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.