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DS-18-219Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. OS-1-18-219 ermt P . Permit Type: Driveways/Sidewalks/Slabs Work Classification. Addition/Alteration Permit Status: APPROVED Issue Date: 2/13/2018 Expiration: 08/12/2018 Parcel Number Applicant 270 NE 104 Street Miami Shores, FL 33138-2016 1121360130320 Block: Lot: JOESPH BASSETT Owner Information JOESPH BASSETT Address 270 NE 104 Street MIAMI SHORES FL 33138- 270 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) ROSS SERVICES Phone (954)227-8944 Cell Phone Phone (305)484-6527 Cell Valuation: Total Sq Feet: $ 9,362.00 2500 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Work: INSTALL PLAIN BROOMFINISH CONCRET Bond Return : Scanning: 3 Additional Info: Classification: Residential Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $6.00 $3.38 $2.25 $2.00 $5.00 $225.00 $9.00 $8.00 $760.63 foster( �ASS�tI Pay Date Pay Type Invoice # DS-1-18-66257 02/13/2018 Credit Card 01/29/2018 Check #: 1369 Bond #: 3657 Amt Paid Amt Due $ 710.63 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Foundation Review Building Review Planning 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 is permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required fo ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS construction Auth FIDAVIT: er that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating thermore, I authorize the above -named contractor to do the work stated. izedSignature: Owner / Applicant / Contractor / Agent February 13, 2018 Date Building Department Copy February 13, 2018 1 INSPECTION RECORD STRUCTURAL INSPECTION Foundation DATE INSP Stemwall Slab Columns (1st Lift) Columns (2nd Lift) Tie Beam Truss/Rafters Roof Sheathing Bucks Interior Framing Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Driveway Driveway Base Tin Cap Roof in Progress Mop in Progress Final Roof Shutters Attachment Final Shutters Rails and Guardrails ADA compliance FINAL DOCUM Soil Bearing Cert Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification ENTS STR } RAL COMMENTS WINDOW6 & DOORS INSPECTION Attachment FINAL INSPECTION Excavation FINAL INSPECTION DATE PUBLIC WORKS Temporary Pole DATE ELECTRICAL 30 Day Temporary Pool Bonding Pool Deck Bonding Pool Wet Niche Underground Footer Ground Slab Wall Rough Ceiling Rough Rough Telephone R Telephone TV Rou TV Fi Ca• ough e Final tercom Rough DATE INSP INSP INSP Intercom Final Alarm Rough Alarm Final Fire Alarm Rough Fire Alarm Final Service Work With FINAL ELECTRICAL COMMENTS INSPECTION Final Sprinkler Final Alarm FINAL FIRE DATE INSP PLUMBING INSPECTION Rough Water Service 2nd Rough Top Out Fire Sprinkl Septic Ta Sewer -up Roo :ins ank ell Lawn Sprinklers Main Drain Pool Piping Backflow Preventor Interceptor Catch Basins Condensate Drains HRS Final FINAL DA PLUMBING COMMENTS INSP INSPECTION MECHANICAL DATE INSP Underground Pipe Rough Ventilation Rough Hood Rough Pressure Test Final Hood Final Ventilation Final Pool Heater Final Vacuum FINAL MECHANICAL COMMENTS BUILDING PERMIT APPLICATION BUILDING E ELECTRIC El PLUMBING ❑ MECHANICAL PUBLIC WORKS 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 RECEIVED JAN 2 9 2018 b.41 FBC 2011 Master Permit NODS I V —cam 1 Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 210 n E. I OLI 5T City: Miami Shores /� County: Miami Dade Zip: 33 13 $ Folio/Parcel#: I I ZI3(p OI:3O3•� . D Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): J OSEP E-I A 55T Y Address: 2.'70 N E 104 ST city: M ► A M 1 61-4©RE5 State: F L BFE: FFE: Phone#:805. LISA. 6577 Zip: 3313X Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 11053 SE-R-V ICES Phone#:Q5 2.27 $QL4(4 Address: 14 (D Zo (.A.) (.0 rvI rnei2C-I A t_ 15I Vci ' City: tarY10112A G LStaate: I L zip: 3f 33 IC) Qualifier Name: S ' . (3o�.122i- 1.PER. Phone#q5 :L1 2_2.7 be i t I State Certification or Registration #: J C_C,CI 15 Z 2— Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State:atZip: Square/Linear Footage of Work: ISO° Value of Work for this Permit: $ q3 to 2 Type of Work: ❑ Addition ❑ Alteration Description of Work: I 1.15 471 I I (r CU C3;.12. CIX t v ekoc i ❑ New El Repair/Replace ❑ Demolition p lain br©©mPi n t s k eon0xe,4-e Specify colors of color thru tile: Submittal Fee $ Permit Fee $ 2 2 S ' Ca CCF $ CO C� CO/CC $ Ji Scanning Fee $ Radon Fee $ 2 ' 25 DBPR $ 3 •3 Notary $ CO Technology Fee $ .B . Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ 0- 00 TOTAL FEE NOW DUE $ 2-I0 • 63 (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 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. Signaturtp OWNER or AGENT The foregoing instrument was acknowledged before me this day of "Tny-),� _}} ,20 1ZJ , by t—I os p f 1 �. �-wHo isnperssoonally known to rAe or who has produced -f i ( 1(0. 1)Se- • as identification and who did take an oath. NOTARY PUBLIC: Sign. Print: Seal: NIINNEMMinadltv •ir10Pt4P•. MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 "5 EXPIRES: November 2, 2020 •.Eo. pg Bonded Thru Notary Public Underwriters The foregoing instrument was acknowledged before me this day of nnb��,EC rJ, actR. Z,(.1 Gat ertie, who is me or who has produced as • identification and who did take an oath. NOTARY P Sign: Print: 5A tOrAZA L . (.t Seal: by to 0410312021 NOTARY PUBLIC - ommiS510 OF F����• sss*ssssssssss*ssss*sss*sssssss*sssssssssssssssssssssssssss*sssssssssssssssssssssssslrssssssssssssss I /. APPROVED BY Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) OFFICE OF T Property Search Application - Miami -Dade County E PROPETY APPRAISER Summary Report Property Information Folio: 11-2136-013-0320 Property Address: 270 NE 104 ST Miami Shores, FL 33138-2016 Owner JOSEPH BASSETT JOANNE GREEN Mailing Address 270 NE 104 ST MIAMI SHORES, FL 33138 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 1,734 Sq.Ft Living Area 1,714 Sq.Ft Adjusted Area 1,607 Sq.Ft Lot Size 9;225 Sq.Ft Year Built 1949 Assessment Information Year 2017 2016 2015 Land Value $230,638 $198,007 $163,894 Building Value $111,847 $111,847 $111,847 XF Value $20,683 $20,972 $15,096 Market Value $363,168 $330,826 $290,837 Assessed Value $337,773 $330,826 $256,484 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $25,395 Non -Homestead Cap Assessment Reduction $34,353 Homestead Exemption $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values ( Board, City, Regional). .e. County, School Short Legal Description MIAMI SHORES SEC 5 PB 10-47 LOT 4 & E1/2 LOT 5 BLK 119 LOT SIZE 75.000 X 123 OR 15996-2425 0793 1 COC 22332-1977 05 2004 5 Generated On : 1/22/2018 Taxable Value Information 2017 2016 2015 County Exemption Value $50,000 $50,000 $0 Taxable Value $287,773 $280,826 $256,484 School Board Exemption Value $25,000 $25,000 $0 Taxable Value $312,773 $305,826 $290,837 City Exemption Value $50,000 $50,000 $0 Taxable Value $287,773 $280,826 $256,484 Regional Exemption Value $50,000 $50,000 $0 Taxable Value $287,773 $280,826 $256,484 Sales Information Prev'ous Sale Price OR Pa e Book- 9 Qualification Description 05/27/2015 $385,000 29638-0925 Financial inst or "In Lieu of Forclosure" stated 03/18/2015 $0 29548-2883 Financial inst or "In Lieu of Forclosure" stated 07/01/1993 $120,000 15996-2425 Sales which are qualified 05/01/1985 $67,500 12499-1220 Sales which are qualified 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: RICK SCOTT, GOVERNOR C letiNT KEN el.h`VVAVGG;s:1 .r•r' s • LICENSE NUMBER STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1507522 The GENERAL CONTRACTOR Named below IS CERTIFIED Under.the provisions of Chapter 489. FS.. Expiration date:. AUG 31, 2018 GRIEPER, S BARRY ,ROSS SERVICES_ •). 4620 W COMMERCIAL 4VIr2: .--,.. ' '."--,-..' ',----,:"---;--, --2';::',....7._ TAMARAC , ,.... ------.......;----7-7 -,„...— . . . -,,,...:.. --,, ,-.:- ".- — • ----- .,:::-.-:, - '1-- • "r•-• ' \ - ,...--------7.-A... 4.• _ . ISSUED: 06/2712016 DISPLAY AS REQUIRED BY LAW SEQ # L1606270000263 Mailing Address: Ross SERVICES 4620 t4 COMMERCIAL, BLVD #2 TAMARAC, FL 33319 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, VALID OCTOBER 1, 2017 a THROUGH SEPTEMBER 30 2018 000 Owner Name: GRIEpER, BARRy S Business Location: 4620 tN COMMERCIAL BLVD #2 TAMARAC Business Phone: GE4BRAX, CONTRACTOR Business Opened:12/02/2010 State/County/Cert/Reg: CGC15 0 75 2 2 Exemption Code: THIS RECEIPT MUST BE 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 fi1CP-16-00010641 Paid 07/12/2017 27,00 07/11/2017 Effective Date AC 0* CERTIFICATE OF LIABILITY INSURANCE DATE INIMI 0111612018 D THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOES MOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUWG REPRESENTATIVE OR:PRODUCER, AND THE CERTIFICATE HOLDER. CERTIFICATE HOLDER. THIS AFFORDED BY THE POLICIES INSURER(S), AUTHORIZED IS WAIVED, subject to does not confer rights to the IMPORTANT: If the cettiiicate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION the terms and conditiofs of the policy, certain policies may require an endorsement A `statement on this certificate certificate holder in list of such endorsement(s). PRODUCER • REEL INSURANCE AGENCY DB1Al COVER ALL INSURANCE 5800 W. ATLANTIC BLVD. ; MARGATE FL 33063 CONTACT NAYS (pHoue AN) Alm P'e)•(9 956 0008 FAX Nor. (954) 956-0555 A/C reelinsurance@yahoo.com ,AGGRPcs: INSURERISI AFFORDING COVERAGE NAM N INSURER A: ROCKINGHAM CASUALTY COMPANY 42595 INSURED ROSS MANAGEMENT SERVICES INC DBA ROSS SERVICES 4620 W. COW*IERCIAL BLVD. #2 • TAMARAC Fli 33319 ! INSURER B : OLD REPUBLIC SURETY COMPANY 40444 INSURER c: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THA3 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHS'CANDING 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 CONCNTIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. , LTR TYPE OF INSUUANCE ADDL INSO SUER YVVD POLICY NUMBER POLICY EFF iMWDDIYYYY} POLICY DO' IMM'DD7YYYn LIMITS , A X COMMERCIAL GENERAL LIABILITY RFLG200065-01 7116/2017 711612018 EACH OCCURRENCE $ 1,000,000 CLAIMS MADE Pri OCCUR DAMAGE TO RENTED FREitISFS (Fa occurrence) S 50,000 MED EXP (Any ore Person) S 5,000 . PERSONAL & ADV INJURY $1,000, )00 GEM. AGGREGATE POLICY OTHER; LIMIT/PLIESP[R JC�T i L LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG 32,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED _.. • i SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT LEa acadeol) S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (per ar 'dent) $ S UMBRELLA LIAR EXCESS LIAB T ,l• OCCUR CLAIMS -MADE • EACH OCCURRENCE $ r AGGREGATE S DED I I RETENTS S VYORILERS COMPENSATI AND EMPLOYERS' LIABI YIN- ANY PROPRIETOR/PARTNEM/F-XECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory M NH) U lea, deavibe order DESCRIPTION OF OPERATIONS below N / A • I PER F0 H- STATUTE R E.L. EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ B 33 BOND 0FL0595152 41612017 41612018 r BOND LIMITS $100,000 DESCRIPTION OF OPERATIONS I I.00KnONS I VEHICLES (ACORD i0t. Additional Retreats Schedhde, may be attached N more space is required) GENERAL CONTRACTOR j . i i CERTIFICATE HOLDER CANCELLATION MIAMI SHOR • S VILLAGE BLDG. LDEPT 10050 NE 2No DGAVENUE MIAM I SHOR4S, FL 33138 • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCO NCE THE POLICY PROVISIONS.. AUTOO ACORD 25'(2014101) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISIONOF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 1/24/2018 EXPIRATION DATE: 1/24/2020 PERSON: GRIEPER FEIN: 262372977 BUSINESS NAME AND ADDRESS: ROSS MANAGEMENT SERVICES INC ROSS SERVICES 4620 WEST COMMERCIAL BLVD , FORT FL LAUDERDALE SCOPE OF BUSINESS OR TRADE: Licensed General Contractor 33319 S BARRY IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252'CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Notice to Owner -Workers' Corn 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: I. 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 SIGNIN BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. t; Signature Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 2.2 day of J A N , 20 13 . By Jo S E P i4 -BASSET T who is personally known to me or has produced Ditty t25 GL=n St� Notary: SEAL: as identification. Financing Available joss SFLVICFS u� 4620 W. Commercial Blvd., Suite # 2 Tamarac, FL 33319 Phone: 954.227.8944 • Fax: 754.223.5562 License #: CGC1507522 January 22, 2018 State of Florida County of Dade Before me this day personally appeared AIrZ/2 (- 12/ EPE12 duly sworn, deposes and says: That he or she will be the only person working on the project located at: 2.70 AlE 10 Li sr Mi4Mf sorzcs Pc., 33/38 Contractor Sigdature Sworn to (or affirmed) and subscribed before me this 22- day of JAN , 20 ig , by 5. 13 arty y i2/ &PER. . who, being \►►►►►NI I I I UI//,,/ / �d�aLR; 5�.'cc,11)I 0410312021 NOTARY PUBLIC Commission # c- 11310�\0�-4r t Type or S mplame of Notary $A&UD/'Z,k L l2JUERA OF F� �.� Personally known Or Produced Identification ✓ Type of Identification Produced 6 ju ►1et2 U (Fil S t Brick Pavers • Travertine Marble • Eurotile • Stamped Concrete • Diamond Brite • Pool Coping • Pool Tiles --- AND SO MUCH MORE!!! Miami Shores Village Building Department SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, JOSEPN Ott SSET , does hereby attest that (Property owner) The attached survey, performed by rim L L C— (Name of surveyor's company) For address: 2'10 N E 1 O Ll ST Performed on (01 S 1 t 5 (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 ma, violate zoning or building code regulations. The Affiant further understands that the existence of any such stru tures may affect final inspections as applicable to this or other permits. Fu er, A :n�say eth naught. Prope Owner Signature SWORN TO AND SUBSCRIBED before me this Affiant is Revised on 5/22/2009/ Revised on 6/12/09 JosEPN `BI ssErT (� Property Owner Print Name Len — \ day of I -A produced as identification. Notary • • • • • • • . •. • II•••• • 1 • • • • • •••• •••• • •••• • •••• • •••• • •MI • • • M • • •• • • • • • •••• • • •• • •• • • • • • •• II • •R.•••• •• •••• • • •••• N.E. 104th STREET 75.0' R/W FOUND 1/2" IRON PIPE FOUND 1 /2" IRON PIPE 25.00' • •• • • • WEST 1/2 • OG LO: 5 •EMI(• 119 ••NOI :1f�C� DED •••• • • •••• • • •• • • • • • FOUND 1/2" IRON PIPE o Al 00 N 10.1' 25.00' K 12.4' 5.3' x 10.1' n 0 17. 18.9' BUILDING #270 50.00' 13.9 co 22.9' n M 19.6' r 19.7' A2 • EAST 1/2 OF LOT 5 BLOCK 119 cUIC , POOL A4 LOT 4 :BLOCK 119 A3 152.05' (P) LOT 3 BLOCK 119 FOUND 1/2" IRON PIPE BLOCK CORNER P.I. $URVEY NOTES CONCRETE WALK CROSSING PROPERTY BOUNDARY ON ;n NORTHERLY SIDE OF LOT 0 J THERE ARE FENCES do CBS WALLS NEAR ME BOUNDARY OF THE PROPERTY co o FOUND 1/2" IRON PIPE 75.00'... 15.0' ALLEY (P), (IMPROVED) 1.5' A1= 90'12'15" (P) A2= 89'47'45" (P) A3= 90'14'30" (P) A4= 89'45'30" (P) (SIGNED) PAGE 2 OF 2 PAGES BOUNDARY SURVEY SURVEYORS CERTIFICATE I HERESYCERI7FY THAT THIS BOUNDARY SURVEY IS A TRUE AND CORRECT REPRESENTATION OFA SURVEY PREPARED UNDER MY DIRECT70N. NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, OR A RAISED EMBOSSED � �SIGNATURE. Clyde ' DN CN .0 Md4". �___. 7° McNealy ;�� 5,12 / / .a'00' CLYDE O. WHEAL, PROFESSIONAL SURVEYOR AND MAPPER #2883 LB #7893 TARGET SURVEYING, LL.0 SERVING ALL FLORIDA COUNTIES 6250 N. MILITARY TRAIL, SUITE 102 WEST PALM BEACH, FL 33407 PHONE (561) 640-4800 FACSIMILE (561) 640-0576 STATEWIDE PHONE (800) 226.4807 STATEWIDE FACSIMILE (800) 741-0576 • 4.,