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DS-12-23-3166Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 190 NW 100TH ST, Miami Shores, FL 33150 Contacts Permit NO.: DS-12-23-3166 Permit Type: Driveways/Walkways/Slabs Work Classification: New Permit Status: Approved issue Date: 07/22/2024 1 Expiration:01/22/2025 Parcel Number 1131010230330 MICHAEL PEREZ Owner HOMEOWNER Contractor 190 NW 100 ST, MIAMI SHORES, FL 33138 Home: 3057739559 mikeperez2987@gmail.com Inspection Requests: Description: NEW CONCRETE DRIVEWAY Valuation: $ 7,500.00 1 Visit our website www.msvFl.gov and Total Sq Feet: 1,200.00 Click on Permits Fees Amount Application Fee - Other $50.00 CCF $4.80 Concrete/asphalt/pavers, slabs, dways, $100.00 swalks DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $2.40 Planning and Zoning Review Fee $70.00 Scanning Fee $9.00 Technology Fee $15.00 Total: $255.45 Building Department Copy Payments Date Paid Amt Paid Total Fees $255.45 Credit Card 12/20/2023 $50.00 Credit Card 07/22/2024 $205.45 Amount Due: $0.00 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 foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con tri cti ning. Futhermore, I authorize the Aove named contractor to do the work stated. �.v�l oe2 as Authorized Signature: Owner I Applicant I Contractor / Agent Date July 22, 2024 Page 2 of 2 Miami Shores Village BUILDING PERMIT APPLICATION WILDING ❑PLUMBING ❑ ELECTRIC ❑ MECHANICAL Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 JLL L 0 2M FBC 20A Master Permit No. Sub Permit ❑ ROOFING ❑ REVISION ❑ EXTENSION ORENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I9d Nw /OU ST City: Miami Shores County: Miami Dade Zip: S SI5-6 Folio/Parcel#: //--W/—b23 — 033d Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): MG//AGL pErmr4 Phone#: (60SJ 'r%3- 9 Add City: /i'1/�1M�` S!!'0/!EJ State: FL Zip: 33i SO Tenant/Lessee Name: Email:) k'vPn : O�OSJ r7'73 —'I CONTRACTOR: Company Name: 06r//✓C/Z /,3p/LDL iG Phone#: Address: Email: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: _ Address: City: State: _Zip: r Value of Work for this Permit: $ � r60 Square/LinearrFF000tage of Work: f 2U0 S!� r, - Type of Work: ElW/ Addition ❑ Alteration New LIQ Repair/Replace ❑ Demolition Description of Work: i(/ew 60N&45: LY />mleKWf! Specify color of color thru tile:. Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee DCA Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary Double Fee $ Structural Reviews $ IRevised04/05/20221 P&Z Review $ Bond $ 1, TOTAL FEE NOW DUE $ �S . 1S 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. Signature / v k JE OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 3 by M�tira� �e rt 2 who is personally known to me or o has produ d R_ IL as identification and who did take an oath. NOTARY PUBLIC: Print: YY .' /fV wSeal: i✓r "&'' KRISTINE KEPFLE vA0 Notary Public - State of Florida Commission R HH 452227 My Comm. Expires Oct 8, 2027 Bonded through National Notary Assn. APPROVED BY CONTRACTOR The foregoing instrument was acknowledged before me this —AL— day of &Ct rbcn , 20 oil—, by Mtaa ff-cz who is personally known to me or who s prod ed Ft ll L as identification and who did take an oath. NOTARY PUBLIC: Print: r IVKJJ sJ.... pE1EEPPtf-y0.� Seal: �?Notary Public - State of Florida ;g®tee; Commission A HH 452227 My Comm. Expires Oct 8, 2027 QI10nPd through National Notary Assn, Plans Examiner GaPAIW4 fi 7eze4 Zoning Q6 Structural Review Clerk (Revised04/05/20221 NOTICE OF COMMENCEMENT 11�!1111111111811111111111111111111111111111 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION fr44 210124R 057 269,8 OR BK 34335 Ps 1777 (iPss) PERMIT NO. j S - /.2-.23FOLIO NO.J/ 3�b��Ol3- M-0 RECORDED 07/30/2024 13:13:08 AM FERNANDEZ-BARQUIN CLERK OF THE COURT & COMPTROLLER STATE OF FLORIDA: STA:rE OF FLORIDh COUtr IIIIMIr3YMif T)MTY r FL COUNTY OF MIAMI-DADS 1 hereby certify tba fore.,za;ng is a t e�, e, tgiaa on rT�� THE UNDERSIGNED hereby gives notice that improvementswill be made to certain re 7 property, and in accordance with Chapter 713, Florida Statutes, the foltowing information is provided in this Notice of Commencement. of the y�i 'owt and Comv) roller W e Csx>Sty ��� tw°y #311459 rug 1_ Legal description of property and streetladdress: /'M ~ 2. Description 3. Owner(s) name and address: ,,rw 6� Interest in property: Olv 1c)e — i Name and address of fee simple titleholder. 4. Contractor's name, address and phone n 5. Surety. (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: use of recording office -3 3iso > S315-C 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number 1Z9 8_ In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, addre, nd phone number. Cup yU/lF �Oi7CC_ (Grp czo � �b3—!>7a 0 eS SW /(yZ J°T RL/iE'77D ,cfy 1' 9. Expiration date of this Notice of Commencement ��Y 3C7 fA e2a2 y (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OFTHE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, 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 AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner( w_n HI f icer/Director/Partner/Manager Prepared By % Prepared By Print Name f 1FIQ. E%/ • Print Name _ Trtle/Of ice nu). l E _ - - Tdle/Office STATE OF FLORIDA COUNTY OF MtAMr-DARE The foregoing m ent was acknowledged before me this S0 day of 7V �'y Z By fCHAEL Pe12 0 Individually, or O as for M Personally known, or ❑ produced the following type of identification: Signature of Notary Public: Print Name: Ibd L if (SEAL) V VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of er(s r kuthorized Officer/Director/Partner/ By B MIGUEL ANGEL ALVAREZ Notary Public • State of Florida Commission p HH 492728 My Comm. Expires Feb 14, 2028 eQthrcugh National Notary Assn. M-m-se waa3 V2 Mission: To ploled, VaTota &improve the heath of all people in Florida hmugh integrated state, mrty&mnrrunity efforts. OWNER 190 NW 100 Station Miami, FL 33150 HEALTH Vision: To be the Healthiest Sate in the Nadon March 15, 2024 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: AP2034972 Centrax Permit Number: 13SC-2843654 190 NW 100 Street Miami, FL 33150 Lot: 1-4 Block:5 Subdivision: Dear Applicant, Ron oNantin Governor Jeaaph & Wqo, ED, no State Surgeon General This will acknowledge receipt of a floor plan and site plan on 01/24/2024 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. NO OBJECTION FOR NEW DRIVEWAY AS PER SITE PLAN. NO FLOW INCREASE, NO BEDROOMS ADDED. 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, Gabriel Toledo Engineering Specialist II Department of Health in Dade County arwwa o.wdr.,t s Raaru wNar.8orMYwaft4w in Dade County • • , Florida TwITTER:HeafthyFLA PHONE: (305) 623-3500 FACESOOK:FLDepartmentoMealth YOUTUPIE: 6doh Al. 50. 'MTALR/w 'q NO OBJECTION 25.OP soo laz3•E..mmlmae weM1-- FNntlB HBDtlh MwxmDOW Loanµ' "•.•.'I• h _ - g11 ° O. S.iO S.AP�S13A5/L•�t W/L o Application No _ W/M '? Data 03/15/2024 Stquature s 9 GENERAL LEGEND & SYMBOLOGY FN, SOY %� •ELEVAIgw NW.L :.WaIFA LLYFIELFV AWP�6 •� :[ Q CRWY. pMyEWAY WL WATEflIEYklF1EV � All UP _ UP •ulaJ1Y14LF LEM •LOW6TFIEV UFMACwxflF g•p`_ V Oqy 808. •BAASOFBEMINGS COW .R •CRONOFROPO0 41.60 .• A/C .Yfl CONLYLIp.VINGPIO LEE .LOWEei FLOOR EIEVRIWN� DLDG .BI.. O.L •CNUNE CB ...8ASM 1. •MEASUED g {{{ IQ CBS •CgiC DLOCY. STRVCIVM 1. -REG.. A.w 6C0 CX. .CNOgU pSiMICE OM.w. .OVFAXFADWM�Kw.utl/Mu�AI wi<u, OO IYY+Y�1 ICI •SA ATE. PL .POIITOFWTEASE.II Z ST, • Le O flEA. r CLR CLEAR • 8/C BLD .NER NaN -ram "� SFOgOOMS Q .CENTFAUNE It •flM.115 CONC. •CONCRM PRO •MDW PAC • M11TOF REVERSE CURVE RES. •gE510ENCE y ORS Z:AT' --� 6 Ll 300' PG •PJINTOFCUIN1lVRE R/W .glGll}UF WA! PCC. •.MTDFCEOMMMUCUgVE SIR, -S IRGNw£ [ It O. .MpX11MENiuxE AFA.OMIMTEMA K STY .STpiY 3.10' HARP EC SYSTEM NO VD. •NAT.4E.EeC VERT. WTUM SWn .SOEw. µK 3835 FIRUCTEOPREs OE .WERNFPUELECiflIC UNE VE .RALRYEAGIE • vL°I P.B P1AigWx 2}2}xp. TRVNn016Mf%µOPYI'IMEI4NT1'l PCP .PERM4VE4LCONTROLPoINi •ELEVATKKI PoIM PRO .PAGE -.._. WODOEFHEE POB •iVINTOFBEGINNWG-•—•CNVNUN(FFNCE P . IO [ •PRDPFAT EE �. METKFENCE 8 q .'." n NTO .xOETDECALE E[ISrw45EwERUNE _ - ._•` _� Kis. t_ _ Q �R,A, —. NEW SEALLFEA E SOO'13'x3'E 101.AO'weq RO •'P8 ROD ®•CR.S. WALLiENCE i PT --' -a -R -a--y --a -A -.. -. • • .-v -� y -Y -rt y -p-Y -f -f -F ti' PHC 9EN NA<OMMENCEMEM ©'IILEEN -a MY ENC.-gPojPaDF EYENG•L`•2 ®=cON BETE 24tl PAPtWaY FN FwFM-inWTY] ~i 'A,cg -- g J fIP • 38ayw > •>RNSTIC CONCPER - F F.IR (QOnREhN•w1 �•ASPXALTPAVEMENT IwN F.F.E �Ic,,[��[.' VAVEMENTgESfgUTION p A.GS. . CA E�AO ELEV •W ARD/DAS7AAC MES o X.P G. RIe�—ILA'' CENTG�EV T •MAILD - LAG .��OPADE EI£V ti .WWDPoIEIFowffl Ew/MMi� x}DASN PYMr. QkC CMCOPE LEGEND&SYMBOLOGY aCu TOM •TFMICMRY DFIiCNMARn �. - N.W N AV tE - FCO cLWR�O �.UNOBSTT .AREA $O V. VEO SEPTIC SYSTEM \\, SIT�E,P_ D N —I m r-t\ mar D ss IsP w ;,. N. W. 100th STREET 1E Rm Ji I 1 ram' �a Y1 LOT-4 wok - 5 CERTIFIED TO: RAPID TITLE SERVICES COMPANY, OLD REPUBLIC NATIONAL TITLE INS BRITTANY JUST/ANE RETKOFSKY, PARAMOUNT RESIDENTIAL MORTG/ SUCCESSORS AND/OR ASSIGNS AS W/N NO BLOCKGf I Cl i/111a t R=25.00' THE EAST 25' I A=39.37' 5 LOTI5 I D=90°13'23" BLOCK T=25.10' T�t I CH=35.42' _ I CHB=S44°53'19'W rA - o THE EASr25' 2 , /w 'loc N LOT-2 - —I BLOCK5 1 C.90" III I L` M. ... W.U.P.: FLP. '/,.• W.U.P. L. .... TREE 6' WOOD FENCE i NO ILf I �I TRUNK WEST E'll o 70.00' TOTAL R/W� LOT - 5 BLOCK-16fo7 0 ti N n r BLOCK FI.P.%z. CORNER NO 10 PROPERTY OF: BRITTANY JUSTINE RETKOFSKY 190 N.W. 100th STREET. MIAMI SHORES, FLORIDA 33150 LOCATION SKETCH NOT TO SCALE NCE-CO GROUP/NC., ITS #11l'2q�LLsL,1 iIR INTEREST AFMPAepMAM pue salnJ Aauno , 31a75 'IeJapaj yl aoueydwoo oa ao - _ r"-�1F-La� �]'0 lda0'6ul�D a. d �eQ •lda0 6 aw�JedaO 6ulpl g a6eplA saJoySaL 1 a a � o (y r\ T LEGAL DESCRIPTION: LOTS 1,Z,3 AND 4, LESS THE EAST 25 FEET, BLOCK 5.-BONMAR PARKADDITION-, ACCORDING TO THE PLAT THEREOFAS RECORDED IN PLAT BOOK 24. PAGE 71, OF THE PUBLIC RECORDS OF MIAMI-DADS COUNTY, FLORIDA. 1 -) SURVEYOR'S NOTES: LOT- by e-, � `N b THE EAST 25' ` �`1' L�� G !` — LOT-3_—I V `1U7 �S" r` l qy BLOCK-5 I ^ `_ �7 0. r� LEGEND \\ 1) NOT VALID UNLESS SIGNATURE IS EMBOSSED WRH THEREGISTERED"NO SURVEYOR'S SEAL. 2) LEGAL DESCRIPTION PROVIDED BY OTHERS 3) PROPERTIES SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER RECORDED ENCUMBRANCES NOT SHOWN ON THE PROPERTY PLAT OF RECORD. 4) MEASUREMENTS TO WOOD FENCES ARE TO OUTSIDE OF WOOD. $ GROUND URLIDES, FOUNDATIONS, OR OTHER IMPROVEMENTS IF ANY. WERE NOT ELEV S.IFSHOMOTOEBASED NATIONALGEODETICVERTICAL DA TUM 1829. m D SS WIZRE-SC . ��)Aram CENTEROFW#iE ENSHIP WIRE FENCES ARE TO CENTER O B) REASUEMENTS ARE TNCESARFAC WALL 9) WALL MEASUREMENTSARETdFROMFACE 10) DRAINING D/STANCEBETWEEN WALLS ANWDF FENCES AND PROPERTY LINES MAY BE )R TED FOR CLARITY. 1 L ONE INFORMATION WAS DERIVED FROM FEDERAL EMERGENCY MANAGEMENTAGENCY IL A L OD/ MATll SRATE MAPS S IFANV SNOWNAPS BASED ON ASSUMED PLAT MERIDIAN AT SOUTH FIGHT OF WAY OF STFEEi=EAST THE EAST 25 awff'—RR coNand+eR CIF. IPD.v PIVE PLs PRDFEwmNAL cavn sunY — LOT-4- ` AVE AVENUE FPL FLORIW NWERStIEIiF P3Y PROFESSI0.Wt>f/RV£LDR BLOCK-5 '/I ��T BLVO ScuumARO FAP FOL/!®MONgFE R P/tOP£RT'LINE gy VgNaq M.LRI( FAR FgAOIMAYRvo P.OB POINTOF3EGc.'Nm0 GELETHENSWIB8 FNA FOI.YID P.0.G PWN(G'CGNM£HtiEUENI G'TWAAS/N L ARL'.[EW1N PAZ PONTOFREVERSELURVA p' CBS OLWC fitOOLSR+LCTLFE IN LEG& PAM. PFRMIVENTREFERENCEAi F.T.R. ND ID. CIIB OIOROBEARm LP LKJ'ITPpE PT. FONTOFTANGENCY LM CfKAY0015T.4K.E LB LIGENSE091/5ME55 R RADIUS LOR CCANEII LS IANO SURVEYOR IR/ RELORD C( L r IN 4I615URE0 MM NORTNAAIE WV£ LMI M NE RW R41EL£VATICW R4HT.OFWAY CL OEMERUME OAEAR wm NA (IONAI GEOOET/CVERRCAL DANM BAN SANITARY" (.-Ohy�. CO Gpy(,RETF CLEANIXFT HOLD. AOTIDEVRFLABL£ NO NUMBER SIP S.LA SETIRONPLPE SE(MONRCD EB. ELECR caox NTS LvrTOBGLLx ST. STREET BUSY ElE.110N ORB OFRI'W RECLMO SW" T UNGFM ENCRJA[HLIENT GWH ONPROP£RTYLM£ O.UL OVERIIEtO UR[RYONES TBM M. TEMPORARYBENCNMJ MEPHONE /� E.RP FV a EIEIATXINREFFRENCE FOWT FWLYIFUNV` ewv urron PC FOINTDFCLIRL'AR PLG Al4VT/IFM1eCMl.Vn „Fvn:L,FF TYP UE T'RlAL. UIM'TYEM1SEB-FNT j r NISED SEAL OFAFLORIM SURVEYOR AND MAPPER. I M)CERREYTIIATTMSBOIANDARYSLMVEY WAASS MMADE UNDER MYSUFERTFOK ANO MEETS STANDARDS DF PRACTICE SSIOWI. N BYTHE FLORIDAABOARDOFPRO-17.00NALSUGHOY1SAND MAPPERS INCHAPTERIVECOE0 THROUGHT f7.0.5i. RORIGADMINISTRARIO COOT.PURSUANT TO THE SEER IIHER OW IS MU A M) CO RECTT. THAT ME ISED TOME BEST EST 0FMYKDNISTRUEAND CDRREC UIVECT BEBTOFMYkNOWLEWEANO BELIEF. Sll6/ECT 1TL NOTES AT0 NOTAliO(6 SF,DWN HEREON FRANC."F FAJARDO FLORIDA PROFESSIONAL SURVEYOR AND MAPPER REGISTRATIONNO.476/ A9Af W.Y. WUP SYMBOLS �R£/E -- OYDUffAO UTNTYLAVES .. _- WWEFPYCE WpWFEM-6 PATER TYG'ORNFJi rvASTWOOW B.bY1 EYL.STINED GRA'ELE ATI "TER EOGRAOE£LEVATIUN N WATER VALVE T SIGN ORAINA6EAUNTK4E SW/TrIRYAFWICLE PROFESSIONAL SURVEYING AND MAPPING ANNES AND GARCIA, INC. LB # 2098 FRANCISCO F. FAJARDO PSM It 4767 (QUALIFIER) 4967 SW 75th AVENUE, MIAMI, FLORIDA 33155 PH (305) 666-7909 FAX (305) 442-2530 SCALE'1-=20' 1 DRAWNBY.J.LJ. I DWG. Ne.. 267562 0 P Q i C N 2• a e 7 R/W IV. W. 100th STREET 3 CERTIFIED TO: — —' — - — - _ o p k RAPID TITLE SERVICES COMPANY, r /S ASPI]ALT y j �� v OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY, A. n \ nATTC ' -0 1•C� F. /,p.Z'• BRITTANYJUSTIANERETKOFSKY, PARAMOUNT RESIDENTIAL MORTGAGE GROUP INC., ITS SUCCESSORS AND/OR ASSIGNS AS THEIR INTEREST MA Y APPEAR KwaT F.I.P. No LP, 7 . ( W/0 ) NO ID. F .. %]" ` BLOCK O ID.. CORNER 77.JO' LOT -J W.U.P. . W. U.P. ... 3 .. ... F.I.P. % ' TREE NO /cc T.Wh'K F.LP. $" BLOCK CORNER NO l0. LOT-4 LOCK - 5 kvm3A%jq woo Cl —LOT - 1> THE EAST Z5• I A=39.37' C) �+ BLOCK-5 D=90°13'23" 2 BLOCK - 3 I T=25.10'C O� G�1 CH=35.42' ,a.01 I CHB=S44'53'19"W I afi� fN rn N ` 0 7NEASTZS' LOT-?LIBLOCK - 5/I �BLOCK 5 � I rags�'1T m LOT e/Ocaf.75p�� n THE EAST ZS' i C7C -� T C�•+4•C5' LOT-J — O A BLOCK - 5 ^ \"A kci 3 V I... ... LOB I... _ .. WEST 75.00' (R8M) LOT-5 BLOCK - 5 PROPERTY OR BRITTANY JUSTINE RETKOFSKY 190 N.W. 100th STREET. ` IT t 1 j� IA P'A�R nr-\iiFw THE EAST ZS' ^� —H Ltl4- .17 BLOCK - 5 11 1T`�`�, I F. 1.A NO 10. 0 N\ r LEGEND LLv. ,W� w � IF. AVE AVENUE FPL BLW. BOL4.EVAWD FIA BM BENCHMARK FI.R. CAN G6LETELENSI SM ma CB. cArCH8A5w L an corvLRElEeuxxsTRwruRE X) pm crloRnsaWo-x LP CH CIIORO DLSTiWL.E LB CPR LOANER LB CT L r R4 LFjyrERLME �Li N9L9 L[EAA GWVY: NGLD IYOIO. cD CLFi1NOUT claWWT NO. ELECFKB6Y NIS BUSY ELEVAT(GY O.RPB ENCR. ENCRDAGIMENT OuL L ELEVAIXIN REF£RENCEPOWT O.U.L UP PVV,.w.Fi'rm P.4 LOCATION SKETCH NOT TO SCALE I�I x,<m AF• LL I II 1 vawoa: , " r � ° a• I LEGAL DESCRIPTION: LOTS 1,2,3 AND 4, LESS THE EAST 25 FEET, BLOCK 5. "BONMAR PARKADDITION'. ACCORDING TO THE PLAT THEREOFAS RECORDED IN PLAT BOOK 24. PAGE 71, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. SURVEYOR'S NOTES: 1) NOT VALID UNLESS SIGNATURE IS EMBOSSED WITH THE REGISTERED LAND SURVEYOR'S SEAL 2) LEGAL DESCRIPTION PROVIDED BY OTHERS 3) PROPERTIES SHOWN HEREON WERE N'OTABSTRACTED FOR EASEMENTS OR OTHER RECORDED ENCUMBRANCES NOT SHOWN ON THE PROPERTY PLAT OF RECORD. 4) MEASUREMENTS TO WOOD FENCES ARE TO OUTSIDE OF WOOD. 6) UNDERGROUND UTBTDES, FOUNDATIONS, OR OTHER IMPROVEMENTS IFANY. WERE NOT LOCATED. 6) ELEVATIONS. IF SHOWN ME BASED ON NATIONAL GEODETIC VERTICAL DATUM 1929. 7) FENCE OWNERSHIP NOT DETERMINED UNLESS OTHERWISE NOTED. B) MEASUREMENTS TO WIRE FENCES ARE TO CENTER OF WARE 9) WALL MEASUREMENTS ARE TCVFROM FACE OF WALL 10) DRAWING DISTANCE BETWEEN WALLS ANDIOR FENCES AND PROPERTY ONES MAY BE EXAGGERATED FOR CLARITY. 11) FLOOD ZONE INFORMATION WAS DERIVED FROM FEDERAL EMERGENCY MANAGEMENTAGENCY FLOOD INFORMAT RATEMAPS 14 BEARINGS /F ANY SHOWN ARE BASED ON ASSUMED FLAT MERIDIAN AT. SOUTH RIGHT OF WAY OF N.W. I" STREET=EAST RALMIPfPE PLS PROFE5961NLLM95utvt rt.>+ W.v. ww,ert wLLrc R CWERI LIGIR PP.LW FPROFEiYIONLINGLE>URVEYON A.W NAPPEq W✓P ➢.I/RUT1'fY1LE FcwP IXmon,O POBPIMTOFaW . P.S PMVTOFLOM ARCYry PONOFEWECLRVAf SYMBOLS &65A[ PAN. PEWMANENTREFFAENCEd1ONt mae,m CONGl1EiE LI(fLrpgE Pr POINroP TANGENcv - UIQRYLIN6 L:CENSEOBUSWE55 R R WRFREAO -i-'°--WSB=TENCE 1 oR IH WOMFY R£ F PROFERTYCOR.VEA NORTHPAfER/CrW VDDY'•lL R9M1 .TIW -WAW WATER FLOiV swrARF-WAI' N9 TKW9L •aTOOET.0 VBLTIf..V.OaNN BaN SAMTARI' 7— ASV IXASIM (Y410E ELEVATpN MJr IDEN11R9BLE SIP. SETIRCNARE �� PRCN4¢P GRAOEELEYATIQ•I NUMBER SLR. S Aoffl RI'X) N WATDt VALVE ImrmseuE sr. smEEr •� slGl+ pfFLOyy RECORD ypOR T TAW^EWT �1 ORVNAGFMAN112.f GV PROPERTY LINE Tam TEMP04AR1'BENCH M✓FN VG ARY~OLE DVGWFACUTTIJITIXNEB T£L TELEPhONE .K FWEHTOMNr ADNTOFC Ef TTP. TYR'C9L tiF LI WGFIX]URE "A r,uvw n,x U2 UNJTY EAGEd1ENT 'C FREOFPhIALEVTOCNNECCW 1 HEREBYCEiTi1FYTHAT TMS BOUNMRV BUFVEY WAS MADE LWlOER W BUPERVISION AIA) MEETS SraNLWtL15 OFPRACROEBET FULM BYTHE ' FLORIN BWRp OF PROFESBIONat SURVEmR$ ANC MAPPERS INCHAPTER51EWO THROUGH6FiT052 FLORIDAECVAOIAINISTRATIVE CODE PURSUANT TO THE SECTION4REON ISTRU AND CORRECT T THATTNE LSED BEST TOFMy EON ISTRUEANO SWU. b&WT BESTOF MY KNOWLEDGEANp BELIEF S(IDJECT TO NO tE5 AND NCTA TIObS SHOWN HEREON FDRO. ESSIONO FLORIDALOIPRONA10.4 AL SURVEYOR AND MAPPER REGISTRATONNQ d]6] PROFESSIONAL SURVEYING AND MAPPING ANNES AND GARCIA, INC. LB # 2098 FRANCISCO F. FAJARDO PSM # 4767 (QUALIFIER) 4967 SW 75th AVENUE, MIAMI, FLORIDA 33155 PH (305) 666-7909 FAX (305) 442-2530 SCALE: 1•=20' 1 DRAWNBY:J.LJ. I DN/G.No.:267562 x� rv2�v� G Nv� Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:08/07/2024 Location Address Parcel Number 190 NW 100TH ST, Miami Shores, FL 33150 1131010230330 Contacts Permit NO.: REV-07-24-1978 Permit Type: Revision Work Classification: Public Works Permit5tatus: Approved Expiration: 01/27/2025 MICHAEL PEREZ Owner MASTER CONSTRUCTION MANAGEMENT Contractor 190 NW 100 ST, MIAMI SHORES, FL 33138 LLC Home: 3057739559 mikeperez2987@gmail.com CARLOS GIOVANNI RICARDO 801 W BECKLEY SQ, DAVIE, FL 33325 GI0927@ME.COM Description: TWO NEW ENTRANCE APPROACHES FOR Valuation: $ 4,500.00 Inspection Requests: DRIVEWAY i Visit our website www.msvFl.gov and Total Sq Feet: 230.00 i Click on Permits Fees Amount Payments Date Paid Amt Paid Revision: Minor Change of Plans $60.00 Total Fees $69.00 Scanning Fee (Manual) $9.00 Credit Card 08/07/2024 $69.00 Total: $69.00 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 foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatin t cti nd zoning. Futhermore, I authorize the above named contractor to do the work stated. r ���1�ael��eZ ���- Authorized Signature: Owner / Applicant I Contractor / Agent Date August 07, 2024 Page 2 of 2 mow• Miami Shores Village °"� Public Works Department r " (305)795-2210 Public works forms are available from the building department, 10050 NE 2nd Ave., MiamFELL&J PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Pro erty Permit#:__ Name of Applicant (if utility see below): A415A46'2 /'L-21CL Owner off the following described property: �` Legal Description: Lot Block .f Subdivision /x�t1MAW1e A,q,0 1G Folio #; //- 3/0/- Dy3 - v 330 Address: Ad NW /00 fT IAKIVI ' J/YO,& ;t S1150 UTILITY NAME: Qualifier/Authorized Agent: Address: Citv: Telephone: State Certification or Registration #: Email: State: Certificate of Competency # CONTRACTOR NAME: LZWJ7/CUUfioN /�lqJ /*7R/+ebE/Nr Qualifier/Authorized Agent: CAW40 f ti, /LCAn.oO Address: /O y0 /yw /T9�A Si City: J1141C414 6,4,9b;vf State: FL ZIP: Telephone: / - 5t7q Email: 610tf-lmrtyz oA-umUe77,a^ State Certification or Registration #: C66 In R7d4 Certificate of Competency Requests permission to install (describe work, attach way: 760 NCW E4UMAN6Lr LC C !6 if necessary) in the adjoining right of Type of Work: L7 Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: Citv: Telephone: Registration #: _ State: Email: Value of Work for this Permit: $ �I t,�UO Square/Lineal Footage of Work: ZIP: ***** 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: 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 reinspection will be charged. Signature Applicant or Authorized Agent The foreg ing instrument was acknowledged before me this J day of 20_g2� , by who is erson ly know o me or who has produced as identification. NOTARY PUBLIC: Sign: SEAL: " µIGUEL ANGEL ALVAREZ Notary Public •State of Florida K Commission # HH 4927288428 My Comm. Expires Feb 14, h National Notary Assn. Signature —A.,no0wolro o y ili gent The foregoing ins; nt was acknowledged before me this day u 20� by .e I mare Z who is pe onally known to me or.who has produced. i'L 0vi✓LYs Lt«-is-< as idpnti�atTrL NOTARY PUBLIC: Sign: l Print: U),t � I�o� ` i u o 2- SEAL: WENDY RODRIGUEZ •Y,RL Notary Public - State of Florida �• Commission # HH 528699 My Comm. Expires May t 9, 2028 Bonded through National Notary Assn. BondedthrQua APPROVED BY: , Public Works Director, or Designee 2017-04-15 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 190 NW 100TH ST, Miami Shores, FL 33150 Issue Date: 07/22/2024 Parcel Number 1131010230330 Permit NO.: PW-05-24-1203 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 01/22/2025 Contacts MICHAEL PEREZ Owner MASTER CONSTRUCTION MANAGEMENT Contractor 190 NW 100 ST, MIAMI SHORES, FL 33138 LLC Home: 3057739559 mikeperez2987@gmail.com CARLOS GIOVANNI RICARDO 801 W BECKLEY SO, DAVIE, FL 33325 GI0927@ME.COM Description: TWO NEW APPROACH ENTRANCES FOR DRIVEWAY Valuation: $4,500.00 Inspection Requests: Visit our website www.insvfl.gov and Total Sol Feet: 230.00 Click on Permits Fees Amount Copies Fee (Manual) $1.00 Education Surcharge $1.50 Public Works Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $10.00 Total: $121.50 Payments Date Paid Amt Paid Total Fees $121.50 Credit Card 07/22/2024 $121.50 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shares Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws ling stru n�zoning.uthernore, I authorize the above named contractor to do the work stated. MXTNlrc�c�l �6eZ 7l991� Authorized Signature: Owner / Applicant / Contractor / Agent Date July 22, 2024 Page 2 of 2 .,,-moo Miami Shores Village `°" Public Works Department MAY 1'4' 2024 (305)795-2210 Public works forms are available from the building department, 10050 NE 20d Ave., Miam chores, FL 33138 ,to_ PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: GS-/o2-.13-3/6L -ZK- 1 ZA3 Name of Applicant (if utility see below): N1iCNga %�E/?EL Owner off the following described property: Legal Description: Lot Block Jr Subdivision 861,/1-44RJk PART! Folio#; 1) -3161-623-- 0330 Address: 190 n/W ioo sT 14,dmi' SNa/2Es , T315-0 UTILITY NAME: Qualifier/Authorized Agent: Address: Citv: Telephone: Email: State Certification or Registration #: CONTRACTOR NAME: /i7957£?' Qualifier/Authorized Agent: G'A/lt�ar Address: 106)0 Nw 1364A 3-7 Um City: U14Lf4A &AL0CtJX Telephone: 8G e21$ ' y$'79 Email: State Certification or Registration #: r; GG State: ZIP: Certificate of Competency # State: f ` ZIP: G Certificate of Competency Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: two 105ti/ Ap9 VA61y E,VT4AA47--f Type of Work: E Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: Citv: Telephone: Registration #: _ State: Email: M2 Value of Work for this Permit: $ L,�5-619 Square/Lineal Footage of Work: oZ30 sq Fl- ***** Fees***** PermitFeb'S 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ 1 2 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 reinspection will be charged. Signature Applicant or Authorized Agent The foregoing instrument was acknowledged before me this_Ly day of Mf1�e 20dL/,by /L CL Ae-12E-Z who is personally known to me or wh as produced F I)wmCRS 4, c as identification NOTARY PUBLIC: Sign: Print: L-N/ L L✓41FIEL SEAL: APPROVED BY: Signature S�� v Company/Utility Agent The foregoing instrument was acknowledged before me this /3 day of /yW 20 , by tr 200 who i ers Wally known o me or who has produced as identification NOTARY PUBLIC: Sign: Print: /°�%6dEG LlG�gI�L SEAL: MIGUEL ANGEL ALVAREZ r;Upx'i',. MIGUEL ANGEL ALVAREZ Notary Public • State of Florida %?° • K, Notary Public • State of Florida Commission d HH 492728 ': Commission AHH 492728 My Comm. Expires Feb 14, 2028 ' n,,,. My Comm, Expires Feb 14, 2028 ad thro National Notary A n, Bonded through National Notary Assn. �Iblic Works Director, or Designee 2017-04-15 );: (I�' :1! i 131;iI-i;J•jit !! H iil?Iliai 1 1 f t {£ 1 1It � I!I IOIii I/i Yl i! .111 !£6f Miami Shores Village F^="--,`+-^=`---t--" "u Public Works Department 1r tK.. 4 e'e (305)795-2210 STATE of FL kffih G®�d� Ptl UA1JE . ; Public works forms are available I ilel'ehV' g{r that £he fore�011tg 15 8 . ,,, from the building department, p the ! '' 7 1'aeet CO+� ' 1�, 10050 NE 2"" Ave., Miami Shores, ���r3, , T`j�? 5�a� file iff Clerk of dta t ti /y, WAI AND ada County Cow and '6idp o COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAYDeputY Whereas, (hereby referred to as the owner) 1-1'OHME:U 1 Cr02=G Wl Of the following described property: ewmwx Legal Description: Lot Block 'S Subdivision pgr!6 Folio #; — 31(7/ — UL3- U33e5 Address: )JO MW 166 ST H;,VJNI SNoacS , fL 331-s-6 Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of 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 item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Miami -Dade 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 Owner or 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 their facilities at their own expense, within 14 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 obligation has been cancelled by an affidavit filed in the Public Records of Miami -Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized represe ative). Signature Owner or Authorized Agent Stateof Vlolvloa County of 1 IJc The foregoing instrument was acknowledged before me this AL day of MAZ 20p, by 1%GNACL 6-E12& who is personally know o me or who has produced as identification. NOTARY PUBLIC: Sign: Documents are recorded at the Clerk Print: /�6s�bZ AcOA/lcrL SEAL: of the Courts, MIAMI-DADE COUNTY RECORDER, - RT1-1Dt7RS'Ert-AST,— ......., 22 N.W. First Street, 1st Floor, Miami, .lax AIIGUELANGELALVAREZ FL 33128. %• ...% Notary Public • State of Florida Commission # MN 492728 ".?or r X, My Comm. Expires Feb 14, 2028 Bonded through National Notary Assn. 2017-04-11 ❑� Ron DeSantis, Governor Melanie S. Griffin, Secretary Florida STATE OF FLORIDA dopr DEPARTMENT ^E BUSINESS AND PROFESSIONAL REGULATION 10910 NW 138 ST SUITE 1 HIALEAH GARDENS FL 33018 LICENSE NUMBER: CGC1528720 EXPIRATION DATE: AUGUST 31, 2024 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 7317380 RECEIPT NO. RENEWAL BUSINESS NAME/LOCATION 7608322 MASTER CONSTRUCTION GROUP 10910 NW 138TH ST UNIT 1 5 0 HIALEAH GARDENS, FL y� 33018-1142 y+p;' EXPIRES SEPTEMBER 30, 2024 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED MASTER CONSTRUCTION 196 GENERAL BUILDING BY TAX COLLECTOR MANAGEMENT LLC CONTRACTOR 49.50 10/02/2023 r./r1 r.ARi nq r inVANNl Pir.ARnn Worker(s) 1 CGC1528720 INT-24-001568 This Local Business Tax Receipt only confirms payment of the Local Business Tax, The Receipt is not a license, permit, or a codification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which applyto the business The RECEIPT NO. above must he displayed an all commercial vehicles —Miami —Dade Code Sec he-27E MIAMI,� For more information, visit www miamidade oovdaxcell ector vn.w i.w..«�.... . . -r acoRD� CERTIFICATE OF LIABILITY INSURANCE 511412024 THI TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such enAdcarsemenf s . xE: PRODUCER _.-"-.._PHONE 954 962-SQ00 _ _.i�l 954 981-8624___. PLACE FOR INSURANCE E�am9,. --�Q. 1092 S State Rd #7 __ A(L PLACE41NSURANCE AOL.COM .._. ,� 1'IoilywOOd, FL 33023 INSURERS AFFORDING COVERAGE i`` NAIC # �l---au-_- r.-- AA I - - -- INSURER A: INSURED - Master Construction Management LLC 10910 NW 138 ST unit # 1 Hialeah Gardens, FL 33018 INSURER 8 : INSURER C INSURER D : INSURER E. tNtiURER r OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: OD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE OFBANY CONTRACEEN ISSUED T OR OTHER DOCUMENT WI HTHE INSURED NAMED ERESP CT TOFOR THE LWHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �ADElL SUBR � POLICY EFF POLICY EXP LIMITS ;R TYPE OF INSURANCE ! POLICY NUMBER MMfDD MID COMMERCIAL GENERAL LIABILITY ;EACH OCCURRENCE b 11000.00( d ° ( S 100 fl0i 1 i PREM occurrence CLAIMS -MADE C OCCUR ; I ( MED EXP { �r one Parson $ r3 Odd I � AAA AA! A __ __ ... _ _..." " _ �- GEN'L AGGREGATE LIMB' APPLIES PER: I (��._..f LOC X POLICYL JECTPRO- t_ J OTHER: 00127647-t} 211512024 i I ` I E s 2/15l2025 ! " PERSONAL 8 ADv INJURY s GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ ` s ; j ; i ! I i COMBtr�IED SINGLE LIMIT S a AUTOMOBILE LIABILITY ANY AUTO i OWNED `-^ SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per person) $ BODILY INJURY (Per aakient) i S PROPERTY DAMAGE Per ccidwd _ 5 EUMBRELLA LW03 OCCUR ` EXCESS L WB CLAIMS -MADE I I ` ; NIA Exempt j i ; I ,_ I EACH OCCURRENCE S AGGREGATE $ S 3TA TE ! _ ERH _...._._ _. I DED RETENTION $ WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY Y t N ' ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, despite under DESCRIPTION OF OPERATIONS below T E.L. EACH ACCIDENT Iyb i E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT � S DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Scheduto, may be attached If more space Is required) CGC1528720 TE Miami Shores Village Building Dept 10050 NE 2nd Ave Miami Shores, FL 33138 ANY OF THE CR19ED POLICIES BE CANCELLED BEFORE PIRAT110 AT THEREOF. NOTICE WILL BE DELIVERED IN THE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ACORE® CERTIFICATE OF LIABILITY INSURANCE �..� �'�`M"��' 7/15/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(tes) nwst have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER SUNZ Insurance Solutions, LLC. ID: (TLR) c/o TLR of Bonita Inc 700 Central Ave buite 500 St. Petersburg, K 33701 CONTACT NANIE: Wo&.m' Comp Department PHONE 727-520-7676 3 FAX o • �z7-525-�8s2 ADDRESS:. certs@encorehr oom INSURER(S) AFFORDING COVERAGE NAIC O INSURER A: SUNZ Insurance Comoany 34762 INSURED TLR of Bonita, Inc dba Enter riseHR 700 Central Avenue Suite 500 INSURER B : `"� c St. Petersburg FL 33701 INSURER D: RER E INStiRER P. r`nVFRArkFS CERTIFICATE NUMBER! stn00010A REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lLT R TYPE OF INSURANCE DL 8UBR POLICY NUMBER POLICY E3�F POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE R TO $ MED EXP (Any one neon $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY EJ JJEECT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accidera $ $ UMBRELLA LIAR EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DED I I RETENTION $ A WORIe:RSCOMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y� OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N f A I WC039-00001-024 I 6/1/2024 6/1/2025 PER OTH- EL EACH ACCIDENT $1 000 000.00 EL DISEASE- EA EMPLOYEE $ EL DISEASE - POLICY LIMIT 1 $1,000,000.00 DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (ACORD 101, Additional Remaft Schedul% maybe attached N more space Is required) Coverage Provided for all leased employees but not subcontractors of: Master Construction Management LLC Client Effective: 6/21/2020 CGC 1528720 CFRTIFICATF NnLDER CANCELLATION 1939 Miami Shores Village Building Department 10050 NE 2nd Ave. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Rids Leonard 01988 2015 ACORD CORPORATION. All rights reserved. 0 JIMMY PATRONIS 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 * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 2/24/2024 EXPIRATION DATE: 2/23/2026 PERSON: CARLOS G RICARDO EMAIL: GIO@MASTERCONSTRUCTIONFLA.COM FEIN: 472136728 BUSINESS NAME AND ADDRESS: MASTER CONSTRUCTION MANAGEMENT LLC MASTER CONSTRUCTION GROUP 10910 NW 138 ST UNIT 1 HIALEAH, FL 33018 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to wvvw.myfloddalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(11). F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT E01877479 QUESTIONS? (850) 413-1609 RULE 69L-6.012, F.A.C. REVISED 01/2023 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov 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: R T 1 V 4110n Cr►teYL'l is re nesting a permit under this workers' compensation exemption and has acknowledge that he tr 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 1AN THIS NOTICE N11O,TIlCE AND r UNDERSTAND ITS CONTENTS. Signature: 1 F Address: I0 `C)y� Owner State of Florida County of Miami -Dade The foregoing -was a0cknowledge before me this day of �1 u� , 20�. By O',' -n94,Ul:2l who is personally known t or has produced as identification. l` .,&,.ar, KRISTINE KEPPIE YAO Notary: 9&.-S4;r6 IC 4Y`, Notary Public -state of Florida <: commission p HH 452227 i MY comm. Expires Oct 8, 2027 SEAL: Bonded through National Notary Assn. Rev12122022 Notice to Owner Page 1 of 1 � A 1 t r s r I i i l