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DS-18-1462
Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pei Permit NO. DS-5-18-1462 a Permit Type: Driveways/Sidewalks/Slabs MI workClassifcation: Addition/Alteration Permit Status: APPROVED Issue Date: 6/22/2018 Expiration: 12/19/2018 Parcel Number Applicant 31 NW 92 Street Miami Shores, FL 33150- 1131010170110 Block: Lot: ROBERT BURLEIGH Owner Information Address Phone Cell ROBERT BURLEIGH 31 NW 92 Street MIAMI SHORES FL 33150- 31 NW 92 Street MIAMI SHORES FL 33150- Contractor(s) Phone ANTHONY BOBCAT SERVICE INC (786)709-3622 Cell Phone Valuation: Total Sq Feet: $ 4,775.00 630 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Work: SQUARE PLAIN CONCRETE DRIVEWAY A Bond Return : Scanning: 3 Additional Info: SQUARE PLAIN CONCRETE DRIVE). Classification: Residential Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge P&Z Review Fee Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $3.00 $2.00 $2.00 $1.00 $35.00 $125.00 $9.00 $4.00 $681.00 Pay Date Invoice # 06/22/2018 06/22/2018 05/29/2018 Bond #: 3805 Pay Type DS-5-18-67727 Check #: 1197 $ 131.00 Check #: 76155235. $ 500.00 Check #: 1186 $ 50.00 Amt Paid Amt Due $ 550.00 $ 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 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 all the foregoing informatioryls accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above - contractor to do the work stared. Authorized Signature: Owner / Applicant / Contractor 1� Agent June 22, 2018 Date Building Department Copy June 22, 2018 1 q.76.)-40 BUILDING PERMIT APPLICATION BUILDING ❑PLUMBING JOB ADDRESS: 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 ❑ ELECTRIC ❑ ROOFING ❑ MECHANICAL OUBLIC WORKS =3 j u u) q 2 sr - RECEIVED • MAY 2J2t8_4 FBCCC2O Master Permit No. tD ��— ILO 2- Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: 33 LW) �A Is the Building Historically Designated: Yes NO i. Occupancy Type:Qt43 • Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder)` O & �LJQ.ti 1 ' Phone#: M) " 1 ` (t O ) Address. 3 ) t4 qz&— City: LU4CY\( C.7t4cf-£5 State: R•ekD19-- Zip: 33iS Tenant/Lessee Name: Phone#: Email: BFE: FFE: City: Miami Shores County: Folio/Parcel#: I — 310l ©I'4-C ! ° f�� �/�,� p,�]� \per /� ,J �) d FllO" CONTRACTOR: Company Name: ,r uV 1 bOfk 302-0C Pf ne# 1093 o9 �— Address: OGO a-14 o L'i'rNA D tui City: 1.104i'1'ti State: f lek-1 - Qualifier Name: euN`b -r rnoLiock. State Certification or Registration #: �lC°a�8 �d U`l `t� Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Phone#: Zip: V 3 Value of Work for this Permit: $ Lit Type of Work: ❑ Addition ❑ tion ❑ Newtepair/Replace De ition� a Icw Thin �6'e" Thwteji4Ja/p Description of Work: Specify color of color thru tile: Valk - Submittal Fee $ Permit Fee $ - S ' CCF $ CO/CC $ DBPR $ Z • CAD Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ CO 7gz-z % 3Q--' co TOTAL FEE NOW DUE $ I 3 I • o� Scanning Fee $ Radon Fee $ 2 - Square/Linear Footage of Work: 151.30 (Revised02/24/2014) t'3I•O 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. Signature Signature 1476( OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged beforemethis The foregoing instrument was acknowledged before �me this day of , 20 IS , by day of L.. , 20 t7 , by Obi Who is personallyknown to me or who has produce 1.tea identification and who did take an oath. NOTARY PUBLIC: Sig Print: Seal: as me or who has produced identification and who did take an oath. jQ1^ , a c*ASUSANALAMi�ERt ~ •� CsmrnIssion 6 • 950862 Expires 14, NOTARY PUBLIC: Sig t( p�,�� ,�jy� Print: 14^' frItg —""' O Commission rr •Ww/Z OJ. ?tor a 0* Jewry 14, cwA,04F eawaanwe Moms. ./ ***************flfl`k********** Sordid 11no "*01*'********************************************* ************* *********** a I/ APPROVED BY Plans Examiner (-1111Y�+ (1/ (// Zoning �► GLORIASUSANAWAMR ? :�.�*","�, OLdWSUBANAlAM1EleT Seal: +�'j"'� CommiisebnaeFF9S08d4 4 i'. ? * • Expires Jrwery 14, 2020 (Revised02/24/2014) Structural Review Clerk Property Search Application - Miami -Dade County OFFICE FTHE Page 1 of 2 ROPERTY APPRAISER Summary Report Property Information Folio: 11-3101-017-0110 Property Address: 31 NW 92 ST Miami Shores, FL 33150-2226 Owner ROBERT BRUCE BURLEIGH LE REM REBECCA LUND BURLEIGH REM DEMET DALKIRAN ROBERTS Mailing Address 31 NW 92 ST MIAMI SHORES, FL 33150-2226 USA PA Primary Zone 0800 SGL FAMILY - 1701-1900 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 2/1/0 Floors 1 Living Units 1 Actual Area 1,338 Sq.Ft Living Area 1,128 Sq.Ft Adjusted Area 1,233 Sq.Ft Lot Size 7,500 Sq.Ft Year Built 1938 Assessment Information Year 2017 2016 2015 Land Value $164,862 $164,862 $122,049 Building Value $85,817 $85,817 $85,817 XF Value $0 $0 $0 Market Value $250,679 $250,679 $207,866 Assessed Value $160,667 $157,363 $156,270 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $90,012 $93,316 $51,596 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description CANADAY EXTENSION PB 41-71 LOT 11 LOT SIZE 75.000 X 100 OR 19430-3071 12 2000 1 COC 26324-1369 04 2008 1 Generated On : 5/18/2018 Taxable Value Information 2017 2016 2015 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $110,667 $107,363 $106,270 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $135,667 $132,363 $131,270 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $110,667 $107,363 $106,270 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $110,667 $107,363 $106,270 Sales Information Previous Sale Price OR Book- Page Qualification Description 12/06/2017 $100 30812- 2129 Life Estate interest 04/01/2008 $269,000 26369 Sales which are qualified 06/01/2005 $0 23611- 1963 Sales which are disqualified as a result of examination of the deed 12/01/2000 $122,500 19430- 3071 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 https://www.miamidade.gov/propertysearch/ 5/18/2018 An(®y [)r°veway ❑ PROPORSAL ❑CONTRACT t • _',,..-v R tip, (* 786.800.8500 - 786.709.3622D ,.. a^ = `, - . = = Fl. 8690 Grand Canal Drive - Miami, 33144 .3' ; .i,, . .. ,;. Ce u , 381 , �, e- l �C J1/4 G' O C� r\ DOME PROPORiSAL SUBMITTED5° 0\0 e c2A Q) (ZA e \ ciN PHONES DATE / 619 / 8 ADDRESS \ * Qi u�V Cr r s `� ��J ❑ RESTORE AMOUNT ❑ REPAIR ❑ RESEAL ❑ PRESSURE CLEAN ❑ NEW STAMPED CONCRETE D/W ER NEW PLAIN D/VV `,, -.- ; t-D 3 C) . c1 `_, ';L l �2- ❑ EURO TILE SPRAY DECK . 7) \-\ ., '\ A ,`?_. '\ \) ( \.)-- 1 G ❑ NEW BRICK DNY F- ,,.- (... ❑ COLOR ❑ MOLD MODEL ONLY NEW DRIVEWAY INCLUDES: - PERMIT ' - LIFT OF EXISTING DRIVEWAY - HAUL AWAY DEBRI - AREA MEASURED IN 4" DEEP WITH 3000 LBS OF FIBER BLEND CLEAN CEMENT - PRESSURE CLEAN -SEALANT • ONE YEAR GUARANTEE NOTICE TO OWNERS TOTAL PRICE $ -4 r 5- o) !DADS & BROWARD COUNTY BUILDING CODE REQUIRES THAT ANY SIDEWALKS THAT ARE PART OF AN ENTRY WAY MUST BE s' INCHES OF THICKNESS. ANY SIDEWALK THAT �,� t_ \,22�,-� O DEPOSIT $ 3 00 IS NOT 6' INCHES THICK MUST BE REPLACED AND WILL ADD TO THE CONTRACT $100.00 DOLLARS FOR PERMIT AND 595.00 DOLLARS PER 5' FEET SECTION OF SIDEWALK BALANCE $ c� 3 % DO REPLACED 1F YOU RESIDE IN CORAL GABLES IT WILL ADD $150.00 DOLLARS PER 5' SECTION REPLACED. IN THE EVENT THAT A SWALE IS NEEDED TO OBTAIN FINAL INSPECTIONS A 51.00 PER SO FT WILL BE CHARGED TO THE BUYER FOR RESODING j Balance $ to be paid as follows: • ° ° % COMPANY NOT RESPONSIBLE FOR DAMAGE TO UNDERGROUND 50%to Start 3 PIPES THAT ARE NOT UP TO COUNTRY CODES OR PLUMBING o b 40% to Pour `�1 J � a le* have read going Proposed coed � ;;;;I a terms and conditions stated t� . �/ 10% to Seal ii Purchaser. ' / Approved by: •'� `� � ,..._'. f ,a ACORti CERTIFICATE OF LIABILITY INSURANCE ior....-'" DATE(MM/DD/YYY1) 06/13/2018 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 Accurate Group LIc 8300 West Flagler Suite 114 Miami, FL 33144 Phone (305) 226-8727 Fax (305) 226-8767 CONTACT NAME: Lucia Estrella AX Pre o, Eat): (305)226-8727 • (A/C. No): (305)226-8767 DDRIESS: iuciaestreua(i©bellsouth.net - INSURER(S) AFFORDING COVERAGE NAM # INSURER A:, RLI Insurance Company INSURED Anthony. Bobcat Service Inc P 0 Box 443353 Miami FL 33144- INSURER 8: INSURER C: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR LTRINSR-- TYPE OF INSURANCE ADDLSUBR WVD- POLICY NUMBER POLICY EFF 1MMIDD/YYYYUMM/DD/YYYY) POLICY EXP LIMITS A ►n COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE 0 OCCUR • N N GGL0000443 08/10/2017 08/10/2018 EACH OCCURRENCE $ 300,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1 OO,000.00 MED EXP (Any one person) $ 5,000.00 ill PERSONAL 8 ADV INJURY $ 300,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: 5 POLICY ® j CT • LOC GENERAL AGGREGATE $ 600,000:00 PRODUCTS- COMP/OP AGG $ 300,000.00 III OTHER $ • AUTOMOBILE LIABILITY El ANY AUTO AALLUTOS AUTOS OWNED SCHEDULED • II NON -OWNED HIRED AUTOS AUTOS. ® U COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ .. $ UMBRELLA LIAB ®OCCUR II EXCESS LIAB I♦ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ U DED U RETENTIONS $ WORKERS COMPENSATION• AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECl1T OFFICER/MEMBER EXCLUDED? N / A PER OTH- STATUTE �ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Concrete Construction (Driveways) CERTIFICATE HOLDER CANCELLATION Miami Shore Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138. ACORD 25 (2014/01) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WI ' THE POLICY PROVISIONS. AUTHORIZED REPR The 8= r1 A RD CORPORATION. All rights reserved. d logo are registered marks of ACORD CT,*Construction Tradfyirg Board BUSINESS CERTIFICATE OF COMPETENCY El 600448 ANTHONY BOBCAT SERVICE,INC D.B.A.:ANTFHONY DRIVEWAYS ot- ,a,s MOLINA, BELINDA Is certified under the provisions of Chapter 10 of Muni -Dade County Local Busi ness Tax Recei pt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7211170 BUSINESS NAM E/LOCATION ANTHONY DRIVEWAYS 2337 NW 41 ST MIAMI, FL 33142 OWNER ANTHONY BOBCAT SERVICE INC CIO BELINDA MOLINA PRES Worker(s) 1 RECEIPT NO. RENEWAL 7494723 SEC. TYPE OF BUSINESS 196 SPECIALTY ENGINEERING E1600448CONTRACT r LEcr EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 09/29/2017 0224-17-005013 This Local Business Tax fceipt only con"rms payment d the !zeal Business Tax. The Receipt is not a license. permit, or a certi ^cation of the holder's quail "cations, to do business. Holder must comply with any governrrental or ncngoeerrrnental regulatory laws and requirements which apply to the business. The REM NQ above oust be (bpi eyed on all conrrercial vehicles - Miami -Dade 03de Sec 83-276. MIMI For more information, visit www.niarridade rovitaxcdIector Municipal Contractor's Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO: E1600448 BUSINESS NAM E/LOCATION ANTHONY DRi1IBNAYS 2337 NW 41 ST MIAMI, FL 33142 RECEIPT NO. 7517922 OWNER TYPE OF BUSINESS ANTHONY BOBCAT 83TACE INC S'ECIALTY ENGINEERING G O BBINDA MOLINA FRES CONTRACTOR EXPIRES SEPTEMBER 30, 2018 Pursuant to County Code Sec 10-24 PAYM ENT RECEIVED BY TAX COLLECTOR 175.00 09/29/2017 0224-17-005013 This receipt is not valid in the following Municipalities Arentura, Doral, l ialeah, Key Biscayne, Miami Off, Miami Lakes, Palmetto Bay, Rnecrest, Sunny Isles Beady, Town of Cutler Bay. For more irfometion, visit www.mianidade.gov/taxcdlector A �..' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYr) 05/29/2018 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 Accurate Group Llc 8300 West Flagler Suite 114 Miami, FL 33144 Phone (305) 226-8727 Fax (305) 226-8767 CONTACT Lucia Estrella NAME: —LAL"co,No so; (305)226-8727 i , No): (305)226-8767 ADDAIRESS; Iuciaestreila@bellsouth.net INSURERS) AFFORDING COVERAGE i NAIC 0 INSURER A: RLI Insurance Company j INSURED Anthony Bobcat Service Inc P O Box 443353 Miami FL 33144- INSURER 8 : INSURER C: INSURER D : INSURER E : INSURERF: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (1M/DD YYY) POLICY EXP (MMIDD/YYYY) UMITS A ❑/ COMMERCIAL GENERAL LIABILITY III CLAIMS -MADE OCCUR N N GGL0000443 08/10I2017 08/10/2018 EACH OCCURRENCE $ 300,000.00 DAMAGE TO RENTED PREMISES {Es occurrence) $ 100 000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL 8 ADV INJURY $ 300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY • jEei • LOC GENERAL AGGREGATE s 600,000.00 PRODUCTS - COMP/OP AGG $ 300,000.00 Ill OTHER $ AUTOMOBILE UABILITY S ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS IIIHIRED AUTOS AAOtOSWNED II III eBId COMBINED SINGLE LIMITLigent $ BODILY INJURY (Per person) $ BODILY INJURY(Per accident ) $ PROPERTY DAMAGE (Peracadent) S $ II UMBRELLA LIAR IIIOCCUR 111 EXCESS UAB in CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ IIII DED II RETENTIONS 1 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PROPRIETORIPARTNER/EXECUTNL N I A PER OTH- II STAIItIF ❑ E.L. EACH ACCIDENT $ ANY OFFICER/MEMBER EXCLUDED? i E.L. DISEASE - EA EMPLOYE S (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CANCELLATION Miami Shore Village Building Department 10050 NE 2 Ave Miami Shores, Fl 33138 ACORD 25 (2014101) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THE EOF, N•TICE WILL BE DELIVERED IN ACCORDANCE WI Y P •' ISIONS. AUTHORIZED REPRES ©19 The ACOR RPORATION. All rights reserved. re registered marks of ACORD 8/15/2016 Report Viewer 1 !1 100% JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF 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: 8/12/2016 EXPIRATION DATE: 8/12/2018 PERSON: MOLINA BELINDA FEIN: 813114283 BUSINESS NAME AND ADDRESS: ANTHONY BOBCAT SERVICE INC 8690 GRAND CANAL DR MIAMI FL 33144 SCOPES OF BUSINESS OR TRADE: CONCRETE CONCRETE OR CEMENT WALLBOARD,SHEETROC CONSTRUCTION NOC WORK -FLOG K,DRYWALL, P P ii Io Chapter 440.05(14). FS.. andicer *la carpomtionwho dects emnption tan this doctor try Ming acertidaledehxiaMuder Hs section may not recover boodle or compensation tmler dds chapter. Pursuant loChapter440.05(12j. FS- CrftieMasdebedarlobeexempt_ apliyedy Wain beaus* di the business or trade listed mVas melee ddecton lobe exempt. Pursuant bChapca 440.05(i3). F.S. Nelms detedlonbbe exempt Ind certificates d election b be exempt Wall be n*jeca b remoatlan if. Many tme aria the tiling d the roam ar the issuance of to cmUUce e. the person named on Menace or cmtldeate no laver meets the roaireneitsotitis section for Issuance ofa certificate.TMdepoenedshad revdtea DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 httpsJ/apps8.fldfs.Com/Crreportviewer/reporHlewer.aspx?data=kdvpginc9D7Q3gH6TER6eP1KMZ%2fSz5bXKYIBxkrekeESoPVy1v4NPOPN42XeirDRGXVW i... 1/2 Anthony Bobcat Service Inc. DBA Anthony Driveways Date: State of Rim • County of ,t it -dam Before me this day personally appeared .46//%/&/ who being duly sworn deposes and says: That he or she will be the only person working on the project located at: 3/ 9 ? s> /a/n/ 5i MAJ ---C..eSeld;Set Gz Contractor Signature Sworn to (or affirmed)and subscribed before me this 313-1 day of20 18 By &Jirtdfi nt iina .a„tete GLORIAweAw►w1eERr * Cambria) FF950062 Jeri:wi l4, 2020 Bomdstiln erro+Nobly e Personally know OR Produced Identification Type�of Identification Producfd C'111- & 07 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 wider 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 ACKNOWL DGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade w r horegoing was ackn . w 44.14, •gebefore met i�day of 1. aG , 20 ,b. i 4, who is personally known to me or has produced _' Li �/, ►� �_�ff�,�.!l 11.4. entificatio NotaL�"'r ! ‘A' I I If/ SEAL: ,9•••••. Commleilo,t00 950862 Expinicial uwy14,2020 a, IN SWIM TAN i. .tI ryS ates t Block PREPARED B KNOW ALL MEN WHEREAS, the undersigned situated and being in Miami Shores Village, Florida: Lot(s Page -+ of the Public Records of Miami -Dade County, Florida, (address) 3 t U to 9 2 5-i'• ESE PRESE S: ()"�islbib4'fe'fee simple owner(s) of the following described property ("Property") of 0 S116d� ivision), according to the plat thereof, as recorded in the Plat Book Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DECLARATION OF USE and WHEREAS, the undersigned owner(s) have sought certain development approval from Miami Shores and are providing this document in consideration thereof and to induce the Village to grant same: NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which is acknowledged, the undersigned do(es) hereby declare and agree: 1. That the Property will not be used in violation of any ordinance of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. 2. That the property will be used for a single family residence only. 3. 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 concerning 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 accordance with the codes, ru s and regulations of said Village then in effect. IN WITNESS WHEREOF, the undersigned has/have caused hand(s) and seal(s) to be affixed hereto on this I day of Signature and Prin an Signature and Print STATE OF FLORIDA COUNTY OF MIAMI-DADE %au MAMA LAMBERT ) * •r * Commission0FF950802 • +,Fan an* apExPi ea January 14, I NEREB`� CERTIFY that on this day persona II y peal OWN "S: Signature fob Ptik~!• GLMAb ORIASUSANAUER1 Commission /FF960862 I ; Expires January 14, 2020 ;FOFFv:r BradedThem MO licariltantolli who is personalty known to me or has produced (type of identification) as identification and he/she acknowledge that he/she executed the foregoing, freely and voluntarily, for purposes therein expressed. SWORN TO AND SUBSCRIBED before me on this 1 day of My commission expires: f,,, GLORIABUSANALAMBEN * * CoaxWNion 9 FF 950002 Expires January 14, 2020 '*eip4 MdMnwMONoisy OWNS NOTARY PUBLIC, STATE OF FLORIDA U Clear Title ECTIMMEM Serving all of vrnir FInrinlo Rc+a1 Fciafa_naads — — NO REVIEW REQUIRED• • • Florida Health Miami -Dade County': O.S.T.D.S. &Well Pro ; ram •• ' • ,R6 Date: tj•4I i .P #J Iojb a.: a• 1 1.1 fl.70' . .. • • • •. • • MOO' PAW ISJW- • . .. . . . ...• •. . ...•• •• 13.ect I �` NW 92 STREET 17.00" ASPHALT PAVEUENT ebe efol-i = a sP I �w I tS-3 3= 3Co 3, a era i= r flPPit0634. it1'3Q3 Accepted By: OS PERMIT #: Miami Shores Village GULATIONS upaT- SCALE 1/20 I00.00' BG 49irP ith e S'n14i,. T FOQ,UV _t PPI H. Property Address: 31 N.W. 92 STREET MIAMI SHORES, FL 33150 NOTES: NO NOTES SURVEYOR'S CERTIFICATION• I REPRESENTATION OF A SU TECHNICAL STANDARDS, SURVEYORS IN CHAPTE SIGNED MIGUEL S REPARED ET FORTH BY THE -17. FlelltICIAA,OPeAINIST THAT THIS 'BOUNDARY SURVEY' IS A TRUE AND CORRECT R MY DIRECTION. THIS COMPLIES MATH THE MINIMUM TE OF FLORIDA BOARD OF PROFESSIONAL LAND THE CODE PURSUANT TO 472.027, FLORIDA STATUTES. FOR THE FIRM P.S.M. No. 5101 NOT VALIttigoDT AN ,�ay i ELECTRON NATURE AND AUTHENTICATED ELECTRONIC SEAL AND/OR THIS MAP IS NOT VALID _.)"AND THE ORIGINAL RAISED SEAL OF A LICENSED SURVEYOR AND MAPPER. M.E. Land Services, Inc. 10665 SW 190TH STREET SUITE 3110 MIAMI, FL 33157 PHONE: (305) 740-3319 FAX: (305) 669-3190 LB#: 6463 TILIW` Survey:A-2161 Client File #: 08-0173 BURLIG 14 Page 1 of 2 Not valid without all pages. ••• , Surveyors • •• •• • • PROPERTY LINE • • • • • • Lggend •• •• • • • • • • • • • • • STRUCTURE FND• • • FOUND IRaN APE ./ • • • • B.R. BEARING REFERENCE TEL TELEPHONE FACILITIES ® CONC. BLOCK WALL PIN AS NOTED ON PLAT L, CENTRAL ANGLE OR DELTA U.P. UTIUTY POLE —X—X— CHAIN -LINK FENCE OR WIRE FENCE LB/ UCENSE / - BUSINESS R RADIUS OR RADIAL E.U.B. ELECTRIC UTIUTY BOX • • • • • • • • —r'H,'— WOOD FENCE Y6/ • IMMENSE . - 6UrN"EY•R • • • RAD. RADIAL TIE SEP. SEPTIC TANK • • • • • • • •• • • • • • • o o IRON FENCE •ALIB •ALCULATPD•POINT • • • • • • • • • N.R. NON RADIAL D.F. DRAINFIELD .. — — — — EASEMENT SL1 • SLt PIN • • • • • • • TYP. TYPICAL A/C AIR 'CONDITIONER — - — CENTER UNE ♦ CONTROL POINT I.R. IRON ROD S/W SIDEWALK P.I S ' / U • • C(.!f•RiTE ypWUMEI{T • • • I 1I P: i ;.IRON tPIPE V t • ' . ' pV`Y DRIVEWAY WOOD DECK • • • • • • • • "• J , , • • BENOHNAR• • • • • • • • `` NRD'", NAIL 'k DISK i SCR., SCREEN 'mow.*_.. IISK,:I ':i:(? .y. • . _ .. CONCRETE ELEW ELEVATION • Lfrtl"�"^` 4 `/I ,,..I c: i PK NAIL PARKER-KALON NAIL GAR GARAGE • • E • • • • • • • • • ! n ` ,% Y` P.T. C POINTOF TANGENCY D.H.t.%"D ,,i ENCL ////// ASPHALT .H. DRILL HOLE ENCLOSURE 1 P.C.-' POINT, .OF CURVATURE ® WELL Ot" kN.T.S.4iNOT4TO�SCALE ,-`- - - -` ♦:A!���!,..�Sv T ? t BRICK / TILE `' I P.R.M. PERMANENT REFERENCE MONUMENT W, FIRE HYDRANT " •F.F. FINNISRED FLOOR , P.C.C. POINT OF COMPOUND CURVATURE" - MANHOLE " OF BANK ®"'M.H. T.O.B.-TOP r/ WATER + r'///// P.R.C. I• POINT OF. REVERSE CURVATURE . a.- O.H.L: ^^ OVERHEAD LINES °E.OiW.t EDGEIOF WATER N ��- APPROXIMATE EDGE OF WATER P.0.8. POINT OF BEGINNING TX TRANSFORMER a E.O.P EDGE OF PAVEMENT P.O.C. POINT OF, COMMENCEMENT CONCRETE VALLEY GUTTER CATV CABLE TV RISER C.V.G. COVERED AREA P.C.P. PERMANENT CONTROL POINT W.M. WATER METER B.S.L BUILDING SETBACK UNE 0TREE M p FIELD MEASURED P/E POOL EQUIPMENT S.T.L. SURVEY TIE UNE XX `, 'POWER POLE P PLATTED MEASUREMENT CONC. CONCRETE SLAB Q. CENTER UNE pp CATCH BASIN '*Ni D DEED ESMT EASEMENT R/yV RIGHT-OF-WAY C.U.E. 'COUNTY" UTIUTY EASEMENT f C CALCULATEDt D.E. DRAINAGE EASEMENT PUBUC UTILITY' EASEMENT P.U.E. I.E./E.E. INGRESS / EGRESS EASEMENT LM.E. LAKE OR LANDSCAPE MAINT. ESMT. L.B.E. LANDSCAPE BUFFER EASEMENT C.M.E. CANAL MAINTENANCE EASEMENT U.E. I UTIUTY EASEMENT R.O.E. ROOF OVERHANG EASEMENT L.A.E. UNITED ACCESS EASEMENT A.E. ANCHOR EASEMENT • Property Address: 31 N.W. 92 STREET t"-- 1 i MIAMI SHORES, FL 33150 I 4 't General Notes: 1. The Legal Description used to perform this survey was supplied by others. This survey does not determine or is not to imply ownership. 2. This survey only shows above ground improvements. Underground utilities, footings, or encroachments are not located on this survey map. 3. If there is a septic tank, well, or drain field on this survey, the location of such items was shown to us by others and the information was not verified. 4. Examination of the abstract of title will have to be made to determine recorded instruments, if any, effect this property. The lands shown herein were not abstracted for easement or other recorded encumbrances not shown on the plat. 5. Wall ties are done to the face of the wall. 6. Fence ownership is not determined. 7. Bearings referenced to line noted B.R. 8. Dimensions shown are platted and measured unless otherwise shown. 9. No identification found on'property corners unless noted. 10. Not valid unless sealed With the signing surveyors embossed seal. 1 11. Boundary survey means a drawing and/or graphic representation of the survey work performed in the field, could be drawn at a shown scale and/or not to scale. I t " y 12.- •Elevations ii shown are Lased upon NG`vD-1929 unless otherwise noted. 13. This is a BOUNDARY SURVEY unless otherwise noted. 14. This survey is exclusive for the use of the parties to whom it is certified. The certifications do not extend to any unnamed parties. 15. This survey shall not be used fo'r construction/permitting purposes without written consent from Miguel Espinosa. j; Flood Information: 4 - — - Community Number: Panel Number: 0090 Suffix: L Date of Firm Index: 9/11/2009 Flood Zone: X Base Flood Elevation: Date of Field Work: ., 12/1.2/200g Date of Completion: I . Legal Description: ,� —- LOT 11, OF SUBDIVISION CANADAY EXTENSION , ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 41: PAGE 71, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA--1 ... I , f I. ,- I ^ k e . r , a J . 1 . PRINTING INSTRUCTIONS: Certified To: ROBERT BURLEI(H; CLEAR TITLE SERVICES, INC.; ATTORNEY'S TITLE INSURANCE FUND; PRIDE MORTGAGE LLP; . Its'successors and/or assigns as their interest may appear. While viewing the survey in any Acrobat Reader, select the File Drop -down and select "Print" Select a color printer, if available, or at least one with 8.5" x 14" paper. Select ALL for Print Range, and the # of copies you would like to print out. Under the "Page Scaling" please make sure you have '+ selected "None." Do not check the "AutoRotate and Center" button. Check the "Choose Paper size by PDF"checkbox. Click OK to Print. Please Copy below for Policy Preparation Purposes only: This policy does not insure against loss or damage by reason of the following exceptions: Any rights, easements, interests or claims which may exist by reason of, or reflected by, the following facts shown on the survey prepared by MIGUEL ESPINOSA dated bearing _ Job tt A-2161 : a) NO NOTES b) c) M.E. Land Services, Inc. IE 10665 SW 190TH Street, Suite 3110 MIAMI, FL 33157pawlit PHONE:(305) 740-3319 FAX #:(305) 669-3190 LB # 6463 —Mat- -:7 WWW.MELANDSERVICES.COM Survey:A-2161 Client File #: 08-0173 BURLIG Page 2 of 2 Not valid without all pages.