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DS-10-1691Inspection Number: INSP- 155297 Permit Number: DS -9 -10 -1691 Scheduled Inspection Date: January 31, 2011 Inspector: Bruhn, Norman Owner: PERRY, ROXANNE Job Address: 868 NE 100 Street Miami Shores, FL Project: <NONE> Contractor: EUROPEAN SCULPTURED STONE CORP Building Department Comments REPLACE EXISTING SIDEWALK AN DRIVEWAY WITH NEW CONCRETE Passe Failed Correction Needed Re- Inspection Fee January 28, 2011 No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments, CREATED AS REINSPECTION FOR INSP- 151551. Re -sod disturbed areas. repave area at swale paving. remove red concrete color from Village property NB For Inspections please call: (305)762 -4949 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New ei iimo Phone Number Parcel Number 1132060340020 Phone: (954)742 -6832 Page 16 of 29 PERMIT NO.. _TAX FOLIO x40JL 4:14,=:> - STATE OF FIDRIDA: COUNTY or MAW-DADE: . tiettkettibtiaiterebygives heibt that linprovoments wWb� m. Lo certain rciai itsi ndbi ectiOrdance With Chpter71.3; RiOrideStidtes, thei foloWing tat:irritation is provided fa this Notice of Coaftnencernant. SPaceabeve reserved for use- of recs. office 1. Legal deseriptiott pnvexty and streetiaddiess:. . • . "2: Description of imptivernent 3. Owneo(e) name:end address: tnterest kr:property: . - Nariiirafittaddress'ef fee shrtp 4. •Contractor•narne, address told phone number r . . . S. Sikety:. (Payment bond required by <witutr from contractor, f any) Nook address and phone Amount. of bond $ Lender's name and address: . . • ( #' - • • 7. Persons within the State of Frorida.designated by Owner upon :whoiri notices tri; other documents Maybe dented Ita Provided bY Section 713.13(11)(tip., ...Statutes; Nam. address antiphons number: _ . . • - • 8. to himself. Owners•designates the following person(s)te NiCatta cOpy of The Lienor's Notice as provided Iry Section 713430)(4, Florida Statutes, Name; ad:frees and phoneraunber: • • • Amato* OspinaiWei Prepared Print Nan* Title/Office STATE OF FLORIDA COUNTY OF MIANiiDAOE The foreaolfv) -Instionvintwee NC * .,,, .., ; OrroeilDirethoriFertrierManager V. / , a i /,,/,,i /Ai, - - •pi .. Print Marie: . Titio/Offoo L -'1 Y*.;;, 11.:11 Under penal** of perjOry, 1 declare that I have read the foregoing-and that the facts stated in it are true. to the beet of InY knOwlodge and begat ON . 0 . TIE XRIPSITE AT TWO Fwar INSPECTMX HARVEY 1111111111ainti1111111iiiiiiimini CF . 2 0 10 RO 4- 4-3:50 . OR Bk 27429 Pa 4574; (1ss) RECORDED 09122/2010 13:21:15 'HARVEY RUVIN, CLERK OF COURT HIM!' -DADE COUHTY, FLORIDA LAST PAGE 9. Expiretkin digs Of this Nettle Cotnniencernent- . EIltooxpIrathatr ttato Is year Itom the -deo of warding Wow dIfferoat gloN If! opoolfotl " - WAfiNIN GTOOWiEfl .. WPAYMTS . M D BVTh E(*(483 OP'thENOTroEOPOONIMENOEMENT ARE DONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PAM t, SECTION 113.13. FLORIDA SMITES, AND CAN RESULT IN YOUR PAYING TWICE FOR' IMPROVEMENTS TO YOUR PROPERTY- A NOTICE OF COMMENCEMENT MATE* RECORDED AND POSTED. MIRE JOS SITE SWORE THE FIRST INSPEcTK3N. IF YOU IMMO TO OBTAIN FINANCING; CONSULT VA114 YOUR LEKIER OR AN AITORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE oF COmMENcEMENE * MY COMMSSION EXPIRES:May 9, 2013 * Bondd Budget Nato semtes 'kap s. ere AiitherizeitMeerititrectoriParaitimodatietteilivaftme Bit 0 1 II ERE 131: . CER77 70 7 , thid , _ fa 13 4 I 3 ri se Tenant/Lessee Name: Folio/Parcel #: BUILDING PERMIT APPLICATION FBC 20 City: t1ii. i. `vh€ e State: JOB ADDRESS: 6 to N • F • lOV "'' b' I re.a City: Miami Shores D the Building Historically Designated: Yes State Certification or Registration #: 0 bav Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): 1 ' e' �� Phone #: 306 751 -7.1131 Address: etr 6 ALI. /O r.. 5frec t Email: County: /1 — 3 7-e) - 0 3 4 6 -- 63 , a� Qualifier Name: / o gi- 51 5 Miami Dade CONTRACTOR: Company Name: C uv f w' SW 1p}urte,( SAvisi o Address: Jip1 fr4 $� re Sits f City: 6C,vwi sG State: JAL Certificate of Competency #: paTmq SEP22 2010 ��) BY: . Permit No. S Q J(q 1 Master Permit No. Phone#: Zip: S1 3R; Zip: 3 13 $ NO Flood Zone: am Phone #: 4r 4 2' ( � 2 Zip: 333 Sl Phone #: - 7 c 2- 7 r C. Contact Phone #: Email Address: DESIGNER: Architect/Engineer: e Phone#: Value of Work for this Permit: $ 3 Square/Linear Footage of Work: Type of Work: OAddress OAlteration ONew C8flepair/Replace ODemolition Description of Work: r>044-01- C e- IgCcsrt /6 S' a ,ec c) ^— et' ,,?` .sir COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by ****** **a ** ******* *** **** ********18 Fees************* ** ** ********** ** *************** Submittal Fee $ Permit Fee $ / °o° CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1r 1 (g .90 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 �L M Owner or Agent The foregoing instrument was acknowledged before me this 2.Z� day of 00 20 /O, by , I ;7,) tN0 l© , who is personally known to me or who has' 1 / As identification and who did take an oath. NOTARY PUBLIC: Print: My Commission Expires: q �� d d d d d d d dd d d ddd d d d d d ddddd'6gpf`m'w MUNE RROSS ' c MY COMMISSION I OD 061772 EXPIRES: May 9, 2813 ' wiled ThNBudget Netwi Seivites dddd dddddddddddddddd ddddddddddddddddddddddddddddddd varlY Ris APPROVED BY a l.i Plans Examiner (Revised 0710 07)(Revised 06 10 2009)(Revised 3 15 09Xiev6 410) Structural Review Contractor The foregoing instrument was acknowledged before me this Z Z- day of Szra %k 20 i , by AO aye i4A4 -5 1 who i ersonasy to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print My Commission Expires: 4e MELANIE R. ROSS * MY COMMISSION 6 DD 561772 EXPIRES: May 9, 2013 oe�o Bonded Thru Budget Matey Services AT FOF Fb ddddddddddddddddddddddddd / / l C1 Zoning Clerk ANCE JD AS A MATTER OF INFORMATION IO RIGHTS UPON THE CERTIFICATE rt re kPFORDED BY THE POLICE EXTEND, DA>E'D, ammo OR 2AGE NAIC # )RED NAMED ASOVE FOR THE POLICY PERIOD R DOCUMENT WITH RESPECT TO WHICH THIS BEO HEREIN is SUBJECT TO ALL THE TERMS tEDUCED SY PAID CLAIMS. Oars EACH oscuRSNOS 1.000,00080 DANIAME TO NENTm MED 4(P (Any once Foram) 100, 1300.00 $ 5.000. PEn$cAAL & ADV IN.IIJaZy s 'I .O00,OOQ.00 °DNERAL GRa3ATE R 2.000,000.00 PRODuCTB COSIROPMG $ $2.000,000 ( BI LE LIMIT (person) RY De Y JURY $ PROPEATY BAMAGE (Per etieriatp AUTO ONLY EA ACCIDENT $ OTHSR THAN EA ACC S AUTO ONLY: A00 EACH OCCURENCE $ AGOReaATE ss l� TORY Lams � EL EACH AcciDENT EL. DISEASE- EA EMPLOYEE 11111.11 $ $ et. O*S A&E- PC)LGY uNIT $ OEM. AGGREGATE LIMIT APPLIES PER Pt7LICY 7., f ioc AIITismoTNE LIA$$JTY . ANY AUTO ■ ALL OWED AUTos C SCHEDULED ALMMOS HfRED . CEO AUTOS r LIDEDUCTIfSLE I 1RETcHTicsu $ iw0RI W$ COMASR ANp ErNPS,oYER$' LIARILITY ANY PIZOFRIEFOR1PARTNERIEXECUTryE OFFIC EM ID(CLUDEM it roe damn* under sFEdIAL MovrslaN$ bow O'R CERTIFICATE OF LIABILITY INSU PRbDUCER Photse - 9544 5$ -G444 Fat[ - $ 4- s83.2820 Pelican Insurance Agency 6950 Cypress Rd Ste 208/7 Plantation, Fl 33317 HAIdiwn — NsutiRtA: Concrete By Design Inc. dba European Sculptured Stone,Corp. 10001 NW 50 St #104 Sunrise, FL 33351 COVERAGES A 6Ei(BtAL LIABILI b IDOMMERCIAL GENERAL LIAKITY ILXAIMBMADE C UR OTHER CERTIFICATE HOLDER Miami Shore(' Village Attn: Building & Zoning Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 305-758-8972 ACORD 2S (200110&) 1 OT 1HIS CERTIFICATE IS I ONLY AND CONFERS HOLDER. THIS CERT ALTeR THE COVERAGE INSURERS AFFORDING DOVE iRRURER B: MOUSER C. NOURER p: INSURER E Burlington DESCRIPTION OF QPERATtONs t7CA CLUSION$ Apps Ey REES ENT1SPE CIAL PROVISIONS THIS 15 TO CERTIFY THAT THE POLICIES OP INSURANcE LISTED BELOW HAVE BEEN ISSUED TO THE IN INDICATED, NOTWI ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHE CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THe INSURANCE AFFORDED BY THE POLi)IeS DESCRI EXCLUSIONS AND CONDITIONS OP SUCH PCUCES LIMr'ts SHOWN MAY HAVE EWEN f TYPE OFtW$u NCNi F ucY Nue®ER DATE ue D EX PI RAT G 359B003600 Sf1 312011 CANCELLATION (Soo @ BeIovllt EXPIRATION GR T T H E aV2 R®DP, THE G CO Y� � T O MAIL, E 1C J7rPIR¢1 DAYS N4T10E TA THE CERTIFICATE HOI.biga ammo a& ri r '90T FAIL Ht TO N AIL OUCH SHALL IMPOSE l OBLIGATION OR VFANYKWDUPONTHE COMP ITS APSITP OILRE!RESISETAIWE4 AUTHORS REPRESSIVIA'IWE Samuel Jacks C4CORD CORPORATION 1868 DuCY PERIOD INDICATED. :H THIS CEhTTIFICATE MAY AIS, EXCLUSIONS AND CONDITIONS LAM NOTW TH3TANDINO SE 13UtD OR OF SUCH EACMOM1S1081,mR g IV t[tri l su PREM ES (Eat o>xl r Its) $ NED GNP (Any one person) E PERSONA/ &ADV INJURY $ GENERAL AGO:te # TE 8 PRODU TS- COAProPAI $ co k tNGLE L1MIT INJURY ( L R V aq, NODDY $ (P ) ALITp EAACCIDENT $ IRAN EAACC $ AUTO MY AGG S +u $ Af3GATE $ $ $ $ tc PI- X E.L. EACH Ammon S 1.000,000 • ELDt ASE- EAEMPIATE IS 1,000,000 a=LTAsEJ E- POUC;YLIMPT $ 1,000.000 , Georgia and Taxed 101 PLEASR CALL P/RST Operation $INANCIAL ACORD,, CERTIFICATE OF LIABILITY INSURANCE PRODUCER Risk Tranefer Programa, LLC 219 "Pat Livingatan Street Orlando. FL 3280i Mon, 866- 481 -9363 First Financial E,P1oyoe Leasing II, Inc. Ph 941 .-925 -7141; 800 -424' $ 5 /Fx 941.$82_9852 2745 Temiam4 Trail Port Charlotte. FL 33952 COVERAGES MMus. Warty comMISta.ALmmSvALLmsturr 01.AtMS MARE OCCUR AISPRE RE LA STAPPLESPER: Pintcf JSGT. F LOC AUTOMOBILE L A$ILI1Y ARYAN() AU-QAUTUS scHEDULEDAUTt MIRED AUTOS NON -OWNED AUTOS 6ARAC•.E LIAgILI1Y ANY AUTO oncui: claims MADE DF.UODEELE NETENTIoN $ =OM CUMPEN$A oN AND 15IPLOWERP IJA$ILITY OFF CUTt 5P C PIAL ROLISi . CABER CERTIFICATE HOLDER Miami Shores Village 10050 N.E. 2nd Avenue rtiami 8$C,YQ:e, FA 33138 ACORD 25 (2001 /OM ASLTRP3 000065 OS Q3TR8APIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW INSURERS AFFORDING COVERAGE IIY$UR RAcaat).ePaint national aueurance coma INSURER C: INSURSRD: tF: THE POLICIES OF tNSIURANCE LISTED BELOW HAVE SEEN ISSUED 1 O THE IWSVRED NAMSD AB.OW. FOR THE P ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRAACT OR OTHER DOCUMENT WITw RESPECTTO WHI MAY PCRTAINI. THE INSURANCE AFFONDEo SY THE POLICIES DESCRIBED HEREIN 15 SUS.JECT TO ALL THE T EfF POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY MID CLAIMS. PoiscyNISKteft DATE 9551190PPA RATE IMINIDDNYI 12/21/2009 01/01/2011 OEStk/ PTIONCR$ Posmas8 mamma ntEMOt.esnatussoNS 8Y END T (59ECM FROMM Coverage ia1 extended to the leased asplo�y of alternate employer (Alabaitta, Florida Only): European Sculptured Stone Corp. dba Concrete by Design #3864S(Rffective S /20/ E'OR AN TIPDA:115r LIST pg' CDYLsRED EMPLOYERS. . CANCELLATION ANTRaPAREDINEPREBarTATIVE Page 1 of 2 DATE BOWDDRITY1 09/22/2010 NAIC # OKAD 8 ANY OPIEE MIME DEOCR18ffi maim BE OANDELLBD isysTesiut E7@MRATNSH son 1z ss TIM Malmo watt= VDU.EIDEAV&RY@RAasaDAY8%F6TS N NOIICETO THE CERTIRO tE DOWER NAI EDyry E L> 413th FA/ mamma) &&TALI RNPdm. NO OBLIGATION 1 UA$SITY OF ANY KIND UPON THE INSURER. {Tt Awns ON sersEsemsrms.s. ® ACORD CORPORATION 1988 The boundary or feuded. I Hereby Certify That the dhwtlan also that there are F1,01t1 I/1 11r I I l NU & HEALTH D NE - -DAM— FLOOD INFO: Community Miami Dade Co. 120852 Map & Panel & 12086CO306 Suffix L Flood Zone: X Base Flood Elevation: SURVEYOR'S NOTES: 1- OHPERSiaP IS SU&ECT ID OFTNION OF 7IJLE 2 -NO UNDERGROUND IMPROVEMENTS WERE LOCATED .3-ELEVATIONS ARE REFERRED TO NATIONAL G930271C VERACAL DATUM OF 1929 PUNS ASSUMED 4 -TNERE MAY BE MITIM . DNS MOT A tA SNOW IN MS RUT MA PUBLIC 5-LEGAL 9- UNLESS DARERM$ 7- BEFORE ANY MOST BE B -ALL FIELD 18111 ELECTRWUC TRANSIT 9-DOS SURVEYS FOR USE AND NOT Fe? ARV OTHER 10- WAS OREP 11- DATE dAFPFer1 NOM( • • • • • • • • • • • •• •• ••• • • otter th • • - • •• • ••• • • • • • • • • • • • • •• •• • ••• • • BOUNDARY SURVEY PROUDLY SERWI0 FLORIDA COAST TO MAST LOT -2 BLOCK-169 LEGAL DESCRIPTION: LOT 3 AND EAST 3 OF LOT 4, IN BLOCK 169, OF "MIAMI SHORES SECTION 8 ", ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 14, AT PAGE 33, OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIDA OFF:(877)- 894 -8CW 22400 WEST 80 STREET "3 H)MEAH. FLORIDA 33018 r lc (R) LOCATIONIes Village DATE APPROVED ZONING DEPT BLDG DE SIAM STATE AND 'Peva 7 ?8 _So IT SrA44ALa ,4c.tcre pf ; by eW Y F.LP 1/f NO CAP CERTIFIED TO: ROXANNE PERRY This • has Men prepared for She ,Ni, sdu me of the entities named herein and the tkrtglmBm does not ester d to may unnamed pate WOOD L 4 Ut1 T PCLE E •• FIRE HYDRANT S V AP m CONC. AMER POLE GM GV w OAS M OA V: SAN. • SANITARY MANHOLE S.S. • DRAINAGE MANHOLE NOTE THE PLODS DATA PHOYIDED STOR INPOBMA1ON PURPOSES QLLY,ffi SURVEYOR MAKES NOGIARANI ® AS70 M1E ACCURACY ME TIM D41•MATION PROVID®1DE LOCAL F. MA AGENCY SHOULD HE CONTACIPD FOR VFHIFSAMON. rL!U / i Aftr e., „rcdok ' ADDRESS: 868 NE 100th ST. MIAMI SHORES 81.. 33138 LEG Re c d ERE P E lm g : /p lal PVMT= Pavement d P m Concrete Found arch W.' Wood F WaY F trap Pipe - - Chain Link Fence I.R.G® trot Rod and Cap 1 a Centerline__ A/Ost Air Conditioner, - P.L - Property line U.E• Utlty Easement P.O.L. o Point on Una B.0.8.= Basta of Beadng 9' t Pipe RAH... Roof Overhang Swk ® PL ti Planter Cana = Concrete k CBS wi Concrete Sladt r, _ UaelsgWeeesU )7 Ei 7 S S d g Elavation RES m Residence pp IDiB ! 3= = AfanG a m mod / UCEelsp "rp� Nasrlb e (” �QRCw' CARLOS HERNANDEZ PROFESSIONAL SURVEYOR AND MAPPER PLSM 5718 08 ELECT FIE CODEMNEME1tmnT LASH Survey le net mad without the signature and rakred /dleRd seal at the Flaade Regteteed Pretest I Land Surveyor and 1 BASIS OF BEARING BASE: BASEeHDWN1EREONAPB ONNORIN LINE Cf LOT 3sLo -' 9 N9093097E ASSUMED WITH ALL FEDERAL MTV RULES AND REGULATIONS /010 0