DS-16-766 Miami Shores Village
Building Department
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10050 N.E.2nd Avenue,Miami Shores,Florida 33138
\N& Tel:(305)795-2204 Fax:(305)756-8972
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INSPECTION LINE PHONE NUMBER:(305)762-4949
BUILDING Master Permit No. rc) b l
PERMIT APPLICATION Sub Permit No.
®BUILDING ❑ ELECTRIC ❑ ROOFING �q REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP
�(( �1 t CONTRACTOR DRAWINGS
JOB ADDRESS: I" y 'Eq-
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:
1 �n
OWNER:Name(Fee /v Simple, (Titleholder):, CQ 4&'T"C�� Phone#: �i6S �3 '6(f&'6(f&Address: ) 'T r�4 � t oZ
ST-
City: ��-� State• Zip: �,3,1
OT
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: fie' - "�� Phone#: 6)5q-bso
Address: flZ r
City: (fj-e S State: ' fi' Zip:
Qualifier Name: k k6C4 '� kwthe- Phone#:
State Certification or Registration#: <f ���Z ��' 9 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ `i 1 v i0 Square/Linear Footage of Work: 802:�'
Type of Work: [] Addition ❑ Alteration ❑ New ❑ Repatr/Replace ❑ Demolition
Description of Work:' v.! c Wks(- '.,sN f(.x►c�. carte-xrc _ `po�o/%�..r�..� a�irc rru�S-nw.�
Specify color of color thru'tile:- ..__
Submittal Fee$ Ste' Permit Fee$ ( 6 a CCF$ 2 CO/CC$ 0
Scanning Fee$ Radon Fee$ zoo DBPR$ 00 Notary$
Technology Fee$ Training/Education Fee Double Fee$ O
Structural Reviews$ Bond$ 0�y/-�
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable) F
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 exc ed* $25 , the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law broch a ill be elivered to the person
whose property is subject to attachment Also,a certified copy of the recorded notice of commence en must a posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the bse ce of uch posted notice, the
inspection will not be approed an a reinspection fee will be charged.
Signature Signatur -
NER or AGENT CO
The foregoin instr ent was acknowledged before me this The for�7 oing instru nt was acknowledged before me this
day of ,20 by r Q day of � r�t 20 by
S C-A e- ('9 U Wo is sonall kn n to �o is ersonall knowh to
P P Y
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: Upllgl NOTARY PUBLIC: ,
VE
•°° °� i9 •. '� MARCOS LNiIAWS
Sign: 0 NN ?0 Fs ; Sign: An &a=
Print a :" °® i o Print EXPIRES Fein'07,2017
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Seal: ' a�`� Seal:
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lot
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APPROVED BY Plans Examiner �� Zoning
Structural Review Clerk
(Revised02/24/2014)
soon amshores Village
Building Department
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 Y A OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
E
CONTENTS.
Signature:
er
State of Flori
IVde
County of Miami- e
.11 t2
The foregoing was acknowledge before me this. 010 day of N%4e CPA, 20 1
By OS C-A-tZ- C(--E �* ClaUJE -S_who is r1qn-al1y-1no-w-RV me or has produced
a ation.
N IRS 8/1jy
Nota,.
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6,
SEAL:
3
FF 954760
'
mission:
Rick Scott
Toprah4proli &hrp=thehe8M Gowernor
9 people ht ra�gh hdegramed
st �p6r col ,o 10111111 MDQ MPH
t r&mmnr HEALTH hderhnStae&rgemC
Vision:To be the HwAdW Sho In the Nat m
May 31,2016
Oscar Goncalvez
11098 Biscayne Boulevard
Miami, FL 33161 JUN 0 2 2016
i
RE:Modiftcatlon to a Single Family Residence-No Bedroom Addition
Application Document Number: AP1233385
Centrax Permit Number: 13-SC-1673007
1421 NE 102 Street
Miami,FL 33138
Lot:23 Block:1 Subdivision:
Dear Applicant,
This will acknowledge receipt of a floor plan and site plan on 04/05/2016 for the use of the existing
onsite sewage treatment and disposal system located on the above referenced property. NO
OBJECTION
Replace walkway and driveway.
A.Edwards
This office has reviewed and verified the floor plan and site plan you submitted,for the proposed
remodeling addition or modification to your single-family home. Based on the information you provided,
the Health Department concludes that the proposed remodeling addition or modification is not adding a
bedroom and that it does not appear to cover any part of the existing system or encroach on the
required setback or unobstructed area. No existing system inspection or evaluation and assessment,
or modification, replacement,or upgrade authorization is required.
Because an inspection or evaluation of the existing septic system was not conducted,the Department
cannot attest to the existing system's current condition,size,or adequacy to serve the proposed use.
You may request a voluntary inspection and assessment of your system from a licensed septic tank
contractor or plumber,or a person certified under section 381.010 1, Florida Statutes.
If you have any questions, please call our office at(305)623-3500.
Sin ly,
• �• �d�aLd�
•• •:E1VMe&ri5gV*erftorIII
•• •••Department of Nealth in Dade County
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In Dade County• •,Florida TWITTER:HealthyFLA
PHONE: (305)623-3500 «•• • • • « ««. « • FACEBOOK:FI-DeparhnentofHealth
• • • • • • • • YOUTUBE:fldoh
• «« «« • • • •• ««
g��� I�iilll iilil Bill liiEi illli lilll lilll 1�11i11
Miami Shores Village CFH 2016RO176909
••.• oma Building Department OR er, 30011 F9s 4288-4289 (Pss)
10050 N.E.2nd Avenue RECORDED 03/24/2016 13°25:35
�� ►� HARVEY RUVINY CLERK. (3E COURT
A R Miami Shores, Florida 33138 MIAMI-DADE COUNTYP FLORIDA
Tel: (305) 795.2204 .
Fax: (305) 756.8972
COVENANT OF CO TT UCTION WITHIN RIGHT OF WAY
71
Whereas, (owner)-� ''1 % ' WA kt' m
hereinafter referred to as the owner the following described
property (address): f ! 102 Sf UVl?AM 5
Legal Description: Lot ' Block
Folio# 2Subdivision
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Requests permission to in,tall (describe work): 4WW6
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 au riz :presentative).
Signature
Owner or A�„Qent
State of Florid
County of Miami Dade
The foregoing instrument was acknowle veFo this r-( day of '^"'m`'" , 20 ILP , by
who is p sonally kn n to me or who has produced
as iden ificatio .
NOTA
Sig
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Print: ,ti..t `..`-1*LOCCL, SEA
MPW* joforda
Mici947
SITE ADDRESSz 1421 M.E. 102nd S:, MUM SHMES, R..33138 FOLJO NM U-MOS-024-000
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SFTE CRESS: 1421 N.E. 102nd ST., MIAMI SHORES, FL 33135 FOLIO 9- S-+raga-a
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Gallon Septic Tank
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Drain Field
rip
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-New cast in place concrete
IC50 °
driveway and walkway to 85.0
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-4" thick inside property
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pavers --- 4:
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Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795-2204 Fax:(305)756.8972
Inspection Number: INSP-261513 Permit Number: DS-3-16-766
Scheduled Inspection Date:June 28,2016 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Mesa,Michel
Inspection Type: Final
Owner: S Work Classification: Addition/Alteration
Job Address:1421 NE 102 Street
Miami Shores,FL Phone Number (305)898-7882
Parcel Number 1132050240190
Project <NONE>
Contractor: NICNAR CONSTRUCTION LLC Phone:(954)896.4575
Building Department Comments
NEW CAST IN PLACE CONCRETE DRIVEWAY OVER Intacu° Pa—esed Mmments
EXISTING INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP 255375. 1. Not ready. Need to
finish driveway to asphalt connection.
f4l 2.Clean p drivewa . '
Failed G
Correction
Needed
Re-Inspection a
Fee
No Addidonal Inspections can be scheduled until
re-Inspection fee is paid
tib
June 27,2016 For Inspections please call:(305)762.4949 Page 17 of 32
t r.
Miami Shores Village
10050 N.E.2nd Avenue NE '
Miami Shores,FL 33138-0000
i—WOO` Phone: (305)795-2204 , if''•. r
,� :• Expiration:
11129/2016
Project Address Parcel Number Applicant
1421 NE 102 Street 1132050240190
;
Miami Shores, FL Block: Lot: BAY CONSTRUCTION&DEVEL(
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
_.�...�..•.......... ,�.� ..w- ..w... _.....r.. _.._....��... 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 DRIVES Additional Info: Review Planning
Bond Return: Classification:Residential Review Building
Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40
DBPR Fee Invoice# DS-3-16-58120
$2.00 03/23/2016 Credit Card $50.00 $99.40
DCA Fee $2.00
Education Surcharge $0.80 06/02/2016 Credit Card $99.40 $0.00
Notary Fee $5.00
Permit Fee $125.00
Scanning Fee $9.00
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 is accurate and that all work will be done in compliance with all applicable laws regulating
construction n' . Fp#�Pmoreml authorize the ab e- ed contractor to do the work stated.
June 02,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 02,2016 1