DS-16-2851 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-269337 Permit Number: DS-10-16-2851
Scheduled Inspection Date: December 15,2016 Permit Type: Driveways/Sidewalks/Siabs
Inspector: Naranjo, Ismael
Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address:175 NW 109 Street
Miami Shores, FL 33168-4316
Phone Number (786)444-2945
Parcel Number 1121360030170
Project: <NONE>
Contractor: CAIBAI CONSTRUCTION LLC Phone: (786)229-2770
Building Department Comments
EXISTING CONCRETE SLAB TO BE REPAIR AT PATIO Infractio Passed Comments
AND WALKWAY AT FRONT. INSPECTOR COMMENTS False
Inspector Comments
Passed
0
ELI,-
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
December 14,2016 For Inspections please call: (305)762-4949 Page 8 of 33
" M5
Miami Shores Village61� �� a
10050 N.E.2nd Avenue NW '
" Miami Shores,FL 33138-0000 L
P�mtlStatS` ��
Phone: (305)795-2204 ry
Expiration: 05/27/2017
Project Address Parcel Number Applicant
175 NW 109 Street 1121360030170
Miami Shores, FL 33168-4316 Block: Lot: JCAS FUND CORP
Owner Information Address Phone Cell
JCA S FUND CORP FL 0 SW 135 Street (786)444-2945
FL
Contractor(s) Phone Cell Phone Valuation: $ 975.00
CAIBAI CONSTRUCTION LLC (786)229-2770 (786)470-4207
Total Sq Feet: 135
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:EXISTING CONCRETE SLAB TO BE REPA 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 $0.60
DBPR Fee $2.00 Invoice# DS-10-16-61719
DCA Fee $2.00 11/28/2016 Check*1167 $64.60 $50.00
Education Surcharge $0.20 10/19/2016 Check#:1165 $50.00 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
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 AFF rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construct' and zo ' hermore,I authorize the above-named contractor to do the work stated.
November 28,2016
Authorized gna nt / Contractor / Agent Date
Building Department Copy
November 28,2016 1
RECEIVED
Miami Shores Village OCT 1 1016
Building
Department c
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014
BUILDING Master Permit No-ps(k�- 282
PERMIT APPLICATION Sub Permit No.
F-]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
r-1 PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: U vu C7�� c�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: l FfFE: ca
OWNER:Name(Fee Simple Titleholder): C A S PC) Phone#: (0 �4(Q Z 1 ��
Address:J� �, `-�LZ-� �j S< 7
City:g C7",\ State: Zip: c� c
Tenant/Lessee Name: Phone#� 7s Jo k
Email b Q ca ('o
CONTRACTOR:Company Name: ej >6,4 /�� ���`'� Phone#: 7/i% 770
Address: 1087 � S`—)
City: State: Zip:
Qualifier Name: -05—� ``__ Phone#: �L)
State Certification or Registration#: � � �/� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �� Square/Linear Footage of Work: )
Type of Work: ❑ Addition ❑ Alteration F-1New ❑ Repair/Replace ❑ Dem li 'o.,
De riptio&of W illi: `: •
, ; r,'�..°Slr tl�'U"'�}'.roy'ss�•._,8,,�,,ar.�g�7s:�'-�E"�r
Specify co/of of tor6r thru tile:
Submittal Fee$ f Permit Fee$n� CCF$� • �,O^� CO/CC$
Scanning Fee$_ " �.l 1 Radon Fee$r7C• DBPRR'$0 W Notary$
Technology Fee$ Training/Education Fee$ (`1 ozLl Double Fee$ qn
Structural Reviews$ Bond$ C�I
TOTAL FEE NOW DUE$ 64.
• 'V V
(Revised02/24/2014)
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 comrvencement must be ost d at the job site
for the first inspe ' n which occurs seven (7) days after the building permit is issued. In 4absen4suc�h sted notice, the
inspection will t be pproved a reinspection fee will be charged.
Signature 1G Z► t , �Cefc—/I-Cz Signature
OWNER or AGENT CON �CT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged befor This
( � day of C 20 �%' ,by day of G2 C_ N 20 ,by
t, q'y"'C 1 r,w7ho is personally known to O P �—�-� �� �� .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 PUB NOTARY PUB
✓gn• IU gn.
• 3 •i s ^ lOrtda
Print: I3WG 00 78S° Print: •,, •.� on`
PNOs Oct 3,2020SeSeal ended through Pah'"Oct 3,20'al: �•••, fond dthrou
through Alational Notary�1. X181 Notary�,
�*�xx���*r�*�****x����***�**** **s a�*�**��*��*�a�**�**�***�xr�*��****��**�x*��*s****a�x�xs*�*a****ass*�*•��x*�***�****
APPROVED BY Plans Examiner I Zoning
Structural Review Clerk
(Revised02/24/2014)
Property Search Application- Miami-Dade County Page 1 of 1
,0 FFI
CE OF THE PROPERTY APPRAISER
Summary Report
Generated On : 10/19/
Property Information
Folio: 11-2136-003-0170
175 NW 109 ST
Property Address: Miami Shores, FL 33168-4316 ,
Owner JCAS FUN
,
5600 SW 135 AV 109
Mailing Address �M
MIAMI, FL 33183 USA
Primary Zone 0800 SGL FAMILY-1701-1900 SQ
.7
Primary Land Use 0101 RESIDENTIAL-SINGLE
FAMILY: 1 UNIT
Beds/Baths/Half 2/1 /0
Floors 1
Living Units 1 €
Actual Area 1,846 Sq.Ft ,
Living Area 1,450 Sq.Ft
Adjusted Area 1,648 Sq.Ft
Taxable Value Information
Lot Size 12,692.9 Sq.Ft
2016VW 2015 2
Year Built 1938 --
County
Assessment Information Exemption Value $0 $0
Year 2016 2015 2014 Taxable Value $395,933 $274,733 $249.
Land Value $228,687 $228,687 $136,392 School Board
Building Value $147,199 $149,111 $147,117 Exemption Value $0 $0
XF Value $20,047 $14,092 $14,293 Taxable Value $395,933 $391,890 $297.
Market Value $395,933 _ $391,890 $297,802 city
Assessed Value $395,933 $274,733 $249,758 Exemption Value $0 $0
Taxable Value 1 $395,933 $274,733 $249.
Benefits Information Regional
Benefit Type 20161 2015 2014 Exemption Value $0 $0
Non-Homestead Ca Assessment
Taxable Value $395,933 $274,733 $249.
Cap Reduction $117,157 $48,044
Note: Not all benefits are applicable to all Taxable Values(i.e.County, Sales Information
School Board,City, Regional). Previous OR Book-
Sale Price Page Qualification Description
Short Legal Description Financial inst or"In Lieu of
10/12/2015 $285,600 29846-2556
MIAMI SHORES EXT PB 43-40 Forclosure"stated
LOT 17 BLK 219 Financial inst or"In Lieu of
LOT SIZE 104.900 X 121 07/23/2015 $250,100 29717-2970 Forclosure"stated
OR 14622-1233 THRU 1238 0690 4 01/01/2005 $275,000 23046-2669 Other disqualified
COC 23046-2669 01 2005 6
11/01/2003 $177,500 21871-1593 1 Sales which are qualified
The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appra
and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hftp://www.miamidade.govfinfo/disclaimer.asp
Version:
http://www.miamidade.gov/propertysearch/ 10/19/2016
Detail by Entity Name Page 1 of 2
3 �
y Name
Deta
II by EntiL-L
Florida Profit Corporation
Filing Information
Document Number P15000047871
FEI/EIN Number 47-4184173
Date Filed 05/29/2015
Effective Date 05/29/2015
State FL
Status ACTIVE
Principal Address
5600 SW 135TH AVENUE
STE 109
MIAMI, FL 33183
Mailing Address
5600 SW 135TH AVENUE
STE 109
MIAMI, FL 33183
Registered Agent Name&Address
MULTI-BUSINESS CENTER CORP
8051 W 24TH AVE
STE 8
HIALEAH, FL 33016
Officer/Director Detail
Name&Address
Title P
5600 SW 135TH AVE STE 109
MIAMI, FL 33183
Annual Reports
Report Year Filed Date
2016 04/28/2016
Document Images
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/19/2016
lbs -
CAIBAI CONSTRUCTION, LLC
Date : 10/25/16
State of Florida
County of Dade
Before me this day personally appeared JOSE LOSA who, being duly sworn, deposes and
says
That he or she will be only pers" working on the project located at:175 NW 109 ST. MIAMI
SHORES. FL 33168.
Sworn to (or affirmed) 2nd subscribed before me this ?--I day of �r 20 , by
Personally know -
OR Produced Identification
Type of Identification Prod e
° NEIOY CERTAIN
Notary Public-State of FWAa
Commission rK GG 008785
' „«o?;°,'� My Comm.Expires Oct 3.2020
"'��"" Bonded throw h Nat n a;y Assn.
Print ,Type or Stamp Name of Notary
♦5t{URES r'I
s� `g Miami Shores Village
Building Department
re *1o,� 10050 N.E.2nd Avenue
IORiDA 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.
Signature
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this �z —day of ,20
By�_ 'j CC,9)"l*k C ` who is personally known to me or has produced
as identification.
No -- 4 �11�„ „ CERT of Florida
baba•BG ON785
SEAL: Comm. od 3,2020
'••:'Fosters wry Assn.
q/11111
PROPSiTY ADDRESS: SHEET
175 NW 109 STREET MIAMI SHORES,FL.33168 U17
'°" '►1�A® � �F8 rFLOOD ZONE INFORMATION:
COMMUNITY NO.120652 PANEL NO.0139 SUFFIX L - - - - - - - - - - - - - - -
FIRM DATE:09.11-2009 FLOOD ZONE:X o�
LEGAL DESCRBn=: FOUND 1IY0 15' ALLEY `°� b°° FOUND 1/2'0
LOT 17,BLOCK 219 OF'MIAMI SHORES EXTENSION',ACCORDING TO THE PLAT (i 3 a /4 " ti !P ; ' 4/o a 9 a B IRON PIS, / 104,85,(R&M) PAVEMENT RON PIPE
THEREOF,AS RECORDED IN PLAT BOOK 43,AT PAGE 40,OF THE PUBLIC RECORDS !
r b !r � � � � • - � 1° 10'ASPHALT (NOIJ).)
tI� w !6 - - - - —
OF MIAMI-DADE COUNTY,FLORIDA. :I '� HIGH OD v
I 14 5
' / h P! n IhPSURVEYORS NOTES wo .2
LEGAL DESCRIPTION WAS FURNISHED BY THE CLIENT. n
{ '4P �Oo
LEGAL DESCRIPTION SUBJECT TO ANY DEDICATIONS,LIMITATIONS, 0.11
s ALMOND TREE
RESTRICTIONS,RESERVATIONS OR RECORDED EASEMENTS. N t saeo.v aeo .v s ,�ti0=3.0'+/- W
3
S
.so
-- 3Y$e ••/NYS. y, ee 6 H=35'+/- �.� Lu-.rlc. IN*
=
THERE MAYBE LEGAL RESTRICTIONS ON THE SUBJECT PROPERTY THAT ARE NOT � � C 45'd-
�
SHOWN ON THE MAP OF SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS w " POOL
a
OF MIAMI-DADE COUNTY,OR THE RECORDS OF ANY OTHER PUBLIC AND PRIVATE m z �� )S�� �"r ,b �; 30.5'
ENTITIES AS THEIR JURISDICTIONS MAY APPEAR LOCATION MAP N Lu
o n, U��( CON� 16. ' wLU
THIS SURVEY WAS CONDUCTED FOR THE PURPOSE OF A BOUNDARY SURVEY (NOT TO SCALE) LL
¢ a � t "/�� z o
ONLY AND IS NOT INTENDED TO DELINEATE THE REGULATORY JURISDICTION OF C t V E D o LL o
ANY FEDERAL,STATE,REGIONAL OR LOCAL AGENCY BOARD,COMMISSION OR S N = O B 9 G 1 o =
OTHER ENTITY. N OCT1 1016 9
THE ELEVATIONS OF WELL-IDENTIFIED FEATURES AS DEPICTED ON THIS SURVEY + le `x" 17,B
AND MAP WERE MEASURED TO AN ESTIMATED VERTICAL POSITIONAL ACCURACYv-x 41
OF 1/10 FOOT FOR NATURAL GROUND SURFACES AND 5/100 FOOT FOR J_ �. 26.6' P.B.43,PG.40
HARDSCAPE SURFACES,INCLUDING PAVEMENTS,CURBS AND OTHER MAN-MADE Z 5' /- 12:9 a' z
FEATURES AS MAY EXIST. W I AG r _)z o5 a 5,3' WOOD N X o
c o o Y t- �r
a c / f c � W d
SCALE:
BSAA a /1 �- / 5.T vi otf
WELL-IDENTIFIED FEATURES AS DEPICTED ON THIS SURVEY AND MAP WERE e�J�sALL�0 1" 0 64A� L- Q L o w / / / �6.6 ' / 9' v)
MEASURED TO AN ESTIMATED HORIZONTAL POSITIONAL ACCURACY OF 1/10 FOOT W 0 cm 73 ?1: / F56 .1 y // / W �
UNLESS OTHERWISE SHOWN. m cd
THE MAP OF SURVEY IS INTENDED TO BE DISPLAYED AT THE STATED GRAPHIC ® p r o / ��� // /
SCALE IN ENGLISH UNITS OF MEASUREMENT.ATTENTION IS BROUGHT TO THE G7 W a` / / / Q2
FACT THAT SAID DRAWING MAY BE ALTERED IN SCALE BY THE REPRODUCTION EtdD z' ( o m x v O.T
uj
PROCESS UNIT _ Ir ;�•� o � 5g/
ALL MEASUREMENTS SHOWN ARE IN THE UNITED STATES STANDARD FEET *b4ATION
ER UNE Q 26 6' 10 / / /� / 3
REFERENCE BENCH MARK:N-566 ELEVATION:10.78 FEET(N.G.V.D.1929) ow Q I O ( U W 06/x' PINE TREE LLILL-LLL 'TLLLLLLLL 1 . 2'
'� m Z FOUND 1@'0 ! 0=1.8'+/- ORCH �` GP • •
SHOWN ELEVATIONS ARE REFERRED TO N.G.V.D.OF 1929. PERTY LINE t) ¢ ¢ IRON PIPE H=1T+I " '•• • •
• • •
THE SURVEYOR MAKES NO REPRESENTATION AS TO OWNERSHIP,POSSESSION "lwO 0, (NO I.D.) ; C=15+/_ I •• • •• ••
OR OCCUPATION OF THE SUBJECT PROPERTY BY ANY ENTITY OR INDIVIDUAL. T o6 • • • •'
ABBREVIATIONS TIONS In a I R, .. L� • ••••i•
CL
SUBSURFACE IMPROVEMENTS AND/OR ENCROACHMENTS WITHIN,UPON, AIC=AIR CONDITIONER UNIT > ® ^"- M • • • :*Get:
R=25.00 1 ORCHID TREE
ACROSS,ABUTTING OR ADJACENT TO THE SUBJECT PROPERTY WERE NOT ® o� =396 *so*** * •
U 0=1.8'+/ PINE I�c•r•
LOCATED AND ARE NOT SHOWN. A=CENTRAL ANGLE(DELTA)LL_
Cc ••s•r
�. D=89 5855 0=1�'-K . •
• ••• •• •••••
NOT VALID WITHOUT THE SIGNATURE AND ORIGINAL RAISED SEAL OF A FLORIDA CONC.=CONCRETE cL I C=20'+/- H=15'd• • 6h• • •
LICENSED SURVEYOR AND MAPPER.ADDITIONS AND DELETIONS TO THIS MAP OFn 38.7 C=I I/ �' �� •' • ••+•••
0=DIAMETER _-__._ i 6 •• •. •
SURVEY BY OTHER THAN THE SIGNING PARTY ARE PROHIBITED WITHOUT THE ^06 o� 79.96'(R&M) ��` o • e9 '
F.F.EL.=FINISHED FLOOR ELEVATION ° ��� ••
WRITTEN CONSENT OF THE SIGNING PARTY. I r. • •
H=HEIGHT .,b FOUND100 ( 5'JrOIdC S�EVYfC� • +F:
THIS MAP OF SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE �`'. I IP �' 'f+.*•'
ENTITIES NAMED HEREIN AND THE CERTIFICATION DOES NOT EXTEND TO ANY I.D.=IDENTIFICATION NO BJ E� FOUND 1/2.0 • �RON
UNNAMED PARTY. L=LENGTH PIPE •• F(WHEN USED IN CURVE DATA) OUNDa E31th Miami-Daam -Da C • CONC. (NO I.D.) 14'PARKWAY PIPEPE
CERTIFY TO: PG.=PAGE `. D.S. L'I I P fO a~` - AMP (NO LD.)
GINA BARROSO AND KELLEY MITCHELL
P.B.=PLAT BOOK
Applic n No.:
SURVEYO"CERTSCATION: R=RADIUS I i'
IN MY PROFESSIONAL OPINION,THIS°BOUNDARY SURVEY',MEETS THE � e — 17 ASPHALT PAVEMENT
STANDARDS OF PRACTICE AS SET FORTH BY THE FLORIDA BOARD OF (R&M)=RECORDED&MEASURED [� �O 5'CURB ?,
PROFESSIONAL SURVEYORS AND MAPPERS IN CHAPTER 5J-17.05 FLORIDA ' Sig natu
ADMINISTRATIVE CODE,PURSUANT TO SECTION 472.027,FLORIDA STATUTES.
AND,IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. N.W. 109th STREET
3W SlRVFfM AND MAPFMG,LLC MEDIAN GRASS 75'PUBLICRIGHT-OF-WAY
FLORIDA CERTIFICATE OF AUTHORIZATION N0.LB 6356 OPIGWL 11-11-2015FED DATE A7N 360® SURVEYING AND MAPPING, LLC -
roe No. 1511-0277A LAND SURVEYORS-LAND PLANNERS \ 5 CURE
R' 2000 S.W.83RD COURT MIAMI,FLORIDA 33155 tom` 12 ASPHALT PAVEMENT
OSCAR E. -`CUSID0,P.L.S. 0402-2016 ADD TREES
REGISTE D SURVEYOR PHONE:(305)265.1002 __�-