DS-15-3011 ► V
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-248692 Permit Number: DS-12-15-3011
Scheduled Inspection Date:April 12,2016 Permit Type: Driveways/Sidewalks/Slabs
Inspector. Rodriguez,Jorge
Inspection Type: Final
Owner: MILITANA,JOHN AND ADRIENNE Work Classification: Addition/Alteration
Job Address:8900 BISCAYNE Boulevard
Miami Shores,FL Phone Number
Parcel Number 1132060110160
Project: <NONE>
Contractor. FLORIDA PAVEMENT SERVICES Phone: (305)663-3070
Building Department Comments
REPLACE STOREFRONT WALKWAY TO ALLOW FOR Infractio Passed Comments
ADA ACCESS FROM PARKING LOT INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
C
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
April 11,2016 For Inspections please call: (305)762-4949 Page 6 of 37
9 i
�3 3
Miami Shores Village
10050 N.E.2nd Avenue
Miami Shores,FL 33138-0000
3�
Phone: (305)795-2204
Expiration: 06/1112016
t
Project Address Parcel Number Applicant
8900 BISCAYNE Boulevard 1132060110160 JOHN AND ADRIENNE MILITAN/
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
JOHN AND ADRIENNE MILITANA
8801 BISCAYNE Boulevard
MIAMI SHORES FL 33138-3381
III 8801 BISCAYNE Boulevard
MIAMI SHORES FL 33138-3381
Contractor(s) Phone Cell Phone
Valuation: $ 5,270.00
FLORIDA PAVEMENT SERVICES INC (305)663-3070 (786)457-2980
�...... .__�__..._�-. �_.__...�... ��......._ �,_...._ Total Sq Feet: 200
Approved:in Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:REPLACE STOREFRONT WALKWAY TO A Additional Info: Review Planning
Bond Retum: Classification:Residential Review Building
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00 Invoice# DS-12-15-57925
CCF $3.60 12/03/2015 Check*2249 $50.00 $572.60
DBPR Fee $2.00
DCA Fee $2,00 12/14/2015 Credit Card $572.60 $0.00
Education Surcharge $1.20 Bond*2927
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $4.80
Total: $622.60
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: Iify that ail the foregoing information is accurate and that all work will be done in compliance with ail applicable laws regulating
construction an ConF'21. F ermor%I authorize the above-named contractor to do the work stated.
�� December 14,2015
A orized i ature:Omer / Applicant / Contractor / Agent Date
Building Department Copy
December 14,2015 1
Miami Shores Village c �D
4
Building Department DEC 0 3 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Bim:
C Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
Q&ILDING_ ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION SHOP
qCONTRACTOR DRAWINGS
Q
JOB ADDRESS: C�-I UO Er SGA���i ��•
City: fMiami Shores County: Miami Dade Zia:
Folio/Parcel#: I/3�6""�/�"` ���® Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):� 1n1 �JIL/ � Phone#•:°r
Address: D ®� iSGd�-c1r ��1I�1
City: d2jem, ,fLQ nA�S State: )I:?— Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: ei�/i7t� /f�V +'► �►C �-Li`��• Phone#:
Address: 511 6"'o
City: i State: IC-L_ Zip:
Qualifier Name: t�2M►47j Phone#: -79 e 3 �".
State Certification or Registration M Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ S�--7 '60 Square/Linear Footage of Work: .2-D®
Type of Work: ❑ Addition ❑ Alteration ❑ New1❑Repair/Replace ❑ Demolition
Description of Work: iT"
Specify co ol'gym :o o/or thrtie•
JiSY.ffi3'Eah`�el6t•6"A
Submittal Fee'$ (.)��� Permit Fee$ CCF$ CD"/Cir$
Scanning Fee$ Radon Fee'$.' DBPR$ Notary$=
Technology Fee$ .Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
Q Ole
TOTAL FEE NOW DUE$ :1 Z 4:�;G
(Revised02/24/2014) 5--�-Z
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 attachmen lso,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occ sev n (7) days after the building permit is issued. in the absence of such posted notice, the
inspection will not be approve nd a r nspection fee will be charged.
Signature Signature
"�Z�1�
&ents
NT CONTRACTOR
The foregoing instrk'nowlledged before me this The foregoing instrument was ack owledged before me this
a� day of 0 e;r / .20 /9 .by 41 day of 20 / ,by
M , L-i who is personally known to eEnl ��' �A r�_m a.J .who is personally known to
me or who has produced as me or who has produced h- L as
identification and who did take an oath. idengPUC:
o did take an oath.
NOTARY PUB NOTSign• �(J Sign•
Print: u S Print
Seal: Seal:
F-0-- RUTH A.BYDASH
m-u-0-roeono
Notary public-State o FFlorida�g g# p �� q, RUTH A.BYDASH& /�6v •ate o •,27,2018Commission#� _/ N• •off My Comm.Expires Mar 18is/(fes`
v Plans Examiner '•",�FOFIRW4-d TIN—�� Commission+r FF'n2
75
Zoning
Structural Review' P Clerk
(Revised02/24/2014)
L
3
f • Villagerss. Miami shores
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33938
Tel*.;(305)795.2204
Fax:;(305)756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE'S
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPAM MUST ISSUE A CERTIFICATE AS FOLL
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10 050 NE 2ND AVE
MIAMI SHORES,FL 33138
Certificate must specify the description of operations or contractor license number.^5
sssswswrrwrwr+rrsr®rrnraarwsswswesswwssssssasswwssswswwrwsswwsssreatrsswssaw'sssriwswwwwwswww®.e
BUSINESS E: r /g �9vr tT� o
BUSINESS ADDRESS:,L021" 1�0 . CITY &8C �STATE_f ZIP -
BUSINESS PHONE: .j641 02 0 FAX NUMBER °' '� -'"`�
CELL PHONES7—
— 6�
( ) QUALIFIER'S NAME: .
QUALIFIER°S LIC NUMBER: —
i
� a
„M
I tl
as CERYMMY
`
W4,M44M J
i�
TAUFYING TRADES)
0007 PAVING ENGINEERING
I
eft mew
I
x
00214& � �,. � wwe+ rwwwwi'3w'wwawwat�wwyww' r
POW
s
MN
SERV.TV"OP
'OVMEPTt'SEMIjo* °I96 SPI�IAL7Y �. �CiP r Tax C t i
- 5.00 t /17j2fTf5
b
CHECK21-15-115277
BMWM Tax.The is sot a
lot M
Holder 3 any @ i
A�.al sra as hA �; f1a-OL
0dz5tt
3 €
_ z�i nwT3,
RI,
mc
�� ..
8@C.TtPk OPS PAt►MH1sT�ttICffit9W u
SVEI4�ENT SfTt C PEGtAt 'ENG �a tw ��1R,, rax
,175.W,08/17/2'015
4ECK21-15-11577
CERTIFICATE OF LIABILITY INSURANCE111/19/2015°
TTNB ATE IS IMIED AS A MATTER OF WORMATION O11X.Y AND CoNFEjtS ABI RWTB UPON THE CERTIFICATE HOLDER.THIS
CERWICATE DOES NOT AFFWMTnfELY OR NESATIVMY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED BY THE POLMS
BELOW T" CERTIRCATE OF MURANCE DOES NOT CONSTIMTE A CONTRACT BETWEEN THE WSMG Xp), AUTHORmw
REPRESEITATIVE OR PRODUCEK AM THE CERTIFICATE Ham.
BIIII'DRTART: It the swifflosto hokfor Is an AGONAL BIBURIM,Me p"Wks)must be wk%rwd. B SUBROSATION IS WAIVED,mdod to
MB techs and condition of do poft,owtdo polhdg8"W#qQUIM an emlomemoft A GIAMMOd on Ida eordfmft dope not Collier rW t to Vo
tarot In No of audk }
PRODUCER
HARDEN INSURANCE A=NCY INC 305 606-6891 No.305-359-9255
15321 SN 86th Ava. hard ina@ 1.com
Villa" of Palnetto Say, Fl 33157 .
UNUREW AFFORW= C *AM
hINSURERA:ARCH SPECIALTY 21199
� + ° FLORIDA PAVEMENT SZRVICES, INC INSURER a:X' HANDY INS CO 37974
10901 SK 60T13 AVE mURER c:AISSOCIATED IMUSTRIZ8 23140
BINCR=T, FL 33156 INSURER 0:
786-4517-2980 INSURER E
INIKIRER F;
COVERAGES RM" FICA`TE NLRASER.- REVISION NU ER:
THIS IS TO CERTIFY THAT THE POLICIES OF 94SURANCE LESTED BELOW HAVE BEEN Mum TO THE IN8 IRE D KAMM ABOVE FOR THE POLICY PERIOD
INDICATED, NOTtgT E ISSUED ANY Y PERT ENT,TERRA OR CONDIT"OF AMY CONTRACT OR OTHER DOCLUENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR tltrlY PERTAIN, THE INS1)RANCE AFFORDED BY THE POLICIES DF.SCRt9Eo HEREIN is SUBJECT TO ALL THE TERA9S.
EXCLUSIONS AND CONDITIONS OF=H POUICIES.L TB SHOWN MAY HAVE BEEN REDLICED BY PAID CLAfkA.S.
Eta TYPE OF WSUPANMPOLICY
GENERAL LIABRM NUMBER MOTS
X cD1► RC�L GENERAL LIABq.RY EACH OCCURRENCE S 1 000,000F.a $ 1o�-a0a
E OCCUR AGL004530-02 9/19/1 9/19/1 PERSONALeADV URr $ 1,000,000'+
_
MED EV(Ary 10 000
A a � and Non- Y Y
x OF GENERAL AGGREGATE 2,000 000
° AGGREGATE_A`PPER: PRODUCTS-C OOP Acca $ 2,000,000
PDLICY LOC $
AnDMOSU Lb4B9.ITY
AOWNED
ALL
BODILY INJURY(PW per) $
— AUTO�VVNED ODULED BOMY NAM(Par ) $
HIRED AUTOS AUT '
$
UAB I
B $ B g 0320856 9/19/1 9/19/1 °CCURREHCE .4-2,000,000
CZAR E Y AQWQATE s 2,000,000
RETommit
Atm
EMPLOYERS' r,p $ITUYWSI 17
C (K NIA y ANC2{t51?71 9/1911 911911 E.L.EACH ACCIDENT $ 1,000,000 urxw El.DtSEASE-EA FJi !aYE $ 1 000 000
OF ERAT bM w E.L.DISEASE-PAY L T 1$ 11000,000
DESCRIPTION OF OPERATIONS I LOCATIONS t VEMICL88 ACORD 101,ASI Ronoft$ ,if mare spm is"woo-
CONTRACTORS LICEN8E # E-1200503
RIIFIGATE HOLDER CANCELLATION
MIAMI SHORTS VILLAGE BLDG DEPT SHOL)LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
100:50 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
MIAMISHORES, iIdRtDA 33138 ACCORDANCE OaDANCE WITH THE POLICY Paws.
77 sENTA
7/
1988.2}10 ACORD CORPORATION. A$dgtft mwved.
ACORD25(2010=) The ACORD cgrar*ON OW.Ice registered maft of ACORD