Loading...
DS-15-660Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235784 Permit Number: DS -3-15-660 Scheduled Inspection Date: June 05, 2015 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez, Jorge Inspection Type: Final Owner: DIAZ, RAFAEL Job Address: 9618 N MIAMI Avenue Miami Shores, FL Project: <NONE> Contractor: DECO CONCRETE INC comments NEW BRICK PAVER DRIVEWAY Work Classification: Addition/Alteration Phone Number 305-310-7876 Parcel Number 1131010330310 INSPECTOR COMMENTS False Phone: (305)828-5158 Inspector Comments �a CREATED AS REINSPECTION FOR INSP-230913. Must have sod or Passed �`�'� landscaping on diturbed areas Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 05, 2015 For Inspections please call: (305)762-4949 Page 11 of 27 Miami Shores Village Building Department �,�Y o's Zo�� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 Ad BUILDING Master Permit No S ISS Z��� PERMIT APPLICATIONSub Permit No. ❑BUILDING ❑ ELECTRIC F-1ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: q(019 Al_14v67je16_• City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11— 3 %0% —®3.3 —o 3lo Is the Building Historically Designated: Yes NO Occupancy Type: Load: Const ruction Type:: ' Flood Zone: BFE: FFE: p OWNER: Name (Fee Simple Titleholder):1- 4!i,- fD`2A� o Phone#:Address:96/ X N• /77f/ - City: / ? ftel 61'10Y2�s State: Zip: 33f Tenant/Lessee Name: �� Phone#: �VF• 92-'9 -S7 Email: IiJ'����L®i'>�P��• �� a CONTRACTOR: Company Name: _ALJ CL7J�K ��T�a Phone#: Address: P® f2V 1 4 City: State: Zip: 33 1 7Z/ Qualifier Name: Phone#: �•���� State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $_ Square/Linear Footage of Work: d Type of Work: ❑ Addition ❑,�,A,ltteration El New ❑ Repair/Replace ❑ Demolition Description of Work: - �5? � ( � vie r �}'rfw-�b°(r-�/ Specify color of color thru-tile: Ar p� . Submittal Fee a �+ CCF $ e; RCola $ Scanning Fee $ Radon Fee $ DBPR Technology Fee Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State 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 approvwd and a reinspection fee will be charged. �- -- '- Signatu OWNER or AGENT The foregoiVnstrument was acknowledged before me this dayofof 20 /f5 , by .Ii�Q�I-�i- . who is personally known to me or who has produced I LCC as identification and who did take an oath. NOTARY PUBLIC: Sign: Print:_ Seal: .Ott, .,� MA11lA N. Af3fNl.Afii �r a►w u ., Nauy PUbft - fitaro of Florida -' My Comm. Expit" Jul is. 2018 The foregoing instrument was a knowledged before me this day of 20J by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: ar` Seal: •" MA JA M. AGUILAR o��,�. p`B` Notary Public - State of Florida • •= My Comm. Expires Jul 15. 2018 Commission #FF 142170 as **3******f*s*tlt*>kii<�iak3A�f>k.�rAA.k..kx�***.k****�exe**�e�x*�k+�k�x*ikAtAii��r*nR�elklk�s. tcz APPROVED BY j7 tS Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk BOUNDARY SURVEY SC R:1 "=20' f LEGEND: �wM4.W—AWrW nAnnf zwmoIr ra ++ MLW H P" -• -- f3o0iN 1�8`�bl1AAi iaN MAY O'S 2015 BY: RP w RP K .FAST 130.00 tR & Ao - I fear CORM. WAt W ea: "r AM" of nf� �� .ASPMLT AM ► M nli EW of AN MOYMMW AIS e v#NMM n f8 ALSO Yr PAS. VPW= WA Am 10 f no#&" srAwAmSEr A'M my niB nom e&w or Pfiawwma SIA?YlE"m Am mvFm AN aw= M 6-1" QF W FLOW A0100 -MM CSE PLMLIANr TO &rCMW 47.116'W QF TW FLa AA STAn= LEGAL DESCRIPTION: S 20' LOT 2 & LOT 3 BLK: 130, MIAMI SNORES', SECTION ACCORDING TO THE PAGE 39,LAT £ 0F0F AS THE PUBLIC DEO IN PLAT BOOK RECORDS OF MIAMI DADE COUNTY, FLORIDA PROPL'RTT ADDRESS- 961!4 N. MIAMI AVE. MIAMI SHORES, FL 33150. cNimmeD !'0: RAFAEL G. DW. TITLE COMPANY OF AMERICA.. ' ATTORNEYS TITLE INSURANCE FUND. Q .. Q ++ 1.00' �. ...............: V K .FAST 130.00 tR & Ao - I fear CORM. WAt W ea: "r AM" of nf� �� .ASPMLT AM ► M nli EW of AN MOYMMW AIS e v#NMM n f8 ALSO Yr PAS. VPW= WA Am 10 f no#&" srAwAmSEr A'M my niB nom e&w or Pfiawwma SIA?YlE"m Am mvFm AN aw= M 6-1" QF W FLOW A0100 -MM CSE PLMLIANr TO &rCMW 47.116'W QF TW FLa AA STAn= LEGAL DESCRIPTION: S 20' LOT 2 & LOT 3 BLK: 130, MIAMI SNORES', SECTION ACCORDING TO THE PAGE 39,LAT £ 0F0F AS THE PUBLIC DEO IN PLAT BOOK RECORDS OF MIAMI DADE COUNTY, FLORIDA PROPL'RTT ADDRESS- 961!4 N. MIAMI AVE. MIAMI SHORES, FL 33150. cNimmeD !'0: RAFAEL G. DW. TITLE COMPANY OF AMERICA.. ' ATTORNEYS TITLE INSURANCE FUND. Q .. Q ++ 1.00' �. ...............: • d ^1 4+30' i rip 5/8 K .FAST 130.00 tR & Ao - I fear CORM. WAt W ea: "r AM" of nf� �� .ASPMLT AM ► M nli EW of AN MOYMMW AIS e v#NMM n f8 ALSO Yr PAS. VPW= WA Am 10 f no#&" srAwAmSEr A'M my niB nom e&w or Pfiawwma SIA?YlE"m Am mvFm AN aw= M 6-1" QF W FLOW A0100 -MM CSE PLMLIANr TO &rCMW 47.116'W QF TW FLa AA STAn= LEGAL DESCRIPTION: S 20' LOT 2 & LOT 3 BLK: 130, MIAMI SNORES', SECTION ACCORDING TO THE PAGE 39,LAT £ 0F0F AS THE PUBLIC DEO IN PLAT BOOK RECORDS OF MIAMI DADE COUNTY, FLORIDA PROPL'RTT ADDRESS- 961!4 N. MIAMI AVE. MIAMI SHORES, FL 33150. cNimmeD !'0: RAFAEL G. DW. TITLE COMPANY OF AMERICA.. ' ATTORNEYS TITLE INSURANCE FUND. .J 2' GUTTER. w mum is NOT vAw wwwr iw stow nm Aw SEAL 4'i' A FLaWA 5LWWW AND MAFM SUJIVRYOAqS <f I-owwasilp IS SUBJEOr TO M,,, OF MiE 2-D0AffMTXNV /: IW ABSTMa OF 7ME WALL AWE ro I a, _ Kcomw INSFRUAgNM IF ANX AFFECMW R .. x,. . LWDERCROUND jMpflVwmEN= WERE LOWED Rx x -r r. s �. c.,i:, a r• � /. [COWW .r . r;"Ih �..x 0.ear .,t- Now RECOMW AND / "M pRVWW By CLOW DAM ARE IN SMUN17AL AMMOM 8-REFORE ANY M,r... O ARM ._ txI / DATE OF FaD'WM CARIBBEAN INSPECTIONS & SURVEYS CARIDB.BAN N A CONSULTING INC I L87294 781 f N. F 72nd AVE., St1'ITB 108 MA"DL8'Y, FLORIDA 89188 .YOB # A-9618 RA#'N DY: J.M.J RFV: N.A. JUSTCOAST OPJUUTIONS MUMI D dDE/Mt1NROR DROIIARD (905) 888-1100 ("4) 498-0220 FAX (908) 888-8800 FAX (884) 498--7278 PALM BEACH MARTIN/ST. LUCIN/INDIAAi 1 MJI (881) 741-4860 (772) 888-8889 PAX (861) 741-4289 FAX (772) 998--88s.8 1111 TCUA.YT urffJmJJvn.J COLLIER B 1.19 /FAX: 848-6811 (298) 849-88! ! T LL F _ IW 1RD.8 -1 800 261-CBIC .. �. ...............: .J 2' GUTTER. w mum is NOT vAw wwwr iw stow nm Aw SEAL 4'i' A FLaWA 5LWWW AND MAFM SUJIVRYOAqS <f I-owwasilp IS SUBJEOr TO M,,, OF MiE 2-D0AffMTXNV /: IW ABSTMa OF 7ME WALL AWE ro I a, _ Kcomw INSFRUAgNM IF ANX AFFECMW R .. x,. . LWDERCROUND jMpflVwmEN= WERE LOWED Rx x -r r. s �. c.,i:, a r• � /. [COWW .r . r;"Ih �..x 0.ear .,t- Now RECOMW AND / "M pRVWW By CLOW DAM ARE IN SMUN17AL AMMOM 8-REFORE ANY M,r... O ARM ._ txI / DATE OF FaD'WM CARIBBEAN INSPECTIONS & SURVEYS CARIDB.BAN N A CONSULTING INC I L87294 781 f N. F 72nd AVE., St1'ITB 108 MA"DL8'Y, FLORIDA 89188 .YOB # A-9618 RA#'N DY: J.M.J RFV: N.A. JUSTCOAST OPJUUTIONS MUMI D dDE/Mt1NROR DROIIARD (905) 888-1100 ("4) 498-0220 FAX (908) 888-8800 FAX (884) 498--7278 PALM BEACH MARTIN/ST. LUCIN/INDIAAi 1 MJI (881) 741-4860 (772) 888-8889 PAX (861) 741-4289 FAX (772) 998--88s.8 1111 TCUA.YT urffJmJJvn.J COLLIER B 1.19 /FAX: 848-6811 (298) 849-88! ! T LL F _ IW 1RD.8 -1 800 261-CBIC PERMIT APPLICATION Miami Shores Village _ Building Department MSR 2 4 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 h Tel: (305) 795-2204 Fax: (305) 756-8972 LBY�-INSPECTION LINE PHONE NUMBER: (305) 762-4949��_ FBC 20 1 Master Permit NODS6 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [-] SHOP ��yy CONTRACTOR DRAWINGS JOB ADDRESS: 19 R.& City: Miami Shores County: Miami Dade Folio/Parcel#: 11 0 33 6,116Is the Building Historically Designated: Yes NO i✓ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: Address City: ulikul & 1M t. State: Zip: ,050 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: (' Y line, Phone#:(305 8RB,91 ,91 Address: '(.�� City: I State:'V Qualifier Name: whair Phone#:(I State Certification or Registration #: C 1, Certificate of Competency #: .� a DESIGNER: Architect/Engineer: Phone#: Add Value of Work for this Permit: $ ���� • (�' Type of Work: ❑ Addition ❑ Alteration Description of Work: City: State Zip: Square/Linear Footage of Work: flew ❑ Repair/Replace ❑ Demolition Specify color of color thru tile. Submittal Fee $ � ° Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (q9 0t e Bonding Company's Name (if applicable) Bonding Company's Address City State 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 $2500, the applicant must promise in good faith. that a copy of the notice of commencement and construction 'lien law brochure Mli be delivered fo the person whose property is subject to attachment. Also, a certified copy of the r6ccirded notice of commencement Mm sebe posted `at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be appr94ed and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this day of UAWAq '20 by —&L who is personally known to me or who has produced ` as identification and NOTARY PUBLIC: wiv i nrr , vn The' f6tegoing instrument was ack owledged befori m` 6 this day of2015 by , 6W 1J AMIrild"' who is personally known to me or who has produced I�ll a f it s identification and who did take an oath. NOTARY PUBLIC: Sign: Sign• Print: 0 Print. Seal:Seal• Nomry Pubtle Stdo®� Fl�de a ate' of"Flsrieie �j My � r C.. 181782 ; J %"r" Prad My Cw=mmv* w EgEg 181782 WWWWWWWWWWWWWWW+k E*m JLJL WWWWWWWWWWWWWWWWWWWWW W WW�$eW{WWWWWWWW WWWW Jo--PlansExa-mlner APPROVED BY(—Pqlt / 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 Notice to Owner - Workers' Compensation 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. 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 BEL¢ YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. / J Signature: Owner State County of Miami -Dade The foregoing was acknowledge before me this, day of % , 20,. io is personally known to me or has produced tion. POW Notary Public State Of r•Wda Jewinia Prado My � � SEB 181782 R Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL. 33138 March 23, 2015 Project Address: 9618 N. Miami Avenue Miami Shores, FL. 33150 Notice to Owner — Worker's Compensation Insurance Exemption I Jose Monnar acknowledge that I will not use day, labor part-time employees or subcontractors for the project. I will be the only person allowed to work on your project. Jose Monnar State of Florida County of Miami -Dade rN The foregoing was acknowledge before me this day of Ja 20 By ��� who is personally kno5'1r has produced 9 o. (Eggs TrL identification. Notary: SEAL-- y lCstereof FWft dessania Prado • My COrt1m185ioo EE 161782 A EX�r85 0412913016 _ i ` . P.O. Box 720067, Miami, FL. 33172 * Phone: 305.828.5158 Fax: 305.828.7375 BOUNDARY I�S/j SURVEY SCALE:1 "—,20' LEGEND:Id _mavuww LAW J� tti+!ialn; Shores AI -ARAM t aw gY p Airs ScAitAl OvrE •LJ � - Rr*cm soar 7 LAAO -CV#M LW DG DE FzT EDERAL �' P. a OF colfum C&W� cvftMI�IAm _ o COMPLIANCE WITH ALL F �, P. r. -PMr Or rANODWT' ;;UE3JEC T D �EC,UI_ATInNS EJE,F_S AN P.CLG-f+l�ltr CM' aawAtkoawrvr ., � COt,N� R _Awff OF Kamm alta -POWT OF NEWM CUWAnWr _400w Pat aaP. amommor e wma povr EAST 130.00' (R & M) AA -RAT BOW ft -PAN $ ARA, r AiTfllr Cr MOWAVVT o 0 at�S suRMErc�t F/P way SICTAorM ' ' . ♦ME -AWAW 6.00' V V 4.00' sw SLR. - f+w atfi.' .#. �� ;' �; '� �• 28.55` _w him sw rTA MW • *� is 'w r Ad OXV +STORY r AW RBSI08NCk �? 0 -� AN&E # 9818 cry -v $ ! POW Ail�AA� r PAU 0 .00 B m - AMRK ,CA _ smwnow+ ' aw -aw wr 1. v0' 33.05. z F {Y'' -'�i° a Affrc>raAArr P Fr:" mov ROP k 4.50 ALA ' RAG -raw BOWFA _FvLw Llai-LWrk"J! CONSMUCIM c!i FF.fMLAat - 4 C BLOW COAMN 161/o x F.J%MCALL ffa r F.M -PC" NAA 1 j MW EAST 130.00' (R & M) (MI -AWASURO v -� wueE . 130. aw) -mm of aeA� NO REVIEW R E Q U I I�`� � ELK � -CA>W AfASw Florida Health Miami -Dade County cQ, -uwrr Paz --c -UWTY fW AMaW O.S.T.D.S. &Wel Program ,- fr-� Application No.: ` a� �n n 4" NOW -CHAN Lrwr f�rcBate: 1�j 2 01 _ 5 WA -14.WAR SIE V AAAa-fracA-'Mmml�� watt Signature BY: % f -Ai-!'mr t tAMY CDPW7: Affilr ve actme y swwr or TME Aww QED pmvmry IS 1Jw " © ANO C A FMCr M TIM' nar or My KNDMtt' W AW Anit'i; AS WCEMTt r SI+iRtiMM UAW Nr • -MAW DMVNM fr IS AM MY PRO73SIONA aprow THAT no su Rwy AAtarm TH1f www TfCpww F MVA L AMNA LEGAL DESCRIPTION: 0 OT 2 & LOT 3 BLK: 130, MIAMI SHORES, SECTION 6, f ING TO THE PLAT THEREOF AS RECORDED BOOK 10, PAGE 39, OF THE PUBLIC, ` C0 S OF MIAMI DADE COUNTY, FLORIDA �- 2' GUTTER. $ CARIBBEAN INSPECTIONS Ai .SUR vp YS CARIBBRAN N A CONSULTING INC I LB7234 7911 X•W 72nd Aff., SUITS 108 MSPLEY, F,LOALI7A 38188 JOB # A-9618 RAIN BY: J.Af.J PIRY: N.A. JrASTCOAST 0P8RAT10NS HL4Hx D lDZINONROZ BRO FAED (305) 889-1100 (884) 488-0220 FAX (308) 888-2900 TAX (864) 438-7272 PALM BRACH MARr1N/ST. LUCIRIINDIdN RMA FAX (B 1) 7418 4259 FAX (772) 988633 8592 wRsr4868°I3COLLLBRMB (239) 5 -; AX. (29) 549-5811 TOLL F STATE JP7.0Z 1-888-281-CBIC ff".CBICc0RP. c0M PROPERTY ADDRESS: 9618 N. MIAMI AVE. MIAMI SHORES, FL 33150. CERTIPIED TO: RAFAEL G. DIAZ. TITLE COMPANY OF AMERICA. ATTORNEYS TITLE INSURANCE FUND. SUAVRYORS NOTZS4- r 2-WWWON OF THE ASSWCr OF MLE *XL HAW TO BE WDE TO ♦:ft-COMED PROPERTY J -NO UNDERWWWD IMPROWMEWS *tWE LOCMD LA ,x.. WTUM I. (W= mow" IN rhu PURX - ;�, r , r.�� ovickmm pRomw ey aAevr 404 ARE W r4 AWr BE CHECKED •♦♦ • ♦♦• T -06-0-1 r. r r ♦ ♦ ♦ I.- 0 51oww W" SEr f'Cwiry Or THE ILIANQA BOARD a< PRUFF 90AW bTMMEl M ARID AtAVPM AVA ` iriAwie aF ftaaaA ~Mx n 0­176-fe CM' 7W fLGRIQA AAAAr11R57IPAAME Lti10E PURSUANT TO SECMW 471-07 of THE � Slpp�g�OMN HERfpV /S NOT YAW N/A/Allr TFIOE 9dVATLMif NO FURM S7A111TE3 61PGNAL R SEAL QF A ftGaADA SiAA!MEYQR ANO AIAPe'tR Project Address Parcel Number Applicant 9618 N MIAMI Avenue 1131010330310 RAFAEL DIAZ Miami Shores, FL Block: Lot: Owner Information Address Phone Cell RAFAEL DIAZ 9618 N. MIAMI AVENUE 305-310-7876 Miami Shores FL 33150 Contractor(s) Phone Cell Phone DECO CONCRETE INC (305)828-5158 (305)345-4740 In Review Approved:: In Review Denied: of Work: NEW BRICK PAVER DRIVEWAY Return nino: 3 Fees Due Miami Shores Village Bond Type - Contractors Bond 10050 N.E. 2nd Avenue N CCF Miami Shores, FL 33138-0000 > Phone: (305)795-2204 Project Address Parcel Number Applicant 9618 N MIAMI Avenue 1131010330310 RAFAEL DIAZ Miami Shores, FL Block: Lot: Owner Information Address Phone Cell RAFAEL DIAZ 9618 N. MIAMI AVENUE 305-310-7876 Miami Shores FL 33150 Contractor(s) Phone Cell Phone DECO CONCRETE INC (305)828-5158 (305)345-4740 In Review Approved:: In Review Denied: of Work: NEW BRICK PAVER DRIVEWAY Return nino: 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 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $647.60 Additional Info: Classification: Residential Valuation: $ 5,952.00 Total Scl Feet: 992 Pay Date Pay Type Amt Paid Amt Due Invoice # DS -3-15-54916 04/08/2015 Credit Card $ 597.60 $ 50.00 03/24/2015 Credit Card $ 50.00 $ 0.00 Bond #: 2661 Available inspections: Inspection Type: Final Review Review 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 zoph)g. Futhermore, I authorize the above-named contractor to do the work stated. April 08, 2015 ,AMorized Signature: Owner / Applicant / Contractor / Agent nate Building Department Copy April 08, 2015 1