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DS-03-20-559Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1177 NE 300TH ST, Miami Shores, FL 33138 Contacts Shore Crest USA LLC Owner 1177 NE 100TH ST, Miami Shores, FL 33138 n i co l a soff ret@gmaii.com Permit NO.: DS-03-20-559 Permit Type: Driveways/Walkways/Slabs Work Classification: Addition/Alteration Permit status: Approved Issue Date: 09/30/2021 1 Expiration:03/30/2022 Parcel Number 1132050190350 ALL DADE GENERAL CONST INC HERNAN GARCIA 3451 NW 16 ST, MIAMI, FL 33121 Business: 7863075891 Other: 7864525627 Description: REMOVING SOME PAVERS FROM EXISTING Valuation: $ 8,000.00 DRIVEWAY ON THE EAST PART AND ADDING PAVERS IN THE Totals FRONT SAME MATERIAL q Feet: 200.00 Fees Amount Application Fee - Other $50.00 CCF $4.80 Concrete/asphalt/pavers, slabs, dways, $50.00 swalks DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $1.60 Planning and Zoning Review Fee $35.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $156.90 Contractor kissahouse@aol.com Ins ection Requests: 305-762-4949 Payments Date Paid Amt Paid Total Fees $156.90 Credit Card 09/30/2021 $156.90 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the f going information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. F e, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent Date September 30, 2021 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village NTERED Building Department MAR 19 020 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �i7 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ccFBC 20 n b+h Master Permit No. �,)S-()3-2c-5sq RUILDING ❑ ELECTRIC D ROOFING ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS JOB ADDRESS: l I �'j Al F /01-) ( Y Sub Permit ❑ REVISION ❑ EXTENSION ❑RENEWAL CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Folio/Parcel#: /d 13 &. L 1/ i l o l� iL I??- Is the Building Historically Designated: Yes NO _ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �Ap ( j-ji IJ.fA /_/ZPhone#: r City: / 116 I Tenant/Lessee Name: Email. State: CONTRACTOR: Company Name: e�5-En- CO hone#: Address: :3 F D o Ai 4r/ 2� /VI (Ui-4 j 7—A._ City: t46 A /y, / State: L Zip: 3 3 1 6- Qualifier Name: �af5-�rA,A— P C< / %ii d C rrA Phone#: � g 6 3 Y 3 State Certification or Registration #: '� ertificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ () 11 D Type of Work: ❑ Addition 14 Alteration Description of Work: { ,, a t , y / r City: State: Zip: _Square/Linear Footage of Work: l(5 ( i (R ❑ New ❑ Repair/Replace ❑ Demolition l r . Submittal Fee $ U Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ 11 p TOTAL FEE NOW DUE $ 1 C�? • S3 4 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lenders Address City 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 low 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 A ,DWN�ERor AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of €,2200 0Jtby da of 1 ,� �✓ - Ill y %r /I 2 to .._._ _ i IC�t./ ,who' rsonally known' o who' personally kno n to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print Seal: Gb-' Y clr-4�Lc/i. �:�a�.'a'., ELIZA?_TH DENISE MONTEALEGRE ' %?°; notary Public - State of Florida Commission a GG 351435 reereer ilkaiAeesyNF{ F'E'lpr""Wo 11"t er�sssrrrsr 3onded through National Notary Assn. APPROVED BY identification and who did take an oath. NOTARY Sign: Print: Seal: Plans Examiner ELIZABETH DENISE MONTEALEGR Notary Public • State of Florida Notary Assn. (Revised02/24/2014) Structural Review Clerk Miami Shores Village Building Department SURVEY AFFIDA 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, )it) /t G-e-i 6 VM 1,4666s hereby attest that (Property owner) The attached survey, performed by &Ot L/ a V. ten tL 3 (Name of surveyor's company) For address: /Vy lob f r fir( 0 41n y f ¢'/ 3313(' Performed on q11l7(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' tions as applicable to this or other permits. Further, Affiant naught. edy Owner -Signature nn�ll� 'n Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of VVy,1Y�V l Affiant is ersonally know tome, produced identification. �fUn� �u.t ode_ Notary ELIZABETH OENISE MONTEALEGRE Revised on 5122120091 Revised on 6112109 �$� Notary Public • State or Florida '.'�' F Commission x GG 351435 'd�Dor n�` My Comm. Expires Sep 19, 2023 Bonded through National Notary Assn. 0 0 000 0 o a ee0 •o 00 0 0 o so 00 0 0 0 0 0 0 o G 0 0 0 0 0 o soo a o G 0 0 0 0 0 e o 0 0 o Goo o 0 o 0 000 0 000 0 0 0 000 00 0 000 Goo e o 0 0 0 o G o 0 0 0 ssalss�Ta-vsa yr +�+vu�araascs v'�sar s o ° o ° �1NUAMY L-ANU SUHVf: 0 0 0• 0 0 0 • g►+•max rOuneOEP / 86ti`' INC. ----__-..___-___-_ __---_ asoera. --------------- __ nr•aa. L8-000490� 3...... BOUJOARY SURVEY OF: SAW ASPHALT AUE7;'`::..: � -` :. , .' ��•' LOTS 13 AND 14. IN BLOCK 177 OF REVISED PLAT OF TRACTS 175A, 175% 175C. `: ::"":r }: ` :: r" •�, 0 ko 0 0 676A, dV6. 176% 177A, 177 11 AND 178A OF THE REVISED PLAT OF WALMI SHORES 0 0 0 o SGCT1 X 88, 4000RDINC TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 43. ceteSc r -.-- •— \ 0 — »— 2.ff• 0 e o • o o PASE "OF THE PUBLIC RECORDS OF iJ1AMI-DARE COLINrY, FLORIDA. tar PoolMCC W00p I o e • s o 00 0 0 �M b o 0 0 rbd o 0 1170 0 A� TIE 0 �s 7 *10 9;EEf. MUNq SIME% FLOWM 33188 0�• �� PS ! FLOOD ZONE: AE BASE ELEVATION: &0' r' ,• COMMUNITY CRAP: 120652 PA14EL: 0306 L ✓f ;' �4 DATE 9-11-2009 SCAM L ` - M T=20' �L r t •r n / Lt. =i O 2 ILL 6C�OO7id�77 e» raw up s'atao+ct � as r4= som 4 east » K Er. sr 0 •• c s 1. s Z 1 tT 7 13�1 CK g t0 It t2 t4 >S a . ..., �.. N.E Tooth. 8T ccrwar>Cwalt��rr AW !b 3bas, CERTmc4TE on a to Gamer w s wAt iasow Wow sw 11"Mmi M rK RR47sta7 uu C1i m w eaac su at town 1iwArba ! a rACA= TO THE MT OP MW IOR 40M AM OCUW. CERTIFY TO. c rmwm COMM n" ma swear bam on 1. CALVAN MESSICK LLP 6119WM 119WJL aN OAN! FW 2. OLD REPUBLIC NATIONAL TIRE INSURANCE COMPANY Loco srw^v44 own owmL J. SHORE CREST USA, LLC. crr MA sx W= a mr:s_0-n Acanm »? wr vw R0104 mGD OF W t oaaosn uta ;, slkt • • • • R= "- •+:•: r: , Qite.� v atta�o Gas Rom 7 ww ma easssec tsss scar wrtwa "a earoeurt, ooasa�r-sA,. m scr aea, e�sssesa :w "� m tom o smnee rA oem.e:� e+xsw raa wurtraa nar+e Burrow U.& DEPARTMEW OF HOMELAND SECURmr FEDERAL EMERGENCY MANAGEMENT AGENCY NdbtW Abod fnauwartoe Program ELEVATM CER71RCATE eW Col" NuntbW tGfiH e <b 0WANr. FQLLOWIVE INWILI ONB ON PAGES 8-16 11rEQfTOtB �..�-..�_- f.V. A1lr.INlnn e...rt wl SECTM A - PROPERTY WORMAWN FOR INSURANCE COMPANY USE Al. Ssufty O► wits Nttwttt; SHORE CREST U . S . A. , LLC PoUq Numb A2. Buiidrtg Sheet Address (mdd*q Apt.. Wait. Star. endretr IE49. NO) or P.O. Routs and company NAIC Box ft #1177 . A.E. 100th STREET • , Number. Cfly MIAMI SHORES , Fftfo FLORIDA ::��t code331 8 A& PirtlD" De 1(Lot and Bradt Ntur bm Tax Pw oel NutnW. Legal 0=00= eyA) LOTS 13&'140 BLOCK 177, REVISED PLAT OF MIAMI SHORES SECTION AA. Bubng use (64. Reside:rt6al. Nan.R�Il, Ad&Jw%Aooessory. dM) RESIDENTIAL (PB.43, P.67) A5. I.at LOM, lforiaaaw Dwurn: r• NAD 1927 r MAD 1S83 AS. Attach at lease 2 photographs of the building if ass cue is befog used to obtain flood lows Ve. A7. 8 A& Fora binding wNt a as t;l= orendastue(s}: AS. Faa building with an aitaedtsd gerega: a) BWate footage of aawtspaoe or etndOsure(a) 3.100 sq g a) Sure tttertsgs of sftadxW garage 4 4 0 aq fi b)1+had* of Pernta =t Hood 0WIngs in the b) Number of petln:ntettt flood opeurinp e o • aawtspace or enclasum(s) within 1.0 foot 2 2 In the affected garage within 1.0 foot 1 0 0 • Above t*aueni grade abaft 00owd grade O - O o) Total net area of flood openings In A8.b 1,540 eQ in C) Total net aura of Retod openings In A9.b 220 0 0 6R d)• Engh*cedood o 0 fletp fro? r Yes r No �� d} t:n(�rtse�d flood gpertirtgs? (-Yes r No BEC m B - FLOW ENt31FRw= RATE MP (FlRt3R% i#FORINATIQN 0 iff -pip Comentutliy Naate Can Nu fate MIAMI SHORES-120652 MIAMI-DADE y, o 0000 8ei. VAOPane! Nkanber $6. SUffar B6. FM tnda Data 07. FIRM Pane! EffsdW 88. Rood Zone($ lood 12086CO306 L 9-11-09 AE VAn AO. u5ebo de°d gRelubed0Dab . 8' oeoo. 810. it:d=xt fhn source of fhe Base Flood tilt:vaban (8FE) dam ar basw flood aeprh wftmd m Item► 89: O o O O r ns Prom of F" t" commuriy DetBn aned r omedsom : ,. ftfasts ewv4don datum used foram in tarn ft kl• Naw,g28 f •Naw less t' 0a>Bri wj= B12. Is fits buttding tomwd in o Coostsl Banier Rssoumm 8yMm (OMM am a Olhenwisa Probdod Ama (OPA)7 ryas r No Desigm Date: r CBRS C• OPA til:C WN G - 51111.131Alt,; FOXWOR DWORNAMN EM REQWRSD)' Cl. Btui tg etvations am based on: r ConWuattat Dom• r &a t9 tinder Conatrutdton• r Finished Gonsbucaan A new Bevabon Ce riffikole vA be regtdred when owsvucftn of the buftfrfg 1s awl naL C2. Elevations: Zones Al-A30. AE. Alt, A (with SM, VE, V1440. V Mitt BM ARC AWA, AWAIT. AR/A1-A30 AWAH. ARrAO Canpfete tense C7 afi bedow aoowft to Ow bu7ft dWasm apodflod In ilrmtA7. In Ptreft K= any. enter meters. Bttthrrw*0t8xed: REP. DADE COUNTY B.M. Ver%I084W N.G.V.D. 1929 radicals ele 44on detum rued for the elvsafione in ifemns a) through h) b &,m o wm 1e29 f NAVD 1988 r OthedSouroe thrum usrxl for twwft a Waf a must be ate t ame a" used me tits WE. Chalk the rruww:emmt used. 8.2' Top of bob m floor (tnduft be moment. aawbpace. orwwImmet' &)Nj r medete ) Top of Qte need bor 10.4' r feet r mfewm Bottom of the loft horfboatel structure! member (V zones w* NIA r fart r Misters aM%hW q=p (top of stab) 8.5' r fort C' meters • •� •) L&WOot alsvason Of M*chinery or eQUIPrtern servWM the bulding 9.0' (' font r metals (Deewbe type of egt8WYwg and Ioodiv in Comments) ' r t M � grade maxi to buR ttg MG) � ' C bet r metes g) No" ad)acaot Vh*heM grape nod to bultding pM) 8.0' t'• fact r mega aegaoe A grade at lowest eW ati n of deck a stairs, hWueftng .... struaural support . r i8e! ;"ureters rutn rapt ueHo33 (7m) Repleoes aD Psewl" Od3&ons. Psga 3 et 16 0000 • : • • O 0 e 00 O O O 00 0 0 o.00 o . • 0 00 0 :00.00 0 0 0 •• 00 O O O O : 0000 : O e000 t 0 0 00.000 o • o..000 0 0 O . O e 0 . 0 e0000 e o 00000 0 0 :e0000 0 0 000000 0 O O 0 0 0 0 0 0 2 e e es000e e o 000000 e 0 e 000000 O e e e e 0 0 0 e e e 0 0 0 0o000e 0 0 000000 0 0 e 000000 DODO e o 0000 00 0 0 0 0 0 00 0 0 0 O0:0 0 00 0 0 e e e e f e O e 0 00 0o 0 0 0 0 0 0000 0 0000 5 ELEVATION CERTIFICATE, pap 2 Otis cmft tAxnbkf .. mum I3i10RTAR ; in these sRame. ,copY the ll+ont 9aCtiosi A. FOR INSUMXCE COMPANY - BtdSdFrtg Sfw Aftm (im+xt[ng Apt.. UrA Sub. 8nd/or Mg. No or P.O. Roate anti em No. 0 1177 N.E. 10 0 th STREET PoGey Nano CRY MIAMI SHORES FLORIDA 33138� � 'ymaic Number. Sk�CTION D - OR ARCItITECC CI=RTMS Thiscardfimlion fs to be signed and sealed tiY a 4W W iayor. matg mw. oramchrodaurltmli ad by taw to otu* eiaysttort tnt*rrnaaort, fop* Ural the WommNon on V* t whfficattr mpmw rls mybad odd to r7t wpfer u* dots evsAlim. f ruMarstand od arty false staortmam may D. by fm crimprisarunerri turdar f8 U.S Qoft axat►r low. Wap9MIN* and bngtbrda to SteCtaOn A Check here if abcfter4L pmvMed by a Homnsad land surveyor? e f. Yes C No c~a Nam t�9 E M10 V. LLOFRIO ive P.$.M. "No p 8URVBYORS, C. Vale Add=(%AXV1C 6120 N.S. 6th AVE. �D PARK FL.P�! M `T10426 M0 0 0 aft pies of this Elevatlon CertiRcaDe f (�) oornmtm� otT}�1, (7a trraura:toe asertt/aartpsrgr. srd {8) bur'�"mg owner. t'amme fskd"ng type ofeQtrip»taMOd low9m, per C2(e). Kapp a} 00 0o 0 0 000006 0000 0 o s 0000 r00000 0 8igm tt m Date 0 0 0 H 6 - BitrWIM ELBVAMON it FORMTWX (StrRiW titOTRf:W RM FOR ZONE AO AND ZONE A (YMW= SFE) For Zones AO and A *1tlfout BFE), aorn*M ltta'rts EI-E& tfftte Cobom b Uft ded t * sq*cd a L OMA or LOMR-F rrequost, oomytete Se*ps A. S. and C. For flow El-E4. tree mtural grade. if ava{EBbie. Cltactctfte memure not used to Puerto Rio* ardy, girder nton. Et. Pmvidc elevaton fnf oration for the foffow V anti dmc k the 8pproprieft boxes to of toW % tether fh9 ebyMbn is above at below the fastest aklacent grade (tiAOy and the rowast v*mM grade (L%X a) Top of bottom floor (fnduding basenwk c vw%paoa. r feet r metres p 09w3 or [j below the HAG. or anCfaSt m) is b)Top of bottom floor rhubift baser A cravr%pW— r fee r maters p obwn or ❑ below the LAG. or enaoauk+e) is E2. For 80fi sg D:eBsatrts"with pormcnem flood openlrtgs pmvkbd in Section A hams 8 sndtar tf (see page 8 of irrstruattens). the nem higher floor (elevation =bin the tllagium) of the WWI" WI" is . r Beet r natem p above or p betaw fhe HAG. E8. Atfakdted games (lop of sue) is . f feet r knsiers p above or p below the tfAG. E4. tap of p{aff*rm of rnaditW and for a staat nAa reet C t9rs r t,efow Inc trrs buWng is fmews ❑ above ar ❑ 65. Zone AO *W. if no flood depth numbar is & dafso, Is Ote to of %o boftm Roar elevated In accordance with the oonv,m4ft ft Wpfein mertageamu ordinance? f Yes r No ; ' tinlmmm Tft locw owai tmret ow* this lnforma m in Section G. 88=0N F - PROPERTY OWNER OR OWNER'S R6PRMNTAnW CERTfF[CAMON The property owner or ownefs authofted mp=entative vft cmupkfas Sedions A. B. and E for Zane A (vuftft*nt a FEMAAssued at c=rxrttfly ftW BFE) or Zone AO gust so hem Ibb Gft* kerkts in Sedimm A, B. 8id E are awW to Oka bad of my tcamIfta Pm" Oww or OmWs Auft&od RBpwmt3&� Hghw- t Address Crp► Stm Lip Coda 3ignsbue Oate Tefeph*ne t:omnants Q Check here ftaUmhmem FEMA Font 088.433 (711 15) Repkft d previous edkftanL Page 4 of % 0 BOUNDARY LAND SURVEYORS, INC. f�Q Q PROFESWNAL SURVEYING SERVICES �i 6120 N.E. Bth AVENUE. F )RT LAuDEFiDALE. FLORIDA f 33334 ; PHONE (954) 771-0426 ' 772-0155 ' ' FAX tom) , GALVAN *MESSICK LLP '• TO; 7--21-16 {� DATE: --•---- -- -- _....� ' '.; IN 01M No. 16309 !f i (PLEASE. WCLUDE THIB N C4CC— OR INV. NUMBER IN YOUR PAYMEM') a THANK YOU ; •r e s e :0000 0 0 0 0 0 00 0 LABOR AND BEflVICE3 FURNi3FiEC7 ON: e s e eee0ee _: o �' •e s• 0000 0 0 o v o 000000 0000 0 0 0000 oaa.0e e e0a000 SURVEY AT: #1177 N.E. 100th STREET MIAMI SNORTS, FL. ------- 11$600.00 0 oe 0 oso0a0 0 0 0 90 eo 0 0 0 0 0 0000 e 0000 0 0 000000 0 0 0000so e o- a0000o oao0o 0 0 00000 0 0 000a00 0 0 000000 0 0 0 000000 SJ PE of wo 0( try �%Vi ,:4.i�ii" 1 �....^i �f�..J 6,7 �..11 1 YL. [ �.dy61i�..s. _______,_». __........-_«_..__e. �.._» __-- ► ^•V:twl+2tn_ae rvun+CEi> -- 488j 6170$grelk wagNJt r6 m, u v L rGl L' L/— r tr 0 t1 �S 1 S�7t 17P- DS° < tOT tx r� �J� 6.._ ' . -'_ .. _ .. i A-8 9-0136 L—R aunt f.,.e4A f CAL.E V120' BOUNDARY SURVEY OF: LOTS 13 14, 176A, 1768,176C,M1 BLOCK77 It RISED O PLAT E REMSEDt PLATSOF 1M AMI SHORES SECTION 88, ACCORDINO T© THE PLAT THEKOF AS RECORCED IN PLAT BOOK 43. PAGE 67 OF THE PUSUC RECGROS OF MAMI—OApE coUNry, FL.OR10A. A�oa1�: 1177 NE 100 STREET, MIAMI SHORES, FLOMDA 3318$ FLOOD ZONE: AE BASE ELEVAtiTX)N; $,0' S -U3_ s COMMUNITY MAP: 120662 PANEL: 0306 i_ � �� � � j DATE: 8»-11-2009 Miami Shores Vi11ac1e P2ECEIVED MI'llz?a 13Y: � I mo %-IV w wa 4 ww=" S"MN ki ftms APPROVED I n BY I DATE ZONING DEPT DLDG DEPT SUITIFCT TO COMPLIANCE WITH All FFDFnkA Y f2111 FS Ar1[1 R�CUI All�)N1 N. cm tU1si: Si FA n v d g tQ • 11 1Z ;5 ik iS . � yii� AMT' 1"f I t R - V-Tt .-AG G.: - PUBLIC WORKS REVf@V46vv&m7my APPROVE C�`^'_--p E �' z0L _. CERTIFICATE M5 a To Ci mff T31JT 1 W MMOM 5p11YCtLD Rre "oom IN r'% R>rlFA c Y1 r 047m 4VD "C 5V GR !'QW 10/0IS M f4A ►1C ' CN nOlt SKe%4 MO W SW AOM CtK M tufwv NQ sxtrcw Aw A40 'Aw m "w44.: To TN% ow OR Im K*o tscc oft sc1v. CERTIFY TO: I 7" T„s mmt&-f Ilmm tltr 1. CAiLVAN MESSICK LLP wmvm no*- L n+ w*m A w 2. OW REPUBUC NATIOUAL AXE INSURANCE COMPANY vxo "N"a k"m cKwom 3. SHORE CREST USA, LLC. eM ftk PA'%= t ME U-0-17 AW"M NMI ux UK" sue" IRII"% ICU kn AerP4cm fat totm aT. xvm-a-1rhy, CIF t,=Kw , tacm mite wiw r m wm"a mitox rm oow*Ara tws;ru ovem" • RAO-10 V. S.LVF4tIPU Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1177 NE 100TH ST, Miami Shores, FL 33138 Contacts Issue Date:09/30/2021 Parcel Number 1132050190350 Permit NO.: PW-09-20-2104 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 03/30/2022 Shore crest usa Ilc Owner Shore crest usa Ilc Applicant Nicolas Off ret Nicolas Offret 1100 Ne 100 st ST, Miami shore, FL 33138 1100 Ne 100 st ST, Miami shore, FL 33138 Mobile:7863856943 nicolasoffret@gmail.com Mobile:7863856943 nicolasoffret@gmail.com HERNAN GARCIA 3451 NW 16 ST, MIAMI, FL 33121 Business: 7863075891 kissahouse@aol.com Other: 7864525627 Ins ection Requests: Description: Relocate existing pavers to another location Valuation. $ 1,500.00 accordingto permit application ds 03-20-559 305-762-4949 Total Sq Feet: 200.00 Fees Amount Education Surcharge $0.40 Public Works Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $105.90 Payments Date Paid Amt Paid Total Fees $105.90 Credit Card 09/30/2021 $105.90 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction 50---u `more, I authorize the above named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent Date September 30, 2021 Page 2 of 2 Et 7 2021 Miami Shores Villa Public Works Depart(305)795-2210Public works forms are available from the building department,10050iami Shore , L PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: 20 *21 O Name of Applicant (if utility see below): v /c [.✓C J / 1 /1/Y L/ 1. Owner off the following described property: /-7 0 F Legal Description: Lot_ R Block Subdivision Folio #; ` �31M Address: /( i� .& F (o/� /� /rh � i.,ti r / UTILITY NAME: _ ) /70 Qualifier/Authorized Agent: Address: //�� City: Telephone: State Certification or Registi C�7�Y1:7[�l�illf I_1 �I�I Address: r S ( J�11/ � 1� City: CZ Telephone: C, Email: State Certification or Registration t Requests permission to install way: /—e- / ' 'e //7L State: /'! ZIP: of Competency #: work, attach separate page if necessary) in the adjoining right of Type of Work: X Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: Citv: Telephone: Registration Email: ZIP: Value of Work for this Permit: $ .5,0 O Square/Lineal Footage of Work: 1,00 ***** Fees ***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ Bonding Company's Name (if applicable): Bonding Company's Address: City: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, 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 the 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 public works permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature Signature cant or Authorized Agent Company/Utility Agent The fo 'ng instrument was acknowledged before The fore instrumen as ackn ledg before me this "day of. 20 LL. by me this ay of 2 by yu wi who who ;R is ersonally known to me or who has produced is personal) kn ryto me or who has produce l.� Z identification. identification. 0 ngd a a NOTARY PUBLIC: NOTARY PU C: 3 3 c z as �) o } Sign: Sign: T r �• / 0 ,`.. ..;, H Print: �`t �f//�d �C'7`'' Print: n Mo: SEAL: SEAL: •ussq,pe7oN lau seh fi�o•ti7 paPU0q noz rZ Snq san wwa7 ZW .... ZILPS69D "alssiwwo7 veo 'P ... ePNoup ale76-011Qnd tiPION!' L G Z383d APPROVED BY: i Public Works Director, or Designee 2017-04-15 Miami Shores Village Public Works Department (305)795-2210 Public works forms are avaliabte from the building department;-:' 10050 NE 2°dAve., Miami Shoses„ft3313g COVENANT OF CONSTRUCTION WITHIN RIGHT OF W4y CFN: 20200405010 BOOK 32020 PAGE 4954 DATE:07/2412020 11:05.41 AM HARVEY RUVIN, CLERK OF COURT, MIA•DAD£ CTY Whereas, (hereby ref& d to as the owner) ) lad f2 j z jx —�--1� L�`G t i Of the following described property: —J ��C� �1Sr. Legal Description: Lot « Block I? -t„Q_FolioN;%� Address: Rees p �ssinn o Ril (describe work, aLt'flff e r t elf )in, ea mng rE t : IN CONSIDERATION of the zWndval of this permit by the village e owner agrees as follows: 1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Miam-blade County to make repairs or maintain said items within the public right of way including restoration of the street by reason of the owner's failure to do so, such expense shall be paid by the Owneror shall constitute a lien against the above described property until paid. 2. The owner does herby agree to indemnify and hold Miami Shores Village or Miami -Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate theirfacilities at their own expense, within 14 days' notice by the Village to do so, failure to comply with this notice willrlesult in the Village causing the item(s) to be removed and a lien being place: on the property and/or assessed againsttitegwner fur all costs incurred in the re•:mova! and disposal of the 4. The undersigned further agrees that these conditions deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, ., Theirs and assigns until such time as this obligation has been cancelled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). Signature ' ow . Ed Agent State of Y i County of 4, i The foregoing inst urnent was acknowledged before methh; day of by 1K.T. rlo,ls personally known to me of who j7ass Droo'dtrcetl ARY P J i ce✓ asidentification. ARY PUB Siin: _...__ Fri. -—SEAL: h<a y CSo pnienjt[s are recorded at the, Clerk of the Goulds, 4 h brrym gi 'sateafltryE7AI3Ea llig) COUNTY RECOi UFFI C0 UA-ft4()URSE EMT, '°ae „mksa�n a a�: 4tpdS 2 /• First Street, 151 FIUOT El; �t,tir•o4-�s