DS-12-937Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 174014 Permit Number: DS -5 -12 -937
Scheduled Inspection Date: September 18, 2012
Inspector: Bruhn, Norman
Owner: ROMANIK, DAVID
Job Address: 95 NE 95 Street
Miami Shores, FL 33138-
Project <NONE>
Contractor: BEAUTIFUL CONCRETE
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060130730
Phone: 954- 693 -7777
Building Department Comments
STAMP CONCRETE DRIVEWAY AND RIGHT OF WAYS
8/30/2012 - PENDING NOC
09/05/2012 - RECEIVED NOC
Passed
Failed
Correction
Needed
Re- lnspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 17, 2012
For Inspections please call: (305)762 -4949
Page 1 of 25
ftMiami Shores Village
Building Department
*)1a-tili4 )4, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
"51 k......0.142i.g. INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. DS 12.---(-93-7-
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 20
RECEIVED
MAY ; � Olg
Permit Type: BUILDING l / / ,('J f,, �/ u
OWNER: Name (Fee Simple Titleholder): ` G �d V 1 ‘ k Phone #�V , (0 ( 3 -b ` 0
/( 1V
Address: q fJg d S )-^ L •
City: iini1S,y■. t �rle-.1'ly -„ State: '' Zip: 3 31II & y
Tenant/Lessee Name: Phone # :fa • 3' ' 3YY d
Email:
JOB ADDRESS: `
City: Miami Shores County: Miami Dade Zip: ' 3 ) 3 t
Folio/Parcel #: 1) -• 32-0 (o - 0 673o
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: a45 l$- J) C--1(.s.^.2 Phone #:
Address: 0 '/ G. f U in 1 S ) 1) Py ''309C-
City: ON— State: Zip: '335 2-72-___
Qualifier Name: U \ b-er-4 'DO -c. Phone #: 5-'1- 693-7 ? n
State Certification or Registration #: tv CJ'C D S3 ki ! G , Y Certificate of Competency #:
Email Address:
Contact Phone #:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ cti 90 Square/Linear Footage of Work: '7 J°
Type of Work: OAddress A Aiteration New URepair/Replace ODemolition
Description of Wor • • / ��
. ��A,
-AL-411-.41 s t v1 -e
OLJ
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
*****t *********************************F ************** ** ** **** *:r ** ** ** * *** ** * * ** * ***
5
Submittal Fee $ e' Permit Fee $ / -Q a CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ (061 •(
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature 3)
gt/ C1.A,/j
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this off- / The foregoing instrument was acknowledged before me this t!r
day of , 20 /Zby 7)40Adt CI 0):AINCft t C , day of , 20 ft —by 4641-6-D11/0.1—e.
who is pe onally known to me or who has produced }) L. who is personally known to me or who has produced s/L-
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Si
Print:
My Commission Expires:
MARJORIE A SHORT
�N
0120410N 10Nt t,` Dp947991
EXPIREY ,lanua y 04.2014
Po
* * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
NOTARY PUBLIC:
***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
(Revised 07 /10/07)(Revised 06 /10 /2009)(Revised 3/1 5/09)(rev6/4/10)
CD 7//,,2
Zoning
Structural Review Clerk
1111 iamiShores
Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: )
DATE:
I,
rtontractor
❑ Owner
❑ Architect
Picked up 2 sets of plans and (other)
Address:
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.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
05/29/2012 15:31 FAX 1 800 685 7530
DATA SCAN FIELD SERVICES
* * *** ************ ****
* ** TX REPORT * **
**Ee************ ******
TRANSMISSION OK
TX /RX NO 2606
RECIPIENT ADDRESS 919542376095
DESTINATION ID
ST. TIME 05/29 15:29
TIME USE 02'04
PAGES SENT 1
RESULT OK
2,1 I '7...- C1 Ari,f:Si
Permit N : 12 -937
Job Name:
May 24, 2012
Miami Shores Vivage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Budding Critique Sheet
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
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 -762 -4859
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
Folio Number :11320601 30730
Owner's Name: DAVID ROMANIK
Job Address: 95 95 Street
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 400
Total Job Valuation: $ 5,490.00
Contractor(s)
BEAUTIFUL CONCRETE
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 5/23/2012 : Yes
Comments:
Miami Shores Village
10050 Northeast Second Avenue
Miami Shores, Florida 33138-2382
Telephone: (305) 795-2207
Fax: (305) 756-8972
www.miaraishoresvillage.corn
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY,
WHEREAS, DPrO A' , hereinafter refeffed to as the Owner of the following
(owner)
described property: qc j4c-- qc-
Legal description/folio#: (v-ev 51k0-1.-e--, Se_ c_
Lot 9.2, 3-'1/44 Block s- Subdivision
Tax Folio #:
Requests permission to install:
1.47-A—sphalt, concrete, brick pavers
u Landscaping
u Other
Within the public road right of way of qr lq
(address)
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 Wage or i -se County to make repairs or maintain said items within
public right of way inducing 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 \fillage causing the item(s) to be
removed and a lien being placed on the property andlor assessed against the Owner for all costs incurred in the
removal and cisposal 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 Pubnc Records of Dade County, Florida by the
\Tillage Manager of Miami Shores Vglage (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this
day of
owner)
SIGNED, SEALED, AND DELIVERED in the presence of:
MARjORIE A SHORT
°ors my CW1089101:4 # DD947991
OCHRES Jantiitry04, 2014
Permit No: 12 -937
Job Name:
May 24, 2012
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
Building Critique Sheet
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
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 - 762 -4859
Permit N : 12 -937
Job Name:
May 24, 2012
Miami Shores Village
Building Department
Building Critique Sheet
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
1) Provide approval from Miami Dade County Health Dept. (DOH /HRS)
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 -762 -4859
Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
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5-.73
BLDG DEPT
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SUBJECT TO COMPLIANCE WITH ALL FEDERAL
f ; 1 ATF AND COUNTY RULES AND RMUI ATIONS
r-CE:VE,D
MAY 2 3 29fi
931
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MIAMI-DADE COUNTY HEALTH DEPARTMENT
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PARYWAY
PIMES: Legal description furnished by client.
lands hereon were not researched by the Surveyor for easements, legal overlaps or- any
other instruments of record. No Utilities located.
There may be additional restrictiaa/easements that are not shown on this survey that may be
found in the public records of this county.
Surveyor makes no claims to subsurface features other than evidence of same as shown hereon.
This drawing is the property of B.P.I. LAND SURVEYING, INC. and shall not be used in whole or
part without the written permission of B.P.I. LAND SURVEYDZ, INC.,
This survey is RV for construction purposes.
Liability limited to survey fee charged. •
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BGAL ION: for
OBDIVISI: AMENDED PLAT OF MIAMI SHORES SECTI
OCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT B0( R 10 AT PAGE 7th
WORDS OF MIAMI-rADE COMM, FLORIDA.
CERTIFIED TO: John P. Maas, Attorney at Law,
Co TiMorgage Company,
Company,
David'Romanik
1
LEG D: zL= Centerline,
M = Measured,
P = Plat,
No -= Number,
Conc = Concrete,
Clr = Clear,
LOCATION SIB
BDOCK:
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OF THE PUBLIC
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SCALE: 1" = Not To Scale
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WE HEREBY CERTIFY: That the attached BOUNDARY SURVEY of the above describei propeerty is trip
and correct to the best of our knowledge and belief as recently surveyed under c diFectiun;,.
and meets minimum technical standards set forth by the FLORIDA BOARD of LAND SURVEYORS, pursuant
to Chapter 61 G17 -6 Florida Administrative Code. Examination of abstract of title will have
to be made to determine recorded instruments, if any, affectiong the property. Location and
identification of utilities on and /or adjacent to the property were not secured as such
information was not requested; Ownership is subject to opinion of title. This survey is
performed for David RoIOBILUC.
for the singular purpose of obtaining Mortgage Title Insurance and does not extend to any
unnamed party. No liability is assumed by the undersigned for any loss that may be
associated with the use of this survey other than for the purpose of obtaining Mortgage
title Insurance. Acceptance of this survey plat or use of . the corner monuments found or
set during the performance of the field survey hereby limit the undersigned liability
related to professional negligent acts, error or omissions to an amount not to exceed the
fee charged.
.••.••
Lincoln Iturrey
Professional Land Surveyor
and Mapper No: 5719
state of Florida
Not Valid without embossed seal.
TTitS SURVEY. IS NON- ASSSI4,aNABLE
PREPARED BY: LB #: 4742
B.P.I. LAND SURVEYING, INC. (305) 274 -4292
11330 S.W..56th STREET MIAMI, FLORIDA 33165
SCALE: 1,1 = 30,
APPROVED BY
96
PG: 49
DRAWN BY
DATE: 6- �4-2000
REVISED
PREPARED FOR: DAVID ROMANIR
ADDRESS: 95 N.E. 95th Street Miami Shores, Florida
Flood Zone: 12O*52 CO9 3 3 -2 ? 4 'I ,X, "
Closure at-•Least 1: 7500
DRAWING NUMBER
00- 6413 -45
407
'O
BUC3UNTILDING CODE COMPLIANCE OFFICE (BCCO)
PRODUCT CONTROL DIVISION
NOTICE OF ACCEPTANCE (NOA)
MIAMI-DADE COUNTY, FLORIDA
NIEIRO-DADE FLAGLER BUILDING
140 WEST FLAGLER STREET, SUITE 1603
MIAMI, FLORIDA 33130 -1563
(305) 375-2901 FAX (305) 372 -6339
www de.nov/buildbiecode
Buckeye Technologies, Inc.
1001 Tillman Avenue
Memphis, TN 38112
SCOPE:
This NOA is being issued under the applicable rules and regulations governing. the use of construction
materials. The documentation submitted has been reviewed by Miami -Dade County Product Control Division
and accepted by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas
where allowed by the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami-Dade County Product Control
reserves Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) resery a tth4>;ight
to have this or for quality ce purposes. If this ' €am to ......
the manufacturrer will incur the e� of such testis acid t$e .say •
perform in the manner, ..... . � .... � +
immediately revoke, mod fy, or s��d the use of such product or material withi th �� motion•
the right to revoke this acceptance, if it is determined by Miami -Dade Co%roduct Control +....:
Division that this � fails to meet the requir of the applicable b ' cads::'. '.
This product is approved a rdescribed herein, and has lea designed to comply with tbe+ a Burl iiig ...........
• • ..'
• Code, including the High Velocity Hurricane Zone. •' • • • • • • ......
•
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•••••• ••••••
APPROVAL DOCUMENT: Drawing No. I, titled "UltraFiber 500 Concrete Rennf go Fibe "a 1 of : ....
1, dated 11/24/08, prepared by Buckeye Technologies, Inc, signed and sealed by Thomas A. KoldCn,•le. , •
beating the Miami-Dade Control Approval stamp with the Notice of Acceptance number and
approval date by the Miami Dade County Product Control Division.
MISSILE IMPACT RATING: None
LABELING: Each unit/bag shall bear a permanent label with the manufacturer's name or logo, city, state
and following statement "Miami -Dade County Product Control Approved ", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been flied and there has been
no change in the applicable building code negatively affecting the performance of this product.
TERMENATION of this NOA will occur after the expiration date or' if there has been a revision or change
in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of
any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to
comply with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA munber preceded by the words Mianti-Dade County, Florida, and followed
by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then
it shall be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its
distributors and shall be available for inspection at the job site at the request of the Building Official.
This NOA consists of this page 1 and evidence page E -1, as well as approval document mentioned above.
The submitted documentation was reviewed by Carlos M. lifters, P.E.
DESCRIPTION: UttraF"iber 500 Concrete Reinforcing Fiber
NOA No. 06- 0501.12
Expiration Date: January 28, 2014
Approval Date: January 28, 2009
Page 1
Buckeye Technolozies. Inc.
NOTICE OF ACCEPTANCE: EVIDENCE SUBMIT 1.1D
A. DRAWINGS
1. Drawing No. 1, titled "U1traFiber 500 Concrete Reinforcing Fiber", sheet 1 of 1, dated
11t24/08, prepared by Buckeye Technologies, Inc, signed and sealed by Thomas A.
Kolden, P.E.
B. TESTS
1. Test report on Concrete Residual Strength per ASTM C1399 of UltraFiber 500
Concrete Reinforcing Fiber, prepared by Stork Twin City Testing Corporation, Test
Report No. 308195.1 and 308195.2, both dated 10/24/08, signed by Thomas A.....
Kolden, P.E. •••• • • • •
••••• •
•
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C. CALCULATIONS
1. None.
D. QUALITY ASSURANCE
1. Miami Dade Building Code Compliance Office (BCCO).
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E. MATERIAL CERTIFICATIONS
1. Engineering Evaluation Report and Addendum per ASTM C1399 of Buckeye
UltraFiber 500, prepared by Ardaman & Associates, Inc., dated on 01 /10 /06 and
01/04/07 respectively signed and sealed by Joseph A. Amon, P.E.
F. STATEMENTS
1. Code conformance letter issued by Stork Twin City Testing Corporation, dated
09/26/08, signed and sealed by Thomas A. Kolden, P.E.
E -1
,/ D,
Carlos M. Utrera, P.E.
Product Control Examiner
NOA No. 06- 0501.12
Expiration Date: January 28, 2014
Approval Date: January 28, 2009
I
General Notes:
Buckeye UltraFiber S00®
Buckeye Technologies, Inc.
1001 Tillman
Memphis, Tennessee 38112
(901) 320.8100
www.ultrafber500.com
1.0 Description:
•
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• • • •4.0 Evidence Submitted:
••• ••• • ••• •
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• • •.• • ••• •
•••
••• ::.•. •• •••
•• o . : ••
Buckeye UltraFiber 500 is made from virgin cellulose fibers that have been
chemically processed and then treated with a mineral -based chemical that
results in an alkaline- rosistant fiber. The fibers are used in normal weight and
light weight concrete. The fibers are used as a concrete admixture to assist in
controlling plastic shrinkage of reinforced concrete and structural plain
concrete. The fibers are also used to reduce shrinkage and temperature
cracking in structural plain concrete slabs on grade. Structural plain concrete
provisions are found in Chapter 22 of ACI 318 and section 1910 of the FBC.
2.0 don:
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 kg/m3) of concrete. The dosage must not exceed
1.5 pounds per cubic yard (0.89 kg/m3).
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 D7357 - Standard Specification for Cellulose Fibers for
Fiber Reinforced Concrete.
• •. • 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.
• • • Underwriters Laboratories, Inc. CBXQ.R25038 and BXUV.D973
•
••
Drawing No.1
Sheet 1 of 1
Date: 11/24/08
Buckeye Technologies, Inc.
UltraFiber 500
Concrete Reinforcing Fiber
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. D5 -.S") - R.37 TAX FOLIO NO. /) -3o- 0/3-675D
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. Legal description p pro arty and stre t/address:
2. Description of improvement: („' y C/L A
1 1111111111111111 11111 11111 11111 11111 1111 1111
CFN 2012R0605986
OR Bk 28245 Ps 3750; (fps)
RECORDED 08/28/2012 13 :41r08
HARVEY RUVIN, CLERK OF COURT
11IA11I -DADE COUNTYr FLORIDA
LAST PAGE
Space above reserved for use of recording office
S 5e-e- i a-- 9.3f 2y $)Ls''
13
ti�r�t�v�
3. Owner(s) name and address: DA-Lit d K d Yho fit 1C.
Interest in property: -15 /,/(( Cj'� S4- yr-NA
Name and address of fee simple titleholder.
4. Co actor's name, address and phone number.
j 3 f3 fl"
332. --
5. Surety: (Payment bond required by owrrr 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
0
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 i 0
(the expiration date is 1 year from the date of recording unless a different date Is specified)
16
9. Expiration date of this Notice of Commencement:
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 REC' •DING Y• - NOTICE OF COMMENCEMENT. Pe 1.
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Own (s)' Authorized Officer/Director/Partner/Manager
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Pri e
Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
Be fo m e instru ent was know before 023 re me this � day of
Individually, or ❑ as for
DI Personally known, or roduced the following type of identification:
Signature of Notary Public:
Print Name:
(SEAL)
VERIFICATION PURSUANT TO SECTION 92525. FLORIDASTATUTES
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.
Signs . re(s) of Own
By
Print Name
Trtle/Office
123.0142 PAGE3 11/07
MA€tY.`{i=ocE A SHORT
My c.i' ,'la ?$iON #0D947991
Januajy 84..21114
30 -0153 *u+ vYm com
er(s)'s Authorized Officer/Director/Partner/Manager who signed above:
By
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BROWARO COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954-831-4000
VALID OCTOBER 1, 2011 - THROUGH SEPTEMBER 30, 2412
DBA:
Business Name: BEAUTIFUL CONCRETE
FLORIDA INC
Owner Name: ROBERTO .705E DUARTE
Business Location: 1852 N UNIVERSITY DR
PLANTATION
Business Phone: 954 - 693 -7777
OF SOUTH
Rooms
Seats
Employees
2
Receipt #180 -5130
Business Type•GENERAL CONTRACTOR (GENE
CONTRACTOR)
Business Opened:07 /01/2001
State /County /Cert/Reg:CGCO 53 498.
Exemption Code :NONE %EMPT
Machines Professionals
For Vending Business Only
•
Vendittsl Type:
Tax Amount
. Transfer Fee
R NSF= Fee
Penally
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
2.70
• 0.00
.0.00
29.70
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non - regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location: This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
ROBERTO JOSE DUARTE
1852 N UNIVERSITY DR
PLANTATION, FL 33322
2011 - 2012
Receipt d01C -11- 00000005
Paid 10/03/2011 29.70
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
1940 NORTH MONROE STREET
TALLAHASSEE = FL 32399 -0783
DUARTE, ROBERTO JOSE
BEAUTIFUL CONCRETE OF SOUTH FLORIDA INC
1876 N UNIVERSITY DRIVE SUITE 309C
PLANTATION FL 33322
Congratulations! With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
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.myflorldalicense.com.
There you can 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 mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business In Florida, and congratulations on your new license!
DETACH HERE
DOCUMENT i{AS A COLORED BACKGROUND M RO P !NTlNG !iNEMARK`" PATEN1ED PAPER43
DATE BATCH NUMBER
' C --iCERTIFICATE OF LIABILITY INSURANCE I DATE HIMMIwyrn
.— _ SI1e/2di2
TINS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON MS CERTWCATE- HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED? BY THE POLICIES
BELOW. THIS CERTIFICATE OF !MURMUR DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURM), AUTHORIZED
REPRIEMITAIWE OR PRODUCER, A}JD THE CERTIFICATE HOLDER. i.
IMPORTANT':' IT the aeltMeefe holder fe an ADDITIONAL INSURED, the poBry(las) must ha endorsed. If SUBROGATION IS VANEt), subject to
the tenT s end condition of Nur ps n certain poncho may require an endorsement A sNatement on this osrtlloata does not oo'*r rlphts to the
Certltloate holder In gnu of such
P0oouoel P
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Brrsndo % FL 3351
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VISVIWN Aa Antlitot ITS
Manegnt Inc.
Fitchburg MA 01420
IIIMMOR r
COVERAt# TE 13112
THIS IS TO CERTIFY THAT THE POUCISS OF INSURANCE: LISTED BtLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
NIDICATTC, NOTIMIHSTANDING ANY REQUIREMENT, TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT T WITH RESPECT TO WHICH This
ATE SW BE MusD ott IIMY PERTAIN, TlEI; INSURANCE Ammo SY 9i18 POUCIES OSSOMBED HEREIN IS SUBJECT TO ALL THE TIC,
OHS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED SY PAID CLAM
MEMNON DER:
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MILT MhR2f O'er inoon
BODILY MAW (Per none*
TYYt 11B (FL)
TWCSIII6822 (TX)
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DESORIPTIM IllOnss /MATO/al Dtesch
101, Ade9em1 Neannb Scriedtao, Qemm spew b topetelf
P reSIob Irdo (If : / OLEIVCAL WORK ONLY!
Workers' Dn comae is provkled Wordy leased to. but not autcettractors of &rautIftd Cormier/ South Florida. Inc.
PEO Client Name: Seauf8W Concrete of South Inc LoostIon: See page 2 far WHIM PEU COn40311* 401010
Miami Shores
VI
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Avenue
M • res FL 33138
SHO1LD ANY OP TIM ABOVE
THE EXPIRATION DATE THEREOF, NOTICE WILL M DRUMM IN
ACCORDANCE WITH THE POLICY
AUMONIZED RIVREENTATIVE,
DaYld E f!'Ltlrsni .
1 010 ACCENT CORPORATION. All righin reserved.
ACORD 2S (201WOE) The ACORO name and logo erne registered marks at ACORD
RE gaunt 1.2,riti.r4ft.gratrairuat
05/16/2012 13:09 9549560555
COVER ALL INSURANCE
ACORD,, CERTIFICATE OF LIABILITY INSURANCE
FROsucisi
COVER ALL INSURANCE
50014 W. ATWLRIC BLVD.
MARGATE, FL
MIRED
BEAUTIFUL CONCRETE OF SOUTH FLORIDA, INC.
1576 NORTH UNIVERSITY DR. # 309C
PLANTATION FL 33322.4117
PAGE 05/65
BATSi
0511212012
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 AGE
COVERAGES ISdit
FEDERATED NATIONAL INSURANCE CO
NAIL
THE POLICIES OF FRANCE MOO B E L O W H A V E B I S U E P TO THE INSURED NAMED ABOVE FOR THE POLICY PERK INDICATED. NOTwITHSTANOSIG
ANY REQUIREMENT, TERM OR CONOmON OF ANY CONTRACY OR OTHER DOCUMENT MTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES GIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCWSIONS AND CONDITIONS OP SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. t- si......: . ,. ,- r,.,•.;_7
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sEacRornON OF OPE RA11MM I LOOATION®I Y®YCLS61 Ciux.11103NB ADDEO FIN EM QRSE6ENT
DRIVEWAY, PARKING AREA ANDIOR. SIDEWALK PAVING OR REPAVING
MIAMI
1 ., NE AVENUE
WM SHORES FL 33136
FAx: 954. 237 -3045
ACORD 26 (20011($)
SHOULD ANY °Fre
DATE THHREDP, THE
pETOTIF
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