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DRIVEWAYInspection Date: 07/03/2006 Inspector: Grande, Claudio Project: <NONE> ........................... ............................ ........................... ................... ................... ................... ................... POP ...:. Owner: DUMAS, YIANNIS & VERONIC Job Address: 1179 98 Street NE Miami Shores Village, FL 33138- Contractor: HOME OWNER Building Department Comments Friday, June 30, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 JUL 0 6 ENT Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Block: Phone Number Parcel Number 1132050180290 Lot: Page 1 of 2 1 Passed 1 j D A P Inspector Comments Failed Correction Needed Re- Inspection Fee ($ No Additional Inspections can be scheduled re- inspection fee is paid . until Inspection Date: 07/03/2006 Inspector: Grande, Claudio Project: <NONE> ........................... ............................ ........................... ................... ................... ................... ................... POP ...:. Owner: DUMAS, YIANNIS & VERONIC Job Address: 1179 98 Street NE Miami Shores Village, FL 33138- Contractor: HOME OWNER Building Department Comments Friday, June 30, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 JUL 0 6 ENT Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Block: Phone Number Parcel Number 1132050180290 Lot: Page 1 of 2 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Issue Date: 6/5/2006 Expires: 11/20/2006 Owner's Name: YIANNIS & VERONIC DUMAS Permit Type: Driveways /Sidewalks /Slabs Work Classification: New Job Address: 1179 98 Street NE Miami Shores Village, FL 33138- Contractor(s) Phone Primary Contractor HOME OWNER Yes Comments: CHANGE TILE OF FRONT STEPS TO COROLINA STONE Additional Information Type of Work: FRONT STEPS Additional Info: Bond Return : Classification: Residential 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. Fees Due Amount CCF $0.60 Education Surcharge $0.20 Notary Fee $5.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.30 Building Department File Copy Applicant Signature Permit Status: APPROVED Permit Number: DS -5 -06 -1397 Phone: Parcel #: 1132050180290 Block: Lot: Section: PB: Total Square Feet: 70 Total Valuation: $ 600.00 Required Inspections Foundation Sidewalk Landscaping Final Invoice Number DS - 6 - 06 - 25068 Total: Amt Due $111.30 Amt Paid M 0 6 P NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. BUILDING PERMIT APPLICATION FBC 2004 Owner's Name (Fee Simple Titleholder) t., Owner's Address 7/7 /1-) 9a' 4 City iY(Ai4/ Sr'D4t 5 State GL Tenant/Lessee Name Architect/Engineer's Name (if applicable) Type of Work: ['Addition ❑Alteration Bond $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel (305) 795.2204 Fax: (305) 756.8972 BY: ,5 7 . • f Is Building Historically Designated YES NO Submittal Fee $ Permit Fee $ 6 OD ' Notary $ ' co Training/Education Fee $ • 2-7 Permit No.b . 12 11 Master Permit No. Permit Type (circle)/Building• Electrica Plumbing Mechanical Roofing Phone # Zip .3.51 Phone # Job Address (where the work is being done) 5 , ;'7_? S `r !, (--'e._ City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Contractor's Company Name (2 //(f .N Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Code Enforcement $ Double Fee $ Phone # Value of Work For this Permit $ 6 0 Square / Linear Footage Of Work: ['New pair/Replace ❑ Demolition Describe Work: C"" d''i/ �' /CJ Q ,47 r� �-; �� S Cc / //�Cr° — 54,t12 ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF $ 0 .(0 0 CO /CC Technology Fee $ Z eD Scanning $ 3 • 00 Radon $ DPBR $ Zoning $ Structural Review. $ Total Fee Now Due $ 1 '� See Reverse side —) 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 a reinspection fee will be charged. Signature \. - %7 _ Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this :74-_ The foregoing instrument was acknowledged before me this day of �l :�� , 20(.,•byU VC`l' - 1"i CC .L Y1C). \day of , 20 , by who is ers nal�'y�cnown to me or who has produced who is personally known to me or who has produced L C k As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissi • Expires: ' * * * * * * ** * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) NOTARY PUBLIC: Sign: Print: My Commission Expires: ************************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: )eaitJ /G4 /Jt1/W1 S • DATE: ADDRESS: /J ,I 987 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 Ihave read and understood the following disclosure statement, which entitles the 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 underyour 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 construction Initial /8 2. I understand that as an owner - builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application Initial KO 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. 4. I' understand that the building official alter or give advice on how to meet minimum code. Initial and inspectors are not there to design, code —. only if the structure meets the Initial //C-) 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 6. I understand that if I compensate any person or company for work performed 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 any wrong doing from this unlicensed company-or person. Initial 7. tunderstaiid that if any person.gets injured on my construction project —they 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. Initial 8: I. understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my•property with out first obtaining the proper permits by licensed contractors. I nitia l Was acknowledged before 'me this Z4 day of ► 20 ( By \YtDY) C_C2( CL .S who was personally known to me or who has Produced there License or Lc as identification. • locations of all structures on the property as of this date. Affiant is personally known to me, produced 'STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, YE /Ciq , does hereby attest that the (property owner) attached survey, performed by A/ e 494r/ac name of surveyor's company) performed on 7 , is an accurate representation of the existing conditions and (date of survey) 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.. Further, Affiant sayeth naught. Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this 2 4day of Affiant/Property owner L� as identification. Date Time Type Insp'n • Permit No. — / , t l / / 1/4--f,j n."----' i Address ✓ V e ) j" Company Phone # -1/ ,) /1 // 8 For Inspector: 1 0 o Name & to G r 17/ 12.x_ Name Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Type Insp'n Permit No. Compan Phone # For Inspect : Approved 1 / Correctio Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Time 7 , 0 2 (9Oc Date f r° Name Address/ / N 5 g-/ o Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11/19/2002 Applicant: RICHARD Owner: CHATTERTON JOB ADDRESS: 1178 NE 98 Contractor PERFECT PAVERS Local Phone: Parcel # 1132050180400 Fees: FEE2002 -6583 FEE2002 -6584 FEE2002 -6585 Description Building Fee CCF Builder's Bond Total Fees: Amount $85.00 $3.00 $300.00 $388.00 Total Fees: $388.00 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 5/18/2003 Construction Value: $4,784.00 Work: INTERLOCKING BRICK PAVERS ON DRIVE WALK WAY & PATIO If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the b ordinances pertaining thereto and with the understanding that the work will be perfom and approved by the proper municipal authorities. This Permit may be revoked at an authorization. A further condition upon which this permit is granted is the understandi ordinances and regulations pertaining to the work covered hereby whether shown on by his agents, servants or employees. Signed: (INSPECTOR) Building Permit Permit Number: BP2002 -1999 (Contractor or BL CHATTERTON RICHARD ST Contractor's Address: 528 NW 1 AVE Legal Description: REV PL MIAMI SHORES SEC 8 2 2 5 i In consideration of the issuance to me of this permit, I agree to perform the work co with the plans, drawings, statements or specifications submitted to the proper authoril v! myself, my agent, servants or employes. A Q ijonnw C/ coil . 964-781 -8082 2d � fb 2O9 2.on /aiw caC4 8806 A ORDER OF TO THE WASHINGTON MUTUAL BANK, FA POMPANO BEACH FINANCIAL CENTER 1765 2401 E. ATLANTIC BLVD POMPAN! BEACH. FL 33062 1 -800 -7 24 HO OMER SERVICE Page 1 of 1 PB 43-69 LOT 23 63- 8413/2670 DATE .: 267'b84 L3 LI:83 L11109 7 2 3 7 111 311' 378 L BLK 180 LOT 3781 /6 2— DOLLARS B buSwa b. 5582 N.W. 7th STREET, SUITE 202 MIAMI, FLORIDA 33126 TELEPHONE: (305) 264-2660 FAX: (305) 264 -0229 DRAWN BY: f ._ Survey of Lot: 23 Block: 180 Subdivision: REVISED PLAT OF MIAMI SHORES SECTION 8 According to the Plat thereof as recorded in the Plat Book No. 43 at Page No. 69 of the public records of MIAMI -DADE County, Florida. Property Address: 1178 NE 98 ST, MIAMI, FL 39138 For: RICHARD CLAUDE CHATTERTON A = ARC. NC = AIR CONDITIONER PAD. A.E.. ANCHOR EASEMENT. A/R = ALUMINUM ROOF. NS . ALUMINUM SHED. ASPH. = ASPHALT. B.C.. BLOCK CORNER. BLDG. • BUILDING. B.M. BENCH MARK. 8.0.8. = BASIS OF BEARINGS. C. • CALCULATED. C.B. = CATCH BASIN. C.B.S. = CONCRETE BLOCK STRUCTURE. CBW = CONCRETE BLOCK WALL. CH.. CHORD DISTANCE. CH. B. = CHORD BEARING. CL.. CLEAR. C.L.F. = CHAIN LINK FENCE. C.M.E.. CANAL. MAINTENANCE EASEMENT. CONC.. CONCRETE. C.P.. CONC. PORCH. C.S. = CONCRETE SLAB. D.E.• DRAINAGE EASEMENT D.M.E. = DRAINAGE MAINTENANCE EASEMENT. DRIVE.. DRIVEWAY. o . DEGREES. E.. EAST. E.T.P. • ELECTRIC TRANSFORMER PAD. ELEV.. ELEVATION. ENCR. =ENCROACHMENT. F.H. = FIRE HYDRANT. F.I.P = FOUND IRON PIPE. F.I.R.. FOUND IRON ROD. F.F.E.. FINISHED FLOOR ELEVATION. Nona ffitrurvirs Jim LAND SURVEYORS LOCATION SKETCH Scale 1" = /Vr, N.E- 16 98 18 ABBREVIATIONS AND MEANING F.N.D.. FOUND NAIL 8 DISK FR.. FRAME. FT.. FEET. FNIP. = FEDERAL NATIONAL INSURANCE'bROGRAM. F.N. = FOUND NAIL. H.. HIGH (HEIGHT). IN. 8 EG.. INGRESS AND EGRESS EASEMENT. L.P.. LIGHT POLE. L.F.E. = LOWEST FLOOR ELEVATION. L.M.E.. LAKE MAINTENANCE EASEMENT. ' = MINUTES. M. = MEASURED DISTANCE. MON. = MONUMENT. M/H.. MANHOLE M/L. = MONUMENT LINE. N.A.P. = NOT A PART OF. NGVD= NATIONAL GEODETIC VERTICAL DATUM. N. = NORTH. N.T.S. • NOT TO SCALE. 4 - NO. = NUMBER. 0 /S.. OFFSET. OH. = OVERHEAD. O.H.L. OVERHEAD UTILITY LINES OVH.. OVERHANG. O.R.B.- OFFICIAL RECORD BOOK. PVMT.. PAVEMENT. PL.. PLANTER. P/L.. PROPERTY LINE. P.C.C.- POINT OF COMPOUND CURVE. P.C. = POINT OF CURVE. PT.. POINT OF TANGENCY, POC. - POINT OF COMMENCEMENT P08. - POINT OF BEGINNING. 13 1 19 BLOCK P.R.C. = POINT OF REVERSE CURVE. PROP. COR. = PROPERTY CORNER. P.B. = PLAT BOOK. PG.. PAGE. - PWY = PARKWAY. PRM . PERMANENT REFERENCE MONUMENT. P.L.S. . PROFESSIONAL LAND SURVEYOR. R.. RECORDED DISTANCE. RR.. RAILROAD. RES.. RESIDENCE. RAN. . RIGHT- OF•WAY. RAD. RADIUS OR RADIAL. R.P. = RADIUS POINT. RGE.. RANGE. SEC. = SECTION. STY.. STORY. SWK.. SIDEWALK. SET IRON PIPE L.B. 46044 S.. SOUTH. S.N.D.. SET NAIL E. DISK L.B.46044. SP.= SCREENED PORCH. " = SECONDS. T. = TANGENT. • TWP.. TOWNSHIP. U.E. = UTILITY EASEMENT. • UTIL . UTILITY. U.P. = UTILITY POLE. W.M. . WATER METER; W.F.. WOOD FENCE. . W.S. = WOOD SHED. • D = CENTRAL ANGLE. W. - WEST. C - CENTER LINE. X- = ANGLE. LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY (SURVEY): EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT TO DEDICATIONS, LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORD. LEGAL DESCRIPTIONS PROVIDED BY CLIENT OR ATTESTING TITLE COMPANY. BOUNDARY SURVEY MEANS A DRAWING AND/OR A GRAPHIC REPRESENTATION OF THE SURVEY WORK PERFORMED IN THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND/OR NOT TO SCALE. EASEMENTS AS SHOWN ARE PEFC1'LAT BOOK, UNLESS OTHERWISE SHOWN. THE TERM 'ENCROACHMENT' MEANS VISIBLE AND ABOVE GROUND ENCROACHMENTS. ARCHITECTS SHALL VERIFY ZONING REGULATIONS, RESTRICTIONS AND SETBACKS AND THEY WILL BE RESPONSIBLE OF SUBMITTING PLOT PLANS WITH THE CORRECT INFORMATION FOR THEIR APPROVAL FOR AUTHORIZATION TO AUTHORITIES IN A NEW CONSTRUCTION, UNLESS OTHERWISE NOTED, THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTINGS AND/OR FOUNDATIONS. FENCE OWNERSHIP NOT DETERMINED. THIS PLAN OF SURVEY, HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMED HEREON, THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY: THE FNIP FLOOD MAPS HAVE DESIGNATED THE HEREIN DESCRIBED LAND TO BE 2 OA I. ST. „ .2i 0.00 X SHEET NO. Situated in Zone: X Community /Panel /Suffix: 120652 - 0093 -J Date of Firm: 07/17/1995 Base Flood Elevation: Certified to: RICHARD CLAUDE CHATTERTON AND JEAN CLAUDE FRANZ US TITLE SERVICES, INC. COMMONWEALTH LAND TITLE INSURANCE CO. MERRILL LYNCH CREDIT CORPORATION, ITS SUCCESSORS AND /OR ASSIGNS A.T.I.M.A. SURVEY No. Date: 01/31/2000 LEGEND TYPICAL $URVEYORS'S NOTES: 1) IF SHOWN, BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN, BY SAID PLAT IN THE DESCRIPTION OF THE PROPERTY. IF NOT, THEN BEARINGS ARE REFERRED TO COUNTY TOWNSHIP MAPS. 2). IF SHOWN. ELEVATIONS ARE REFERRED TO B.M.4 ELEV OF N.G.V.D. OF 1929. 3). THIS IS A SPECIFIC PURPOSE SURVEY. 4). THE CLOSURE IN THE BOUNDARY SURVEY IS ABOVE 1:7500 FT. I HEREBY CERTIFY: THAT THIS 'BOUNDARY SURVEY' OF THE PROPERTY DESCRIBED HEREON, AS RECENTLY SURVEYED AND DRAWN UNDER MY SUPERVISION, COMPUES WITH THE MINIMUM TECHNICAL STANDARDS AS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL LAND SURVEYORS IN CHAPTER 61017.6, FLORIDA ADMINISTRATIVE CODE PURSUANT, TO 472.027, f I,ORIDA STATUTES. 0-0000722 OF 2 - WOOD FENCE. CHAIN LINK FENCE. C.B.S. WALL (C.B.W.) EXISTING ELEVATIONS. PROPOSED ELEVATIONS. PR BY: QQ�� 2 -/ -00 OF A LAND SURVE NO. F .2.53 ¢ STATE OF FLORIDA. (VALID COPIES OF THIS SURVEY WILL BEAR THE EMBOSSED SEAL OF THE ATTESTING LAND SURVEYOR). REVISED ON REVISEDON 5582 N.W. 7th STREET, SUITE 202 MIAMI, FLORIDA 33126 TELEPHONE; (305) 264-2660 FAX: (305) 264 -0229 Nnua urnrl etc LAND SURVEYORS SURVEY NO. &722 SHEET NO. • .2 OF 2 N BOUNDARY SURVEY scale 1" _ 20' 6582 N.W. nn STREET, SUITE 202 MIAMI, PLOH10A 33126 TELEPHONE: (305) 264.2660 FAX: (306) 264.0229 i HUU - 21 - 211 1:1 ; HL:L:I JUN I 1 NU Nona frutttPl3rnL 3Jiu. 5OUNDARY SURVEY scale 1° _ `(P ti 0 LAND SURVEYORS SURVEY NO. SHEET NO. P . 02 a9- 0712 OF T ITAI P.GI7 Coverages: Insurer Affording Coverage Continental Casualty Company The policy(ies) of Insurance listed below have been issued to the insured named above for the policy period indicated. The insurance afforded by the policy(ies) described herein is subject to all the terms, exclusions and conditions of such policy(ies). Type of Insurance Certificate Exp. Date ❑ Continuous ❑ Extended *23 Policy Term Policy Number Limits Workers Compensation 1 -1 -2003 WC 189165165 WC 189165182 WC 247848874 WC 247848888 Employers Liability Bodily Injury by Accident $1,000,000 Each Accident Bodily Injury by Disease $1,000,000 Policy Limit Bodily Injury by Disease $1,000,000 Each Person Other. Employees Leased to: Effective Date: 1/1/02 FL 1 H 058846 12279 Perfect Pavers Inc. The above referenced workers compensation policy(ies) provide(s) statutory benefits only to the employees of the Named Insured(s) on such policy(ies), not to the employees of any other employer. Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policies listed below. Named Insured(s): Staff Leasing Inc. d /b /a Gevity HR and its wholly owned subsidiaries including Gevity HR, LP; Gevity HR IV, LP; Gevity HR IX, LP; and Gevity HR X, LP 600 301 Boulevard West, Suite 202 Bradenton, Florida 34205 INSURANCE IN TOUCH WITH BUSINESS * If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of the continuation of coverage. Notice of Cancellation: (Not applicable unless a number of days are entered below) Before the stated expiration date, the company will not cancel or reduce the insurance afforded under the above policy(ies) until at least 30 days notice of such cancellation has been mailed to: Certificate Holder: City of Miami Springs 261 Westward Dr Ste 116 Miami Springs, FL 33166 -5207 Trudy Williams Authorized Representative St. Louis, MO (877) 427 -5567 12/15/01 Office Phone Date Issued LEWIS, JOHN C .PERFECT PAVER INC 528 NW 1ST AVE FT LAUDERDALE 13 1BUS.: OVERNO, STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSSEE FL 32399 -0783 FL 33301 DETACH HERE 4TCENSE NBR 06 / 1 0/ 2 00.' 3' 40911''21 R . CBCO1 79OR. The. BUILDING. •,., }Named below 2S , CERTIFIED' : Under the provisions of Chapt+er1, Expiration .date: AUG 31, 2004'.`t DISPLAY A5 RFOl 1IRFn RY I AW • (850) 487 - 1395 :STATE OF FLORIDA DEPARTMENT „OF BUSINESS. +.: ;PROFESSIQNAL'S AREGULATIO . OFFLORIDA- PARTMENT OBUSINESS ;AND PROFESSIONAL REGULAT�IO CONSTRUCTION INDUSTRY LICENSING BOARD '(,�,`::' s•� 4. L0,2-0,610.00'03t BINR S,EYER SECRETARY „• 4 '.� ''Vt,:/�n1i F 1.0Ur1 ]. — 19 8oai - d'O, County Commissioners, arowurd County Florida anowAno COUNTY OCCUPATIONAL LICENSE TAX FOR PERIOD OCTOBER 1, 2002 THRU SEPTEMBER 30, 2003 FORM NO. 401-280/AC 25-061 dRENEvwL CI TRANSFER SEC # 18 / 180 [t NEW DATE BUSINESS OPENED 10/01/88 STATE OR COUNTY CERTIE1EG » CB reCi: Business Location Address: 528 NW 1 AVE FT LAUDERDALE 33301-000C CWSlNESS PHONE: (000)491-2444 THIS LICENSE MUST BE CONSPICUOUSLV DISPLAYED TO PUBLIC VIEW AT THE LOCATION ADDRESS ABOVE. gnOWAno COUNTY REVENUE COLLECTOR 115 S. Andrews Avenue, Governmental Center Annex FORT LAUDERDALE, FL 33301 TAX BACK TAX PENALTY T. C. FEE TRANSFER TOTAL 27.00 27.00 � L Ci.00OS0000O 0000002700 00000018O0000842 '1001 7 PERFECT PAVERS IN: LEWIS JOHN C 528 NW 1 AVE FT LAUDERDALE FL E OF LICENSE TAX PAID ~=2C""`'' n`yro�r�nn F . 0 R ... .~,.'`"^.=` � '�'��� RENEW ON OR BEFORE SEPTEMBER 30, 2003 PENALTIES IF PAID OCT. - ^ DEC. 'eo% I After DEC. 31 - 25% Plus Tax Collection Fee of up to $25.00 . Based on Cost of License if Paid On or After November 30, 2002 ACCOUNT NUmBER 10 UNITS 2002 - �������� ^�.�n�^� ^�n�"��� PAYMENT RECEIVED AS VALIDATED ABOVE *SEE BACK FOR TRANSFER INFORMATION NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. !4 7i Q 50 ? 0 OC STATE OF FLORIDA: COUNTY OF DADE: O2R67997 2002 NOV 01 13:3 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. Legal description of prope and street address: ,< or .43 /lex /JU WhA„ri SNoa,• r Sec- y 2. Description of improvement: —Z rift Locic (A) a- A.L.icaL . , i/ 4.4 eve 114 to P+91 3. Owner(s) name and address: ?it *ILO 6#4 7 r.E4, To./ // 'E 9j> r /1/M0 i S NI),e.Er FG . Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: r �PEitFB�T ?As/s,e.s / , Sag , Li �f r 4c/4---; / r . 144/ o /41-E �—c. 3330 5. Surety:(Payment bond required by owner from contractor, if any) co! r1T� OF �,:,�1 Name and address: that this ;we " °',.;e !'•';;;; ji;,o�H r.7 !irr� ran n -,y n. Amount of bond $ / , • •0 20 ( 0 ` `• 6. Lender's name and address: IN, CLERK o D. • 1111113111111, ram 7. Persons within the State of Florida designated by Owner upon whom notices or o er documents may be served as provided 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 dat _ is specifie of Owner Print Owner ' ame Sworn to and subscribed before me this ar day of Notary Pu Print Notary's Name L. White # rx' 946000 :.\:gyres Daly 30,2004 Br'i rd1hru Atlanuc Co., EQ. eal. rcuit and Count C O.C. Prepared by: l ELF-- t t P . Address: Sae'' A/. rJ- / r. jive 14✓0 et 1-F 3 33 ,31 .7•!n..c, nx3, CONTRACTOR Name yer � �V e rs Lic�sp,N O 1 -' 90 Addres� N. Lo yJrs_4" v 1 / L td f/ 333 Telephone 9.L °� / 2 • y V /� � l O ax 9 Y �/ q � 7 Qualifier N ame .�- l I. PROPERTY OWNER Name � � Ii1/f J A. ''� Address /in /t P4-: *(.__)111/ . �j fer �' Home Tele hone J J Business Telephone3 0 5 S3 b l� a Fax la 3 0/') TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. $ubmit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: ,/ // 8s is) rea 3 2 J Lot Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Folio Number // 3 a - 01 ? � 0 1 3 Block W Subdivision m NMI St iO4 a s 53c, p' Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Address PB Apt. Master Permit No. . Subsidiary Permit N City Descr 'on of Wor 1 - D1A .tee 6» /k PERMIT APPLICATION State Zip PG Zoning L inear Feet Square Feet 1.3S Units Floors Value of Work 7 1. 7 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 1NIPORTAN'I' NO'T'ICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE Si ature of Owner g 76/6 - iV 5249107 Print Name S . •m to and subscribed before me this / day of1=41A/ , 000;0 /fib gnaturFrof SEAL: 1 N Y OF MIAMI -DADE t.tY'!NiF 1.Q JISE Wit KERSON My Comm Enr. 7/23/2003 /No. CC 0` 50899 r . / r.w y nncvn 11 over to Personally known OR, Produced Identification Type of Identification Produced: STATE OF FLORIDA, COUNTY OF MIAMI - DADE Signs of Contractor / Qualifier J d (.�.✓ C, E J/ J Print Name Sworn to and subscribed before me this / e' day of a TIP At- _100 . Signature of Notary Public - State of Florida SEAL: L. White CC 946O0O ly ,2004 �q�. �. Personally kno " ' ��� ,, � ' Ox , t! titification PERMIT APPLICATION Type of Identification Produced: ELECTRICAL TVPI•. Minimum Fee QTY. 'TYPE Dryer QTY. TYPI'. Outlet, Appliance Q'rV. 'rv'ri•: Service Repair QT y. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL 'rYPE. Minimum Fee QTY. •ryPE. Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons Q•I' '. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING T\PI: A/C Condensate Q'rv. 'l'YPr Drains, Roof QTY. TvPI: Miscellaneous Fixture Q'FV. 'I'm: Soakage Pit Q'FY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY C1IECKL1ST O OWNER - BUILDER FORM (Attach) O FIRE DEPARTMENT APPROVAL (Commercial / multi - family) O CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) (sq.ft. x/1000 $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) SECTION Zonin Electrical Mechanical Plumbing Fire Public Works Structural Building Official DAT if t 9 Z-4z, PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PI:RN1I'I' FEES TOTAL $ ? A ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Aillication is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure berein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regula- tions of the Building Division of Miami Shores Village shall be complied with, whe • . ,erein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address r t) Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot_____________________ —_ Block________________ Subdivisio Street and Number whare work is to be done work to be done and pur ose of building oors) lq New Building STATE OF FLORIDA, COUNTY OF DADE. and who, being b of the above desc therein by him st Permit No._ Disapproved (Signed) _ MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Remodeling________________ Addition To be constructed of Kin Estimated Total cost of improvements $_ Zone cubage required Distance to next nearest building____________.___ —_ Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said b be sent to Building Inspector Chairman Member Member Council Approved Repairs Roof Covering__ Amount of Permit $ _ ® __ Ian Cubage __Size of Building `Lot —Ir uilding. All notices with reference to the building and its construction may The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, compiled) Gensfal Laws of Florida, Permanent Supplement. and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit: and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such su tors, on work to be performed under,,,Ahis permit, as are licensed by Miami Shores Village. Remarks ,.4 (Signed) my sworn, upon oath deposes and says that he ction, that carefully read thl fore PLANNING BOARD _ 1__ DATE Date Date__ 19 "- No My Commission Expires __ Date �•� '" Q Read, Sworn to and Subscribed before me. Notary Public, State of Florida Member Member Member Disapproved and for no other purpose. No. of Stories "110441/Keue Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, e application, and that he did sign the same, and that all facts _Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. BUILDING ELECTRICAL PLUMBING. Owner of Building Legal Lot Description Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA DATE 16,:, Z. Y 194 PERMIT N° 7450 Work to be performed under this Permit • CONTRACTOR OR BUILDER Bl. Subdi- vision Contractor's License No. d eLe..-1.„ N-1,-4.....1 Address of g ��-/ Value of Amt. of Building �� �° Project Permit This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the state ents or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. t Signed. - ‘0 0 - By INSPECTOR In consideration of the issuance to me of this permit I agree to perform ie4vork covered hereunder in compliance with all and Aegu, jations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Sho s Village. Inaept ghis Qermit I assume responsibility for all work done by either myself, my agent, servant or employee. AUTHORITY MIAMI SHORES VILLAGE, FLORIDA 0ILUING ir# DATE 6 f° . 194. t,ECTRICAL PERMIT N? 7450 iUMBING h oner of .gilding rchiteet i _30ntractor Builder egal Lot 1 Bl. ! escriptiOn �s of . . s L1 Value of 1 Amt. of g � Y Project Permit i This p 't is granted to the contractor r builder named above to construct the building or to install the equipment or device described in the appli- ition herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any Tans, drawin s statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this zrmit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and igulations pertaining to the work covered hereby whether shown on the plans or drawings or in the states ents or specifications and that he assumes respon- bility for work done by his agents, servants or employees. 1 r Signed. employees. . A � ..c 4 . B 4 INSPECTOR In consideration of the issuance to me of this permit I agree to perform Ale ork covered hereunder in compliance with all ordinanaeI and regulations .. taining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. 3 pia g "s permit I assume responsibility for all work done by either myself, my agent, servant or employee. • CO} Work to be performed under this Permit CTOR OR BUILDER ( or;-,/-1- dill... ''.4.....4..."..x--4... ,.. Subdi- vision BY fi Contractor's License No AUTHORITY