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DS-12-23-3010Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: DS-12-23-3010 Permit Type: Driveways/Walkways/Slabs Work Classification: Addition/Alteration Permit Status: Approved.: Issue Date: 01/16/2024 Expiration: 07/16/2024 Location Address Parcel Number 30 NE 106TH ST, Miami Shores, FL 33138 1121360060010 :ontacts GREGORY BASIL Owner EDFM CORP Contractor 90 NE 106 ST, MIAMI SHORES, FL 33138 FERNANDO RODRIGUEZ Home: 5615488548 gregory.basil@gmail.com Business: 7865862576 Inspection Requests: Description: CONCRETE DRIVEWAY, APPROUCH, WALKWAY & Valuation: $ 22,000.00 305-e Inspection BACK PATIO SLABS WITH ARTIFICIAL GRASS INSERTS Total Sq feet: 1,900.00 Fees Amount Application Fee - Other $50.00 CCF $13.20 Concrete/asphalt/pavers, slabs, dways, $125.00 swalks DBPR Fee $2.63 DCA Fee $2.00 Education Surcharge $6.60 Planning and Zoning Review Fee $70.00 Scanning Fee (Manual) $12.00 Technology Fee $17.50 Total: $298.93 Building Department Copy Payments Date Paid Amt Paid Total Fees $298.93 Credit Card 12/04/2023 $50.00 Credit Card 01/16/2024 $248.93 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 .tegula ing-construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. AuthorizeH Signature: Owner / Applicant / Contractor / I Agent Date January 16, 2024 Page 2 of 2 ivllami bnores vliiage Building Department CEO 10050 N.E.Znd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2020 —'- BUILDING Master Permit No.'Tr_2- t'z-23 -13010 PERMIT APPLICATION Sub Permit No. BUILDING ® ELECTRIC ROOFING 0 REVISION ® EXTENSION ©RENEWAL PLUMBING []MECHANICAL ® CHANGE OF ® CANCELLATION ® SHOP CONTRACTOR DRAWINGS JOB ADDRESS: q AAF 106 City: Miami Shores County: Miami Dade Zip: 1111 / Folio/Parcel#: �1 ~ 2-43 -00rp ' 00 10 Is the Building Historically Designated: Yes NO Occupancy Type: 5. Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): gQiC% W i!/ ( M— Si / Phone#: Address: gi0����,,//V& /D�Q City: M 1904l SG,ryre"7 State: j Zip: _?3139 Tenant/Lessee Name: Phone#:_9-45"_15w_" N Email: I . CONTRACTOR: Company Name: �.lJ Phone#: /� Address: � VM almiL 3 ,6 Email: A r tv com Qualifier Name: a / Phone#: " State Certification or Registration #: CA-D Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Z� , 4000 Square/Linear Footage of Work: I e 0 Type of Work: ® Addition © Alteration FE-11 New 0 Repair/Replace FE-3 Demolition Description of Work: f✓ AnV&W. &noivaii� &,n(6M/ ­i- j%et /Z�� Specify color of color thru tile: Submittal Fee $ 50• Cl�) Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ DCA Fee $ Training/Education Fee $ CCF $ DBPR $ P&Z Review $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 2`i�• Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State ELI Zi 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 appLayed and a reinspection fee will be charged. /`i Signature l Signature__ �� 6 OWNER or AGENT The foregoing instrument was acl nowledged before me this day of 20,_, by If Y :1 ywho}-iis personally known to ho me or who has produced 4� L, as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Q Seal: REYNELCLEMENTE i,%Y COMMISSION # GG 953194 �p� EXPIRES: May 20, 2024 Bonded Thru Notary Public UndervmterS ******* CONTRACTOR The foregoing instrumen was acknowledged before me this _ day of ►" 20, by WLI Y1who is personally known to me or who has produced I �—,y L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 1 �2(,li to Seal: ;otPn4;P�a` REYNELCLEMENTE MY COMMISSION # GG 953194 EXPIRES: May 20, 2024 FUF F�Q• Bonded Thru Notary Public Underwriters ***************** APPROVED BY ' �" Z' Plans Examiner T ?-� /A D04- Zoning Structural Review Clerk Mission: To protect promote & inpuve the health of ail people in Florida through integrated state, comfy & oorrmu rty efforts. EDFM CORPORATION 90 NE 106 Street Miami, FL 33138 Ron DeSantis Governor ®1 16A4J6 Josoph A. Ladapo, MD, PhD HEALTHState Surgeon General Vision: To be the Healthiest State in the Nation November 30. 2023 Y RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: AP2023525 Centrax Permit Number: 13-SC-2826865 90 NE 106 Street Miami. FL 33138 Lot: 1 Block: 202 Subdivision: Dear Applicant, OFC 04 M3 This will acknowledge receipt of a floor plan and site plan on 11/28/2023 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. Reviewed by Ana A Flores Moreno on 11/30/23. No objection to driveway ONLY as per your site plan. The septic system exists outside the scope of work and will not be affected. NO BEDROOM ADDITION. NO FLOW INCREASE. Existing septic system is close to installation, and any damage incurred during construction will require a repair permit. 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, Aga-ALe�c4- a- Raves, Mo-re,o- Ana A Flores Moreno Environmantal Specialist II Department of Health in Dade County Florida D"uwbnent of Healfh www.fforidahanith.gov in Dade County • • , Florida TWITTER:HealthyFLA PHONE: (305) 623-3500 FACEBOOK:FLDepartmentofHealth YOUTUBE: fldoh MAP OF BOUNDARY, TOPOGRAPHIC & TREE SURVEY Y s �G ct I�iat� �'�IIf j45 f/3' 3c� P 1 _ _ 4fy\ NE 106TH STRE 76 TOTAL FtK;KT.OFWAY �. BOB NBT° 1111: t26PAVEMENT 023' PARKY+A'+ 7 2 9 { 6' Sro6WALK _ FIR 12' �� NO CM v G O 10 9 , y t00T it 50' p o 23.20'ri e� 250 LOWEST ONE STORY FF.htd22' STEPS o RES. #90 NEVTM'NER \y EFE•7237' L 20 60' 14 90' i L4 N� �i i I I i t9 {y LOT-1 O' BLOCK - 202 I 17 i 3 CBS + GATE WALL ` Od F j tYl VO to I 'v o, TCBS WALL - 14 ! C I4 1 i xl I6 O �J 7 C �I C-1 R=25' AL = 39.13' CL = 35.26' CB = S 47035'57" E 0 = 89°41'08" TREE TABLE NO COMMON NAME 013H'03 HE'CHT CANOPY t OAK *8" 40. 10' 2 OAK 18` 40' 33 3 dACARAA`jA 12- 28 30- 4 OAS( `6" 35 35' ° - s 5" t6' 20' E 0" 30' 22' 6' 25 16' " ALEX PALv 3' 25 6 0 5" 25' t5 • PA, B' e' +0' - = 40" 40 15' • - .- _(C-USTER 6) 3" 20' 4' .. - .. C_�,;STER 8} 4" 20' 8' 25 30' :8 -' '.: EE 4' '2' '2 •F FAI V 3" 'A' .2. -. 70- 55 35' .V 6- 5. 10, - .. -_.. 6" 15 . - - - 3" 20 6' 12` 50. 18. - _ f -2-. 50. .a. . -. 3" 25' 6' . ... AN ARBORST REPCRT WLL GOVERN , 23 , _ ___r_ ` - i 18 + - s 60 ? 15'ALLEY `V NO OBJECTION _i�` Florida Health Miami -Dade County LOT • 16 0.S.T.D.S. & Well Program BLOCK - 202 PLP2023525 E Application No.: Date: 11 /30/23 Signature Anw ALGxa cL �FLorey Mo-re•o GRAPHIC SCALE SURVEYOR'S CERTIFICATE. 7 F'r pI vn MAP OF BOUNDARY, TOPOGRAPHIC & TREE SURVEY l�,6s �r�ve 0,0fico'k Va s re5 , 1 Ii 2 - ABBREVIATIONS:^/I A ARC DISTANCE / //n��w �/' !//// �W�/ �'�/ /,��YI•/ AC = AIR CONDITIONER PAD eCR= B COUNTY RECORDS BLDLDG = BUILDING BM = BENCH MARK BOB = BASIS OF BEARINGS CBS = CONCRETE BLOCK & STUCCO (C) = CALCULATED C&G = CURB & GUTTER NE 106TH STRE T CLF = CHAIN LINK FENCE 76TOTAL RIGHT.OF-WAY 10 COL = COLUMN D.E. = DRAINAGE EASEMENT F.' a- BOB: N8773'&E D.M.E. = DRAINAGE & MAINTENANCE EASEM NT D/W = DRIVEWAY S26, PAVEMENT .9R' EB = ELECTRIC BOX ENC. - ENCROACHMENT EP = EDGE OF PAVEMENT EW = EDGE OF WATER V� FDH = FOUND DRILL HOLE FEE = FINISHED FLOOR ELEVATION � � t23'PARKWAY FIP = FOUND IRON PIPE (NO ID) Q FIR = FOUND IRON ROD (NO ID) JJ O 20 FN = FOUND NAIL (NO ID) � � 1 1 2-0� 9) FPL = TRANSFORMER POWER &LIGHT 3 F.00 TRANSFORMER PAD tv1 2' 4.8'SIDEWALK , BBB �NOC L.E. LANDSCAPE EASEMENT —' LAKE (M)E MEASURE MAINTENANCE EASEMENT MDCR = MIAMI-DADE COUNTY RECORDS` NOCAP MH = MAN HOLE 90e 'r ML = MONUMENT LINE (P) = PLAT V `• �� r PB = PLAT BOOK _ PC = POINT OF CURVATURE \\^� /��' PCP = PERMANENT CONTROL POINT v 'T 30' PE = POOL EQUIPMENT PAD «� - 5.14.50'30' PCP PG = PAGE 20 c -NO AP PL = POINT OFF INTERSECTION �/� 10.0 11 51, y, o a POB = POINT OF BEGINNING 3 I►Ir N 23.20'x c� O 4 POC = POINT OF COMMENCEMENT ` 28C) / 12 PRC =POINT Of REVERSE CURVATUR A O PRM = PERMANENT REFERENCE O LOWEST w MONUMENT ONE STORY FFE•1211' PT - POINT OF TANGENCY - STEPS a RES.#90 NEXTHIGHER R = RADIUS DISTANCE FFE-12.37' (R) = RECORD ro R/W = RIGHT-OF-WAY 20.60' in 14.90' RES = RESIDENCE m � C.0 5 , SIP = SIP LB#8023 i $ 00 O SND = SET NAIL & DISK LB#8023 1 A 6 STL = SURVEY TIE LINE \ LOT-2 W : _. - O SINK = SIDEWALK . -� (TYP) = TYPICAL BLOCK-202 N UB = UTILITY BOX U.E. = UTILITY EASEMENT W/F = WOOD FENCE 0� S. SYMBOLS: � I lea : WAU� WALE ❑T = TELEPHONE RISER 19 /_�� 14 ® = CABLE TV RISER XG.B.S. O + a & �n o ® = WATER METER WALL O X 0.00 = ELEVATION LOT- 1 2S• L ^^ �. (00') = ORIGINAL LOT DISTANCE BLOCK-202 " A = CENTRAL ANGLE = CENTER LINE 17 1O /0L1 3'C.B.S. O• 7 WV = WATER VALVE 09e GATE WALL +/0 + Wd CURB INLET k I 82• 30' S.I.R. 10 FIRE HYDRANT �{ LB8023 180 =V � _ � ' 1BB023 Y01G Y I o x (= LIGHT POLE a2"� l w 15' ALLEY = CATCH BASIN rQ, = UTILITY POLE OD = DRAINAGE MANHOLE Q = SEWER MANHOLE Nplb = METAL FENCE LOT -'IG " = WOOD FENCE I BLOCK - 202 �c--x--x-- CHAIN LINK FENCE ------ - EASEMENT BOUNDARY LINE _)IL L/�1Y,nj FiL.�✓ — - -- -- = OVERHEAD UTILITY LINE ) L/ ' C �17 ❑❑ ❑ ❑❑ ASPHALT CONCRETE PAVERS/ TILES COVERED BRICK AREA - • - _. ,,,,., am )-tQ,iy urFraneQ wtql �'utk� wok Atn�R�opv CERTIFICATE OF AUTHORIZATION # LB-8023 Survey Pros, Inc. 4348 SW 74TH AVENUE, MIAMI, FL. 33155 Tel: 305.767.6802 www.survey-pros.cam LOCATION MAP: I��� �.D Py NOT TO SCALE 6 4 -1-Ofa1 W 10 JP y CURVE DETAILS: -. 5x 40� (O(P. s - H; I�C Y [ Cf, 47 CB = S 47°35'57" E (�] � l A = 89°41'08" �reUa2—}:s,cZS = �i2 S0 - 97WE a h vty;0.4" TABLiE.• NO COMMON NAME DBH 0 HEIGHT C OP 1 OAK 18" 40' 3 1.OAK 18 40 30 3 JACARANDA 12" 28' 30' [,, l�/D 5 FICUS 6" 16' 20' ee Vl / aW let+ 6 OAK toll 30' 22' 7 JACARANDA 6" 25' 16' 8 ALEX PALM 3" 25' 6' 9 ALEX PALM 3" 25' 6' 10 MANGO 5" 15' 15' 11 AVOCADO 5" 25' 15' 12 COCONUT PALM 8" 18' 10' 1.3 FICUS 40" 40' 35' 14 ARECAS(CLUSTER 6) 3" 20' 4' 15 FISH TAIL(CLUSTER 8) 4" 20' 8' 16 AVOCADO 25" 30' 18' 17 ORANGE TREE 4" 12' 12' 18 ALEX PALM 3" 18, 12' 19 FICUS 70" 50' 35' 20 PLATAIN PALM 6" 15' 10' 21 PLATAIN PALM 6" 15' 10' 22 PLATAIN PALM 6" 15' 10' 23 PLATAIN PALM 6" 15' 10' 24 PLATAIN PALM 6" 15' 10' 25 ALEX PALM 3" 20' 6' 26 ROYAL PALM 12 50' 18' 27 ROYAL PALM 12 50' 18' 28 ALEX PALM 3" 25' 6' IN CASE OF A DISPUTE, AN ARBORIST REPORT WILL GOVERN GRAPHIC SCALE 30 0 15 30 1 "= 30' A/E. /06 *'a l 0 5 3 2 �Z I r lZ /3 /4 I /5 i /6 PROPERTY ADDRESS: 90 NE 106TH STREET, MIAMI SHORES, FL. 33138 LEGAL DESCRIPTION.' LOT 1, BLOCK 202, OF DUNNINGS MIAMI SHORES EXTENSION NO 2, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 41, PAGE 78, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. FLOOD ZONE INFORMATION: THE GRAPHICALLY DEPICTED BUILDINGS) SHOWN ON THIS MAP OF SURVEY IS WITHIN ZONE X BASE FLOOD ELEVATION COMMUNITY NAME & NUMBER VILLAGE OF MIAMI SHORES 120652 MAP & PANEL NUMBER 12086CO302 SUFFIX L SURVEYOR'S NOTES: 1. ELEVATIONS WHEN SHOWN REFER TO 1929 NATIONAL GEODETIC VERTICAL DATUM (NGVO 1929). 2. NO ATTEMPT WAS MADE TO LOCATE FOOTINGS/FOUNDATIONS, OR UNDERGROUND UTILITIES UNLESS OTHERWISE NOTED. 3. THE LANDS SHOWN HEREON HAVE NOT BEEN ABSTRACTED IN REGARDS TO MATTERS OF INTEREST BY OTHER PARTIES, SUCH AS EASEMENTS, RIGHTS OF WAYS, RESERVATIONS, ETC. ONLY PLATTED EASEMENTS ARE SHOWN. 4. THIS SURVEY WAS PREPARED FOR AND CERTIFIED TO THE PARTY(IES) INDICATED HEREON AND IS NOT TRANSFERABLE OR ASSIGNABLE WITHOUT WRITTEN CONSENT OF THIS FIRM. 5. ALL BOUNDARY LIMIT INDICATORS SET ARE STAMPED LB# 8023. 6. THE BOUNDARY LIMITS ESTABLISHED ON THIS SURVEY ARE BASED ON THE LEGAL DESCRIPTION PROVIDED BY THE CLIENT OR ITS REPRESENTATIVE. 7. FENCE -OWNERSHIP IS NOT DETERMINED. 8. ADDITIONS OR DELETIONS TO THIS SURVEY MAP AND/OR REPORT BY SOMEONE OTHER THAN THE SIGNING PARTY(IES) IS PROHIBITED WITHOUT WRITTEN CONSENT OF THE SIGNING PARTY(IES). 9. BEARINGS WHEN SHOWN ARE TO AN ASSUMED MERIDIAN AND BASED ON PLAT. THE CENTERLINE OF NE 106TH STREET BEARS N87'33'28"E. BENCHMARK INFORMATION.' ELEV(NGVD29): 10.54 LOCATIONI: NE 104 ST - - - 29' SOUTH OF C/L LOCATION2:N MIAMI AVE - - - 14.5' WEST OF WEST EDGE OF PAVEMENT DESCRIPTIONI: PK NAIL AND BRASS WASHER IN CONC CURB AT NW EDGE OF HANDICAMP RAMP. CERTIFIED TO: GREGORY WILLIAM BASIL KRISTINA CATHERINE KHAZENI e 4 SURVEYOR'S CERTIFICATE: I HEREBY CERTIFY THAT THIS SURVEY IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AS RECENTLY SURVEYED AND DRAWN UNDER MY DIRECTION AND MEETS THE MINIMUM TECHNICAL STANDARDS SET FORTH BY THE FLORIDA STATE BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 5J-17 FLORIDA ADMINISTRATIVE DATE OF ORIGINAL I CODE PURSUANT TO SECTION 472.027 FLORIDA STATUE. FIELD WORK: 0410812021 ✓OB#.- 21036449 SEAL DRAWN BY AORIEL AUTHENTIC COPIES OF THIS CAD FILE. BASIL SURVEY SHALL BEAR THE ORIGINAL SIGNATURE AND SHEET I of 1 RAISED SEAL OF THE NICOLAS DEL VENTO ATTESTING REGISTERED PROFESSIONAL SURVEYOR & MAPPER SURVEYOR AND MAPPER STATE OF FLORIDA LIC. # 6945 0 L =BT PIUSI EW MWE&IMATIM 38596M EXPIRES 1=1 SW, 88TH AVE ���pqq�y,.pp��qq ��EE yy�} T aal�pp .-. ... .... ._. ._.. _. �1tie ptam }b�usiness Chspi¢rBA--Art, 9 & 10 rsx�ro+SEta SEC.. TYPE 04: SinUMSS LFSh�tmkEiYl' FtE�4v.Et3 EDFM CORPORACtOVA 196 GENERALBUR DING BY TAX COILE41.vfT FER14AMM R RODft BUU, CONTRACTOR MOD fi&t 112023 W t k-(S 2 Mr-024746 M 234,1882't T{w€a�1 Tuse�2szo'sse isay�vatai84a#.oca#6�+rsari-a,�'i4zuPaee'tPAisaaYatiecasa. {�slaia a#�a�a#3�a's mdu&.ass.t€c��rc�ngiyeadtisaar��wemriteatai x�StTF'S.axact$a���I - ef�ss��S�cia-�7v. ct�at� - �,srcacsa" :S3it'°�li��4•aF9axcffi�ut. Local Business Tax_ Miami -Dade County, State cA Florida THIS M MT A $RL- DO NO i FAY 3693644 °ATE(Mlwomrr) CERTIFICATE OF LIABILITY INSURANCE 12104/2023 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: K the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. U 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 endorseme s . PRODUCER Estrella Insurance #309 6758 Pembroke Rd c . T Manuel Peguero PxoNE (954) 837-2250 �FAX &HIVE ADDRESS: agency309@estrellainsurance.com__ _ _ INSURERS) AFFORDING COVERAGE NAIC li Pembroke Pines _ FL 33023 INSURED EDFM Corporation 10021 $W 98th Ave I NSURERA: Next Insurance US Company ---------. INSURER 8 : 16285 INSURER C : _ INSURERD INSURER E : -----_ miami 33176 cnvl=Rer-cc INSURER F : — -- — KCVISIONNUMBER: 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. INSR ADDL SUER --- TR TYPE OF INSURANCEam im POLICY NUMBER POLICY EFF POLICY EXP "---- AMISS COMMERCIAL GENERAL LAAIULn'Y EACH OCCURRENCE S 1,000,000 CLAIMS -MADE OCCUR PREMISES EsEoa:urrence $ 100,000 MED EXP (Any one arson) $ 15,000 A PERSONAL & ADV INJURY $ 1.000,000 nxtdd44y3w-00-g1 03/09/2023 03/09/2024 _ AGGREGATE LIMIT APPLIES PER: GEN'L GENERAL AGGREGATE $ 2,000,000 X POLICY J�LOC ET PRODUCTS-COMPlOP AGG -'— $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea sadden! S ANY AUTO BODILY INJURY (Per person) $ - N OWED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED BODILY INJURY (Per aotiderd) $ AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accdem UMBRELLA L AB OCCUR EXCESS LU16 CLAIMS -MADE EACH OCCURRENCE f AGGREGATE $ DED RETENTION$ j ---- WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y / N STATUTE ERA ANY PROPRIETOR/PARTNEPJEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in Nth E.L. DISEASE - EA FA4PL0yEE — $ II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Contractors Errors and Omissions Each Ocurrence 25,000 A NXTDD44Y3W-00-GL 03/09/2023 03109/2024 Aggregate 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 707, AddWonal Remarks SchedWe, may be aUached I more space Is required) License number CGCO24746 CFRTIFICerc 1.1A1 ncD Miami Shores Village 10050 NEW 2nd Ave Miami Shores, Fla. 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I troo-" 10 Ak UKU cUKFUKATION. All rights reserved. Arnon �c ionAarn�� Tl.e e/-ADn ..�..... o...l 1....,. .,.e rn..lch..nd ...—Ui .-f APADn A� Roy DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the Policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, 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 endorsement(s)- PRODUCER CONTACT SUNZ Insurance Solutions, LLC. ID: (Cornerstone) NAME:HONE C/O Cornerstone Capital Group, Inc. Alc. No, ExO: 870-376-2871 FAX 1 S. Main Street E-MAIL Alr�Woj' Medford, NJ 08055 ADDRESS: -- c°i•r_eguests comerstonepeo.com INSURED Cornerstone Capital Group, Inc. 1 S. Main Street Medford NJ 08055 C ram^ o CERTIFICATE NUMBER: 77384493 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, R TYPE OF WSURANCE ADDL SU POUCV L GENERAL LDU31LRy EFF POLICY EXP -_--- PODCYNUMBER M/DD MMID EACH LIMBS $: COMMERCIA OCCURRENCE CLAIMS -MADE 0 OCCUR i DAMAGE T RFNTFn — GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ [I LOC OTHER: AUTOMOWLELIABItiTY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LUIB — OCCUR EXCESS LIAa ... ..........._ EMPLOYERS' LIABILITY Y / N ROPRIETORIPARTNERIEXECUTNE "EPJMEMBEREXCLUDED7 ❑ NIA datory in NH) , describe under 1/1/2023 1 1/1/2024 MED EXP (Arty one person) $ PERSONAL B ADv INJURY $ GENERAL AGGREGATE $ .PRODUCTS - COMP/OP AGG $ $ COMBINED SINGLE LIMB $ Ea accitlent BODILY INJURY (Per person) $ BODILY INJURY (Per etxldeni) $ Peer 2gggenDAMAGE $ -- S DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD �Oi, Addltlonal Remarks Schedule, maybe attached H more space is required) Coverage provided for all leased employees but not subcontractors of: EDFM Corporation Client Effective: 8/7/2017 4452 Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave Miami Shores, FL 33138 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE Wmt THE POLICY PROVISIONS. AUTHORQEDREPRESENTATIVE Rick Leonard Amnon ,2r /in,am-1% 01988-2015 ACORD CORPORATION. All rights reservei The Arnon nemn end Inns ern —i-+--A of A!`non Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:01/16/2024 Location Address Parcel Number 90 NE 106TH ST, Miami Shores, FL 33138� 1121360060010 Contacts Permit 1 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 07/16/2024 ......................— _ _ -------------------- ___ GREGORY BASIL Owner EDFM CORP Contractor 90 NE 106 ST, MIAMI SHORES, FL 33138 FERNANDO RODRIGUEZ Home: 5615488548 gregory.basil@gmail.com Business: 7865862576 Description: CONCRETE DRIVEWAY, APPROUCH,-777 WALKWAY & Valuation: $ 100.00 Inspection Requests: BACK PATIO SLABS WITH ARTIFICIAL GRASS INSERTS 30576-4�49 [ Total Sq Feet: 0.00 Fees Amount Education Surcharge $0.30 Public Works Permit Fee $100.00 Scanning Fee (Manual) $9.00 Technology Fee $10.00 Tota I : $119.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $119.30 Credit Card 01/16/2024 $119.30 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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. t-P v-v76t rd t z Authorized Signature: Owner / Applicant / Contractor / January 16, 2024 Page 2 of 2 14s5'1 E,33138 Miami Shores Village Public Works Department (305)795-2210 ��LC 0 4 ?_0?.3 Public works forms are available from the building department, 10050 NE 2°d Ave., Miami Shore PUBLIC WORKS PERMIT APPLICATION gy_ 44M Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property -�1 Propterty o� Permit#: I -n -�"�U� ( Name of Applicant (if utility see below): orq u% (((' Owner off the following described property: Legal Description- Lot Block_ Subdivision Folio #; Address:_�j)12 10iYilQ:24l SYl(%ffS 4q33%3� UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: Email: State Certification or Registration #: CONTRACTOR NAME: Qualifier/Authorized Agent: i Address:4V(? City: Telephone: Email: State Certification or Registration #:C& Request permission_to install (desc__rik�e� wo way: CXhCMIf ,�.ODKOGlr✓!/I u. Type of Work: ❑ Paving ❑ Utility ❑ Landscape ❑ Antenna DESIGNER: Architect/Engineer: Address: City: Telephone: Registration #: Value of Work for this Permit: S Permit Fee $ 100.00 Notary $ Bond $ State: Email: State: K4 1 State: h ZIP: Certificate of Competency # ZIP: Certificate of Competency #: rgte gage if necessary�in the adjoining right of Sidewalk ❑ Electric ❑ Irrigation Other:AD0r'0aCh - ZIP: Square/Lineal Footage of Work: ***** Fees ***** _Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ (if required) Total Fee Now Due $ _ [� Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ma 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 rejection will be charged. Signature Applicant or Authorized Agent The foregoing instrume was a9k,,nowledged before me this ZZ, day of 20_, by lu G1 who is pers�D� nown to me or who has produced Ci as identification. N OTF Sign: Print: SEAL: APPROVED BY: 2017-04-15 Signature Company/Utility Agent The foregoing i trum n was a knowledged before meth' � day of OVpmVteo 20 23 , by who is personally known to me or w o has produced �bL, as identification. .�)tAU ZIRE �--ELCLEMENTEREYNELCLEMENTE ISSION # GG 9531 MY COMMISSION# GG 95319411 S: May 20, 2024 EXPIRES: May 20,2024 >,Qota FOF F Bonded Th. Notary Public Underwrften3 ry Public Und — Public Works Director, or Designee 111111111111111111111111111111111111111111111 Miami Shores Village Public Works Department (305)795-2210 R­.__.Pub4c works forms are available C�the building department, J, F 0 NE 2"d Ave., Miami Shores, FL 33138 N WITHIN RIGHT OF WAY OR 131, 3398i i F's 820 (Ps s ) RIEi=ORDED 1.7/22121235 11:15;:17 jUAN FERi•?€ NDEZ--gAR?UI R CLERK OF TIME COURT ). C:r3NF'TROLI_ER hIANI.-CAFE COUNTY-, FL Whereas, (hereby referred to as the owner) Of the following described roperty: Legal Description: Lot _ Block 2.0Z. Subdivision h Folio #; 1(' 00+ QD/V Address: Q0 NE 406 577 -.331 M RMu sts pejmission to install (desgibe work, attachlseparatf- qaU ifpe;essary) in the adjoining right of way: IN CONSIDERATIOW of the approval of thiL Oermit by the vij(age, 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 fu uthorized representative). 3"IATE OF FLORIDA. COUNTY OF MIAMI•DADE I HEREBY CERTIFY that this is a true copy of the CLERX o eilkii %d iRthAAf" on day of �� Pao �OUhTy'o Signature Owner or Authorized Agent J W m � t;ierx C Courts \� a By _ D.C. state of o i !�, Paola MunTYLOZ 1-- County of a e The foregoing instrument was acknowledged before me this I day of20 L3 , by u who is personally known to me or who has produced my hand a Documents are recorded at the Clerk of the Courts, MIAMI-DADE COUNTY RECORDER, COURTHOURSE EAST, 22 N.W. First Street, 1st Floor, Miami, FL 33128.