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DS-15-1173 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-234939 Permit Number: DS-5-15-1173 Scheduled Inspection Date: July 23, 2015 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: PREDRAG STARCEVIC, KAREN BLAIR Work Classification: Addition/Alteration Job Address: 1225 NE 92 Street Miami Shores, FL 33138-2936 Phone Number (305)751-9333 Parcel Number 1132050270300 Project: <NONE> Contractor: ROSS SERVICES Phone: (954)401-2013 Building Department Comments TRAVERTINE PAVERS 1200 SDFT DECK AREA Infractio Passed Comments INSPECTOR COMMENTS False RENEWAL OF DS14-2040 Inspector Comments Passed Failed Correction ❑ , Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 22,2015 For Inspections please call: (305)762-4949 Page 5 of 39 `SNORES Lit Miami Shores Village °. •••i "IR'1#rlypB:( IC(i#E:lAf1y1 iF3' & q 10050 N.E.2nd Avenue NE IlVork Clan ifi atit r .Ad-01410iftIteration - Miami Shores,FL 33138-0000 Pen"it$tatulsAOROVED YOEw r� g� e e Phone: (305)795-2204 FLORIDA ' ;.:• Issue> at :8t2612Q15 Expiration: 11/ 201 Project Address Parcel Number Applicant .... -- 1225 NE 92 Street 1132050270300 _ � Miami Shores, FL 33138-2936 Block: Lot: KAREN BLAIR PREDRAG STARt Owner Information Address Phone Cell KAREN BLAIR PREDRAG STARCEVIC 1225 NE 92 Street (305)751-9333 MIAMI SHORES FL 33138-2936 HH 1225 NE 92 Street MIAMI SHORES FL 33138-2936 Contractor(s) Phone Cell Phone ROSS SERVICES (954)401-2013 { Valuation: $ 12,000.00 Total Sq Feet: 1200 i Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved:: In Review Final Date Denied: Foundation Type of Work:TRAVERTINE PAVERS 1200 SDFT DECK Additional Info: Review Planning Bond Return: Classification:Residential Review Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7.20 DBPR Fee Invoice# DS-5-15-55601 $225 05/26/2015 Cash $ 187.70 $0.00 DCA Fee $2.25 Education Surcharge $2.40 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $9.60 Total: $187.70 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. OWNERVand T: ertify that fore ` ' information is accurate and that all work will be done in compliance with all applicable laws regulating construcin . ut _ o auorize t e a ve-named contractor to do the work stated. May 26, 2015 thorized Signa ne pplic nt Contractor / Agent Date Building Department Copy May 26, 2015 1 Miami Shores Village REcFary Building Department MAY 18 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY, Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-0949 FBC 20 1 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ;&BUILDING ❑ ELECTRIC ❑ ROOFING ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I.Z,25 1yE '7 2. 57- p City: Miami Shores County: �A E Miami Dade Zip: ,331.30 Folio/Parcel#: 1/,3Z Q 50 270 3Gb Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: _ 5iA2CE2(C OWNER: Name(Fee Simple Titleholder): KAREN PLR/P- l Plc D 2}I G Phone#: Address: 122 AIE 92 c5 / City: M I qm! 5HO R ES State: 1-L zip: 33/38 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 2055 cSE.RV/C,1= S Phone#:954. 227 ?9V(/ Address: 4/620 I.U. COMM El2C l N L J3LV b _1t 2- City: City: '_TA/4MMC State: L Zip: 33,31 9 Qualifier Name: S. ?Akk/ 6/2/EPEC Phone#: ?5q-227. 89Y State Certification or Registration#: CGC 150 75ZZ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 12—POC) Square/Linear Footage of Work: 12-00 Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: 'C(Z i1U C(ZT� N t P A�EIZS '9-5�mr /t/- Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip 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 issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. c Signature Signature OWNER or AGENT COTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of�A7Gjy 20/ r , by day oft 20 /J by iP.Z►BN r ,whoispersonally known to :13yr�-n�/ Izj �1,L,who is ersonally kno to -Of I � me or who has produced �/`— as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign. Prin Y P Notary Public St2te of Florida Print: ; Joanna I FF osz753 Seal. a My Commission Seal: wo��o� eS�a7o�irpuoy £S l0 Q6£(LOb) •^� " 7,S G 11121^G18 ys QV,=' E:CaI�vS APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) =DATEYYY) Ac CERTIFICATE OF LIABILITY INSURANCE 14 GHTS UIPUN FHE CERTIFICATE HOLDER. TIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, TEND OR ALTER AND CONFEK5 NO TIHE COVERAGE AFFORDED BY THE POLICHES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. lder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to may require an endorsement. A statement on this certificate does not confer rights the terms and conditions of the policy,certain policies ts to the IMPORTANT: If the certificate ho certificate holder in lieu of such endomement(s). CONTACT PRODUCER NAME: Michael FAX PHONE (A/C,No): Ross Management Services Inc. DBA �°Ext►*561-628-3842 Ross Services ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 4620 W. Commercial Blvd. Ste.2 Tamarac, Fl. 33319 INSURER A: Southern Owners Ins. Co. 10190 INSURER B: INSURED Ross Management Services Inc. DBA INSURER C INSURER D: Ross Services 4620 W. Commercial Blvd. Ste 2 INSURER E: Tamarac 1 1 INSURER F REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW H 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. --FF POLICY EXP LIMITS INR TYPE OF INSURANCE INSR NND ADDLSUBR POLICY NUMBER MM/DD MM/D0 EACH OCCURRENCE $1,000,000 GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 A X._COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) $5,000 CLAIMS-MADE X OCCUR 7272186438 5-14-15 5-14-16 1,000,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $2,000,0-00 PRODUCTS-COMP/OP AGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ PRO- POLICY JECT LOC COMBINED SINGLE LIMIT(Eaacci $ BO AUTOMOBILE LIABILITY t) BODILY LY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED PROPERTY DAMAGE AUTOS $ NON-OWNED (Per accident) HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR AGGREGATE.. ._ $ EXCESS LIAB CLAIMS-MADE DED RETENTION WC STATU- TH- WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N/A OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Pool Decking & Marcite & Swimming Pool Installation & Services CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Miami Shores Building Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, F1. 33139 AUTHORIZED REPRESENTATIVE' " >>f ©1988-2010 ACORD CORPORATION. All rights reserved ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD _ &414% % SEP �1 '�nNOW FsiMrsa 100-W IPA t► o 100.30 JR)ADAACM N 10 r1 i2wo Ms•rw _ r3 •e,�,..,,,e. •aE. , •Our POOL -� g b W 17 14 IS ~ 14 S Owes ke� MC M1� i �� ►alp`, �•1 '�. OWWRIMET _ -_• ii -hrw♦ tk,Y+ M •her (/ 1 r 1 vrr )V�. •a 1006 ✓ t(u ,oi �1Sz a ."Menem r.. qwpm AIM OnegAPC -♦ -.�.c.r. •wr.rw less cat (SO Amessm, J -�� �i 1 Oft :�j� g ,rte .pr•rr��yr !1!0 PORCH lE{iN "• •,M4 +s East 2S Na and the East SO fm of Lot 11.!sock 2.NAY '• IOca 44L pop&I somer */� rMm 4 o the A�mKwds of t�AAfMMM �Flp Obi a •��•••r M" +1 J Mpr11L�OrtY{ ` C Cl"M TO. Karen Ow i heaaq SMOMI;Law OMces Of CWSld K SPli,WShores VIII Sc"MANUFAoldlimplitl r MRoonsiTwo vwanttcamow..wokFargoRoe 80*NAMl6 Roc V gy DATE PKFAKO FOR Krm Ow i F'naaq SUKVAt. F g r 122S N E 12 S"ft MMM Shores FL 33136 SOI \ 0 M�uib� •awn~ ZONING DEPT M int yArm AMPOW POW M :� BLDG SPT L•� 2 ForOWU a OW a,pw1 awe re twroactwnq WPO the strep �e1„' •a+ra*�•w•r O". way(KE 9&W Sri" Palo Of the•bot high wood Noce n entroachlnq oeM tfle Eats :` '""" SUBJE TO COMPLIANCE !VIA'RMMAIrrRBDBFIAL �r •� Faoon d the aq♦cant•foot high wood Nnct a tntrwcfwrlq oMtr +^ j rfP f+lOrlh t101ldfry Int. 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Karni Shores, Florida 33138 Tel: (.305) 795.2204. Fax: (305) 75(;,,8972 Notice to Owner — Workers' Compensation Insurance Exemption it)Stjrnmci: covemjv ondvi ('hapict- 440of0w jrj'jj-]:4 I o.(I J.];k S11 vNemill 111cillselves hom lhir. requm!nit,w, f6j- al)N; ill the indtls(rvdlo or II,111-611le To Ili'oflkor own";a IL'a'I W I1t:IV(111 of(he stock- ofthc orponl1i ol,;-m 1,1 (".a Slillelliell;alles0m.1 III(11L, Illitl7rilum I !"he of'llckn- is jl�;wtl it,, an 01 111v cflrpov;tlioll ITI lilt' lilt' I lorid;j x1d I lie corporalwri is Iv,,..rJswrcd 1w11 Imed as amjvc %001 Ific 1`1(vit4:! OcIN17,1111ell! Of. sTatc. Division of,('ot-pomlions. mort, chxi 11-livc corporal(' offi;:rrs per t,oqpormion or liniiied 11;0ijjjv cotnpav� \;d d ()r Fl period t)J*1,AA.1 I oclal It'll I's filt!d I)('lilt'CXCll)j:I1I0Tl I,1-00kCrd 1-sV 1111:7, J)iviSloll. permil lllld(t�rt9i:unlShore: (Inc', not requve covt•nlvc Iroill 111L:coll1ractol"!, p %v(,)1-k u Ildt'.1jills perl ni 1. 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