DS-12-1435Miami 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
B 1 � DING
PERMIT APPLICATION
�EEVVE
JUL NO 2I2
FBC 20
Permit No. DS " 1 LI 3S
Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: 2 9 M /Oil 3 Tre r
City: Miami Shores County: Miami Dade
Foho/Parcee#: 1 I — 21- 3 � ®D 11 - 00 -7 0
Is the Building Historically Designated: Yes NO
zip: 33/38
Flood Zone: _ X
OWNER: Name (Fee Simple Titleholder): Cydc A< //CA and Care Re / /%one#: 703- 571-44,06 aAci
Address: 21 N E/ lJ 4 Si- j-€ 44-
City:M /4m.' Siff aec A
Tenant/Lessee Name: MA
Email. C19 d e r°e k Vv■ Co rb
State:
Fb
CONTRACTOR: Co any Name: ,4ylh.e ricer
Address: // Z c
City: L e
Qualifier Name:
Sit
e
State: P1e-
eoiet
State Certification or Registration #: E d (fl ®/ /-1
Contact Phone#:,3dr- 2 2 6 - Sv' 9
DESIGNER: Architect/Engineer: Pao, /
51/-276-5311
Zip: 3 ?/f'
Monet
a P` 1, coil,
eor)Crc4e 22.4 znes
Email Address:
Ley v
Phon
Certificate of Competency #:
zip: 001 7
0
WNW allot tereCt 1vep Cta .ci -ee4e . r --
Phone#:3 45 - 2'Z 6 2' f e
/e y va e col.
Value of Work for this Permit: $ 2g0® Square/Linear Footage of Work:
Type of Work: °Addition °Alteration °New: i tepair/Replace °Demolition
Description of Work: Re pi s to rive cadge" w rte' h e an cee-A e al rd v c
Color thru tile: 7- c, .��.
Submittal Fee $1b, ._ , Permit Fee $ /TO e) " CCF $ CO /CC $
Scanning Fee $
Notary $
Radon Fee $ DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ ? RD
Bonding Company's Name (if applicable) N/ A
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) X/4
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! -j9 hl R &L
Owner or Agent
The foregoing instrument was acknowledged before me this 50
day of , 20 by C i42 C ,
who is personally known to me or who has iuosdi 2— I
As identificatiq,eurs1 who.did ta,1013oath.
o °* •
p,
NOTARY PUBLIC:
7
Sign:
Print:
My Commission Expires:
41444 i�lii�l�� <<�.∎\
Signature
Contractor
The foregoing instrument was acknowledged before me this _3 .3j
day of Sim , 20 by 'PAW' l 1. ',./,/�
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:
ZO q:� 4 17477
*+ k*4'+ k***** ********B ****+ k*****A+ N****+ k***+ k***& **+ N*+ k* *+ k**+ k*R **+ k*ris* ******** ***********+N***+b*** ** +b*** *+MI6
�nmu�a��
Plans Examiner Zoning
APPROVED BY
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
Miami Shores Village
Building Department
RECEIPT
PERMIT #:rDS ( /.2 d f d-3�DATE:
I, 'a,- 4 Re /lc k
❑ Contractor
wner
❑ rchitect
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Picked up sets of plans an other)
Address: 2- NAL
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: /r'e,
PERMIT CLERK INITIAL: ..'
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
PERMIT # OS LQ, — 14-65
CONTRACTOR: MAC/6 o� Ga1/010k
SUBMITTAL DATE: 1 3
jot
ADDRESS: d 1\1E-- 1 G�
NAME:
RESUBMITAL DATES:
1S
PROJECT TYPE: p I nap
ZON
IRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
BLY 5'
1114
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) eo_ roi ffe`i cIs hereinafter referred to as the owner of
the following described property (address): 2 9 A/4
PZ 3/
Legal Description Lot 7 Block Subdivision 13e ver'ftf ‘jien
Folio #
Requests permission to install (describe work):
Pri re Wet r
? Within the public right of way of (address) 2 ��L.�. ) 0 t{ Ls 7
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).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this 3 0 day of , 201 2
SIGNE ' SEAL !a AND DE
2
%u►w►►n,,, j
the p.reee ce of:
P7'erni CD E-
pa ga�'Cij
I WO'�`\\
(Owner's Signature )
Rick Scott
Governor
John H. Armstrong, MD
State Surgeon General
August 06, 2012
Clyde Relick
29 NE 104 St
Miami, FL 33138
RE: Contingency Letter
Application Document No: API079309
Centrax Permit Number: 13 -SC- 1423366
OSTDS Number:
29 NE 104 St
Miami, FL 33175
Lot:7 Block: na Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 08/01/2012 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
From a review of your completed application, it has been determined your existing system is
adequate for the proposed use (driveway construction).
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Sincerely,
Josepp P' rge , En i Specialist II
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com
wev lortp
We need to take
every opportunity
possible to thank our
amazing clients
for their support..,
W W W.MELANDSERVICES.COM
3H1 SS37
A'1
Miami Shores Village
PRO \tED
!G DEPT
Accepted By: wl r1-1 Al I FEDERAL
Property Address: 29 N.E. 104 S, j • TONS
MIAMISHO S
NOTES: NO NOTES
FORTH BYTES
MY DIRECTION. THIS COMPLIES WITH THE MINIMUM
TE OF FLORIDA BOARD OF PROFESSIONAL LAND
r�.. TIVE CODE PURSUANT TO 412.027, FLORIDA STATUTES.
SIGNED
MIGUEL
STATE OF
OT VALID WITHOUT AN
MAP IS NOT VALID
MAPPER
vivre OF
.Alias„
Survey: A-32110
FOR THE FIRM
P.S.M. No. 5101
C- %iATURE AND AUTHENTICATED ELEOTROWC SEAL ANDIOR
AND THE ORIGINAL RAISED SEAL OF LICENSED SURVEYOR
Client File #: 12 -1797
MIGUEL ESPINOSA LAND SURVEYING, INC.
10665 SW 190TH Street
Suite 3110
MIAMI, FL 33157
PHONE:(305) 740 -3319
FAX #:(305) 669 -3190
LB # 6463 ,s
Page 1 of 2 Not valid without all pages.
f
r.:
PROPERTY LINE
STRUCTURE
CONC. BLOCK WALL
CHAIN -LINK FENCE OR WIRE FENCE
WOOD FENCE
IRON FENCE
EASEMENT
CENTER LINE
W000 DECK
CONCRETE
ASPHALT
BRICK / TILE
WATER
APPROXIMATE EDGE OF WATER
COVERED AREA
TREE
POWER POLE
CATCH BASIN
COUNTY UTIITY EASEMENT
INGRESS / EGRESS EASEMENT
UTILITY EASEMENT
END
Surveyor's Legend
FOUND IRON PIPE /
PIN AS NOTED ON PLAT
LBO LICENSE O - BUSINESS
LSO LICENSE O - SURVEYOR
CALL
SET
•
•
ELM
P.T.
P.C.
P.R.M.
P.C.C.
P.R.C.
3.0.8.
P.O.C.
P.C.P.
M
P
0
C
LM.E.
CALCULATED POINT
SET PIN
CONTROL POINT
CONCRETE MONUMENT
BENCHMARK
ELEVATION
POINT OF TANGENCY
POINT OF CURVATURE
PERMANENT REFERENCE MONUMENT
POINT OF COMPOUND CURVATURE
POINT OF REVERSE CURVATURE
POINT OF BEGINNING
POINT OF COMMENCEMENT
PERMANENT CONTROL POINT
FIELD MEASURED
PLATTED MEASUREMENT
DEED
CALCULATED
LAKE OR LANDSCAPE MA1NT. ESMT.
ROOF OVERHANG EASEMENT
A
RAD.
N.R.
TYP.
LR.
I.P.
N&0
PK NAIL
O.H.
• M.H.
0.H.L
TX
CAN
W.M.
P/E
CONC.
EMT
D.E.
L.B.E.
LA-E.
BEARING REFERENCE
CENTRAL ANGLE OR DELTA
RADIUS OR RADIAL
RADIAL TIE
NON RADIAL
TYPICAL
IRON ROD
IRON PIPE
NAIL & DISK
PARKER -KALON NAIL
DRILL HOLE
WELL
TIRE HYDRANT
MANHOLE
OVERHEAD LINES
TRANSFORMER
CABLE TV RISER
WATER METER
POOL EQUIPMENT
CONCRETE SLAB
EASEMENT
DRAINAGE EASEMENT
LANDSCAPE BUFFER EASEMENT
LIMITED ACCESS EASEMENT
TEL
U.P.
E.U.B.
SEP.
D.F.
A/C
SAY
0WY
SCR.
GAR
ENCL
N.T.S.
F.F.
T.O.B.
E.O.W.
E.O.P
C.V.G.
B.S.L
S.T.L
R/VI
P.U.E.
CAL.E.
A.E.
TELEPHONE FACILITIES
UTILITY POLE
ELECTRIC UTILITY BOX
SEPTIC TANK
DRAINFIELD
AIR CONDRIONER
SIDEWALK
DRIVEWAY
SCREEN
GARAGE
ENCLOSURE
NOT TO SCALE
nNMISHED FLOOR
TOP OF BANK
EDGE OF WATER
EDGE OF PAVEMENT
CONCRETE VALLEY GUTTER
BUILDING SETBACK LINE
SURVEY TIE LINE
CENTER LINE
RIGHT -OF -WAY
PUBLIC UTILITY EASEMENT
CANAL MAINTENANCE EASEMENT
ANCHOR EASEMENT
Property Address:
29 N.E. 104 STREET
MIAMI SHORES , FL 33138
Flood Information:
Community Number. 120652
Panel Number. 0302L
Suffix: L
Date of Firm Index: 9/11/2009
Flood Zone: X
Base Flood Elevation: N/A
Date of Field Work: 7/18/2012
Date of Completion: 7/20/2012
General Notes;
1. The Legal Description used to perform this survey was supplied by others.
This survey does not determine or is not to imply ownership.
2. This survey only shows above ground Improvements. Underground
utilities, footings, or encroachments are not located on this survey map.
3 If there is a septic tank, well, or drain field on this survey, the location of
such items was shown to us by others and the information was not verified.
4. Examination of the abstract of title will have to be made to determine
recorded Instruments, if any, effect this property. The lands shown herein
were not abstracted for easement or other recorded encumbrances not shown
on the plat.
5. Wall ties are done to the face of the wall.
6. Fence ownership Is not determined.
7. Bearings referenced to line noted B.R.
8. Dimensions shown are platted and measured unless otherwise shown.
9. No Identification found on property comers unless noted.
10. Not valid unless sealed with the signing surveyors embossed seal.
11. Boundary survey means a drawing and/or graphic representation of the
survey work performed in the field, could be drawn at a shown scale and/or
not to scale.
12. Elevations if shown are based upon NGVD 1929 unless otherwise noted.
13. This is a BOUNDARY SURVEY unless otherwise noted.
14. This survey is exclusive for the use of the parties to whom it is certified.
The certifications do not extend to any unnamed parties.
Legal Description:
LOT 7 LESS THE NORTH 130 FEET, OF SUBDIVISION BEVERLY GLAN, ACCORDING TO THE PLAT THEREOF AS
RECORDED IN PLAT BOOK 38, PAGE 74, OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA
PRINTING INSTRUCTIONS:
While viewing the survey in any Acrobat Reader, select the
File Drop -down and select "Print'
Select a color printer, if available, or at least one with 8.5" x
14" paper.
Select ALL for Print Range, and the # of copies you would like
to print out.
Under the 'Page Scaling' please make sure you have
selected 'None."
Do not check the "AutoRotate and Center" button.
Check the "Choose Paper size by PDF"checkbox.
Click OK to Print.
oOBONIS; JOSE C. MARRERO & ASSOCIATES, P.A.;
IDELITY NATIONAL TITLE INSURANCE COMPANY; ; .
ts'successors and /or assigns as their interest may appear.
Florida Land
Title Association
AFFILIATE
MEMBERS
M.E. LAND SURVEYING, INC.
10665 SW 190TH Street, Suite 3110 MIAMI, FL 33157
PHONE:(305) 740 -3319 FAX #:(305) 669 -3190 LB # 6463
WWW.MELANDSERVICES.COM
Survey: A -32110
Client File #: 12 -1797
Page 2 of 2 Not valid without all pages.
09/22/2012 11:26 3652792549 WESTSUNSETINSURANCE PAGE 01
Is
...„....--.10.41 DATE 01 MI10131YY)
,-14C;PRI/r311° CERTIFICATE OF LIABILITY INSURA NCE 08/, 2/12
PRObuceR West Sunset InStrencs Agenq . • . THIS CERTIFICATE IS ISSUEDA:iiiiiiiiiER OF iii6Eiiii II iiiicii4
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICal rE
10300 Sunset Drive, Suite #4,1t: : HOLDER. This CERTIFICATE DOES NOT AMEND, EXTEIP 0 OR
MIMI, FL 33173 , .4.i.g.13.THE..99.MgRAgg 4FFORD_EP in 11:T .17P41.9142P V .%9VV.,........... .
Phone (306)270.8499 Fax .. (306)279-2549 . INSURERS AFFORDING cOVERAGE NPCif
iNsURED American Stamp Concrete
•INS1.11,N .IRAVELERS INSURANCE COMPANY
............ . ..... .. . ......... .... ..._
INSURER S: -
11362 S.W. 7th Street : INSURER c:
MIAMI, FL 33174- INPM5P:. - — •••- -,,..
: INI-15...q1,.. i.
COVERAGES INSURER F:
THE POLICIES OF INSURANCE us-rcii.iiiVEiriE.N issilib.rdti1E INSURED I *viiiitiAiovE FOR n:iiFof.ToY PERIOD iniiidAfir):Nonrtni-FiaTAi,i6 . 16
ANY REQUIREIVIENT, TERM OR CONDITION CP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE OR
MAY PERTAIN. THE INSURANCE AFFORDED tY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS 1 SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAy'HAVE SEEN REDUCED BY PAID CLAIMS,.
,., ._.... ...
MR AMA POI:ICY iFPECTIVE ki6o;:i iiiiiiA-46-N ' ' • ' ' ----- '''
. LTR. INSRD . TYPE Or INSURANCE POLICY NUMBER umg (mmtroiyy) EiNrgrylalry) LIMITS .__
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GENERAL LIABILJTY
COMMERCIAL GENERAL LIABILITY
A
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GEN'L AGGREGATE LIMIT APPLIES
POLICY , PROJECT LCO
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
, HIRED AUTOS
NON OWNED AUTOS
GL-24825-0
EACH OCCURRENCE
• DAMAGE TO REHTED— *****
. 09/23/11 1 09/23/12 ..PRViSES (PA
MED EXP (Any one person)
PERSONAL & ADV INJURY.
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ANY PROPRIETOR/ PARTNER / EXECUTIVE
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DESCRIPTION OF OPERATIONS TUOGRFIONI BY ENDORSEMENT / SPECIAL PROVISIONS
STAMP CONCRETE
CERTIFICATE HOLDER
MIAMI SHORES VILLAGES
10060 N,E. 2ND AVENUE
MIAMI SHORES, FL. 33138
Acokii 25 (2001/08)
. ...... . .
CANCELLATION
. .
1,000,000
giabb:
6 oo ,
,
110.99429.9.:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEL I I3EFORE THE
EXPIRATION DATE -ni BEOP, THE ISSUING INSURER WILL ENDEAVI It TO MAIL
30 DAYS WR1fN NOTICE TO THE CERTIFICATE HOLDER NI' VED TO
LUT, BUlAILthE TO DO • HAL MPOSE NO OBLIGATION LIABILITY
OF ANY 19N6 UPON THE INSUR ITS AGENT OR REPRESENTATIII
A ......._ _ -
EPRESENTA
.-_-_-_, •
1988 •
AUG -22 -2012 WED 10:59 AM
MULTILINES RISK UNDERW
FAX No. 3055987851
P.001
.�co'' CERTIFICATE OF LIABILITY INSURANCE
8 /22` 20D12
THIS CERTIFICATE IS ISSUED AS A MATTER OP 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 pcllcy(iee) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain ',Moles may require an endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such andoraement(s).
PRODUCER
MULTI LINES RISK UNDERWRITERS INC
10250 SW 56th St #C202
Miami, FS� 33165
•,
PPHONE
�.Estr. (305) 5.98 ^1411 ( Ne);(305) 598 ^7851
A{t
ADDRESS:mlines @bellsouth.net
INSURER/SI AFFORDING COVERADE
NAM
IN8URERA: Gurantee Insurance Co.
INSURED Arltorican Stamp Concrete Corp.
11362 SW 7 St
Miami , FL 33174
INSURER B:
INSURER C •
EACH OCCURRENCE
INSURER D:
INSURER E :
DAMAGE TO RENTED
PREMISES (Ea occurrence)
NSU;E; F.
CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT 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 AFPORDEb BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
7 e�EXCLUSIONS
LyO
TYPE OF INSURANCE.
A°°i.
INa�i
SUNK
WV])
NUMBER
_pomp EFF
(MM/OuNYYY)
POLICY EXP
(MMIDp/YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
8
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
8
CLAIMS -MADE
OCCUR
MED EXP (Any one person)
$
PERSONAL &ADVINJURY
$
GENERAL AGGRE ®ATE
ID
GEN'L AGGREGATE i,IMJT APPLIES PER:
—I POLIOY n 528f JI LOC
PRODUCTS - COMP/OP AGO
$
$
AUTOMOBILE LIABILITY
COMBBIINE STNtIMIMIT
accident) (Ea
8
—
_
ANYAUTO
ALL OWNED
BODILY INJURY (Per person)
$
HIRED AUTOS
—
AUTOS AUU4EO
NON-OWNED
BODILY INJURY (Per occident)
3
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAR
EXCESS LIAR
, ..-
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
�
• DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LJAaILITY Y/N
WC22488
a 0-7— 1
0 7 12
I WC^$TATU- %-
i TORY LIMN I
OFFIOPERIIIFRWO ARTNE: CUTIVE
N/A
E.L. EACH ACCIDENT
1�
$ 0b 000
(Mandatory In NH)
(ryas describe under
DE$$RIPTION QF OPERATIONS below
E.L. DISEASE - EA EMPLOYEE
$ 500,000
E.L. DI8EA8E - POLICY LIMIT
3 10 0 , 0 0 0
oascnIPTiON OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addklonel Remarks Schedule, if may space, is required)
MIAMI SHORES VILLAGE
10050 NE 2 AVENUE
MIAMI SHORES, FL 33138
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICTROVISIONS.
AUTHORIZED REPRESENTATIVE
CI 198E-2010 ACORD CORPORATION. All rights reserved.
ACORD25(201 0105) The AGORA name and logo are registered marks ofACORD
1111111 1111 1111 1111 HIM 11111111
CFN 2.012R053919t.,
DR Bk 28236 Ps 2930 (1os)
RECORDED 08/21/2012 155442
HARVEY RUVIM, CLERK OF COURT
MIAMI-DADE COUNTY, FLORIDA
LAST PAGE
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON TIM JOB SITEAT ME OF mg INSPECTION
PERMIT NO D5'A2-14/35 TAX FOUO NO 11—(2/3t B42- 007
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED hereby gives notice that knprovements wM be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
Is provided hi Mk; Notice of Commencement
1. Legal desprip__tion of property and street/address:
47/i/tM, .5ho."-'45 M- 33/ .7'
2. Description of improvement: _DrY Vo Way
3. Chariter(S) naineand address: eljde, 1?e htk an.d. C - 01 c- l?e 1 ,- C lx. ,_ gq ifv&-----..: joy 54., al,-
Interest in property: blokrci-C
Name and address of fee Millets titleholder. / nc... #.,„,,,e, Be /cc,
4. Contractors name, address and phorIT4s1
.CLAre-e-4-10/44-e-, fr.1-4- T,? 1/
r 1 n e 4- - i tan •sitohul a rIC.e't e. ii .5• 1V .7
P )
. .
5. Surety: (Payment bond requited 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.,,Olorida Statutes,
Name, address and phone number:
Space above reserved ter use ttf recording office
q
Li pnet, 1.0 47 Size o cac)
X 23i/
& In addition himself, Owners designates the following person(s) to receive a copy of the Llenor's Notice as provided In Section
713.130X0, Florida Statutes
Name, address and phone number:
•
9. Expiratkon date of this Notice of Commencement: •
. . • , she experanon date Is 1 year iron the dated tecording uniea a Oftereili date Is socemeco
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THBNOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTEB, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB BEFO- HE
OR RECORDING YOUR NOTICE OF COMMENCEMENT:
FIRST INSPECTION. IF YOU INTEND To OBTAIN FINANCING, CONSULT WITH YOURLENOfFIDRAN ArroFIN. Ey BE-F. - 0 MMENCIN
a IA It Of- 1-LUKILA, COUNTY OF DAD \AID COtriv
I HEREBY CERTIFY that this is a true ,1,4"- P
Signettge(s), CLf
By ed Officer/pirector/Partn ...107- 1406A (:# o
- Prepared By s fh
rAtaltial ....dmit ---
,t.
Print Name Print Nam , ."11-11.91:1;MAMINIOWare ,..
Mi./Office Title/ ti a e
, o ircw an LIIITAIIIIIM .R-
mit ot FLoApt■ 0,9
q-
411_IN/t)..Cao. 1 2_ ,
arts 40 (("-
CO ' OF M I-DADE 44)E cou0'
ed before me this rgl day of
The • ‘. • 4 f ' ji t) '
By lent w: I c' .
13 Indivicloolilf, or ''' as a 1?11.41, it.. 11 t•
,_ for
IJ Personally known, or CI produced the following type of identificatio
Signature of Notary PUblic:
Print Name:
(SEAL)
All
M1/1111411141111T/MIANINF
Mit WIJIIIMIMPItt
VERIFICATION PURSUANT TO SECTION 92525. FLORIDA STATUTES
Under periaitles 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.
Signatuse(s) of Owner(s) or.Owner(sys Authorized Officer/Director/Partner/Manager who stnso o :
By rdielatk--- By
CLAUDIA V. CUBILLOS
Notary Public - State of Florida
My Comm. Expires Sep 23, 2015
(07, Commission # EE 128810
129.01.52 PAGE 3/10
Bonded Through National Notary Assn.
-141r '11117 ,111I 0, 'WI w 11Ir