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DS-16-2119 (2) ��� r ,�` �,1-= �� Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-264831 Permit Number: DS-7-16-2119 Scheduled Inspection Date:August 09,2016 Permit Type: Driveways/Sidewalks/Slabs Inspector: Mesa,Michel Inspection Type: Final Owner. NEWBAUER,JEFFREY ADAM& Work Classification: New AAAI CMA QATTA Job Address:70 NE 92 Street Miami Shores,FL Phone Number (305)799-0885 Parcel Number 1132060130020 Project: <NONE> Contractor: ONE STOP PAVING Phone: (786)299-1354 Building Department Comments ASPHALT DRIVEWAY Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-264292 8-4-16 need to finish landscaping. Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid I August 08,2016 for Inspections please call: (305)762-4949 Page 19 of 35 z r �' Y e�vr .ten! - • Miami Shores Village " M PBlTTT1t to Tjri!ria �ntWSiewalkla6s 'f S.� 10050 N.E.2nd Avenue NE Ili/fftj# lBSSt>!C€I01? � 1N.. Miami Shores,FL 33138-0000 d- �. Pe1a f tits AI�Pt oUED Phone: (305)795 2204 .. �tiRTD y �a; rs$, lat�:7/28�)"" f Expiration: 01/24/2017 .. Project Address Parcel Number Applicant 70 NE 92 Street 1132060130020 JEFFREY ADAM&MALENA BO' Miami Shores, FL Block: Lot: Owner Information Address Phone Cell JEFFREY ADAM 8,MALENA BOTTA 70 NE 92 Street (305)799-0885 — — -- MIAMI SHORES FL 33138- 70 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 ONE STOP PAVING (786)299-1354 .. Total Sq Feet: 800 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:ASPHALT DRIVEWAY Additional Info: RffeviewPlanningBond Return: Classification:Residential Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# DS-7-16-60778 CCF $1.80 DBPR Fee $2.00 07/28/2016 Check#:1488 $647.80 $0.00 DCA Fee $2.00 Bond#:3169 Education Surcharge $0.60 Notary Fee $5.00 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $647.80 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 i§ accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-na;eo - ctor to do the work stated. July 28, 2016 Authorized Signature:Owner / Applican Contractor / Agent Date Building Department Copy July 28,2016 1 10 T Q z ° co 3 a 3 cp © ° . z o a o LLLL LD as l{1� 1LLJN i Q N r4 Q9 V Z 10 ❑ ..� �, ND 9 uu w L I Z H IV LL N IV Y O u' m c c c cCA Z Z Z V C s 0 s° °c °O N C O O m E � cc Z CL CL CL CL z U p 14 m Q.o w LL /7T m N N bn C: mma 3 ❑ ❑ L �O a U f�0 O' O �V I, W GJ 7 r 44 .._ ° Lo Ln co L L O ° U LL '�'� a' Ln M c Z U = LL m ~ t/f LU a � 3 w O W O Z I- •a J V m N L! ` ) W = O m U p ^' � U U Z O Q OC d j � V/ O Z v, S N o.El El _ GJ N 0 CL A '� LL dY C LU D O V1 aj a' ^ z o N 0 N .. 0 LLU U S N N ...+ W 0, o m c�1 •— Ln a u d u U O •a Li c ma z El ❑ 041 N E coo F- aEio v ac Q ma = ° O a� oUn m S Q E LU > d to y ° CCc LU aApLft En m v1 44 c� o ?�. p yl, a ai a Z O Z '� xe T E r w °C E ``-' Se c V-\ ° '� U '> o Z m H LU wH m v, O ^ uEr- Q O ► 4 y w w a W� Ja Q a CC LA w N WW a, c _ v w U Cz7 a ° '� V c c v co CL ElLL. u LU > o to v H n 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 absence of such posted notice, the inspection will not Peapproved and a reinspection fee will be charged. talSignature -9Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this '.eKaZ 6 day of / 20 16 by ZOO day of To 20 1 � by Iv-va E* r�i o is personally known to �D�"-IT,- 4 "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: NOTARY PUB L Sign: t Sign: Print: r CL/D �°b'^ Print: a� �'I IM t1ARR��+��C ' it0 Seal: o Seal: ;�' " _ Kw c,: Fsa C 3,MR * f 3 ri9� e hu i �l�riciS.iLrS +k�k�k�k�k�k�k�k�k�k�k+k�k�k�k�k�k�k�k�k�k�k�kek�e*�k��kak�k�k�k�k�k+k�k�kffi�e�k�krk�k�k�k*�k�k+kik+kik#�k�k�k�k�k�k��k�k�k*�k�k�k�k�k�kek�kak�k�k�k�kokak&Mak�k#�k�le�kyeye �k#i�k�kak�k�ktkAe&�k�k�eMe�k APPROVED BY i Plans Examiner �Zoning Structural Review Clerk (Revised02/24/2014) One Paving Inc . TO: I•X.(m vNl i S�n a�S 5W �d�h ti PROJECT: �/�V-9-w- NAME: NAME: ADDRESS: ADDRESS: °i 53 144 PHONE: FAX: DATE Z 20 DESCRIPTION "T� vl�. WAI `Og -\ �Ve o vl\� ?14- W C)V-A L1 2 v so 2 G'C L o,+e d -q- Ave ij S w a m OL t-J J s C v: Lp ire v,A ff �` o ? O o�psaYPy®� Nofa(y::'i,; ,c $tete of Florida bid Cornmis8icp PF 15ii750 �pFatExPiires09!03;2,l1c3 ��4a-rn 1463 NE 173 ST N.MIAMI BCH.FL 33162 PHONE:786 2991354 7 305 947 3233 5�►ORFS pI s� Miami shores Village Building Department "-F � 10050 N.E.2nd Avenue ORNA 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 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 UNDERSTAND ITS CONTENTS. ignature. , caner State of Florida County of Miami-Dade / The foregoing was acknowledge before me this 2� day of BTU` '20 By /�Cl fe e)a 23e 0Q V eul a U¢►/ who is personally known to me or has produced as identification. Notary: eAraoRo somas iO T mgr ,GN#FF 195634 SEAL: - io' rXPI;1ES:Febn.ary 3,2019 '%F,oF'F�,. Bonded'hralJ��taryP;,bi�cUndenvriters ♦5 0Rs `i Miami shores Village ones Building Department 1�1 10050 N.E.2nd Avenue 2 76 Miami Shores, Florida 33138 �ZORIDA Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT STATE OF(FLORIDA) COUNTY OF(DADE) The undersigned Affiant, a�e'^ �o`�A "'roes hereby attest that (Property owner) The attached survey, performed by ?1yxyi 2 So�y (Name of surveyor's company) For address: 4 8 617- res -4--L Performed on 2 3 (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 5urtheF, ntsLaetf nal inspections as applicable to this or other permits. naught. ✓� PkA�E M* e�mi ���a j p Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this Z(o day of s`' Affiant is personally known to me, produced as identification. 155634 Bonded 7 hr..Pl,sryv P,biic Und,nvriters Notary Revised(6/25/12)Revised on 5/22120091 Revised on 6/12/09 ,SHORE,p Miami Shores Village ••ll oil : Building Department OR SY, 30168 Pg 2564 (1Pss) L.,7- 10050 N.E.2nd Avenue RECt�HAROR�{ i�ED j-17/27/20-1 �i0RNp' Miami Shores, Florida 33138 ,T�`t of F� F2IDA.COUNT 41696����- 11 (�OIUIF4 i ,P �,L Tel: (305) 795.2204 V 0- ST a true copy of Fax: (305) 756.8972 HEREBY CER FY that this day o/ _a N is R(ti U original/iled!(�1 AD 20 s� o hand and Otficia eal. -7 IN "' COVENANT OF COT S�TRUCTI�OJN 1(UITHI)V RI�HT ®F� ' A�ECO� - V J \j o C� " of c uit and County couO.rt Whereas, owner a evti a. aw C 1 hereinafter referred to as the owner of the fo owing de n I S�gApRNQI® 0114 property (address): `7 D IJ Legal Description: Lot Block l Subdivision I•Wavvi t S(A v r•e c S-mc- I Folio # Requests permission to install (describe work): Aslr��►� �t IJ-i�,c,y�I Within the public right of way of (address) -7C) �rr q, des 3�3 me 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 fYiy au or' d representative). Signature Owner or Agent ',A/. LIE 0 A _1?,)v_[T-A 04:�_ State of Florida County of Miami Dade The fore oi'n1g instryment was acknowledged before me this 2� day of �� , 20 , by 014(1.a u tea Oaid l�"e/ who is personally known to me or who has pr duced fl as identification. 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