DS-16-1035 Inspection Worksheet C�'
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-257774 Permit Number: DS-4-16-1035
Scheduled Inspection Date:April 29,2016 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Porto Jr,Jose
Inspection Type: Final
Owner: HARRISON, EVELYN Work Classification: Addition/Alteration
Job Address: 10640 NW 2 Avenue
Miami Shores, FL 33150-1228 Phone Number
Parcel Number 1121360020080
Project: <NONE>
Contractor: M B BROWN CONSTRUCTION COMPANY INC Phone: (954)261-3312
Building Department Comments
INSTALLATION OF CONCRETE DRIVEWAY AND SIDE Infractlo Passed Comments
WALK REPAIR INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-257673.
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
April 28,2016 For Inspections please call: (305)762-4949 Page 28 of 29
a 3 �
Miami Shores Village ;§
10050 N.E.2nd Avenue NWE
Miami Shores,FL 33138-0000
t nI Phone: (305)795-2204
"M
`�4£ x Expiration: 10116/2016
Project Address Parcel Number Applicant
10640 NW 2 Avenue 1121360020080
Miami Shores, FL 33150-1228 Block: Lot: EVELYN HARRISON
Owner Information Address Phone Cell
EVELYN HARRISON 10640 NW 2 AVE
MIAMI SHORES FL 33150-1228
Contractor(s) Phone Cell Phone Valuation: $ 6,177.00
M B BROWN CONSTRUCTION COMP) (954)261-3312
_.._ ............ . .......__. ,,,v..w.._ _ _.. _ _.:. .__..__ .e Total Sq Feet: 1107
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:INSTALLATION OF CONCRETE DRIVEWA 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-Owners Bond $500.00
CCF Invoice# DS-4-16-59446
$4.20 04/19/2016 Check#:7968 $674.70 $0.00
DBPR Fee $2.25
DCA Fee $2.25
Bond#:3058
Education Surcharge a ge $1.40
Permit Fee
150.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $674.70
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
constructio and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
April 19,2016
utho e nature:Owner / Applicant / Contractor / Agent ate
BuildingDepartment
p Copy
April 19,2016
1
Miami Shores Village FMcIT
Building Department APR 1 tats
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 $Y:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762.4949
FBC 2014 s4ti
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
106UILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /�041d/I/JV 09 41-1e-
City:
1-1eCity: Miami Shores County: Miami Dads Zio: -'31•��
Folio/Parcel#: �i2/.��!"�d� A9 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: ll `Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 6��// �(� TT� �V
Address: ld��0��/x 1-file y
City: 104P10G•ghares State: A-4 Zip: .33/. 0
Tenant/Lessee Name: Phone#: �"litP:4W&IT
Email: ghwmciZi—tjoO hpikvpd, mw go-o'7;%; (�
CONTRACTOR:Company Name: ) &&IS� Phone#: 95" 26/ A4/,
Address: L,23/ kwow S4-
city: AY8V12ar State: �/G Zip:
Qualifier Name: //[e�✓�'� 3�Wh / �/ / Phone#: Tawls L�9
State Certification or Registration#: M&11- /6YDh 6 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: / - City: State: Zip:
Value of Work for this Permit: 7V Square/Linear Footage of Work: IwT
Type of Work: ❑ Addition ❑ Alteration ❑ New -1 ❑ Repair/Replace ❑ Demolition
Description of Work: I.SG��Id/tB�
0
5 ` a f'a atr
Specify color of color thru tile:
Submittal Fee$�/ Permit Fee$ •� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ 1�-7•�
TOTAL FEE NOW DUE$ t ` '10
(Revised02/24/2014)
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 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$25W,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 Signatu
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
4''11 dayJo�._o4p&t ,20 .by �iV day of A 'It1 .20. 16 .by
IF Nk who is personally known to i 1K AMD Q) ,who is personally known to
me or who has produced Az Gth!'U rlds 16dloseis me or who has produced d&W6� as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: —.11MIJIvex 4ofe fiCr Print:
Seal: ! (LUTE Seal: �o� i11TE
* My OMAMM#FF040891 * * #FFOM
E>( S Nove>�er�,2017
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��oF B�dit�u8ar��YServ�s �e,n BadedThntBN
APPROVED BY d4l,y v r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores 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) hereinafte refs to as�"e
owner of the following described property ddress): U2 $ ESj �
t�iZ i<G
Legal Description - Lot Block Subdivisfull
Folio#1/-A/9 02 -44l70
Requests permission to ' all descri a work): a7
Vwx
Within the ublic right of way of(address)
IW 49- IfAy 2 Ave ms's iso
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above-mentioned items) 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.
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 Rem(s) 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).
Signature &ZLI
,
Owner or Agent
.1be foregoing instrument was acknowledged before me this day of L , 20 by�-k-WN �A- S'l-y �vho is personally known to me or who has produced +�-- ' y
as Identification and who did take an oath.
i�`tttli#li101111!/�
NOTARY PU
Sign:
Print:
My Commission Expires: = '
OR
Miami hores Village
.... u... Building Department
y� 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
lORU� Tel: (305) 795.2204
Fax: (305)756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant, 11gnzk0j 1 .does hereby attest that
(Property owner)
The attached survey,performed by c�• yT '� ��'�` C
(Name of surveyor's company)
For address: /d D�llJ 2 Q /yll01yie
Performed on ' �� (date of survey)is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7)years old old. The Affiant, as property owner,further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Fu"r,Affi nt say eth gaught.
�1,hn ,�r�. lcllt fbrresv�
Property Owner Signature n Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this ay of Aldo
Affiant is.personally known to me, uced ise didl '-15!moi as iden'kation.
WCOMMUNJIFFOW
*
EXPIRES:Wader 3,2017
Revised on 50=11 Revised w 020 0V r,orBe�edThre Bta Namry�rokss
e.
�. Miami shores' Village
F.V Building Department
R>l1 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305)756.8972
Notice to Owner Workers' Compensation Insurance Exemption
FR
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:
1- 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-
ND UNDERSTAND ITS
CONTENTS.
Signature: y `j
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this. A -day of ,G 20 16 .
By �I/d1��2 �� #arraOyf
who is personally known to me or has produced
/12 dr` etlei4s Ai en dentification.
Notary:
SEAL:
'FaFa sr*drft X17
A to Z Home Improvement&Property Management Inc.and Brown Construction LLC
7231 Ramona Street
Miramar,FL 33023
7S4-281-3480,9S4-261-3312
Email: atozhomeimgrovement070emx.com
April 13,2016
State of Florida
County of Miami-Dade
Before me this day personally appeared lawn JrW)n who being duly
sworn,deposes and says:
That he or she will be the only person working on the project located at IW fo /r�u� .L
(or a a d subscribed before me this �6 day of r!C 20_Z4_by
Personally known
OR Produced Identification
Type of Identification Produced S $2
/
Print,Type of Sta Name ofmum
o
otter°�
* • * AIY #F
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ANNE M. G AN N O N P.O.Box 3353,Wag Palm Beads,FL 33402-3353 "LOCATED AT**
wrCORSTITMflONAL TAX COLLECTOR www.pbdax-OOm Tel:(561)356.2264
Serving paten Beach County 131 HAWTHORNE DR
Serving you. LAKE PARK, FL 33408
TYPE of:BtAndw OWNER Cq:mFG:MM R Pr#"TE PND AAAI PAID MLO
23-MI a8RALCONMCMR SFOWN MASON 6J a3c WM4 U%434139-04ManS $1-OD 840117454
Thft doctoW t Is vend"when receipted by the Tax CollecWs oHtce. STATE OF FLORIDA
PALM BEACH COUNTY
2015!2016 LOCAL BUSINESS TAX RECEIPT
M B BROWN CONSTRUCTION COMPANY INC LBTR Number: 200423328
M B BROWN CONSTRUCTION COMPANY INC EXPIRES: SEPTEMBER 30,2016
375 NORTHLAKE BLVD
NORTH PALM BEACH,FL 33408 This remW grards the Peep of ongaft in or
n11n41�n1u���nA�A�1� managing any Wistness profession or ocCtq)Won
within Its jtN Wciion and MUST be canspicxrm*
displayed at the place of bustriess and In such a
mwner as th be open to the view of the polo.
Miami
Shores . •
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