DS-14-1467 t Miami Shores Village VED
Building Department JUL 0 9 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY'-
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 2010
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.�.�f' -- e��-
Permit Type: BUILDING ROOFING
JOB ADDRESS: 12-S U M C 9
City: Miami Shores County: Miami Dade Zip: . 3 0
Folio/Parcel#:
Is the Building Historically Designated:Yes NO e/ Flood Zone:
OWNER:Name(Fee Simple Titleholder): b; w n SG�O w Phone#: 3 0 S G 1& 4 9 3
Address: Sa w.P e-
City: State Zip:
Tenant/Lessee Name: Phone#:
Email: Aee dle • Pccke0.K—eirr-w�l•cor+�
CONTRACTOR:Companry�y�Na�m�e: (HCd
lW 0fwe_ Phone#:
Address: 11 0 0l `U rp� -5py
City: co r 4� Phone#•State: Zip:
wJ
Qualifier Name: A ��'
State Certification or Registration#: Certificate of Competency : CC-®5.J8.S'004
Contact Phone#:305 Email Address: _) ,o"m'e ` ®ej
DESIGNER:Architect/Engineer: Phone#:
�ra
Value of Work for this Permit:$ ®4 f7 O� Square/Linear Footage of Work:
Type of Work: ❑Addition UAlteration ONew ORepair/Replace ODemolition
2Nunn to fog-am
twos g
SLOT°� cepa �'
Iwo hsvo Paw
Color thru-tile:
Submittal Fee$ Permit Fee$ r1:5-00 , CCF S- 51 L4 0 CO/CC$
Scanning Fee$ Ot °LXD Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ �� Technology Fee$ '
Double Fee$ Structural Review$
' TOTAL FEE NOW DUE$
. �
Soo.ot-D
(40(n
i
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 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, t applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be del' Bred to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be osted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the ab. ce of ch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this� The foregoing instrument was acknowledged before me this
day of ,20 L,by �%C(Ame I—( or day of -,204V,by,:F0iRe, /l i
who is personally known to me or who has produced who i ons ly known"e or who has produced
As identification and who did take an oath. s identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: RI
Print f Print:
lease
My Commission Expires: '�� '� My Co s xpN•WXdXZ
state Flom®
_. NMI Pma'> d $ Jo
7
� 1 8.201? 6V—..Al My82793
•,,� ORM � Ex
APPROVED BY l I �y Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Miamishores
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) AIAK)k; - hereinafter referred to as the owner of
the following described property(address): (,"Z;< E_ q5 $�—
L
s
Legal Description Lot Block Subdivision
Folio#
Requests permission to install(describe worky ftv'fo
Within the public right of way of(address) MS'o tj L_7 � -
s
j3
gateeo¢uil
�tf3Ti #
*%go"loovwimoo
IN CONSIDERATION of the approval of this r oom
s 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.
l
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 1 L day of -Jy^ �- ,201'
(Owner's Signature)
SIGNED, SE ED,AN DELIV RED. he resence of:
:ate •ftodflu*
• MY Comm,.F �1810.0 FF/� 9.2017
Con2
(httPJPowm.rtdarrdd2d8.gOV/Pa/RfOPOnY- -helRAP)0 QMp.JA1..faoeboo& PA) (MtpsJ/iwiiter MUJamiDadePA)
...............
Address Owner Name Sub Division Foto
EAR
p
SCfUICII. 1250 NE 95 ST Suite Q
..................... ........................................__._._.__...._......
PROPERTY INFORMATION ® _ =
III11-3206-0144070
�� CA
MIAMI SHORES SEC 2
Property Address
1250 NE 95 ST
Merril Shares,FL 33138-2550 n
owner
DIAMVE O FISHER
1111I Address
1280 NE 95 ST
MIAMI SHORES,FL 33138.2550
Primary Zone `?
1400 SGL FAMILY-3001-3250 Sa -
Primary Lams Use
0101 RESIDENTIAL-SINGLE FAMILY:1 UNIT
Beds I Bathe I Half 415/0
Floors 2Fks"„�;
A
LNltng Unite
Actual Area 4,521 Sq.R
FTS
�3
LIvIM Area am Sq.R
S(I
Adjusted Area 3,638 Sq.Ft a s
Lot Sim 12.500 Sq.R
Year Beat 1989 a
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ASSE MENT INFORMATION ® BEATS INFORMATION 0
2014 IMPORTANT NOTICE:The assessrant and a xemptim values amenity dwwn we
preliminary end are subject to change u n91 they we ce8lled an.ABS 1. Berretlt type 2014 2013 2012
Year 2414 2013 2012: Sara Our Homes Cap Aid $73,617
10.e8p) ReI
Lend Value $23 AW $157.620 $149.80:
Hamad E=Wan 5525.0 $25.00D $25.000
Building Value $245,657 $246.657 $281015: (IMpOww—rdamidade. 1pt1Wd-WP)
Extra Feature Value $12,940 $12040 $18.447 Second Homestead EnnenWftm $25,000 $25,000 $25,000
AU~value $497.00 $417,217 $448,277
0710912014 15:47 TAX) P.0011001
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CERTIFICATE Off' LIABILITY INSURANCE DATE a
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 tho cartlficats holder is an ADDITIONAL INSURED,the policy(las)must bo endorsed. If SIIBRO0AT10N IS WANED,subjactto
the torms and conditions of the policy,certain policies may require an andorssment. A statement on dale cartiticataa does not confer rights to the
certificate holder In[lad of such endoraement(e).
PRODUCER OWr Luda Estrella --
Accurate PHONE . (305)228-5727 (Ar o (305)226-8767
8300 W.Flegler St#114 PAX
'aWUL Iuebmtralla(Mbelbioulb.net
Miami,FL 33144 INSU 9)AFPORDiNG COVERAGE "co
Phone (305)226-8727 Fax (30 228-8787 INSURERA: Granada 111DUMm:8 Company
INSUREDINSURER B. Normandy Harbor Insurance
Jamie BasillD Corp dba Champion Concrete INSURER O:
11001 NW 83 Street Suits 103 INSURER D:
Doral,FL 33178. (305)252-8055 INSURER E I
INSURER P I
COVERAGES* CERTIFICATE NumaER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POucros OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TFIS INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN LS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTRITYPINER E OF INBURANCe ADD UIaR LILY NUMBER EXP LIMITS
GENERAL LIABILITY EACH O r 1 000 000.00
® COMMERCIAL GENERAL aJA ury � $ 100,000.00
A ❑ ❑ CL MS-MADE 56 OCCUR 0185FL00055712 LIED EW one S 5.000.00
❑ 01/28/2014 01/28/2015 PEt$ONALAADV INJURY 8 1,000,000.00 .
❑ GENERAL AGGREGATE S 2,000,000.00
GERL AGGREGATE LIMIT APPuES PER: FRODUCTB-COMP/OP AGG S 2,000,000.00
® POLICY ❑ P,,RkT ❑ LOC 6 .�
AUTOMOBLE LIABILITY _0Ma11d&D INGLE LIMIT
❑ ANY AUTO BODILY INJURY(Per prion) 5
❑ XOWNED �] UTOESULED BODILY INJURY(Per au ddvnt7 5
❑ HIRED A(rrOS ❑ AUTOS ® OPER AMAGE $
❑ $
❑ UMBRELLA UAB ❑OCCUR _ n _ EACH OCCURRENCE S
❑ EXCESS LIAR ❑CLAIMS MADE AGGREGATE S
❑ gro n RETENTIONS $
WORKERSCOMPENSAWON =A&
EMPLOYERS'LIABILITY Y/N
ANYPROFRIETOR/PARTNERIMCUTWE NHFL1415M E.L.EACH ACCIDENT S 100,000.00
S OFFICERIMEMBER EXCLUDER? NIA 06/261214 06/26/2016
(Nlefdstery In NH) F-..DISEASE-EA EMPLOYE a6 100,000.00
rc deealue aPBRATIONB WlW r £L 018EA86-POLICY LIMIT S 500 000.00
D IPTtON O
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Atmeh ADORD 101,Additional Remarks 8ehadute,It mow space is roqulmd)
Concrete&Pavers CCntractor
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED poijamS BE CANCELLED BEFORE
Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
10050 NE 2nd Ave ACCORDANCE NTH THE POLICY PROVISIONS.
Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE
305-758-8972 Lucia Estrella
®4988 204 AC COR ORATION. All rlshto reserved.
ACORD 25(2090/05)QF The ACORD name and logo 040 registered marks of ACORD
x Rick Scott
e Mission:
To protect,promote&improve the health Governor
of all
lorida through Integrated 7t
state,coun &
lty e in Fcommunity efforts. John H.Armstrong,MD, FACS
HEALTH State Surgeon General&Secretary
Vision:To be the Healthlest State In the Nation
November 20, 2014
Champion Concrete
11001 NW 83 Street
Miami, FL 33178
RE: Modification to a Single Family Residence- No Bedroom Addition
Application Document Number: AP1165483
Centrax Permit Number: 13-SC-1569764
1250 NE 95 Street
Miami, FL 33138
Lot: 7 8 9 Block: 85 Subdivision:
Dear Applicant,
This will acknowledge receipt of a floor plan and site plan on 11/07/2014 for the use of the existing
onsite sewage treatment and disposal system located on the above referenced property. Proposed to
replace driveway and walkway with pavers.
No objection letter was issued by C. Icaza on 11/20/14.
This office has reviewed and verified the floor plan and site plan you submitted, for the proposed
remodeling addition or modification to your single-family home. Based on the information you provided,
the Health Department concludes that the proposed remodeling addition or modification is not adding a
bedroom and that it does not appear to cover any part of the existing system or encroach on the
required setback or unobstructed area. No existing system inspection or evaluation and assessment,
or modification, replacement, or upgrade authorization is required.
Because an inspection or evaluation of the existing septic system was not conducted, the Department
cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use.
You may request a voluntary inspection and assessment of your system from a licensed septic tank
contractor or plumber, or a person certified under section 381.0101, Florida Statutes.
If you have any questions, please call our office at (305) 623-3500.
Sincere ,
Carlo I
Engineer III
Department of Health in Dade County
Florida Department of Health www.floridahealth.gov
in Dade County• •,Florida TWITTER:HealthyFLA
PHONE: (305)623-3500 FACEBOOK:FLDepartmentofHealth
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