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BPP-16-1792 (2)xokJ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC ❑ ROOFING RECE JUN 28 2616 3Y: FBC 20114 Master Permit No. f 16- (4- ctZ Sub Permit No. Sto ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR .DRAWINGS JOB ADDRESS: '15 ( Ne City: Miami Miami Shores County: Miami Dade Zip: &313cg Folio/Parcel#: (1 /30C1 017 030 Is the'Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: conAc , Cruz4'ess,ir'Ieckcn Cp►SCc, 1( Ch yChpnc. OWNER Name'(Fee Simple Titleholder): -m-f--,scZ. Phone#: `7$4 31 Si 1 yq9 Address: 456 NC'' 111 6fte.ek City:, f1kQyv1[ 54w� Tenant/Lessee Name: Phone#: Email: State: 'R... Zip: _ 33 iS CONTRACTOR: Company Name:i,.�i1 Ctu .. (1 056 utc-\-k Phone#: (359 a 6 3, 7 )a 0 Address: 65`7kA . 'Sid kr Q 1 �' / (00 city: C-Oc oncA4- �•e-G(C Stater iF L Zip: Qualifier Name: !'` + Ctilu e L_ P QCt( Phone#: State Certification or Registration #: C.GC (5(`401.1'' Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ .Z (pr c,nn , O O rSquare/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration I DescriptionofWork: 1•161/44) ?Cbl c:Ayr S#rc,r,}, c%\ ❑ New ❑ Repair/Replace yS o S1, (-4 ❑ Demolition Qtcbce_ perim,4 gPp_ (a- ly-�cs,60 Specify color of color thru tile: Submittal Fee $ Permit Fee $ 9-3o CCF $ / 5 • (O 0 CO/CC $ 60 Scanning Fee $ (2,, , �� Radon Fee $ �0 DBPR $ • �0 Notary $ .�fp Technology Fee $ W • g1::7 Training/Education Fee $r. ? Double Fee $ Structural Reviews $ / 1 10 Bond $ 5(D0 (Revised02/24/2014) TOTAL FEE NOW DUE $ r o0 5(f -- Bonding Company's Name (if applicable) Bonding Company's Address City State Zip a�1 • 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 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. Signature OWNER or GENT The foregoing instrument was acknowledged beforeme this Se/ day of �w.� , 2016 , by j 5p OT.'Z , who is personally known to as me or who has produced identification and NOTARY PUBLIC: Signe ake alt'pliQb.0 HAMBRICIC ►+ +? MY COMMISSION # EE867056 .EXPIRES January 22, 2017 n•°�; 0.7)39B-0153 FiaridallotaryServlce com Print: /c�CG ])awrlby ►<!C' Seal: APPROVED BY (Revised02/24/2014)_ CONTRACTOR The foregoing instrument was acknowledged before me this "Zr?# day of , 20 tPD , by )jtop ,Q \ , who is personally known to me or who has produced as identification arc' who dirt +aka an oath o;;'";>".,, KYLE C HAMf3RICK NOTARY PUBLIC:; ' ra, MY COMMISSION # EE867056 •fcF;, EXPIRES January 22, 2017 07) 398-0153 FbridallotarySer,ice com :/ Sign44L. jos Print: Seal: '-. ******************************************************* . , Plans Examiner Structural Review !1 • - J, Clerk Lelack Construction 6574 N State Rd. 7 #160 Info@lelack.com GCG1514048 Coconut Creek, FL Licensed and Insured 954-263-7120 Date: State of Pc 1,, j a County of Picwa, Before me this day personally appeared being duly sworn, deposes and says: That he or she will be the only person working on the project located at 4'5 p /CO41 r'QQ 4 %t (crni t S erQ Sworn to (or affirmed) and subscribed before me this l day of , 2016 by "It( hsqP( L -e((CI( :*":°•° KYLE C HAMBRICK ::*?••" 4=4:. MY COMMISSION # EE867056 -34a;F EXPIRES January 22, 2017 (4t7) 398.0153 FbridallotaryService corn Personally Known c/ Or Produced Identification Type of Identification Print, Type of Stamp Name of Notary Miami Shores Village Building Department 10050 N.E.2nd Avenue 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. State of Florida County of Miami -Dade The foregoing was acknowledge before me this eiS h day of ,}..lit. , 20 Ito . By -$fie, Ori who is personally known to me or has produced Notary: 04#fr***71-.7.--B, SEAL: as identification. t ku KYLE C HAMBRICK MY COMMISSION # EE867056 -;� EXPRES January 22, 2017 471'n-G7S3 noroaNc1aryServicecom Lelack Construction 1705 BANKS RD OFFICE: (954) 688-4577 MARGATE, FL 33063 FAX: (954) 263- 7120 August 28", 2014 Proposal #0710/186 Project: CHURCH OF THE RESURRECTION (EPISCOPAL) FATHER ORTEZ RESIDENCE 456 ne 100 ST Miami Shores, FL We are pleased to present this proposal to provide our contracting services for the above referenced project. Our services and fees will be as followed: DESCRIPTION: Residential Swimming Pool Construction and new driveway Swimming Pool Size: *(14'x28') • SKETCH DESIGN, PLAN DESIGN, ENGINEERING & ALL PERMITS FROM REQUIRED MUNICPALITY • 3' to 5'6" DEPTH. • EXCAVATION AND REMOVAL (NO DEMUCKING OR DEWATERING INCLUDING) • HAUL AWAY OF EXCAVATED FILL MATERIAL AND DEBRIS • GUNITE (CONCRETE STRUCTURE) 3,500 PSI • ONE LAYER STEEL REINFORCEMENT #3Qa 10'EW • 1" BACKFILL AND 2'" BACKFILLS • PLUMBING • DUAL MAIN DRAIN FOR NEW FBC WITH VENT LINE • 1 WIDE MOUTH SKIMMER (ENCASED IN CONCRETE) • VACUUM LINE TO FACILITATE HOOK UP FOR VACCUUM CLEANER • STANDARD 6" WATERLINE TILE • STANDARD COPING • STANDARD ELECTRICAL WORK AND ELECTRICAL HOOK UP OF ALL EQUIPMENT (Exposed pipe maximum of 50' from electrical panel to pool equipment) • APPROX.1000SQFT OF POOL DECK AROUND THE POOL AND PATIO AREA • STANDARD MARCITE PLASTER(diamond brite) • (1) POOL LIGHT LED (COLORED) • PUMP AND FILTER COMBO (To be installed within 40' to pool) • JOB SITE CLEANS UP. • SALT CHLORINATOR. • SAFERY BARRIER (CHILD FENCE OR ALARM) • POOL VACUUM CLEANER. • CHEMICAL START UP (2 VISITS) AND INSTRUCTIONS. *** Extra electrical work may be required - To be charged separately. *** Faze 1 of 2 "THE PRESSURE'S ON US.,.." Lelack Construction 1705 BANKS RD OFFICE: (954) 6884577 MARGATE, FL 33063 Flax: (954) 263- 7120 August 28�', 2014 Proposal #0710/186 Project: CHURCH OF THE RESURRECTION (EPISCOPAL) FATHER ORTEZ RESIDENCE 456 ne 100Th ST Miami Shores, FL • DESCRIPTION: Residential Swimming Pool Construction and new driveway Swimming Pool Size: *(14')(28') Swimming pools with dual main drain systems by code. Swimming pool construction will be done within 8 to 10 weeks after permit. EEC is not responsible for damages to the lawn, landscape, underground utilities, sprinklers or sidewalks. As well for drain field and septic tank relocation. The total cost for the work above-described based on job visit we come with a total of $26,600.00. After permit which will be paid by owner. ADDITIONAL FEATURES; (X) SPA WITH HEATER $4,500.00 (k) SMART PHONE FUCTION $1,500.00 (() LED WATER FALL $1,200.00 () DRIVEWAY FOR THE GARAGE $3,500.00 Payment schedule: 20% upon signing contract 20% when excavation is completed 20% when shotcrete is placed and forming of the pool deck. 20% when tile, coping have been Installed, pool deck completed. 15% when pump and filter have been installed 5% before plaster (DIAMOND BRITE is placed) LE CONCRETE CORP. ;.I"''+% KYLE C HAMBRICK E •1- MY COMMISSION # EE867056 EXPIRES January 22, 2017 (407) 398-0153 PoOdallotary3ervlce com Pape 2 oft HE PRESSURE'S ON UB...." ;:•w{, KYLE C HAMBRICK "'•:1,-.• MY COMMISSION # EE86705(i �.? 0.1V EXPIRES January 22, 2017 (407) 3980187 Floodallotoryiemice cols 31 � 3 00 _D 15 u� o T, o4A Property Search Application - Miami -Dade County Page 1 of 1 HCE OF THE PROPERTY APPRMSER Summary Report Property Information Folio: 11-3206-017-0350 Property Address: 456 NE 100 ST Miami Shores, FL 33138-2447 Owner THE CHURCH OF THE RESURRECTION Mailing Address 11173 GRIFFING BLVD MIAMI, FL 33161-7249 Primary Zone 1200 SGL FAMILY - 2501-2800 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3/2 / 0 Floors 1 Living Units 1 Actual Area 2,239 Sq.Ft Living Area 1,861 Sq.Ft Adjusted Area 2,045 Sq.Ft Lot Size 10,062.5 Sq.Ft Year Built 1946 Assessment Information Year 2016 2015 2014 Land Value $251,663 $241,762 $211,232 Building Value $142,332 $143,518 $140,962 XF Value $1,927 $1,526 $1,531 Market Value $395,922 $386,806 $353,725 Assessed Value $395,922 $386,806 $353,725 Benefits Information Benefit Type 2016 2015 2014 Parsonage Exemption $395,922 $386,806 $353,725 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description PB 15-14 AMD PL OF MIAMI SHORES SEC 4 E12.5FT LOT 5 & LOT 4 & W1/2 OF LOT 3 BLK 89 LOT SIZE 87.500 X 115 Generated On : 6/28/2016 Taxable Value Information 2016 20151 2014 County Exemption Value $395,922 $386,806 $353,725 Taxable Value $0 $0 $0 School Board Exemption Value $395,922 $386,806 $353,725 Taxable Value $0 $0 $0 City Exemption Value $395,922 $386,806 $353,725 Taxable Value $0 $0 $0 Regional Exemption Value $395,922 $386,806 $353,725 Taxable Value $0 $0 $0 Sales Information Previous Sale Price OR Book -Page j Qualification Description 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 Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 6/28/2016 Detail by irAity N ie FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS *-'\-' ;:1flkZ0 5/31/16, 1:24 PM Detail by Entity Name Florida Not For Profit Corporation SANTA CRUZ - RESURRECTION EPISCOPAL CHURCH, INC. Filing Information Document Number 726889 FEI/EIN Number 59-0806966 Date 'Filed 07/06/1973 State FL Status ACTIVE Last Event AMENDED AND RESTATEDARTICLES/NAME CHANGE Event Date Filed 09/25/2015 Event Effective Date NONE Principal Address 11173 Griffing Blvd BISCAYNE PARK, FL 33161 Changed: 03/10/2014 Mailing Address 11173 Griffing Blvd BISCAYNE PARK, FL 33161 Changed: 03/10/2014 Registered Agent Name & Address ORTEZ, JOSE L, REV 11173 GRIFFING BLVD BISCAYNE PARK, FL 33161 Name Changed: 02/02/2008 Address Changed: 09/25/2015 Officer/Director Detail Name & Address http://search.sunbiz.org/Inquiry/CorporationSearch/SearchRes...al%20church&IistNameOrder=HOLYCROSSEPISCOPALCHURCH%207268890 Page 1 of 3 Detail by tn"tity None 5/31/16, 1:24 PM Title Treasurer Zapata, Susie 6024 SW 8 St MIAMI, FL 33142 Title D MORALES, FELIPE E. 14555 N MIAMI AVENUE MIAMI, FL 33168 Title PD ORTEZ, JOSE L 11173 Griffing Blvd BISCAYNE PARK, FL 33161 Title VD Floyd, Charlotte 14401 SW 30 Court Davie, FL 33330 Title member Thomas, Christine 12905 NE 12 Avenue North Miami, FL 33161 Title VP Duarte, Eliseo 170 NW 49 St. Miami, FL 33127 Annual Reports Report Year Filed Date 2014 03/10/2014 2015 02/23/2015 2016 02/19/2016 Document Images 02/19/2016 -- ANNUAL REPORT View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchRes...al%20church&IistNameOrder=HOLYCROSSEPISCOPALCHURCH%207268890 Page 2 of 3 Detail by'tritity .Nye 5/31/16, 1:24 PM 09/25/2015 -- Amended/Restated Article/NC View image in PDF format 09/25/2015 -- Merger 02/23/2015 -- ANNUAL REPORT 04/10/2014 -- AMENDED ANNUAL REPORT 03/10/2014 -- ANNUAL REPORT 01/22/2013 -- ANNUAL REPORT 02/13/2012 -- ANNUAL REPORT 03/14/2011 -- ANNUAL REPORT 08/16/2010 -- ANNUAL REPORT 03/19/2009 -- ANNUAL REPORT 02/02/2008 -- ANNUAL REPORT 04/26/2007 -- ANNUAL REPORT 07/03/2006 -- REINSTATEMENT 02/26/2003 -- ANNUAL REPORT 02/26/2002 -- ANNUAL REPORT 02/05/2001 -- ANNUAL REPORT 03/27/2000 -- ANNUAL REPORT 03/11/1999 -- ANNUAL REPORT 04/13/1998 -- ANNUAL REPORT 03/24/1997 -- ANNUAL REPORT 02/13/1996 -- ANNUAL REPORT 02/16/1995 -- ANNUAL REPORT View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View'image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Copyright Cc; and Privacy Policies State of Honda, Department of Stale http://search.sunbiz.org/Inquiry/CorporationSearch/SearchRes...al%20church&IistNameOrder=HOLYCROSSEPISCOPALCHURCH%207268890 Page 3 of 3 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS '4:51intriz-ac 5/31/16, 1:23 PM Detail by Entity Name Florida Not For Profit Corporation THE CHURCH OF THE RESURRECTION (EPISCOPAL), MIAMI, FLORIDA Filing Information Document Number N05923 FEI/EIN Number 59-0737864 Date Filed 10/30/1984 State FL Status INACTIVE Last Event CORPORATE MERGER Event Date Filed 09/25/2015 Event Effective Date NONE Principal Address 11173 GRIFFING BLVD BISCAYNE PARK, FL 33161-7249 Changed: 07/17/2000 Mailing Address 11173 GRIFFING BLVD BISCAYNE PARK, FL 33161-7249 Changed: 07/17/2000 Registered Agent Name & Address ORTEZ, JOSE L, RECTOR 11173 Griffing Blvd Biscayne Park, FL 33161 Name Changed: 12/11/2014 Address Changed: 04/16/2013 Officer/Director Detail Name & Address http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResu...0of%20resurrection&IistNameOrder=CHURCHRESURRECTION%207447590 Page 1 of 3 ie 5/31/16, 1:23 PM Lie SWD FLOYD, CHARLOTTE MRS 16475 NE 32 AVE NORTH MIAMI BEACH, FL 33160 Title Treasurer LaBarbera, Justin 11111 Biscayne Blvd PH 51 Miami, FL 33161 Title Vestry Member Francisco, Carol 637 NE 92nd St. 10c Miami Shores, FL 33138 Title Clerk of the Vestry Thomas, Christine 12905 NE 12th Ave North Miami, FL 33161 Title VESTRY MEMBER FRENCH, JOHN 12555 BISCAYNE BLVD. # 404 MIAMI, FL 33181 Title President ORTEZ, JOSE L, rector 456 NE 100th St Miami Shores, FL 33138 Annual Reports Report Year Filed Date 2014 04/30/2014 2014 12/11/2014 2015 02/23/2015 Document Images http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResu...0of%2Oresurrection&IistNameOrder=CHURCHRESURRECTION%207447590 Page 2 of 3 ie 3/2015 -- ANNUAL REPORT 12/11/2014 -- AMENDED ANNUAL REPORT 04/30/2014 -- ANNUAL REPORT 04/16/2013 -- ANNUAL REPORT 03/30/2012 -- ANNUAL REPORT 04/08/2011 -- ANNUAL REPORT 02/22/2010 -- ANNUAL REPORT 03/10/2009 -- ANNUAL REPORT 03/24/2008 -- ANNUAL REPORT 03/20/2007 -- ANNUAL REPORT 04/25/2006 -- ANNUAL REPORT 04/27/2005 -- ANNUAL REPORT 04/26/2004 -- ANNUAL REPORT 04/14/2003 -- ANNUAL REPORT 03/05/2002 -- ANNUAL REPORT 04/23/2001 -- ANNUAL REPORT 07/17/2000 -- ANNUAL REPORT 04/23/1999 -- ANNUAL REPORT 04/28/1998 -- ANNUAL REPORT 07/25/1997 -- ANNUAL REPORT 01/31/1996 -- ANNUAL REPORT 02/20/1995 -- ANNUAL REPORT View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format 5/31/16, 1:23 PM Copyright d> and Privacy Policies State of Florida, Department of Slate http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResu...0of%2Oresurrection&listNameOrder=CHURCHRESURRECTION%207447590 Page 3 of 3 { Date it It -51 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION Miami Shores Village Building & Zoning Department Attention: Building Official certify that I am the legal owner of the property described as , located at viS(z› '"e t GO vt4Sr In accordance with Section 33-12(0, Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. further understand that this certification, however, does not eliminate the need for obtaining a permit andrerecting and approved barrier prior to final inspection and use of the pool. Legal Owner Note: This certification is to be submitted with a swimming pool ;s:• KYLE C HAMBRICK� o1i�slfl�lfi"It�s fig' doss EXPIRES Janu ry b17 1407) 396.O1PioridallotaryServloe corn 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned Rgsti est CA 1r Z is/are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: 'ASCD �� LJ��^ CGM• 1 �'-i Whereas, the undersigned owner(s) desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows: 1 That the property will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade I County now in effect or hereinafter enacted. II. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the required enclosure is not on the subject property where the pool is located. III. That if any of our adjoining neighbors remove any portion of their fence or wall, or if our/my property shall fail to meet code requirements for pool barriers, we, as owners will immediately install a protective enclosure to meet code requirements and will obtain a permit for such fence. IV. That, I/we, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is damaged or removed by any case. NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant conceming the use, enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its successors, in - • Ice of said Village then in effect. • 'NERSI 1r'RINT OWNER SING & PRINT I Hereby Certify that on this day personally appeared before me and has produced ID # f (-1) as identification and he/she acknowledge that he/she executed the foregoing, freely and voluntarily, for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this 2 5 day of U '-2" , 20 k•ki\ (Revised 05/2209 NO AKx,�I�{�SLIL J 1 A U 1- U I A �*•'-if � I�YI� �MBRICK A. MY COMMISSION 1 EE867056 1 ,4ecie dP� EXPIRES January 22, 2017 (+07) 398-0153 ftaidaNatary86Moe can STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Village Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, ;So,e C) Ir - . , does hereby attest that (Property owner) The attached survey, performed by Onna, j '-\ M Cr'l 1 c$SY\ Assoc- wc. . (Name of surveyor's company) For address:.' LOOM' St Performed on vs jet 1S- 1 (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 ariy such structures may affect final inspections as applicable to this or other permits. th naught. pe-' OwneSignature SWORN TO AND SUBSCRIBED before me this -Z. 4- day of ✓n),07 . ''SLA �RJ• JJSL •Y t, Property Owner Print Name Affiant is personally known to me, produced Ft- Da11/E,s LG:. -.St as identification. Revised on 5/22/2009/ Revised on 6/12/09 KYLE C HAMBR ry a'c MY COMMISSION !t EE867056 dF' LAPIRES January 22, 2017 (407) 398-0153 F oridallotaryServloe can Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at `1,0c. Aim. cftlt'^ Miami Shores, FL, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues and the Florida Building Code R4101.17. Please initial the method(s) to be used: The pool will be equipped with an approved safety pool cover that comp lies with ASTM F1346-91. (Submit Manufacturer's Specifications). • A continuous, one-piece (child) barrier meeting the requirements of Florida Building Code R4101.17.1.15 will protect the pool perimeter. The plans shall show the fence location and method of attachment, including one end that shall not be removable without the aid of tools. (Submit Manufacturer's Specifications). A combination of non -dwelling walls and fences (screen enclosure, child fence, masonry fence walls, chain link or wood fence, etc.) will protect t he pool perimeter. The plans must specify t he type and location of all non dwelling walls. Florida Building Code, R4101.17.1 . Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code, R4101.17.1.9 (Submit Manufacturer's Specifications). Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all doors will be equipped with a self -latching device with positive mechanical latching/locking installed a min. 54" above the threshold. If this option is selected, submit plans showing all types and location of all perimeter protection. The plans must also show the location and type of all openings, and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Code, the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements, and upon expiration of the permit, the pool shall be presumed to be unsafe . I understand that not having one of the above installed will constitute a violation of Chapter 515, F.S ., an d will be considered as committing a misdemeanor of the second degree, punishable as provided in Section 775.082 or Section 775.083 F.S . This form must be signed by th • •wnerlagent and t • rime contractor. ACTOR'S GNATURE AND DATE . &r In cc2 lLao lo-ctG CONTRACTOR'S NAME (PLEASE PRINT) OTARY PUBLIC 41a% ir,KYLE C HAMBRICK 'c MY COMMISSION # EE867056 EXPIRES January 22, 2017 3 • .O 8ervbe acro 1a07)398-01�9 RiatltleMolWY 0 NE.'• '. IGNATURE AND DATE civ 1e OWNER'S NAME (PLEASE PRINT) -k-'HAMBRICK 1 MY COMMISSION # EE867056 V 'A- EXPIRES January 22, 2017 "', Frood6Na1 Service oom (a07) 3980193 �'