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DS-07-362Inspection Number: INSP -41295 Permit Number: DS -2 -07 -362 Scheduled Inspection Date: November 30, 2010 Inspector: Bruhn, Norman Owner: LIBONATTI, BRUNO Job Address: 10401 NE 6 Avenue Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Building Department Comments DRIVEWAY RESURFACE ASPHALT RENEWED 11/29/10 Failed Correction Needed Re- Inspection Fee November 29, 2010 No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments For Inspections please call: (305)762 -4949 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Repair Phone Number (786)200 -4774 Parcel Number 1122310120190 Page 22 of 24 f-ti\l/ek* Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: CAme112- 1 l 0 n DATE: I ))2 ,-/ 0 ADDRESS: (0 901 A) E NO E )I( I Y t Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; !further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner- builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is res construction and is not hiring a licensed contractor to assume responsibility. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that 1 ma from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name ins name. I also understand that the contractor is required by law to be licensed in Florida and to list his or li permits and contracts. Initial 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may als.lsuild or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or o upancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that 1 b\'It,.r substantially improved it for sale or lease, which violates the exemption. Initial .r Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. sible for the protect myself ad of my own e numbers on 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner- builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial V 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is no I censes to perform the work being done. Any person working on my building who is not licensed must work under my direc supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers , o -nation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial Initial Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide b all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http: / /www.myfloridalicense.com /dbpr /pro /cilb /inde .ht I 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am tt party legally and financially responsible for the proposed construction activity at the following address: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informati ' /at I have provided on this disclosure. Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does no have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may b unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 2- day of 00J €A- 20 ( 0 Produced there License orll VQ}ZO 1 S' U.0 . ion. Initial Initial who was personally known to me or who has NOTARY ; 19N f; e :6.,5 l• ' - A ° � �s BUILDING FergEVICI Permit No. D3 ‘7=362.. J1 FFR262O1 PERMIT APPLICATIO Master Permit No. FBC 2004 BY: _ �� 1- _:._ - - -- Permit Type (circle) Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple 1 eholder) ) dlJ o L- (7,0 d3 4-1 - 1 Phone # 0 . 1 ? T Owner's Address (0 4 01 E , hAin City AA (AilA ( C Pe Lt4 State r Is Building Historically Designated YES Miami Shores Village Building Department 03112107- 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 iNALAAD Tel: (305) 795.2204 Fax: (305) 756.8972 NO Zip Tenant/Lessee Name Phone # 33 ( Job Address (where the work is being done) 5 A City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Contractor's Company Name, Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable). . Phone # Value of Work For this Permit $ 0 ®o Square / Linear Footage Of Work: ( SQ F Type of Work: DAddition DAlteration DNew• [Repair/Replace ❑ Demolition Describe Work: W 1� S Oi -FX.G- ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * *** * * *** * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 1n o� Notary $ 5 Training/Education Fee $ g`l� Technology Fee $ �- Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ � Structural Review. $ Total Fee Now Due $ / � • (, See Reverse side -* CCF $ 4 tP 0 CO /CC MAR 2 I PAID Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 charged. :ftpA d a reinspection fee will be charge 1 Signature Signature , Agent The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of F y , 20 I , by 310) �, i,bj 1 l , day of , 20 , by who is personally known to me or who has produced F(; d uet f Z l� who is personally known to me or who has produced NOTARY PUBLIC: . - p►AZ �P,,,, y�pN►GALISSET� ` _ ;e MY COMMISSION # DD 483995 Sir? -� _ttp„ Sign: ira r�uu.� s B�ttd Print: !"/l�kit ` �. My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) As identification and who did take an oath. 06 3(5 (07 NOTARY PUBLIC: Contractor as identification and who did take an oath. Sign: Print: My Commission Expires: Plans Examiner Engineer Zoning Page 2 of 2 FL0702.0487 CDNC BLACK WALL cHAIAIEINKor WIRE FEAGE WOOD MiCE b- b--o- -o o- IRON FEN E EASEMENT - — f CENTERLINE ■IeBI®I■OA x 0 q PROPERTY LI E EF STRUCTURE WOOD DECK CONCRETE ASPHALT SWIG TILE WATER APPROXIMATE EE OF WA T E R COVERED C.U.E COUNTY MUTT ESIVT. IEEE INGRESS/ME SSESAIT. • • ••• • • • ••• •• •• • • • •• •• • SPECIAL sci 01 4167Fs • • •• • ••- • • • • • • • •• • • • • • • •• • • • • • • • • • • • • • • • • • • • • • • • ••• ••• • • • •• • • • •• ••• •• • • • • • • •• • • •• • • ••• •• • • • SURVEYOR'S NOTES 1. THIS SURVEY HAS A SHA -1 °SECURE HASH MESSAGE DIGESTAUTHEN77CATION CODE WITHIN ITS SIGNATURE FILE: A MANUALLY SIGNED AND SEALED LOG OF THIS SURVEYS SIGNATURE FILE IS MDT ON FILE AT EXACTA LAND SURVEYORS; THEREFORE, IN ACCORDANCE WITH FLORIDA STATUTE 61G17-7.0025, THIS SURVEY IS ELECTRONICALLY S /GAEDAND SEALED ANDCAN BE DEEMED AN ORIGINAL DOCUMENT. 2. ANY ATTEMPT TO CHANGE ANYTHING ON THIS SURVEY WILL RESULT IN A CHANGE IN ITSAUTHENT/C4710N CODE THEREBY REMOVING THE ELECTRONIC SIGNATURE AND VOIDING THE VAUDATYOFTHISSURVEY. 3. THE LEGAL DESCRIPTION USED TO PERFORM THIS SURVEY WAS PROVIDED BY OTHERS. THIS SURVEY DOES NOT DETERMINE OR IMPLY OWNERSHIP. 4. AN EXAMINATION OF TIE ABSTRACT OF TIME WAS NOT MADE BY THE SURVEYOR TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY. 5. BOUNDARY DISTANCES AND D/RECTIONS ARE PLATIEDAND MEASURED UNLESS OTHERWISE MINED. 6. ELEVATIONS AND VERTICAL DATA, IFSHOWN, REFER TO NGVD 1929, UNLESS 07HERWSE NOTED 7. TM S S UR VE Y ONLY S HO W S IMPROVEMENT S FOUND A B O V E G R O UND. UNDERGROUND U TILI T I ES, F0077NGS AND ENCROACHMENTS ARE NOT LOCATED ON THIS SURVEY MAP. 8. IFA SEPTIC TANK OR DRAINAGEFIELD LSSHOWN ON THIS SURVEY, THELOCATION WAS SHOWN TO US BY OTHERS. 9. FENCE OWNERSHIP IS NOT DETERMINED, APPARENT CLEARANCES AND / OR m CROACHMEN SARENOTED BY VISUAL MEANS ONLY. 10. NO IDENTIFICATION CAPS FOUND ON RECOVERED MONUMENTS UNLESS OTHERWISE NOTED. 11. THIS SURVEY LS E72LUSIVELYFOR THE USE OF7HEPARTIES TO WHOM IT IS CERTIFIED. 12. ADDITIONS OR DELETIONS TO SURVEY MAP SAND / OR NOTES' ARE PROHIBITED. 7HIS SURVEY 15 ONLY VALID WIN ALL OF THE PAGES CONTAINED HEREIN. 13. IF THIS SURVEY WAS RECEIVED ELECTRONICALLY, MIS SURVEY MAP LS NOT VALID WITHOUTA SIGNATURE AND AN AUTHEN17C4TED INK SEAL OFA FLORIDA REGISTERED PROFESSIONAL LICENSED SURVEYOR AND MAPPER, AND IT LS ONLY VALID IF ITS SHA -1 HASH MATCHES THEAUTHENT7CA770N CODE ON BLEAT EXACTA LAND SURVEYORS. 14. IF THIS SURVEY WAS RECEIVED BY MAIL, THIS SURVEY IS NOT VALID WIMOUTA SIGNATURE AND RAISED sac OFA FLORIDA REGISTERED PROFESSIONAL UCEN.SED SURVEYOR AND MAPPER. 15. BASIS OFBEAR/NGS ARE ASSUMED•OR BASED ON THE UNE MARKED AS B.R. OR AS 077IERW5ESPECIFIED 16. DIMENSIONS ARE IN FEET AND DECIMALS THEREOF. 17. EXACTA LAND SURVEYORS (SNOT REGISTERED WI771 FFMA TO PROVIDE ROOD CERTIFICATES THEFEMA FLOOD ZONE DATA ON 77I5 SURVEYS FOR INFORMATIONAL PURPOSES ONLY. PRINTING PROCEDURES 'BECAUSE THIS RLE HAS BEEN SENT ELECTRONICALLY, IT IS IMPERATIVE THAT THE PR/NTSEI7INGS BE CORRECT IN ORDER TO DEPICT AN ACCURATE REPRESEN7A77ON OF THE DOLUMENT ON PAPER. 1. INSERT LEGAL SIZED PAPER INTO YOUR PRIN7DZ 2. WHILE VIEWING 7HE SURVEY /N THE ADOBE READER, SELECT PRINT UNDER THE FILE TAB. THE FOLLOWING COMMANDS ARE INSIDE THEADOBEREADER PRINT BOX 3. SELECT COLOR PRINTER (IFAVAILABLE.) 4. UNDER PRINT RANGE, SELECT ALL. 5. UNDER PAGE HANDLING, SELECT NUMBER OF COPIES. 6. UNDER PAGE HANLING, SELECT 'NONE •FOR PAGE SCALING. Z UNDER PAGE HANDLING, UNCHECK AUTO ROTATE' AND Ce4TEL 8. UNDER PAGEHANDUNG, CHECK CHOOSE PAPER SOURCE BYPDFSIZE 9. CUCK PRINT. SURVEYOR'S LEGEND POWER POLE CATCIBASIV BENCH MARK pass ELEVATIGV IIIIIIII FOUND NOT FO UD SET CONTROL POINT CONCRETE MONUMBVT TREE P.CC POLNTOFCURVATURE P.P. C. POINT OF REVERSE CURVATLNTE P.O.B. PONT OF P.QC PONT OF COMMINCIGIBIT P.C.P. PER/ANBIITCONTROLPONT AL REI DLEASURED P. PLATTED MEASURMEAIT LAE LASTED A EASEMENT LAZE LA14EorLANISCAP8U4GVT. ESML C BA A R R4 NR TYR LR LP. NA D. P.T. POINT OF P.0 POINT OF CURVATURE PKN4IL DJL PAM PERMAN NTREFEREN EMONFSI6VT ARX aH.L TX GA7V WM ESMT. ENCIE DE LAE CALaSATED TEL REARM REFERIACE W01. ALP. CEVTRALAEa LI.& DELTA E RA0PJSorRAOML SEP RADIAL TTE NON RADML TYPICAL IRONROD RRONPL E NAIL & DISK PAFWER- IGALONNAL DRILL HOLE WELL L�SMMRFREHYDRANT MANHOLE OVERHEAD LINE LI P.P. POW&RPOLE TRANSFORMER CABLE W. RISER WATER MEIER EASEAeff EACROACHMBT U.E DRAINAGE WNW R.OE LANDSCAPE BUFFER EWE LAE D.F ARC SAN DMI SCR GAR ENCL ALTS F.F. T.O.S. E0.W. E0.P. Cua BSL SETT. � RAN TBD EFACIU)IES UTILITY POLE ELECT= UTILITY BOX SEPTIC TAM( DRAW FIELD AR CONDITIONING SIDEWALK DRIVEWAY SCR GARAGE MORSE NOTTOSGALE RNISHED FLOOR TOP OFAWN EDGE OFWATER EDGE OF PAVEMENT LTE VALLEY GUTTER SWIM SETBAGKLWE SURVEY TLELAE CENTER RAW OFWAY UTBJT`LASNW RUOFOVERfLV1G EASEAE7VT LASTEDACCESSEMBIENT Was acknowledged before me this �= day of r O 5. I understand that as an owner- builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial Initial 6. I understand that if I compensate any person or company for work p rformed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for : wrong doing from this unlicensed company or person. \►, Initial 7. I understand that if any person gets injured on my construction project— ` ey are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. 8. I understand that under state and local laws I' can not do any E - ctrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. ,20 C B y ° L--,c e3 e3 0 ' � 7 1— � Who was personally known to me or who has Produced there License or F7, ": WO,/� L c& r as identification. VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: ] LU tJO l_1 fSOijAt -1 DATE: 2 2 I rJ ADDRESS: 1 0401 tkiE 2 A\( Kk 1 A ( S kPLE-S Fi 3 Do hereby petition the Village of Miami Shores to act as my own contradtor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and • provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this cons ction Initial 2. I understand that as an owner - builder I must abide by all zoning ordi antes and building regulations in effect at the time of permit application Initial 3. :I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code —. only if the structure meets the minimum code. Initial PREPARED BY: DECLARATION OF USE KNOW ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned 4 k P b ® 11 k is /are the fee simple owner(s) of the following described property ( "Property") situated and being in Miami Shores Village, Florida: Lot(s) Block of (Subdivision), according to the plat thereof, as recorded in the Plat Book Page of the Public Records of Miami -Dade County, Florida, (address) and WHEREAS, the undersigned owner(s) have sought certain development approval from Miami Shores and are providing this document in consideration thereof and to induce the Village to grant same: NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which is acknowledged, the undersigned do(es) hereby declare and agree: 1. That the Property will not be used in violation of any ordinance of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. 2. That the property will be used for a single family residence only. 3. That he /she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant concerning the use, enjoyment and title to the above Property and shall constitute a covenant running with the land and shall be binding upon the undersigned, his /her successors and assigns and may only be released by Miami Shores Village, or its successors, in accordance with the codes, rules and regulations of said Village then in effect. IN WITNESS WHEREOF, the undersigned has /have caused on this day of , 200_ WITNESS(ES) OW hand(s) and seal(s) to be affixed hereto Signature and Print Sign d Print U 4 L. P 1 r� Signature Signature and Print and Print STATE OF FLORIDA COUNTY OF MIAMI -DADE ) I HEREBY CERTIFY that on this day personally a p red before me r (MO L/t *IV who is personally known to me or has produced PT . t ✓fJ L 1( Tfir0 (type of identification) as identification and he /she acknowledge that he /she executed the foregoing, freely and voluntarily, for purposes therein expressed. SWORN TO AND SUBSCRIBED before me on this 2. C day of My commission expires: r , 200 STATE OF FLORIDA) COUNTY OF DADE) Property Owner Signature 56e d ` illoie Rolf Vefrit(me e 10050 NE 2 Ave Miami Shores, Fl 33138 Phone 305 - 795 -2204; Fax 305-756-8972 www.miamishoresvillage.com AFFIDAVIT The undersigned Affiant, ! , 6J 0 L. t fl U A fl , does hereby attest that (property owner) The attached survey, performed by `X AC.r f�- iname of surveyor's company) for address: (040\ J L.. /p A V Lk 1 1 kiO S t 3 7133 performed on Z ( 'moo ( (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. er, Affiant sayeth naught. - (4) r J o L-1 - A-I I Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of Affiant is personally known to me, produced T7 Oyt 414/'3 as identification. Ili 6'lt•1Xr�iu11�AJVI��tlFt `. t�' - - ' < EXPIRES•Oct N;jtittV. BondedThruN COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, 50,) !,)'O L (BO. &) A 17 ( , hereinafter referred to as the Owner of the (owner) following described property: Legal description/folioff: Lot Block Subdivision Tax Folio R: requests permission to install: SIGNED. SEALED AND DELIVERED in the presence of: Thia,nL SIior 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (3051 ..75,6- 8972 M MY COMMISSION # DD483995 EXPIRES: October20, 2009 Bonded Tfw Notary PubkUnderwriters Nr�tvL 7 f� PPR 0 ( [ halt, concrete, brick pavers [ ] Landscaping [ ] Other within the public road right of way of ( 0 O ( NE. 6 .4-0 . C A-c ( S LS Ft 33 13Y (address) 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 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 obligation 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). , SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this day of / e6 Page 1 of 2 FLO702.0487 Boundary Survey PROPERTY ADDRESS: 10401 NE 6 AVENUE MIAMI: SHORES, FLORIDA 33138 LEGAL DESCRIPTION: •• • . • .• • Lot 21, CORRECTED PLAT GOLF VIEW ESTATES, accejdti tg tie , • plat thereof, as recorded in Plat Book 41, Page 51 of they Public, • • Records of MIAMI -DADE County, FLORIDA. Ma, Community Number 120652 Panel: 0093 Suffbc J Index Date: 7/17/1995F.I.R.M. Date: Flood Zone X Field Work 2 /17 /2007Completed: 2/20/2007 Revision History: (rev.1 2/22/2007) (rev.0 2/20/2007) ate Created 2.99 /9007 • • ... • • .. .. • • • • . • • • • • ... • • • • • • • • • ... • • . SURVEY # FL0702.0487 03/02/94 • • • .. • . • . •.• • • • • • .. • • • • • • • • • . • .• • ... •0• • ¢ERTIFIED TO: For Surveyors Notes and Legend, see page 2 9200 S. DADELAND BLVD., I Air, BRUNO LIBONATTI; SELF 'PAY; ; ; . FND. IP 1/2 ONING DEPT - , lI STATE NE 105 • FND. IP 1/2 S t a t e o f R o n d a P I I ., end Maxtor LkaenseNa8527 POINTS OF INTEREST NO POINTS OF INTEREST WERE OBSERVED AT THE TMEOFTH/BSURVEY. T f /E R E A R E FENCES NEAR THE BOUNDARY OF THIS PROPERTY, FENCE OVVNERSHP WAS NOT DETERMINED. iam S .'res Villa 16,10' LOT22 LOT21 390 °00'OONV 150.00' 152.98' (M) NE 105TH STREET GRAPHIC SCALE (In Feet) 1 inch = 30' ft. 02 -0487 LOCATION MAP NTS MI FEB 2 6 2007 JJ BY:D5..1 n. MC N.A O•111/!M.