DS-01-22-148Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit No.: DS-01-22-148
Permit Type: Driveways/Walkways/Slabs
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date:03/03/2022 1 Expiration: 09/06/2022
Location Address Parcel Number
100 NE 105TH ST, Miami Shores, FL 33138 1121360130690
Contacts
SUSAN TREVISA Owner CASTILLA CONCRETE FINISH DESIGN Contractor
100 105 CORP
JAVIER M BARRIENTOS
442 NE 103RD ST, Miami Shores, FL 33139
ANGELICA.MEDRANO@YMAI L.COM
Description: STAMPED CONCRETE DRIVEWAY Valuation: $ 7,990.00 Ins ection Requests:
805-762-4949
Total Sq Feet: 1,000.00
r-
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.80
Concrete/asphalt/pavers, slabs, dways,
$75.00
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
$3.13
Total:
$3.82.53
Payments Date Paid Amt Paid
Total Fees $182.53
Check# 1397 01/20/2022 $50.00
Check# 1952 03/03/2022 $132.53
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 requi_reQor ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOLwork.
I certify Mot all
and zoning. Fbihe
)rmation is accurate and that all work will be done in compliance with all applicable laws
the above named contractor to do the work stated.
7
Signature: Owner
/ \ Contractor / Agent
March 03, 2022 Page 2 of 2
3 202-2 Miami Shores Village AN 202022 �'
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By
b Tel: (305) 795-2204 Fax: (305)756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 207.o�7u
BUILDING Master Permit No.ly�-61-22- I49
PERMIT APPLICATION Sub Permit No.
ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MMECHANICAL ❑PUBLIC WORKS CHANGE OF [:]CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10 b t1k l DS 5 )_' 1?_�
W-0f-i.
Occupancy Type: Load:
OWNER: Name (Fee Simple
_ U �Q 61 �) Is the Building Historically Designated: Yes
Construction Type: Flood Zone: BFE: _
City: rn%C(mk SV`ofeS • State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
City: rn k at
Qualifier
Value of Work for this Permit:
Type of Work: ❑ Addition
- C-��(5y
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone
_City: State: Zip:
Square/Linear Footage of Work:
❑ AlteralFlon ❑ New 0 Repaaiir/�Re�place emolition
Description of Work:
33\3'
NO-
FFE:
3 3\ 38 -
rip: 33155
6�Su S9 \--J'KOS
I
i
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Tralning/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ I C 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
E.
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 commencen(FFM4Vust be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is Issued. In the a Bence such posted notice, the
inspection will not be approved and a reinspectjpn fee will be charged.
Signature
OWNER or AGENT
Th foregoing instrument was acknowle ged before me this
20 7�4 by
(V who er ally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
IM1r1e�rr—
• coww"0 k
�edTM�
APPROVED BY
The f r going instrument as acknowledged befor me this
day of 20 by
VI✓ % who is personal y known to
me or who has produced as
identification and who did take an oath.
PUBLIC:
Plans Examiner
2/1112-'` Zoning
(Revised02/24/2014)
Structural Review
Clerk
Property Search Application - Miami -Dade County Page 1 of 1
OFFICE OF THE PROPERTY APPRAISER
Summary Report
Property Information
Folio:
11-2136-013-0690
Property Address:
100 NE 105 ST
Miami Shores, FL 33138-2033
Owner
SUSAN TREVISA
Mailing Address
100 NE 105 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
0700 SGL FAMILY - 1551-1700 SQ
Primary Land Use
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds I Baths I Half
3/2/0
Floors
1
Living Units
1
Actual Area
2,250 Sq.Ft
Living Area
1,953 Sq.Ft
Adjusted Area
2,098 Sq.Ft
Lot Size
12,937.14 Sq.Ft
Year Built
1940
Assessment Information
Year
2021
2020
2019
Land Value
$371,807
$323,446
$323,446
Building Value
$146,021
$146,021
$146,021
XF Value
$6,984
$7,068
$7,152
Market Value
$524,812
$476,535
$476,619
Assessed Value $474,886
$468,330
$457,801
Benefits Information
Benefit
Type
2021
2020
2019
Save Our Homes
Cap
Assessment
Reduction
$49 926
$8,205
$18,818
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
MIAMI SHORES SEC 5 PB 10-47
LOT 13&14 BLK 121
LOT SIZE 105.180 X 123
OR 16467-1744 0894 1
Generated On 1/20/2022
Taxable Value Information
20211
2020
2019
County
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
1 $424,8861
$418,3301
$407,801
School Board
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$449.8861
$443.3301
$432,801
city
Exemption Value
$50,0001
$50,0001
$50,000
Taxable Value
$424,886
$418,330
$407,801
Regional
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$424,886
$418,330
$407,801
Sales Information
Previous
Price
OR Book-
Qualification Description
Sale
Page
Corrective, tax or QCD; min
10/13/2015
$100
29820-0758
consideration
Corrective, tax or QCD; min
09/16/2015
$328,600
29796-3336
consideration
04/18/2013
$430,000
28596-0677
Qual by exam of deed
08/01/1994
$115,000
16467-1744
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 rewrd. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hdp:/Awnv.miamidade.gov/info/disclaimer.asp
Version:
https://www.miamidade.gov/Apps/PA/propertysearch/ 1 /20/2022
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:03/03/2022
Location Address Parcel Number
100 NE 105TH ST, Miami Shores, FL 33138 1121360130690
Contacts
Permit NO.: P W-01-22-149
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 09/06/2022
SUSAN TREVISA Owner CASTILLA CONCRETE FINISH DESIGN Contractor
100 105 CORP
JAVIER M BARRIENTOS
442 NE 103RD ST, Miami Shores, FL 33138
ANG ELICA. M E DRANO@YMAI L. COM
Description: STAMPED CONCRETE DRIVEWAY Valuation: $ 500.00 Ins 305-pe 62-4762-4 Requests:
949
Total Sq Feet: 53.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$105.70
Payments Date Paid Amt Paid
Total Fees $105.70
Check# 1952 03/03/2022 $105.70
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, M HANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFF IT: I certify that he fo goin information is accurate and that all work will be done in compliance with all applicable laws
requlatin9 nstruct' n and zonin . Futhermor , ut or,
the above named contractor to do the work stated. j
Signature: Ovhor / Applicant
/ Agent
March 03, 2022 \—J v Page 2 of 2
� @C 0 T T
�I AN 2 0 202Z
,,� Miami Shores Village By
Public Works Department
(305)795-2230
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: VS" 0k `22-- 1 4 V
Di1 - I- ZZ-/45--)
Name of Applicant (if utility see below): Sj' Glay\yey/ c' Q
Owner off the following described property: 1
Legal Description: Lot k2j*A4 Block (a-k Subdivision S✓WV'PS S-ec'
Folio #;
Address: \oo tJe \05 S-iY-e(f
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME: u6)� 1I GL e ncye-kc 6f\6.�
Qualifier/Authorized Agent: \w kt6yI(
Address: !p 3'1S Sub LVIIS-
city:rn kr✓ ONIi State:
Telephone: L03k 6S232 Email: QY�L,RAICQ. M 174
State Certification or Registration* AQ4 Certificate of
way:
Type of Work: Paving ❑ Utility
page if
A
in the adjoining right of
❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
_ State:
Email:
ZIP:
Value of Work for this Permit: $ Sit% Square/Lineal Footage of Work:
Permit Fee $ 500.00
Notary $
Bond $
***** Fees *****
Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
(if required) Total Fee Now Due $
�3
Bonding Company's Name (if applicable):
Bonding Company's Address:
City:
State:
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 reinsp to ill be charged.
Signature X-'
Applicant or Authorized Agent
The foreg i instrument acknowledgore
me this da of , 20Jdby
is personally knoOin tome or
identification.'
NOTARY PUBLIC: « +
a
61•Ynll
Signature
Company/ tility Agent
The foregping iPstrument w acknowledgN efore
me this-fl�(�/d2y„Qf V`-" _J„0(/ by
J 7
is personally known to me or who has pr
identification.
NOTARY PUBLIC: �
Print:
SEAL:
0
APPROVED BY: i Public Works Director, or Designee
2017-04-15
DOCUMENT COVER PAGE
For those documents not providing the required 3 x 3 inch
space on the first page, this cover page must be attached.
An additional recording fee for this page must be remitted.
.Document Title:
(Mortgage, Deed, Etr.)
,Y'c2
Return Domment To / Prepared By:
CFN 2022ROO55754
OR BY. 32969 Fes 4118-4119 (2P9s)
RECORDED 01/19/2022 15:35:42
HARVEY RUVINr CLERK OF COURT
MIAMI-DADE COUNTYr FLORIDA
(Space above tins line = vrd forrecmihng office vse)
Rule 2-520 (d) On all ... doc=ents prepared ...which are to be recorded m the public records i
3 - in&space at the top right-hand comer ontbe frstpage and 1- inch by 3 - inch space
oneach subsequemtpageshallbelei3bhmkandreservedfor use by the clock of coact
CLKICT 155 Rev. 0a`16
Clerks web addrs
OR OK 32969 PG 4119
LAST PAGE
STATE OF FLORIDA, COUMOF MIAMI.DADE
I HEREBY CERTI
FY that this is a true copy of the
iNd�,�
oripinaII l"a on_ day of
20
d and OfFlclaa
Clerk of Clr l K
Miami Shores Village
Building Department
10(050 N.E.2nd Avenue
i Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT CONSTRIXTIONVITHIN RIGHT OF WAY
Whereas, owner S� S�IV eV IS( )hereinafter refelirred to as the
owner of the following described roperty (address): Ib0 � lbs S-ee'-t -
Legal Descnption�idAu �J`(MLot 13'-1 Block 1'z-\ Subdivision
Folio # ' j- Lt3lo-U\ 3 - CUCAC)
Requests permission to install (describe work ):�5AOn �' ej CanC�e'er AV(t Le„ 6q
Within the public right of way of (address) e t oS
(Clyvl t sh t�Y S IF>_ 3 313
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above -mentioned Rem(s) installed within the
dedicated right of way. If it becomes necessary for Miami Shores Village ;or Dade County
to make repairs or maintain said items within public right of way including restoration of
street by reason of the Owner's failure to do so, such expense shall be paid by the Owner
or shall constitute a lien against the above:described property until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or 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 their facilities at their own expense,
within 60 days notice by the Village to do so. Failure to comply with this notice will result
in the Village causing the item(s) to be removed and a lien being placed on the property
and/or assessed against the Owner for all costs incurred in the removal and disposal of
the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant
running with the land and shall remain in full force and effect and be binding on the
undersigned, their heirs and assigns, until such time as this obligations has been
canceled 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).
atureX n SAS yl TV'2"ASCl.
Owner or Agent
The foregoing instrument was acknowledged before me this C� day of � `° . , 202, by
v� who is personally known to me or who has produced
as identific tion and who did take an oath.
Sign:
Print:
My Commission
oce t�
C:FN 2022ROO55752
OR BK 32469 Ps 4116 (IPss)
RECORDED 01/19/2022 15:35:42
NOTICE OF COMMENCEMENT HARVEY RUVINr CLERK OF COURT
A RECORDED COPY MUST BE POSTED%GN THE JOB SITE AT TIME OFFIRST INSPECTION MIAMI-DADE COUNTYr FLORIDA
(PERMIT NO. TAX FOLIO NO
5. Surety: (Payment bond required by owner from contractor, if any)
Name,. address and phone number:
.Amount of bond $-
6. Lender'sname and address:
I. Persons within the State of Florida designated by Owner upon whomnotices or other documents maybe served as provided by
Section 713.13(1)(a)7., Florida Statutes,
Name, address and.phone number:. .
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Llenor's Notice. as provided in Section
713:13(1)(b), Florida Statutes.
Name, address and phone number.
9. Expiration date of this Notice of Commencement:
(the expiration dale Ise year from W date efiecording unless a different date Is speolfieco
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OFTHE'NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
.IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
'FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR _LENDER .OR ANAT708NEY BEFORE :COMMENCING WORK
DA RECORDING YOUR NOTICE OF COMMENCEMENT.
Prepared ey
Print Name __4 J
Tltle/Office
STATE OF FLORIDA
IIOWNTY OF MIA
The foregoln I
By
O In �Ijg o
By.
Print Name
Tltle/Office
.before me this, I l / day
Iced the following type. of Id
Signature of Notary Public:
Print Name:
(SEAL)
that the facts stated in it are true, to the best of my knowledge and belief.
Signatures) ofOyw ws@uthgris!jd OfficerlDirector/Partner/Manager who signed above:
By/Y.By
us-01 $2 PN1E3' ells
ORDERED BY:
NE 1060, St
PERDIGON TITLE SERVICES •
NE sosm s, �r'
Robert I Perdigon / 305.670.3707
rperdigon®perdigontitle.com NE10ehM
One Dotron Center Miami Beach Office
PH15utle 1701 1681 Michigan Ave .
Miomt FL 33156 Q' Suite 1001 q
Fax 305.670.3711 Miami Beach FL 33139 Z,oznd si
PROPERTY ADDRESS: 100 NE 105TH STREET MIAMI SHORES, FLORIDA 33138 , SURVEYHgl� IDER: FL. 3C3.1312
FIELD WORK DATE: 3/19/2013 REVISION DATE(S):(REV .0 3123/2o 31
FL1303.1342 it��wA C 9v�Sa B� G I 1✓[ l� ....
BOUNDARYSURVEY ..
MIAMI-DADE COUNTY
1t2'
NOID PIP ro
JAN 0 2022
Nol¢o8 E79.2' ,105.10'QC/A
NO ID25. ,r
B.C. r
,'I .I GI 112'FlP
NO ID
Calf �4e Gd v cve u r I 3o.a �BI� I I i m BLK 1 2 1 V" t M 1 O
112 Fir
/ fs 61, NO ID ;:` $': 14.Ta n/irlrJ� fy1{ h JINC rl
O.I' ON (7C
9.
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19.4' BLK 12 ID3 M.
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4 10 .I (P P T
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Xk V
lG Y I
E
NOTE5: 0 In U' a
LOT APPEARS TO BE 5ERVICED BY Cltt WATER AND 5EMP,
PENCE OWNER5NIP NOT DETERMINED
�d A STpp�
� Et1Sa N
I hereby certi/y a Sketch o of the hereon
described pro h s b&W k7ade u my direction,
and to the as wl n l f, !t is a true
andis n at meets the
minimum tech sta a s forth Me Florida Board 40 0 20 40
Of Pro d Su as d bed in Chapter
5J-17oftheFlon L.Sisba • e.
�'4moraY°a GRAPHIC SCALE (In Feet) I.I
KEITH A. STEPHENSON 1 inch = 40' ft.
State d FhrMa Ptofesebnel Stlsve)otend Mapper
License No. 6521
Use of This Survey for Purposes other than Intended, Without Written Verification, will be at the Unres Sole Risk and Without liability to the Surveyor.
Nothing hereon shall be Construed to Give ANY Rights or Benefits to Anyone Other than those Certified.
FLOOD INFORMATION: POINTS OF INTEREST
BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING NONE VISIBLE
MUNICIPALITY OR W W W.FEMA.GOV, THE PROPERTY APPEARS TO BE
LOCATED IN ZONE X. THIS PROPERTY WAS FOUND IN THE VILLAGE
OF MIAMI SHORES, COMMUNITY NUMBER 120652, DATED 09/11/09.
' ' • ' AFFILIATE
CLIENT NUMBER: PP13-143 DATE: 3/23/2013
BUYER:JOHN E. DUETSCH
FV A MEMBERS
SELLER: JAY D. BOOKBINDER
CERTIFIED TO: JOHN E. DUETSCH; PERDIGON TITLE SERVICES; FIRST
AMERICAN TITLE INSURANCE COMPANY; NYCB MORTGAGE ;.
COMPANY LLC; ITS SUCCESSORS AND/OR ASSIGNS -I = Inc.w.exactaland.[om
,� Land Surveyors, I IP (305)668-6169• F(305)668.6325
This is page 1 of 2 and is not valid without all pages. LBe 7337 12220 Towne Lake Drive, Suite 55 • Ft. Myers, FL 33913
Mission:
To protect, promote & in -prow the health
of all people in Florida through integrated
state, county & comnmity efforts.
Susan Trevisa
100 NE 105 Street
Miami, FL 33138
HEALTH
Vision: To be the Meatthie a State in the Nation
February 03, 2022
RE: Modification to a Single Family Residence - No Bedroom Addition
Application Document Number: AP1788422
Centrax Permit Number: 13-SC-2450330
100 NE 105 Street
Miami, FL 33138
Lot: 1314 Block:121 Subdivision:
Dear Applicant,
Ron DeSantis
Governor
Joseph A. Ladapo, MD, PhD
State Surgeon General
This will acknowledge receipt of a floor plan and site plan on 01 /25/2022 for the use of the existing
onsite sewage treatment and disposal system located on the above referenced property. No objection
for Driveway construction as per your Site Plan. NO BEDROOM ADDITION. NO FLOW INCREASE.
This office has reviewed and verified the floor plan and site plan you submitted, for the proposed
remodeling addition or modification to your single-family home. Based on the information you provided,
the Health Department concludes that the proposed remodeling addition or modification is not adding a
bedroom and that it does not appear to cover any part of the existing system or encroach on the
required setback or unobstructed area. No existing system inspection or evaluation and assessment,
or modification, replacement, or upgrade authorization is required.
Because an inspection or evaluation of the existing septic system was not conducted, the Department
cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use.
You may request a voluntary inspection and assessment of your system from a licensed septic tank
contractor or plumber, or a person certified under section 381.0101, Florida Statutes.
If you have any questions, please call our office at (305) 623-3500.
Sincerely,
Danny Wells
Engineering Specialist II
Department of Health in Dade County
Florida Department of Health www.florldahealth.gov
in Dade County - - , Florida TWITTER:HealthyFLA
PHONE: (305) 623-3500 FACE BOOK: FLDepartrmentofHealth
YOUTUSE: fldoh
`.ORDERED Ev Im+ s
Robert T. Perdigon / 305.670.3707
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One Do an Center Mimi Beach ORIOe I:
FH15Ae 1701 a • 1681 Kchgon A> C.
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Fec 305.670.3, Miami Beach FL 33134 1 o
FL13031342
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Florida HaaIN Muni -Dade County
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APPlnnhenkn: AP1788422
Data 2.3.2022
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GRAPHIC SCALE (In Feet)
I inch = 40' ft-
FLOOD INFORMATION: POIN"i 5 OF INTEREST
BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING NONL VI56
MUNICIPAUTY OR `V WM.FEMA.COV. THE PROPERTY APPEARS TO BE
LOCATED IN ZONEX. THIS PROPERTY WAS FOUN D IN THE VIIAGE
OF MIAMI SHORTS, COMMUNITYVED NUMBER 05SI. OAT09/11/Oc I"
CLIENT NUM8ER:PP:3-1E3 '; DATE: 323/2013
BUYER: JOHN L DUETSCH
SELLER jAY D.'_OO:CSINDEP....
AFFILIATE
MEMBERS
1 MCAN TITLE INSURANCE COMPANY; WOE MORTGAGE
OMPANY U C tTT SUCCESSORS AND/OR ASSIGNS
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LdllC) SUI'V2YOF9, Inc. P ( Suite 6160. F(3cs)saa mvs
i. Ths spagei oi2an'x dnot valid v.rthout a!I pages �-: L3=ns; Irizo-cane Lake Drive,e, Suite 55E,. Vyerf R3em=1
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 —yyorKers uorrlpensayon Insurance tXempilon
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 3 day of P v , 20 2.2
By ,(.11SQV) I VeO SQ who is personally known to me or has produced
as identification.
Notary: T "
,p� g r��.y , H04aY WWII State of FlonCa
SEAL: 9LOABLI00 M�Mdx3 p p B Jr
/ ': my Iyabn HH 146852
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CASTILLA CONCRETE FINISH DESIGN CORP.
5campea uoncrere unveways • root ueeus • ratios • & more
STAMPED
CONCRETE
State of Florida
County of Dade
6375 SW 41st Street
Miami, rU3314
Email: beautifuldriveways@MaU.com
License CC # E2160120
"Yheddw;kW)vuneed,,
the Imprkeyou want,
thecustomerserWe
YOU deserve!"
Before me this day appeared personally Javier Barrientos who being duly
sworn deposes and says that he or she will be the only person working on
the project located at IOC iJ' )oS sk}(ff�� -
Javier Bard
Sworn to or affirmed) and subscribed before me this 3 day of
"(AyCIA. 20 Z2..
Personally know
Or produced identification
Type of Identification Produced OL
,fir p�pry Pobtic Slate d FbMa
yv" � OWria Medrano
} ��yiy� � 148852
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Print, Type or Stamp Name of Notary