DS-12-1128Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 174992 Permit Number: DS -6 -12 -1128
Scheduled Inspection Date: August 15, 2012
Inspector: Rodriguez, Jorge
Owner: POLANCO, DEYSI
Job Address: 1183 NE 91 Terrace
Miami Shores, FL 33138-
Project: <NONE>
Contractor: DISTINCTIVE HOMES
Permit Type: Driveways /Sidewalks/Slabs
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1132050010200
Phone: (305)279 -2088
Building Department Comments
NEW OLD CHICAGO BRICK DRIVEWAY
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 14, 2012
For Inspections please call: (305)762 -4949
Page 12of34
d
ETNTY
TAX COLLCOR
140 W. FLAGLER ST.
1st FLOOR
MUM, FL 33130
2011 LOCAL BUSINESS TAX RECEIPT 2012 FIRST -CLASS
MIAMI -DADE COUNTY - STATE OF FLORIDA I U.S. POSTAGE
EXPIRES SEPT. 30, 2012 PAID
MUST BE DISPLAYED AT PLACE OF BUSINESS j MIAMI, FL
PURSUANT TO COUNTY CODE CHAPTER BA - ART. 9 & 10 ; PERMIT NO, 231
320857 -6 RENEWAL
eU I A_NAME C p�Wpp . 334265-6
TICIVE HOMES STATE# 57514
5535 SW 112 CT .
33165 UNIN DADE COUNTY
OWNER
JOSE M GOMEZ WORKER /S
sectTYg° %Et`SEM BUILDING CONTRACTOR 1
-mut IS ONLY A I.00AL
IIUE*NESS TAY. RE' ^:•IPT if
DOES HOT PERMIT THE
IIOLOER TO VIOL ATP- ANY
xlsnnO RECULArURY OR DO NOT FORWARD
70111116 LAWS OY THE
COUNTY OREECOII�tyS. NOR
Hr]LOYR AX 741G)
1)IFrAA
PFRNIT OR L1:71TNSE
FtEQUIREU DT t AW. THIS IS
NOT A CERTIFICATION OF
THE ROWER'S QUPL)FTCA-
TIOHS.
PAYGt6NT RW EIVEG
TMAAtl.DADE COUNT/ TAX
COLLECTOR:
07/21/2011
nQA1flR 1nflt
990z6LZSEl 2
DISTINCTIVE HOMES
JOSE M GOMEZ
5535 SW 112 CT
MIAMI FL 33165
S3WOH 3AII3IMIISIQ WV LT: T [ zT— zz —Nnr
JEFF ATWATER
CHIEF FINANCl/LL. 0
* * CE
c ONSTRUCTI
This certifies th
EFFECTIVE D
PERSON:
FEIN:
BUSINESS N
U M G INVES
DSA DISTINCT
15535 SW 112
MIAMI
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
IPICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW >*
INDUSTRY EXEMPTION
the individual listed below has elected to be exempt from Florida Workers' Competlsation law.
03- 1502012
:SCOPES OF
1- RESIOENTI
04/20/2012
GOMEZ
650474081
AND ADDRESS:
S INC
HOMES
FL 33165
EXPIRATION DATE: 04/20/2014
JOSE M
SINESS OR TRADE:
BUILDING 2- BUILDER
IMPORTANT: Pursuant
section may not recav
scope of the business
'faction to be exempt
Certificate no toager
named on the codified
C -252 CERTIFICATE
Chapter 440. 05(14), F.S., an officer of a corporation who elects exemption from this chapter by tiling a certificate '1 election under. this
btinelits or compensation under This chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only withle the
dude listed an the notice el election 10 be exempt. Pursuant to Chapter 440.05413), F.S., Notices of election to be ox end and cerlilkttes of
11 be subject to revocation if, at arty time alter the filing of the notice or the Issuance el the certificate, the person ,named on the notice m
s' the requirements of this section for Issuance of a certificate. The department shalt revoke s certificate at any tine i for falter. of the perdu;
r.to meet the requirements of this section.
QUESTIONS? (soy 4141.4.
ELECTION TO BE EXEMPT REVISED 01 -11
£0'd 990Z6LZS0£ S3WOH 3AI13NI1SItI Wl3
81:1T ZT— ZZ —Nnr
rn:tireiN11I.na.r1'I_VILID WN-14H3SfflYNtallIZALTARN 01,;i11kal[tlliffi ILLIMill21ra.uaur.r_.0 -
STATE OF FLORIDA
DEPARTMCONSTRUCTION$ INDUSTRYRLICENSINGGLBOARDLATIONj
$ECI# IA2060601249
lei i E' E 7 'CH NUMBER
LICENSE NBR
06/20X2 1.0+415298 CGC057514
e. GENER iL • . TRACTOR
-.d below CERTIFIED
r the: pr 0.sions of Chapter 489 FS.
iration d.`te: AUG 31, 2014
QOMEZ.; J• - MIGUEL
DIS'T'INCT HOMES
5535 SW 1 COURT
MIAMI
RICK
40VE
TT
R
FL 33165
DISPLAY AS REQUIRED BY LAW
KEN !LAWSON
SECRiETARY
0'd 990Z6LZ502 S3WOH 3AIiONIISIQ WV GT:TT ZT- zz -Nnr
aqla
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type
JOB ADDRESS: ®/ 3 6 `71 / err
County: b ctel e Miami Dade Zip: 3 3 / 3�
Permit No.
d JUN 2 ozusi2
b
Master Permit No.
ROOFING
City: Miami Shores
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
Flood Zone: E
OWNER: Name (Fee Simple Titleholder): l) may.( Po ' a /) W Phone#: 78C0-07,1-E? f / %
Address: vZ ,3 -7 5 vr7 5 e:�- Si-rip
City: S.0 r) ("5 State: F L Zip: 33 3 a.
Tenant/Lessee Name: Phone#:
Email: d E-41 sA ,r, etc) (on c,c
CONTRACTOR: Company Name:
Address: 5:5 3 5 S 60 11 G�
L lit -nCI, v
Air r'r7'5 Phone#: 306 ?7 ` 0`x088
City: %4" a rn , State: F Zip: �`3
Qualifier Name: 1 C10/11 Phone#:
State Certification or Registration #: C= ® 5-7-5" jl Certificate of Competency #:
i� y
Contact Phone#: 305 - -.279- AO se Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ / 000 Square/Linear Footage of Work: /060 6qc +
Type of Work: °Addition °Alteration °Demolition
Description of Work: / o-) ride 61.20-1
Lit few ORepair/Replace
in Sitk Chino n
Color thru tile: 'rear
10e4. /741-.4
***********e****** **** **** **** **+x******F **** ** * * **************w * * *e**** ********* ***
Submittal Fee $ Permit Fee $ /_S..00 4‘) CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ jI a °Vfl
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, HEATERS, TANKS and 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
delivered to the person
e posted at the job site
uch posted notice, the
promise in good faith that a copy of the notice of commencement and construction 1' %+ ochu
whose property is subject to attachment. Also, a certified copy of the recorded no
for the first inspection which occurs seven (7) days after the building permit
inspection will not be approved and a reinspection fee will be charged
Signature 1�
Owner or Agent
The Irstrument was ac ' o wledge4 bef. °� W The fo in instrument was kno
day . 20 1 Qby `► i �, r l day of , I 1 20 laby
As identificatdon and who did take an oath. 411r0 onall known me or who has produced tification and who did take an oath.
w persanall .. ,..'to me or who . • produced
Sign:
Print:
My Commission Exp
NOTARY PUBLIC:
Sign:
Print:
My Co
*****+ k*+k*+k+b*+k******** *** * * *******# *Ks*** ***+ k*************+k**+A******
APPROVED BY
4<2,2-41
Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
CLAUDIA
ssig i>ses' Public - State of Florida
�,, 'Notary
,: My SeP 23, 2015
*
? • Q.` Commission # EE 128810
, T r ' ugh National Notary Assn.
Zoning
Clerk
Miami Shores Vivage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) .21Ey$1 PoceiniC.0 hereinafter referred to as the owner of
//4"3 AJE 4j/-17L r- r
the following described property (address):
R ocn Jhorcs FL 33/3 g
Legal Description Lot a3 Block Subdivision
Folio #
Requests permission to install (describe work): r; Ve tetra y
Within the public right of way of (address) / �.� ti' `'//
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.
1
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 authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this Q-0 day of (7MICJ , 204—)
I1V �s
Ct.P.1100. Ctat ptotida
State 2p15
``hC`yt,PUg� C NotatY QmbExPtites Se 123, 0
• Comission # E otat1 Assn.
Bo• nded Shtou9h MVO N
2
(Owner's Signature )
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Explres:Not Issued
Folio Number:1132050010200
Owner's Name: DEYSI POLANCO
Owner's Phone:
Job Address: 1183 91 Terrace Total Square Feet: 840
Total Job Valuation: $ 5,000.00
Miami Shores, FL 33138-
Contractor(s)
DISTINCTIVE HOMES
Phone
(305)279 -2088
Primary Contractor
Yes
1
Planning and Zoning Criteria and Comments
Approved: No
Date Denied:
Comments: PLEASE CONTINUE DRIVEWAYS SO THEY EXTEND THROUGH SWALE TO ROAD SURFACE
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number:1132050010200
Owner's Name: DEYSI POLANCO
Job Address: 1183 91 Terrace
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 840
Total Job Valuation: $ 5,000.00
Contractor(s)
DISTINCTIVE HOMES
Phone Primary Contractor
(305)279 -2088 Yes
1
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/21/2012 : Yes
Comments: PLEASE CONTINUE DRIVEWAYS SO THEY EXTEND THROUGH SWALE TO ROAD SURFACE
6/21/12
NEW PLAN OK
FLORIDA BUILDING
J..,1,., urEr „u J..J.e..TJO.
BOUNDARY SURVEY
PROUDLY SCRIMS FLORIDA COAST TO COAST
1 t817)- 884-80o1
www.FloridaLandSurveying.com
2400 'AEST 80
FLORIDA 33T 0
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i I NOTE:
BM USED
DADE CO. BM # B-62
1V0 5/ ELEV. =B -74'
74.98'0
7500(R)
i 80. '(R) 80.14 M)
.1. N� 1�89.07'00tJ 16'
l
2
(REDUCED TO: NGVD 1929)
•.,
SOP 18'A8PAALT Rp'�.
tr
N.E 91st TERRACE
LEGAL DESCRIPTION:
LOT 23, LESS THE WEST 15.00 FEET, AND THE WEST 45.00 FEET OF
LOT 24, BLOCK 1, OF "WATERSSEDGE ", ACCORDING TO THE PLAT
THEREOF, AS RECORDED IN PLAT BOOK 9, PAGE 141, OF THE PUBUC
RECORDS OF MIAMI —DADE COUNTY, FLORIDA.
111833 N.E. 91st 3 rERR ACE
MIAMI SHORES, M. 33138
E.
Ile. R�ecordd' � =". . ,
16 PpWV�AT7 Fragment
OP - Concrete Path R/Tw- Rlgh of WaY
FI.P.- Found' Iron Pips -0. - Wood Fence
C,- Iron Rod and Cop w-- Chain Unit Fence
- Centalkie A /C- Ale Conditioner
P.L. - Property line U.E.- Utility R:asatient—
PAL a Line 13.0.8.. Of Bearing PL a
Skiwalc
Caw a Concrete a< 0 er
CBS Concrete Bodo yr' F-Ueenses Ulm
F° °- � Strookze
g let - Bev.
- ` == •a` '
�pAaFkowuay ` -- ENCRa Enaoachmattt/
P n�� =� .Vlad
FLOOD INFO:
Comma yMonl Dade Co.
1201352
Maapp de Panel / 120860306
Suifbe L
Flood Zone: AE Base Flood Devotion:8.0'
CERTIFIED TO:
DEYSI POLANCO
_
This fey has bon prepared ear the actuate toe
at rte eeU es mAped- MratroaM4her
does not atekd to any,emmned party.
SUR O -'S NO
1— ORNFl1519PISSUBJECT70 OpNIONArTnLE
2—NO UNDIMMED 0 BI ROVEMEN7S MERE LOCATED
RPP '" -
a
SEC. �.{O. ,SECnceb.,
CPF ° - " C ONC. POLE
y g VAI.
by. GV ■ S�_ V
.1. 14
rC/6-
�.
'-'" � , 9+ERlvgy
. �.e,,,tt 1ls$ O "�?
U rss7la N4
* o
ATIONS ARE REFERRED 70 NATIONAL
YERRCAL DATUM OF 1928 PRESS ASSUME)
11EfE MAY BE ANAL A`ES7TdCT1(S4S NOT SHOWN
IN ADS SURVEY THAT MAY BE FOUND IN THE COMFIT
PUBLIC DESCRIPTION
• x D1AOW PROVIDED BY CUBIT
..ti 07HERRBE NOTED RECORDED AND MEASURED ARE THE
--BERNE ART CONSTRUCTION THE SET HACKS
MUST 15E CREVICE)
ALL RED MEASUREMENTS TA /017 THIS SF MOO' MADE
Nl11l ELECTRONIC TRAANT AND STEEL TAPE WAWA 1.7500
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r� MOOD awrweaovm�e era ,
euerosasauy =awe
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CA10..04Y1
I0T•At {1TiN MAPPER
' ' " LB a 781c9opE1e 02032012Me�
THIS SURVEY IS FOR IO1I AS PER
AND NOT IS ANY ISE A PUN
0— THIS SURVEY WAS PREPARED 111AR:UT ALE NETT CF A
COMMITMENTS FOR 7771E WSURANfE
S OF BEARING B�g� ,
OARING BASE SHO • fAtld
HwSEDON swim tax mots 3w2
WOCC4B LNG- S89"Wta'Ew'891BdNa.
R m . rovrvsy i not vraAdr ia+t lia agnaaus
l s W
Registered Professional La Surveyor ad
∎ - ...
The b survey to i *pinion tale and dedications. 16nitatiana
for aaavesoy a amtsskas Sub
I Hereby Cart* That the attached boundary survey of ea property deeortbed
direction also that there ore no above grand encroachments other than those
restrictions or easements of regard. No undergmrmd'� improvements and/or butities were
below le to the best of my knowledge and billet aoourate as recently strayed under my
shown, and that thle gassy meets the minimum technical etandenb est by the Florida
CITY
COPY
SUBJECT TO COMPLIANCE WITH AU. FEDERAL
STATE AND COI INTY RULES AND REGULATIONS