RC-15-3071 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-251685 Permit Number: RC-12-15-3071
Scheduled Inspection Date: January 27,2016 Permit Type: Residential Construction
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: SHAW, PETER&LYNNE Work Classification: Alteration
Job Address: 1226 NE 97 Street
Miami Shores, FL 33138-2560 Phone Number
Parcel Number 1132050090600
Project: <NONE>
Contractor: ARCO CONSTRUCTION Phone: 305-892-6507
Building Department Comments
PATIO STEPS Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
January 26,2016 For Inspections please call: (305)762-4949 Page 58 of 62
Miami Shores Village
Building Department DEC 112015
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 .krji a
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 �-04
FBC 20 14
BUILDING Master permit No.-L-6-3®P I
PERMIT APPLICATION Sub permit No.
23BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
T CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: R
Folio/Parcel#: Is the Building Historically Designated:Yes NO {
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):q':'-aF''-7 I LYIej u r Phone#:
Address:
City: State: tel_. Zip:
3"3?
Tenant/Lessee Name: ���, Phone#:
Email:
CONTRACTOR:Company Name: r)A jai QK �A!z! Phone#:
Address:
City: State Zip: �h
Qualifier Name: L.I-5 TV Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer:_4�jr IP-A,4 A Ln aJr t,,r Phone#:
Address: 9 �� (6 City: — Stater Zip:
Value of Work for this Permit:$ ca- A®® Square/Linear Footage of Work: tTrT 4_
Type of Work: ❑ Addition EF Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: _ �s�t �`✓� � (g� A —flu
Specify color of
color thru tile: �o
Submittal Fee$ Permit Fee$ L!0 > g1 CCF$ �j(-) CO/CC$
Scanning Fee$ � GO Radon Fee$ -U) DBPR$ Notary$
Technology Fee$ ` q 0 Training/Education Fee$ 0 �� Double Fee$
Structural Reviews$ E513 - Bond$
TOTAL FEE NOW DUE$ p r
t;-2 . 20
(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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT C T CTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
— ;�—day of _,20.16— , by �_day jof (\A 20 IS by
pwr e✓ G Shmxu ) ,who is personally known to f` ivs who is personally known to
me or who has produced 111$/5 as me or who has produced T ( V )—I` �'�
SIAT
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUB
Sign: Sign'
Print 4/�'Yl Print:
Seal: y�! Seal: �a P, Notary Publi!�Y of Florida
,,,
NANCYNU MS Sindia Alva
MY COMMISSION#FF 130790 ag o° my Commis15875A
g a` EXPIRES:June 9,2018 mor�o'� Expires 0910312018
.gP„j:R' BoiMed Thru Notary Pubk Undonrrbm
############# ########################## # # #
APPROVED BY Plans Examiner /'Z! ` Zoning
Structural Review Clerk
(Revised02/24/2014)
Arco Construction Corporation
December 11, 2015
State of Florida
County of Miami Dade
Before me this day personally appeared Lester Jensen who, being duly sworn, deposes and
says:
All work to be performed by Lester Jensen or licensed and insured subcontractors.
Sworn to (or affirmed) and subscribed before me this A day of C 20 by
Personally know
Or Produced Identificatioje;2-9 -5 2-0 1 Lj v
Type of Identification Produced -IFL vtal�A u
Print,Type or Stamp Name of Notary
,#V%, Notary Public State o4 Florida
:° �� Sindia Alvarez
og My Commiseian FF 958750
®Rp�oQ Expires 09103!2018
General ContractorsXG050516311665 N.E. 10h Terrace/N.Miami,FL 33181
305.892-6509
,,,, ,,,,, Miami shores Vvillage
o-� Building Department
OR 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:
I. 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS
Signature:_ r) b�h )
caner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this daY of 2_
0�,
By t, who is personally known to me or has produced
as identification.
Notary:
+° ONLE�XPPIRES:
FF 130790
SEAL: � �,• une 9,2018
pu*UndeMb,
F'ermtt R C x- 5-3 71
Miami Shores Village Pennrt 7Ryo.* on,
10050 N.E.2nd Avenue NE Wb&Oalssfflcafidn
Miami Shores,FL 33138-0000
k Pert►if,StatuvAPPROVIED
hF Phone: (305)795-2204
416 Expiration: 010t21
U60
Project Address Parcel Number Applicant
1226 NE 97 Street 1132050090600
PETER 8~LYNNE SHAW
Miami Shores, FL 33138-2560 Block: Lot:
Owner Information Address Phone Cell
PETER&LYNNE SHAW 1226 NE 97 Street
MIAMI SHORES FL 33138-2560
1226 NE 97 Street
MIAMI SHORES FL 33138-2560
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
ARCO CONSTRUCTION 305-892-6507
Total Scl Feet: 77
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Window Door Attachment
Date Denied: Framing
Type of Construction:PATIO STEPS Occupancy:Single Family Insulation
Stories: Exterior: Drywall Screw
Front Setback: Rear Setback: Window and Door Buck
Left Setback: Right Setback: Fill Cells Columns
Bedrooms: Bathrooms: Final PE Certification
Plans Submitted:Yes Certificate Status: Review Electrical
Certificate Date:
Additional Info: Review Structural
Review Planning
Bond Return: Classification:Residential Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Plumbing
CCF $1.80 Review Mechanical
Invoice# RC-12-15-58024
DBPR Fee $2.00
DCA Fee $2.00 12/23/2015 Check#:5393 $ 152.80 $50.00
Education Surcharge $0.60 12/11/2015 Check#:2825 $50.00 $0.00
Notary Fee $5.00
Permit Fee $100.00
Plan Review Fee(Engineer) $80.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $202.80
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 zoning. Futhermore,I authorize the above-named contractor to do the work stated.
December 23, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
December 23,2015 1
hit re Items ?pblv& 4F LY"" s"c"
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tlato X.*to Avg.-. ACCURATE LAND SURMQNIPA" MACH in..
(303) 585-7303 no"
BOUNDARY SURVEY OF 'E• 97 6'
LOT 18 AND THE EAST ONE HALF OF LOT 19, BLOCK 4
OF "EARLETON SHORES" ACCORDING TO THE PLAT THEREOF w 21 24 +' IBS 17
AS RECORDED IN PLAT BOOK 43 , PAGE 80 OF THE PUBLIC
RECORDS OF DADE - COUNTY, FLORIDA. .
FLOOD ZONE AE ELEVATION 8 LOCATION SKETCH
. — MIAMI SHORES—
MIAMI SHORES, FL.
REF. B.M. - ELEVATION: 8.74 (N.G.V.D.)
N.E. 96 ST.-66' M OF N.E. 10 AV E.- 23�•51 W. OF. 70.7' N.W. FROM
CENTER OF P.I. - BRASS .BAR IN CONC.-{&M.# 8-62)
HOUSE LOWEST FLOOR ELEV. — 9.66 (N.G.V.D.)
BUYER: PETER G. SHAW
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CERTIFY TO : CALIFORNIA FEDERAL BE AL
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CERTIFICATE ' 7
THIS IS TO CERTIFY THAT 1 HAVE RECENTLY SURVEYED THE PROPERTY DESCRIBED IN THE FOREGOING TITLE CAPTION AND HAVE
SET OR FOUND MONUMENTS AS INDICATED ON THIS SKETCH AND THAT SAID ABOVE GROUND SURVEY AND SKETCH ARE ACCURATE AMC
CORRECT TO THE DEBT OF MY KNOWLEDGE AND BELIEF. 1 FURTHER CERTIFY THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL C
STANDARDS FOR LAND SURVEYING UNDER RULE 21HH-S. F.A.C. ADOPTED BY THE FLORIID{JA{BOARD OF LAND SURVEYORS.SEPT. 1. I961. I
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