DS-11-1167BUILDING
PERMIT
FBC 20
Permit Type
OWNER: Name
Address:
r U' 1 i 1 —'- 1
APPLICATION
INSPECTION'S
a
Miami
Building
10050 N.E.2nd
Tel:
in
in h<
Shores Village r �� 201`
Department
Avenue, Miami Shores, Florida 33138 ° I: °°
(305) 795.2204 Fax: (305) 756.8972
PHONE NUMBER: (305) 762.4949
Permit No. 1)10)--)
Master Permit No.
ROOFING f
4 L.,4 �- C� i l L-LL Phone #: ""3- 6 / . sy?. 9, 93
I I 1
(Fee Simple Titleholder):
5 9c, SL., t S"%
4 ' (°1g1.
+
City: I l Q - State: 'ri-- Zip: 3313 8
Tenant/Lessee
Email: h'`
Name: r - levy k
a dam , Phone #: S� /. 3. 9) 3 93
vis- � �l f t-k-F ki o. C.
JOB ADDRESS:
City:
0 9 1y 100.+L\ ct.
Miami Shores County: Miami Dade Zip: 33 /71
Folio/Parcel #:
Is the Building
CONTRACTOR:
Address: b
Historically Designated:
Company Name:.DE
.2 gw N s--
Yes NO Flood Zone:
32 E
, /;I;, L-V C.. Phone #:(- 5.)- C -13. �?
A.
City: µ ► n. m.A State: ---TL- Zip: 1 S-;
Qualifier Name:
State Certification
Contact Phone#eeic,
DESIGNER:
Value of Work
Type of Work:
Description of
e'U+4
e ,..►D,S .., Phone #:
or Registration #:e
- - • -k70...
Gc- ‘S 08 q-.1---‘1 Certificate of Competency #:
Email Address: .
Architect/Engineer: Phone #:
for this Permit: $ / / Ov Square/Linear Footage of Work: Z Sd
UAddition ❑Alteration UNew �ltepair/Replace ❑Demo lition
Work lfrout -$ Kee' , L 1) vi -t t^e� IA-7/ In e W al.eka/ le i-
go.L
ex.s 4 new *vd ?oav
, ,
tiArb -1)01C
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *** * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ / CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ ®0 ®c.) Training/Education Fee $ Technology Fee $
Double Fee $ i Structural Review $ 1 t ,,
TOTAL FEE NOW DUE $ 1 L9 Y
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me thisD-74-- The foregoing instrument was acknowledged before me this 20-
of j4JA � , 20 11 , by (( p(C 1,c. ��15 2.^�1'�- , day of 3J , 20 K , by
who isyersonally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
l2
NOTARY PUBLIC:
Sign:
Print: r '\ rt t S ,Pf - si
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * **
APPROVED BY
Ou"°• STELLA MARIS PRENDES
Commission #OD 855155
Expires January 27, 2013
iie1490
(Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
Print: SEe 4t-A i,A AR21 s { ,,, +» S
My Commission Expires:
* * * * * * * * * * * * * * * ** *.
Plans Examiner
Structural Review
* * * * * * * **
Zoning
Clerk
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
269 NE 100 Street
Miami Shores, FL 33138-
1132060134690
Block: Lot:
ALBA INVESTMENT II, LLC
Owner Information
Address
Phone
Cell
ALBA INVESTMENT II, LLC
690 SW 1 Court
MIAMI FL 33130-
Contractor(s)
Phone Cell Phone
DEERE INDUSTRIES LLC
(30)986 -8632
Valuation:
Total Sq Feet:
$ 1,100.00
250
1
Approved: Yes
Comments:
Date Approved: 6/28/2011: Yes
Date Denied:
Type of Work: DRIVEWAY
Bond Retum :
Scanning: 2
Additional Info: TRAVERTINE PAVERS
Classification: Residential
Fees Due Amount
CCF $1.20
DBPR Fee $2.00
DCA Fee $2.00
Education Surcharge $0.40
Permit Fee $100.00
Scanning Fee $6.00
Technology Fee $1.60
Work without Permit Fee $100.00
Total: $213.20
Pay Date Pay Type Amt Paid Amt Due
Invoice # DS -6 -11 -41315
06/28/2011 Check #: 1034 $ 50.00 $ 163.20
07/21/2011 Check #: 1048 $ 163.20 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
July 21, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
July 21, 2011 1
Planning and Zoning g o ng Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number:1132060134690
Owner's Name:
Job Address: 269 100 Street
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet: 250
Total Job Valuation: $ 1,100.00
Contractor(s)
Phone Primary Contractor
DEERE INDUSTRIES LLC
(305)986 -8632 Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/28/2011: Yes
Comments:
CERTIFICATE OF LIABILITY INSURANCE
OP ID: JL
DATE (MM/DD/YYYY)
03/15/11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
M DW Insurance Group Inc
362 Minorca Ave
Coral Gables, FL 33134
Paul S Echevarrla
305 -444 -2324
305- 444 -4980
CONTACT
NAME:
PHONE
JA/C. No. Est):
E -MAIL
ADDRESS:
FAX
(A/C, No):
PRODUCER DEERE -1
CUSTOMER ID is
INSURERS) AFFORDING COVERAGE
NAIC /
INSURED
Deere Industries LLC and
Deere Construction LLC
6222 SW 152nd St
Miam i, FL 33157
INSURER A :Accident Insurance Company
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
•
THIS IS TO CERTIFY THAT THE POLICIES OF INS RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTW(rHSTANDING ANY REQUIRE ENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIE . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SU R
POLICY NUMBER
POLICY EFF
IMM/DDIYYYYI
POLICY EXP
(MMIDDIYYYYI
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
AGL9004694
03/12/11
03/12/12
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES(Eaoccurrence)
100,000
$ �
CLAIMS -MADE
X
OCCUR
MED EXP (Anyone person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY PRO-
JECT LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
H RED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea acd dent)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
_
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y /N
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDE?
(Mandatory In NH)
If yes. descnbe under
DESCRIPTION OF OPERATIONS below
N / A
WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach
Executive Supervisor
ACORD 101, Additional Remarks Schedule, If more space is required)
OLDER
CANCELLATION
CITYMIB
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 1988 -2009 ACORD CORPORATION. All rights reserves_.
ACORD 25 (2009/0 The ACORD name and logo are registered marks of ACORD
LAID SURVEYOR it PLANNER
13217 SW 48 LANE
MIAMI, FL 33175
PHONE: (30223 -8080 FAX: (305) 223-4007
•
BOUNDARY SURVEY
PAGE 2 OF 2
e ro T Weitt VIMMUT PAW 1GV2,
JOB No. 09-0110
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SCALE: NTS
PAGE 1 OF 2
NOT VAL18 WITHOUT 9902 2 OF 2
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JOB No. 09 -0110
PROPERTY ADDRESS
LEGAL DESCRIPTION:
LOT 20 & W 1/2 OF LOT-21,
" MIAMI SHORES SE0-1 AM() "
269 NE 100th STREET,
IAMI SHORES, FL 33138
BU< 34
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 AT PAGF 70
OF THE PUBLIC RECORDS OF _ DAM-COUNTY , FLORIDA.
LEGEND AND ABBREVIATIONS
DRWf.
U.P.
BOJi
MOS
CA.
CJS.S.
121.
CL
CA
CONK;.
■ ELEVATION
- SWAY
•
MTV POLE
• BAS CF BEMIRE
AIR coonramo Pi O
- NC CEP1=
. &7AOINO
. CATCH BASBI
• CONCRETE ROCK STRUCTURE
- CLEAR
OSTAMOE
• OENTER URE
. CONCRETE
SLR.
P.O.C.
F.N.
P.T.
E.N.C.
FJL
F.LP.
F.LR.
LF.E
TO
a)
ELEVATION INFORMATION;
BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY DATED OR
09/11/2009 THE HEREIN DESCRIBED PROPERTY IS SsTUATm
P.1.
• SET TROTT ROO PFT.0
• PONT CF cokom-catoor P.C.
.
FOUND NA2 FRO.
- POINT OF TANO7ICY P.C.C.
• mangrove U/I.
• AMINO IRON PIPE 0.E.
.
FORD RESIN P.B.
• LET f70OR ELEMICO P.C.P.
- UGHT POLE P.C.
• MEASURED P.0.0.
RECORD PA
• RED & MAD NSA.
•
POINT OF RIERSECTION .
PORN OF RattisE CURVE
. POINT OF CUNSCURE
. FOUND NARRK •
• P0947 OF =POUND CURVE
- MONUMENT UNE
• NATIONS. STN'. VERTICAL ONUTA
• SAD ELECWIN WC
- PLAT BOOK
-
PERMANENT CONTROL POW
* PACE
. POINT OF B10N TEND
PROPERTY UNE
• NOT TO SCALE
REVISED ON
SASE FLOOD ELEVATION N/A COMMUNITY 120652
ELEVATIONS(WHEN SHOWN) REFER TO N.G.V.D.. 1929 DATUM.
COWRY BENCTEMARX USED N/A ELEVATs
THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY.
CERTIFIED TO;
ALBA INVESTMENTS II, LLC.
LEGAL NOTES -
° 7l1i§' SIAM I NES ACTT. MOOT OR 0Et219194E OWNS.
OF THE ABSTRACT OF TITLE NIL.61VE;'TA 9 MADE: DETERMINATE I AMMO THE PROPERTY. THIS SUOF T TO
i TIONS.�, LEGAL
P R O V I D E D or cum. TIE UABIIRY OF THIS S t 1 R V E Y S LBD m to -fit r THE SURVEY.
BIAMOACIMENT3. IF Mt ARE NOT SHOW MS Fit WS NOT ATTEMPTED In
1 L0011E F001910 AND/Ot 1VAIN AT IONS. AND /L : 4 OF
ANY MATURE ir M9, BEAM= ARE REFERRED ,TO . RISSDJED-MROAN
Y =vet
EMOTIONS AE INFERRED 10,N.O.VA. O. 1928. THE CLOSURE IN THE BOUNDARY SURVEY E
ABOVE 1:10020. '1*D3 SURVEY ILIIPT DIMMED FOR NEITHER DES1OA FOR CONSTRUCTION PURPOSES.
FOR MOOSE PURPOSES A TOPOGRAPHIC SURVEY-ST D
FETNE OWNS NOT DETERMINED --
FLOOR ELEVATION RAT FIFO FLOOR ELEVATION AT THE FRONT DOOR MUSS
OTHERWISE NOTED.
WITHIN ZONE
PANEL NUMBER 0302 SUFFIx
L
0
"✓f
8/C
11
WAD.
RM.
R/0
SEC.
STY
SWK
UE.
CENTRAL MINE
• WOOD VOCE Or 16{81)
*OMNt UBRK FENCE (4' HMO
•CALS. WALL
.fit CORNER
. TUB
REMENCE
ROW OFWAY
SECTION
• SET IRON F4PE
•
STORY
- 90990*
• MITT EST
N/A FEET BA L0 909 N/A
FELD OATA /02/10
REVISIONS
OA1&
THIS CERTIFIES NAT 1i2 BOUNDARY SURVEY
DESCRIBED HEREON WAS MADE UNO9R TAY SUPERVISION
NIO THAT THE SAVE MEETS THE MINIMUM TECHNICAL
STAOOARDS SET FORTH BY THE FLORIDA BOASIT OF
SURVER:SO AND MAC IN CHAPTER 61017 -6, FLORIDA
ADMINISTRATWE CODE, PURSUANT TO BECKON 472027.
8.A SIA1 ns.
VIZCAYA LAND SURVEYORS, INC.
IAND SURVEYOR & PLANNER
13217 SW 46 LN42
TRAK fL 33176
9098098) 733 -6086 FAX(303) 223 -4007
CERTIFICATE OF AUTHORIZATION MN
VIZ« LAND SURVEYORS, INC.
SCAB OF fib
NOT WM MIAOW THE N3 A4® THE WOOL 991. 0$ A
N ORMA =NM ARMOR NO MIWP1R
ARTURO TOIRAC.