DS-17-140 "� �• - ' "�
M.
Miami Shores Village 3 # p nV*I Ca SX�"v Cl)eTaIkS S)
a 10050 N.E.2nd Avenue NW11 Wolk class* �t to" 4t1
Miami Shores,FL 33138-0000
AP"OVI D
Phone: (305)795-2204
Expiration: 07/23/2017
Issue t at :.112412
017'. .
Project Address Parcel Number Applicant
64 NW 99 Street 1131010330060
Miami Shores, FL Block: Lot: THOMAS TELESCO JR.
Owner Information Address Phone Cell
THOMAS TELESCO JR. 64 NW 99 Street (305)216-6161
MIAMI SHORES FL 33150-
64 NW 99 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 5,950.00
ARTISTIC CONCRETE GROUP INC (305)888-9095
Total Sq Feet: 812
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:RESURFACE EXISTING DRIVEWAY AND Additional Info:RESURFACE EXISTING DRIVEWAY Review Building
Bond Return: Classification:Residential Review Building
Scanning:3 Review Planning
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00
CCF $3.60 Invoice# DS-1-17-62653
DBPR Fee $2.00 01/24/2017 Credit Card $647.60 $0.00
DCA Fee $2.00 Bond#:3300
Education Surcharge $1.20
Permit Fee $125.00
Scanning Fee $9.00
Technology Fee $4.80
Total: $647.60
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 AFFIDAVIT: I certify that a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. FyV authorize the above-named contractor to do the work stated.
January 24, 2017
Authoriz natur . wner / Applicant / Contractor / Agent Date
Building Department Copy
January 24,2017 1
y.
a
Miami Shores Village --
Building Department ! JAN 19 2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 .E Y-
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20 ((4
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: f1.o iyw eI S-�'
City: Miami Shores County: Miami Dade Zip: 33 1'50
Folio/Parcel#: !t"310 r - 033—00 Co Is the Building Historically Designated:Yes NO
Occupancy Type: 2 S Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder) 1 oyh �
Te 1,es C O Phone#: S•390• C2-50
Address: c k)vj Qq 5-j'
I r
City: i6l ►"'I.T S koYe 5 State: Zip: 33 15 0
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Namen"":��Q•C4T5+1 C i�ytcf-- e' G�Cn w Phone#:30 S'W 109 S
Address: C I Zf S P' 663 TEtf
City: 1V1j&in 11 �C? State: �� Zip: 33l
Qualifier Name: f4e,- c i\\yeTt, Phone#: 5 S 8Ff6'•a,0g5
State Certification or Registration#: Certificate of Competency#: Cog 000 4CI
DESIGNER:Architect/Engineer: Phone#:
Address: Q��� City: State: Zip: (n�11
Value of Work for this Permit:$S'-'0.oa Square/Linear Foota a of Work: S CK 4.4
Type of Work: ❑ Addition ❑ Alteration ❑ New ' Repair/Replace ❑ Demolition
Description of Work: 2S C e f ks* '141✓C wwv ma W-0 k " I'Da v, Cor a Ct�e
Cat cf-ele StAL "nEa•r ?lat,. car.c1e4e
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ Q CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ A •
(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 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 w ' o urs se3wf7 days after the building permit is issued. In the absence of such posted notice, the
inspection will not be rove and a Ins p ctio fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me thisThe foregoing instrument was acknowledged before me this3�
day of N ,20 by ovh�� �- Te I es c o day of �J' ,20 f�by
who is personally known to me or who has produced -FL-- who i ersonally known t e or who has produced
0 L As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
7T7 14 —1 Sir
Print: a�n V\ John Rogues Print: b OF S
My Commission Expires: ®� NOTARY PUBLIC My Commission Expires: p Y John Roques
STATE OF FLORIDA Q o� NOTARY PUBLIC
Comm#FFW106 STATE OF FLORIDA
s�yC 19�® E ires 4/17/2020 Comm#FF946106
�'I�'11"2020
(? G
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-280196 Permit Number: DS-1-17-140
Scheduled Inspection Date: April 07,2017 Permit Type: Driveways/Sidewalks/S labs
Inspector: Porta Jr,Jose
Inspection Type: Foundation
Owner: TELESCO JR.,THOMAS Work Classification: Addition/Alteration
Job Address:64 NW 99 Street
Miami Shores, FL Phone Number (305)216-6161
Parcel Number 1131010330060
Project: <NONE>
Contractor: ARTISTIC CONCRETE GROUP INC Phone: (305)888-9095
Building Department Comments
RESURFACE EXISTING DRIVEWAY AND WALKWAY Infractio Passed Comments
PLAIN CONCRETE ADDING CONCRETE SLAB IN REAR INSPECTOR COMMENTS False
LOT PLAIN CONCRETE
04/05/2017
04/05/2017
AS PER B.O NO INSPECTIONS UNTIL OWNER AND
QUALIFIER MEETS WITH HIM.
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-280164. CREATED AS
1� REINSPECTION FOR INSP-278973. CREATED AS REINSPECTION FOR
INSP-278172. CREATED AS REINSPECTION FOR INSP-277273.
CREATED AS REINSPECTION FOR INSP-276979. CREATED AS
Failed ❑ REINSPECTION FOR INSP-274980. Not per plan
3/10/2017
CONCRETE WALKWAY&DRIVEWAY ALREADY
Correction ❑ NO ONE HOME
Needed 4/3/2017
NO PERMIT POSTED
FOUND NO WORK IN-PROGRESS NO OPEN FOUNDATION AT FRONT
Re-Inspection ❑ OR REAR
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid. Z t n
April 06,2017 For Inspections please call: (305)762-4949 Page 16 of 40
1
STRUCTURAL GROUP
March 29"2017
WHANII SHORES VILLAGE
10050 N.E. 2nd Avenue,
Miami Shores,FL.33138
RE: 64 N.W.99a'Street
Miami Shores,FL. 33138
DRIVEWAYS/SIDEWALKS/S ,PERMITDS-1-17-140.
To whom it may concern:
In reference to the above project, this letter is to address the construction of the front concrete driveway,
walkway,sidewalk and approach slab that leads to the existing residence.The driveway is 11'-0"wide by
33'-0" in length and the walkway is 3'-0" wide by 26'-0" in length and both run in the north/south
direction starting at the south edge of the 5'-0" sidewalk. The driveway has a gravel filled strip in the
center that extends the full length. The sidewalk is 5'-0" by 75'-0" long and runs in the east/west
direction. There is also an approach slab that leads from edge of the roadway to the north edge of the
sidewalk.
Based on the information contained in the permit drawings,the construction was as follows:
• Driveway from the south edge of the sidewalk to the residence, 6" concrete slab, 3,000 psi
concrete with fibermesh reinforcing.
• Walkway from the south edge of the sidewalk to the residence, 6" concrete slab, 3,000 psi
concrete with fibermesh reinforcing.
• Sidewalk was constructed with a plain 6"thick concrete slab with 3,000 psi concrete.
• Approach slab from the roadway to the south edge of the sidewalk was constructed with a plain
6"thick concrete slab with 3,000 psi concrete.
To the best of my knowledge, belief and professional judgment, those portions of the project outlined
above are in substantial accordance with the approved permit documents.
Respectfully submitted,
``%\\%IIIIII//�/�
o` RC Sq '�.
CSW •�UP INC
ti
J
3.� M7
3r c auve,P E.
tlNkRegMoa:No.57
CSW STRUCTURAL GROUP
\5397 Orange Drive Suite 203.,Davie,FL 33314 954-316-9001/954-316-9002(Fax)
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�N� `EC1'oON [RD , POS,T ®N SITS
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INSPECTION REQUESTS, 30b i'6Z ., ` ps� '
( j -a949;or Lo on at hit //6!d mamisoresrriltage comrcap
REQUESTS AREACCEPTED.DURING8.30AM-3 30PItFOR tHk,FOLLOW11141's BU$lIVESS DAY;',
Retfliests must 6e-received by,3 Pm for foliaiytng day inapectioris.:
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Drweways/ igeww CS/S1a�b Parce� �'f 131 A.
30Ds_
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Owner`' Name THOMAS T�LESCO JR
Owner's'Phone ��0 �16-x, 61.
Job Address. '
[36 Number 3300 Total,[ob Yate tion $5,`950:30
Contractors p�ron,� � ,, MONDAY THROUG1 FRIDAI�,sa ooAt obPnq
ARTISTIC CONCRETE GROUP ING SATURDAXS:oOANG" 6 ROPM
(305)8$8-905 NO:WORK IS'ALLOWED'OPI SUNDAX ORM0LIDAYS'
BUILDING AND ROQFING:INSPECTION:i ARE DONE
NONDAY_THRO... FRIDAY
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NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AN614-A$BEEN APPROVED. 'PLANS ARE READLY AVAILABLE IT IS:
THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK V%ACCESStBLeAND EXPOSED FOR INSPECTION PURPOSE$; NEJTHER'
THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILE11IN tHE REMOVAL
REQUIRED.TO ALLOW INSPECTION. OR REPLACEMENT OF ANY MATERIAL
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE QF
COMMENCEMENT MAY RESULT IN YOUR PAYQNG TWICE FOR IMPRO.1ENIENTS'--
TO YOUR PROPERTY;: A NOTICE OF COMMENCEMENT MUST BE :RECQRDE`D.
AND POSTED ON THE JOB SITE BEFORE _THE. FIRST' INSPECTION. IF: YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH, YOUR LENDER OR` AN
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR .
NOTICE OF
COMMENCEMENT.
14770 8M 4&d MAT, $me 1"28' xm N01 1505-M
D"TilhSIONS INC. PNONEI (O!812.4225 TYPE aPOMTt
Land Surveying Services FM (305)512.1914 BOUNDARY SURVEY
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GUARANTEED RATEJNC.0'S RICCESSORS
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comm 9f NOM AALID
91iEET?OF 1
gA� 14-10 SW 43rd WAY, SCALE: 1°=20' JOB N0: 1505-008
MIAMI,FL 33185. FIELD DATE: 05-07-2015
DM E N S I O N S INC■ PHONE: (305)512-4225 TYPE OF PROJECT:
Land Surveying Services FAX (305)512-1914 BOUNDARY SURVEY
FOR: THOMAS J.TELESCO,Jr. LEGAL DESCRIPTION:
PROP.ADD: 64 N.W.99th STREET,MIAMI SHORES,FL 33150 LOT:9&the E 25'of Lot 10 BLOCK:I2SUBDIVISION:MIAMI SHORES SECTION No.6
PLAT BOOK: 10 PAGE: 39 OF: MIAMI-DADE COUNTY,FLORIDA,
70.00'Total RNV
N.W. 99th STREET _
19'Asphalt
0 0
0 0
c')
M
Conc. 16'Parkway
5'Conc.Walk 75.00' FND.I.P.1/2"
B.C.
tNn In)
180.88' 89LU
°
Z 42�o I 90°1
LU
c o M
V N N
I
- I 15.97'
F I
6.50' 6' i R4Wo 14.70' O x—
Z 8.20' Planter aoFqn
10.80' 17.70' PL
rn
,
REMAINDER LOT 10 N o 2.05 J
BLOCK 128 2.05' M 6 LOT 8
oConc. 5 94, ^ BLOCK 128
.h CR N ONE STORY CBS I M
o M i RESIDENCE#64 16.03
. 1
.� I 18.00' X
c I a E.M0.00'
cli
160'
1A],
CL x 10.10' wii' Conc. CL
Conc. I Steps
x Steps ID 21.00'
9 ' I m x
0
CL 'i
The East 1/2 I y
li of Lot 10 I LOT 9 BLOCK 128 0
Jx Block 128 I x
V.
�j I R
• • •
LXL
••� • 9�`��.0FND.I.P.I/2' x x 4'C.LX x x F FND.I.P.I/2'
••••• Goes .0 ' 13 000' W.P.P.
• • 15' ALLEY W.M.
..•.. •• . .•..
' 10'Asphalt
• a .. ....
•:•••• •••••p •••••• CERTIFIED TO.
•�•••• •••• •••••s THOMAS J.TELESCO,Jr.
! GUARANTEED RATE,INC.,ITS SUCCESSORS
SURVEYOR'SNOMSO AND/OR ASSIGNS,AS THEIR INTEREST MAY APPEAR.
1.)THE SURVEY OF THE PROPERTY SHOWN HEREON IS IN ACCORDANCE WITH THE CARLOS DEL AMO,P.A.
DESCRIPTION C FURNISHED BY Nr. OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY.
2.)UNLESS A COMPARISON IS SHOWN,ALL BEARING,ANGLES AND DISTANCES SHOWN
ARE THE SAME AS PLAT VALUES. ABBREVIATIONS:
3.)THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER SWK-Sidewalk,CBS=Concrete Block Structure,CLF=Chem Link Fence,
RECORDED ENCUMBERANCES NOT SHOWN ON THE PLAT AND THE SAME,IF ANY MAY PL=Property Lina,DUE=Drainaga UdI ty Easement,IP=Iron Pipe,
NOT BE SHOWN ON THE SKETCH. AIC=Air Conditloner Ped,PIC-Property Comer,DM=Drilled Hole,
4.)UNDERGRAUND PORTIONS OF FOOTINGS,FUNDATIONS OR OTHER IMPROVEMENT W/F=Wood Fence,RES=Residence,CL=Clear,IR=Iron Rebar,UE=Utlity
WERE NOT LOCATED. Easement,CONC=Conc.Slab,RNV=Right of Way,DE=Drainage Easement,
5. FENCES TIES ARE TO THE CENTER LINE OF THE SAME. CIL=Center Lina,0=Diameter,TYP=Typical,M=Measured,R=Recorded,
6. WALL TIES TO THE FACE OF THE SAME. ENCR=Encroachmerd COMP=Comppuuter,ASPH=Asphalt NID=Ned&Disc.,
7.ELEVATION WHEN SHOWN ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM S=Set,FFE=FWsh Floor Elavatlon,DIS=Offset,PIP=Power Pole,
(1929)UNLESS OTHERWISE NOTED. OHP-Overhead Powedlne,WM=Water Meter,WPP=Wood Power Pole,
8.)THERE NO ABOVE GROUND ENCROACHMENTS OTHER THAN THOSE SHOWN. E.M.=ElecWc Meter,M.F=Mehl Fence,P.F.=Piasdc Fence,D.M.E.=Dratnage
Maintenance Easement,C.M.E.-Canal Maintenance Easement,L.M.E.-Lake
9.)THIS SURVEY IS FOR MORTGAGE PURPOSES ONLY,NOT TO BE USEOR pC�enatemenME. MaidtlB.C.=�Comer,
CONSTRUCTION PURPOSES,
Point Curvature, = NONo .
I HEREBY CERM:
(FLOOD LONE INFORMATION) ramnw°maws•souHoaRYeuRYe1^mar.Ivmsslmwnma°°mmoomxrrolm
.e,rawYk—1 d.°a°d.oaefmraoonuywwr°aawdraw w,bamysuparri.la°am
ZONE: X COMM:120652 PAN EL:1208600302 SUFFIX: L DATE 9-11-2009 BASE: NIA lMft
""°a°° er�nrear'°� W�s� ,
NOTE:DETERMINATIONOF FLOOD ZONE LINES WERE BASED ON SCALING OF FEMA MAP LISTED ABOVE.NOTE:ALL BEARING HEREON ARE BASED TO THE PLAT BEARING OF N/A /�
ON THE CENTER LINE OF NIA PROPERTY LINE.
EASEMENT VIOLATIONS: 0 YES KI NO DAVID L. FOCH
REGISTERED LAND SURVEYOR#4843
APPARENT VISIBLE ENCROACHMENTS' EIYES ®NO STATE OF FLORIDA LB#0006874
COMENTS: NOTE:NOT VALID UNLESS
SIGNED AND SEALED SHEET 1 OF 1
Job No.
ARTISTIC
-J CONCRETE GROUP PROPOSAL - CONTRACT
6945 NW 53 Terrace Miami,FI 33166 9-1
Dade:3054688-9095•Broward:954962-0243
Fax:305-888-4366•Toll Free:1-688-326-9331
www.artisticconcretegroup.com
Proposal Submited
Tom Telesco V
Horne Phone 11-21-1s
Address Work
57 �- �J b 6.ZSo SII Phone05-216- 6161
64 NW 99th st
CRYState c L ZIP Code Job Location
Miami Shores
Design Plain concrete rte. Color NONE
780 square feet
-Demolition of existing sidewalk, driveway, and
front walkway
-Form work
-19 sidewalk squares total
-Concrete pour
-3000 PSI
-Wire mesh ,
-Light broom finish
At
V .a
We pull permit, owner pays permit price +fees
NOTICE OWNERS
DADE&BROWARD COUNTY BUILDING CODE REQUIRES THAT ANY TOTAL PRICE$ 51950m00
SIDEWALKS THAT ARE PART OF AN ENTRY WAY MUST BE 6"INCHES OF 21975.00
THICKNESS,ANY SIDEWALK THAT IS NOT WINCHES THICK MUST BE DEPOSIT$
REPLACED AND WILL ADD TO THE CONTRACT 5100.00 DOLLARS PER 5'
OF SIDEWALK REPLACED.IF YOU RESIDE IN CORAL
GABLES T WIFEET ILV ADD$150.00 DOLLARS PER 5'SECTION REPLACED.IN BALANCE$ 2,975.00
THE EVENT THAT A SWALE IS NEEDED TO OBTAIN FINAL INSPECTIONS A
$1,00 PER SO FT.WILL BE CHARGED TO THE BUYER FOR RESODING,IN
THE EVENT THAT CHIPS OCCUR DUE TO THE PATTERN SELECTED BY Balance$ To be paid as follows
THE BUYER,THE SELLER SHALL NOT BE RESPONSIBLE FOR SAID CHIPS,
ANY REPAIRS WILL BE CHARGED TO THE BUYER.
500/0 to Start 40%to Pour 10%to Seal
COMPANY NOTR.ESPONSOLE- FOR DAMAGE TO UNDERGROUND
PIPES THAT ARE NOT upTo COUNTY CODES.
In the event that the deposit is given in a credit card payment,and the buyer has
SEE REVERSE FOR TERMS&CONDITIONS Inot made payment within 72 hours of job completion the full balance will be
applied to said credit card without further notice.
We have read V for mg p posed frac nd accept a the terms �■��■
and conditions stat Exp: CVy:
Purchaser Approved By
CFN: 20160690218 BOOK 30328 PAGE 2556
DATE:12/02/2016 08:28:33 AM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
,
Mimi Shoo V81a1110
sJulliOng Deparanent
1050 N."nd Avenue
Muni Shoes.Ftortda 33138
Tei:(305)7911.22"
Fax:(305)756.81t72
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whams.(owner) herseirumer as
owner of the following described d property(address).- -AAAL-
Legal
Description_Lot-9------Block t,3,B Subdivision
Folio
R+ permission to Install(deacribe umrk): Am,* Gs
Within the public right of way of(address) •►. •- 2 33 t3"$
IN CONSIDERATION of the approval of this permit by the Village,the owner agrees as fes:
1. To maintain and repair, when necessary,the above-mend items)Installed within the
meted right of way. If it becomes necessary for MlarW Shorties Village or Dade County
to make repairs or maintain said%sms within public right of way including restoration of
stmt by reason of the Ownees failure to do so,such expense shall be paid by the Owner
or"I constitute a Ilan against the above described property until paid.
2.. The owner does hereby agnea to indemnify and hold Miwni Shores Village or Dade
County harmless from any and all liability, which may rose by virtue of parmht ng the
Irudatiation of these Rams within the public right of way.
3. The owner does hereby agree to remove or relocate their facilities at their own expense,
within tag days notice by the Village to do so. Failure to comply with this notice win result
in the Village causing the tiffs)to be removed and alien being placed on the property
and/or assessed agate the Owner for all costs WKxured In the removal and dispersal of
the Itern(s).
4. The undersigned furl agrves that these conditions shall be deemed a covenant
running with the land and shy remain In full ford and +ef[ect and be binding on the
undersignesf, #wk hers and assigns, until such time as this obligadom has bot
ca m*ded by an affidavit filed In the Public Records of Dry County, Florida by the
Villa"Manager of Miami Sbores Village(o€his fully authorized representative).
Signawre-
Owner or Agent
e fon oirhg ins�arument WaiB wteclged a me BttaR _day of� ,...201 by
� who is penally known tome or who has produced
as Iderhti#ia ffoi n and who did take an oath.
j
Y C.
Sir
Prink
MY Commission Ex;*nes:NADIA V. �'to
`w°0 .�
StiO1.93
Miami shores Village
logo ®1 ������ Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
�OR1Dp' Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
The undersigned Affiant,_� At QSc does hereby attest that
(Property own r)
The attached survey, performed by 05 7f0't1i)i V-/5,
(N�are of eyor's company)
For address: br�Y AJ'J 71 t 1-it ,
Performed on q`1t-2oqq (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
structures ma fiInaught
ns as applicable to this or other permits.
Fu r,Affiant say
PropertyOwner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this�P day of K6,Wrvt1--e1r G
. Za1
Affiant is personally known to me, pry oduced FL DL— as identification.
John Roques
�� Y NOTARY PUBLIC
a STATE OF FLORIDA Notary
Revised on 5/22/2009/Revised on 6/12/09 ,
Comm#FF946106
As7NCE I Expires 4/17/2020