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DS-11-2224Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 168562 Scheduled Inspection Date: January 12, 2012 Inspector: Bruhn, Norman Owner: KAWACHIKA, JON & CYNTHIA Job Address: 179 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: M & C PAVERS INC Permit Number: DS -11 -11 -2224 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Foundation Work Classification: Addition /Alteration Phone Number (305)758 -0927 Parcel Number 1132060132930 Phone: (954)782 -4600 Building Department Comments CONCRETE PAVERS ON APPROACH AND PATIO Passe 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- 168043. CREATED AS REINSPECTION FOR INSP- 167199. Front only, required set back and sidewalk separation must be maintained. NB No access to rear yard, dogs. NB ec January 11, 2012 For Inspections please call: (305)762 -4949 Page 24 of 31 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO S \1 P `+�� TAX FOUO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be property, and in accordance with Chapter 713, Florida Statutes'(" is provided in this Notice of Commencement. 1 original 1 111111 1111111111111111111111111 11111 1111 1111 CFN °?011R.s s;s.a; OF; OR Bk 27928 Ps 3978; Ups) RECORDED 12/15/2011 09:40150 HARVEY RUVIHr CLERK. OF COURT MIAMI -DADE COUNTY? FLORIDA LAST PAGE day of obit lite On NA 1. Lego/ 7 pt p proper ty a J ryl, reet/a 2. Description of improvement: /0014-46,- "AV/ 0 / pootel / Ai. tills 3. Owner(s) name and address: 0 rtiaidootiejlrAL l Interest in property: Dd-4/64 - Name and address of fee simple titleholder. 4. Contractor's /< n add p one number A e et-� i --� m� 330 o 786 -'c‘ -1-/ 9 5. Surety: (Payment bond required by owner fro con ctor, 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. Space above reserved for use of recording office 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 Signature(s) of Owner(s) or Owner(s)' Authorized Officer/Director/Partner /Manager Prepared By Prepared By Print Name Print Name Title /Office Title /Office STATE OF FLORIDA COUNTY OF M The • ;,• • gin By Individually, or ❑ as ❑ Personally known, or I -DADE incyyjixVed before me this k3 day of occiAloor ,1) for produced the following type of identifica Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO 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. Signature(s) of er(s) or r(s)'s A th • ed Officer/Director /Partner /Manage Mt %i 3lritli ttiZikairte r> By 123.0152 PAGE 9 s', 44% CLAUDIA V. CUBILLOS r° , �`�- Notary Public - State of Florida _• ' 1 My Comm. Expires Sep 23, 2015 ''tlz'�,F„ ,r' Commission • EE 128810 Boles Through National Notary Assn. By 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 ROOFING CEIVED NOV 2 9 2011 Permit No. 0 N -f %a2 Master Permit No. OWNER: Name (Fee Simple Titleholder): ® / C.� Pone #: c�0� %58. - . 2' 30S• 0 32- DSZY Address: L7 90' c /r City: /1(OM £ � _ State: �/. Zip: 33 / ,• Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: /79 /t/6 9 57 City: Folio/Parcel #: Miami Shores County: Miami Dade zip: ( Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: City: �d/l�l�✓ A�� ,e/ Qualifier Name: U RfX., LC) b G (\ NO `— Flood Zone: 1,,J4-7fidt0 78-(0 — B6, 49 Phone #: ar_S ° 7 k 2 go A71 lTiveeik State: Zip: 3 pc Phone#: State Certification or Registration #: C' ( Li 5∎ q Certificate of Competency #: Contact Phone #: 4IOc - 5.1-9Email Address: 1.../e, �liewcy 4f-/�l�' c0�y DESIGNER: Architect/Engineer: ' hone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration EWE* ❑Repair/Replace ❑Demolition Description of Work: G Co ��f( /S 77 ,,4 ,'V1*ei 4%N.� ** ***** ******** ** *** *** * *** * * **a:***** **Fees J �x+ x�x* a�********+ ��x�xx��x *a��x�r�n�x�x�xx� *�x+x****** ** * ** Submittal Fee 6 0 _ o Permit Fee $ 10Z CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 th absence - such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature /Cw �� Signature Owner or Agent ntractor The foregoing instrument was acknowledged before me this 53 foregoing instrument was acknowledged before me this Z . day of W , 20 A, by W 1 day of NIOVOMbQ1 , 20 t( , by U (\&l (O b c..✓) who (s personally known to 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 oath. NOTARY PUBLIC: Sign: Print: \\\\0��`�1a t�ii6tru,1 /,� // o ,� • My Commission Expires: aft ✓r.�,,Z ORtD14, NOTARY PUBLIC: Sign: %WI,. k — Print: Il.. a si�Vr(+.�1P . ;R, i, "A My Commission Exp'e .` • *= MY COMMISSION # DD765737 -.' ,. EXPIRES March 05, 2012 '4n7199a.n+ ,, >' ndallotaryService.com mm*>x**********.x x***=' t'•i�x�xx�x�x��xx��x�xx�+x�x+xa •x•x•xa.x.x�n�x�r�x�.x x� �x�a�xa��x�xm APPROVED BY /CR/ Plans Examiner /' Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) DBPR - COBAN, UNAL; Doing Business As: M & C PAVERS, INC, Certified General ... Page 1 of 1 9:16:55 AM 11/30/2011 Licensee Details Licensee Information Name: Main Address: County: License Mailing: LicenseLocation: County: License Information License Type: Rank: License Number: Status: Licensure Date: Expires: Special Qualifications Construction Business COBAN, UNAL (Primary Name) M & C PAVERS, INC (DBA Name) 455 NE 17TH AVE FORT LAUDERDALE Florida 33301 BROWARD 510 NW 84 AVE APT 419 PLANTATION FL 33324 BROWARD Certified General Contractor Cert General CGC1519885 Current,Active 08/03/2011 08/31/2012 Qualification Effective 08/03/2011 View Related License Information View License Complaint Contact Us :: 1940 North Monroe Street. Tallahassee Ft. 32399 :: CaII.Center @dbor.state.fl.us :: Customer Contact Center: 850.487,1395 The State of Florida is an AA /EEO employer. Copyright 2007 -2010 State of Florida, Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mall. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmaster0 dbor.state.fl.us. https:// www. myfloridalicense .com/LicenseDetail. asp ?SID= &id= 01EBE62D02BE5DB87... 11/30/2011 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT 1' ' ENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) '✓ 0° ✓� ' hereinafter referred to as the owner of the following described property y (address): / % 6, / 7 `i--7-c /ter 3/aD(E S 3 3/36 Legal Description Lot Folio # R��equ4ests permission to install (describe work): D G / 7 i 7v 6- 7' S-7 c 7 / Block Subdivision 570 S6( F7 /?q /cam- /1 10 ,9Gc Within the public right of way of (address) s 6 3 3 /361 IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. 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. 1 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 item(s) 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 the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). Signature (1 (-‘2,=-,7-e-1"-i&) or Agent The foregoing instrument was acknowledged before me this 21 day of 4\(N , 20 , by -5- i I who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: 2 •o• �, °' `' � N. ,,��1O ►l l 1��1"‘\�`\\\ Permit No: 11 -2224 Job Name: November 30, 2011 Miami Shores Viiiage Building Department Building Critique Sheet 1) Provide approval from HRS /DOH/ 2) Corrections must be made for Zoning. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit NO. DS -11 -11 -2224 Sidewalks /Slab. iron Addition /Alteration ,y Expires: Not Issued Folio Number:1132060132930 Owner's Name: JON & CYNTHIA KAWACHIKA Job Address: 179 94 Street Miami Shores, FL 33138- Owner's Phone: (305)758 -0927 Total Square Feet: 850 Total Job Valuation: $ 4,400.00 Contractor(s) M & C PAVERS INC Phone Primary Contractor (954)782 -4600 Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 11/30/2011 Comments: A GRASS LANDSCAPE STRIP OF NOT LESS THAN 2 FEET IN WIDTH MUST BE LEFT BETWEEN THE DRIVEWAY AND SIDEWALK. IVliami Shores Voiage Building Department RECEIPT PERMIT #:i 1 — � i -t DATE: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ❑ Contractor ❑ Owner ❑ Architect Picked up 2 sets of plans and (other) Address: 779' 47c Y J7 From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. V Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit NO. DS -11 -11 -2224 Owner's Name: JON & CYNTHIA KAWACHIKA Job Address: 179 94 Street Miami Shores, FL 33138- Folio Number:1132060132930 Owner's Phone: (305)758 -0927 Total Square Feet: 850 Total Job Valuation: $ 4,400.00 Contractor(s) M & C PAVERS INC Phone Primary Contractor (954) 782 -4600 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 12/13/2011 : Yes Comments: A GRASS LANDSCAPE STRIP OF NOT LESS THAN 2 FEET IN WIDTH MUST BE LEFT BETWEEN THE DRIVEWAY AND SIDEWALK. NEW PLAN OK STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ ] New System [g] [ ] Repair [ APPLICANT: Jon Kawachika Existing System [ ] Holding Tank Abandonment [ ] Temporary APP DOC it AP 1055110 PERMIT 4: 13-SC- 1382412 DATE PAID 12/09/2011 FEE PAID: 70.00 RECEIPT # :13 -P 1 D- 1792986 [ ] Innovative [ ] AGENT: Jon Kawachika MAILING ADDRESS: 179 NE 94 St Miami, FL 33138 TELEPHONE: 1 (305) 632 -0588 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(0 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: 22 23 SUBDIVISION: PROPERTY ID #: 11- 3206 - 013 -2930 PROPERTY SIZE: 0.29 ACRES BLOCK: 21 PLATTED: 01/01/1940 ZONING: WATER SUPPLY: [ ]PRIVATE IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y 4-71 PROPERTY ADDRESS: 179 NE 94 St Miami, FL 33138 I/M OR EQUIVALENT: [ ]<= 2000GPD [g]>2000GPD DISTANCE TO SEWER: FT - DIRECTIONS TO PROPERTY: BUILDING INFORMATION: Ix] RESIDENTIAL Type of No. of Establishment Bedrooms 3 [ ] Floor /Equipment Drains [ ] Other (Specify) SIGNATURE: [ ] COMMERCIAL Building # Persons Total Design Flow Area Ft Served For This Unit 2313 6 400 APPROVED +DO 001iNil ' HIsALTH OEPARTIENT DH 4015, 08/09 (Obsoletes previous editions which may Incorporated 64E- 6.001, FAC v 1.0.0 not be used) AE'1055110 EID1382412 DATE: 12/09/2011 Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Additional Notes and Comments: County Notes Fields: County Process #: APP DOC #: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: API055110 13-SC- 1382412 12/09/2011 70.00 13 -PID- 1792986 County Permit #: Storage Box #: Zone: Permit Type: County Status: General Co tall concrete pavers only. Doe not have any impact with the existing OSTDS. Ped : • = • Ina Engineer II APOE MIAMI -DADE COUNTY NEALTtf DEPARTMENT PERMrr #: i Of P- CD DATE: v 1.0.0 AP1055110 EID1382412 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ ] New System [ ] Repair [ ] APPLICANT:C' ��' l/(7: AGENT: / ` MAILING ADDRESS:` ' / 7 7 Existing System Abandonment [ ] Holding Tank [ ] [ ] Temporary J PERMIT NO. DATE PAID:u_'-- °R; °-' FEE PAID: RECEIPT #: Innovative TELEPHONE' g(-.9 ('' 5 -05-4529 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 LOTS 4 ?tjBLOCK:w SUBDIVISION. 1 .�9? fir" `.? PLATTED: PROPERTY ID #: ZONING: 1411 I/M OR EQUIVALENT :I[ Y;% N PROPERTY SIZE: L. ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC ['+- <= 2000GPD [ ] >2000GPID IS SEWER AVAILABLE AS PER 381.0065, PROPERTY ADDRESS: LA DIRECTIONS TO PROPERTY: , FS? [ C DISTANCE TO SEWER: .f -' FT BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 RESIDENTIAL No. of Building Bedrooms Area Saft Floor /Equipment Drains SIGNATURE: i'> 4441 [ ] COMMERCIAL Commercial /Institutional System Design Table 1, Chapter 64E -6, FAC Ai, 4 s. Other (Specify) DATE: DH 4015, 10/97 — Page 1 (Previous Editions May Be Used) Stock Number: 5744 - 001 - 4015 -1 Page 1 or 4 V ti 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 owners full name. Property owner's legaily authorized representative. Telephone number for applicant or agent. P.O. box or street, city, state and zip code mailing address for applicant or agent. 9 Lot, biock, and subdivision for lot or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot legal descnption or deed must be attached. Official date of subdivision recorded in county plat books (mo r) or date lot originally recorded. Dividing an approved lot into two or more parcels for the purpose of con 'nQ ownership shall be considered a subdivision of the 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 rights-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 gallon per day Is sewer available as per 381.0065, Florida Statutes, and distance to sewer in feet. Street address for property. For Iots 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 U. 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 applications only. List number of emptoyees, shifts, and hours of operation, or other information required by Table 11, 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 and attachments. ATTACHMENTS: A site pian drawn to scale, showing boundaries with dimensions,.Iocations of residences or buitdings, 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 welis, onsite sewa 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, afloor 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. STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II SITEPLAN Scale: Each block represents 10 feet and 1 inch = 40 feet. J c-t-K- +rv+.v,_ anayxas..euaac....a.mas says —.ale ..9�c +msst Notes: �S1 #A Site Plan submitted by: ifr Plan Approved By cl>ric b , r glop,i STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT. Permit Application Number r PART II - SITEPLAN Scale: Each block repre§ents 10 feet and 1 inch = 40 feet. Notes: i Site Plan submitted by: Plan Approved By Signature _,+ Not Approved Title Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used) (Stock Number: 5744-002-4015-6) Page 2 of 4 . • - :* 4.....••••••••••• •••• . • • , • ••,• , , , C12.ogi on. os- Olo qv, k)*14- liff Iosd' a200 Friday, December 9, 2011 OSPINA,PEDRO N DAU : 110921 PSN : 027449 Hours : 8 Days : sMTWTFs Activity and Time Reporting by Program Component DAU PC Code #Service #FTTY Loc Time 110921 61 8070 31 240 110921 61 3100 6 31 180 110921 61 9080 31 60 Total Time Hours : 8 Mins : 0 Time Completed : 0 Page 1 of 1 Beginning Odometer Reading : Ending : I Personal Miles Total : Total Work Miles : Reviewed by : Data was created on December 9, 2011 15:18 by OSPINA,PEDRO N Data was last updated on December 9, 2011 15:18 by OSPINA,PEDRO N https: //hms 13.doh.ad.state.fl.us /csp/hms 13/EARPrint.csp ?oid= 1654 &rec = 62434 ^OSPINA,... 12/9/2011 1150 E. ATLANTIC BLVD. POMPANO BEACH FLORIDA 33060 ACCURATE LAND SURVEYORS, INC. L.B. #3635 TEL. (954) 782 -1441 FAX. (954) 782 -1442 POWER POLE qt— • 9'. ASPHA FOUND 1/2' IRON PIPE NO I.D. 3.16' LOT 21 BLOCK 21 4' CHAINUNKx FENCE 6' WOOD FENCE 2.87 SUBJECT 1-0 CCMPLIANC STATE AND Cr IJN,Y HL 4 w ':.'.16.75,...... • a c. ft=-7(1 • '- -tee-• - .'. ASPHALT ROADWAY • •N.E.• 94TH STREET'' :.. 75' RIGHT —OF —WAY 1. UNLESS OTHERWISE NOTED FIELD MEASUREMENTS ARE IN AGREEMENT WITH RECORD MEASUREMENTS. 2. BEARINGS SHOWN HEREON ARE BASED ON A BEARING OF N/A 3. THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR OWNERSHIP, RIGHTS —OF —WAY, EASEMENTS, OR OTHER MATTERS OF RECORDS BY ACCURATE LAND SURVEYORS, INC. 4. OWNERSHIP OF FENCES AND WALLS IF ANY NOT DETERMINED. 5. THIS DRAWING IS THE PROPERTY OF ACCURATE LAND SURVEYORS, INC. AND SHALL NOT BE USED OR REPRODUCTED IN WHOLE OR IN PART WITHOUT WRITTEN AUTHORIZATION. 6. THIS SURVEY CONSISTS OF A MAP AND TEXT REPORT. ONE IS NOT VAUD WITHOUT THE OTHER. 7. THIS SURVEY IS MADE FOR THE EXCLUSIVE USE OF THE CERTIFIED HEREON, TO BE VAUD ONE YEAR FROM THE DATE OF SURVEY AS SHOWN. 8. THIS SURVEY WAS MADE FOR MORTGAGE AND TITLE PURPOSES ONLY AND SHOULD NOT BE USED FOR DESIGN OR CONSTRUCTION PURPOSES. REVISIONS DATE UPDATE SURVEY SU -11 -0406 02 -18 -11 DATE OF SURVEY 07 -27 -98 DRAWN BY S.V. CHECKED BY S.V. BY AL /RLT FIELD BOOK 519/74 CERTIFICATION: THIS IS TO CERTIFY THAT I HAVE RECENTLY SURVEYED THE PROPERTY DESCRIBED IN THE FOREGOING TITLE CAPTION AND HAVE SET OR FOUND MONUMENTS AS INDICATED ON THIS SKETCH AND THAT SAID ABOVE GROUND SURVEY AND SKETCH ARE ACCURATE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BEUEF. I FURTHER CERTIFY THAT THIS SURVEY MEETS MINIMUM TECHNICAL STANDARDS UNDER RULE 5J -17 ADOPTED BY THE FLORIDA BOARD OF LAND SURVEYORS, OCTOBER 1ST, 2009. SEA < NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ROBERT L THOMPSON (PRESIDENT) PROFESSIONAL SURVEYOR AND MAPPER No.3869 — STATE OF FLORIDA I SCALE 1”--= 20' I e SU -98 -3613 Dec. 16. 2011111:06AM "MC Pavers, Inc, : No. 2580 IN CERTIFICATE OF LIABILITY INSURANCE °A'�g"M'°°^^ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C � 01/04 /2011 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE APPOR DED DY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOLTS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INE URER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy((es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms ane eondltlons of the Polley, certain pollciesi may require an endorsement. A statement on this oertillcate dose not confer rights to the certificate holder in Lieu of Such endorsement(s?. PRODUCER Insurance Office of America;, Inc. P.O. Box 162207 Altamonte Springs, FL 32716 -2207 sumo AS54, Inc, 999 Vanderbilt Beach Road Suite 200 Naples, FL 34108 Alternate E:nployer: M&C Pavers, Inc. COVERAGES ! (407)783 -3000 ce 0UeTCkIERID e: Ne (407)788 -7'33 INSURER A; INSURER!: INIIUR&(I) APFOROAIG COVERAGE Guarantee Insurance Co NAIC 11398 INSURER INWARD ; INSURER E t INSURER F; CERTIFICATE NUMBER: 11/12 MSC Pavers, Inc. THIS Is TO CERTIFY 'D AT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED Ago E NOR THE POLICY PERIOD INDICATED, NOIWITHSTANDINO 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 SUBJE YTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L IR TYPE OP INSURANCE -ADDL. R r POLICY NUMBER thsvD . GENERAL LIABILITY COMMERCIAL. GENERAL LIAa0.1TY CLNMS -M■DE 0 OCR GEL AGGREGATE LIMIT APPLIES PER PRICY 71 JERC 11 LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDLLEDAUrOS HIR EOAUTOS NON•OWNEDAUTOS UMBRELLA LUIS E %CESm LIAR DEOUarisLE RETENTION $ OCCUR CLAIMS.MADE BURNERS R QMP • ioN .� AND EMPLOYERS' LIABILITY A ofF p ICEP/MEEN NE TIVE (Mendetery In tot �aP�ED7 II yes, OP�tERATIONS Now YIN R.-.4-4:t UMrr$ EACH OCCURRENCE P'r1 5 r e aprrensal $ 1 MED (Ary one Pinion) $ PERSONAL A ADY INJURY GENERAL AGGREGATE Ei PRODUCTS • CDMP,cp AoG g COI19n.B0 8 NGLE LIMIT (Ea maiden() $ d BODILY INJURY (Per parson) 4 BODILY INJURY (Per maiden!) PROPERTY DAMAGE (Per eeeldentl 1 NIA 0PE0213000001 -111 s EACH OCCUERENCE 5 AGGREGATE 1 01/0112011 01/01 /3012 X CY S @.L. EACH AOCIDE:NT 1 1,000,000 E.L. DISEASE • EA EMPLOYEE E f 11000,000 E.L. DISEASE • POLICY LIMIT 5 DESCRIPTION OF OP&RATIONS / LOCATIONS I WHOM (Mich =RD 101, Additional 1ppedN$eeedub,Iinenmace imputed) Coverage is provided for only those employees leased to but not subcontractors of ABM, Inc./ MSC Pavers, Inc. per endorsement effective 1/1/10 for any or project performed during the above policy y job, CERTIFICATE HOLDER g Y ACORD 28 (2009/03) CANCELLATION 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED FQI.ICMS BE CANCELLED BEFORI1 THE 3XPIRA?ION DATE THLkECF, NOTICE WILL BE DOUVERBD IN ACCORDANCE WITH THE POUCY PROVISIOA EL AUTNORQ0D REPR09ENTATNG Cheri 1e Boorna2ian RzcxA 4319811,20139 marks of ACORD ACORD CORPORATION. All rights rsvefvsed, The ACORD name and Togo are registered Dec 16. 2011 11:06AM MC Pavers, Inc. .C.OR ;P* CERTIFICATE OF LIABILITY INSURANCE PRODUCER (954) 942 -4400 No. 2580 P. 2 Southgate In Agy of Pomp Bch Inc 639 North Federal Highway P 0 Box 728 Pompano Beach ... -- - - -... ...._._._.. _F14..330627 ..__.. INSURED M & C Pavara , Inc 11 Sw 5th Court POMPANO (BEACH COVERAGES FL, 33060- DATE (MNUDD/YYYY) 12/13/2011 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 INSURER A: Landmark American In Co INSURER B; Progressive Express In INSURER INSURER b: INSURER E: NAIL #) THE ANY MAY POLICIES. INSRi10 POLICIES REQUIREMENT, PERTAIN, L OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED AGGREGATE LIMITS SHOWN MAY ' ..._..... ... -..__. - HAVE BEEN ISSUED TO THE INSURED OF ANY CONTRACT OR OTHER BY THE POLICIES DESCRIBED HEREIN HAVE BEEN REDUCED BY PAID -•-- -... - -- - -- • . _...._. POLICY NUMBER NAMED ABOVE DOCUMENT WITH IS SUBJECT CLAIMS. ...._.__... ..-.._. POLICY EFFECTIV! FOR THE POLICY RESPECT TO WHICH TO ALL THE TERMS, -. pi f .. P Y EXPIRATION PERIOD INDICATED, NOTWITHSTANDING THIS CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONDITIONS OF SUCH ...._ _ .. LIMITS A X oENERALUABIUTY X COMMERCIAL GENERAL LIABILITY LBA102061 -01 12/13/2011 12/13/2012 EACH OCCURRENCE DAMAGE TO RENTED ' S„ _1 , 000 opo I I / / / / pREMISEQ.(Ekacxwrraneel_ $ ...... 50,000• .. CLAIMS MADE , X] OCCUR / / / / MED EXP (Any one perem). __ _$ . .. 5 , 090 / / / / PERSONAL SAM, INJURY • S „1, 000.,990 • ....• • • ••• / / / / GENERAL AGGREGATE , A • 2/9.q0/000. GEN'L AGGREGATE LIMIT APPLIES PER; PE / / / / .PRODUCTS- COMP/OPAGQ„ $ - ,000,000 X POLICY : i ' LOC / / / / Dec/par Claim _ 500 )3 AUTGMOEILELIABILITY OB0974405 06/07/2011 06/07/2012 COMBINED SINGLE LIMIT ANY AUTO / / / / (EP wccldent) $ 500 , 000 ALL OWNED AUTOS / / / / BODILY INJURY X SCHEDULED AUTOS / / / / (Per parson) $ HIRED AUTOS — Y — — — NON OWNED AUTOS / / / / BODILY INJURY (Per =Went) - • - • -• • • -• • • .... / / / / PROPERTY DAMAGE / / / I (Per *widget) $ GARAGE LWBILnY ANY / / / / AUTO ONLY • EA ACQIDENT 9 . - -• • AUTO / / / / OTHER TH AN _A ACC .. _$ __.. / / / / 1 AUTO ONLY: AGO 5 EXCESS /UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR I •, I CLAIMS MADE / / / / AGGREGATE DEDUCTIBLE / / / / .. .0• - .. _ $ ....... . RETENTION $ / / / / $ WORItER9 COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE / / / / INC &TATU• TOTH- . TORY. LIMITS I I ER OFFICERIMEmsER EXCLUDED? ❑ / / / / •E.L EACHACCIDgNT $ (Mendatery bi NH) If yes, tlaacrihs ender / / / / . E.L DISEASE. EA EMPLOYEE $ SPECIAL PROVISIONS below / / / / E.L. DISEASE - POLICY LIMIT $ OTHER / / / / / / / 1 / / / / DESCRIPTION OP OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROV &IONS SOOpa Of Work Installation of Brisk Pavpra CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores FL 33138 - ACORD 25 (2009/01) INS02S(mom) SHOULD ANY OF THE ABOVE D!$CRIDED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LABIIJTY OF ANY KIND UPON THE INSURER, 179 AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE r.r 01588.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD :>rDec.16. 2011t11:06AMLORM.C.Pavers, Inc. No. 2580 P. 4 ill.j'k , DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET (850) 4871395 TALLAHASSEE FL 32399-0783 COBAN, UNAL M & C PAVERS, INC 11 SW 5TH CT POMPANO BEACH FL 33060 F oridians Iloensed by thesDeparrtment of Business and the rrofession one Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business In order to serve you better. For information about our services, please log onto www,myfloridalloense.com. There you den find more Information about our divisions and the regulations that Impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our constantly mission to serve you License that you can serve youer customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE STATE OF FLORIDA AC# 5 6 6 6 5 'F 1 DEPARTMENT•,;OS BUSINESS AND PROFESSIONAL REGULATION CGC1519885 08/03/11 110008115 CERTIFIED GENERAL CONTRACTOR COBAN, UNAL M & C PAVERS, INC IS CERTIFIED under BAs provisions of 0.489 PS noir tion 6tatsx AUG 31, 2012 L11080300321 STATE OF FLORIDA 'DEPARTMENT CONSTRUCTION BUSINESS STRYRLICENSINGLBOOARD REGULATION SEQ# 1x11080300321 IIICENSE NBR he••. GENERAL• :CONTRACTOR ,Named-.•Yielow•.•IS 'CERTIFIED •Under' th'e provisicnel of Chapter. 489 •9'S: •. Exp4.ral.tion date: AUG 31, 2012 COS./LW, UNAL • • M & C PAVERS, INC • 210 •NW 84 AVE .APT 419 • • ...PLANTATION FL 33324 RICK. SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY 1150 E. ATLANTIC BLVD. POMPANO BEACH FLORIDA 33060 TYPE OF SURVEY: ACCURATE LAND SURVEYORS, INC. LB. #3635 BOUNDARY 98 -3613 SHEET 1 OF 2 TEL (954) 782 -1441 FAX. (954) 782 -1442 JOB NUMBER: SU -11 -0406 LEGAL DESCRIPTION: LOTS 22 AND 23, BLOCK 21 AMENDED PLAT OF MIAMI SHORES SECTION ONE, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, PAGE 70 OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIDA ADDRESS: 179 NE 94TH STREET MIAMI SHORES, FL 33138 FLOOD ZONE: X BASE FLOOD ELEVATION: N/A CONTROL PANEL NUMBER: 120652- 0302 -L EFFECTIVE:, REVISED: 9/11/2009 LOWEST FLOOR ELEVATION: N/A GARAGE FLOOR ELEVATION: N/A LOWEST ADJACENT GRADE : N/A HIGHEST ADJACENT GRADE : N/A REFERENCE BENCH MARK: N/A CERTIFY TO: 1. JOHN KAWACHIKA AND CYNTHIA KAWACHIKA 2. SUNTRUST MORTGAGE, INC. 3. CHRISTOPHER P. KELLEY, P.A. 4. OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY 5. 6. EASEMENTS ACCORDING TO THE AFORESAID PLAT: NONE ABOVE GROUND ENCROACHMENTS ACCORDING TO THE AFORESAID PLAT: DRIVEWAY IN ALLEY RIGHT OF WAY ALONG THE NORTH BOUNDARY NOTICE: THIS SURVEY IS MADE FOR MORTGAGE AND TITLE PURPOSES ONLY AND SHOULD NOT BE USED FOR DESIGN OR CONSTRUCTION PURPOSES. NOTES: 1. THIS SURVEY CONSISTS OF A MAP AND A TEXT REPORT. ONE IS NOT VAUD WITHOUT THE OTHER. E A 2. OWNERSHIP OF FENCES AND WALLS IF ANY, NOT DETERMINED. 3. THIS SURVEY IS MADE FOR THE EXCLUSIVE USE OF THE CERTIFIED HEREON. TO BE VAUD ONE YEAR NOT VAUD wHOUT FROM THE DATE OF SURVEY AS SHOWN HEREON. THE SIGNATURE AND THE ORU NAL RAISED ANGLE +NCO LEGEND OF ABBREVIATIONS: ENCIL - �"'� SAL A FLORIDA A • - ARC LENGTH (M) MEASUROL LICENSED SURVEYOR CB - CHORD BEARING - ELEVATIONS BASED ON N.avn. MAD:T. - MAINTENANCE LP - LIGHT FOUL AND MAPPER. / // R - RADIUS SQ. FT. - SQUARE PEST H.C.R. - BROWARD COUNTY RECORDS CONC. - CONCRETE RIW - RIGHT OF WAY P.C.P. - PERMANENT CONTROL POINT D.CR - DADE COUNTY RECORDS D$. ■ DEED BOOK P.C. - POINT OF CURVATURE P.B.C.IL - PALM BEACH COUNTY RECORDS P.B. - PLAT BOOK CLF - CHAIN LINK PENCE P.T. - POINT OP TANGENCY P - PLAT O.R.B. - OFFICIAL RECORDS BOOK WF - WORD FENCE WM - WATER METER N&D - NAIL & DISC FP. - FINISHED FLOOR BLVD. ■ BOULEVARD OH ■ OVERHANG P.O.C. - POINT OF COMMENCEMENT OAR. - GARAGE AD - ASSUMED DATUM N - NORTH P.O.B. - POINT OF BEGINNING ELEC. - ELECTRIC LP. - Et0N PIPE S SOUTH NC - AIR CONDITIONER SEC. - SECTION LR. - MON ROD E < EAST END. - FOUND TV/P. - TOWNSHIP P.RM. - PERMANENT REFERENCE MONUMENT W ■ WEST CHATT. - CHATTAHOOCHEE ROE - RANGE N.O.V.D. ■ NATIONAL GEODETIC VERTICAL DATUM B.M. ■ BENCHMARK STA. - STATION C/L ■ CENTERLNE U.E. � UTILITY EASEMENT FH - FIRE HYDRANT EEL - FLORIDA POWER & LIGHT MH - MANHOLE D.E. DRAINAGE EASEMENT oIi - OFFSET ELEV. - ELEVATION ESMT. ■ EASEMENT A.E. ■ ANCHOR EASEMENT