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DS-15-3118 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249509 Permit Number: DS-12-15-3118 Scheduled Inspection Date: February 26, 2016 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: DAVIS, KARIN AND TIMOTHY Work Classification: Addition/Alteration Job Address:80 NE 94 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060130300 Project: <NONE> Contractor: CHAMPION CONCRETE Phone: (305)252-8055 Building Department Comments POOL DECK TRAVERTINE PAVERS 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 February 25,2016 For Inspections please call: (305)762-4949 Page 7 of 33 N-X \ \ \ �k i Ilxbi311T� %F'i D& i 4 Miami Shores Villageik $i1teWSlk $i) S y 10050 N.E.2nd Avenue NE VVetrltCtas!>ScaGort tdiltnlAltltlrf .... Miami Shores,FL 33138-0000X 0; 1111171 t Phone: (305)795-2204 1 ra Sta#us, RC3VEiT� �ox> I�� 101 ,yr• ; Expiration: 7/24/201 Project Address Parcel Number Applicant 80 NE 94 Street 1132060130300 Miami Shores, FL 33138- Block: Lot: KARIN AND TIMOTHY DAVIS Owner Information Address Phone Cell KARIN AND TIMOTHY DAVIS 80 NE 94 Street MIAMI SHORES FL 33138- 80 NE 94 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone CHAMPION CONCRETE 305 252-8055 Valuation: $ 9,750.00 ( ) (786)402-4802 _,» _.. ._.. Total Sq Feet: 1500 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:POOL DECK TRAVERTINE PAVERS Additional Info: Review Planning Bond Return: Classification:Residential Review Planning Scanning:3 Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# DS-12-15-58083 CCF $6.00 12/17/2015 Check#:2078 $50.00 $660.26 DBPR Fee $2.63 DCA Fee $2.63 01/26/2016 Credit Card $660.26 $0.00 Education Surcharge $2.00 Bond#:2969 Notary Fee $5.00 Permit Fee $175.00 Scanning Fee $9.00 Technology Fee $6.00 Total: $710.26 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this pe it ssume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required L TRIC ,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OW R F IDA T: I rti t II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating cons ruct on n on . F e, authorize the above-named contractor to do the work stated. January 26, 2016 u horized Signature:Owner / Applicant / Contractor / Agent ate Building Department Copy January 26,2016 1 Miami Shores Village Building Department DEC 17 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 �\V INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20lq BUILDING Master Permit No. V-.p PER IT APPLICATION Sub Permit No. UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP p CONTRACTOR DRAWINGS JOB ADDRESS:_ s® SVS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: i 17--3-Zck0 r 3—010® Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:'' OWNER:Name(Fee Simple Titleholder): �I B"Iw �)~�`E _ �1�Y��, Phone#:-2cl�; Sos Address: e C) 0 ,/�� City: tgwy4 i 5'D u n'05, State: f Zip: Tenant/Lessee Name: Phone#: Email: P ` ,� CONTRACTOR:Company Name: e-Uz Q i� �. Phone#:' i� Address: City: State: ° Zip: I T� Qualifier Name: =j >� Phone#: State Certification or Registration#: Certificate of Competency#: ez DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 7 0 Square/Linear Footage of Work: /e'Oe®� Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: -7fM vew7txv—*-1 YAek j Specify color of color thru tile: ff�� Submittal Fee$ '� Permit Fee$ °�J CCF$ CO/CC$ Scanning Fee$ q r 63 Radon Fee$ KI DBPR$ `63 Notary$EO, co Technology Fee$ 8 °C-13 Training/Education Fee$ Z" 00 Double Fee$ Structural Reviews$ Bond$ 5M - TOTAL FEE NOW DUE$ (rU" 2G (Revised02/24/2014) 0 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 inspe ion w . occurs seven (7) days after the building permit is issued in the absence such posted notice, the inspection will n prove nd a reinspection fee will be charged. Signature Signature OWNER or AGENT CQTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of 20.0 by day of U'r ,20 (J�, by }Nmo�U ► )n U o S ,who is personally known to w(0� A�1 �J ,who is personally known 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 PJ AJ UQf Qdn 4 QA Sign: Print: cdr Print: Seal: Sealo��x pua� Notary PULIIc State of Florida MARCELA PABON' r Syco Alvarez 1►r!�.".os•, ¢ �y Commission FF 156750 01 :Notary Public-State of Florida `11'dQ Expires 09/03/2018 F`,gAMy Comm.Exp.July e,2019 Bonded T ru Plchard Insurance !�/ APPRO 9 FF Plans Examiner l Zoning "414-11�ly Structural Review Clerk (Revised02/24/2014) CERTIFICATE OF LIABILITY INSURANCEDATEIrAMIDD/YYYY) 01/29/16 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 WAIVED,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 lieu of such endorsement(s). PRODUCER ACT Y Lucia Estrella — Accurate O c t: (305)228-8727 rAxNo: (305)228-8787 8300 West Flagler Suite 114 ApDRL iuciaestrella@beilsouth.net Miami,FL 33144 INSURER AFFORDING COVERAGE NAIC# Phone (305)226-8727 Fax (305)226-8767 INSURER A: Granada Insurance Company INSURED INSURER B. SUA Jamie Basilio Corp dba Champion Concrete INSURERC- 10430 NW 74 St INSItRERD: Doral,FL 33178- (305)252-8055 114SURER 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 1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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. INSR ADM UBRI POLICY EFF POLICY EXP -- 1 LTR TYPE OF INSURANCE POLICY NUAABER PBAdlE1D tdAttD LIMITS _ GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 0 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 _ PREMISES a ac urcence $ ❑ ❑ CLAIMS-MADE Q OCCUR 0185FL00055712-2 MED EXP{Any one person) S 5,000.00 A 01/28/2016 01128!2017 _---- ❑ _ PERSONAL&AOV INJURY $ 1,000,0)) ❑ GENERAL AGGREGATE S 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000,000.00 RJ POLICY ❑ M ❑ LOC S I ( AUTOMOBILE LIABILITY E a8 aEDISINGLE LIMIT S j❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS BODILY INJURY{Per accident S 4❑ HIRED AUTOS ❑ AUTO-3WN� PP�OaE�R MAGE $ !I ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE 5 ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE S ❑ DED ❑ RETENTIONS 1 WORKERS COMPENSATION WC STATU- DTH- S I AND EMPLOYERS'LIABILITY YIN T 1 1 ITS 11E I ANY PROPRIETORIPARTNERIEXECUTWE SUA07874$780 E.L.EACH ACCIDENT S 100,OOOAO i 8 ` (Mandatory in HR EXCLUDED? Y NIA 08/Ol/2015 0$/01/2016 E.L.DISEASE-EA EMPLOYE S 100,000.00 1 tx+ ry ") ❑ It yes,describe under E.L.DISEASE-POLICY LIMIT S 500,000.00 I DESCRIPTION OF OPERATIONS below f 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,Irritate space is required) _ License CC05BS00815 f ' I I 1 E f CERTIFICATE HOLDER CANCELLATION i SHOULD A14Y DF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores,FL 33138 - AUiVO town REPT L 1305-756-8972 Lucia Estrella j 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)OF The ACORD name and logo are registered marks of ACORD Ordered By: We neecl tc) take every c>t)p-or-ttxnit3r t)'0--qSible to thank our � \\ '_ 1 s, ania7ing 'client,--; for- tli+ -ir SlLlppcirt... & QUARAN7 Thank You!! ! -LS-9M FQF �- I; Florida iami-Dade CounX, I /,i��,STD.S- &W&II Program A MAY Vd 91 "Q3 IGrp lication No., 4L 61.10 5 + Iqnature CS 00,90 p - 0*9 9,01 LU 00 ge 0 g LLJ mi .99 L 0, 00 3n1210 Uj U j IJ 00 'ON00 LLJ P 00-ge Q CI) > Qj 09'Zel 3 69,ql.10 Ni mm '09zf > ,II "tz 'K. Q:i Cj t> go. Accepted By: Property Addresl'. 0 NOTES:NON dTNS MlAjl:S9HO'RESFL 33138 AS61 -C"o IS MIGUEL ESPINOSA LAND SURVEYING,INC. REPRESENTATION W "" _._7 0a PROESSIONA LAND TECHNICAL STANDAR '.'f SURVEYORSINCHAPTE""ii A� k.. 4P 472.027 F1&'IDA STATUTES 10665 SW 190TH Street :0 see Fo Suite 3110 SIGN. FOR THE FIRM MIAMI,FL 33157 M UELO 9 PHONE:,1305)740-3319 IG Te # X..AA, FAX#:(305)669-3190 STATE F FK P.S.M.No.5101 N0TVALIDWTH0UTMAUTH=tEC A DA j-ELECTRONIC LB#6463 -".'ATH 'jl�j THIS NO, OR SEAL AN.=PL oT go* Survey: A-3407D: • CI�n?Fj;#1g0VT--'g Page 1 of 2 Not valid without all pages.