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CLARISSA RODRIGUEZ AND DAMON STINSON: WCS LENDING, U.C. I S
SUCCESSORS ANDiOR ASSIGNS, AS THEIR INTEREST MAYAPPEAR.
FLOOD ZONE: X
PROPERTY OF. CLARISSA RODRIGUEZ
AND DAMON STINSON
236 NORTHEAST 103rd STREET
MIAMI SHORES, FLORIDA 33138
MAP &PANEL= 12086C0302
COMMUNITY No.: 120652
SUFFDC L
DATE OF FIRM: 9-11-09
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SURVEYORS NOTES: •••••• • • • ••••••
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10) DRAWMDISTANCE SETWFEN WALLSAMWOR FENCESANO PROlPS37YUNES ALAYSE
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11) FLOODZONEAVFOFU"nON WAS DEWVED FROM FWBUL EMERGENLYMANAGFAIENTAGENCY
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IOCATES OVIRCI SMLAIE
PROFESSIONAL SURVEYING AND MAPPING
LANNES & GARC4A;) INC..
LB # 2098
FRANCISCO F. FAJARDO PSM # 4767
- 385ALHAMBRACIRCLE -SUITEC,
_ - CORAL GABLES, FLORIDA 3313,4 ~
PH (305) 666-7909 FAX (305) 669-3002
SCALE 1' 2(T I DRAWN BY.. M PIO I O WG. No.: 22258:
�7�SZ- tJ lQ
A SUPER SEPTIC & DRAIN FIELD INC.
CC: SR0161772
PHONE: 305-364-0113
DATE: 11-1-- 1 fi
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
7701 WEST 18 LANE
HIALEAH, FLORIDA 33014
Licensed and Insured
E-MAIL: ASUPERSEPTICOGMAIL.COM
WW W.ASUPERSEPTIC.COM
FAX: 305-364-0349
BEFORE ME THIS DAY PERSONALLY APPEARED, /s PM-w 21=rLy WHO
BEING DULY SWORN, DEPOSES AND SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT:
3 6 4-,E �v 3 s�-, 3 317 ff
Contractor Signature:
SWORN TO (OR AFFIRMED) AND SUBSCRIBED TO ME THIS DAY OF
2018, BY: IR YU o n -7-C r C5
?os�aY Pyc :
'*r
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
�;r •o?:°
Bonded Thru Notary Public Underwriters
PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION
TYPE OF INFORMATION PRODUCED
PRINT, TYPE, OR STAMP NAME OF NOTARY
Notice to Owner — Workers' Com
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
sation 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 The foregoing was acknowledge before me this day of DC C , 20
By(' GY �Cir "1y�� who is personally known to me or has produced
QU) S el as identification.
Not
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12/3/2018 Property Search Application - Miami -Dade County
"""Y 'A
OFFICE OF THE PR A PRAISER
Summary Report
Property Information
Folio:
11-3206-013-4890
Property Address:
236 NE 103 ST
Miami Shores, FL 33138-2431
Owner
CLARISSA RODRIGUEZ
DAMON STINSON
Mailing Address
236 NE 103 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
Sq.Ft
Living Area
Sq.Ft
Adjusted Area
2,120 Sq.Ft
Lot Size
11,300 Sq.Ft
Year Bulk
1950
Assessment Information
Year
2018
2017i 2016
Land Value
$304,996
$304,996 �$253,884Building
Value
$105,576
$105,576
XF Value
$35,064
$35,442 $35,848
Market Value
$445,636
$446,014 $395,308
Assessed Value
$354,594
$347,301 $340,158
Benefits Information
Benefit
Type
2018
2017
2016
Save Our Homes Cap
Assessment Reduction
$91,042
$98,713
$55,150
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 I
1 5341 6 53 42
MIAMI SHORES SEC 1 AMD PB 10-70
LOTS 8 & 9 BILK 36
LOT SIZE 100.000 X 113
OR 18616-2546 05 1999 5
Generated On : 12/3/2018
Taxable Value Information
2018
2017
2016
County
Exemption Value
::4-4,594
$50,000
$50,000
$50,000
Taxable Value
$30-
$297,301
$290,158
School Board
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$329,594
$322,301
$315,158
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$304,594
$297,3011
$290,158
Regional
Exemption Value 1
Taxable Value _
$50,000
$304,594
$50,000
$297,301 °
$50,000
$290,158
Sales Information
Previous
OR
Sale
Price
Book-
Qualifcation Description
Page
02/23/2012
$333,000
28055-
Qual by exam of deed
0171
05/01/1999
$0
18616-
Sales which are disqualified as a result of
2546
examination of the deed
08/01/1998
$145,000
18277
Sales which are qualified
0481
10/01/1996
$0
17379-
Sales which are disqualified as a result of
4197
examination of the deed
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property
Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
�C s�
BUILDING
Miami Shores Village
RECEIVED
i Building Department OCT 25 2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 s%ti
FBC 201`i
Master Permit No. w -I - ).,53 i4
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
PLUMBING [—]MECHANICAL [:]PUBLICWORKS
Sub Permit No.
❑ REVISION ❑ EXTENSION EJRENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: o) '21 /t?l k�- f b '� S
City: Miami Shores County: Miami Dade Zip: / cT
Folio/Parcel#: f / — q a D 4 G / 3 — y 8 9 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �(��I 3 _S is � r u 2 Z Pho
Address
City: 14o'p A State: T9 • Zip: 13
Tenant/Lessee Name: Phone#:ye
VY
Email:
CONTRACTOR: Company Name:gC1OP ki _ ,-e �� n r ; o f �nr' Phone#:30�'
Address: �za / )A
City:
Qualifier Name:
`�? 36/�/
Phone#: ,J(1r' �,/ q(, - (,q/ n
r
State Certification or gistration #:.5 UCertificate of Competency #:._S'd�-
DESIGNER: Architect/Engineer: % Phone#:
Add
State:
Value of Work for this Permit: $CV. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 1,9 CCF $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Zip:
I 34. "T04nei r
❑ Demolition
CO/CC $
. Notary $
Double Fee $
Bond $ til
TOTAL FEE NOW DU
a
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 issu f a building permit 'th an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notic Ar ftncjment a de�struction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy l7trieihrded notice of commencement must be posted at the job site
P P Y J
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.
C -Cr�
Signature
OWNER or AGEN
The foregoing instrument was acknowledged before me this
day of �� (�120 J by
1vf10 i �t'sLily known to
me or who has produced -�� 1 fax) �Q as
identification and who did take an oath.
NOTARY PUBLIC:
„M
MAHARAIK.GONZALEZ
Sign: 044602,
Ni
EXPIRES: November 212020
Print: a;. oe dervMters
•••'��iii0•.• 0
Seal:
Signature Saado�m zz�
CONTR OR
The foregoing instrument
//was acknowledged before me this
�v day of l�� 120 t- . by
1 `-�1� ��Y� , who is personally knnown to
me or who has produced C QXl as
identification and who did take an oath.
NOTARY P
'
Print: ' MY COMMISSION # GG 044602
=*: c+=
•o: oven r 2, 2o2o
Bonded 7hru Notary Public Underwriters
Seal: F.....
;; °Q
�***ss****a******rs***ss*ssss**s*ss+e*s*******r*ss**r*rs**srrs*******ss**:s**rs*s*ssss****s*•****s*s***.*s*.*
APPROVED BY �� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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.
7� ILA A- I
Signature e
Owner
State of Florida
County of Miami -Dade
`SPY PVe .�
•4 :
MAHA RAI K. GOND0446o2
MY COMMISSION # GEXPIRES:
m
Nove berBonded
Thru Nota ry Public
The foregoing was
acknowledge before me this day of oy+ , 20
By �5Cf �QQk iq\)Q Who is personally known to me or has produced
as identification.
Notary:
SEAL:
A SUPER SEPTIC & DRAIN FIELD INC.
CC: SR0161772
PHONE: 305-364-0113
DATE: 10-25-17
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
7701 WEST 18 LANE
HIALEAH, FLORIDA 33014
Licensed and Insured
E-MAIL: ASUPERSEPTIC@GMAIL.COM
WWW.ASUPERSEPTIC.COM
FAX: 305-364-0349
BEFORE ME THIS DAY PERSONALLY APPEARED, /311-If4ry 7 ,= 12t7 WHO
BEING DULY SWORN, DEPOSES AND SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT:
236 WE 103 STREET, MIAMI SHORES FL, 33138
Contractor Signature:
SWORN TO (OR AFFIRMED) AND SUBSCRIB D TO ME THIS S DAY OF
0C)C7Z-R7 , 2017, BY: �;'' PN
PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION f�:L— D Jr0-
TYPE OF INFORMATION PRODUCED
����NUuu11/q/i
�
�� O • ;�iaWri ayq �i
REGISTERED SEPTIC TANK CONTRACTOR
BRYAN K. ZERO
7701 WEST 18TH LANE
HIALEAH, FL 33014-
A SUPER SEPTIC & DRAIN FIELD
INC
Business Authorization: SA0161922
SR0161772
Registration Expires on September 30, 2018
FLORIDA DEPARTMENT OF HEALTH
CERTIFICATE OF AUTHORIZATION FOR SEPTIC TANK CONTRACTING
The Florida Department of Health hereby certifies the business or entity named below has satisfied the requirements of Part
III, Chapter 489, Florida Statutes, for septic tank contracting and has been duly authorized by the Department to provide
septic tank contracting services under the name of
A SUPER SEPTIC & DRAIN FIELD INC
Qualifying Contractor: BRYAN K. ZERO
SA0161922
March 29, 2017
Authorization Number Date Issued
March 31, 2019
Expiration Date
001052
Aacal Business Tax Receipt
Miami -Dade County, State of Florida
—THIS IS NOT A BILL — DO NOT PAY
3820314
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
A SUPER SEPTIC & DRAIN FIELD INC RENEWAL SEPTEMBER 30, 2018
7701 W 18 LA 3988772 Must be displayed at place of business
HIALEAH FL 33014 Pursuant to County Code
Chapter 8A — Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED
A SUPER SEPTIC &DRAIN FIELD INC 196 SPECIALTY PLUMBING CONTRACTOR BY TAX COLLECTOR
C/O BRYAN ZERO PRIES .. SEP0161772
Worker(s) 1 $45.00 08/30/2017
CREDITCARD-17-056586
This Local Business Tex Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec 8a-276.
For more information, visit www.miamidade.govftexcollector
CERTIFICATE OF LIABILITY INSURANCE DATEamonnnm—
� �TiRCATE � iSSU®
CERTIFICATE DOES NOT A ��� 6i1FORMA710N ONLY AND CONFERS tY0 03/17/17 47MMY OR NMATMMYARMNDUER well TS UPON TW THE CERTIFCATE
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Rp �NOT 'T GEUI�/1FFapRpAFUMUUMS �g �A POUCIES
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Blame A Tyson Inswalloes
9958 SW 21st Sbeet (9S4) 989-®Ci24 r,Ax
Hd4vj pd, FL 33t123 ) 589 6998
Phone (954 9gg' 4 F�K
arsuas D 9894M
A• MIRE INSURANCECO
A SUPER SEPTIC & DRAIN FIELD. INC = GSA
7701 W 18 LANE
I IALEAH. FL 33014
THIS IS TO ApIDIIJG ANY OF 11111111(321,113 TED BELow HAVE BEEPI LssuED TO THE
CERTINDICATED. REQT 'EM OR CONDITION OF ANY NA1/FDABOVE APR 7HE POlLtCY
C@tTIACATE tiN►Y BE fSSI1ED OR MAY PERTAIN. THE 1 CONTRACT OR OTHER DOCUINENT D(C111S10NS AID NSURANCE AFFORDS BY THE POLICIESWITH ACT TDWFgCH B
R CONDRiON3 OF SUCH POLICIES LIeLIIS SIIOYYN MAY HAVE BEEN REDUCES gYHEREIN Is SUQJBCTTO ALLTHE TERIy .
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SEPTIC AND D"NFIELD IMST'ALLA ar aae m
TIOPI. SERVICE AND REPAIR
Lroense Nl *mS are: SR0161772 and SAD1619M
CERTIFICATE HOLDER --
Warm Shores wage
10050 NE 2nd Avenue
MIN. u Shores VNage
f=305-75648972
ACOM 25 (20IMS) QF
1
SHOULDANY OF THE ABOVE DESCRIBEDPOLICES BE CANCELLED BEFORE
THE EXP RATM DATE WIiH ETT�tEOF. NOTICE WILL BE DELIVERED IN
ACCORDPOLICY PROVISIONS,
AUFnORMW MMRftEWAME
01888,MG ACORD CORPORATION. Ad rights reserved.
The ACORD rmme and logo are registorqd narks of ACORD
I 0., [ ,00%
® Image
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 `
I
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 5/9/2016 EXPIRATION DATE: 5/9/2018
PERSON: ZERO BRYAN K
FEIN: 811781785
BUSINESS NAME AND ADDRESS:
A SUPER SEPTIC & DRAIN FIELD INC.
7701 WEST 18 LANE
HIALEAH FL 33014
SCOPES OF BUSINESS OR TRADE:
IRRIGATION OR
DRAINAGE SYSTEM
Pursuant to Chapter 440.05(14), F.S., an officer of a corporation v4ho Neils exemption from this Chapter filing a certificate of election under this section
nay rot recover henefds a conhpahsalia! urhder Nis chapter. Pursuant to Chapter 440.06(12), F.S., Ce ' cafes a electon m he exempt... applyy only
asrenNe scope of the brwirhess a trade lekd on the f10llce of election to be exempt Puannl to Chapler 440.D5(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation it, at any time after the filing of the notice or the issuance of the cenitfcete,
the
person named on the notice a certificate no longer meets the requremenls of tNs section W issuance of a certificate. The department shall revoke a
DFS-F2-Dw0252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
DIVISION of
Environmental Health
Florida Health 9%
y� Miami -Dade County
OSTDS(Well Division
11805 SW 26th Street - Miami, FL 33175�
Inspector1 de / ' �-' n f Pro Date �l ' � � —1�.r'
Address
3 d . , %f/ S"/� OSTDS #
Comments:
Signature