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DS-10-203 ow Miami Shares Village 10050 N.E. 2nd Avenue '• Miami Shores, FL 33138 -0001 1 e m Phone: (305)795 -2204 Expiration: 0811612010 Project Address Parcel Number Applicant 160 104 Street _ 1121360130760 JOHN BALDWIN Miami Shores, FL 33138 -2029 Block: Lot: Owner Information Address Phone Cell JOHN BALDWIN 106 104 Street MIAMI SHORES FL 33138 -2029 Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 PAVERS AND BRICKS SERVICES COI (305)986 -2544 (786)443 -7107 Total Sq Feet: 800 Approved: Yes For Inspections please call: Comments: (305)762 -4949 Date Approved: 2/10 /2010: Yes Available Inspections: Date Denied: Inspection Type: Type of Work: BRICK DRIVEWAY Additional Info: BUILDING l Final Bond Return : Classification: Residential Sidewalk Landscaping Foundation Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $ 1.80 DS -2 -10 -37022 $ 135.80 $ 50.00 1 Education Surcharge $0.60 F'- Permit Fee $125.00 DS-2 -10 -37022 $ 135.80 $ 135.80 $ 0.00 Scanning Fee $6.00 Technology Fee $2.40 Total: $135.80 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 February 17, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Departmen Copy February 17, 2010 - 1 4. 1Vliami Shores Village �1 Building Department FEB 1 0 2010 10050 N.E.2nd Avenue, Miami Shores,. Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. `D S I 0 PERMIT APPLICATION Master Permit No FBC 2004 Permit Type (circle): Building Roofmg Owner's Name (Fee Simple Titleholder) OM 13 VvW Phone # 3 0,5_ q5'16 Owner's Address city A wm i 5g rS State e— Zip 331 TenangLessee Name Phone # Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO g Y � Contractor's Company Name TAy6n,S �`H I ht! Phone # 05 9 9 1 Contractor's Address ` ��+� �y a 5T Sk SE City /V M , iAA4 i, _. State F Z Zip 3 �l Qualifier Nam p e R A-ul P • FA Q.4VDC Z Phone # y �l q 3 ?107- 6l A, ` CO� State Certificate or Registration No. �voc u ap 6 ! o Certificate of Competency No Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: goo Type of Work: OAddition ElAlteration New El Repair/Replace ❑ Demolition Describe Work: C-%/ Vn e Vg' WA Y kyl> AdapnaA C WT TH 1V C Qx A -SAN A SS e c osyk „ � • Submittal Fee $ Permit Fee $ CCF $ P • CO /CC - '%p Notary $ _ Training/Education Fee $ n Technology Fee Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ rtn o 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 hick occurs seven (7) days after the building permit is issued. In the absence of such posted notice, .the inspection will not be a roved a reinspe . o a will be charged. Signature Signature Owner or Agent Contractor The fore of instrument was acknowledged before me this The foregoing instrument was acknowledged before me this. V day of , 2014, by �iMna M . �pL WiN day of 4 20.-, by RAVI- A- FAau�v®i✓ who is personally 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. as identification and who did take an loath. NOTARY PUB Ng" plreLtc sTA of FL ORIDA Ruth Cordeiro NOTARY PUB NOTARYPUBLIC-STATEoFFLORIDA Ruth Cordelro Commission #DD734765 � -4 _ Commission #DD734765 Expires: NOV 15, 2011 V °•..��...•� Expires: NOV 17, 2011 Sign: Q BONDED MU ATLANTIC BONDING W IN Sign Print: G yc d eeo Print: My Commission Expires: N C) V . 1l.� My Commission Expires: NO U APPLICATION APPROVED BY: tr��'�(� Plans Examiner e Engineer Zoning (Revised 07/10/07) Planning and Zoning Criteria Miami Shores Village Permit NO. DS-2 10050 N.E. 2nd Avenue .w hil Miami Shores, FL 33138 -0000 fr R Phone: (305)795 -2204 Fax: (305)756 -8972 Issue Data: Not Issued Expires: a r S 'Y :3 Folio Number) 121360130760 Owner's Name: JOHN BALDWIN Owner's Phone: Job Address: 160 104 Street Total Square Feet: 800 Miami Shores, FL 33138 -2029 Total Job Valuation: $ 2,400.00 Contractor(s) Phone Primary Contractor PAVERS AND BRICKS SERVICES CORP (305)986 -2544 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 2/10 /2010: Yes Comments: i I tip: e .. , ? n , .` f t! a ,...` J`.� d l �•{J ... � "'� r..r M -- t:t . } .. r. fl._ fi � .. ?. ( f / u 'Tf } ♦ , V _t om'; g- 7"1 D I v' I L - C :1.,�iilf ���i . LO ti .'��ar;d e, in EloCk , 22, of A,rq AN I�DD.: i .^ 0::! � ; cr . m - , L 3H0" r { -'� tom the plat ther�b••f :zs`' G. 0� �► a,cco_d_,. I ar recr_ded �:. r__' 4t Duck 109 4t -Padp $7, of the pudic - acorls Of Dade � ,' ' ` AX' ' Ni< OCti:it�•, ^yr_�r:.: v : S ih j tact tl� n�. �.eda cat:: ons thereof . � � L 4% ' - �P�' I Order _, o 7a1: Scal e: as ohv►,rrri Fi ►�L-1 F,o:,xt, } „ Date: JU1 1:, 9 1 (�. 3 0 x_';" 104:xh 3t -^eet ,.. �. Nom Shov lr�r .da {1.4:. .:s.i>v .I il.7 i i 1.f: .• L•si�t. 4 vhe7 • , '4 ira Oun ur,.re '1. s •i@ r ^'. '• ' • . ��, D 3 S � Y rs r r�: sea ., Q survP� r :.tde ;,I:G r m direction, and is true arsd correct to the fast c -y k!v)%; _ °ids^. ;and !'::.1'.'.:` • Thiry :art! no encroacrl'iT mte an)-ea -s sbowri t."":'C. Otl ��� IT � ®'• I]:J�7)�° o�� !o• 4' This Fur ey me��: c.irV mum te�cur.:.a..2 stardards se;t forty b the ' ~--` ' S F-- •-�. �.� Miand Shores Viila e . ti'• } BOQXd Of Le rld e.r , t , t o ^ -eZ ° } r 7 02 C •F - ne- J ► P ., p e -• 4 7 • 7 plt r: w3 3. t . L' v • i. x APPROVED i �`_ By m r•', ;' _ ,,.+•`. SOLTmIl 1. TIC S i' ;T! :ar,S f P. YL0'! TD- ., !!Ic 83 ? ZONI r'J. 1',�a Dw l l•' 9 1r9 ! NG DEPT {� ., i ? 10 0 ��, 3 . '� --,,, �.":»�►... ��,w; BLDG DEPT zr c � Ojj .. . m it , Px't", s SUBJECT TO COMPUAN&M' kFi ALL FEDERAlk3 f z .*� Reg- st - red L ,- S'C ! NO • 2 � „at %.te of rlcrida STATE A�4D COONTY RUL_5S AND REGULATIONS PT',GF ,*.R.1 LPC'ATZ D IR L00D 20jE: (Fanel 00 F) _ 1 1, I ED P. I.T. . P't0�TGA%]t I: ^_o, :.ts successors andfvr ii;c asst i�o 035 P 1251,} .45t • uite 308, fTarth pl mm ,, .-p �'ri;:r, 33'; (:� � 2 mtu} 'J T J1i.T�.A2tTE$ ; -' T I `�'.i.,:�' .*'D D'RT.;ST COr:I'114y °' j �o ' 1= ,�! •.,r x- 4445 sake F0rjs -1 D^ ve, Cinnciaa•ty, Y�';�� -A IR:�'At TIT'W vvpi t . AL ppp .. .. }• 1 V qs •• ••• • • • 1 1atl psi ► r• SS rfr wry _. C a• • • • •• ••• •• • • • • • • • • • r t} r/ / . :,1 � irk' • -- ' • • +% • • • • • • • Lc • • • • e • • - • •.. --- •- i FEB 1 0 2090 Rj _. .. • M� L.i• /. / / ' V V . ,'' � � •' r ' -0.-1 -_ i ; . •.. •.• — • P W ARTMBNT OF ALT Charlie Crist Ana. M. Viamonte Ros, M.D., M.P.H. Governor State Surgeon General February 04, 2010 Paulo Ramos 160 NE 104 St Miami, FL 33138 RE: Contingency Letter Application Document No: AP951133 Centrax Permit Number: 13 -SC- 1119614 OSTDS Number: 160 NE 104 St Miami, FL 33138 Lot: 7 -8 Block: 122 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 02/03/2010 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. 1. -There is no increase in sewage flow, change in characteristics compromising the integrity or function of the system installation. 2. -This project entails: "BRICKS PAVERS DRIVEWAY " From a review of your completed application, it has been determined that your existing system is adequate for the proposed use: "APPROVED ". G/P If you have any questions on this matter, please call our office at (786) 315 -2444. Sincerely, sep r, Engineer Specialist II Enclosures cc: Miami -Dade County Health Department 1765 NW 167 St, Opa Locka, FL 33056 Phone: (786) 315-2444 Fax: (786) 315-2090 STATE OF FLORIDA DEPARTMENT OF WEAL H � " FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMI� Permit Application Number' PART II - SITE PLAN -- — -- .; — -- _ ice° r .Scale: Each.blo& represents 5 feet and 1 inch - 50 feet. ._ .. i £ w i £ �y £ 1-7 ji I - _. -_, - d Ij 3 £ $ -°p' T 14 } £._ s T J " ". f+ . - .i _ 4- i * £ ' _.., £.. d. i , € g £ $ E £. ' .s £ -. € - § p. P g t } 4 r f p - Nap. Site Plan submitted -, t Signature -- �= Title Plan Approved Not Approved Date'1- By Z County Health Department AL L CHANGES MUST BE APPRQV BY THE COUNTY H EALTH DEPARTMENT I DN 401 6, tta R S-H f=orm 40t5 which maybe used) 'Plock N~M44 M Page 2 of 3 r STATE OF FLORIDA. ` DEPARTMENT OF 14E" APPLICATI(WfOR ONSITE "SEWAGE DISPOSAL- SYSTeM CONSTRUCTION PERM °- ` Permit Application Number — — - - -- - - -- PART If - SITE PLAN -- Scale Each block represents 5 feet and 1 inch = 50 feet. LJ € € ?a '. i _� $ 1 g _4 d €. d ,. £ { S - } p^^•} w. p ...,....d w„ ¢..-„, '.° ...„erg $^` .j- P € € %ml d .. z 1 € .t.._ ..: S -:.. t I j r° q q.... p I ." £.. q ,., w_... Y €"- £ a T f ,a § r 4 4-,.,.. q 4 Z € € I _J a r g LJ ^T "E' _ ,• _-2, q € S. „.4- # . - "''," € g § +J4 " ". ,. ..,- ........ ......�.. .-,... . 3 ... € - s f_ §.s". .,„.._..«.- € ._6 ,... p £ 1 t _£ - - € a " t • -a- e .p ., g $,„ . ¢ .... L€ s �� f_J f A J "v-- -i - . -. - _..°-t p £ "z , a� a 41 „ r Y € A d Y Y € -.-- -§ � i-�- • -4 s„„. ...„„ Notes: r Site Plan submitted b -/ Signature lie Plan Approved - Not Approved Daie�4j � r BY. County Health rtnent _ ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTI#!1 DH 4015,10P (Rs&m HRS-H Form 4015 which may be used) , (Stock Number 5?d4 p 02401 q # 2[ 2'b , a ' t ssgi'ea€s.t.aL # &a 1 A 4.3� w X3es1s $iYf+'K �ieSNEr , S+Bi•`ZAG$+G.aA{ �.i #.Y.f ..e � � ; 4 ter_ .�. �. � �t j.: � a e a .g w�.s .i ff .,i a .a �, � r • FJ=IT NO. _ = STATE OF FLORIDA =__= DEPARTMENT OF HEALTH DAM PAIDt -- ONSITE SEWAGE DISPOSAL SYSTEM F� PAID: • APPLICATION FOR CONSTRUCTION PERMIT M APPLICATION FOR: I l New System [!/i3xisting System [ ] Rolding Tank [ ] Innovative [ ) Repair [ l Abandonment [ ] Temporary [ 44 Du i t16L wVA APPLICANT: �l-t iv AA �3AZ- t) i J✓ AGENT: _`'f,/� V c JkA-A 0 TELEPHONES MAILING ADDRESS: 0 N �: +!� `f S t .M AM i ,I Gw2o FL casxsc�x== �= =xa� == mss= =xx _ TO BE COMPLETED BY APPLACA040i. 4 ' ;S;gtr . ED AGEMT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(x) OR 489.552, FLORIDA STATUTES. PROPERTY INFORMATION t_ t LOT: '`.� BLOCK: 2 Z Z SUBDIVISION: l i -.!/ j I Ao- { p i PROPERTY ID #`: f Z j 0 ( -; U ZONING: I/M OR EQUIVALENT: [ Y / N ] I Z PROPERY SIZE: ACRES WATER SUPPLY: [ ] k VATS PU AT� [ < =2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /) DISTANCE TO SEWER: FT PROPERTY ADDRESS: - � (�O /V C I O l St M/AMI S& =f F& ,jam r 'DIRECTIONS TO PROPERTY: til, i A�•e moo. �� `f S , "[t! BUILDING INFORMATION [ RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commerc Institutional Sysem Design No Establishment Bedrooms Area Sgft Table 1, Chapter 648 -6, FAC 1 TAB L�( Z 3j ? 1 t ����w� w ! ►fin sck �ia�,i 2 3 ' [ ] Floor /Equipms t Dr SIGNATURE: DATE: � to Q �� ®/ DH 4015, /97 Page 1 (Previo s`etlition` ma us)fd) page 1 of '3 Stock Nu ber 744- 001 - 4015 -1 APPLICATION FOR: he typ6 of perrInit, if "Other" specify type in blank. APPLICANT: Property owner's full name. AGENT: Property ownees legally authorized representative. TELEPHONE: Telephone number for applicant or agent. MAILING ADDRESS: P.O. box or street, city, at and zip code malling address for applicant or agent. LOT, BLOCK, Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a SUBDIVISION: recorded subdivision, a copy of the lot legal description or deed must be attached. DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month/day/year) or at lot originally recorded. DWIng an approved lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot. PROPERTY ID#: 27 charactern r for property. CHD may require property appraiser ID # or section/township Iran gelparcel number. ZONING: Specify zoning and whether or not property is in I/M zoning or equivalent usage. PROPERTY SIZE: Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas mid prepared road beds within public rights-of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. Contiguous unpaved and non® road rights-of-way and easements with no subsurface obstructions may be included in calculating lot area. WATER SUPPLY: Check private or public <= 2000 gallons per day or public > 2000 gallons per day. SEWER AVAILABILITY Is sewer available as per 381.0065, Florida Statutes, and distance to sewer in feet. PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county. DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location. BUILDING INFORMATION: Check residential or commercial. TYPE ESTABLISHMENT: List type of establishment from Table 11, Chapter 1013-6, FAC. Examples: single family,1 single wide mobile home, restaurant, doctor's office. NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully screened patios or decks. Based on outside measurements fora story of structure. BUSINESS ACTIVITY. For commercial/Institutional applications only. List number of employees, shifts, and hour's of operation, or other information required by Table 11, Chapter 1013-6, FAC. FIXTURES: Mark Floor/Equipment Drains or Others and specify it or "NAO if not applicable. SIGNATURE / DATE: Signature of applicant or agent. Date application submitted to the CHD with appropriate fees and attachments. ATTACHMENTS: A site are drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded easernerds, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface watere, and other pedinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any public well within 200 feet of lot. For residences, a floor plant s° en s} showing number of bedrooms and building area of each unit. . For nonresidential establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other features necessary to determine composition and quantity of wastewater. 7 1l iami lots L L c h e OR Z 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138.2382 Telephone: (305) 795 -2207 t3Q5 }_75E -8972. Nk COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, Irt✓i hereinafter referred to as the Owner of the (owner) following described property: Legal description/folio#: Lot - AV� Block i !LL_ Subdivision Tax Folio #: requests permission to install: [ A phait, concrete [ ] Landscaping [ J Other within the public road right of way of IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: I • To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3• The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the items) to be removed and a lien . being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4• The undersigned further agrees that these conditions shall be deemed a covenant running with'tlie land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager or Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on s ® d of U 2,01 t (o er) SIGNED, SEALED AND DELIVERED in -the prese e : NOTARY PUBLIC-STATE OF FLORIDA "" Ruth Cordeiro Commission #DD734765 } ''•.,' °,,•' Expires: NOV.15,2011 110101M MU Aztec soxnnva co, INC. Property Information Map Page 1 of 1 My Home Miami -Dade County, Florida MI AM et ' Property Information Map s Summary Details: Folio No.: 11- 2138 -013 -0760 Pro 160 NE 104 ST Mailing JOHN BALDWIN &W PILAR {� dress: 160 NE 104 ST MIAMI S HORES FL 13 3138-2029 Property Information: Prima Zone: 1000 SINGLE FAMILY Primary RESIDENCE A 01 RESIDENTIAL - r CLUC: INGLE FAMILY � f � Beds/Baths: 2 y Floors: 1 L iving Units: 1 A ' Sq Footage: 1,821 Lot Size: 12,400 SQ FT b , Year Built: 1950 t3 6 52 41 31 52 42 MIAMI �€ SHORES SEC 5 PB 10 Legal 7 LOTS 7 & 8 BLK 122 Description: LOT SIZE 100.000 X 124 R15216- 206809911 R 15216 -2068 099100 Assessment Information: 2009 2008 Land Value: $190,925 289,86 �'�r' Buildin Value: $188,648 200,562 arket Value: $379,573 90,430 Digital Orthophotography - 2007 0 112 ft eased Value: $180,473 180,293 This map was created on 2110!2010 2:14:45 PM for reference purposes only. Exemption Information: ear• 2009 2008 Web Site © 2002 Miami -Dade County. All rights reserved. Homestead: $25,000 $25,000 _n! Homestead: YES I YES _ Taxable Value Information: Y ear: 2009 2008 Applied Applied T axing Authority: Exemption/ Exemption/ y Taxable Taxable Value: Value: Regional: $50 $50 $130,473 $130,293 County: $50,000/ $50 $130,473 $130,293 $50,000/ $50 $130,473 $130,293 ool Board: $25,000/ $25,000/ $155,473 $155,293 Sale Information: le Date: /1991 le Amount: 102,000 ale O/R: 15216 -2068 les ualification [as which are qualified Descri 'on: View Additional_Sales http: / /gisims2 .miamidade.gov /myhome /printmap. asp? mapurl= http: / /gisims2.miamidade.go... 2/10/2010 Y �i ,��. a s a 1 7 iF r �i *"E", � cy ; .� ` s b ax a (�^ M. ,��+ C � � `F' � 3Y 'W i' S `�' J � �' - x g s '; • -� -,. ti � a- `§�'* - �'z '�"S'i rzt a>In }n ✓ f * ' €Y3�.�`*r`,g* �.�' 4� k�"rv 9 pr , k. , ds , y -1 � 'r � �,x5'{S�' f � 3'LT � 2,, Sat *w'.. k" ��?�. y G3 F+ y �i Lx ; fi �*✓r? � E 9'h-� c� Y . �: � S�iq �`'�� ..'set �,�• m' ; s a d t `1` F rtr at :a er,. w' `"'��r " -1 M EN "rt�'`3 EMIR x k^a� Hk S S'}w`�t ,§ r .M � � - ' '.'�, � , '��e�`a y y�r a � � €'n ws`� r w ,� k � q,��t�}s���, � '� �� �� ' • `'_� .�t ,�}rxr �as4'�' �' !� ey 11 9 -1 , s ��'h, ��t"2� v a3 z� a �• , � '�-� aR ltw'a �."za� ` x' 'J Bi "<?',.j;�.`•z�as +" 4 Q3 ��� � ; d ��� � � a 4 2"a t� s'� � �. t � y ` *�, Cv�A' 3 �� ; re by q ¢ r`�`�i� � �s�"�1 '" ,�'4 y�, u�„�� �5�`�� . !. {f 1j r 1`fi yyam�:♦ •: : • • ♦ • .♦ { � r.•: • � ACO C! � DATE (MMIDD/YY) CERTIFICATE OF LIABILITY INSURANCE 12108/09 PRODUCER Accurate THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 8300 West Fla ler Suite 114 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)226 -8727 Fax (305)226 -8767 INSURERS AFFORDING COVERAGE NAIC # INSURED Pavers And Bricks Servises Corp. INSURER A: Lloyd Of London INSURER B. SUA 11835 W. Dixie Hwy INSURER C: North Miami, FL 33161 INSURER D: INSURER E: COVERAGES INSURER F. THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR NSRI) TYPE OF INSURANCE POLICY NUMBER D TEYMMIDD THE DATE MMIDD TION LTR INSRD LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 0 COMMERCIAL GENERAL LIABILITY ARTE009373 12120/09 12/20/10 PR Ea occurence 50,000 ❑ ❑ CLAIMS MADE © OCCUR MED EXP (Any one person) 5,000 A ❑ ❑ PERSONAL & ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG 1,000,000 ❑ POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY ❑ ❑ SCHEDULED AUTOS (Per person) ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) ❑ PROPERTY DAMAGE ❑ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC, ❑ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND ©W STATU- E] OTH- EMPLOYERS' LIABILITY 0002478787 04/07/09 04/07/10 TORY LIMITS ER B ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT 100,000 OFFICER / MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE 100,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Village of Miami Shores 30 DAYS WRITTEN NOTICE TO THE CERTIFIC LD ED TO 10050 NE 2 Avenue . THE LEFT BUT FAILURE TO DO $O SHALL IMPOSE OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR T S. Miami Shores, FL AUTHORIZED REPRESENTATIVE Lucia Estrella ACORD 25 (2001/08) CIF ©ACO CORPORATION 1988 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 135221 Permit Number: D -2 -10 -203 Scheduled Inspection Date: March 04, 2010 Permit Type: Driveways /Sidewalks /Slabs Inspector: Bruhn, Norman Inspection Type: Final Owner: BALDWIN, JOHN Work Classification: Addition /Alteration Job Address: 160 NE 104 Street Miami Shores, FL 33138 -2029 Phone Number Parcel Number 112136013076 Project: <NONE> Contractor: PAVERS AND BRICKS SERVICES CO RP Phone: (305)986 -2544 Building Department Comments NEW DRIVEWAY AND APPROACH WITH OLD CHICAGO BRICK ON SAND BASE. Inspector Comments Passed r Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 03, 2010 For Inspections please call: (305)762 -4949 Page 3 of 18