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DS-10-1271
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 160056 Scheduled Inspection Date: May 24, 2011 Inspector: Bruhn, Norman Owner: LIDDLE, IVAN Job Address: 10125 N MIAMI Avenue Miami Shores, FL 33138- Permit Number: DS -7 -10 -1271 Project: <NONE> Contractor: BEAUTIFUL CONCRETE Permit Type: Driveways /Sidewalks/Slabs Inspection Type: Final Work Classification: New Phone Number 305 - 758 -1452 Parcel Number 1132060131500 Phone: 954 -693 -7777 Building Department Comments STAMPED CONCRETE DRIVEWAY Passed,--o�.f l Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP - 158776. CREATED AS REINSPECTION FOR INSP- 148383. Remove concrete from drain gutter, you cannot stop the flow of water to drain. Clean debri from gutter. Approval from Miami Dade public works is required prior to my approval. NB May 23, 2011 For Inspections please call: (305)762 -4949 Page 15 of 21 .41'41° WtiLlfik 1\TOVO pri,i\ovo)o, 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): / 1 I Z0i Address: /0 / a S' rl Yn. l C.r- -i City: (Y\& y� State: Tenant/Lessee Name: Phone#: Permit No. DS-1- tO \ Master Permit No. ne#: ( -71- Email: Zip: 3 _O JOB ADDRESS: ! 0 /2c r en it-1-4 An,— City: Miami Shores County: Miami Dade Zip: 33 / C-b Folio/Parcel#: /)'a o Co o / 7 I sV Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: O2cwi-t•� -,,k i'_d •Phone#: cl i1(° 4675- —277? Address: / 5'7(..e 11 l./10 ( vtii.S. 1) 14'7139 (.._ City: _ �.. State: "9'k Zip: 33 3-X2 Qualifier Name: CLV 11 eii, %tz 7.)■. Phone#: "TY "(P`/3 —7777 State Certification or Registration #: C. co G 0 5-3/ ,Y7 Certificate of Competency #: Contact Phone#: ? Sal — (0 Y • —la I is 4'I Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 5- b Square/Linear Footage of Work: I ti 3 of Work: []Address Alteration ONew UR air/R lace ODemolition Type ep ep Description of Work: S Cc'i COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: Submittal Fee $ 50.00 Permit Fee $ /i 6 O7 CCF $ CO /CC $ PAID Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE g J t0 . (e c7 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 CONDTITONERS, 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 Owner or Agent The foregoing instrument was acknowledged before me this 3 day of Ju) , 20 w , by gil be* , who is personally known to me or who has produced PL, As identification and who did take an oath. NOTARY PUBLIC: Si Signature Contractor The foregoin instrument was acknowledged before me this S day of 20 10 , by (66-#47N. TAda /Cir , who is personally known to me or who has produced / as identification and who did take an oath. NOTARY PUBLIC: Print: u‘il t S My Commissi . n Expires: J01 * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY f My Commission Expires: )4- 112 (Revised 07110 /07)(Revised 06/10/2009)(Revised 3/15/09Xrev6/4/10) *** ** * *** * ** * * **r* *** ***** **it* ** Plans Examiner • t■ ? Structural Review Zoning Clerk NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. t(— 3206— O t3— 15 Q'® STATE OF FLORIDA: COUNTY OF MIAMI -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. 1. Legaj descrippon of proesarty and str t/a dr 1°11C 14` Ill.'RAO C(n.Cacut MCU e 144 cry • 2. Description of improvement: 11111111111111111111111111 11111 1111111111111 C.: M 2008805- 10)308 OR Bk 26968 Ps 3831; (!psi RECORDED i �8/136/210i l9 12 :33 :015 HARVEY RUVIH? CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA LAST F'AiGE • • ••0 • • • 555••• • •1••.. • •••• •••• • • •••. ••• • • • • • 5555•• • • • 000000 • • •. Space above osuse • 8record ng o ee ' LO A-v-e kc i 304... 4.•. •••••• • • •••.:• •••••• • • • • • • • • 3. Owner(s) name and address: 12 f i t IOU S Interest in property: Name and address of fee simple titleholder: 4. Contractor's name, address and phone number: • .5.5:5 • F(• ,al. d :..•.: 0000. • Pwl Cawi eJ e Is5o N. Uttivetw -1,1 DR Pie J tk& . F( , 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 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) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Sign <;,� =(s) By Prin ei wner(s)' Authorized Officer /Director /Partner /Manager By Print Name Title /Office addle Title • -- lce STATE OF FLORIDA COUNTY OF MIAMI -DADE r9insttwas acOo.�N�e�jged before me this 3 day of or ❑ as ❑ Persona The for By 1 t MaVORIa he COM NI PEK:IN 1) 41114 td3 Mende Newly Oam• for 250 wing type of identification: Notary Public: Print Name: (SEAL) VERIFIC .1 * ° , ' ` 0 SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, .I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signatures) of Owner(s) or Owner(s)'s Authorized Officer /Director/Partner /Manager who signed above: PrYtts‘_!!? (' '3431-1— STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Viiiage Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, 01120 (. t 441t , does hereby attest that (Property owner) The attached survey, performed by KQ(i to -o4 _ (Name of surveyor's company) For address: f ° J 9--C i/yvt,),r Performed on C I -a F (date of survey) is an accurate representation of the existing conditions and 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 seven (7) years old 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 say eth naught. Property Owner Signature Lo Property Owner Print Name SWORN TO AND SUBSCRIBED before me this 3 day of .201 U Affiant is personally known to me, ' produced as identification. Revised on 5/22/2009/ Revised on 6/12/09 : om 1SS1os # D0947991 pr wri xoRe nary 04, 2014 a:� �► - �(pIR�� J0.. •cam Floes ,. �i 1.89 409) :.: r. mer""41*. :1,4p ‘.„ 0 2*§M 21055r ts- b.* ttatumera4aeuetwat aRti uittuntAlt. smitingmbiggm ar.ATier maw. arm MM. ao ;Se, &,,Zgeg anu Wk. JUG NORM FANS ISL ATIM NOASPI rogAT.,ff..101. EdiONS 044 47:walt) r,A,T,R-A4.173.ame '11,11NCORIZAIMOBT4PIA-itiSt; Nalleatrut Nzemoceotakvstrime4m.soc.,,s. <11 LU LU LI <71.- ) teeI=tt$ (1) i401111 MIA M I AVala I • .4, -,44 ,,, 4 - 1 1 11.1 1 -Se.)‘14. ljt i_anATM 'AA) ;1T• r_ zAg ,iaNwlift.TE=RiE* N „IA 'WOO It " .1.1it, t ; J.49:/ /344-• / „/ ' / / /4 4. / / / 1 / IKE -/ / Mair,7 I v / / / ./"7,1//4/.; r /2,/ // A 4$ 4 I ECM ALL. OF WT 12 AND THE NDRTH 5 FEE7 CI L0; UI. '6LOCK fl OF AN AMENDED MAT tle- MIAMI SHORES SECTION ACr:oRly.:-;:; et: THE PIM THERECF REGOGGED N MAT BOON ID A'r*FACE MR.* PI.11.11,G REC,T;InS CU D4.rIF _11110lii0A • • • •Sa • 00000• • •00000 • 5:„,4 wis,„ THE E.,1:RWEOR FOR RIGHTS—OF—,W2•10/OR • FAFFMFNErs oF ammo. 11-tEROF0ii&-7 ONLY ilitiSC" I —WAY AND EASv-ME,Ori• ON 71--W g REFERENcED, PLAT ARE SHOVM. • • • • • 55 • • • 000000 1-4.44411-.1). . • •••4 ,1•8 -11k3-• 91/,';',1/42 j9 2,9 , 5.c(y.”Sikt +Y-fit -2; """ -:•! JD7/ gi ti • ) "UN =`, T_ THE .f..A.710NAl_ O,aDET:C. VERTICAL DATuN 2.) UNDERGROUND IMPROVEMENTS AND/OR UNDERGROUND ENGP.CACHMENTS i_;;;C;A ILO LAi TrL.EG SHOWN HEREON ARE BASED ON ThE 4:i ROOF OVERHANG NOT LoCAMD UHIESS crERtSE SHOWN. 3-115 statvEY m FOR FERMI P ONLY. o.HG s) All IS ISFORTS WERE 44,17.1' fl 5- CASTENM AND LOCA:iON oF UNDERGROth4D D-DLITEF... THIS FIRM, HOWEVER: DOES t401. ACCEPT REEPONSIWR.EPr: FOR THIS INF01.11AI:oz4. EXCAVA-fit.*. GC.IWACT THF ARPROFRiA(E UTILITY C-s-iiiPANiES FOR FIELD VERIFICATION. 7.) MI SLANINOS/ANGLF.51 AND DISTANCE HiFnEow AKE 90I1.-1 MEASURED NA MC r;;;OUND AND pFr, '0415 SURVEY IS CERTIFIED EXCLUSDiFt Y Wk. CLIZ AND SDEL CONORf.:TC OF .st-turl FlORIDA W.; CITY OF Witkili SHORES, FLORIDA ''..."ttHEAD WIRES. ,c;.? Oi:N3TE':; Eg'SIINC CRADE 8.EVATION. 1.** •0000• • • • 000000 • • ••000• • • 0000• • * 000•• 000000 • 0000 • •oo••o • • C ITT,,PE,17 ..._....,....___,__._.___...__,__ E CEPrilFiCATION% :. .... 11 ! Tif.1., THAT 11-i5 SKETCH of 51.Ki.le0.1.5. Al TrCii#44.11CALE,-IANCAPDS ST fORTM I.4543-, • Pee., 'I e'Roft-z:.,,..t4c..:ete.i.,....-4xyr:r4..„1-t±±,!:1C.: fLORMA ALX,Ittalf.';,-1-RA4tife.:: CODE. EL, ;*-1?-1?..rp. c,*r.ATi rir --,.. . .4.: • 1 NOT V • • D ',4 41 4-4 .• -*' • •-' - -: " ' AU =.4. : . :1=,.==, = =,_ ..."th-,NAt LArk, . II 4...4qp.Q, rz,IDA rikOft 3.41614AL ...., . ... . .... ......._ — , km_ . PR.OrE5SiONP4- 5ORVCYQk WC MAt1tM& t72 lissugggeommataxmomsg5mm' 1 MIAMI- BUILDING CODE CONIPI.,IANC9 .11( PRODUCT CONTROL DIVISION NOTICE OF ACCEPTAINcE Oi Buckeye Technologies, litic„. 1001 Tillman Avvarac Memphis, TN 31 12 S( Ft<4 ti-ofroDIK (sA KINIY, FLORIDA )vt1“,-;-% BUtLINNo !i40 SUITE tEV lVl,'('v'l{, i'LDR/D.A 33 30-1563 ( FAX. 13(Y) • • .• vii.ntaniffpia .octlt• • 040 • 000000 • • • •• 000000 •• •• • • • • •••, ...... • ...... r. 're • This NOA is being issued ur apn r IU.1:11116 •.: materials. The doetiniell1,1itiOn ii ihted haS boei, re IV; )(tidy t=miltnoratrol.Dstott and accepted by the Board of Notes and Appeeis k ii Mialni..0adc. tYy ad Ia • • ..... where allowed by the Authoritylktvinp. Jurisdiction At. • • • • • . This NOA shall not be valid ;filer he expiration date StalCd betf,W.TlIc.% Miatin-Dade Countyli'roduitriti4tattrol Division On Miami :Dade Coutityy and/or the Al I 0.101 if1119 Mianti Dade County) rcservestiftarrght to have this product or materitd tested for ql/a0.1y purposes. 1.1 tliis product or material fails to perform in the accepted manner, ilia mantiraetztrer the '.:::N.z1v1.:,trS(:: StC;.ti testing and the Atli may immediately revoke, xnodify, or suspend the t:tieh jailsdictlen, OR reserves the right to revoke this acceptance., .k it :It;i,rn:?.t...-,;f:;,1 by M iarn Ic ■,•A Product katrel Division that this proctur met:A. This product is approved as described herein, and lias heei, designed to comply With the FlOtida Building Code, including the High VeJy litaricane Zotre. DESCR1 10N: UltraFi 50 ber 0 C.o3nictrete Reinfostciip4 51, 1 APPROVAL DOCUMENT. !)i-itwiitg No. 'i+..=;;O of` 1, dated 11/24/08, prepared by Teehwomg.ics, . 'i.mS A. bearing the Miami-Dade County Product We ramOrlor and approval date by the Miarriiit..;tadi r'codtwt Com '10 MlSSILE NORtiC: LAVELING:; wriiitbag aWl boa.: a pen.' i or logo., 6ty, nle and following stiAto.ment, "Mjsay.r.. i;"' ^tiAff1WiSif; RENEWAL of i his NOA shall ier 14.1s hj5O iSL S J ilicre tition. no change in the a ppl perfi)rmi-03,;c:: 0 t TERIVIINATIION of this NI 'h,\ will o‘xur i:hais: has beau a .rovis'iou, ckv.su..gi,7. IT), the materials, use, and/or arm facture 01 in ;froducl proc,.,-Is, lVOStiSC of this 1\10.A, as an endorsement of any product, for sates, advertisimg or any other 1o5c s 1iui a:Atom:Ade:J.1y terminate. this NOA ailure to comply with anY section of this NOA. shall be ,:i.Luse R)1. of .N(. ADVERTISEMENT: 't'he Ni Lry Il ords Vba Dak C, y,, by the expiration date may be displayed in adiertisint2, literature ft any portt4n.i 'the NOA is displaiyo, then it shall be done in its entirely INSPECTION: A eopy it ire NV i/\ Sims' he pr,..vi,it:d ise 'Wt.; u.;-.:(:4 by h olaoufa(qUiel: or or distributors and shall be avail,tbie ha nasbeetfat,i at tic j: it 55 St We fetrou.si of the This NOA consists of this page and i...,videnee age t 'ie01 0,4,024,1.0.cAkt .0y0A1ione:d above, The submitted doeitmetii.ai ion was reviewed l.)y ic...earkvN UnriNrai: il,, • No., VA-4601. Expiratitua iiitatez january 2, ,)l4 Appiroval Date: Samtelary 28, 2009 Page 11 •000•o • 0000• o 00000 • • • •0000 • • 00000 000•o• • • 000000 • • • 000••• • • Buckeye '11'eizbnc.liteina.% .NOT10E OF ACCEP1.A& '1/4/1.11)tr •••• • • • • • • • •••• •• • RAWINGS •..... • • • • • , L D.-awing No. .(, d.l.ect '. '',00 A-ete keintOicipr, Pibo.:".,44.44,1 ri'' 1., .,fiattM 11/24/08, prepared by Bucicep.,'Vt;chi'igie.,8, i.nc, signe;tiaLd settleit**I:f hornes A,.. • , Kolden„ P.B„ •••.• • ...... • ••••• • . • •• • „, • „ • • • .5 •„ TESTS 1. Test report on 'oncret...- Res Streoy, Concrete RebifOyeing Fiber, Report No. 30S 9'.5.1 and 30814.61, boe Kolden, C. CALCULATIONS 1, NOrie. L. QUALITY ASS LI RAN Miami Dade hui tdi rig •••••• • • • • • C1399 of '..ittratibser ••• • St(wk 1 ww City besting Cebrpitfratian,I14t 6iten 0/24/08,, signed by Thomas 4_, • • • • F. MA,TERIAL CERTIFICA'IlONS Engineering Evaluation .Rep(w. and %.c.i.d(:ran per Asnvf. cl 399 of Buckeye UltraFiber 500, prepared hyA duoa -tc• ilASSOeinieS, be. dat-stt on 01/10/06 and 01/04/07 cespeci. \fey gigged :n0 see by ,!u;,;,,-.,p1.1 Amon, P,E. F. STATEMENTS Code eordokirlartee ;elitei issued by Stork. '1'win 'besting prakiou, dated 09/26/08, signed and sealed by Thom,, Koidon, Carlos Cittreifas..„' Product Control Examiner 110A NO. (36-0501.112 Egpiirailion Date: January 28, 2014 koprovall Mite: Janwary 28., 2009 •••••• • • •••• : • • • •••••• • ••••• • • ••••• OOOOOO • • OOOOOO O • • OOOOOO • • Buckeye UitriffribeT 500 Buckeye TeeillialOgie,59 ht 1001 TIlluiau Memphis, Teinamsee 38112 (901) 320.8100 liTwAllitrarlb.ff5g),(:‘ Buckeye UUraiber 300 made from Yitgin c1iWose fibers that have beer! Ghernically prtx:essed and then treated with a mineral-based chemical .that results in an alkaline-resistant fiber: The fibers are used in norrn.al weight and light weight concrete. The fibers are used as a concrete admixture to assist in controlling plastic .iirinkage of reinforced concrete and structural plain concrete. The fibetc;; are also ilsed to reduce shridkage and temperafdre t:rackirig to so plain tabs c scace. Strucr*ial Piovisiom Chaocer :ier(ion 2A) Insmior Buckeye UltraFiber 500 virgin cellulose fibers must be dispersed uniformly through the concrete mixture in accordance with ASTM C1116, The fibers must be blended into the concrete mix at a minimum rate of 1,0 pounds per cubic yard ,(.0,:59 kgiml: of concrete. The dosage must not excete 1,3 pounds per cubit yard (C,89 kgirn3), Buckeye's published installation instructions using either a dispersible bag system or a bulk time metric dispenser must be strictly adhered to. 3,0 Specifications: Buckeye UltraFiber 500 meets or exceeds the following specifications: A. ASTM C1116 — Standard Specification for Fiber Reinforced Concrete. B. ASTM 1)7357 — Standard Specification for Cellulose Fibers for Fiber Reinforced Concrete. • 4,0 ddenca Submittext • ICC Evaluation Services, Inc. Report ESR-1032. • Data in accordance with .ASTM C1399-- Average Residual Strength of Fiber Reinforced Concrete from Stork Twin Cities Testing, St: Paul, MN. • finderwdzers Laboratories, Inc. CRXQ.R25036 and ii:XITV,D973 Buckly4-reetoligids,hici Ultranther 500 CongetiRettitnFily,Fiber, • • • • • miamidade.gov Permit #: Date of Issue: Date of Expiration: Extended To: PW #: Work Order #: Permit Status: PUBLIC WORKS DEPARTMENT 2009003628 08/12/2009 08/12/2010 Open Comments and Conditions: 110125 N MIAMI AVE TYPE OF WORK BEATIFUL CONCRETE OF SOUTH FLORIDA 1868 N UNIVERSITY DR STE 100 DUARTE ROBERTO JOSE 305-- 49 -3 -22 queenmomsflol@yahoo.c om Qualifier # E20203 Z. P UNIT QUANTITY COST CONCRETE APPROACH ONLY APR 1 $100.00 NON - REFUNDABLE FEE FOR PLANS AND SPECIFICATIONS EA 1 $30.00 CURBS LF 10 $160.00 TOTAL $290.00 BEATIFUL CONCRETE OF SOUTH FLORIDA Acknowledges the sum of $290.00 dollars in payment of this permit, and it is understood and agreed that all work to be done hereunder will be in accordance with the requirements of this department. The work herein described and permitted is to be commenced and completed within the above reference time frame. 24 hour notification shall be made to Miami Dade County Public Works Department, phone 305 - 375 -2135 when work for which this permit is granted is ready for construction. This permit is issued subject to actual work being done by a contractor properly certified by the CONSTRUCTION TRADES QUALIFYING BOARD. In accepting this permit, the permitee agrees to hold thereof harmless from payment of any compensation or damages, resulting from his exercise of the privileges granted under this permit. Construction must be in accordance with the approved plan, and /or to recorded portions of the Public Works Manual. All required Traffic Control devices must be installed prior to placement of asphalt surface. Inspection can be requested online at www.miamidade.gov /pubworks/ Inspection Date Passed Failed Comments pertb_permit THIS PERMIT MUST BE KEPT ON THE JOB SITE Issued by: GONZALEZ, HORACIO Contractor Copy THE PERMITTEE and /or HIS CONTRACTOR SHALL: 1. Prevent the creation of any obstructions or conditions that may become dangerous to the traveling public, and provide, where necessary, adequate signs, barricades, warning lights, flashing arrows boards, flagmen and/or other necessary precautions for the prevention of accidents or injuries to persons or property result- ing from his exercise of the privileges granted under this permit. 2. Notify the local police department if lane of travel will be blocked more that two hours. (Section 336.048, Florida Statutes 1986) 3. Repair promptly any damage or injury to roads, driveways or other paved surfaces caused by his exercise of the privileges granted under this permit. Restoration shall be equal to or better than the condition existing at the time of damage or injury. 4. Move or remove, at the expense of the Permittee and/or owner, any utility as may be required for public convenience whenever specified by Miami -Dade County in the event of any future widening, repairs, instal- lation, construction, or reconstruction by or for Miami -Dade County of any road, bridge, canal, culvert, traffic signal, street light, water, sewer, storm drainage system or any other County facility within the public right -of -way in which the Permittee and/or Owner has constructed said utility. 5. Install temporary asphalt patches prior to opening area to any traffic. 6. Provide not less than 48 hours notification to all owner of existing facilities in the proposed area of work. IN ADDITION, the Permittee and /or his contractor, along with the owner of the utility must cooperate to determine the exact location (field exposure as warranted) of the respective utility facilities, by what- ever means available. 7. Obtain necessary easement where required right -of -way has not been dedicated. 8. All permit fees include the costs of inspections and any applicable engineering and material testing procedures. However, the costs of additional testing, due to the failure of the Permittee and/or his contractor in achieving the County's specification requirements, will be the sole responsibility of the Permittee and/or his contractor. 9. The maximum allowable time for right -of -way restoration for permits issued to private companies shall be 45 days from the date construction commences, in accordance with Miami -Dade County Ordinance No. 03 -89. 10. Comply with current FDOT Roadway and Traffic Design Standards, Index No. 304 and No. 515 for ADA compliance. Use "safety yellow" as the contrast color for the truncated domes detectable surface area. tan Vdse11.111.111, 93~ tt.fftreletEn963 •-1,4`.1.1, '11111. essisczgessscace* ses le/seent=gA 4F,we.,,!eee AWI6 .."41r". V-7:7 seWeesesseeess'eete& FM 740 ft-MC NORTH WINE REAM' EOZ r.F; obtmAjf$,1 d2114-* *AGMs (W.) 4.7•LWrifa gita 0;X...14734AM tr'Siifadiititaff. ,14:057..a4,11014 dWieSS ggstiOrt,t ItEgUruAMPISMIdgifiAgHtiliWIG ACRIR tAM Ava f* v•*./24:11 '1 Tr 1 rL ;II I. i.fi 1-4 1-- • ,,,...r, 1.__WATM. Fli..LiT.r.*-i°-'•'it-4*.' CT T° ec.4.1 ,--:' -t; , wiseiCettnilrA11,1_ 1 ; • *:. 441, 4:51-„.t t,..wrote 'NI • .40, r•W ea, •• • etr nT • 1' 111141) tit- i,11.1.14TH ET 1.0. 1..1% 11 01- H Of MIAMI SHORES SECTION O. R') THE KAT 11-IEREC1 IN Pt A SOO1 3D AT rACE. 70 c.ce-q-vanc *rw t-skrIr 41Pwq, ‘.4,7cit ••••anT :77.Y THE SVRVT.:YOR FOR RIO-ITS-OF-WAY AND/OR EA'.1■IIVNTS or Rrcost. THEREFORE. ONLY THOSE .4)4E.4 E.ASIEPITS Slir,gisi ON ITIC REFERENCE!) PLAT ARE SHOWN. Eill119,MERMIVEVM . ,_..,• , ,........ ,..,.0 -,...)-.3p:. ,•.;. t:ii;17.) itjyrt›....2 /r:LIP' -::: 4''') / ,#. ' ,;),: ,,f13, . i li) . '•.. -4— \ ..): rIL:....:1 c_ ' j i . ,., \,-.'. 1 '. "1:•t -i.,;3:7;.C.,i4"-Iles .i: ...0 , -12/ X ac";:11:, ; ,4i $.' ‘7,.-'',„ • ,.../' 7 „S3' I ......4.;i: ,..i 1 1 t i i 1:4 c1,36 .167 71- / /14P"- WA' / /1./ • / A _ • I III 21 14 1.4- / r1 11. IS: 61$12. 511.4?".4 a"Mn53 t — PLAT 5006( tele z ','• :11-1sr.,, '' 1.::-..'....AN *-11./111........'1. .41'1'.E 16:, .Ti'y'Ll ..d • - - VERT/CAL 4.‘,..111. 1 4' 92',.% uNDEkGRoLiN0 imPROvE.mEkTs AND/OR UNDEFGROUND z1- CACt-tkiE34TS NO f I_ ..,;.),'A ; t.....0 OE; 1I.SLICS: SHOWN HEREON :ARE 5ASED ON ThE i..; ” RECLITZO PLAT, 11T Pe ei. 4-i ROOF OVERHANG NCI LOCATTD iiiii.Ett..-1; fg i tI'DiE041is-5.. Fa-tc..=imki. 5) Tlir, SURVEY IS FOR RE-,ttr'.1:41m:o ONLY. g •■-i S) EC 1115. EXISTENCE AND LOG A NUN of UNDEROD.01.t:4D T:LCOES. THIS I4OWEWLR .. DOE.S No 1...COLPT FOR THIS INEORIL41%0I.I. 100300 EXCAVATION, 1.....;001AOT THE APPROFMA ;L. wito-cy ofiLIPANIFS CI,R FIELD VERIFICATION. ALL 5LARINO1-VANCLES ANO DF...,TANISCI; EIEREm P.IiE HO HI SEASURED r41 THE GROUND AI401 i,.•:,:=,....17.7..n t,a,-,:. Pi'vr."‘ rj.-1.AT., 'Cil-Z r..n. IDTITERWISE. SHOISI, v a) THIS SURVEY IS CERTIEWD --..:,COLI..ISI‘Xl */ R'): 5;12 AND NOEL LiZOLL, ....:::::,:r.7.,....-11: OF 301/TO ri.osiDA, A4,..: . ek COY OF IJI 0,4I SHORES: FL A p,=. etl•Pe•elne wwwww 00# •ID•a•.aat:alsia. wwwwww Vasile104111.101111.0en CE.°1-TriPiCATIONt . . . 1 1L T.RTir( fHAT TKS %era'. or 51.4f,Vift4ft:'-tt=t- Tr...CtiNICAL SIAM:AK:6 rl?A rg.C.•gt=f2I,12.1. cr rOA ADMINISTRAI.Ditf st;ODt, Ortmt 4 SY'f),TI N • ' 5i, 4,4At • • PRok;;510t11i_ SUR\ 111 • ' • •,),A, Cr.' • PO ft 5.5i01'-1ik 50F...‘itYOR MAreEf's. O. t7' a IDA& PLOCAl. vA ic....-..c.)4Mtit15-ry rms., , r O/AGg.:4' N.bs. mAr DATt: 05-02 04 tF-741,""1- • GAR.Af.A- Ftcx-,R 'Ps . • t;-, - ; s r41/414.11-' sl'aC :411 e NO,R131 CetiMeta AVENUE. UBLIC WORKS HIGHWAY 0IVISIO APPROVE: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: Elizabeth Little [X] Existing System [ ] Abandonment [ ] Holding Tank [ ] Temporary APP DOC # = AP940275 PERMIT #: 13-SC-1007018 DATE PAID: 10/23/2009 FEE PAID: 70.00 RECEIPT #: 13 -PID- 119447 [ ] Innovative [] AGENT: Beautiful Concrete TELEPHONE: 1 (954) 693 -7777 MAILING ADDRESS: 1868 N university Dr Fort Lauderdale, FL 33822 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. LOT: 11 SUBDIVISION: Miami Shores PROPERTY ID #: 11- 3206-013 -1500 PROPERTY SIZE: 0.19 BLOCK: 11 PLATTED: 01/01/1949 ZONING: I/M OR EQUIVALENT: ACRES WATER SUPPLY: [ ]PRIVATE [X] <= 2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y PROPERTY ADDRESS: 10125 N Miami Ave Miami, FL 33150 DISTANCE TO SEWER: [ [ ] >2000GPD DIRECTIONS TO PROPERTY. North Miami Ave to 101 St BUILDING INFORMATION: [X] RESIDENTIAL [ ] COMMERCIAL Type of No. of Establishment Bedrooms [ ] Floor /Equipment Drains SIGNATURE: DH 4015, 04/2006 (Previous Editions May Be Used) V 1.0.0 [ ] Other (Specify) Building Area Ft 1400 # Persons Served 2 Total Design Flow For This Unit 300 Ml ,n# as c ou PERMIT Ar940275 EID1007018 DATE: 10/23/2009 Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM Additional Notes and Comments: County Notes Fields: County Process #: APP DOC #: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: AP940275 13-SG1007018 10/23/2009 70.00 13 -PID- 1194474 County Permit #: Storage Box #: General Comments: This pe granted for a d 've .'y (N Miamai Ave) side only. Does not have any impact with the existing OSTDS. o !'spina Engineer II v 1.0.0 AP940275 EID1007019 STATE. OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL, SYSTEM APPLIC TION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ ] New System [/"] Existing System [ ] Repair [ ] Abandonment APPLICANT: /2_cc i A/k C c g I II— AGENT: ( Cudt k1/4 [] [] Holding Tank [ Temporary [ ] PERMIT NO. DATE PAID: FEE PAID: RCEIP # Innovative MAILING ADDRESS: IX ICI ' 'v\ + , s Vim" TELEPHONE:7 (- 6 I3 - 7)7 P tc- z kf , �� 3 ? 3 2 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: 11 BLOCK: I 0 SUBDIVISION: PLATTED: 11 PROPERTY ID # ° .3,2 C® l ZONING: I/M OR EQUIVALENT: [ Y / N PROPERTY SIZE / 9 ACRES WATER .SUPPLY: [ ] PRIVATE PUBLIC [ 1 = 2000GPD [ ] >2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y/`* DISTANCE TO SEWER: FT PROPERTY ADDRESS: I 0-12'5"- N \ , ` "` '\ \=-t o 33 / c o DIRECTIONS TO PROPERTY: Nit try L - e _ —'I' t, BUILDING INFORMATION Unit Type, of No Establishment 1 2 3 4 [f] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial /Institutional System Design Bedrooms Area Soft Table 1, Chapter 64E -6, FAC Floor /Equipment Drains [ ] _ Other (Specify) SIGNATURE: °' �r �� c \Uc DATE: (k / 3 1 s1 DH 4015, 10/97__- Page 1 (Previous Editions May Be Used) Page 1 or 4 Stock Number: 5744 - 001 - 4015 -1 APPLICATION FOR: APPLICANT: AGENT: TELEPHONE: MAILING ADDRESS: LOT, BLOCK, SUBDIVISION: DATE OF SUBDIVISION: PROPERTY ID#: ZONING: PROPERTY SIZE: WATER SUPPLY: SEWER AVAILABILITY: PROPERTY ADDRESS: DIRECTIONS: BUILDING INFORMATION: TYPE ESTABLISHMENT: NO. BEDROOMS: BUILDING AREA: BUSINESS ACTIVITY: FIXTURES: SIGNATURE / DATE: Check type of permit, if "Other" specify type in blank. Property owner's full name. Property owner's legally authorized representative. Telephone number for applicant or agent. P.O. box or street, city, state and zip code mailing address for applicant or agent. Lot, block, and subdivision for lot (recorded or Unrecorded subdivision). If lot is not in a recorded subdivision, a copy of tie lot legal description or deed must be attached. Official date of subdivision recorded in county plat books (month/day/year) or date lot originally recorded. Dividing an approved lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of lot. 27 character number for property. CHD may require property appraiser ID # or section/township/range/parcel number. Specify zoning and whether or not property is in I/M zoning or equivalent usage. Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and 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-compacted road Irights-of-way and easements with no subsurface obstructions may be included in calculating lot area. Check private or public <= 2000 gallons per day or public > 2000 gallons per day. Is sewer available as per 381.0065, Florida Statutes, and distance to sewer in feet. Street address for property. For lots without an assigned street address, indicate street or road and locale in county. Provide detailed instructions to lot or attach an area map showing lot location. Check residential or commercial. List type of establishment from Table II, Chapter 64E-6, FAC. Examples: single family, single wide mobile home, restaurant, doctor's office. Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. 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 for each story of structure. For commercial/institutional applications only. List number of employees, shifts, and hours of operation, or other information required by Table II, Chapter 64E-6, FAC. Mark Floor/Equipment Drains or Others and specify item or "NA" if not applicable. Signature of applicant or agent. Date application submitted to the CHD with appropriate fees ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded easements, 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 waters, and other pertinent 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 plan (residences) 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. *77 V•Plift. "cM ZS, 57:-; +•-• " " 7 St NC.dirro. 4E SL 141 A'att.04. 4 v....A 00A"ca:stti'..iaT:414? AEITOOrixrialitVr: &NAIL: allitELAND.31,1k3/1 301101&61111 A Ch1 1818AU➢JN @N1:1 it...SCSI lottivAl F.:IL:WI. . '. - -: tr.,..:17: ' .• •S : . . 4,..•••••.4',..i 3 ;.: •:• - • ;;:.1-.4 ! - , .1, . • r,.";• ' ?:" , • • ;f5ikt4::, • " **" ' """ • ! • • • nt !1, f!.• : • • Al; •• ;:.: ; r•A XI. 7C; ;'..7 nix•F hh... 1 • •••• ”t• • W4•1`..k.`fOte t•Utt !INAS CV' REVORM .fl-tERF;. (AL. Y r AT =:Lt 4.1". ••■•••■■-its2 * "7. • ""* • ! 7 , . 1 4vra!;;' • . ; • . • . 4 3 I • a a r • a si 11 NB F. ! ... ; LVABer PLAT i*:..101( • "...v....." • ; : : - . . • • • • • • .1 0 • • . , -11\ • • , .. ff • is •"' t.'•••.• . ! • • it . • •.,. I • • tt.4: • .• . . 4 .. • . 241 .i.-.....-::,: - i !i1 ••.. '1'-'., '114-•v.t:C.r."-* 4 ../.1 '.1 , •• 'i . .. 4■3.'"sr— i i. 4.----, 'n T•c ..i.!•. ••••:4,.." - :4: CH flFICKflON : ; •,• HAT 711:3 5?:.ETCH Or ivith,nr.AUM 31.%111- eIRIDA A rim *1.0 re FOC:SLANT- r) .4 pu",45#.9,3 3:1,fup.itiPZE r..=.-R.11.7.11:4.44*FZ.Ar5t ".Xt.: A1.47. Pt. .1•:= is_? $: "0 • x'; • - ffl :IL::: •g !"!!!:M. • ,•"" win • 7!•.7..!' • • 3 =4* i....1A•g".1' 111.€ . ‚F • CVERHANC, NU. L:X.:t. !CI; 1'7 %.4/1:R‘ Pc,,,,zr•u••••• ; Al-IL- rtkli, • • ,• 41.; r, • •• • V • 'T(AN, ae. rriE• APP•41.7Ptiii, fi Ft'R Afjr. •-•,;•;.-• t4t,s, r:;.! 'Pr %** yr( 1 '4. GER r.1 • 1'1 .4;Tir:n ot 44;Am: , r,R,,or Tt• 46' a a a • ▪ ••••••?.... p. • 3'14 :A;(7, (OK iviArrEA. .410.*:4-i1444 0?•• imr-CD,14 • a ati.00..% ZOlic: re,KiE *1.00D F.ye'v".•LWA " !•'? IPA:: Rift. ." — • ••-••, M.11112 F•11 0,;,■ O 0' .”q • • ',........E1 1...••• iAW2* I" Lt"2:S. 7 S 1 PR•.".."....X.". NC.; 151V4=— 'i. 1 f 3teVEY D.A31.775 .11-:W r. va.,§. Nor-rni MIAMI A.VEI,P.J7. _ 11 ■ .......---11 ")61; -:":7-... -41 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IM 08112120/0 4 na PRODUCER COVER ALL INSURANCE 51300W. ATLANTIC BLVD. MARGATE, FL. 33063 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 BELOW. INSURERS AFFORDING COVERAGE NAIC S MIMED BEAUTIFUL CONCRETE OF SOUTH FLORIDA. INC. 18OB IL UNIVERSITY MINE #100 PLANTATION FL 33322.4129 NNBURER a AMERICAN VEHICLE INSURANCE COMPANY INSURER a: ENSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW 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 TM POLICIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LENTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NIA alDDI. (: ee • POLICY NUMBER GENERAL UABIITTY X COMMERCIAL c, a '. LIABILITY MAIMS MADE OCCUR GE7ML AGGRE(G'A—T)E LENT APPLJS PER: —1 POLICY I J 1 LOC AL-0310BILE UABILITY ANY AUTO AU. OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GL•0504004815.00 May 6, 2010 May 6, 2011 EGE LIABILITY ANY AUTO EXCESSIUMBREI.LA UABI,UTY 7 OCCUR Q CLAIMS MACE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS' UABILfIY PROPRIETOATNERJEXECUTIVE DOFF ERREEXC UDEDD? Eyee describe under SPECIAL PROVISIONS belaa OTHER LIMITS s 1,000,000 a 100,000 XP L" .. ,000 PASS ADV INJURY $ 1,000,000 GENERAL AGGREGATE a 1,000,000 41,000,000 0 A�� O PREMIRES (a occu en e) DUCTS - CONS/OP AGO COMBINED SINGLE LIMIT (Ea accident) a BODILY INJURY (Par person) BODILY INJURY (Per accident) a PROPERTY DAMAGE (Per accident) a AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EA ACC a AGO a EACH OCCURRENCE $ AGGRE . TE 1 411178 NIV- EL EACH ACCIDENT a a ELL DISEASE -EA EMPLOYEE $ E L ptSEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES N EXCLUDONS ADDED BY 1 SPECIAL PROVISIONS DRIVEWAY, PARKING AREA ANDIOR SIDEWALK PAVING OR REPAVING CERTIFICATE HOLDER MIAMI SI4OREiNIL IGE ATTN: BUILC1Ne. _ 10050 NW 2 AVE :g MIAMI SHORES, FL33138 FAX: 305. 756.8972 ACORD 26 (2001108) SHOULD ANY OF DESCRIBED PDLIi ECANCEI.LEDBEFORETHEEXPIRATION DATE THEREOF E Nft4 UR $ j(ILL E, ,/0R ,,,..ii4 DAYS WRITTEN NOTICE TO ,r TE HOLDIfFENA/reD TOT$EEI PT, BUT FAIluRE TO DO SO SHALt. IMPOSE NO OBLLGATIOE4OR mature, O?`'NLAIY KIND WON THE INSURER, ITS AGENTS OR .,,, REPRESENT A7IVE AUTHORIZED REPRESENTATIVE ® ACORD CORPORATION 1988 NOTICE OF COMMENCEMENT A RECORDS, COPY MUST BE POSTED ON THE JOB SITE AT ME OF FIRST INSPECTION TAX FOLIO NO. it 320+ ©t3 it 5 QO PERMIT NO. STATE OF FLORIDA COUNTY OF MIAMI -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 in rxmation is provided in this Notice of Commencement. 111111111111111111111111111111111111111111111 CFhi 2OO9RO57O3O8 OR Bit 26968 Ps 3831; (1tn) RECORDED 08/06/2009 12:33:0.5 HARVEY RUVIHr CLERK OF COURT MIAfI -DARE COUNTY, FLORIDA LAST PAGE Space above reserved for use of recordbig office f - t r e • kg:VA Skettite Ft 3 3 (so 1. Legal dear 'on of proplarty and t/ &apt was- M• AL `t µltfi.tM►L 4O Sae 1 I.l wtcI :v b 10 -76 2. Description of improvement Cekttufiet.tt 611 Cu Q w ay • 3. Owner(s) name and address: interest in property: Name and address of fee simple titleholder: 4. Contractor's name, address and phone number eseausrw( call it* (%' O ot. un eaucy DR Pla440Lia". 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1Xa)7., Florida Statutes, Name, address and phone number: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(6), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a diifinent date is spedtled) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR T. R URNOTICE OF COMMENCEMENT. ner(s)' Authorized OfCerJDirector/Partnei/Maflager By • `, ,�f Fri► By Pri '_-- idd {� Print Name Titl ,,.. r: Title/Office STATE OF FLORIDA COUNTY OF MIAMI-DADE foreDgifrg ins umerSt was ac ged before me this day of V. BY ndividuafy, or O as ❑ Perso for ing type of identification: Notary Public: Print Name: qp d.26ifl (SEAL) '1 - a. 1L : Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: tow �,,.,. _. • • c 1 1h111- 411, #v . Book26968 /Page3831 CFN #20090570308 .Art Page 1 of 1