30 NE 100 St (4)n o* €1<)<%_,40
MIAMI SHORES VILLAGE 0 'b
BUILDING DEPARTMENT
305- 795 -2204 ®Os`
Building Inspection Request
Dates )3l (OS
Type Insp'n r C. 1 - II) rTV'sC� .) O J
Permit No. 1 'PC 3 t 5 — 804
N ame - 1zak 4h rry Pomorlt►(
Address 3r,) M I ST.
Company Ca I I r"l a ,` ..' `d 1 I�
Phone # ( 5) 205— 4538 .
Inspection Date q
Approved
Correction
Re- Insp'n Fee
f lila Oitzt
MIAMI SHORES VILLAGE p�
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date1 /Z /
Type Insp'n � i� c1 1 VTC.I)C.
Permit No. — 8°4
Name
Address 30 ME- 100 ST'
Company Cal—C, 1 I i I d 0-73 .
Phone # vJ
Inspection Date
Approved
Correction
Re- Insp'n Fee
V\I-z ndy = Fern i n9
Sod 0 s &
l �
,J So ✓2J&x,N C�, LA: Arty
yz-tveZ)n 4--W A4
3cj2e?
MIAMI SHORES VILLAGE •1
BUILDING DEPARTMENT "
305- 795 -2204
Building Inspection Request
Date 1 /2,C7 /05
Type Insp'n F c >� d O ( )KM
Permit No. e-)RC 6304
Name €-1 1 h 2o k y n 1 k
Address a 14E. 1 'ST
Company CO fC: 1 f V )U epui Id f' 11 CI
Phone # ( ) - 19, - 3403 �
�
Inspection Date 7
Approved
Correction
Re- Insp'n Fee
Building Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2005 -804
Printed: 6/9/2005
Applicant: WENDY
Owner: ROMANICK
JOB ADDRESS: 30 NE 100 ST
Contractor CATALINA BUILDING CORP
Local Phone: 305 - 271 -9996
Parcel # 1132060131230
FLEMING
ELISABETH
Contractor's Address: 11460 SW 99 TERR
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 9 & W1/2 OF LOT 8 BLK 9 LOT SIZE
Fees: Description Amount
FEE2005 -7823 Building Fee $125.00
FEE2005 -7824 CCF $3.00
FEE2005 -7825 Training and Education Fee $1.00
FEE2005 -7826 Technology Fee $3.13
FEE2005 -7827 Scanning Fee $3.00
FEE2005 -7905 Builders Bond $300.00
Total Fees: $435.13
Total Fees: $435.13
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 11/27/2005 Construction Value: $5,000.00
Work: BRICK ON SAND DRIVEWAY AND APPROCH REPAIR
t313PAID
c
ga5 1
Signed: (INSPECTOR)
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
BUILDING
PERMIT APPLICATION
FBC 2001
Total Fee Now Due $
(Continued on opposite side)
i3 1 3 .
Miami Shores Village
Bui .4 ing Department
Miami Shores, Florida 33138
`
Job Address (where the work is being done) 3o AIE j R r E
City Miami Shores Village County Miami -Dade
(305) 756.8972
Permit No. hPOS ° '11
Master Permit No.
Permit Type (circle): Building Electrical n Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) CLI S -i J I A PO/L #NI K Phone # 3 20S ys 3$
Owner's Address J 17 ICE / V 5T,Z
Cit 1Vl (J S ES State F L
Tenant/Lessee Name
Zip 3313T
Phone #
Is Building Historically Designated YES NO x
Contractor's Company Name &47 L/ r d a / L /if 6 61 Phone #
Contractor's Address It 160 S £ 4 19 7
Zip
City n4 I )9 / State Zip 33 /7g,
Qualifier Lows k k cO4 7 -
365-/7/-9935
Architect/Engineer's Name (if applicable) Phone #
r
$ Value of Work For this Permit 5 0D6 ' r� Square Footage Of Work: 6
Type of Work: • ❑Addition ['Alteration ONew ❑ Repair/Replace ❑ Demolition
Describe Work: IM OA) S/`iV4) Dig, JO 44 ' /4#D hAvieohcii 1 REP/4 i/Q
6 Scbuw t4 S CTio�.S
* * * * * ** * * * * *** * * * * * * * * * * * * ** F ees * * * * ** * * *** * * * * * * * * * * * * * * * * ***
C/
Submittal Fee $ Permit Fee $ r 2 'r — CCF $
Notary $ Training/Education Fee $ Technology Fee $ 3.13
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
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.
Signatur _ / Signature
Chc 10/14/03
r 'ficaf
0"/ /
A
xpires:
* * * * * * * * * * * * * * * * * * * * * **
o did take an oath.
NOTARY PUBLIC:
Sign:
Print:
a
ommission #DD 174702
Expires: Dec 30 2006
* * * * * **g $' 4' F * * * * * * * * * * * * *** *** * * * * * * * *,t * **
Atlantic( ( a f.Competency Holder)
My Commission Expires:
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this Z The foregoing instrument V was acknowledged before me this
day of �1 2004` , by ti'se 4 ∎Cr d/L , day of ` %/ , 20 05,, by Lo u't S SC Wed (r z..
whn is nersanall y known to me or who has produced who is personally known to me or who has produced
as identification and who did take an oath.
a fee
kno, P. Gcf E �
.err Ma G
my Commission DD079 +a
irest®ee6n 6r4040vb
State Certificate or Registration No. Certificate of Competency No.
***************m***************************** **,*** ****** * * ** * * *** *** *** ** ***** * *********** * * ** *, *** * ****** ** ****** * ****** **** * ** * **
APPLICATION APPROVED BY: ( G J Plans Examiner
Engineer
.. (65 Zoning
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
N? 163 BUILDING DIVISION
Owner, Agent or Tenant of Building
Miami Shores Village, Fla.,
I YY 7
4 4F
Lot ' Block Subdivision
Street Address
Approved use by occupancy
Remarks-
This Certificate of Occupancy is issued to the above named
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the
erection, construction, alteration or remodeling of buildings or structures'
BUILDING DIVISION
N° 163
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Mimi la mi Shores Village, ,
Owner, .Agent of Tenant of Building
Lot / / Block / Subdivision 7�,
Street Address
Approved use by occupancy
Remarks:
// t�
:/ /` / . =, , / 2 1 . ';
%
/•
This Certificate of Occupancy is issued to the above named � //
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances -of Miami Shores Village pertaining to the
erection, construction, alteration or remodeling of buildings or,structures!' ^ �.
BUILDING DIVISION
N9 163
Misni Sh fes Village,
Owner
gent or Tenant of Building /kJ
L ,
Lo �' +� Block Subdivision
/
Street Address _ _ . g, //J
Approved use by occupancy --
Remarks:
This Certificate of Occupancy is issued to the above named ja i
for building at above named location only upon the express provision that the applicant will
abide ,by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinan c of Miami Shores Village pertaining to the
erectieu, construction, alteration or remodeling of bu' d)ri's or structur ! el l'
F
r'"1 _ l'
BUILDING DIVISION
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
9 W,
owners
/1
Genera
Zone Req. .CLL.-Etc-1 f i: r� tL �. •=elltko
Plat Restriction, _.di-
To 'Plane tig Boar „ : _ /-6 - LK_— ..rpp d �- � Red`
�{ �� 1� � rove '�/ !_ _
P1ari M & .Spai: )checkLd by.c °
To Council
Bldg Permit ^_No.� -.
ress or
Add n''x� 'Phone
�...,�_ Datt
T vi e
Nerd- �onst..� :_..... - ...�_. _ _�-_ - t eiht idn. _ -.- _.. — Repair
tte jetted
_ New 'CO nst tic't1'on - - Alt ern tin& . _. . ___._.. -.- Repaj.
P1umabi- ng--Per•mi't • Nde21 -51 Da.to... . ---Z °..Lt -• Fee _
Sept a -c-- Tank �, $,...er . • sr - - -'.,3 -- r- - -_... �r ® a v
.r
0
Electrical Permit NO. 2 L lI D4te „i ° L ` `., ' P ee -t .a = •
Fixturos v. fl };rr� it
Heater r{ ; *. II it
:iotors '}o 1 = ;
I j
may �� _! _
-- �,
New Construction ✓-- —. , axta: t -ion t p ir
Building . Xnsp._.... _ -t2r. i r. Dy lie- Irisp.
•
Foundaia1s�;:L._ D
•
$ s2a Ein t .bs_
lnal
_F. I-nal - Clean- -Up
. ?.1unbing Insp - Date
• Rough.ng:. ti =
•
S r'`
Soles• -tic er
�F �na1 Certii'i's.
•
.iorvice 0. .if. to Eb�vc�r Co.
cal Insp. Date
Roughing
Fix tunes ff _ .S".30 -
Final
•
r By
•
C t.Of 0.ccu
0/SS
Re-Insp. .
' . is �•+t �� v
ued
Re -Insp. By
4-1 rfip"
LOCATION 3 O 72. e. /0
; pARBAGE TAX RECORD
PAID BY
YEAR
ANNUAL /TAX
PERIOD USED
AMOUNT PAID
DATE PAID
RECEIPT
NUMBER
1940
C 1
C .
, - __
1941
6.2 1
6 -30 -c, /
2726
3 4 ( > 4
I .
/ !
/ / J
/
1942
O C
/ - / 9 - $ 1 . ) •
/O
C •
/,,
1943
/ a - OO
/ - 4r - 5/�3
�.3 - S - Y
01
. - , i .
1 '
&
( .
/
1944
11. f
/
d-U
'1iyL/
1945
/40. 0`17
a 9/4
f- /" 4,4.S
- 6
4 y3
76 4.7.
_ i » L
/a7O 3
/6
/
/4,
zdd -CL!
e..
l.4 4/.{_.)
1946
1947
/®.
/-)/ O 6
/ - / 6
- -a-3- T `
/..?-/7- 5
/ Z / I f- ./
- -
Il
1948
/ E2. co
/2-3/-5
/1 ,
4
(!
ry
1949
"
Al 3/1.99
'1
\
//
q
A-
1950
//
�
�, - � � sa
��
7 1 5
LOCATION 3 O 72. e. /0
; pARBAGE TAX RECORD
30 Z. E. 100th St.
by
9 9
Lam.. J. E. Halligan
year annual tax period used amount paid
19
$12.00
date paid receipt #
Dec. : 31, 1951 $12.00 . 12- 4..-50 n374,
//z° _ ezw,
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot Bl.
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 3749 h
Work to be performed under this Permit
Subdi-
vision
Value of
Project
Amt. of
Permit
DATE 194
Contractor's
License No. '1
l h: i : 'c;i .; ^n `'r+ J't .r.:;!
''7`F ^f
r •
hc.:: u;`,cr. �eure s;at m t,.a 101r. aji,4r x• .,
tli:s prect.
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
application 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 statements or specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed• By
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula-
tions 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, servant or employee.
/'
CONTRACTOR OR BUILDER BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Owner of
1
MIAMI SHORES VILLAGE, FLORIDA
DATE ` '' 194/
PERMIT N9 2118
Work to be performed under this Permit
1
Building
Architect
Contractor
or Builder
Legal Lot Bl.
Description f'
Address of
Building
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
application 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 drawin ..w .the statements or specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed- By
INSPECTOR -.
•
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula-
tions 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, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
Subdi-
vision
Value of
Project
Contractor's w
License No.
Amt. of
Permit
1
'd
Legend of Sum' LAbkesiations
A • Arc Distance
(C)
Cl
ENC
rir
011 Overhang
PO Plat Gook
P/L Property true
UP
Notes
Calculated
Clear
Encroachment
round Iron Pipe
ELQOD ZONE: X
A/C
CO
C/l
ETP
FIR
Alr Con.IdMn.ng Pad
Catch Basin
Center tine
Electric Trnislormer red
Found Pon Rod •
• ORO. Official Records Books
PC Point of Curvature
P00 Point of OegrnnIng
Wady Pole WM Water alder -t
Tangent • LME Lake M..inl. Easement
g) This survey is not to be relied upon for construction.
EL_Qm._2ILINERMAII9.N:
Community Number: 12 0 65
Panel Number/Map # : 12025C0093
Suffix: J
F.I.R.M. Index Date: • 7-17-95
Base Elevation: • Not Available
NOT VALID WIIIIOUf 111E SIGNATURE AND
111E ORIOINAI. RAISED SEA. OP r! CARIA
LICENSED SURVEYOR ANO MAPPER
•
PR... surrvEVOn Ann MAPPER MO.
Y7.L
ncn
,ens
CON;
II)
(M)
0111
rcc
roc
A
AE
A BQUADARY_ SURVEY
1 hereby certify That the survey represented
hereon meets the minlmum technical
eland.vde sit forth by the Board of Land
Surveyors In chapter 111011.11 Florida
Admhulatrative Code pursuant to Section
472.027 Fla. Statutes. Thar* are no encroach
mend.', overlaps. easement, appearing on
the MI, other Than as shown hereto
[froward County Records
Concrete Block Slrucliue
Concrete
found
Mt
YIELD DATE ` I SCALE
,37-4r- z G O
Overhead Utility lines r hat
Point of Compound Curve PG
Point of Commencement • me
Cent;41 Angte PT mint of Tangency
Anchor Easement 0/5 • 011set
raga
Point n1 Reverse
Curvature
('age 2 ..,f 2
UE
' V
a) All Clearances and /or encroachments shown hereon are of apparent nature. Fence ownership by visual means.
Legal ownership of fences not determined. "
f) The lands depicted hereon were surveyed per the legal description and no claims as to ownership or matters of title
are nude or implied.
a
R
Rath
nit!) nad.
IUW 0.gr. nr Wt.,.
SI.0 Sect v.
SCn • ned
SWIG Srda ra?
.1141. ,
Eat. nent
WM WAI• • Meter
b) The issue of this survey is only for the exclusive and specific use of those persons, parties or institutions shown in tale
certification. Any other intended use will require written approval frprrl the certifying surveyor or firm.
c) Code restrictions and title search are not reflected on this survey.
d) Underground utilities and encroachments, if any, not located. .
e) The flood information shown hereon does not imply that the referenced property will or will not be free from flooding or
damage and does not create liability on the part of the firm, any officer or employee thereof, for any damage that
results from reliance on said information.
514' Set r m rte.
Bearings, if any shown based on - (reference)
CERTIFIED TO;
David J. Schottenfeld, P..A.; Attorneys' Title•Insurance Fund,'Inc.;
Romanik, Elizabeth and Garry, and Universal American Mortgage
Company, its successors and /or assigns.
PROPERTY OF: Romanic, Elizabeth and Garry, 30 N.E. 100th Street, Miami Shores,
• o.
Florida 33138
LANNES AND GARCIA, INC.
.. .. _ L.B. #2098
Surveyors- Mappers -Land Planners
BEALE SMITH 15238
Office Address: 359 Alcazar Ave, Coral Gables, FL 33134
(305) 866 -7909 ' .(954) 523.8663
DRAWN BY
1 ORAWIN(: NO
130952
. —..
... _ ,
• - .. ,
22 64,
tl LJ
I 3,52
4
• 4.
•
•••
A
T 5a5au,
r
n
veorateri e W.
_-- Ne /c 57
NOT VAUD WITHOUT THE SIGNATURE
AND THE ORSZNAL RAISED SEAL OF
FLORIDA UCENSED SURVEYOR AND
MAPPER '
■/5'`
/4
/32'
GOGAT /0 A! M
t .)
PROPERTY OF: 30 N.F. 100th Street
Romanik, Elizabeth and Garry, Miami Shores. Florida 33138
A BOUNDARY
SURVEY
I HEREBY CERTIFY THAT THE SURVEY REPRE-
SEWED HEREON MEETS THE BINIMUIA
TECHNICAL STANDARDS SET FORTH SY THE
BOARD OF LAM SURVEYORS IN CHAPTER
61017-41 FLORIDA AlIalt11SIBAOVE CODE
PLIRSUNT TM SECTION 471027,, FLA. STATU-
TE& THERE ARE NO DOCROACHISENTS
OVERLAPS, EASENDO3 APPEPASIO ON THE
PLAT OTHER 1/W4 A3 SHOWN HERETO.
15•47.4 fiX:r,e)Ihtn.
FLOM NOOK WPM= AND WPM
No. Y 7
This property described as:
Lot 9, and the West half of Lot 8,
Block 9, of AN.AMENDED_PLAT OF
MIAMI SHORES SECTION NO. 1,
according to the Plat
thereof, as recorded in
Plat Book 10, Page 70,
of the Public Records of
Dade County, Florida.
HELD DATE
0E3 /5 0/
Page 1 of 2
• LANNES AND GARCIA, INC
LB #2098
SURVEYORS—MAPPERS—LAND PLANNERS
3EALE 5t4 1TH 4 5238
OFFICE PODIUM 3011 AGM NUM COWL CAM. FLORIDA 33134
(306) 646-7909 (154) 523-46113
SCALE DRAWN EfY D. No.
. . 0. 130952
ly17V J
• Liia ht_
Elf' • • '
.9. 9
i ez . L . 40/
et. ;
. 2 0
•
• ••'•
• _;• • •••. t`•••■••
•
/517,111?
22
•702ecA1.
(.0 - Th
4
4 , /3,95 t\
/z
Joq,
ONE 57)
7.5, ctiicis) • .
/4, /o
‘t•
• •
. ,
-AA*
,.-- 'Mar
Catalina Building Corp.
9801 Southwest 121 Street
Miami, Florida 33176
Phone- 305 -971 -3935 Fax- 305- 971 -2147
Grade
2 3/8" Thick Concrete Paver
Concrete Edge
Restraint
1 #5 rod cont. at center
SECTION A: Concealed Edge Restraint
Well Compacted
6" Limerock Base
Ne;
-4 ' • • • ;451,1-7
clee
22' t
41/
/4 .5 22
ONE s7aRy
Re De. ivc6
/4, 10
°
tt s_140 .2 2 . / ..
4. 70
f,.45•5-• -
APh.
pa v
Catalina Building Corp.
9801 Southwest 121 Street
Miami, Florida 33176
Phone - 305- 971 -3935 Fax- 305 - 971 -2147
Grade
Concrete Edge
Restraint
2 3 /S" Thick Concrete Paver
1 #5 rod cont. at center
SECTION A: Concealed Edge Restraint
1" Sand Bed
blell Compacted
6" Limerock Base
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:
ter 9 0 VIE \416-s7 ithz -F of 1~ g
1. Legal description of property and street address:
30 AVE !CV iTAEEr
2. Description of improvement: BA 1 C1 bN 5A-410 DANE A'r IWO APR I
3. Owner (s) name and address: EL/S/445 r 4/Wk
3 o , / /tv $ I FL 33 /3$
Interest in property: is 11 E IL.
Name and address of fee simple titleholder:
4. Contractor's name and address: C/ .'73 L1 NA• A U ) Lj 1 tol 6R, P
gni S 1.0) 12-1 /14)A- FL 3317-6
5. Surety: (Payment bond required by owner from contractor, if at i. issE CF ; t 3^1X1, , C: 7 t.011 " °►. „ y i� C r `
Name and address: 1 FiER!'" _ rh?TiF Y ti a" G ?.s i "j/: ;i: ^� , r. *.; :: A.
on p
1111:.1 Lj
(ZS •h�: u en' , a'S .f \ ; _ � ,;�,;: /y
6. Lender's name and address: I J f , ^ { ,Vr pi . hJ. CLEr?! d: of Give and Caen C ourt,
_ .._. D.C. ...
7. Persons within the State of Florida designated by Owner upon whom notic . or other documents may be served as provided by Section 713.13
(1) (a) 7., Florida Statutes: 11/13
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) 7., 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 date is specified)
varez
gnalUte or owner
Print Owner's Name %"�
Sworn to and subscribed
Notary Public
Print N
My Co
e xpires: Dec 30, 2006
Bonded Thru
Atlantic Bonding Co., Inc.
By
Address:
1
CFN 2005R0615607
OR Bk 23476 F's 3206; Ups)
RECORDED 06/15/2005 10:59:41
HARVEY RUVIN► CLERK OF COURT
MIAMI —DADE COUNTY? FLORIDA
LAST PAGE
Prepared by: /Z14 o y
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Rem 104
M 'AY 25 2005 11:29 FR AFFIN -ALNT MARKET
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PRODUCER
W F ROEMER INS
PO BOX 190669
TAMARAC
76CPF
INSURED
CATALINA BUILDING CORP
11460 SW 99TH TERRACE
MIAMI FL 33176
COMPANY
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED .e NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co
LTR
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
'4 I CLAIMS MADE I l OCCUR.
OWNER'S d CONTRACTOR'S PROT.
AUTOM08R.E UAOIU V
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE UABRITY
ANY AUTO
TYPE OF INSURANCE
EXCESS 'ABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION AND
EMPLOYER'S LIABIUTY
THE PROPRIETOR/
PARTNERS/DIECUTIVE
OFFICERS ARE
OTHER
INCL
EXCL
DESCRIPTION OF OPERATIONS/LOCATION
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE
MC
VILLAGE OF MIAMI SHORES
BUILDING / ZONING
10050 NE 2ND AVENUE
MIAMI SHORES
MAY 25,2005 11:33
EHICLESIRESTRICTIONSISPECIAL ITEMS
FL 33138
FL 33319
(0B- 3984805 -4 -05)
4072543057 TO 9213059712147 P.02
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; � i { ?..:3:%•.• > 02 -01-05
THIS CE R TIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY
HOLDER.
ISCIFICA RIGHTS N CERTIFICATE
NOT AMEND, OR
ALTER THE COVERAGE AFFORDED BY THE POLJCIES BELOW.
COMPANY
A FLORIDA W.C. JUA
COMPANY
8
COMPANY
C
POLICY NU{IIBER POUCY EFFECTIVE POUCY EXPIRATION
DATE (MMIDDIYY) DATE (MMiDD1YY)
01 -28 -05
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. �..;.iY``C':... ^.. ^ ;Y •.. .. ....,. : `':' i +, > f:: ,.•�,. � ... `:,. .•I:;(:; . Y
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
UST, BUT FAILURE TO NULL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR
UABIUTY OF ANY KIND UPON THE COMPANY, ITS AOENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
9072543057
COMPANIES AFFORDING COVERAGE
01 -28 -06
GENERAL AGGREGATE
PRODUCTS- COMPIOP AGO.
PERSONAL a ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE (Any ono M.)
COMBINED SINGLE
LIMIT
BODILY INJURY
(Per Person)
BODILY INJURY
(PO Accident)
PROPERTY DAMAGE
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY;
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
STATUTORY LIMITS
EACH ACCIDENT
DISEASE —POLICY UNIT
DISEASE — EACH EMPLOYEE
LIMITS
MED. EXPENSE (Any One p.non)
$
S
S
S
3
$
S
S
$
S
5 100,000
$ 500,000
S 100,000
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