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PW-17-2757Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 121 NE 110 Street MIAMI SHORES, FL 33161- Owner Information rermit Permit NO. PW -11-17-2757 Permit Type: Public Works Work Classification: Public Works Pennit Status: APPROVED Issue Date: 12/12/2017 Expiration: 03/12/2018 Parcel Number Applicant Address 1121360040220 Block: Lot: ELIZABETH AMARAN Phone CeII ELIZABETH AMARAN 121 NE 110 Street MIAMI SHORES FL 33161- (305)300-6292 121 NE 110 Street MIAMI SHORES FL 33161- Contractor(s) DESIGNER PAVERS INC Phone (954)921-5555 CeII Phone Valuation: $ 5,000.00 Total Sq Feet: 672 Scanning: 1 Fees Due Bond Type -Contractors Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $0.00 $0.00 $0.00 $0.20 $100.00 $3.00 $0.80 $604.00 Pay Date Invoice # 12/12/2017 11/20/2017 Bond #: 3591 Pay Type PW -11-17-65706 Credit Card Credit Card Amt Paid Amt Due $ 554.00 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Excavation Review Public Works Review Public Works Final Public Works 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, UMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AF S IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construe 'o L: nine. Fltthermore, I authorize the above-named contractor to do the work stated. orize• gnature: Owner / Applicant / Contractor / Agent Building Department Copy December 12, 2017 Date December 12, 2017, 1 RECEIVED Miami Shores Village Public Works Department NOV 2 0 2017 (305)795-2210 Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33138 ,se <7/0° PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property \N` Permit#: v(1 21S1 E)).� -aid2o>/ 7 -2 Name of Applicant (if utility see below): Owner off the following described property: ..¢� Legal Description: Lot Q.'3 Block / Subdivision cot 1 ) (L€., &io #" I) `1'/.3G LZ/ o O Address: /9i �� J/1�f�/.�'>`i'�e� /u/C�ni/ .��ddt'S f - 3/(r/ UTILITY NAME: Qualifier/Authorized Agent: DCS s/ /Ii- (P6vers ) %IL Address: x-75) St.) /3 pall y7PAr6 C City: PO ✓/ PState: Fi _ / ZIP: 3_73 3— Telephone: 7 )y 9921 -5 -5 -53 --Email: CIr .P5J,4erJOa✓Crs Q0�0o <On State Certification or Registration #: C(4(fj5-1Vt./3 Certificate of Competency # CONTRACTOR NAME: es)6 f eratier5 Qualifier/Authorized Agent: J,v4, le /A�dP//- n, -5710P6` Address: 2-'7 5/ 5 i L3 °J _ City: 1)0,,)-e.State: t/..- ZIPh 3 3 3 (' Telephone: 0) Sy yZ/ -415 5 5-- Email: c e o re^, ve,' P 1a..4 o. c bii State Certification or Registration #: , Certificate of Competency #: , Requests permission to install (describe work, attach separate page if necessary) in'4the adjoining right of way: Gets (/1 r,jA) o1,--)(,, Type of Work: Paving ❑ Utility ❑ Sidewalk ❑ Electric 01, Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: State: ZIP: Telephone: Email: Registration #: Value of Work for this Permit: $S/ Square/Lineal Footage of Work: Colt- ***** Fees***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scannin Bond $ SOO. GO(if required) Total Fee Now Due $ S . OD cos Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, 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 the 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 public works permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature Applicant or uthorized Agent The foregoing instrument was acknowledged before me this ( day of -)V , 20 /7 , by �'L v e\--- - it ->,v✓ who is personally know me or who has produced as identification. NOTARY P Sign:Ok D. ?s,a_> BLIC: Print: SEAL: •; MARIA D PEREZ, •'c MY COMMISSION # FF987137 •:z . *r,: EXPIRES April 27, 2020� o r� (401) 398-0153 FloridallotaryService.com nrfi•r�••yAt'1�+f••RAr•1.=****** ************************** 1 �� , Public Works Director, or Designee Signature v -i �� .AI pany/Utility Agent The foregoing in ument was acknowledged before me this j day of )UO J , 20 /7 by is per ovally known to me or who has produced "A'W8i Fardel ' PI 54 -Inv' as identification. NOTARY PUBLIC: Sign: Print: ;1ailZ{e, ► aith SEAL: JACKIE FRENCH SPRUNG Notary Public - State of Florida Commission N GG 094098 My Comm. Expires Feb 26, 2019 Bonded through National Notary Assn. APPROVED BY: 2017-04-15 who Property Search Application - Miami -Dade County Page 1 of 1 OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-2136-004-0220 Property Address: 121 NE 110 ST Miami Shores, FL 33161-7045 Owner ELIZABETH AMARAN Mailing Address 121NE110ST MIAMI SHORES, FL 33161 USA PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3/2 / 0 Floors 1 Living Units 1 Actual Area 2,809 Sq.Ft Living Area 2,319 Sq.Ft Adjusted Area 2,590 Sq.Ft Lot Size 9,075 Sq.Ft Year Built 1948 Assessment Information Year 2017 2016 2015 Land Value $226,559 $195,031 $161,304 Building Value $222,326 $180,264 $180,264 XF Value $994 $1,008 $818 Market Value $449,879 $376,303 $342,386 Assessed Value $314,256 .$376,303 $342,386 Benefits Information Benefit Type 2017 2016 2015 Portability Assessment Reduction $135,623 $264,256 $376,303 Homestead Exemption $25,000 $25,000 $0 Second Homestead Exemption $25,000 $376,303 $342,386 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description COLLEGE HEIGHTS PB 42-8 LOT 23 BLK 1 LOT SIZE 75.000 X 121 OR 13840-2300 0988 5 Generated On : 11/20/2017 Taxable Value Information 2017 20161 2015 County Exemption Value $50,000 $0 $0 Taxable Value $264,256 $376,303 $342,386 School Board Exemption Value $25,000 $0 $0 Taxable Value $289,256 $376,303 $342,386 City Exemption Value $50,000 $0 $0 Taxable Value $264,256 $376,303 $342,386 Regional Exemption Value $50,000 $0 $0 Taxable Value $264,256 $376,303 $342,386 Sales Information Previous PriceSale OR Book- Page Qualification Description 05/26/2016 $575,000 30138- 2372 Qual by exam of deed 04/17/2014 $335,000 23314 Qual by exam of deed 04/17/2014 $300,000 23346 Qual by exam of deed 09/01/1988 $0 13840- 2300 Sales which are disqualified as a result of examination of the deed 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/ 11/20/2017 31 ATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ;X)t4STRUCTION INDUSTRY LICENSING BOARD ROAD 2601 BLAIR STONE 32399-07$3 TA LLAHASSEE FL P4RCELL••PISTINER, MELANIE BETH DESIGNER PAVERS INC 2751 .31/W1 130TH TER DAVIE FL 33330 C: rrgratulatians! With this license you become one of the nearly or le mil ion oridi ins licensed by the Department of Business and P •nIessional Regulation. Our professionals and businesses range ton aroritects to yacht brokers, from boxers to barbeque rer t;3urants. ,and trey keep Florida's economy strong. E„ ,y cay v/o work to i nprove the way we do business in order to servo you better. For information about our services, please kop onto vinnnv.myfllovidalicense.com. There you can find more inf:nmation Ebout our divisions and the regulations that impact yo , subscrite to ti apartment newsletters and team more about r Our mission at the D apartment is: License Efficiently, Regulate Fairy. We constantly strive to serve you better so that you can ::e•ae your cacstonier.::. Thank you for doing business in Florida, ;n c congratt late o is m your new license! RICK SCOTT G'YVERNOR FllAZISSZA CGI:1o59643 ME:! GENERAL CC:rNTRACTOR Named below IS CERTIFIED Under the provl:aiole. of Chapter 489 FS. Erl:nration elate: AJl3 31, 2018 (850) 487-1395 STATE OF FLORIDA DEPART, ,11.4%, 4'-zUSINESS AND PROF%" :>";':.r , , CGC059643 ' .. . 07/04/2016 SGA pa .1..;•,,,,.:11,.'7117' iii.74 -:ililNe Ati:04..1 . h:Y° '''[ ;. 11. • IS_L'ERTIFiEo- under the provisions of Ch.4&9 FS. i8 L1807o4000a@39 '[allon Yfate Jf ? !r's ..r-WFr!,�s,."_r =; iii' ' CERTIFIED PARDELL-PI DEStGNER"P ✓ti DETACH HERE STATE OF FLORIDA DEPARTMENT OF INDUSTRY LICENSING BOARD ESS AND PROFESSIONAL u�T10N CONS KEN LAWSON, SECRETARY PAR DE L L -f'I SSTtN EFS; DESIGNER PAVERS-1K'�" DK/ IE - l'•a: i JF D: 07/04/2016 DISPLAY AS REQUIRED BY LAW remormin BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm.- � A 100 Ft Lauderdale FL 33301-1895 — 954-831-4000 . VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018 Receipt #:L OTHER TYPES CONTRACTO Business Type:3E SURFACING) Business Opened:06/09/1992 State/County/CertlReg: CGC 0 5 9 6 4 3 Exemption Code: DBA: DESIGNER PAVERS INC Eusiness Name: Owner Name: MELANIE PARDELL Business L ration:2751 SW 130 TERR DAVIE BlisineSti Phone: 954-921-5555 Rooms Seats 1'e x Amount 27.00 Number of Machines: NSF Fee 0.00 Transfer Fee 0.00 Employees Machines Professionals 1 For Vending Business Only Vending Type: Penalty Prior Years Collection Cost Total Paid 4.05 1 .00 0.00 31.05 THIS RECEIPT MUST BE THI:i BECOMES A TAX RECEIPT WHIN VALIDATED Mail ng Address: MEWNIE PARDELL 275 L SW 130 TERR DAV LE, EI.. 33330 �� IE 11 111111211111111 POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS This tax is levied for the privilege of doing business within'Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Receipt #05C-17-00000510 Paid 11/01/2017 31.05 (ENC ACcRD® CERTIFICATE OF LIABILITY INSURANCE `.-------' DATE(MM/DD/VYY1) 11 /20/2017 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 policy(ies) 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 W.F. Roemer Insurance Agency, Inc. 3775 NW 124 Avenue Coral Springs FL 33065 CONTACT NAME: Certificate Department PHONE FAx (A/C Nn Fxt) 954-731-5566 (AVC. No): 954-731-8438 Al DRESS: certificates@roemer-ins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : National Builders InsuranceCo. 16632 INSURED DESIG-7 Designer Pavers, Inc. 2751 SW 130 Terrace Davie FL 33330 INSURER B: GLP 0247017 00 INSURERC: 8/21/2018 - INSURER D : / INSURER E: CLAIMS -MADE INSURER F : OCCUR COVERAGES :1583058431 • 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 INR LTR TYPE OF INSURANCE IADDL NSD WVD$ POLICY NUMBER POLICY EFF {MMlDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A x • COMMERCIAL GENERAL LIABILITY GLP 0247017 00 8/21/2017 8/21/2018 - EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO AUTOS NED HIRED AUTOS — •COMBINED AUTO NON -OWNED AUTOS SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $• DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License #CGC059643 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 N.E. 2nd Ave. Miami Shores FL 33138 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 - ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4 JIMMI' PN; f 101'JIS STATE OF FLORIDA CHIEF FINE NIC: AL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CI:RTI:KATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CON3TI!tUC'TION INDUSTRY EXEMPTION This .;ertif`es that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE 'DATE: 8/16/2017 EXPIRATION DATE: 8/16/2019 PER:tON: PISTINER MELANIE B FEIN 350305597 BUSINESS NAME AND ADDRESS: DESISNER PAVERS, INC. 2751 SV'J 13('lTH TERRACE FOR"- FL LAUDERDALE SCOPE OF BUSINESS OR TRADE: �censE 1 Geral Contractor Floors Dor Cement Work - Driveways, Yards, or Sidewalks and Drive 33330 corporation who elects exemption from this chapter by filing a certificate of election under s of election to exempt... apply IMs section f m ! rsuant to Chapter 440.00 pe F.S., n officer this a chapter., Certificates F.S., Notices be election to be his onlywctiln he rctop of thehey business or compensation under of election Pursuant to be exempt pursuant to Chapter axe within he xppe s lwsinn to or exempt listed on the notice to revocation n if , at any time atter the filing of the notice or the department shall rece lie sate, the r meets the requirements of this section for issuance of a certificate. The 3xept ane certificates of election to be exePt shad be subject to revocatio � requirements of this section. ,arson nen t a i me notice or certificate no longer on the certificate to meet �rti`rcate a t any tune for failure of the person DFS -F2 -C WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 I DESIGNER PAVERS 11/1/17 State of Florida Broward County Before me this day personally appeared Melanie Pardell- Pistiner, who being duly sworn, deposes says: The she will be the only person working on the project, located at: Elizabeth Amaran Residence 121 NE 110 Street Miam. 40, .: s FI 33161 -r 'avers, Inc., Melanie Pardell-Pistiner, President Sworn to and subscribed before me this November 1, 2017, By 17)--(/1-4411:6 17a r — `9a s4-1 f�s- Personally known Or Produced Identification Type of Identification Print, Type, or Stam . '' a Notary JACKIE FRENCH SPRUNG Notary Public - State of Florida Commission H GG 094098 My Comm. Expires Feb 26, 2019 Woe6 ONO N 00 Ntskiny Assn: Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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 BELO YO ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. \tignature: State of Florida County of Miami -Dade �. The foregoing was acknowledge before me this day of NOW �w/ , 20 A By 'C� ti`' a'`' ` k N `PCaf1" who is personally known to me or has produced ' as identification. Notary: SEAL: . ca,t5 100 MARIA D PEREZ •`: MY COMMISSION ti FF987137 « EXPIRES April 27, 2020 p101) 398.0153 FlorldSNouryservke.Can DOCUMENT COVER PAGE For those documents not providing the required 3 x 3 inch space on the first page,this cover page must be attached. An additional recording fee for this page must be rentitted. Do cu_ment Title: (Mortgage, Deed, Etc.) Return Document To / Prepared By: 111111111M 11'1111111111111 11111 111111111 1111 _ CFN 2017R1_1169.4333 OR BK 30788 P9S 423-424 (2P9s) RECORDED 12;'11/2017 J HARVUX RUVINy CLFRK OF CoURT MIAMI-DADE COUNTY FLORIDA 1. (Space above this line reserved for recording of5ce use) Rifle 2.520 (d) On all ... documents prepared ...which are to be recorded in the public records of any county a 3 - inch by 3 - inchsp ace at the top ght-hand corner on the first page and a l - inch hy 3 - inch space at the top ght-hand comer on each sb se qnent-p age shall beleftblanicandreservedfor use by the clerk of court. CLIC/CT 155 Rev. 08116 Cleric's web address: www.miami-dadeclerk.com ' OR 2 i'�.-- 0 788 g=- as te_24-- LAST---t--AGE Miami Shores Village 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) 14 Z me - ''t`-) hereinafter referred to as the owner of the following described -property address):--- 0-4 A)----Ilv Legal Description Lot Block Subdivision Folio # / ll -.2/O& -Ody- )i () fj nests permission to install (de cribe work): 6ir,L1/ 09 S Ge8 //)-FeGt��r -eai !6c, /he 0{-- Within the public right of way of (address) 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 o(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. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within.60 days notice by the Village to d� 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 M': ores Village (or his fully.authorized representative). i1i i r - n&,,btA Owner : Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-292627 Permit Number: PW -11-17-2757 Scheduled Inspection Date: February 08, 2018 Inspector: Miranda, Chris Owner: AMARAN, ELIZABETH Job Address: 121 NE 110 Street MIAMI SHORES, FL 33161 - Project: <NONE> Contractor: DESIGNER PAVERS INC Permit Type: Public Works Inspection Type: Final Public Works Work Classification: Public Works Phone Number (305)300-6292 Parcel Number 1121360040220 Phone: (954)921-5555 Building Department Comments PAVER APPROACH IN RIGHT OF WAY r Passed 027 Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments February 07, 2018 For Inspections please call: (305)762-4949 Page 12 of 37 FOUND 1/2' IRON ROD FENCE 0.6' OUT LOT 24 BLOCK 1 QUI way/ •JCC JIOIye 0.01 V....M.1,06m. 6, sm. ••••••••••••od •••• • • •••• • — • 10.5 A5PIIALT ALLEY I5 RIGHT-OF4wAy (-4.••j• UP RECovED leflo CONCRETE/ 16.45' 4.70 FENCE 0.2' OUT FOUND I/2' IRON Pilt 7 L ONE STORY RESIDENCE # 1 2 I LOT 23 BLOCK 5.56' COVERED FOUND I/2IRON PIPE AT 5. E. CORNER OF BLOCK I FOUND I/2' IRON PIPE — 479.50 (f tM) 040410264 a t • /*40 tr U•SitL' ke;e1Z betas , is s -m st aryl eseta sater% AERIAL PHOTOGRAPH N,TT S<Al TS7 -TC.-S0=.LE• LINETYPE LEGEND: BOUNDARY LINE EJIIDING UNE — CENTERLINE EASEMENT UNE —44—. ClAIN uNK FENCE WOODEN FENCE —1-1 CVERHEAD CABLE LE-GEND: CA DENOTES CENTRAL ANGLE CAN moo aes TV. BO CH DENOTES CHORD DISTANCE DE DENOTES DRAINAGE EASEMEVT DENO1ES POMO NAL Al DENOTES MEASURED OHC DENOTES OVF_RHEAD CABS P DENOTES PLAT PP DENOTES POOL PUMP R DENOTES RADIUS TR DEMONS TELEPHONE RISER UE DENOTES UTILITY EASEMBT UP DENOTES UTIWY POLE vd_oraod WATER METER 7-Vean iJ•iNkort,tatignele,62,- P c,=.SE N:7E SJE-LEC7 PR3PEF7v :S SERwl:EZ EY PB.) 04; aLIE s P/P2SE no:E* larbec Smelting offers serapes throughout the State of Rorida. Please refer to our website at wthrlandtedavey.on for up to date information about our facia= and °average area. This slimy has been issued by the loll:ming Laridtec Surveying office: 600 Fairway Drive - Ste. 101 Deerfield Beach, FL 33441 Office: (561) 367-3587 Fax: (561) 465-3145 www.LandtecSurvey.com bati:a Ntrnber : T3570 -SE Drawn By : B. ZAB Date of Rdd Work : 05/03016 Ration : Ration : Raton : • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • • • • • • • • • • • • • BEARING REFERENCE: NONE. ZtaIRDNFORMIITION RELIANT UPULAR DATA ONLY. ALL ANGULAR 1DATA 5110WN HEIMRMRENCEQ ntRETP. • • • •• • ••• • • • • • • • LANDg SURVEYING IS, r - is *. • "r7.•./ r:.7.47), 41, f MIAMI-DADE'COUNTV,CLERK OF COURT RECORDS DEPARTMENT 22 N.W. 1ST STREET MIAMI,_FL' 33128 REF:'786333-7228 DATE:12/7/2017 TIME:11:52:19 AM' RECEIPT: 5808808 ELIZABETH AMARAN ACCOUNT #:-0 ITEM - 01 NCO RECD: 12/7/2017 11:52:19 AM FILE: -20170687924 BK/PG 0 30784/841 Recording Fees 10.00 >, COPIES 1.00 CERTIFICATION 2.00 Subtotal 13.00 TOTAL'DUE PAID TOTAL PAID CASH CASH RETURNED -C BY: Girlyne P '1NTY RECORDER $13.00 $20.00 $20.00 ($7.00)