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REV-18-2172BUILDING PERMIT APPLICATION DE BUILDING ❑ ELECTRIC pi PLUMBING ❑ MECHANICAL JOB ADDRESS: City: Folio/Parcel#: Occupancy Type: 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 ❑ ROOFING flPUBLIC WORKS l?� qfh Miami Shores �t , County: Master Permit No. Sub Permit No. RECEIVED AUG 15MO FBC 201°I 12-c..ico-zzqq ?-€\I - 219-Z ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: 2,41 3a Is the Building Historically Designated: Yes NO Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): L LC Address: 20.. TI'Yce , Ai* (U1- City: Ik UG► P( 12,eOkC1. State: FL Phone#: 3p_c 3' R 2 S oL, Tenant/Lessee Name: Phone#: Email: Zip: 330) CONTRACTOR: Company Name: Address:, R , T1lipo—vi1Lv (4.6 1444 (°i City: OCAllnarAla ack State: Zip: 33 Qualifier Name: S ('.(?vk --0.i C eM‘°s C / c •{. \Q Phone#: 17010 • S 7. 9 % b State Certification or Registration #:(G C MO sq its..3 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: ,Zip: Value of Work for this Permit: $31 4- 0V Square/Linear Footage of Work: A 30 3Di 312Z8QC Type of Work: ❑ Addition ❑ Alteration i❑ New Description of Work: \hot t1MQ t)► _ '( f ►mhE ❑ Repair/Replace ❑ Demolition I , ", Specify color of 'color thru tile: • Submittal Fee $ Permit Fee $ "f V • CIO Scanning Fee $ g • 00 Technology Fee $ Structural Reviews $ CCF $ Radon Fee $ DBPR $ Training/Education Fee $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ / • (Revised02/24/2014) • • Bonding Company's Name (if applicable) Bonding Company's Address City State Zip r • Mortgage Lender's Name (if applicable) Mortgage Lender's Address J / I , 'City 1 - I ) State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrum t was acknowledged before me this The foregoing instrume 4,was acknowledged befor a me this _19 day of - Lr 5 u 5 i , 20 /' , by 13 day of 'J14 I 20 1/8 , by L t•n i, qn V a. IN , who is personally known to rI G—(.r 4.; , who is personally known to me or who has producediF- 0 t. L S'oo I N fj5.asses me or who has produced Signature c identification and who did take an oath. NOTARY PUBLIC: ' Sign: Print: Seal: **************** APPROVED BY BRENDA BUCKLEY Notary Public - State of Florida Commission = GC 122455 My Comm. Expire; Jul 9, 2021 Bcrded tbrcu,r Naticral rvclary Asir. CONTRACTOR as identification a did take an oath. i NOTARY PU Sign: Print: Seal: Plans Examiner �G"vvr6 4 /—he— Structural Review J=" s DAVID E REISER Public • State of Florida omission x GG 203818 €' gym. Expires J **A`*' *fffgo. r4jvi' DAVID E REISER '+F • Notary Public - State of Florida i• y MMyC ,omm. Expires Jun 5, 2022 * * ' ' raetff '{M`fMStional Notary Assn. Commission # GG 203818 - - - Zoning Clerk (Revised02/24/2014) • • • • • • • • • •• •••• • • • •• /y 7 T' •• ••• ••••• -R M I T #: - -, Miami Shires Village APPROVED Y DATE ZONING DEPT ���'7`!! BLDG WEPT i i1, l SUBJECT 1.0 CCNIPI-if NCE Wf(H ALL FEDERAL STATE AND L IJN 17 riL,LS AND REGULATIONS ci F • • • 8/6/2018 Lumber Gray Wood Plank Porcelain Tile - 6 x 24 - 100105873 I Floor and Decor • • • • • • • • • • • •• •• • • • •• •• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ••• • • • • • • •• • •• • • Get Inspired Visit •Our Inspiration Ce..te: • Schedule a ?Au Desig$ Costsyitation View My Project Lists Our Blog • • •• • • • . • • • • •• • • • • • • • • HOME > TILE > SHOP BY TYPE > PORCELAIN > Lumber Gray Wood Plank Porcelain Tile Grout Shown: Mapei 27 Silver Flexcolor CQ Grout E.] A FLOOR 1:104:1 DECOR L4 4. : II Ir4ijfge• • • • • • • • Lgn r:GraX Wood Plank Porcelain Tile Size: 6 x 24 SKU: 100105873 $1.84 /sgft $ 23.14 box 12.61 sqft/box 13 pcs/box Miami Gardens's everyday low price! PROJECT SPECS SQ. FT. ® Need Help Calculating? Square Feet per Box: Number of Boxes: Total Price: 12.61 267 boxes in stock at the Miami Gardens location C' PICK IT UP 0 HAVE IT DELIVERED This item can be picked up TODAY for FREE (if ordered by 2:oopm local time) Pickup Lita ; Migpajsctardens946figigivifiltgEg*nd A Store 0 Contact Us Search Floor & Decor Q nnnro C.As111n11 c nnn rn nnn Icnr 110r TILE STONE WOOD LAMINATE & VINYL DECORATIVES INSTALLATION MATERIALS PRODUCT DETAILS SPECIFICATIONS PRODUCT DETAILS The 6 x 24 Lumber Gray Wood Plank Porcelain Tile is gray with a matte finish. Not only does ceramic and porcelain wood -look tile have the dimension and variety of the rich colors of authentic wood, it's also durable and easy to maintain. This tile is made in the USA, where high -quality design meets efficient production. Inkjet technology offers a wider range of color, finer details, and more variation in the design for a wood -look that has more character and authenticity. The P.E.I. scale measures a tile's ability to withstand foot traffic on a scale of 1-5. This tile has a P.E.I. rating of 4, so it can withstand moderate to heavy traffic. It's suitable for all residential and medium -traffic commercial floors or wall applications. SPECIFICATIONS Features & Benefits INDOOR/ OUTDOOR 0 Additional Specs Color: Gray Style: Woodplank Look Size: 6 x 24 Product Type: Porcelain Length: 23.6 Width: 5.9 Thickness: 9mm https://www.flooranddecor.com/porcelain-tile/umber-gray-wood-plank-porcelain-tile-100105873.html 1/3 BUILDING PERMIT APPLICATION "BUILDING ❑ ELECTRIC PLUMBING ❑ MECHANICAL JOB ADDRESS: 13 5 # E City: Miami Shores 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 ❑ ROOFING ❑PUBLIC WORKS q? �-ke FBC2j^0 �-� Master Permit No. C I v - 2-C_44 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL lit CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): Address: 2t4- Th%'G Ca .a Construction Type: Flood Zone: ha LP IL City: f'lo! hoe, Peat State: Tenant/Lessee Name: Phone#: Email: BFE: NO FFE: Phone#: 2O. K ,2 FL Zip: av0C1 CONTRACTOR: Company Name:.3c'C` Phone#: ria •7 7 5% 02 g Address: / a 57 AJ c .209 (,.e.yr� �— City: (`� i G 'n 1 State: Zip: 33) f Qualifier Name: G \Art 0;:e, N i-tP n r l Phone#: 7 k (,,5$77. gi7a3? State Certification or Registration #: C 6-C / Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear—FF000ttage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New L!4 Repair/Replace ❑ Demolition Description of Work: Clr�ca n ()-C GAo Y Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding companyis Name (if applicable) Bonding Comp ny'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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this a 2. day of In�rk- , 20 1 d by Q,uDuh me or who has produced v, who is personally known to rJ yLttea identification and who did take an oath. NOTARY PUBLIC: Sigr: Print: Seal: as Signature CONTRACTOR The foregoing instrument was acknowledged before me this c_! 2 day of , 20 1 , by 1`4e /1 a,Q,l ell c 1 , who is personally known to me or who has produced Vi, C:bY ✓e"1`(---64P as identification and who did take an oath. NORY PUBL afA,C31 Sign: Print: DAVID E REISER Seal: Notary Public - State of Florida ` Commission 0 GG 203818 ` My Comm. Expires Jun 5, 2022 Bonded through National Notary Assn. *************************s******* *'*T ************************** owa-S Red, APPROVED BY Plans Examiner Structural Review ani- 9 k RQitS, DAVID E REISER Notary Public - State of Florida Commission 0 GG 203818 My Comm. Expires Jun 5, 2022 Bond • t r. .... �� **************** Zoning Clerk (Revised02/24/2014) ED AY2'412018 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 p CHANGE OF CONTRACTOR / ARCHITECT Permit N. f C -g- t°-22-4-414 Owner's Name (Fee Simple Title Holder): Owner's Address: CSS NE '1,$"1 5d" City: f 4tw. 1 Cvvee g State : FL, uikabdu� Phone #: 3©5- -4A% - Z, Idco Zip Code: 3313 5t Job Address (Of where work is being done): 13S WE al. 8441 S# City: Miami Shores State: Florida Zip Code: -3-t 3 Contractor's Company Name: AVM`) ►3vt IcJev'5 Co Yr Phone #: 3CS --'2-83 Lei q Address: 1 -1,0-2S3 SW 1442, T vf4,c.e City: Nc,M.,r' State: T (-. Zip Code: 3-"tL 36 Qualifier's Name : Lic. Number: Architect) Engineer of Record Name: Mw ,, K, J 641414"/ Phone #: Address: S9.0tl I-4i16e.v'Z City: c.aKcic,m,a1 State: EC Zip Code: Describe Work: - 4--Vdav �� J hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature '""I�.I� �/ Signature Owner or Agent Contractor or Architect The foreg ng instr ent was aknowledged before me •• '' The foregoing instrument was aknowledged before me this 3ryda of II',2 /(b )((ab da n Cl N �3 day Y Y this of Who is personally known to me or who has produced Notary Pu Sign: Seal: CASSAIIDR3► HARRISON Notary Public, State of Florida Commission# FF 987414 My comm. expires May 20, 2020 as indentification. 2€by Alec. I/4l0es who is personally known to me or who has produced Notary Pu c: Sign: Seal: as indentification. CASSANDRA HARRISON Notary Public, State of Florida Commission# FF 987414 My comm. expires May 20,2020 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade(23,ratA)—aij The foregoing was acknowledge before me this By CA Qn Li\ Notary: SEAL: day of CL_j� , 20 lcs who is personally own to me or has produced as identification. DAVID E REISER x: Notary Public - State of Florida Commission # GG 203818 My Comm. Expires Jun 5, 2022 Bonded through National Notary Assn. Scientific Construction Group Inc. Certified General Contractors License # CGC 1505943 1251 NE 209 Terrace Miami, FLA 33179 Phone (786) 587 9728 Email: Raphael.henri18@gmail.com May 24th, 2018 State of Florida County of Dade Before me this day of May 2018, personally appeared Raphael H. Henri who, having duly sworn, deposed and says: That he will be the only one person working on the project located at: 135 NE 98 street, Miami shores, Florida / c-14 Contractor Signature Sworn to and subscribed before me this Y Print, Type or Stamp Name of Notary ;F;:A,,,. LINA W. NAREDO t i Notary Public. State of f orida ems ;.` My Comm. Expires July 11.2020 `� '° No. Ff e2422 Bonded thru Arthur J. Ga11,agNEr & Co. day of May, 2018 Personally Known Or Produced Identification Type of Identification Produced 5/25/2018 Detail by Entity Name Department of State / Div �rtt riftir:;". .: ynx /. of C orkor.1 )ris / Search Records, / Detail 8y._ ocunjsnt Vurrber / Detail by Entity Name Florida Limited Liability Company ACELAX LLC Filing Information Document Number L16000104705 FEI/EIN Number 38-4005400 Date Filed 05/31/2016 State FL Status ACTIVE Last Event LC AMENDMENT Event Date Filed 03/16/2018 Event Effective Date NONE Principal Address 1930 NE 118ST ROAD NORTH MIAMI, FL 33181 Changed: 06/16/2016 Mailing Address 1300 NE 191 ST ST #311 MIAMI, FL 33179 Registered Agent Name & Address ZHAO, WENTAO 1930 NE 118ST ROAD NORTH MIAMI, FL 33181 Authorized Person(s) Detail Name & Address Title MGRM ZHAO, WENTAO BLDG 175 APT 1-102 OLYMPIC GARDEN BEIJING, HE 10000-0 CH Title AMBR LIN, XIAODAN 204 THREE ISLANDS BLVD APT 102 http://search.sunbi z.org/I nqui ry/C orporati onSearch/SearchResultD etai I?i nqui rytype= Enti tyN am e&di recti onType=Initial &searchN am eOrder=AC ELAX%20L1600 .. 1/2 dotloop signature yerihcation: mew. dnuaop.co: Vhny/veriii-arionl�+- :87122 7-3-2_2U i, RECEIVED MAY 2 5 2018 A. U. S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT Omega Title, LLC 9633 W Broward Boulevard, Suite 7 Plantation, Florida 33324 8. TYPE OF LOAN I 0 FHA 2. 0FMNA 3. E CONY, UNINS. I. ❑VA 5. ]CONV,INS, 6- 766,Number: 7. Lean Auras, 18-15SAR t. Mortgag, l,n. Ca„ No.: C.,VOTE.: Thkformisfurnishedtogive you astatement ofactual settlement caw. Amami: pod toand bythe settlement agent are shown. hems marked (poc) were paid outside the closing. They are shown here for informational purposes and are not included in the totals. D. Buyer: Acelax LLC Florida Minority Community Reinvestment Coalition, Inc., a Non -Profit Corporation E. Seller: 4836 Tuscon Loon Drive Tampa, Florida 33619 F. Lender: 135 NE 98th Street G. Property: Miami Shores, Miami -Dade County, Florida 33138 Miami -Dade County, Florida H. Settlement Agent: Omega Title, LLC Place of Settlement: 9633 W Broward Boulevard, Suite 7, Plantation, Florida 33324 Broward County 1. Settlement Date: May 18, 2018 J. Summary of Buyer's Transnction 100. Gross Amount Due From Buyer: 101. Contract Sales Price 425,000.00 102. Personal Property 103. Settlement Charges to Buyer (line 1400) 2,698.50 Adjustments for Items Paid by Seller in Advance: 106. City / Town Taxes 107. County /Parish Taxes 108. Assessments 120. Gross Amount Due from Buyer: K. Summary of Seller's Transaction 400. Gross Amount Due To Seller: 401. Contract Sales Price 402. Personal Property 403. Adjustments for Items Paid by Seller in Advance: 406. City / Town Taxes 407. County / Parish Taxes 408. Assessments 425,000.00 200. Amounts Paid by or in Behalf of Buyer: 201. Deposit / Eamest Money 202. Principal Amount of New Loan 203. Existing Loan(s) 204. 205. 206. Adjustments for Items Unpaid by Seller: 210. City / Town Taxes 17, 2018 212. Assessments 427,698.50 420, Gross Amount Due to Seller: 425,000.00 211 County / Parish Taxes Jan 1, 201 S thru May 220. Total Paid by / for Buyer: 500. Reductions in Amount Due to Seller: 10,000.00 501. Excess Deposit (see instructions) 502. Settlement Charges to Seller (Line 1400) 503. Existing Loan(s) 504. Payoff of First Mortgage to TD Bank 505. Payoff of Second Mortgage 506. Purchase Money Mortgage 297.66 Adjustments for Items Unpaid by Seller: 510. City / Town Taxes 511. 17,2018 512. Assessments County / Parish Taxes Jan I, 2018 thru May 26,868.39 200,808.56 297.66 300. Cash at Settlement from / to Buyer: 301. Gross Amount due from Buyer (line 120) 302. Less Amount Paid by/for Buyer (line 220) 303. Cash From Buyer: 10,297.66 520. Total Reductions in Amount Due Seller: • 227,974.61 427,698.50 10,297.66 S417,400.84 600. Cash at Settlement to / from Seller: 601. Gross Amount due to Seller (line 420) 602. Less Reductions Amount due Seller (line 520) 425,000.00 227,974.61 603. Cash To Seller: S197,025.39 HUD-1 May 2007 May 18. 2018 12:17 PM dotloop signatureveriticauon:l:^x:v..e;of;oop.ror„rrni verlrrcatiorv� ,"tZ2�t?-3-?LLu ucwcutc! �=:May ld, CUltf File Number, 18.155AR Title Insurance to Omega Title, LLC 1111. Courier/Wire Fee to Omega Title, LLC 1200. Government Recording and Transfer Charges: 1201. Recording Fees: Deed 44.00 Mortgage Risk Rate �• Settlement Charges 700. Totnl Sales/Broker's Commission: Based on Price S425,000.00 ® 5.00% $ $2I,250.00 Division of Commission as follows Paid from Buyer's Funds at Pam id idSf froro's er Funds at 1 Settlement I 701. 10,625.00 to Julies Realty, LLC Settlement 702. 10,625.00 to Keller Williams Elite Properties - 703. Commission Paid at Settlement 1 21,250.00 800. Items Payable in Connection with Loan: 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee 804. Credit Report 805. Lender's Inspection Fee 806. Mortgage Insurance Application Fee 807. Assumption Fee 900. Items Required by Lender to be Paid in Advance: 901. Daily interest charge from May 13, 2018 902. Mortgage Insurance Premium 903. Hazard Insurance Premium 904. Flood Insurance Premium 1000. Reserves Deposited with Lender: 1001. Hazard Insurance 1002. Mortgage Insurance inn: r:... D...........r....__ , 1004. County Property Taxes 1005. Annual Assessments 1100. Title Charges: 1101. Settlement or Closing Fee to Omega Title, LLC 1102. Abstractor Title Search to Omega Title, LLC 1103. Title Examination 1104. Title Insurance Binder 1105. Document Preparation 1106. Notary Fees 1107 Attorney Fees (includes above item numbers: 1108. (includes above item numbers: 1109. Lender's Coverage 0.00 l 1 10. Owner's Coverage 425,000.00 Premium: S2,200.00 0.00 Releases 0.00 1202. City/County Tax/Stamps: Deed 0.00 Mortgage 0.00 1203. State Tax/Stamps: Deed 2,550.00 Mortgage 0.00 1204. Intangible Tax to Clerk of the Circuit Court 1205. E-Record 1206. Satisfaction of Mortgage 1300. Additional Settlement Charges: 1301. Survey 1302. Pest Inspection 400.00 2,200.00 50.00 44.001 1303. 2017 Real Estate Taxes DUE to Broward County Tax Collector 1304. Final Water to City of Miami Shores 1305. Lien Search to Lightening Lien Search 1306. 30 day water holdback to Omega Title, 1400. Total Settlement Charges (Enter on line 103, Section J and line 502, Section K) 4.50 1 595.00 125.00 50.00 2,550.00 4.50 18.50 793.04 937.35 295.00 250.00 52,698.50I S26,868.39 I have carefully reviewed the HUD -I Settlement Statement and to the best ofmy knowledge and belief, it is a true and accurate statement oral! receipts and disbursements made on my account of by me in this transaction. I further certify that I have received n copy of HUD-1 Settlement Statement POC-Paid outside of closing Borrower(B) Seller(S) Lender(L) Buyer. Acclax LLC slue/ Cw x modan Lin, Member dotloop venned 05n8/18 11:31PM EDT K1HO.IAGC•KOA8.GVLI Seller. Florida Minority Community Rcinvesnnent Coalition Inc. Al Pina, Chairman The HUD-1 Settlement Statement which I have prepare. ' a , , nd accurate account of this transaction. 111ave caused or will cause the funds to be disbursed in accordance with the instructions of the parties hgr " Settlement Agent: S Date: May 18, 2018 WARNINGl:�1r'iss a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonmem: For details see Title 18 U.S. Code Section 1001 and Section 1010. HUD-1 May 2007 May 18, 2018 12:17 PM SeulemE. .ie:May 18. 2018 File Number: 18-155AR L. Settlement Citargcs 700. Total Sales / Broker's Commission: Bused on Price S425,000.00 @ 5.00% = S21,250.00 Division of Commission as follows Paid from Buyer's Funds at Settlement, Paid from Seller's Funds at Settlement 701. 10,625.00 to Allies Realty, LLC 702. 10,625.00 to Keller Williams Elite Properties 703. Commission Paid at Settlement j 2 1.250.00 800. Items Payable in Connection with Lonn: S01. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee SO4. Credit Report S05. Lender's Inspection Fee 806. Mortgage Insurance Application Fee 807. Assumption Fee 900. Items Required by Lender to be Pnid in Advance: 901. Daily interest charge from May 18, 2013 902. Mortgage insurance Premium 903. Hazard insurance Premium 904. Flood Insurance Premium 1000. Reserves Deposited with Lender: 1001. Hazard Insurance 1002. Mortgage Insurance 1003. City Property Taxes 1004. County Property Taxes 1005. Annual Assessments 1100. Title Charges: 1101. Settlement or Closing Fee to Omega Title, LLC 400.00 j 595.00 1102. Abstract or Title Search to Omega Title, LLC j 125.00 1103. Title Examination 1104. Title insurance Binder 1105. Document Preparation 1106. Notary Fees 1107 Attorney Fees (includes above item numbers: Title Insurance to Omega Title, LLC 1108. (includes above item numbers: 2,200.00 j 1109. Lender's Coverage 0.00 1 1 10. Owner's Coverage 425,000.00 Risk Rate S2 200.00 Premium: 1 11 1. Courier/Wire Fee to Omega Title, LLC 50.001 50.00 1200. Government Recording and Transfer Charges: 1201. Recording Fees: Deed 44.00 Mortgage 0.00 Releases 0.00 44.00 1202. City/County Tax/Stamps: Deed 0.00 Mortgage 0.00 1203. State Tax/Stamps: Deed 2,550.00 Mortgage 0.00 1 2,550.00 1204. Intangible Tax to Clerk of the Circuit Court j 1205. E-Record 4.501 4.50 1206. Satisfaction of (Mortgage 1 18.50 1300. Additional Settlement Chnrges: 1301. Survey 1302. Pest lnspection 1303. 2017 Real Estate Taxes DUE to Brownrd County Tax Collector 1 793.04 1304. Final Water to City of Miami Shores i 937.35 1305. Lien Search to Lightening Lien Search I 295.00 1306. 30 day water holdback to Omega Title, 250.00 1400. Total Settlement Charges (Enter on line 103, Section J and line 502, Section K) 1 52,693.50 i S26,868.39 1 I have carefully reviewed the HUD -I Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and dishursentents made on my account or by me in this transaction. 1 further certify that I have received a copy of HUD -I Settlement Statement. POC-Paid outside of closing Borrower(B) Scllcr(S) Lender(L) Buyer: Acelae LLC Xinadan Lin, Member Seller: Florida Minas ami Reinvestment Coalition Inc. ma. Chaimmn The HUD-1 Settlement Statement which 1 have prepared is a true and accurate account of this transaction. I have caused or will cause the finds to be disbursed in accordance with the instructions of the parties h Settlement Agent: Date: May 18, 2013 WARNING: tt is a sin 4m smugly make false statements to the United States on this or nay other similar form. Penalties upon conviction can include a firs and imprisonment. For details sec Title 18 U.S. Code Section 1001 and Section 1010. HUD-1 May 2007 May18. 2018 12:17 PM Prepared by and Return to: Seth Kimmel Omega Title, LLC 9633 W Broward Boulevard, Suite 7 Plantation, Florida 33324 File Number: I8-155AR In Witness Whereof, the said grantor has signed and sealed these presents the day and year first above written. Signed, sealed and delivered in our presence: clt6,-Jek,01,-Q \Vitns Printed Name Witness Printed Name (Seal) Al Pins Chairman of Florida Minority Community Reinvestment Coalition Inc. Address: 4836 Tuscon Loon Drive, Tampa, Florida 33619 -0. F\ZCUM ( t 7 Address: (Seal) State of Florida County_ of Mi rni—Bad PLC The foregoing instrument was acknowledged before me this 18th day of May, 2018, by Al Pina as Chairman of Florida Minority Community Reinvestment Coalition; Inc., a Non -Profit Corporation, who is/are personally known to me or who has produced 9t2.1jrQ (' G as identification. ROBERT CHARLES Notary Public - State o1 Flog Commission • FF 973982 My Comm. Expires Jul 11, 2020 DEED Individual Warranty Dccd - Legal on Face Not y Public P tit Name: Q,601 f'.a!(.."eiYf/ / My Commission Expires: 7/``Ion 0 Prepared by and Return to: Seth Kimmel Omega Title, LLC 9633 W Broward Boulevard, Suite 7 Plantation, Florida 33324 File Nutnber: 18-1 »AR General Warranty Deed Made this May 18, 2018 A.D. By Florida Minority Community Reinvestment Coalition, Inc., a Non -Profit Corporation, whose address is: 4836 Tuscon Loon Drive, Tampa, Florida 33619, hereinafter called the grantor, to Acelax LLC, a Florida Limited liability company whose post office address is: 1300 NE 191st Street, #31 I, Miami, Florida 33181, hereinafter called the Grantee: (whenever used herein the term "grantor" and "grantee" include all the parries to this instrument and the heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations) Witnesseth, that the grantor, for and in consideration of the sum of Ten Dollars, ($10.00) and other valuable considerations. receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the grantee. all that certain land situate in Miami -Dade County, Florida, viz: Lot 19, Block 17, Amended Plat of Miami Shores Section No. 1, according to the map or plat thereof, as recorded in Plat Book 10. Page(s) 70. of the Public Records of Miami -Dade County, Florida. Parcel ID Number: 11-3206-013-2310 Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the Oranti)r has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whotnsoever; and that said land is free of all encumbrances except taxes accruing subsequent to December 31, 2018. DEED Individual warranty Deed - Legal on Face