DS-16-1127 Terra Teck Consultants, Inc.
♦Environmental Consultants ♦ Foundations ♦ Geotechnical Testing ♦ Inspections ♦ Construction Materials Testing ♦ Structures
FIELD DENSITY REPORTS
Client: Champion Concrete Date: I 06/02/16
Address: 11001 NW 831d Street, # 103, Doral,Florida 33178 Order No.: 16 2940
Project: Driveway At 38 NE 108th Street,Miami Shores,Florida
Contractor: Champion Concrete
Description: Tan To Brown Silica Sand With Rock Fragments.
Location: Sw Comer Of Driveway Lab# D-36019
Location: Nw Corner Of Driveway Lab# D-36020
Test Results of
Field Densities ASTM method: D-2922-81
Description of Test Area I Driveway Area Densities At 38 NE 108"'Street, Miami Shores,Florida
Lab No. D-36019 D-36020
Test No. 1 2
Depth in inches 1211 1211
Field Density lbs/Cft. 114.9 114.5
Mositure Contents % 7.4 6.8
Maximum Density % in the field 98.4 98.0
Reg. Compaction by jobspecs 95% 95%
100 % Max. Density Proctor 116.8 116.8
Proctor No. P-2978 P-2978
Optimum Moisture% 18.6
Remarks All The Above Tests Comply With Job Specifications
Checked B R.E.D.S. I Report By I A.M.
RespecPall §u'bWj4ed BY,
Tera` e� ta6#, Inc.
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FLORIDA REGISTRATION No. 39228 = -
As a mutual protection to clients,the public and ourselves,all reports are submitted as the confidential property a�,, �and a RbTrf inn for'pe 16 tion of 2
statements,conclusions or extracts from or regarding our reports is reserved pending ouf. appr6�a(%. ',.
u
Miami Shores Village ��, �`� 1"€ Ift �
Ink 10050 N.E.2nd Avenue NE �OtfC Cft
`h Miami Shores,FL 33138-0000 ^ P� 3 AIS'
Phone: (305)795-2204 s
31 1 YH
�1t2016 Expiration: 01/17/2017
Project Address Parcel Number Applicant
38 NE 108 Street 1121360110050
BRIAN WIBORG
Miami Shores, FL 33161-7036 Block: Lot:
Owner Information Address Phone Cell
BRIAN WIBORG 38 NE 108 Street
MIAMI SHORES FL 33161-7036
38 NE 108 Street
Miami Shores FL 33161-7036
Contractor(s) Phone Cell Phone $ 13,200.00
Valuation:
CHAMPION CONCRETE (305)252-8055 (786)402-4802
Total Sq Feet: 1600
Approved:In Review Available Inspections:
Comments:
Inspection Type:
Date Approved::In Review Final
Date Denied: I Foundation
Type of Work:CONCRETE DRIVEWAY AND POOL DECK Additional Info: Review Planning
Bond Return: 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-4-16-59648
CCF $8.40 07/21/2016 Check#:2248 $841.66 $50.00
DBPR Fee $2.63
DCA Fee $2.63 04/27/2016 Credit Card $50.00 $0.00
Education Surcharge $2.80 Bond#:3156
Notary Fee $5.00
Permit Fee $175.00
Scanning Fee $9.00
Technology Fee $11.20
Work without Permit Fee $175.00
Total: $891.66
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either m elf, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOOR ,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is ccur t and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named ntra or o do th tated.
July 21, 2016
Authorized Signature:Owner / Applicant / or Agent Date
Building Department Copy C ct
July 21,2016 1
Miami Shores Village
Building Department 9LpZGti88
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 i r
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 u 5t11
FBC 20 14 �T"`
BUILDING Master Permit No.�� 12�--
PERMIT APPLICATION Sub Permit No.
ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: fye lof�>j
City: Miami Shores County Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): .B���N �4,'1D�1i6 Phone#:
Address: W A�;_ We
I 1
City: �� ��7 Stater Zip:
Tenant/Lessee Name: Phone#:
Email: g C s�
CONTRACTOR:Company Name: ,Di d J 1��1 °� Phone#:.,r") 2§2_yL65
Address: , w
City: /�N�� State: Zip:
Qualifier Name: � � Phone#: 746'1GX
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 13i Ly® Square/Linear Footage of Work:
Type of Work: .❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 1 �/ P /�/ � �S
Specify-color
of color thru tile:
Submittal Fee$ J Permit Fee$ CCF$ ® CO/CC$
Scanning Fee$ G1 t� Radon Fee$ C2 . DBPR$ S tary$_`�
Technology Fee$ I 10-b Training/Education Fee$ Double Fee � 15
Structural Reviews$ Bo 15d® 1,
TOTAL FEE NOW DUE$
(Revised02/24/2014) -r04ct1^ 841 . 66
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 inspection which occurs seven (7) days after the building permit is issued. In the abs e ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or A NT CONTRACTOR
Theloregoinginstrurneviwasa nowledged befor this The foregoing instrument was acknowledged before me this
oday of ' by a� day of t�— 20 ,by
�p9N V 4 01 6 is personally known to ��M�- 1! �—y who isspper y cn a to
trme or who has produced as me or who has produced 4 �.�-- as
identifica 'o and who did take an oath. identification and who did take an oath.
NOTAR IC: NOTARY PUBLIC:
Y"D LUCIA ESTRELLA
.'•• * MY COMMISSION#EE 880165
EXPIRES:July 2,2017
Sign ° Sign: OMM/SS•;slG��
Print: Print:
.e._.�e• a eS _
Seal: Seal:`• r d
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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B.,. loll Miami shores Village
LSF-
rut Building Department
JrjA '�p► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305)756.8972
RECEIPT
PERMIT#: -05 f C I Z7 DATE: '-Y
(Name)
a-Co-ntractor
o Owner
o Architect
Picked up 2 sets of plans and (other)
Address: 3cP' Al2-� t r s j Pt 1-0 YvO
From the building department on this date in order to have corrections done to plans
And/or get County stamps. I understand that a plans need to be brought back to Miami
Shores Village Building Departme to conti a permitting process.
Signature:
(SIGNATURE)
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL: 'L7