4 by thee 000000
2'j "' Florida Society of Professional Load •
l' { Surveyor* and the Florida Land Title***•
0
There eveW encs achment s
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a:.�PF.:' r4::"•• l?t.' .G%»e�:�aP:: rG stored Land QyOr�fZ9G
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Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
vroject Aaaress Parcel Number Applicant
1576 NE 104 Street 1122320320400
FRANCIS GRIFFIN
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
FRANCIS GRIFFIN 1576 NE 104 ST
MIAMI SHORES FL 33138-2666
Contractor(s) Phone Cell Phone
RODWINS PAVING (305)253-5354
In Review
Approved:: In Review
Denied:
of Work: RESURFACING OF EXISTING ASPHALT D Additional Info:
Retum : Classification: Residential
nino: 3
Fees Due
Amount
Bond Type - Contractors Bond
$500.00
CCF
$3.60
DBPR Fee
$3.00
DCA Fee
$3.00
Education Surcharge
$1.20
Permit Fee
$200.00
Scanning Fee
$9.00
Technology Fee
$4.80
Total:
$724.60
Valuation: $ 5,280.00
Total Sq Feet: 2000
Pay Date Pay Type Amt Paid Amt Due
Invoice # DS -4-15-55140
04/09/2015 Check #: 10386 $ 50.00 $ 674.60
05/07/2015 Check* 10489 $ 674.60 $ 0.00
Bond #: 2706
Avauame
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 AFFIDA�: I �certify�hat all the or (g information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z ninq. uthe ore, I o ' e above-named contractor to do the work stated.
May 07, 2015
/ Contractor / Agent
Buildirig Department Copy
May 07, 2015 1