DS-16-763 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax:(305)756-8972
Inspection Number INSP-261088 Permit Number: DS-3-16-763
Scheduled Inspection Date:June 21,2016 Permit Type: Driveways/Sidewalks/Slabs
Inspector. Mesa,Michel
Inspection Type; Final
Owner I Work Classification:Addition/Alteration
Job Address:1391 NE 102 Street
Miami Shores,FL 33138-2619
Phone Number (306)898-7882
Parcel Number 1132050230180
Project <NONE>
Contractor. NICNAR CONSTRUCTION LLC Phone:(954)696.4575
Bulldtnqirltt Comments
NEW CAST IN PLACE CONCRETE DRIVEWAY OVER ctio Passed Comments
EXISTING INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-255361. not ready for Inspection
Failed ND
Correction
Needed
Re-Inspection
Fee
No Additional Inspeotions,can be scheduled until
re-inspection fee Is paid
13
June 20,2016 For Inspections please call:(305)762-4949 Page 20 of 27
ti Miami Shores Village
10050 N.E.2nd Avenue NE
�• Miami Shores,FL 33138-0000
L F} .Y15 ! k-aS.1cS E Y SY k
Phone: (305)785-2204 � £, �� ' �,K� ��� ����� u.•,,,,. .
€Y�� \� S } 4 Yom'- �"�•J ...
Expiration: 10/22/2016
Project Address Parcel Number Applicant
1391 NE 102 Street 1132050230180 BAY CONSTRUCTION&DEVEL(
Miami Shores, FL 33138-2819 Block: Lot:
Owner Information Address Phone Cell
BAY CONSTRUCTION& 201 S BISCAYNE Boulevard (305)898-7882
-- - -----• -• - MIAMI FL 33131-
201 S BISCAYNE Boulevard
MIAMI FL 33131-
Contractor(s) Phone Cell Phone Valuation: $4,000.00
NICNAR CONSTRUCTION LLC (954)696-4575
Total Sq Feet: 800
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:NEW CAST IN PLACE CONCRETE DRIVE% Additional Info: Review Planning
Bond Retum: Classification:Residential Review Building
Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40 Invoice# DS-3-16-59117
DBPR Fee $2.00 04/25/2016 Credit Card $99.40 $50.00
DCA Fee $2.00
Education Surcharge $0.80 03/23/2016 Credit Card $50.00 $0.00
Notary Fee $5.00
Permit Fee $125.00
Scanning Fee $8.00
Technology Fee $3.20
Total: $149.40
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 jiao6brate and that all work will be done in compliance with all applicable laws regulating
construction and7�AVa'7
rize the ove- contractor to do the work stated.
April 26,2016
Auth ed ature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 25,2016 1
Miami Shores Village ----
'��. Building Department MAR 28 1018
0 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201`4
BUILDING Master Permit NO.D S ("-7L es
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 174t Nl- 1 a2yr
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): DM
mo s waC� !, X1. Phone#:
Address: 1 LAeL k KJ 09- (�M
City: State: Zip: 1-0
Tenant/Lessee
-
Tenant/Lessee Name: Phone#:
Email: �@r' c
CONTRACTOR:Company Name: N(+�L3�. C�j5 TICA)CF'i-V', Phone#: 15(4 - 41?ro •`�y�J
Address:
f pZ QLSAA �>et. CT)
City: i 1' C S State: flr—� Z)p:
Qualifier Name: C/fl kmoK Phone#:
State Certification or Registration#: e�C (�7 2 �D-y Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ `fI QED Square/Linear Footage of Work: �aC�
Type of Work:t ❑ Addition ❑ Alteration ❑ New Repatr/Replace ❑ Demolition
Description of Wgi"k - � .rc aST _ ''�;FtaS- _ 'l�•v -'L -: L�. r� ..^ a✓� � �C ASO'•
Specify color of color thru tile:
Submittal Fee$ � •� Permit Fee$ CCF$ CO/CC$ G
Scanning Fee$ Radon Fee$ �® DBPR$ Notary
Technology Fee$ !3 `LCA Training/Education Fee$ n Double Fee$
Structural Reviews$ Bond$ �- t
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable) t
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 250 , the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure w* be d livered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commenceme t ust b posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the ab n of ch posted notice, the
inspection will not be approved an f inspection fee will be charged.
T 0
Signature Signa W
NER or AGENT CONTRACTOR
The foregoing instr ent was acknowledged before me this The for ng instrum nt was acknowledged before me this
VZS dayof
_ �C.�iSS 20 �� ,by da ' U `'C� _,20-- 16 ,by
C�$GA2► GA`'��w-ho is p rson Ily kno to �!� ,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: N1111M l// NOTARY PUBO :
II�COS lM1AMS
Sign: $ .•• B Sign KMIIrEE872882
•
EXPIRES Feb voy 07.2017
Print: o Print:
$.a S �476p
Seal: 9�.q�.•� e , °•e�o+.� Seal:
APPROVED BY Plans Examiner .c, Zoning
Structural Review Clerk
IRevlsedO2/24/20141
0
.RE
•..• a... Miami Shores Village
�10Z ;50�� Building Department
A R 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
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 fled 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 Y ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
er
State of Florida
County of Miami- de
The foregoing was acknowledge before me this�day of MAX CF--k ,20 1�.
By COL:)� c-,MwE .$ who is 1650—nally-Uo–w-h3o me or has produced
tion.
Notary:
•• Ochs?
SEAL:
e r1•qD CCA®.L
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V .a C�� R=2rJ.Qa' F.I.P. ^t✓�L
A=18.34' , 2p�
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R=62.50 18.92 (M&cll� R�
g A=53.36' � �= 9.5� ���' Fn
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RESIDENCE
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-New cast in place concrete l 1/
driveway and walkway to no
replace existing asphalt 6'54"E. 85:60' tM&R F"P.
-4"thick Inside property-6"thick In ROW ,'4"13 0'
-4"wide joints between all
pavers ° d a p
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A 29.5' 22.0'- ui
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r,-,SITE PLAN
U N.T.S ——— --—
APP Doc #AP 1233386
ip
STATE OF FLORIDA PERMIT #: 13-SC-1673011
DEPARTMENT OF HEALTH DATE PAID 04/05/2016
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT FEE PAID: 70.00
RECEIPT #:13-PID-2919624
APPLICATION FOR:
[ ] New System [X] Existing System I ] Holding Tank [ ] Innovative
[ ] Repair [ I Abandonment [ ] Temporary [ ]
APPLICANT: Bay Construction Development LLC
AGENT: Oscar Goncalvez TELEPHONE: 1 (305)439-5369
MAILING ADDRESS: 11098 Biscayne Blvd Miami, FL 33161
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MOST BE CONSTRUCTED BY
A PERSON LICENSED PURSUANT TO 489.105(3) (m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED
(MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
LOT: 4 BLOCK: 4
SUBDIVISION: PLATTED: 01/01/1953
PROPERTY ID #: 11-3205-023-0180 ZONING: I/M OR EQUIVALENT: [ Y ED
PROPERTY SIZE: 0.20 ACRES WATER SUPPLY: I ]PRIVATE [X]<=2000GPD [ I>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? I Y L_r DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 1391 NE 102 St Miami, FL 33138
DIRECTIONS TO PROPERTY:
••••
• 99990
9999•
•• • 9999 •
9999•• 9999 •
• 9999•
9999•• �
•
9999 P 9999•
999 • •
' •• 6696•
BUILDING INFORMATION: [X] RESIDENTIAL [ ] COMMERCIAL 0::66: • • • •
• • 9999•
•• •• 9999••
Type of No. of Building # Perogigg,• Total Design Fl.BO•:•
Establishment Bedrooms Area Ft Served • For This Unit •
3 2350 • 69 '9999• �Q'
• 6 •
.. . 00•0 .9006•
00
[ ] Floor/Equipment Drains I ] Other (Specify)
SIGNATURE: DATE: 04/05/2016
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
V 1.0.0 AP1233386 EID167301:
Miami Shores Village C F N :21'1:114SR0174S9 =A r
•n• Building Department OR Br. 30011 P9s 4284-4285 (Wss)
10050 N.E.2nd Avenue RECORDED 03/24/2016 13°25:35
HARVEY Y OF O
Miami Shores, Florida 33138 MIAMI-DADEICOUNTYr���fLORIDART
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CO TRU TION WITHIL4 RIGHT OF WAY
Whereas, (owner)
hereinafter referred o s e,Qw�nemqrko4l
ollowing described
PG
property (address): l 1
Legal Descrip on: Lot Block Subdivision
Folio# It- ��D�- 3 0��
M4'WV%6 AVO 404eg
Requests permis ion to install (describe work
Within the public right of way of(address)
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 item(s) 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 item(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 a nze epresentative).
Signature
OwnerorAgent IJS�'�/ Qo�caluPS'
State of Florid
County of Mia i Dade
The foregoing instrument was acknowled ed a this Z I day of 20 9 , by
aLLAK-Lj .Vcf-> who is eo�knowto me or who has produced
as identification.
NOT
Sig :
Print: oA—L SEAL-'
�f+PUMc state a
LkTw'.J
I Robert JaarMV Commissron Et 831947 Ei�®s08tf73/20i8
� � N.W. 13th Ave.
$ a � ,� SKETCH OF BOUNDARY SURVEY 9 q.5 E
9
A T g 1 9 1 q
A B E n Lot 3, Blk 4
5f p (PB 55-g 83)
s { ) A N Z C
NO'09 O6"W. 90.45 M&R
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NO.09'06V. 112.50 {M&R)
YY Lot 5, Bik 4 A Mo
�� ..
(P8 55-Pg 83) mo
JOB No. 15-381 LOCATION MAP HOUSE PICTURE
DATE OF SURVEY: AprN 1,2015 VIM
REVISION DATE ,,,
CERTIFY TO:
BAY CONSTRUCTION AND DEVELOPMENT
LLC
VAZOUEZ AND ASSOCIATES Are 97xwrr
OLD REPUBLIC NATIONAL.INSURANCE CO.
m
o i �
SITE ADDRESS: 1391 N.E. 102nd ST.,MIAMI SHORES,FL 33138 FOLIO No.11-3205-023-060
} Waterway R=25.00' F.I.P. `-�
W A=18.34' (� ,0 as•�0' "
A=42.0129 ✓ JA%2 (A�-
R=62.50 ✓ �. Fnd.
A=53.36 f „ 9 D/H
A 4.8.55'01" 7' seawall -`rte o.3'cI
o
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aj
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;u m 1 STY C.B.S. "t
RESIDENCE
W No. 1391 '� " (2'x2)b
m F.F. Elex10.28 z
H O 3' B.S. Garage
Wall
b(2 e9c4s Eley. 6.12
30.85 0
z 10: 640' �°nter m Planter 10.00'
C; Brick39.0
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:•:c-19
As halt Pavement ::.::; :Z;;;::;•:.c:.::': :' :
.................... ....................................................... 50 TOT
: ::: :•::.....:::::::::::::::.::•:::.::•:::::::•:::::::...
:;:_•: _:::.::•;::;:•::.. .E. 102nd STREET':;:.:...:.....PUBUC...RIW
LEGAL DESCRIP7TE>MI•
LOT 4,BLOCK 4,OF MIAMI SHORES BAY PARK ESTATES,ACCORDING TO THE PLAT THEREOF AS REOORDED IN PLAT BOOK 55 AT PAGE 83,OF
THE PWLIC REODRDS OF MIAMI-DADE COUNTY,FLORIDA.
WE HEREBY CERTIFY THAT THE ATTACHED SKETCH OF'BOUNDARY SURVEY'AND ENCROACH�iEAITS AND OTHER PMTS OF INTEREST
THE SURVEY YAP RESULTING THEREFROM OF THE ABOVE DESCRIBED PROPERTY -R92�YtE At0 j�7Stitl : OF THE.SUB7ECI'PROP82TY
IS A TRUE AND CORRECT REPRESENTATION OF A FELD SURVEY MADE UNDER MY
O�ECt[CH AND MEETS THE INTENT OF THE APPUCA�E PROMONS OF Tiff --rHE SUMECT PWPERTY IS WITHIN A FLOOD ZONE AE(SEE NOTE 1)
'imIBKBI TECHNICAL.STANDARDS FOR LAND SURA IN 1HE STATE OF =THERE NO PLATTED U71L.EAS04ENT ON THE SUB.-CT PROPSM
FLORA'PURSUANT TO RULE W-17 OF THE FLORIDA ADMINISTRATIVE CODE AND -
ITS DiOnEYFIM LAV,CHAPTER 472827,OF THE FLEA STATUTES.
AMERICAN SERVICES OF MIAMI,CORP. o< do ORDERED BY:
Consulfing Engineers �
.Planners.Surveyors VAZQUEZ AND ASSOCIATES
7I R VAZQUEZ,PA
9370 S.W.72nd STREET,SUITE A-102 °t�aaaarwv
MIAMI,FLORIDA 33173 ,
PHONE:(305)S98-5101 FAX:(305)598-86V �4 s3tat 70
LB 6683 ASOMIAMI.COM i0AM&t F 305--371-4M-
THIS IS PAGE I OF 2,NOT VALID Wfr KW ALL PAGfS.