BPP-18-1994Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-309584
Scheduled Inspection Date: August 29, 2018
Inspector: Naranjo, Ismael
Owner: MAGNA VIERIA, MARCO VELASQUEZ
Job Address: 25 NW 108 Street
Miami Shores, FL 33168-4310
Project: <NONE>
Contractor: ESSIG POOLS INC
Permit Number: BPP-7-18-1994
Permit Type: Pools/Whirlpools/Hot Tubs
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1121360110300
Phone: 305-949-0000
Building Department Comments
NEW SWIMMING POOL AND DECK
REPLACED 13PP-11-16-3244
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP-309077. 8/1/2018 NEED
APPROVED PLANS
August 28, 2018
For Inspections please call:
05)762-4949
Page 17 of 37
hr„ami 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
RECEIVED
JUL 2 5 Ld
ah
FBC 20A
Master Permit No. B 7{7 1 8 -1(3101LI
Sub Permit No.
❑ REVISION
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 2 5 V V( 108 I
City: Miami Shores County:
Foiio/Parcei#: 1 ` 2(36-011--0300
Miami Dade
❑ EXTENSION El RENEWAL
CANCELLATION ❑ SHOP
DRAWINGS
zip: 33 (38
is the Buiiuing Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): qG CC-) V ict.sclix 3 Phone#: )S — 9R8- 3q 1�
BFE: FFE:
Address:I.eS W 1.08 at
City: ar- �Y 10f`eState: Cotl
Tenant/Lessee Name:
Phone#:
Zip: -33 138
Email:
CONTRACTOR: Company Name: ESSIG POOLS, INC
Address: 1800 NE 151 ST
City: NORTH MIAMI State: FL
Qualifier Name: DANIEL ESSIG
State Certification or Registration #: CPC052505
Phone#: 305-949-0000
'Zip: 331625
Phone#: 305-949-0000
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: /�p City: State: Q Zip:
Value of Work for this Permit: $ SSG° Square/Linear Footage of Work: O o
Type of Work: E Addition ❑ Alteration
Description of Work:
❑ New ❑ Repair/Replace ❑ Demolition
%A'p t-WcR. ejv p i lo- 320
Specify color of color thru tile:
a 4 _rt
Submittal Fee $ Permit Fee $ CCF $ ' eO%CC $'' r ' `•"., " `` '"
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ as .0-
(Revised02/24/2014)
Bonding Company'stName (if applicable)
Bonding Company's Address
--City - State Zip
Mortgage Lender's Name (if applicable)
,i
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 iavJs 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 ofa building pp g 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 apfroved and a reinspection fee will be charged.
Signature -- �( Signature
identification and who did take an oath.
CONTRAC-
The foregoing insfrumeen`-/ , nt was acknowledged before me this The foregoing instrumen was acknowledged before me this.
2 3ay dof�v\20 I 8 by Z 3 �I day of " , 20 I S , by0
` DANIEL ESSIG �`iGf 0 (.i39,,e3 , who is personally known to , who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY- • B IC:. / I/ NOTARY P ? LIC
Si rA/ iiZ-414 Sign.
P" Pri t:
Seal:
Notary Public State of Florida
Estrella Gomez
My Commission GG 162104
Expires 11/21/2021
***************************.
APPROVED BY
** *******
Seal: ,, 1rr, Notary Public State of Florida
Estrella Gomez
My Commiss,o�� GG 162104
3i M1d, Expires 111i 11lu^21
Of
*****************************************************************
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk
5582 N.W. 7th STREET SUITE 202
MIAMI, FLORIDA 33126
TELEPHONE: (305) 264-2660
FAX: (305) 264-0229
DRAWN BY: AL.
��
,.v iiu� urur nrs ..J nr.
LAND SURVEYORS
SURVEY No. 13-0000827-1
SHEET No. 2 ,OF 2
LOT-4
BLOCK - 214
U
LOT-13
BLOCK -1214
0.25'CL.
BOUNDARVY SURVEY
SCALE = 1" = 20'
LOT-3
BLOCK - 214
N
U.P.
LOT-2
BLOCK - 214
F.I.P 1/2"
NO CAP
0.50'Cl..
J
V
LOT -15
BLOCK - 214
N
0.62'CL.
149.73'
B.C.
F.I.P 1/2"
NO CAP
�0
17 0AS HAL�T114s 4
ry p ,1 ''•..
• ,.i' • • 7 min
•
• •
•
•• ••• •• •
• ••• • •
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• • • • • • •
• • • • • •
•• • • •••
• • •
••• •••
• •
• •
• • •
•• ••
• •
23' PWY.
SURVEY ENCROACHMENT NOTES:
A) Northwest side of property: Overhead utility line encroaching onto subject •
pro )erty.
••• • • • « ••• • •
•
SURVEYOR'S NOTE: • • • • • • • 6 • •
- There may be Easements recorded in the Public Records: of ten en ehi. Su ey. • • •
- The purpose of this Survey is for use in obtaining Titledxsurance grad fia.ncyrLan:thdtiid not be used for Construction purposes.
5582 N.W. 7TH STREET, SUITE 202
MIAMI FL 33126
TELEPHONE: (305) 264-2660
FAX: (305) 264.0229
DRAWN BY: A.A.
.Nova Surveyors, Inc.
LAND SURVEYORS
SURVEY NO i 13-0000827-1
SHEET NO i 1 OF 2'
SURVEY OF LOT 14, BLOCK 214, OF DUNNINGS MIAMI SHORES EXTEN ION NO. 7,ACCORDING TO THE PLAT THEREOFIAS RECORDED IN
PLAT B000K 52,' PAGE 33, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
PROPERTY ADDRESS: 25 NW 108 ST, MIAMI SHORES, FL 33168
FOR: MARCOS VELASQUEZ
I
ti
LOCATION SKETCH
7
1
k N
• 7 5_- •
n
Scale 1" = NT.S.
1.1, W. 109TN sTF ELT
N. ln�
6 69.65'
N
� L
1O8'al STREEF.._
G 65.73'
A
ABBREVIATION AND MEANING
A = ARC
A/C = AIR CONDITIONER PAD
A.E. = ANCHOR EASEMENT
AIR = ALUMINIUM ROOF
A/S = ALUMINIUM SHED
ASPH. = ASPHALT
B.C. = BLOCK CORNER
B.C.R. = BROWARD COUNTY RECORDS
B.M. = BENCH MARK
B.O.B. = BASIS OF BEARINGS
C = CALCULATED
C.B. = CATCH BASIN
C.B.W. = CONCRETE BLOCK WALL
CH = CHORD
CH.B. = CHORD BEARING
CL = CLEAR
C.L.F. = CHAIN LINK FENCE
C.M.E. = CANAL MAINTENANCE
EASEMENTS
CONC. = CONCRETE
C.P. = CONCRETE PORCH
C.S. = CONCRETE SLAB
D.E. = DRAINAGE EASEMENT
D.M.E. = DRAINAGE MAINTENANCE
EASEMENTS
DRIVE = DRIVEWAY
ENCR. = ENCROACHMENT
E.T.P. = ELECTRIC:TRANSSORMER PAD
F.F.E. = FINISHED FLOOR ELEVATION
F.H. = FIRE HYDRANT
F.I.P. = FOUND IRON PIPE
F.I.R. = FOUND IRON ROD
F.N. = FOUND NAIL
F.N.D. = FOUND NAIL & DISK
FNIP. =.FEDERAL NATIONAL INSURANCE
PROGRAM
IN.BEG. = INGRESS AND EGRESS
EASEMENT
L.F.E. = LOWEST FLOOR ELEVATION
L.M.E. = LAKE MAINTENANCE EASEMENT
L.P. = LIGHT POLE
M. = MEASURED DISTANCE
M/H = MANHOLE
N.A.P. = NOT A PART OF
NGVD = NATIONAL GEODETIC VERTICAL
DATUM
N.T.S. = NOT TO SCALE
O.H.L. = OVERHEAD UTILITY LINES
O.R.B. = OFFICIAL RECORD BOOK
0/S = OFFSET
OVH.=OVERHANG
P.B. = PLAT BOOK
P.C. = POINT OF CURVE
P.C.C. = POINT OF COMPOUND CURVE
PL. = PLANTER .
P.L.S. = PROFESSIONAL LAND
SURVEYOR
P.O.B.. = POINT OF BEGINNING
P.O.C.. = POINT OF COMMENCEMENT
P.P. = POWER POLE
P.P.S.. = POOL PUMP SLAB
P.R.C. = POINT OF REVERSE CURVE
PRM = PERMANENT REFERENCE
MONUMENT
PT. = POINT OF TANGENCY
PVMT. = PAVEMENT
PWY = PARKWAY
R. = RECORD DISTANCE
to
I ! N.E. -109Tk
b —
74 '\ (74.5] 75 '� -•
M 1 a ;N IN
4 "8 !` 7 I--G
7449 • yf.‘9 i TS-
"-x to
14 z
74.73,
>
h
SUBJECT
PROPERTY M
rs` 1 y a.r3•
D. = RADIUS OF RADIAL
R( E. = RANGE
R P. = RADIUS POINT
R.0 E. = ROOF OVERHANG
EASEMENT
R(W = RIGHT-OF-WAY
S C. = SECTION
S.I P. = SET IRON PIPE L.B. #6044
SWK. = SIDEWALK
T = TANGENT
TWP = TOWNSHIP
U E. = UTILITY EASEMENT
U.P. = UTILITY POLE
W. N. = WATER METER
W R. = WOOD ROOF
W S. = WOOD SHED
= ANGLE
= CENTRAL ANGLE
C = CENTER LINE
= MONUMENT LINE
LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY ("SURVEY"):
- THERE MAY BE EASEMENTS RECORDED IN THE PUBLIC RECORDS NOT SHOWN ON THIS SURVEY.
- THE PURPOSE OF THIS SURVEY IS FOR USE IN OBTAINING TITLE INSURANCE AND FINANCING, AND SHOULD NOT BE
USED FOR CONSTRUCTION PURPOSES.
- EXAMINATIONS OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORI ED INSTRUMENTS, IF ANY,
AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT TO DEDICATIONS, LIMITATIONS, RESTRICTIONS, RESERVATIONS
OR EASEMENTS OF RECORD, AND LEGAL DESCRIPTIONS PROVIDED BY CLIENT OR ATTESTING TITLE COMPANY.
BOUNDARY SURVEY! MEANS A DRAWING AND / OR A GRAPHIC REPRESENTATION OF THE SURVEY WORK PERFORMED IN
- THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND / OR NOT TO SCALE.
EASEMENTS AS SHOWN ARE PER PLAT BOOK, UNLESS OTHERWISE SHOWN.'
- THE TERM "ENCROACHMENT' MEANS VISIBLE AND ABOVE GROUND ENCROACHMENTS.
- ARCHITECTS SHALL VERIFY ZONING REGULATIONS, RESTRICTIONS AND SETBACKS. AND THE Y WILL BE RESPONSIBLE
-- FOR SUBMITTING PLOT PLANS WITH THE -CORRECT INFORMATION PC,^. THEIR APPROVAL FOk AUTHORIZATION TO
AUTHORITIES IN NEW CONSTRUCTIONS, UNLESS OTHERWISE NOTED. THIS FIRM HAS NOT AIITEMPTED TO LOCATE
FOOTING AND/OR FOUNDATIONS.
FENCE OWNERSHIP NOT DETERMINED:
- THIS PLAN OF SuRvLy HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMF
- HEREON, THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY. • • • • D.
• • • • • • •
- THE SURVEYOR MQK.E NO GUARANTEES AS TO THE ACCURACY OF THE INFORMVIQE:N LI V. iHF•l•OCAI,F.E.M.A. •
- AGENT SHOULD BE CONTACTED FOR VERIFICATION. THE FNIP,FLOOD MAPS HA'iE DESIIENATED •HL•HEPEIIO flEscgtED
LAND TO BE SITUATED IN ZONE: X ' COMMUNITY/PANEUSUFFIX: 120652 03112 L • 04TE•(jF•FIF E9/1;/ZOQ9 . •
BASE FLOOD ELEVATION: N/A. • • •
•••
CERTIFIED TO: MARCOS VELASQUEZ AND MAGNA VIERA
RICHARD I. KORMAN, P.A. •
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY • •
•
EQUITY MORTGAGE BANKERS, LLC
• • •
•
•
•
••
•
• ••
•• •
• • • 0
• • •
• • •
• • • •
•• •• •
• • • •
• • • • •
• • • •
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• • • •
• • ••
• •
• •
• •
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• •
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•
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••
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• • • • •
74.73
b
_21,
M
ALc..C."y
7.-
N.
7.6-
LEGEND TYPICAL
-OH- OVERHEAD UTILITY LINES
CBS = WALL (CBWI
C.L.F. = CHAIN LINK FENCE
I.F. = IRON FENCE
W.F. = WOOD FENCE'
0.00 = EXISTING ELEVATIONS
SURVEYOR'S NOTES
1) IF SHOWN, BEARINGS ARE REFERRED TO AN ASSUMED
MERIDIAN, BY SAID PLAT IN THE DESCRIPTION OF THE
PROPERTY. IF NOT, THEN BEARINGS ARE REFERRED TO
COUNTY, TOWNSHIP MAPS. I
2) THIS IS A SPECIFIC PURPOSE SURVEY.
3) THE CLOSURE IN THE BOUNDARY SURVEY IS ABOVE
1:7500 FT.
4) IF SHOWN, ELEVATIONS ARE REFERRED TO
MIAMI-DADE COUNTY.
BM#
ELEV. FEET OF N.G.V.D. OF 1929.
SURVEYOR'S CERTIFICATION
I HEREBY CERTIFY: THAT THIS "BOUNDARY SURVEY' OF
THE PROPERTY DESCRIBED HEREON, AS RECENTLY
SURVEYED AND DRAWN UNDER MY SUPERVISION,
COMPLIES WITH THE MINIMUM TECHNICAL STANDARDS
AS SET FORTH PY THE FLORIDA BOARD OF
PROFESSIONAL LAND SURVEYORS IN CHAPTER 61G17-6,
FLORIDA ADMINISTRATIVE CODE PURSUANT TO 472.027,
FLORIDA STATUTES.
BY:
GEORGE IBARRA
(DATE OF FIELD WORK)
PROFESSIONAL LAND SURVEYOR NO. 2534
STATE OF FLORIDA (VALID COPIES OF THIS SURVEY WILL
BEAR THE EMBOSSED SEAL OF THE ATTESTING LAND
SURVEYOR).
{
REVISED ON: I
REVISED ON:
SURVEYOR'S SEAL
SAFE POOL ALARM
S187D SAFE POOL ALARM
UPC: 014575187011
One unit per single entry/opening (and/or with its screen by using the second set of sensors). Can Not be used for 2 windows next
to each other.
Magnetic Sensor Entry Alarm
"Always On" Alarm Protection
Adult Pass -Through Auto Reset Button
Additional Pass -Through Button For Delayed Entry From Either side Door or Fence
High Output-110-115 db Alarm
Water/VVeather resistant Housing
Intended For Interior or Exterior Use
Magnetic Sensor For Additional Door/ Screen Door
9V Battery Operation (Not included)
Low Battery LED Display
Pool Guard Alarm USA Patent No. 5,473,310 8%, 1;81: • • • • •
•
ETL Approved Under UL 2017 Standards . .. • •
Unit Size: 4.75 x 1.625 x 1.75 " ••• ••• •• • • • ••
Pcs./20Ft. : 9,600
Pcs./ 40 Ft.: 19,680•
• • • • • • •• •••
Pcs./ 40 Ft. Hq.: 22,896 • •• • • •• •• •
••• • • • • • • • •
• •• • • • •• ••
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••• • • • ••• • •
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I\lliami 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 e acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at
— k t x:=Y8 S( 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 com itting a misdemeanor of the second
degree, punishable as provided in Section 775.082 or Sectio 5.0 ; • F.S-- hi form must be signed
by the owner/agent a grime tractor.
NIEL
NO ARY
SI
AND;i E:: • •..\\OYV
. •
ew
• • • •
• • •
• • •
• • •
YORLZN F.1.HERNANDEZ
MY COMMI SION # FF 022108
EXPIRES: S 27, 2037
Bonded Thro Nota rvers
•
• • • • •
• • •
• • •
• • • •
• • • ••
z
YORL NY M. €RNAND2
/fl%/_;_. MYc0MOES0N#F=022108
EXPIRESSeptember 27, 2017
,:4pF ' BondedThw Pubic Underwriters
Date I o
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
zs 1
Miami Shores Village
_Building_&Zoning Department
Attention: Building Official
I certify that I am the legal owner of the propert r_described as
-o�r— 1 2 4-
bL
fl �Cr o PE sZ , located �at
t.7ED,
In accordance with Section 33-12(f), 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.
I further understand that this certification, however, does not eliminate the need for
obtaining a permit and erecting and approved barrier prior to final inspect' n 9nd use of the
pool.
•••••• 1••
.
•
1-ee24 owner
,
• ..
•. .
.
.. ... .. • ....
Note: This certification is to be submitted with a swimmingool permit application in duplicate.
. ... . . .. p.
.. . . . . .•
.. •. •... •
••
.. ... ..
..• . ... •
•
•
.. •..... • •
• • •• •• • • •
• • •••• • • •
...... • • ....
•
Viiami 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 N-71 a'Z
e the fee
simple owner(s) of the following described property situated and being in Miami Shores Village, Florida:
Address: "2— V3 t nr �T , /
Whereas, the undersigned owner(s) �� of vv G I �Z`"` 7
desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows:
1V.
v.
That the property will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade
County now in effect or hereinafter enacted.
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.
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.
That, I/we, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not
having the enclosure.
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 helshe 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.
FURTHERS 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 •ersigned-• is/her successors and assigns and may only be released by Miami Shores Village, or its
success•,'•, in ordance - aid lage then in effect
I. ereby Certify that on thisday_personally_appeared before i\j, •
m 'moo " L a2— ID
and has produced
# V422- -41- 64-1z4 - I as identification and he/she acknowledge that helshe executed thb foregoing, freely and v. untarily,
for purposes there in expressed. • • • • • • • • • • • •
•
•
SWORN TO AND SUBSCRIBED before n12•on tM dap o •
OWNER SING & PRINT
(Revised 05/2209
•• • • • •• • • •
Y LEV M. HERNANDEZ
NW oMMISTJN >« FF.0%10% •
EXPl S: S ptenpei•27,•201a
00 BondeddiruNcvPuNicOldej irs•
0
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•
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• • • • • • • • •
• • • • • • • • • •
• •• •• • • • •• ••
• • • • • • • • • • •
•
•
•
�•
A
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
" I cv`--c-' la does hereby attest that
(Property owner)
The attached survey, performed by ' V6 .�J✓\f-c" L (S 1 .--iL.
(Name of surveyor's company)
For address: Z c N w L, :fi'
Performed on -1 Zc-P (? (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 Tess than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures i ay a -ct fi sections as applicable to this or other permits.
Further,
PrProperty Owner Print Name
SW TO AND '`UBSCRIBED befor.e.meithit �S•• �Ja7 of -
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Affiant is personally known to m2,. •::prtdpcli •,
Revised on 5/22/2009/ Revised on 6/12/09
;Uc-s identifi aion.
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Nota
YORLENYM. HERNA.NDEZ
MY COMMISSION # FF 022108
EXPIRES! September27, 2017
Bonded Thai Notary Public Underwriters