DS-12-2087Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 181150 Permit Number: DS -11 -12 -2087
Scheduled Inspection Date: January 28, 2013
Inspector: Bruhn, Norman
Owner: PORTILLA, ALEJANDRO & HEATHER
Job Address: 9130 NE 10 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: MEGATREND INC
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060030020
Phone: (305)305 -2213
Building Department Comments
EXCAVATE GRADE AND INSTALL NEW BRICK PAVERS II
DRIVEWAY AND WALKWAY
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 25, 2013
For Inspections please call: (305)762 -4949
Page 8 of 28
t
IlliMCTLEVLE1
02A1Virc NOV 0 2 2012 Miami Shores Village �YeO�_�•
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949,
FBC 20
BUILDING Permit No.1l../l> >21 -O l
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING
JOB ADDRESS: q130 30 ,f N I D Ave-
City: Miami Shores
ROOFING
County: Miami Dade
Zip: 33/3e,
Folio/Parcel #:
Is the Building. Historically Designated: Yes NO
Flood Zone:
I OWNE : Name (Fee Simple Titleholder): AledArt.D fOQ"1"1 L14 Phone#:
Address: tso 4E.
City: r ` Akl Sq- O 2 State: Zip: 3-3 1
Tenant/Lessee Name: Phone#:
Email:
h- e c 1 10c. .
CONTRACTOR: Company Name:
Address: ea. I `:a c ■).) e 1--�
City: i 1 a Dey) -4 State r
Qualifier Name: OV\ VC) .S-r) State Certification or Registration #: C 6C. I Si 3S a S
Contact Phone #: 30s 30s- 22k 3 Email Address:
DESIGNER: Architect/Engineer:
Phone#: :;05- 30 S . � 13
Zip: 3 e
Phone #: X0 .s"". 2 1
Certificate of Competency #:
0
Phone #:
CI 4
Value of Work for this Permit: $ t 9519 56 I Square/Linear Footage of Work: �� 9 &
rJ
Type of Work: °Addition °Alteration °New DRepair/Replace °Demolition
Dexctiption of Work:/ € )LC Os\10.--c s c1iot (e - o w) 9i(tR7VO t\\ P
Color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ (0210 •f( )
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, RS, HEATERS, TANKS and AIR CONDMONERS, 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 be a ' and a reinspection fee will be charged.
Signature
Signa
�-1
Owner or Agent / Contractor
The foregoing instrument was acknowledged before me this l The foregoing instrument was acknowledged befo
day of �' 64 , 20 jby ACC7 v i1Z2tJIlly of 140V
,20II-, by
who is personally known to me or who has produced who is personally known to me or who
As identification and who d� id tke n oathi .
NOTARY PUBLIC:
NOTARY PUBL14MISSON# DD865341
tie_
... 4�
—
MYCOMM SSION EXPIRES: March 02 2013
1 ^ ��F4o;:"ct�% Bonded throu
Sign: � Sign:
Print: - o'� S , .• i su Print:
My Commission Expires:
/////60 A
****************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
J
My Commission Expires:
t- Lr-P47 b21 2a °3
APPROVED BY
/Ci1J9- Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 7952204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTOON)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: 1 \k1 1 G -11Gl 1 \ L
BUSINESS ADDRESS: Z 1. �S �' � 1 1 pCITY AA let AA i
STATE -' ZIP CODE 3 31 b 9
BUSINESS PHONE: ( 5—)l 3 22-P17 FAX NUMBER ( KW). S 31 1 1
CELL PHONE (3( ),S0 5- 7--213 QUALIFIER'S NAME: LT )k b ()1�
Ai QUALIFIER'S LIC NUMBER: ( & 3 `3 j B
E -MAIL ADDRESS (IF APPLICABLE): 3 1 -C 1 1 - b - - -
Created on 3119109 BY PALM /RV 3126109 MY
PERMIT # OS 1
CONTRACTOR: 1 IVCO
SUBMITTAL DATE: U 21-1 I2_,
ADDRESS: 3Q NE. 10 A/
NAME:
RESUBMITAL DATES:
I
11.4 12,-
PROJECT TYPE: ,
i /r/
FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRS /DERM
PLUMBING
NOC
MECHANICAL
I �`
1
BL G � \
4
CERTIFICATE OF LIABILITY INSURANCE °'"'""`
11101/2512
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HoLoEi . THis
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OP INSURANCE DOws NOT coNs mrTE A CONTRACT BETWEEN THE ISSUING INEuRER(B), AUTHORmED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It NM uarlitnade holder he an ADDITIONAL INSURED, the poIl0y(i? min be endorsed. If ri--r=- TION IS _', subject to
the tense arid conditions of the policy, certain pohiahes may require an endorsement. A statement on this cerblicate dors not ter reghd9 to the
certifingte homer In I1oU Of Mich s}.
Monet PMT Durance Brokers, LLC
10001 Old Cutler Rd. Ste. 640
Mlantl, FL 331$7
SWUM MEGATREND INC
MEG SW ST FL
MIAMI, FL 33189
COVERAGES CERTIFICATE NumBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE UsrED BELOW HAVE BEEN ISSUED TO THE INSURED WISED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTwaHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT %MTH RESPECT TO WHICH THIS
MITIGATE MAY BE ISM OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER IN IS S*JBJECt TO ALL THE TERMS,
EXCLUSIONS AND COMMONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
soft r
Nis
TYPE OFIId$II • Fumy L1�1" Lana
QE4?RALU5fl&rr'I A 7 GDIDIERDIAL MEDAL LIABILITY 1,000,O#0
0911711012 2013
PI g m $ 100,000
CLAMS— CLAMS-MAGA OCCUR MED E1(P (Any one Pte') s 5
PEasoNAL s sew INJURY $ 1,000.000
OISMALASGREGAIE
PRODUGrs- COMPFOPABG
NS1213427
0
/
EXCESS - r� —LI�AB El mAdAA3 4ADE
DED I 1 REENfQI4_
WORKERS TIan
AND EMPLOYERS'minim
YIN
0ANYFR RJEtY}Rmn�T n
!
OFa:ICE r� MD
E�iChtHY!$?
IfIARIPTION OP OPFRAT 31∎IS rani
,-.--.1 11
24906
N1A
08117/2012
09/17/2013
$ 2,000,000
$ 2,000,000
3
BODILY INJURY (Fermi) $
BODILY INJURY(Peraeddong
TYWERTY DAMAGE
$
6
$
EACH OCCURRENCE
$ 4,050,000
AGGRAVATE
,Tn9Y rT3 t3Z
4,000,00D
S
EL EACH ACCIDJ NT
EL DISEASE -E4 EmpLOYEE
EL DEWS- POLICY UMTT
s
a
Ca t VALDGAIRMS t wash AGORD lot, wand Rarers ua,Ramrewen18
CERTIFICATE HOLDER
Miami Shores Wage Building Department
10050 NE 2nd Ave
Miami Shores, Fl 3313
ACORD 2S (2010105)
CANCELLATION
SHOULD ANY OP TIB3 AB:OVL DEBDEIDED POLICdrali en OANCELLSE BEFORE
THE w aren=N DATE THEREOF, NOTICE WILL BE DELIVERED IN
AcCoaomicE WITH POLICY
AUTROREED
Owan Taylor
A291720
01
The ACORD name and logo are registered marks
Produced egg Rum Bean Web Masan o Ingseeedoo Publish 1300 -295-1371
71014. All rights r+
;'STATE 4F FLybRfD11 — `- �_---- --.,.,
, AC#E 2 481:7
OF EC'SIRESB
PROFESSI .
�! GIILATf ON
CGC151358
IS cERTIFIE,p under the -pmov jo or ts►' 4 99 as
Exixa4par. date: AUG 33.,. .2014 ..Li207220 0105 >'
FIRST-CLASS
US. POSTAGE
PAID
WAN, FL
PERMIT NO. 231
THIS IS NOT A BILL - DO NOT PAY RENEWAL
609595 -4 635855 -0
9K1M� . STATE1'13585
21356 SW 87 PL
33189 CUTLER BAY
paEC3ATREND INC
SliTegEltigrAT. BUILDING CONTRACTOR
. Ti88 IS AMY A LOCAr.
TAX ENCESPL IT
DOES NOT PERM! ROL088 TO V6 �
EXISTING REILUATORY OR
COUNTY OF �p'RES. AMR
DOES IT EXEMPT NW
HOLDER H10M PJIY 01188
paw OR =ESE
RECONRED BY LAW. W
,18 moiters 88
PAYMENT REGGAE])
COUNTY TAX
COLLECRNA
07/23/2012
09010073001
000045.00
SEE OTHER SIDE
WORKER /S
1
DO NOT FORWARD
MEGATREND INC
DEVON DOBSON PRES
21356 SW 87 PL
MIAMI FL 33189
Juiirr,lhjIIrrgrIr�rri rrrirr1IutIIuIr1Irl*IldIuhr 69
ANCR
CJEFF HIEF FIN
F FINANCIAL OFFICER STATE OF FLORIDA
CHIE
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 9/14/2012 EXPIRATION DATE: 9/14/2014
PERSON: DOBSON DEVON
FEIN: 202632578
BUSINESS NAME AND ADDRESS:
MEGATREND INC
21356 SW 87TH PLACE
MIAMI FL 33189
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL
CONTRACTOR
Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may
not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope
of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the
person named on the cerffcate to meet the requirements of this section.
DFS- F2 -DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)413 -1609
NOTICE O! COMMENCEMENT
A BEC011020 COPY MOOT BE POSTED 01.1111 JOB SITE AT 11ME OF MGT INSPECTION
PERMIT NO 1AX FOLIO NoJfr 320p4-10G3- OUZO
BTPTE OP FLORIDA:
COUNTY OF MIAMI•DADE:
THE UNDERSIGNS) hem gives notice that improvements will be mado'to certain rest
property, and in aooaldenoe with Chapter 713, Florida Statutes, the following Information
is prodded in this Notice of Commencement.
description of property and
Pt OF
2. Demon of Improvement
3.Owner(s) name and address:M
Interest ht property:
Name and address of fee simple titleholder:
address - phone number:.
CFN: 20120795982 BOOK 28345 PAGE 1665
DATE:11/05/2012 06:27:27 PM
HARVEY RUVIN, CLERK OF COURT, MIA -DADE CTY
Bpsoe above rear ad far use of r*o rdlas esles
5. Surety: (Payment bond required by owner ism
Name, address and phone number:
Amount of bond $
6. Lender's mane and addresw
T. Parsons within the State of Florida dealiwated by
Section 713.13(!)($7., Florid* Statutes.
Name, address and phone number:
contractor; I any)
Owner upon whom rtioes or other documents may be served as provided by
8. in adt8tion to himself, Owners designates the %Oowi ng person(s) to receive a Dopy of the Uenor's Notbe as provided In Section
713.13(1X4 Ronda Statutes.
Herne, address and phone number:
E. Expbation data of this Notice of Commenoanent:
(m.ezetdion dale ss 1 low few the diesel moodrd Woe • Moore mil*$eedileo)
wartime TO MOM ANYPAYh�fi8MADEBYTHEOMR tAFTERTHE OFIHENCRKEOF00[MM AE TAf CONT�
IMPROPER PAYMENTS UNDER CKAPTER 718, PART!, SECTION 718.13. FLOHIDA MUTES, AM) MN RESUL.T Ii YOUR Pr1YN3 IFOFr
IMPROVEMENTS TO YoUR PROPERTY. A NOTICE OF COMMENCEMENT haw SE RECORDED AND FOOTED ON THE J05 en BEFORE THE
FIRST INSPECTION. IF Y O U INTEND 10 O B T A I N FINANCING. CONSULT WITH YOUR LENDER OR A N /STORMY M RE C 1G WORK
OR REOORDING YOUR ::: OF CCMMENCEMENE
%paha**o
Prepared By
Print Name
•ef
ETATH OF F .ORI A
COUNTY OF MIAMI - ADE
The foreArt- i o bell me 2i day of
,Ihda,Idh or CI as I� for
0 Personally Iaiown, or produced the blowing type 7
Signatum o ►P �:
Part Nam*: ' •
(SEAL)
Under psnahlt*e of perjury,1 declare that 1 have read the foregoing and
that the facts stated In 11 We bus, to the best of my knowledge and belief.
O G ' r d 8 , k1 -
zetZ
VENEICECAMMOCKTENNANT •
NOTARY PUBLIC, STATE OF FLORIDA
COMMISSION# DD865341
EXPIRES: March n2 ?01)
ugh 1st qt"
mss) of or owner(:)'5 Authorized olficer/Dbector/ParhheN whom
BY By
117API-a RIMS ant
PERMIT #:
i Contractor
Owner
D Architect
Picked up
Address:
Miami Shores VllIage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
DATE: ) It
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building 3epartmentto continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE: I a,
PERMIT CLERK INITIAL:
Miami Shores Vivage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No: DS12 -1756
P & Z Critique Sheet
1) PROVIDE PLAN THAT IS TO SCALE.
DRIVEWAY CONNECTION ON SWALE CAN NOT EXCEED WIDTH OF DRIVEWAY
ON PLOT PLUS 2 FOOT FLARES.
CIRCULAR DRIVEWAYS ON SWALE CAN NOT EXCEED 10 FEET IN WIDTH.
CAN NOT COVER MORE THAN 50% OF THE SWALE OR 50% OF THE FRONT
YARD WITH HARD SURFACE.
DAVID DACQUISTO
305 - 762 -4264
Building Critique Sheet
1. Provide HRS /DOH approval.
Norman Bruhn BO
305.795.2204
STOPPED REVIEW
Plan review is not complete, when all items above are corrected, we will do a
complete plan review.
If any sheets are voided, remove them from the plans and replace with new
revised sheets and include one set of voided sheets in the re- submittal drawings.
Kick Scott
Governor
(Veneice Cammock Tennant)
1495 SW 1 Street
Homestead, FL 33030
RE: Contingency Letter
Application Document No: AP1089522
Centrax Permit Number. 13-SC- 1441528
OSTDS Number.
-9- 130 -NE -40 Ave
Miami, FL 33138
November 28, 2012
John H. Armstrong, MD, FACS
State Surgeon General
Lot:2 Block:1 Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 11/26/2012 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
From a review of your completed application, it has been determined your existing system is
adequate for the proposed use.
This permit is granted for the construction of a new brick pavers installation. There will be no
increase in sewage flow or characteristics and no impact on the unobstructed area.
* **'"*"* " ***"***APPROVED
If you have any questions on this matter, please call our office at (305) 623 -3500.
Sincerel
Enclosures
cc:
e Gumbs, Engineering Specialist II
Miami -Dade County Health Department
1725 NW 167 St, Opa Locke, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com
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APPROVED
70NINC DEPT
BLDG DEPT
SUBJECT TO COMPLIANCElMI'rH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
•
MIAMI-DADE COUNTY HEALTH DEPARTMENT
PERMIT* I V O t5 2
DATE: I i 2$`2Ol L