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FW-19-2840 • \�� Miami Shores Village RECEIVED F B 0 7 2019 G Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 20 1 BUILDING Master Permit No.T_�N PERMIT APPLICATION Sub Permit No. � UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP // I / CONTRACTOR DRAWINGS JOB ADDRESS: Io �D S (D ✓Gt�-1 rr1 `�1 C ay ✓ r f. City: Miami Shores County: Miami Dade Zip: 33 / 36 folio/Parcel#: If1 3 110 b 0 / / (p O Is the Building Historically Designated: Yes NO Occupancy Type: Load: n Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1 ti-e Y1e- It o �-4�-� S� Phone#:20T' 4sb - � b i Address: City: LOCO S G State: �L Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Samada Fence Inc Address: 110 W 31 ST i10 City: Hialeah State: FL Qualifier Name: Sergio M. Sarrlada State Certification or Registration #: R 3 3 13 0 ne#: 954-559-4355 Zip: 33012 Phone#: 305-720-6344 Certificate of Competency #: 11 BS00347 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 5,-`i O O • O O Square/Linear Footage of Work: �� ( A, Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work:.... lt.J as Q '- " (. G Specify color of color thru tile: 11AAlArl III Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ Z 3 3 (Revised02/24/2014) 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. C-,*4* Signature _ Sign OWNER or AGENT The foregoing instrument was acknowledged before me this ` day of Qi rVc-4 .20 by PR40 yiC tIa' J0""U--+ Jho is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: �c Seal: EVIft J* 17, 2022 Bonded ON AM Nohry The t day of/ 4(& { J 20 by SWti a. \� who is personally known to as me or who has produced 1*1 identification and who did take k* NOTARY PUBLIC: Cfffflb$M#GMT +� * Fes: A 17, 2022 . %Bonded ft NM Notary Sign: - Print: Seal: ****.«*********«*s**+t�s******* s****s*****s*******s*ss�**x�*r**ss**s•***�******.***s*#**r**:******s********* APPROVED BY ' Plans Examiner 2 12 col Zoning Structural Review (Revised02/24/2014) Clerk Property Search Application - Miami -Dade County Page 1 of 2 A� OFFICE OF NE PROPER"." Y' A Summary Report Property Information Folio: 11-3206-017-2160 Property Address: 665 GRAND CONC Miami Shores, FL 33138-2473 Owner MARK ANDREW LAWSON PETRONELLA LAWSON GORDON DEAN Mailing Address 665 GRAND CONCOURSE MIAMI SHORES, FL 33138 USA PA Primary Zone 1300 SGL FAMILY - 2801-3000 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds / Baths / Half 4/3/0 Floors 1 Living Units 1 Actual Area 3,650 Sq.Ft Living Area 2,764 Sq.Ft Adjusted Area 3,295 Sq.Ft Lot Size 13,431.6 Sq.Ft Year Built 1950 Assessment Information Year 2018 2017 2016 Land Value $472,715 $472,715 $429,741 Building Value $462,123 $467,561 $472,998 XF Value $38,173 $38,590 $39,007 Market Value $973,011 $978,866 $941,746 Assessed Value $973,011 $961,522 $941,746 Benefits Information Benefit Type 2018 2017 2016 Save Our Homes Cap Assessment Reduction $17,344 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption 1 $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 AMD PL MIAMI SHORES SEC 4 LOTS 18 & 19 PB 15-14 BILK 103 LOT SIZE 103.320 X 130 73R-200108 Generated On : 2/7/2019 Taxable Value Information 20181 2017 2016 County Exemption Value $50,000 $50,000 $50,000 Taxable Value 1 $923,011 $911,522 $891,746 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $948,011 $936,522 $916,746 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $923,011 $911,522 $891,746 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $923,011 $911,522 $891,746 Sales Information Previous Sale Price OR Book -Page Qualification Description 03/26/2015 $1,125,000 29565-0413 Qual by exam of deed 02/01/2006 $935,000 24288-2630 Sales which are qualified 11/01/1977 $96,500 09874-1968 Sales which are qualified 08/01/1973 $89,500 00000-00000 j 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.00v/info/disclaimer.asD https://www.miamidade.gov/propertysearch/ 2/7/2019 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 txemwion 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. '1�u U Signature: Owner State of Florida County of Miami -Dade The/foregoing was acknowledge before me this day off' �� bJ', 20 19 . By Pe`ffs-^G11 a— Q" t rv` who is personally known to me or has produced as identification. Notary: " Expires i* 17, 2N2 SEAL: Bonded thu Aden Notary Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) The undersigned Affiant,K t"One &— 1 �/s�` does hereby attest that (Property owner) The attached survey, performed by iK t r 6S e ne' t Ia' I .S'j r v -et e �0­v ame of surveyor's company) / \1 For address: (O� S fp � C ec.•a.,rx { Performed on 0 3 9 0 N (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. urt r, ant say a naught. 4r PC 14 ;N , Q_ Pto��G�� Ufa roperty Owner Signature // Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of `Q b"J9-% O-O I I Affiant is personally known to me, produced �.- "� �- as identification. Aia cmirk" # 0=W0 * Expires: J* 17, 2W Bonded Mm Asian Notary N ary Revised on 5/22120091 Revised on 6/12/09 RECEIVED BUILDING 1� Miami Shores Village Building Department V 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20) % Master Permit No., �%'62 /q r v� PERMIT APPLICATION Sub Permit No. JU Q7 2019 BY: � Tl� BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS [:]CHANGE OF ZTANCELLATION ❑ SHOP {� CONTRACTOR jam' DRAWINGS JOBADDRESS: 60 J G�' ( ��'ti C cu.' ISC_ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: / / 3 �- 0(0 01 � a'/ (P O Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: P� OWNER: Name (Fee Simple Titleholder): �/� 0 � a f e ! (CF J A-v-% Phone#: Address: � � � �a- , d C� COS-+-�'t e. B'(.. City:9 Cis-rv; , J /n.a-J✓ Tenant/Lessee Name: Email State: � Zip: 3-2/� � 1 CONTRACTOR: Company Name:L - 6d C— �_Q� (-'e- 1 i' ` Phone#: 43 S`1-1"T Address: Z/ Q�_ W 3 I �� y City: �('-e/l/` State: L Zip: 3 3 ®/ a Qualifier Name: J �l /� l • 4��✓�P' Phone#:.3 !� �6.3 y State Certification or Registration #: Certificate of Competency #: �/Q� D o3 Ci DESIGNER: Architect/Engineer: hone#: Address: City: State: Zip: Value of Work for this Permit: $ 5 V � Square/Linear Footage of Work: l4!0 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: <<J DS) q: Ii P.i Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF DBPR $ CO/CC $ _ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) r N 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 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 OWNER or AGENT CON ACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 by _ day of ��^ 20 /O by who is personally known to ��P✓ �� d3ho is personally known to me or who has produced as me or who has produced P c� L as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: — ////��,,� Print: Print: 1'�1Zs Seal: Seal: Bow: J* 17, 2022 APPROVED BY C� �/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) .s • I, Sergio Samada, contractor with SAMADA FENCE INC., am writing this letter in order to ask that the attached permit (PERMIT NO. FW-02- 19-274) be cancelled, given that the indicated property owner, PETRONELLA LAWSON, who resides in 665 Grand Concourse, Miami Shores, FL 33138, no longer wishes for the construction of the indicated fence (WOOD FENCE BOARD ON BOARD 6' HIGH 2 GATES 48" WIDE) to take place in the above -mentioned address.