5 NE 99 St (4)038031796 2003 JAN 14 14.29
NOTICE OF CO ENCEMENT
A RECORDED COPY MUST BE POSTED ON E JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO.
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements wilt t
Chapter 713, Florida Statutes, the following information is provide(
1. Legal description of property and street address: 5 1). S -�y 4 -
3.Owner(s) name and address:
'merest in property:
Name and address of fee simple titleholder:
S. Surety :(Payment bond required by owner from contractor, if any)i
Name and address:
Amount of bond $
6. Lender's name and address:
TAX FOLIO NO.
2. Description of improvement: RV/4r [ to r i (Ay/07i,-
4. Contractor's name and address: MPi'y1L//). Pf77 -f
1 afig
7. Persons within the State of Florida designated by Owner upon w om notices or other 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 •erson(s) to receive a copy of the Uenor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
S. Expiration date of this Notice of Commencement. (the expiration (date is 1 year from the date of recording unless a
different date is specified)
My Commission Expires
q■ a O ails
�r N MIN eOn -.rntI •
Sig ature of Owner
Print Owner's Name . Prepared by
Sworn to and subscribed before me this 13 _day of [ J, T , 20 0 3
Address: 4 (00
Notary Public
Print Notary's Name _ 5f D ,'A
•,
1)
,G.,,, Sandra
N = .Commission #
Expires April 2, 2005
•
Bonded 'Ant
*; Atlantic Bonding Co. Inc.
STATE OF FLORIDA. COUNT OF DADE
I HEREBY CERTIF that this is a tru c p of the
original filed in the t{{(een /
l A (
1 , ay
WlTN, SS my h : . and 4,cial Seal.
HARVEY RUV LF ounty Courts
By D.C.
made to certain real property, and in accordance with
in this Notice of Commencement.
5cc.& A — /01
AFFIDAVIT
STATE OF FLORIDA) SS'
COUNTY OF DATE )
S ELczomE VVOIREJ .\X)Ahiof the Village of'Miam hores,
County of Dade and State of Florida,, being duly sworn, loth depose
that under the provisions of Ordinance No. 185,, dated June 15, 1948, amen
ing paragraph (d) of Sedtion B - 368 of Ordinance No. 97 of the Building Code
of Miami Shores Village, he desires to build a
on Lot l3 $ 14 Block. of Subdivision.,
that he is the owner of said property, and will be the owner oi' said
ES tc c ktne , that he will do the work personally, and that
he will, at such times as are required by the Zoning and Building Director : -
1. File plans and specifications and obtain approval of the
Planning Board and the Building Inspector.
2. Apply for and secure a Permit.
3. Pay the required fees.
9. Not set himself up as a "contractor ".
And Further this Deponent says nott
SUBSCRIBED AND-SWORN TO BZFORE ME this 11,1 day of
19 a'
4. Execute the work in accordance with the provisions of this
Code.
5. Apply for inspections.
6. File with the Building Inspector certificates that provision
has been made to carry the necessary Workmen's Compensation,
Public. Liability and Property Damage Insurance.
7. File with the Building Inspector as the job progresses certiu
f icates showing the payment required by the Federal Social
Security Act to the State of Florida or tte United States of
America.
8. Assume the responsibility of not employing other. than. properly
licensed. con racto by Miami Shores Vi.11. tge for shy part or
portion of the work.
10. Sign an affidavit before commencing work to the effect that
he has read this Article and will do the work personally and
observe all of the requirements of the Building, Electrical,
Plumbing and Zoning Codes of Miami Sbores Village. Such
affidavit to be properly notarized upon blanks to be supplied
by the Building Inspector.
11. In order to. prevent abuses and subterfuge tir. right of such
owner.•.builder as herein. provided, ' is limited to but one
owner builder loma t each 2 years, and where an owner'.buUi -
has once exercized the privilege herein conferved no second
app&ication for owner.•builder permit shall be granted_.. in le;
than 2 years, unless the applicant is qualified as a licensed
General Contractor under the
icable R x .-s of *said
Villages
llp
Ilri.w.. ∎ 414 _ ., A
NOTARY PUB * a
Nair.? Pu6Ter Sfafe bf MANHO
My commission expires April 21 Mr,
BMW by Maii. Bsaslio..ii A Isms*
WORKMEN'S COMPENSATION
Policy Number
85693
Date Effective
Date of Expiration
Limits of Liability
7/16/51 6/l
7 / 16 / 52
Complies with requirements
of State Laws
GENERAL LIABILITY
Policy Number
851$91
Date Effective
7/16/51
Date of Expiration
7/16/52
Limits of Liability
Bodily Injury
$ 10,00®. each person
$ 20,000. each accident
2 Property Damage
$ 1,000. each accident
$ lome. a
AUTOMOBILE
Policy Number
Date Effective
Date of Expiration
Limits of Liability
❑ Bodily Injury
$ each person
$ each accident
r'! Property Damage
$ each accident
❑ Comprehensive
$ Amount
❑ Fire, Theft, Windstorm
$ Amount
1:1 Collision
A C V
Less $ Deductible
Year
Model
Trade Name
Serial Number
Motor Number
pinaiii fif . • f : 1,%,,fpf. 177;ff/f
,, . 70 fir 747,17 7 err
ADDRESS' (Street, City and State)
CASUALTY RECIPROCAL EXCHANGE
28th and WYANDOTTE STREETS • , KANSAS CITY 10, MISSOURI
TO
Miami Shores Village, Building Dept.,
ami Shores, Florida
THIS I$ TO CERTIFY that the Policy or Policies listed below have been issued at CASUALTY RECIPROCAL EX-
CHANGE in favor of the following Named Insured, and are in force at this date:
NAMED INSURED:
Jerome J. Dunn
ADDRESS (Street, City and State)
828 B.B. 76th St., Miami, Florida
LOCATION OF OPERATIONS TO WHICH THIS CERTIFICATE APPLIES:
5 N.R. !!tk Street Miami Shores, Florida, and elsewhere in the State of Florida
Nothing herein contained shall be considered
BY:
Fur,n 0 -44 R49
CERTIFICATE OF INSURANCE
COUNTERSIGNED AT
Miami, Florida
DATE
July 1, 1951
Insurance lgeaeey,Iac.
TELEPHONE VALENTINE 2800
COVERAGES, POLICY PERIODS and LIMITS of LIABILITY
Aut rized Representative
as altering or modifying any provisions of said policies.
It is agreed y by the Company t is event of
cancellation of this po]icy days written -
notice by re istered mail wi be given prior
to cancellation to party to whole this certificate
is issued. CASUALTY RECIPROCAL EXCHANGE
Attorney in Fact