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DS-10-1661Tenant/Lessee Name Email BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING Queer's N_aane (Fee Simple Titleholder) e v . � : : 1i✓'t� I' h�ane # Owner' ddress i A9_ 53 9 rl City±` �C^.► ( 3' Ct Phone # i r Job Address (where the work is being done) . City Miami Shores Village County : Miami -Dade Zip FOLIO `1 PARCEL # t 3 - of �- 0! s' S—O Is Building Historically Designated YES NO Value of 'Work For this Permit $; C)0 Type of Work: QAdtlition aeration Describe Work: ; ri t',s b1(b * * * * *:* * * * * ****.* Subml:ttal Fee $ Master Permit No. Contractor's Company ame { t .� 3 Y ' r: Phone # Contractor's Address City Zip Qualifier Name Phone # State Certificate or Registration No Certificate • ompeteney No Contact Phone E-mail • Arcbitect/Engiaeer's Narne (if applicable) Phone / Linear Footage OfWork; New - 0 ".Repair/Rep1are 0 Demolition 'V Permit No. `J 1 0 40(0 `" 0(0 Flood :Zone, Technology Fee $ See Reverse side 4 Notary $ Training Education Fee Miami Shores Village Building Department 10050 N.E.2nd'Avenue, Miai ni Shores, Florida 33138 ..: Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER; (305) 7624949 * ****** ** * * ** **F * * * * * * * * * * * * ** * * ** * *** * * * * * * * *n• * * * * * * ** * ** a.. :, - Permit Fee. $ CCP' $ CO /CC. -$ Scanning $ " Rasa ,n $ DPBIt. S - `. Bond :$ Double Fee $ :./4i Violation dates Structural Review..: $ Total Fee Now Due $ 3)0' 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 Signature' Sign: Print: e p, . `� " Notary Public - State of Florida My Comm. Expires Aug 20, 2013 Commission # 00 918432 ARMS Bonded Through National Notary Assn. My Commission Ex * * * * **,4 * * * * * * * . (Revised 0711D107)(Revised 06110/2009) * 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..... O'WNER'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 Owner or Agent Contractor 'The foregoing instrument was ackno led4ed beforp m (3 The foregoing instrument was acknowledged before me this o is personally known me or who has produced As. identification and who did take in oath, NOTARY PUBLIC/ APPROVED 13Y * • ea Clerk checked Plans Examiner Engineer who is personally known to me or who has produced as identification and who did take an oath, NOTARY PUBLIC/ Sign: Print; My Commission Expires: 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: �' y, �f� i�� , T ®raL) -5 DATE: /7 `6 ADDRESS: 278 /1e: s2'( 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; 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 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. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial /Y 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial /ID 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial "f 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. 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 I built or substantially improved it for sale or lease, which violates the exemption. .41 /7 Initial Initial /V/9 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. Initial /3) 2 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 / 2J 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct 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 compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial_,. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by 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. / Yr, Was acknowledged before me this ) 1 day of Produced there License or OWNER who was personally known to me or who has s identification. NOTARY Initial i 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 /index.html Initial ,/ %� 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that 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 not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be 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 returned 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. - APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: a f NA' Existing System °'' [ ] Holding Tank [ ] Innovative [ ] Abandonment [ ] Temporary n ickyz p c , MAILING ADDRESS: J7 C ` ET 9 �4 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. AGENT: PROPERTY INFORMATION p f LOT: Q BLOCK: 14 SUBDIVISION: � e 4- 0 PROPERTY ID #: --6 ZONING: PROPERTY SIZEr Z a ACRES WATER SUPPLY: [b IVATE IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / PROPERTY ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT [RESIDENTIAL " { No. of Building Commercial /Institutional System Design Bedrooms Area Soft Table 1, Chapter 64E -6, FAC [ ] Floor /Equipment Drains [ ] O + th SIGNATURE: 74 L. A DH 4015, 10/97 — Page 1 (Previous Editions May Be Used) Stock 'Number: 5744 - 001 - 401_5=f , } PERMIT NO, DATE PAID: FEE PAID: RECEIPT #: \3- Q132Ack TELEPHONE: � C d A PLATTED • I/M OR„B VALENT: [ Y / N PUBL1IC'_[' ]<= 2000GPD [ ] >2000GPD DISTANCE TO SEWER: FT [ ] COMMERCIAL (Specify) \ DAT : y — ���!!� Page 1 or 4 I a>� APPLICATION FOR: APPLICANT: AGENT: TELEPHONE: MAILING ADDRESS: LOT, BLOCK, SUBDIVISION: DATE OF SUBDIVISION: PROPERTY ID#: ZONING: PROPERTY SIZE: WATER SUPPLY: SEWER AVAILABILITY: PROPERTY ADDRESS: DIRECTIONS: BUILDING INFORMATION: TYPE ESTABLISHMENT: NO. BEDROOMS: BUILDING AREA: BUSINESS ACTIVITY: FIXTURES: SIGNATURE / DATE: Check type of permit, if "Other" specify type in blank. Property owner's full name. Property owner's legally authorized representative. Telephone number for applicant or agent. P.O. box or street, city, state and zip code mailing address for applicant or agent. Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot legal description or deed must be attached. Official date of subdivision recorded in county plat books (month/day/year) or date lot originally recorded. Dividing an approved lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot. 27 character number for property. CHD may require property appraiser ID # or section/township/range/parcel number. Specify zoning and whether or not property is in I/M zoning or equivalent usage. Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and prepared road beds within public rights-of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. Contiguous unpaved and non-compacted road rights-of-way and easements with no subsurface obstructions may be included in calculating lot area. Check private or public <= 2000 gallons per day or public > 2000 gallons per day. Is sewer available as per 381.0065, Florida Statutes, and distance to sewer in feet. Street address for property. For lots without an assigned street address, indicate street or road and locale in county. Provide detailed instructions to lot or attach an area map showing lot location. Check residential or commercial. List type of establishment from Table II, Chapter 64E-6, FAC. Examples: single family, single wide mobile home, restaurant, doctor's office. Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully screened patios or decks. Based on outside measurements for each story of structure. For commercial/institutional applications only. List number of employees, shifts, and hours of operation, or other information required by Table II, Chapter 64E-6, FAC. Mark Floor/Equipment Drains or Others and specify item or "NA" if not applicable. Signature of applicant or agent. Date application submitted to the CHD with appropriate fees and attachments. ATTACHMENTS:‘ . A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wellsArainage features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any public well within 200 feet of lot. For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other features necessary to determine composition and quantity of wastewater. NAME: Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWN = UILDER DISCLOSURE STATEMENT Please read and initial each paragraph. DATE: 13-i6 ADDRESS: _lac( ci< E 91 Sf 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; 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 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. 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 responsible for the 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 I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on 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 also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. 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 I built or substantially improved it for sale or lease, which violates the exemption. Initial 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. By 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. 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct 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 compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by 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 at850.487.1395 or htt .: / /www.m oridalicense com /db r /.ro /cilbriindex.html 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proed construction activity at the following address: Azclg A3E 9 S 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information tJ t I have provided on this disclosure. ��`'(/ Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be 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 returned 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. 1' ■ Was acknowledged before me this ( 3 day of = u`; 20 1 ( t&Swho NOTARY Initial r who has Produced there License or as identification. Initial )--f ,J Initial__ ��,,,,,,,� MARIA DE BRUZOS • t►�`Y P �e4 '• . Notary public - State of Florida '° � c 4 My Comm. Expires Aug 20, 2013 Y^ Commission # DD 918432 h Nationar Notary Assn. �� ° Bondea Through mi ELKIN DIAZ, PE, MBA PROFESSIONAL ENGINEERING SINCE 1996 September 16, 2010 Building Official Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FI 33138 Reference: Engineering Certification Letter Property Address: 1298 NE 97th Street, Miami Shores, Fi•Y38 • • • • • •• • • ••• • • • To Whom It May Concern, This letter certifies the construction of a stamped concrete Street, Miami Shores, FI 33138 during the month of August 201 Attached to this letter, please find the following docum driveway was built per City requirements: EEP 1 7 2MI • a) A picture of the forms utilized to confirm the depth of the concrete (4" thick for onsite work and 6" thick for driveway apron, b) The ready mix concrete tickets #147424 and #147427 (dated 8/7/2010) from quick - crete ready mix to confirm the use of 3000 psi concrete with fiber mesh, and c) The survey of the property showing the layout of the constructed concrete driveway. Please consider the attached documentation to provide an after the fact permit to the homeowner, who performed the work at the above - referenced address. If additional information is required, please contact me at the email address shown below. Miami Shores Village Best rega 1 Elkin 7iaz. PE, MBA Florid a Registered Engineer Lic. No. PE 63825 APPROVED ZONING DEPT BLDG DEPT 4620 NW 1 00 WAY, CORAL SPRINGS, FLORIDA 33076; ELKINDIAZ @AOL.COM BY DATE SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS • •• • .... • • • • P.O. 4 Tuck # 30 en 3 OP �1 2,p_p_____,L.7:71-0 3 0 c*, READY MIX CONCRETE a PUMP SERVICE e Sales Person PUMP N11?. � i~ *..1.1.13 .- PUE`.: h Date: IF T BECOMES NECESSARY TC BRING ANY ACTION TO COLLECT AMOUNT`: DUE C£V Tri REASONABLE ATTORNEYS FEES AND COURT COTS INCURRED SY VENDOR IN SECURNG PER MCNTH ON (),I BALANCES. IF THIS INVOICE IS NOT LAID WITHIN 3O DAYS BUYER ASSOCIATED WITH THE FILING OF LIENS. BIT OR HIS AGENT AGREE Tic' (1) ON FOB SLYER ?S3UMES P.LL RELATED LIABILITY (2) BUYER ASSUMES RESPONSIBILITY FOR THE Fa T NE i PUC!t MAKING DELIVERY BEYOND CURB LINE AND :3) A .L CLAIMS MUST BE MADE A1' 9160 NM, Vth Avant Medley, Florida 331 Phone: (305) 887 -32 • • • • •••• • .• • • • • • • • • • • •. • AMOUNT DAY DELIVER • •• • • • •••• • • • ..• • •. .• • •••• SLUMP THIS DE;UVt~W°�r TOTAL Cl1YDS. TAX t " ` -�. OF YOUR ORDER FOR . CU YDS. TOTAL 7.USToVER IS AGENT ASSUMES FULL RESPONSIBILITY FOR 81 RENGTH ANDIOR PERFORMANCE OF ANY CC PLACED ABO DESGN SLUMP OP WIIEN WATER IS ADDED. WATER ADDED: rJ YES G NO 3L5 • • • • • PURCHASER SHALL BE RESPONSIBLE ECT1ONS.INTEREST SMALL ACCRUE AT 1 11 PAY ALL PROCESSING FEES AND Cc TWAT THE TRUCK 1S NOT OVERWEIGHT E AND FOR ANY DAMAGE RESULTING Fl DELIVERY. • • • • 5"A 1 \ '' RAY UDF1 GOLF Sofa T Delivery Address: r 1298 N 97 ST P.Q. * Truck # Quail 1 10. 1 .0 1 :1 . i 0 PM EN V1 !IF 113 READY MIX CONCRETE • PUMP SERVICE • SIX DAY DELIVER Sales y� Pen 4 81712010 3000 PUMP ENV .FEE - FUELCH ;RACE FIBER $ • • • • • • • • • 8150 N.W. 87th Aveni, Medley, Florida 331 Phone: (305) 887321 • • • • • • • • •••• • •• • • • ••. • • • • • • • • • • • • • • • •• • • •••• • ••• • • • •• •• • • • •. • • • ▪ • • ,....,� . AMOUNT SLUMP THIS DELIVERY TOTAL DU YDS. TAX ( Z 1 OF YOUR ORDER FOR L + ms. TOTAL f C,USTOMER O IS AGENT ASSUMES FULL RESPONSIBILITY FOR STRENGTH ANDiOR F0 IM AI CE OF ANYQOCRETE PLACED ABOVE-DESIGN SLUMP OR WHEN WATER IS ADDED. WATER AXED: YES 0 NO . ) GLS IF r BECOMES NECESSARY TO BRING ANY ACTION ION TO C0_LECT AMOUNTS DUE ON THIS INVOICE PURCHASER SHALL BE RESPONSIBLE NSIBLE REASOMABLE ATTORNEYS FEES ANC COURT COSTS INCURRED BY vENDCFI IN SECURING COLLECTIONS. INTERFST SHALL ACCRUE AT 1 PER M0N" H ON CM BALANCES. IF 111IS INVOICE IS F4OT PAID WITHIN 30 DAYS sags) ALL PAY ALL PROCESSING FEES AND CO ASSOCIATED WITH THE FILING OF LIENS. BUYER OR HIS AGENT AGREE THAT (1) ON FOS 0 T THE TRUCK IS NOT OVERWEIGHT BUYER ASSUMES All RELATED LIABILITY (2) BUYER ASSUMES RESPONSIBILITY FOP THE (`I - E AND FOR ANY DAMAGE RESULTING FF THE TRUCK MAKING DELIVERY BEYOND CURB LINE AND (3; ALL CLAIMS MUST BE MAX AT s DELIVERY. C c' r 3 X 040 SKETCH OF SURVEY SCALE r - 20, co 75,04)itibtEA ACCORDING TO THE NATIONAL FLOOD INSURANCE PROGRAM I COMMUNITY Na THE SUBJECT PROPERTY FALLS IN FLOOD ZONE' 4f„(jlp,f 7 Z .N1 pol.6 15 Aar 9' ©A6pHALr 7 5 . 00 � �) e .M6 PANEL No.' 030 SUFFIX' DATE OF FIRM» aitt • • • C. •••• • •••• • • • • • •••• • •••• • •• • •• • • • • •• •• •• •••• • • • • • • • • • •••• • • • • •••• • • ▪ • N. T J bJ. 6o • FIRM ZONE» 09- //4009 'A &' Lo?" t 1 PNIP • • BASED FLOOD ELEV.' • • ( 4 LOCATION MAP 04.T.S.) NI E. orgear ea- PROPERTY ADDRESS: 1298 NE 97 Street Miami Shores, Florida 33138. • • • • • • FOR: MICHAEL W. DOWNS & ANTONIE B. DOWNS. L kaq • • • • • • • • • •••• • • •••• • • • •••• • • •••• • •• • • • •••• • • • • ••• • •• • • LEGAL DESCRIPTION: Lot 12, Block 4, "EARLETON SHORES ", ac ▪ • to t gat • thereof, as recorded in Plat Book 43, at Page 80, of the Public Records of M14411-1:ade Cpipwly, • Florida. • • • • • • • • • • • • • Ors NOT 1) This survey was conducted far the purpose of a 'Boundary Survey' ally and is not intended to delineate the regulatory jurisdiction of any federal, state. regional or local agency, board, commission or other entity 2) The accuracy obtained by m•asunsments and calculations an this survey. meets and exceeds the Minimum Technical Standards requirements for a Suburban area (1 foot In 7,500 feet) as specified in Charter 61017 -6, Florida Adnidstatlw Code. lids Survey does not reflect or determine osnerahtp. 4) Legal �descrip d was presided by the client and is subject to any limitations, restrictions reservations or of recor 5) Exwrntrmtton of the Abstract of TNIe ell have to be made to determine recorded instruments. if any affecting the prapert$ search of Public Records not performed by this office. 6) No effort was made by this office to locate any underground utilities and /ar structuree within or abutting the subject Prlicertit 7) y has been prepared for the osdush+e use of the entities named hereon only and the certiRwUam hereon do not extend to any unnamed parties. 8) This survey was prepared far a Mortgage Transaction only, Not to be used for design and /ar construction purposes without the consent of this office. 9) Utility facilities within Utility Easements not noted as violations. 10) Driveways or portions thereof within Roadways not noted as violations or encroachments. 11) Foundation and /or footings underneath the ground surface that may cross beyond the boundary lines of the herein descried parcel are not shown. i 1 All iron Pipes or Re—Bad farad and shown on the sketch of survey have no caps unless otherwise stated. 1 Fence a ended determine by visual means only (if any)S Legal a nesidp not determined. 1 No scorch of records was made by this tlrtn beside the record plat; therefore we do not knply or accept responsibility for any Easement, Dedication or Limitation for which Information was not furnished. 15) Contact the appropriate authorities prior to any design work on the herons— described parcel for Building and Zoning information. 16) Professional Land Surveyor and Mapper 1n responsible charges Rolando Ortiz LS 4312, State of Florida 17) This survey Is not valid without the signature and the raised seal of a Florida Licensed Land Surveyor and Mapper. 1 ho certify to the above nand firm and /or persons that the Sketch of Survey of the described property is true and correct to the k howledge and belief, as recently surveyed and platted under my direction also that meets the Niobium Teclmical Standards est in Florida Administrative Code, pursuant to Section 472.027 Florida Statutes. (() WO F.LP. M FAD C/6 CL W R 9 OF WAY RC. ENCROACH WARRED CU; CHART UW FENCE MIOO 11 . D FENCE cora CCMCRETE Cp. =CRETE POLE F1RE maw W�P�M MAN t WP. WATER POE HD ER LP. LOTT POLE A STUCCO P.CP. PERMANENT C0NTROL CA1 71PIC11L P.C. P.0 uE TULE RECORD CALCULATED FOUND RCN PIPE FCUND FIE-BARD F O DRIU. p CENTER E CONCRETE BI�OgC TER LW MONUMENTU E CLEA R LNE PORT OF N1ElRECR0 4 PCOTT PONT OF COMMENCE U pRAg1 S EA YAN7ENAMCE�EASEMENT VI/ best of my Chapter 81017 -6, PF PAF13l pp��//r� F H.a. LAPD 81.EMEMI - LAND PLWING RO ®A CERW!CAt1E OF AITSI05ZtII N B 18 4511 9350 5.L 22nd 1ER1d*CE MAK ('5)220 -0073 t 1BZ LS 4312 9R 42 LS 5629 BY- R OR : F6CARD0 PRCVESSIONAL LAND SURVEYOR & MAPPER STATE OF FLORIDA. DATE' .i[IB NUMBER, 08-#- L0 /0 o - 2 9-l0 _J SKETCH NUMBER. DRAWN BYh REVISIONS' BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Buckeye Technologies; 1001 Tillman_Avenue Memphis, TN 38112 SCOPE: MLtMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREZT, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 372 -6339 www.maimidade.gov/bufldineeode - -Tbir NOA is bei`ngissued under tli alsplicablerules and regulations of construction -- -- - -- - -- materials. The documentation submitted has been reviewed by Miami Dade County Product Control Division and accepted by the Board of Rules and Appeals(BORA) to be used in Miami Dade County and other areal Wbere allowed by the Authority Having-Jurisdiction (AHJ). This NOA Tlialt not be valid after the eicpiiation date stated below. The Miami -Dade County Product €entt1- . . Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade Colnty) serve tireright to have this . product or material tested -for quality assurance purposes. If this product' er reateriat faA'tp perform in the accepted manner, the: manufacturer will incur the expense of such testtarrd the AID'ili'ay: immediately revoke, modify, or suspend the use of such. product or material within theif firrts'dfction: Bd1t.A reserves the right to revoke _this acceptance if it is determined by Miami -Dade Co 'Aaoduct Division that this 1? roduct or material fails to meet the requirements of the applicable buy &n code. ; This product is approved as d'escr bed Iterem,`arid has been' designed.td comply the os1a:Buildntg :. :. Code,.. inciudingthe:Hagh_ Velocity Hurricane2one, -. , • • •' • i . : a. ...:. DESCRIPTION: - UitraFrber SOQ Coircrete� Rernforcing ]t iTier : � .. • • • • APPROVAL DOCUMENT: Drawing No 1, titled "UltraFiber 500 Concrete Reinforcing';"ibet"., sheet' f of• 1, dated 11/24/08, ' • • prepared by Buckeye Technologies, Iric, signed and sealed by Thomas A. Kolden, P.E., -. bearing the .Miami Dade County Product Control Approval stamp with the Notice of Acceptance number and approval date by the Miaini-Dade County Product Control Division. MISSILE IMPACT RATING: None LABELING: Each imit/bag shall bear a permanent label with the manufacturer's name or logo, city, state and following statement "Miami-Dade County Product Control Approved ", unless 'otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales; advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA ADVERTISEMENT: The NOA.mimber preceded by the words Miami -Dade County, Florida, and.followed by the expiration date may be displayed in advertising literature: If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA consists of this page 1 and evidence page E -1, as well as approval document mentioned above. The submitted documentation was reviewed by Carlos M. Utrera, P.E. NOA No. 06-0501.12 Expiration Date: January 28, 2014 Approval Date: January 28, 2009 Page 1 • • • Buckeye Technologies, Inc. CALCIILATIONS NOTICE OF ACCEPTANCE: EVIDENCE •SUBM1 BRAGS _._ 1• Drawing No. 1, titled "UltraFiber 500 Concrete Reinforcing Fiber", sheet 1 of 1, dated - 11/24/08; prepared-by-Buckeye Tecimologies, -Inc, signed- and - sealed- by-'Thomas -A. -: Kolden, P.E. . : TESTS • 1• Test report on Concrete Residual Strength per ASTM C1399 of UltraFiber 500 Concrete Reinforcing Fiber; prep -by Stork Twin, City Testing Corporation, T Report No 308195.1 and 308195.2, both dated 10/24/088, signed by Thomas A' ••••• Kolden, P.E. • • . .• • • • •• • • • •••• QUALITY ASSURANCE . L • Miami Dade Budding Code Compliance Office (BCCO). • • • •••• - ••••1. . • • •. ▪ • •• • ▪ -• • • •• ft MATERIAL CER1JnCATIONS L Engineering Evaluation Report and Addendum per ASTM C1399 of Buckeye. UitraFiber 500, prepared by Ardaman & Associates; Inc. dated on 01/10/06 and 01/04/07 respectively signed and sealed by Joseph A. Amon, P.E. STATEMENTS 1. Code conformance letter issued by Stork Twin City Testing Corporation, dated 09/26/08, signed and sealed by Thomas -A. Kolden, P.E. E -1 1 • • • • • • • •. • • •••• Caries M Utrera, P.E. Product Control F mminer NOA No. 06- 0501.12 Expiration Date: January 28, 2014 Approval Date: January 28, 2009 • • •. .. ••■.4 • • •••:•••• • - •• General Notes: Buckeye UltraFiber 500 Buckeye Technologies, Inc. 1001 Ti Memphis, Tennessee 38112 (901) 320 -8100 www ultrafiber500.com 1.0 Description: Buckeye UltraFiber 500 is made from virgin cellulose fibers that have been chemically processed and then treated with a mineral -based chemical that results; in an alkaline- resistant fiber. the fibers are used in normal weight and concrete. The fibers areiused as a concrete admixture to assist in contrlling plastic shrinkage of reinforced concrete and structural plain concrete. The fibers are also used to reduce shrinkage and temperature cracking in structural plain concretelslabs on grade. Structural plain concrete provisions are found in Chapter 22 oif ACI 318 and section 1910 of the FBC. • 2.0 Installation: Buckeye UltraFiber 500 virgin celltlose fibers must be dispersed uniformly through the concrete mixture in accordance with ASTM C1116. The fibers must be blended into the concrete mix at a minimum rate of 1.0 pounds per cubic yard (0.59 kg/m of concrete. The dosage must not exceed 1.5 pounds per cubic yard (0.89 kg/m Buckeye's published installation instructions using either a dispersible bag system or a bulk time metric dispenser must be strictly adhered to, 3.0 Specifications: Buckeye UltraFiber 500 meets or exceeds the following specifications: A. ASTM C1116 — Standard Specification for Fiber Reinforced Concrete. B. ASTM D7357 — Standard Specification for Cellulose Fibers for Fiber Reinforced Concrete. $ 4.0 Evidence Submitted: •• -••. • • • • • • • • •• .• •• •• • • • • •• ••• . • . ■ .•• • • • • • • • • • • • • • • • • •• •• ••• • • • • • • ••• • • • •• ••• •' • ICC Evaluation Services, Inc.•Re Data in Accordance vii ASTM ofFiber Reinforced Concrete fr Paul,' MN. Underwriters Laboratories, Inc. •• • • •.• • • • •• ... • -• • •_ Ing 118.1. •:. • .•• •• • • • •• . Sheet 1 Bltckeyc'Tec`hnologics, Inc. UltraFiber 500 Cotx3rete Rginforcing !Fiber ort ESR -10f2. 1399 Ave gg. Residual Strength • m Stork Twi cities Testing, St. BXQ.It2508 and BXUV.D973 f1 Date: 11/24/08 APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: Michael Downs AGENT: Maria Brusos LOT: 12 SUBDIVISION: PROPERTY ID #: PROPERTY SIZE: 0.81 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT [X] Existing System [ ] Abandonment MAILING ADDRESS: 1298 NE 97 St Miami, FL 33175 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE COW83FtUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUT3S. •1.1•• IS tRV :• APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS • OREATE2 • Olt • PLATTED (MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. •••• • 11- 3205 - 009 -0550 IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y PROPERTY ADDRESS: 1298 NE 97 St Miami, FL 33175 - DIRECTIONS TO PROPERTY. [ ] Holding Tank [ ] Temporary BLOCK: 4 •••• • • •••• PLATTED: 01/01/1951 • • ZONING: I/M OR EQUIVALENT: • • • • ACRES WATER SUPPLY: [ ]PRIVATE [ ]<= 2000GJD • • • DISTANCE TO SEWER!" • 1 '" Y BUILDING INFORMATION: [X] RESIDENTIAL [ ] COMMERCIAL SIGNATURE: Type of Establishment DH 4015, 08/09 (Obsoletes previous Incorporated 64E- 6.001, FAC v 1.0.0 No. of Bedrooms 8 [ ] Floor /Equipment Drains [ ] Other (Specify)p$' editions which may not AP976123 Building Area Ft 800 [ ] Innovative [ ] TELEPHONE: 1(786)306-2665 Served For This Unit 6 be used) EI01273819 APP DOC it AP976123 PERMIT #: 13-SC-1273819 DATE PAID 08/18/2010 FEE PAID: 70.00 RECEIPT #:13 -PID- 145818 • • • • • • ••• • e• [ •Y M •• • • • C!]•JL Y 0GPD • • DATE: 08/18/2010 •••• • • • • FT # Persons Total Design Flow Page 1 of 4 800 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM Additional Notes and Comments: County Notes Fields: County Process #: County Permit #: Storage Box #: Zone: Permit Type: County Status: General Comments: This permit is „granted for Pedro Osp a Engineer II v 1,0.0 AP976123 EID1273819 APP DOC #: AP976123 PERMIT NO. 13-SC- 1273819 DATE PAID: 08/18/2010 FEE PAID: 70.00 RECEIPT #: 13- PID- 1458188 • • 0000 • • .. • • •• • • • • 0600 • •••• •.•• •• •• • • • -• • • • • • • • •• •• • • • •.• • • • • • • nstallation of a concrete driveway only. Does not have any impact on the existing ©STDS. " "• • • • • • • • • • • • • 1 111111111111111111111111111111111111111111111 CFN 2010R0552967 OR BK 27388 Pss 3830 - 38831; (2pas) RECORDED 08/16/2010 12:1424 HARVEY RUVIFie CLERK OF COURTo MIAMI- DACDE COMM FLORIDA M iami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 C ANT Olf C 9 T - I8N 1(VI��F�I�V RIGHT OF WAY Whereas, (owner) � N , r\ a . V 3hereinafter r ferred to as the owner of the following described property (address): 1.9 r 9'7 S 1 Legal Description Lot a Block ( Subdivision /c d /'Qfo , S!r S Folio* I (— 3D 0 09— OS50 Requests permission to install (describe work): �, „ .ka re o fOr% 9r) c:`)(� l Oi ppfoCtOl^e Within the public right of way of (address) l: 9 g f\) q g Si 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. SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this SIGNED, SEALED, AND DE ).\ A COLA, A 2 BOOK 27383 PAGE , 8, �. LAST PAGE 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 Tien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). VERE ► the presence of: !; P , MARIA DE BRUZOS g e 1�4 01 Public - State of Florida • i My Comm. Expires Aug 20, 2013 's". ct: Commission # DD 918432 � #4 v4 t" B onded Through National Notary Assn. day of �4 6��, 201 b (Owner's Signature ) Inspection Number: INSP - 152064 Permit Number: DS -9 -10 -1661 Scheduled Inspection Date: October 12, 2010 Inspector: Bruhn, Norman Owner: DOWNS, MICHAEL Job Address: 1298 NE 97 Street Project: <NONE> Miami Shores, FL 33138 -2560 Contractor: HOME OWNER Building Department Comments October 08, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132050090550 STAMP CONCRETE DRIVEWAY ON THE FRONT OF THE HOUSE Passed �/ 11l Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 151405. 2' flair max at west side. NB Page 18 of 30