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DS-14-2072 t, f � � Miami Shores Village _ -_� �VED Building Department 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 q FBC 20 !` BUILDING Master Permit NoMs ILi — PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: —16 Ne Com: Miami Shores County: Miami Dade Zip: 1 Folio/Parcel#: 200 OI 3130 Is the Building Historically Designated:Yes NO ,— Occupancy Type: Load:.Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): ZQ QbT!� C 9 C&ZbPA-VnQf%3 Phone#: ci Address: . `,lrj� �� City: K'"" S Uaks State: FL, Zip: 3 11 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#: —30�'S b(D ®C6 Address: �,0, (:-1>0X 'Co(o 0'f5 7- city: City: tj ImA1 S�Yt�tns��� State: V�� Zip: Qualifier Name: 712is�kc-t— Phone#: State Certification or Registration M r`-, e— i S f 9 Z 3d' Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: !�,°� City: State: Zip: Value of Work for this Permit:$c2w 0 -C)-�' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration , ❑ New ARepair/Replace ❑ Demolition Description of Work: , - Specify color of color thru tile: Submittal Fee$ Permit Fee$ t 2 '00 CCF$ c0/CC$ Scanning Fee$ Radon Fee$ DBPR$ ® Notary$ Technology Fee$ can Training/Education Fee$ 0• �.('� Double Fee$ Structural Reviews$ Bond$ n TOTAL FEE NOW DUE$ • L. (Revised02/24/2014) � I e • -%.j 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. Signature Signa ure OWNER or AGENT XCONTRACTOR The foregoing instrument was acknowledged before me this The fo egoi instrument was ackno ledged before me this �T day of IM t/l 120 by day of 20� ,by who is persom( own to ,who is per Helly wn to 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: Prilnt: Print:� Ir0 0 Seal: Seal: y NAPALIECEPERO NATHALIECEPERO a,, W CMUSSION @ EE 0Wp 50235 MY COAl141ISS10N#EE 050?. EXPIRES:December 19,2014 • EXPIRES:December 19,201• 1�P„ W Thru Noarq PuNo Umlerwritere p Bonded Tluu Notary Public Underwriter- APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �t+vr�vvv i 4,vv V cn1vvn K:N L/KVV* UN, Or-%oMC 1 MM T VF- V, e: .. STATE OFrLORJDk x .m". � Q " ANROM �i� l.":�OU � ' USTRY SOW n 0 ENE JR eid' GERtIFIE�D �. u 77, �:pw KSS �� A v IV P bA Ilk lk N<N At , \ ;g ISSUED. 0sr�7r w QPLY A REQUIRED LAW Q14M1iaasa ORDERED BY: es 1 �rA t• r. > AA a I'� NE 31]1._ - Pill 1, Title &Trust l000 BrickdAvenue Suite 1005 Miami,Florida 33131 ;VE 1 Q�th 5t RAu7m1 Phone:(305)381-9999 rrenze Fax:(305)381-9898 "iE 99111 S www.mia nilawtitle.wm PROPERTY ADDRESS:78 NE 101ST STREET MIAMI SHORES,FLORIDA 33138 SURVEY NUMBER:1401.2216 FIELDWORK DATE:129/2014 REVISION DATE(S):(REv.I 1/312014) 9409.2216 BOUNDARYSURVEY MONDE AN r' B.R. (ASSUMED) 1/2° Fq� NO ID O P.C. NOTES: r' `•,! ' I .S'wos 9 °�w(D40.46- (M) LOT APPEARS TO BE SERVICED BY CITY WATER AND o;'. LO 'A 3 i W 30 LOT I I RMAINDER LOT 2 FENCE OWNERSHIP NOT DETERMINED I BLK 10 ---"'1 NGVD s 0 OD�iC VERTICAL DATUM 1929 �[ r o. BILK BLK 10 OF- v IO (NI INCLUDED) 14.9' 0.3' ON I 2 Qv I OZD •,, N ^' I N l[7 LOT 1 o d LOT 4 a ti..J.. 1 N _j '-1 I BILK 10 L = BILK 10 C; 31.4' d 0 i -1 :'- °.�CRAWL SPACE UYV. 10. 1 _NGW29LU v� $'p F.F. ELEV.=12 41 I�GVD29 W I O G.F. ELEV.m10.60 29 I z 00 Uj PORCH ELEY.=11.601NGVD29 �- I ® wQcV r 1 51Y. I I w �,•- REs X78 I 1. 12.a r I 21 0' 0 13.8' j o1 '- z N T <'� Z aNe 121.6' U) p z PROP. TANK Sep 2 {� ® tT' °_ I CC z U < 0.8'Cj _x1t Iq X � ` j=.I ")5 a OX ON j 0.2' 12 6' 0 `� l hereby certify t o urvey of the 15' ALLEY hereon describel✓`ope�ho$� en made under my direction, aMe& e best my knowledge and belief, it i a to representation 30 0 15 30 of a survey th the um technical standards set bjktaff Flo Board Of Professional Lan eyors described in GRAPHIC SCALE (In Feet) Chapter 5J-17 of s 94 Administrative Code. 1 inch = 30' ft. RONALD W. WALLING State of Florida Professional Surveyor and Mapper License No. 6473 Use of Survey for Purposes other than Intended,Without Writtenverifianton,will beat the Uses Sole Risk and Without UabWty to the Surveyor. Nothing hereon shall be Construed to Give ANY Rights or Benefits to Anyone Other than those Certified. FLOOD INFORMATION: POINTS OF INTEREST NONE VISIBLE CUENTNUMBER: DrAM:: 1/31/2014 1 1 . a t &'?' AFFILIATE 1. � A � ► 1 . I 1 MEMBERS BUYER:ZURDDO CORPORATION,A FLORIDA PROFIT CORPORATION ALTA, SELLER:THELMA,1.,HOLME ' 14 CERTIFIED TO:ZURDDO CORPORkTION;AFLOII®A CORPORATION;MIAMI LAW TITLE&TRUST . E A A Land Surveyors/ Inc. P.866735-11916916 ctalandmm •FM6-7442882 This is page 1 of 2 and is not valid without all pages. Lsa 7337 11940 Fairway Lakes Drivve,suite 1-FL Myers,Fl.33913 NO REVIEW REQUIRED Florida Health Miami-Dade County O.S.T.D.S. &Well Program Applicatio No.: Date: ate Signature s j r � Property: 78 NE 101 ST. MIAMI SHORES, FL 33138. Scope of Work: Replace existing concrete driveway with Multi-size steps (concrete) Material: Concrete 3000 with Fiber. Measures: Total area=27' x 11' Multi-size steps: Size: 5'6"x3' Size: 2'6"x 3' Multi-steps Thickness:6" Minimum Fiber Reinforced Concrete 3000 psi. Foundation:Compacted Base. Detail "B" Scope of Work: Replace existing concrete walkway with multi-size steps(concrete) Material: Concrete 3000 with Fiber. Measures: Multi-size steps: Approx.Size:6"x 3' Multi-steps Thickness:4" Minimum Fiber Reinforced Concrete 3000 psi. Foundation:Compacted Base. Detail "C" Scope of Work: Build multi-size steps(concrete)in existing patio pavers floor. Material: Concrete 3000 with Fiber. Measures: Total area=16'x 18' Multi-size steps size: 4'x 18' Multi-steps Thickness:4" Minimum Fiber Reinforced Concrete 3000 psi. Foundation:Compacted Base. i tz: L3' is 2Z CERTIFICATE OF LIABILITY INSURANCEF5AT"10/16/144 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 WANED,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 Rau of such endomement(s). PRODUCER CONTACT Ariel A o InterAssurance a/c°NNo Ext: (305)758-8322 FAI Nei: (305)758-4456 9190 Biscayne Blvd.,Suite#201 -MAIL ariel@interassuranc.com Miami Shores,FL 33138 INSURER(S)AFFORDING COVERAGE NAIC# Phone (305)758-8322 Fax (305)758-4456 INSURER A: ENDURANCE AMERICAN SPECIALTY INS COMPANY 417418 INSURED INSURER 0: DVG BUILDERS,INC INSURER C: 260 PAYNE STREET INSURER D: MIAMI SPRINGS,FLORIDA 33166 (305)506-7308 INSURER E: 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. INR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTRINSR D POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 ® COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100 000.00 PREMISES Ea occurrence $ A ❑ ❑ CLAIMS-MADE 0 OCCUR Y CBC20000019300 MED EXP(Anyone person) $ 5,000.00 ❑ 07/30/2014 07/30/2015 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000.00 © POLICY ❑ JECOT ❑ LOC DEDUCTIBLE $ 0.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL❑ AUTOS OWNED ❑ SCHEDULED BODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ AUTNOSWNED (j OPERTY AMAGE $ are r accident ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATIONElWC S LATU- ❑OTH- AND EMPLOYERS'UABILnY Y/N AI ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under DES6RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K mare space Is required) GENERALCONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 N.E.2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FLORIDA 33138 AUTHORED REPRESENTATIVE Ariel Ajo ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05)QF The ACORD name and logo are registered marks of ACORD IR 2 z E ._ E i £ r�' u IM rs -- t , i E P own PAY ? W' 06 GE bul5. P "D- 1 Q 3mdo »s Ir� Qa 9: a t