49367Date
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant
No as to a9; ,
My Commission Expires:
State # FC00,0 1058
Architect/Engineer Address
Bonding Company Address
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and
construction : ; r oning. Furthermore, I audio ' the abpve-
, er an. • Con.
d+ President
FEES: PERMIT ' e 7 RADON
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address CO? 4/, ,, ? S e Tax Folio
fl Yht �GI1(�
6 7 ;ev4 j -)erl C Y\ Chu1G1'astkPermit# t g
Plumbing
t
ork stated.
tore of Contra or or
002
otary : (to Con ' tor or
My Commission Expires
Building Electrical
Phone �rr 5
C Address 3 V V- E ( O st
SS # / 4Phone30 — 737/
Municipal # Competency # Ins. Co. l a( Y C 1
Mortgagor Address
Permit Type (circle one): BUILDIN ► ELECTRICAL P i INC MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
4-
Square Ft. Estimated Cost (value) /,, ®,06 c d2 c2
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
Si
er an
C.)
I
,, ,
do the
all
►'
2/
er Buil r • / Date /
,
rk will be done in compliance with all applicable laws regulating
er- Builder te
�� P ie GELA M` 4�«s wy
t
2 �^ ,T ooM nassiora r.;u2E;a
ice. <c CC7d5SW?
.3l 4., Fl �4'. MY CEIN {IS49ON rr' R s •
C.C.F. NOTARYS >C • BOND
TOTAL DUE 3 R.,•476
ate
Structural Engineer
KNOW ALL MEN BY THESE PRESENTS:
KE 19570 P6. 4376
CERTIFICATIONS AND DECLARATIONS
OF RESTRICTIVE COVENANT
WHEREAS, Miami Shores Presbyterian Church, a Florida non -profit corporation (the "Owner" or
"Declarant") is the owner of the following described property (the "Property") situated and being in Miami
Shores Village, Florida:
Lots 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10, Block 61 and the 15 -foot alley
Running east and west through said Block 61, Miami Shores, Section 2,
According to the Plat thereof, recorded in Plat Book 10 at page 37 of the
Public Records of Miami -Dade County, Florida, and
WHEREAS, the Owner, together with Omnipoint Holdings, Inc. a Delaware corporation (hereinafter
"Applicant") with the consent of the Owner, has applied to Miami Shores Village, a Florida municipal
corporation ("the Village ") for a wireless personal telecommunications services antenna permit, pursuant to
Chapter 22 of the Miami Shores Village Code, and otherwise; and
WHEREAS, the Owner and Applicant desire to provide certain assurances and certifications to the Village;
NOW, THEREFORE, the Owner and Applicant each jointly declare and certify as follows:
1. Title. Owner and Applicant have provided evidence as to the status of title to the Property to the
Village.
2. Continuous Compliance. The Owner and Applicant hereby covenant and certify that the wireless
personal telecommunications services antenna proposed for the Property will be made continually
compliant with all present and future promulgated by governmental authorities having jurisdiction
over the Applicant and the operations of the antenna facility, or similar safety standards for other
wireless communications media transmissions. The Owner and Applicant hereby acknowledge the
right of the Village to require immediate removal of any wireless personal telecommunications
services antenna upon the Property which does not meet such safety rules and regulations.
3. Non - Interference. The Owner and Applicant also covenant and certify that any wireless personal
telecommunications services antennas proposed for the Property will not interfere with public safety
communications, and further, will not unreasonably interfere with the reception or transmission of
television, radio, microwave, telephone, digital or similar communications signals or receipt of
signals of nearby residential or business residents. The Owner and Applicant acknowledge the right
of the Village to require, if necessary, frequency relocation agreements.
4. Multiple Accommodations. The Owner and Applicant covenant and certify that the design,
structure or installation of the wireless personal telecommunications services antenna facility
proposed for the Property will be such as to accommodate at least two wireless personal
telecommunications services antenna facilities of other providers, on a non - discriminatory basis, after
applicant's installation, in the manner depicted on Exhibit "A" which is attached hereto and made a
part hereof, to avoid duplication of the erection of wireless personal telecommunications services
antenna towers throughout the Village. Applicant and Owner undertake no obligations hereby to
assure utilization of the structure by other service providers and Applicant and Owner expressly
disclaim any right of power to control or dictate any other service providers' choice or design of
REC 195'79 PG. 4377
proposed facilities for this structure. The Applicant will not oppose and Owner covenants and
certifies that it will permit co -use of the wireless personal telecommunications services antenna
structure upon the Property by at least two wireless personal telecommunications services providers,
in addition to Applicant, on a non - discriminatory basis. Owner and Applicant acknowledge and
agree that unreasonable refusal to permit co -use shall constitute a violation of Section 22-42 of Miami
Shores Village Code and may result in the Village revoking any wireless personal
telecommunications services antenna tower approval and seeking a mandatory injunction to compel
removal of any wireless personal telecommunications services antenna, in addition to all other
remedies available to the Village for violations of its code of ordinances, and any other remedy
available under the law.
5. Attorney's Fees. The Owner and Applicant hereby covenant and certify that the prevailing party
shall be entitled to recover its reasonable costs and attorney's fees in the event any litigation is
brought to enforce the provisions of this Declaration and Certification.
6. Binding on Successors. The Owner and Applicant covenant and certify that this Declaration and
Certification shall be binding upon the Owner, the Applicant, and each and all of their respective
successors and assigns and that they shall faithfully observe and perform hereunder, for so long as
Applicant operated its antenna facility on the Property.
IT WITNESS WHEREOF, the undersigned have caused this instrument to be executed and delivered
on this Z le day of N i n a. , yi , 2001.
WIFIESSES:
J `
OWNER
MIAMI SHORES PRESBYTERIAN CHURCH
BY: /✓ GUf'rn -w
as BUSINESS MANAGER
4,e4.../(ATTEST)
Clerk of Session
.s
'al 19570 PG. 4378
STATE OF FLORIDA
COUNTY OF MIAMI -DADE)
The fo egoing instrument was sworn to and subscribed before age this Z day of January 2001 by
(1\1))d Q \N 7 as Business Manager and E/ jzt.17� - J4 a c.1i as Clerk of
Session ofiami Shores Presbyterian Church, on behalf of the corporation for the purposes therein expressed.
T mtlrre nersona11 known tom ) or have produced and
as identification and did take an oath.
DEBRA J. McCLUNE
MY COMMISSION * CC 830214
EXPIRES: Apr 28, 2003
Fla Rotary Service 13, Bonding Co.
My commission expires:
COUNTY OF MIAMI-DADE)
STATE OF FLORIDA
APPROVED:
ss:
for Miami Shores Village this day of
BY:
NOTARY PUBLIC
APPLICANT:
OMNIPOINT HOLDINGS
A Ton nn
BY: D MK. A4 c,�r'�
As J
TacrlN tc.,40._ D ( Re�
id
e foregoing instrument was sworn to and subscribed before me this day of,Tanuary 2001
by a,t, ' / L)f t711) Og ,as Developer of OMNIPOINT HOLDINGS, a Delaware Corporation, on behalf
of the $ . . . tion for the purposes therein expressed. They are personally known to or have
produced and as identification and did
take an oath.
�. r f k 0-e-
Teresa Blackwell
MY N # CC965/60
E!(P6tES
Septembers, 2004
i y Q' so menfloY FAIN Risumeat e4c
y commission expires:
NOTARY PUBLIC
BUILDING OFFICIAL
RECORDED IN OFFICIAL RECORDS BOO<
OF DACE COLN7Y, FLORIDA.
RECORD VERIFIED
HARVEY RUVIN
CLERK CIacurr ccIurT
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHARGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING •
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY 4..
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 004
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECT ION
WATER SUPPLY TO:
AIR CONDITIONERS
.
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
•
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SW I W I NG POOL
OUTLETS COM,IERC I AL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
GRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
.
W. FT.
C ATCH
r r)l � p (-49 Y1 Cif$
BASIN
j
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
PERMIT NO. .
ADDRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT'
SECTION
BY
DATE
ZONING
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
" PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Subjad to cornpflanei with att Federal, State.
Cotx%ty. VIttage Miss and regctfattc;ts. Yitlage assumes
no re:panstb11(1y for accvrtcy oflar rents from
those flans.
2. Thls copy at plans most be a.Yatlabte on
buftding site cc no Inspection wtft ba c3ndccted,
JOB ADDRESS
• CRITIQUE SHEET
aa ivel4 s�
APPLICANT
PHONE #
APPUCA'fION 4-
SHEET OF
MISCELLANEOUS
DATE COMMENTS
INITIALS
• NOTICE OF COMMENCEMENT
'A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Le . al description of property and street address:
2. Description of improvement:
3. Owner(s) name and address:
0'0 a 4) , E,
Interest in property:
Name and address of fee simple titleholder:
4. Co tractor's name and address:
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as irovided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different d e is specified)
Signature � l a" /�
�"�� �'° �� )
Sworn to and subscribed before me this q/ day of J
DEBRA J. McCLUNE
MY COMMISSION # CC 830214
EXPIRES: Apr 26, 2003
1-800-3-NOTARY Fla Notary Service & Baring Co.
re a e
Owner
Print Owners Name
Print Notary's Name .,S P. J Al `rCAA e.
.Notary Public
• 4 ^
E
;49" Z.00
STATE OF FLORIDA, COUNTY OF DACE
I HEREBY CERTIFY that this is a ti
(cowrie d in th office on
P day of
, AD 20
WITNESS y hand end Official Seal. .
HARVEY RUjVIf�LER .. of cir� ! a ^ unty Courts
D.C.
By
a 1R3 15.220 2001 .JUL 17 10 :43
.5o n55
Address: i 6 /(0 /i , . `GOSH
Iva iG�1 vn n FL„ •3))
ACCOUNT
PAYMENT
(Q
BAL. DUE
DATE
RECEIVED FROM
QFOR RENT
FOR
O CASH
F
Q CHECK
n MONEY
ORDER ..
No. 155755
s( 0-
DOLLARS
7680A200 O'Wi0 /OlTOTL 60.0(
1182