DS-10-2219Scheduled Inspection Date: January 10, 2011
Inspector: Bruhn, Norman
Owner: HUNDERVADT, ROBIN
Job Address: 9100 N BAYSHORE Drive
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ARROW ASPHALT & ENGINERING INC
Building Department Comments
January 07, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 154309 Permit Number: DS -12 -10 -2219
For Inspections please call: (305)762 -4949
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)751 -7624
Parcel Number 1132050010560
Phone: (305)556 -5702
OVERLAY ASPHALT DRIVEWAY OVER EXISTING
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
ee
Page 12 of 18
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
INSR
S VWo
POLICY NUMBER
(MM/D� DD YY
(MOMIDDD/YY�YY)
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
OCCUR
GL0009959
02/28/10
02/28/11
EACH OCCURRENCE
$ 1 , 000 , 000
X
P
$ 100,000
CLAIMS -MADE
X
MED EXP (Any one person)
$ 5 , 0 00
PERSONAL &ADVINJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L
AGGREGATE LIMIT
POLICY n jECT
APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2,000,000
7
LOC
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CA0015433
02/28/10
02/28/11
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
B
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
UMB0010302
02/28/10
02/28/11
EACHOCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
DEDUCTIBLE
RETENTION $ 10,000
$
X
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXEC
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS
Y / N
N / A
1092898
02/28/10
02/28/11
X CSTAT X ca
T LIMITS S ER
E.L EACH ACCIDENT
$ 500,000
E.L DISEASE - EA EMPLOYEE
$ 500,000
below
E.L DISEASE - POLICY LIMIT
$ 500,000
D
LEASED /RENTED
45465147
02/28/10
02/28/11
EQUIPMENT 150,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
MIAMI SHORES VILLAGE
10050 NE 2ND AVENUE
MIAMI SHORES FL 33138
MIAMI S
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
(1)/LA..>--,2-124
® CERTIFICATE OF LIABILITY INSURANCE OP ID CG DATE(MMlDD/YYY`f)
.
12/07/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER -•
BROWN & BROWN OF FLORIDA INC
8000 GOVERNORS SQUARE BLVD 400
MIAMI LAKES FL 33016 -1588
Phone:305- 364 -7800 Fax:305- 822 -5687
INSURED
ARROW ASPHALT &
ENGINEERING INC.
SHAWN O' TOOLE
3051 NW 129TH ST
OPA LOCKA FL 33054
WM IAI.I
NAME:
PHONE
E (A/C, No, Ext):
-MAIL
ADDRESS:
FAX
(AIC, No):
PRODUCER
CUSTOMER ID #: ARROW -4
INSURER(S) AFFORDING COVERAGE
INSURER A : NATIONAL TRUST INSURANCE CO
INSURERB: FCCI COMMERCIAL INS CO
INSURER C : FCCI INSURANCE COMPANY
INSURER D : FEDERAL INSURANCE COMPANY
INSURER E :
INSURER F :
NAIC #
20141
33472
10178
20281
COVERAGES
CERTIFICATE HOLDER
ACORD 25(2009/09)
CERTIFICATE NUMBER:
CANCELLATION
The ACORD name and logo are registered marks of ACORD
REVISION NUMBER:
01988 -2009 ACORD ORPORATION. All rights reserved.
RECEIVED 12/01/2010 05:31 3056725655 DAVIDS CAFE
Fm:Lynn 0 Gold Coast To:Driveway (13056725655) 17:26 12/01110GMT-05 Pg 04-06
R3OTRRVIS
" CRYYt IFS Miami Shores Village
g DEC 1 6 201
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 3313E �� o • . • • • • • • • • • • • • • • • • •' ° °
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 CC
BUILDING Permit No. OS 1 0 — RR )9
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholder): "R oi £ T f- iu..aJ Q , V A ch Phone#: '74 G ca 5 r 3 M
'` � 4.'*1
Address: 9 / oo N . 3 �. y 3 ' ,
City 'n i R .r ■ 5 o tL State: Zip: .3313P
Tenant/Lessee Name: Phone#:
Email: L° 0L73h 1a )ow s 4). O j. C. o rn
JOB ADDRESS: 9 l o 0 040
City: Miami Shores
Folio/Parcel #:
Is the Building Historically Designated: Yes
myaAo 7 t2
County:
Miami Dade
y �v� Vvl�' y 3 05- 6 4% -tb`OP
CONTRACTOR: Company Name : 1 � � � l �Q�-n• � ",one#:
Addres3 OSI S l
City: - bR(ti •�,()P.I,�,a State: t "'^ Zip: 3 3.6 S �
Qualifier N e: 1 *� h � al )!....111 � � ► L! hr. Phone#: �� 3o$- & $ bO(e
State Certification or Registration #: Certificate of Competency #: ` 7 2 O 0
Contact Phone#: I S (O1 0
Email Address: I Y1 1
\/��/�/� /
DESIGNER: Architect/Engineer: Phone#: � lJ l . t o l 'T 1 Q
� �
CD 0
Value of Work for this Permit: $ Square/Linear Footage of Work: II J 0 •s
Type of Work: DAddress OAlteration ONew O3 epair/Replace ODemolition
Description of Work: kc Q "n 4- Nre r t tt A
Zip: ..33 / 3 i
NO Flood Zone:
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
******** ** * * * *** ** * * * ** *** *** * * * * * * * * *, ep ** * * * * ** * * * * *** * * * * * * * ** *** * *** * *** * **
Submittal Fce $ 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 $ 1 . 0
RECEIVED 12/01/2010 05:31 3056725655 DAVIDS CAFE
Fm:Lynn ( Gold Coast To:Driveway (13056725655) 17:26 12I01110GMT - 05 Pg 05 - 06
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
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 approved and a reinspection fee will be charged.
Signatur
Owner or Agent
The foregoing instrument was acknowledged before me thi
day of 4wt ,20
APPROVED BY
(Revised 07 /10 /07)(Revised O6 /10/2009)(Revised 3115/09)(rev6/4/10)
by
whop is personally known to me or who has produced
7 L 1) L As identification and who did take an oath.
NOTARY PUBLIC:
Structural Review
Signature 0 7: 9-11t4---
The forego'
day of 1 1
Sign:
Print:
My Commission Expires:
Contractor (�`�
t was acknowledged before me this - l i
*
who is personally known to me or who has produced
--asideatifieation-and-who-diel-toketr oath.
0AC. "33ION # DD729347
IP.. ' October 25, 2011
rysecvice.com
* * * * * * * *at* * * * * * * * * * * * **
) /c) Zonin
Cler
0 10 20
1 inch = 20 ft.
F.I.P. 1/2'
No I.D.
1.35'
ALUMINUM
GAZE
1.5'
0.20'
F.I.P. 1 /2J
No LD.
LEGEND
A /C. = Air Conditioner
B.M. = Bench Mark
C.B.S. = Concrete Block Structure
CH = Chord
= Center Line
CONC. = Concrete
(D) = Deed
r1= Delta
D.M.E. = Drainage Maintenance
Easement
EL = Elevation
F.F. = Finish Floor
F.I.P. = Found Iron Pipe
F.I.R. = Found Iron Rod
x
40
14.6' PARKWAY
Fnd. = Found
F.N. = Found Nail
F.N&D. = Found Na l & Disc
I.D. = Identification
(M) = Measured
N/A = Not Applicable
N.G.V.D. = National Geodetic Vertical Datum
0/L = On Line
P.B. = Plat Book
PG. = Page
(R) = Record
R/W = Right of Way
U.E. = Utility Easement
LOT 31, BLOCK 2
REMAINDER LOT 32, BLOCK 2
125.00'
4' C.L .
....................... ...............................
SYMBOL
CATCH USN
WATER METER
c urUTY PC.E
ps MANHOLE
ELECTRIC BOX
t `�•t'� COVERED AREA
4...J
x CHAIN LINK FENCE (C.LF)
- off - OVERHEAD LINES
S
0 METAL FENCE (M.F.)
BOUNDAR' URVEY
89'07'00"
0.80'
18.35'
4' C.LF.
x x x
125.00'
BAY COURT (PER PLAT)
57.90'
5300
I
F.I.P. 1/2*
No I.D.
CERTIFIED TO :
1. ROBERT HUNDEVADT AN
2. UJ I1ED WHoLESALE MOs
AS THEIR INTEREST M/
3. KROOP & SCHEINBERG,
4. FIDELITY NATIONAL TITI
PROJECT SITE
SURVEY FOR:
ROBERT AND BERTHA HUNDEVADT
9100 NORTH BAYSHORE DRIVE
MIAMI SHORES, FLORIDA 33138
A HUNDEVADT
3 SUCCESSORS AND /OR ASSINGS
R
ONCE COMPANY
NOT VAUD UM,ESS ENSOSSED'N1H
SURVEYOR'S SEAL
• • rARY 13.�CAST�l..
Rec,�lstered LarrH yor 1Vo. 4129
. .. • •
i a is�f'L
132005 bA R' fi' a fn Yor k5 supW9ers. RD rights reservedt
LEGAL DESCRIPTION:
Lot 33 Easterly 20 feet of Lot 32, Block 2 of "VVATERSEDGE•, according
to the plat thereof, as recorded in Plat Book 9, Page 141, of the Public
Records of Miami —Dade County, Florida.
SUWEYOR'S NOTES:
1) Lands shown hereon were not abstracted for easements, right of
way or other instruments of records.
2) There may be additional restrictions not shown in this survey that
may be found in public records of Miami —Dade County, Florida.
3) No underground improvements were located.
4) Unless otherwise noted, recorded and measured data are in
substantial agreement.
5) Legal description provided by client.
6) This survey must, exclusively, be used for mortgage purposes.
7) Flood Zone "AE" Base Food Elev.: 10.00' as per Miami —Dade County, Florida.
FEMA Community: 120652 and Panel Number: 1202500093 —J March 02, 1994.
8) Bench Mark Used: B -62, Elev. =8.65' of Miami Dade County, Florida
9) This survey leas beel� for the exclusive use of the entities
named'tiereo " z '= Opt' icititn ",: Nreon does not extend to any unnamed party.
• .. . ._..
subeta "tta0
bury =Ives meatQ made- GARY B. CASTEL SURVEYING, INC.
LAND SURVEYORS
•
12016 S.W. 132nd COURT, MIAMI, FLORIDA 33186
(305)253-9720 (305)253-6767
FIELD DATE
07/01/2009
LOCATION MAP
SCALE: (N.T.S)
DATE SCALE: DRAWN BY:
07/02/2009
1' =20'
ELF.
JOB No.
209-