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320 NE 100 StPROPERTY OWNER /� Name / 9 �//� / ?L'f O ti? !4 0D/L Address 3 o?O 4/Z /00sr Home Telephone -3 0 .S 7 5-54.. t3 / Business Telephone3 o f, 0 0 p -� 3^ , 7 e2 Fax Step 1. Job Address: Address Apt. Folio Number 113 f/ 6e O / 35 7 6 2 0 Lot Block Subdivision Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB PG PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Description of Zoning Square Feet _ Value of Work Tax Assessed/A Flood Zone 7 t A A F Master Permit No. PERMIT APPLICATION Subsidiary Permit No. of 0190 • 35' '9- INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: 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 submitted along with this permit application. Step 2. Submit 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. A PPLICATI ON 3 0 11/ e' /v 0 5" Hi/ 5 t Cit» I L A T F r L A T Name Addres MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date data Phone Time Pennit No. B p- Type Insp'n ty . 4 l/ 3 �� 3t Company For Inspector: o. D o j Name D • to Approved t 4 Correction ❑ Re- Insp'n Fee ❑ Page 2 I \I POR'1'AN'I' NOTICES 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 13E 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 OF FLORIDA, COUNTY,SF MI I -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Si ure of Owner ND /6 Print Name /lJ Sworn to and subscribed before me this ) day of SEAL: 3 ,r y > 7GOCD'r 4F Fv ' � S!i,rr102 r Personally known OR, Produced Identification Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: Personally known OR, Produced Identification PERMIT APPLICATION Type of Identification Produced: Type of Identification Produced: MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Type Insp'n �y ..4 Permit No. B p- bOc 3T Name 0 Addres OZO A.(-0 J0. O 3� �. Company a Phone os For Inspector: j Name Date Approved E Correction ❑ Re- Insp'n Fee ❑ // (A" Legend: — Centerf.ne Res — Resilience Fd — Found Conc — Concrete Gr — Gear R/W — Right of way cif — Chain link fence Ms — Measured Encr — EncroaCnment Fp 14" /,eo.4.! P /'E (N° e.+a) 0/5 CC .e . Ns. a° 0 1J .w. • /G ` • • .1 O O . O O' CM 'La . Yl Q • /9 :.*•,0A ,e ∎ar 2t. 7S 100TH H / ?. GO' 33. N ONE - STORY RES. N C..P.e.a c b M. N -1 CD`/c 67Ab64o -49 9 c PAVED ALLEY STREET Elevations bas, on Note- Lands shown heron were not abatrac:ed PCBM s A14.4 f for easements and/ or right -of - ways of reccrd. Bev. — , NGV Datum Legal description provioNrd by client. 1929 kl � s Oy '�CT N f ' t • 0 cis • v /5.0 1 V /5. o 2.4 7.4 • /B. G G 3 9.30 • ■f.K 8 • c/3J ,- _ r4 e' ti cS� . 6 Sc • y , _ s o Beanngs if Mown are a on assumed rngidian s✓ Ptaj Qt R... n ix p/. Na U'J 0 25' �.v 0 Q D • • • • B�DIJ�l.1LDA�2Y� •. ^ Stalk ' • V EY • • ••.• •• • • • • • • • • ••• s a:._ H ock 40, AMENDED PLAT OF MIAMI SHORES aaCTION NO- 1, ac:rdinq to the Q7at ;tbkrga;,••as.recorded in Plat Book 1 0, Page 1 :, of the Public '1t.d4rCLIC.gr•KSamh. -Dade County, Florida. ..:. • a•.• OBRADOR, C. HE 10C:h Street, Cl* IITIBD :O: Andrea C. Obrador Colo.ia Title of Ploride, floor Title Insuxance Company P1LM Mortgage Setvlcts Corpors* *on. es their iecerest may appsar Miami Shores, FL 33138 Inc. `-i•1 tg isp. Q _._ _ _. 4/..i.-- ilae ' .#41e)-- ; 4 1 " BOUNDARY SURVEY 1 N•r+er Certify: That the attee.M damn was wade w •n rerpooseio wrap eve .elfWfMy react tow ,r•teaae loceeleer etrheuee e• eat forth by the 71.001DA BOARD off LAND d4JKY*Y0110 r Cana et 0174, none, Aderd.a.tlre f+erruMt to deem-. • 1 Y B. CASTEL R.4latsred Land Surveyor No. 4129 $tats of Maids • • • • • • • ••• • • • • • •. . •• • ••••• • • • • • • • ••• its Uucces$ors • i7 /b = /9 - , ••••• , .e• FLOOD ZOME: end/ ot e19tts Ins SST e. 30 s r "`T • LOCA71ON M GARY B. CASTEL SURVEYING, INC. LAND SURVEYORS 12016 S.W. 132nd COURT, MIAMI. FLORIDA 33186 (305) 25379720 (305) 253-6767 p //E O 0 F.0 3 4 - /.eo.✓ P /PL` 1140 Q.+v Legend: — Centerline Res — Rei maence Fd — Found Conn — Concrete Clf — Clear R/w — Right of way Clf — Chasn link fence Ms — Mea Encr — Encroachment to , Z , ca ,,,ncc , in _ D 20 — --- .W. 100TH STREET /9 :*A0 A t/ A-1 .0 ( y ! As y IQ 4 � 7 O. C'J.V ! N / vein In 13 23' d0e4itoc w41 V . s s/ w4trk .• I 00.001 CI r � I • • y ' CAS' w.vcc li ,. cof/4 , 0 • le3 1 D /5' 1 a . C .A.. 3 A-.4# - . . 4-.- ,,..--0v/oef s —.. �I -1.: p 2 t. 75 ONE -STORY RES. N_320 39.30 • v, / ?. co%�_ N uu C4 c (:■ N • P A LLE /B. G G N .15 Cam / . L- 6AMCd o ie G' 8 c•/3.5:w44 4.. Elevations bat> on Note Lands shown hereon were not abatrac :ed PCBM tf I✓ /4 f Beanngs if Mown are vs for easements and/ or right -of - ways of record. Bev. — • . NGV Datum on assumed me�idiars / Legal description provided by client. 1929 Pla��f R ►� -• cc` if •z5 O 0 I . '4.• /c• ,oioe A' Uo) dev Jr • D S:i 2TION: az- , Bock 42%. MO. 1, acc :rding to the .p 10, Page ,..:, . of the Publid • . • • SURVEY 70 : WO . MAR, Az ras C. 320 MB 100:h Street, CC T>�FIED ?O: Andres C. �brador Colombia Title of Florida, Inc. nc 'floor Title Insurae Cca►pany PIM Mortgage Services CocporD* on. its auccaseora and /C es their it torost may appear • • ••. • .. • • • ••• r • • • F3ov�.D1�Y S c)i2 V EY Miami Shores, FL 33138 t4) •... • •. ,• • • .• • • • • •• • • • ••• •• BOUNDARY SURVEY B. CASTEL ro Reglatsd Land Sweeper Mo. 4129 State of Fb,lda AMSN1AIL PLAT OF MIAMI SNORES 8>;CTION l:f►C X4144101, as recorded in Plat Book SeNr¢s,.�gt• Miami -Dade County, tlorida.. /�. E. 13 if 1' 1 M...ay c«t tr. TU.t On att.st,•e U.S a" we weft wafer way re.oes.wt. anon. sad •th•t••tWy numb tlr ,ehierw %,.Aela.t standards as *tat forth by tht f►ortiDA 0OAAO to LAM, SURVIVOR, to cagttr at St 74, /ends Arsrr.tr o.. Cep. twrwat to esee. 47 •, 7, �r A • • ••.• •., • • • • ••• • ••• --'— ' co • .570-Ear 1.' 9 B 7 . s� furl VII• /6 • ,7 ib I w , f FLOOD ZONE: W it i9 ` u. E . 30 ST? 17 4.11 4'1 gns • LO CAT? ON MAP' GARY B. CASTEL SURVEYING, INC. LAND SURVEYORS 12016 S.W. 132nd COURT. MIAMI. FLORIDA 33186 (305) 25379720 (305) 263-6767 T JJol so. 02/21/2002 10:40 3058836606 PAN AMERICAN CONST. PAGE 01 CERTIFICATE OF INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. Name and Address of Agency United Service Agency, Inc. Post Office Box 11765 Lexington, Kentucky 40577 Name and Address of Insured APAC - Florida, Inc. Pan American Division 7600 N.W. 69th Avenue Medley, Florida 33166 This is to certify that policies of Insurance listed below have been Issued to the Insured named above and are In force at this time. Company Policy Letter Type of Insurance Policy Number Expiration Date AUTOMOBILE LIABILITY A ® COMPREHENSIVE FORM © OWNED III HIRED ▪ NON-OWNED GENERAL LIABILITY A 0 COM'REHENSIVEFORM O PREMISES- OPERATIONS I EXPLOSION ANDCOUIPBE HAZARD • UNDERGROUND HAZARD 111 PRODUCTS/0OI1LZ Z) OPERATIONS HAZARD tO CONTRACTURAL INSURANCE CI 8ROA0 FORM PROPERTY DAMAGE • INDEPENDENT CONTRACTORS IN PERSONAL INJURY A DESCRIN I ION OF OPERATI • NSJLOCATIONSNEHICLE BLANKET CERTIFICATE CANCELLATION: EXCESS LIABILITY ❑ umase.LA FORM ❑ OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION and EMPLOYERS' LIABILITY Name and Address of Certificate Holder CITY OF MIAMI SHORES 10050 ME, 2ND AVE. MIAMI SHORES, FLORIDA 33138 LAB 26609 Effective: 12/1/98 LAB 26609 Effective! 12/1/98 12/01/02 12/01/02 WLR C4 311097 -4 12/01/02 Company Companies Affording Coverages Latter A Pacific Employers Insurance Company B C D E F G H Date Issued: Unlit* of Liability in Thousands (000) PERBONAL INJURY INCLUDING BODILY INJURY PROPERTY DAMAGE PERSONAL INJURY. BODILY INJURY AND PROPERTY DAMAGE COMBINED BODILY INJURY (EACH PERSON) BODILY INJURY (EACH OCCURRENCE) PROPERTY DAMAGE BODILY INJURY AND ROPERTY DAMAGE COMBINE BODILY INJURY AND PROPERTY DAMAGE COMBINED STATUTORY Each Policy Occurrence Aggregate $ 1,000 $ 1,000 $ $ $ 1,000 (EACH ACCIDENT) Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the Company. February 21, 2002 ntRIRICf9earrL1T11R¢ FO. /rte p �x.o Legend: — Centerline Res — Residence Fd — Found Conc — Concrete Clr — Gear R/W — Right of way Ctl — Chain link fence Ms — Measured Encr — Encroachment •• i ,1 01 C, L v -•••• 0 0 I0 • 2.c' Fo. /,esoid ,D/PE (Ale e, ; '' t Ce . N! 2n BO C& rc/4C,C ) • • 20.76 I. ONE -STORY Q. 7e 2 t.7S' • Note: Lands shown hereon were not abstracted tor easements and/ or right -of - ways of record. Legal description provided by client • •• RES. N!-320 3 a� •a4 4 ; b ! t . Z4 V.ao o /8.60 ,y 1 .J 1 (, r ,.. ,\ `` ` • ' 6-Aar-do _.. .. • . X 44 F3 car. rvA4C L I - J • Y U Bevations Wool on PCBM N /V` , I Bearings 1 shown are based Bev. — • NGV Datum on assumed 1929 --. 0 0 Q 6 ,• GL,e Witness(sign and print) 6�iu�n Shore6 ale STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, %6 S does hereby attest that the (property owner) AFFIDAVIT attached survey, performed by G'li /2) (_ f1 S%FL. S' /2 1/E/(4/o ,/ A/L__ (name of surveyor's company) performed on r e - --oo , is an accurate representation of the existing conditions and (date of survey) locations of all structures on the property as of this date. 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) SWORN TO AND SUBSCRIBED before me this day of Affiant is personally known to me, produced as identification. Bank of America Advantage' ANDRES C. OBRADOR 04-97 320 NE 100TH ST. MIAMI SHORES, FL 33138-2421 2219 63- 27/631 FL Dale 2 l c O2_ , 993 pay to order o pip (.1 5- CO e Dollars 8 BankofAfneric aa � T �� ACH Fi/F 063100277 Menlo 1:063 L00 2? ?I: 0034334 L? L -III' 22 L 9 1 ELECTRICAL TiPI Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTl'. '1'1'1'1: Service Repair Q'I'1'. A/C Central 1 -3 Ton - Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch - Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent - Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton Pressure Vessel 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 'nil: Minimum Fee Q'1'1'. TYPE Condensate Drain QTY TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons QTY. Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of - Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY T1'I'E Drains, Roof QTY. TYPE Miscellaneous Fixture QTY TYPE Soakage Pit QTY. 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: SECTION BY DATE Zoning �i' / a a r� =)? W Electrical Mechanical Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST U OWNER - BUILDER FORM (Attach) U FIRE DEPARTMENT APPROVAL (Commercial / multi - family) U CONCURRENCY (New Construction) U OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ FIRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PI:RNIIT FEES $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 $ 80 �/ g� $ X30 . o o ($35)4 3 $ (¢.005 /sq.ft.) 5- on ) , 0 (¢.01 /sq.ft.) TOTAL (sq.ft. = x/1000 x0.60) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) 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 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date X/3 OA / Job Address 3 .211 11) e- /(' D 5 Tax Folio Legal Description / Historically Designated: Yes No / Owner/Lessee / Tenant g///72/?(.7 /..g #4170 / 7 Master Permit # YiqA23 i/bwnei's Address 3 0 N 6 /) U Sr 'Phone 3 DS " S8 6 , cP q 7 1 Contracting Co. friA)-1/ fJh) Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company • Address Mortgagor / Address Permit Type (circle one BUILDING ' LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION RE PM L S 4�l/l'lL- Signature of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT APPROVED: RADON gl `jl I ©/ zoning 09 5 ata, Building Mechanical Plumbing C.C.F. ' 60 NOTARY C, Q () 7 My Commission Expires: Electrical 00 U 6'f) Square Ft. Estimated Cost (value) ‘O 0- U L) 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. 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. Furthermore, I authorize the above -named contractor to do the work stated. e of Contracto or Owner- Builder mipmso :. as to ontr cto 1-1 - Builder • p l:� :2c CE! 7 TA K 1 Op i1.0 ;, _; rr' `. BOND 30 '0 TOTAL DI3 f/30// Date ate Structural Engineer PERMIT NO. • ADDRESS: • MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT' SECTION BY DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Subject to compliance with alt Federal. State, County. Village rules end regulations. Village assumes no responstbllity for accurecy offor resutts from these plans. 2. This copy of plans mutt be available on building site or no Inspection will be conducted. 311 b � rn„� , CRITIQUE SHEET JOB ADDRES 0 /1 \ ( D 0_17 7 APPLICANT C 9;4 PHONE # APPLICATION t# SHEET OF MISCELLANEOUS DATE COMMENTS INITIALS STATE OF FLORIDA) COUNTY OF DADE) attached survey, performed by AFFIDAVIT The undersigned Affiant, , does hereby attest that the (property owner) (name of surveyor's company) performed on , is an accurate representation of the existing conditions and (rate of survey) locations of all structures on the property as of this date. 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. Affiant/Property owner Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this day of Affiant is personally known to me, produced as identification. Notary 21.75• ONE- STORY RES. N°320 n 24 7.4 4 4 8 car. w 4 C L GAR B. CASTEL Repisterad Land Surveyor No. 4129 Mate of tsletlds FO4- //d id /PE (A/o 0 0 . P /P4f (No e.4o) Legend. - Centertrne Res — Residence Fd — Found Conc — Concrete Cif — Clear R/W — Right of way CI1 — Chitin link fence Mt - Measured Encr — Encroachment O /S C.R. re N.W. 100TH $TR r .tt iS*.l. !'�'. . _.......•'4 J. s.: ' f�. i ti - QS K:n '.n.•.:eu,T i.iS :5:. :., -i:�hd A • *A..' • t J .S / 4 LAC r • 2 3 w 4 V. I0 Elevations bass on Note • Lands shown hereon were not abstracted PCBM • Al Ik for easements and / or right -of . ways of record. Bev. — • NGV Datum Legal description provided by client. 1929 N M ia:> • ?a' 15 PAVED ALLEY 11 05 Beanngs it shown are based on t assumed m - N n� Ptatoaf R 4C Ic 4O . v 0 0 ORIN /40.v ,o /19E (;(/v CAP) NOT VALID IMSLase eraoea1D WITH SURVEYORS SEAL • Bo a 4. i2Y SuJ2 v EY • jrA QFr$C2IPTION: to i an 10, Mock 40, ANDED PLAT OF MIAMI SEiORSB 5 CTION N0. 1, according to the plat thereof, as recorded in Plat Rook 10, Page 70, of the Public Records of sisal -Dads County, Florida. SWAM 708* ODRADOR, Andras C. 320 ME 100th Street, Miami Shores, FL 33138 C8 TIDIED TO: Andres C. Obrador Colombia Title of Biocide, Inc. ?lcor Title Insurance Company PUN Mortgage Ssrvlces Corporation. its successors and /or esalgne es their interest may appear BOUNDARY SURVEY 1 ewes" .sf GMT That n.a attached fhane. Rea sees woes. .v.aq$Maalla aee•eo see aW el allsey menu tee - ulwMw Woeeloel eln.eo,ea w PM tees by r• FLORIDA WAND Of LA110 MIRV$YOIS M Gbayber GI 4114, f't..tee Altielaru a.. c. . poretet. to aeaM. 472..0117, �l. E. 95 S •LOCAT?ON M.4F GARY B. CASTEL SURVEYING, INC. LAND SURVEYORS 12016 S.W. 132nd COURT, MIAMI, FLORIDA 33188 (305) 253 -9720 (305) 263 -6767 FLOOD ZONE: OWN. SY 7g PAN AMERICAN CONSTRUCTION A Division of APAC - Florida, Inc. 7tkz a 7600 N.W. 69th Avenue Medley, Florida 33166 Office: (305) 883 -8770 Fax: (305) 883 -6606 Andres (Andy) Obredor Vice President Sales ' CERTIFICATE OF INSURANCE —1 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THc COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. Name and Address of Agency United Service Agency, Inc. Post Office Box 11765 Lexington, Kentucky 40577 Company Companies Affording Coverages Letter A Pacific Employers Insurance Company B C E F H H I Name and Address gfii,laiur nerican coca d'fmetio® A Division of APAC - Florida, Inc. 7600 N.W. 691 Avenue Medley, Florida 33166 This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Company Letter Type of Insurance Policy Number Policy Expiration Date Limits of Liability in Thousands (OCO) Each Occurrence Policy Aggregate A GENERAL LIABIUTY LAB 26609 Effective: 12/1/98 12/01 /01 IRJURY INCLUDING BODILY INJURY PROPERTY DAMAGE 1 1 .n u) $ J ►7 COMPREHENSNE FORM 0 PREMISES •OPERATIONS ►�� EXPLOSION MO COLLAPSE l IZUNDEERGROUND HAZARD &{PRODUCTS / COMPLETED OPERATONS HAZARD IE CONTRACTJRAL MSUR:.NCE Z BROAD FORM PROPERTY DAMAGE Z INOEPEN0ENT CONTRACTORS PERSONAL a VRY PERSONAL INJURY , BODILY INJURY AND PROPERTY DAMAGE COMBINED n 1,000 S 1,000 A AUTOMOBILE LIABILITY FBI I�COMPRF]1ENSNE FO OWNED &HIRED < ENOt4-0wNED LAB 26609 Effective: 12/1/98 12/01/01 BODILY INJURY (EACH PERSON) BODILY INJURY (EACH OCCURENCEI $ $ ;' , • 41 ,_ + '1.';‘,".' . , : ; fit: '. , • • . ,, PROPERTY DAMAGE $ BODILY INJURY AND PROPERTY DAMAGE COMBINED $ 1,000 EXCESS LIABILITY BODILY INJURY AND PROPERTY DAMAGE COMBINED S S ill UMBRELLA FORM ❑ OTHER THAN UMBRELLA FORM A YWORKERS' COMPENSATION and EMPLOYERS' LIABIUTY WLR C4 299264 -1 12101 /01 STATUTORY •I ' % - $ 1,000 (EACH ACCIDENT) $ $ DESCRIPTION OF OPERATIONS40CATIONSNEHICLES CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. Name and Address cf Certificate Holder Date Issued: )1AJ2,- 1 4 . ■ AUTHORIZED SIGNATURE 201 -7 -- (9 74.