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DS-11-1403Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 162774 Permit Number: DS -8 -11 -1403 Scheduled Inspection Date: June 14, 2013 Inspector: Rodriguez, Jorge Owner: Job Address: 105 NW 92 Street Project: Miami Shores, FL 33150- <NONE> Contractor: ESR FLORIDA CONSTRUCTION INC Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1131010331050 Phone: (305)812 -2716 Building Department Comments BRICK DRIVEWAY AND WALKWAYS AS PER BLDG OFFICIAL, OK TO EXTEND PERMIT 60 DAYS ONLY. 7/31/12 PERMIT RENEWED FOR 6 MONTHS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 13, 2013 For Inspections please call: (305)762 -4949 Page 1 of 25 A\11\ (49 BUILDING PERMIT APPLICATION Fsc zo 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 TO UMW% AUG 0 q 2011 Permit No. Master Permit No. Permit Type: BUILDING ROOFING 1-° n 5 Al 4u GI- 2 j OWNER: Name (Fee Simple Titleholder): 9 (4/� I C � Phone#: CJ S vZ — _2_11 (C� Address: I b 5 Aoki UJ q a Ai.' 5- l City: Ai AN 1 6 tfrvii Q,Q - 3 State: 00 ,44 o k Zip: (330-'0 Tenant/Lessee Name: Phone#: Email: �— JOB ADDRESS: C b t v ui tv City: Miami Shores County: Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Comp Address: City: Qualifier Name: State Certification or Registration #: c ( G d 5 0 0 Certificate of Competency #: Miami Dade Zip: S 6 1..9 y Name: gS'Y2 t e b 4 3-2- 2� to NO °"' Flood Zone: 3MW i :V L, Phone #: 'a 5 g1 7 /L Zip: 534rs" Phoned .z79 4L72,�, Contact Phone #: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ Type of Work: OAddition OAlteration New Description of Work: /S'Gi C4 rvewq/ #' as eayJ' Footage of Work: ORepair/Replace /f o'° ODemolition * * * ** **+ x* *+x+x** ***************** * * * ** ** Fees' * **** ******** * * * *m * * ********** * * ********** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE CCF $ DBPR $ Technology Fee $ CO /CC $ Bond $ Vara 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 ich occurs seven ( ray after the building permit is issued. In the absence o posted notice, the inspection will not be oveiL; nd a reins . ction f will be charged. Signature The for day of ntification and who did take an oath. Contra The for oing ins ment was ac day of , 201 ersonally known to me or who has produced Pitification and who did take an oath. LIC• ti? Sign: Print: My Commission Expires: Sign: Print: My Commission Expires: xOS',,, ***********+x**** * *** x****+x+x*** u:***** + x**** ************a:*********** *** * APPROVED BY ./� /01-71/ Plans Examiner Y Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) . =_Jy * *,... * * * * * * * * * * *, * * * * * * * * * * * * ** Zoning Clerk Miami Shores Vivage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: CAS l i g15.3 DATE: �S t I, M34-‘11Q ( ❑ Contractor ❑ Owner Architect Picked up 2 sets of plans and (other) Address: 10S N From the building department on this date in order to have corrections done to plans And /or get County stamps. I underst . d th. the plans need to be brought back to Miami Shores Village Building Departme t to con roue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: d II PERMIT CLERK INITIAL: BHP- Qx) Permit No: 11 -1403 Job Name: August 5, 2011 Miami Shores Viiiage Building Department Building Critique Sheet 1) Plans must be approved by HRS for the septic system. 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 doa 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 i 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 Folio Number:1131010331050 Owner's Name: Job Address: 105 92 Street Miami Shores, FL 33150- Owner's Phone: Total Square Feet: 1300 Total Job Valuation: $ 5,850.00 Contractor(s) ESR FLORIDA CONSTRUCTION INC Phone (305)812 -2716 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 8/4/2011: Yes Comments: PLEASE SHOW THE DRIVEWAY CONNECTION FROM THE PROPERTY LINE TO THE ALLEY. BUILDING OFFICIAL CORRECTED PLANS FOR THE APPLICANT. APPROVAL IS BASED ON COMPLIANCE WITH PLANS AS AMENDED BY THE BUILDING OFFICIAL. 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 -8 -11 -1403 Issue Date: Not Issued Expires:Not Issued Folio Number:1131010331050 Owner's Name: Job Address: 105 92 Street Miami Shores, FL 33150- Owner's Phone: Total Square Feet: 1300 Total Job Valuation: $ 5,850.00 Contractor(s) ESR FLORIDA CONSTRUCTION INC Phone (305)812 -2716 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 8/4/2011 Comments: PLEASE SHOW THE DRIVEWAY CONNECTION FROM THE PROPERTY LINE TO TH ALLEY. Rick Scott Governor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General November 17, 2011 Joseph Bernard 4001 Madison St Hollywood, FL 33021 RE: Contingency Letter Application Document No: API046871 Centrax Permit Number: 13 -SC- 1368574 OSTDS Number: 105 NW 92 St Miami, FL 33150 Lot:23 Block:134 Subdivision: Miami Shores Dear Applicant: This will acknowledge receipt of an application dated 09/12/2011 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced Proposed new Paver Driveway and walkway at the back yard and a new paver walkway at front. There is not increase in sewage flow, change sewage characteristic, or any alteration that change the conditions under which the system was approved. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: 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 • • • • • • 81.60' • • • ••• • ••• •••• • •• • •••• • APPS Peririt no. k Date: Miami -D Health De d tl 4 d 4 4 4 4 d 4 ° tl tl 4 tl ° 4 4 4 4 4 d N.W. . 92 STREET 4 4 tl 4 4 2 4 4 4 4 4 4 tl 4 4 4 4 4 g4 4 4 4 4 4 4 4 4 4 4 LEGAL DESCRIPTION MIAMI SHORES SEC 6 PB 10 -39 Eye LOT 23 & 24 BLL 134 LOT SIZE 81.640 X 123 OR 17186 -4733 0596 OR 27640 -0650 0211 01 FOLIO# 11- 3101 - 033 -1050 OCCUPANT CLASSIFICATION SINGLE FAMILY RESIDENCE R -1 TYPE OF CONSTRUCTION TYPEVB SITE DATA ZONING CLASSIFICATION RU -1 LOT AREA 10041 SQFT. SITE DATA ZONING CLASSIFICATION LOT AREA SETBACKS FRONT REAR SIDES BUILDING AREA BUILDING HEIGHT EXISMNG BLDG. RENOVATIONS LOT COVERAGE REQUIRED 25' 25' 7.5' 35' 3514.3SQFT RU -1 10041 SQFT. PROVIDED 29.62' 40' 9.93' 19' -1° 2181SQFT. OSQFT. 2181SQFT. RAINWATER SHALL BE RETAINED WITHING PROPERTY LINE (OR 0 SITE MAP /6u_1,_0" .......... Miami Shores Village APPROVED ZONING DEPT BLDG DEPT rif) "(4 • SUBJECT TO COMPLIANCE DERAL STATE AND COUNTY RULES AND REGULATIONS CHARLES MITCHELL, P.E. 924 NORTH FEDERAL HWY. HOLLYWOOD, FL. 33020 305.338.5069 PROJECT: NEW BRICK PAVERS ADDRESS: 105 NW 92ND ST. MIAMI SHORES,FL 33150 OWNER: EQWARD I ZO • • • • 6ATk: 8;440* • • • • .•• •••• • • • • • DRAWN BY JB APPROVED BY: REVISIONS: SHEET NO. A -1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 105 NW 92 Street Miami Shores, FL 33150- 1131010331050 Block: Lot: 105 NW 92 LLC c/o EDWARD RIC Owner Information Address Phone Cell 105 NW 92 LLC c/o EDWARD RICZO P.O.BOX 150472 CAPE CORAL FL 33915- I P.O.BOX 150472 CAPE CORAL FL 33915- Contractor(s) Phone Cell Phone ESR FLORIDA CONSTRUCTION INC (305)812 -2716 (302)279 -4726 Valuation: Total Sq Feet: $ 5,850.00 1300 Approved: Yes Comments: PLEASE SHOW THE DRIVEWAY CONNECTION FROM THE PROPERTY LINE TO THE ALLEY. Date Approved: 8/4/2011: Yes Date Denied: 8/4/2011 Type of Work: DRIVEWAY & WALKWAYS Additional Info: BRICK Bond Retum : Scanning: 3 Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.60 $2.00 $2.00 $1.20 $125.00 $9.00 $4.80 $147.60 Pay Date Pay Type Invoice # DS -8 -11 -41632 01/10/2012 Check #: 1498 08/03/2011 Check #: 1402 Amt Paid Amt Due $ 97.60 $ 50.00 $ 50.00 $ 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. January 10, 2012 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date January 10, 2012 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 193325 Permit Number: DS -5 -13 -1111 Scheduled Inspection Date: June 12, 2013 Inspector: Rodriguez, Jorge Owner: CANDIO, VILMAR & ACELIA Job Address: 500 NW 112 Street Miami Shores, FL 33168 -3318 Project: <NONE> Contractor: HOME OWNER Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360210690 Building Department Comments INSTALLATION OF NEW CONCRETE APPROACH Infractio Passed Comments INSPECTOR COMMENTS False Passed 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- 191799. SOD BOTH SIDES OF DRIVEWAY. JR June 11, 2013 For Inspections please call: (305)762 -4949 Page 26 of 38 PERMIT # CONTRACTOR: SUBMITTAL DATE: ADDRESS: NAME: RESUBMITAL DATES: �3 t 506 kll.0 UVT STRUCTURAL IMPACT FEES ELECTRICAL HRS/DERM PLUMBING MECHANICAL NOC BUILDING 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 TOMIVitlip MAY 202013 8 T: o1000mmmamma0000000o FBC 20 Permit No. ®Irk 1 PERMIT APPLICATION Master Permit No. Permit Type: BUILDING JOB ADDRESS: 5 0 0 MN 1 1 a.+11 ROOFING City: Miami Shores County: Miami Dade Zip: I CA Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): V i 1 ll Ai- CA odic) Phone# :305 9 04°-Is 166 Address: 5bt N W 1i 2.44' SA-rt.-CA" City: v i 'O ilfl l 5h 0 t S State: 51_- Zip: 331 CJ ) Tenant/Lessee Name: Phone#: Email: v l ret or t.gY1 P at i1®o o fe o m CONTRACTOR: Company Name: • IA ) O Phone #: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ C01 Type of Work: OAddition DAlteration Description of Work: Square/Linear Footage of Work: 10' tel DNew DRepair/Replace DDemolition Color thru tile: " ******** **** * **** ** *** * ** *** * ***** *a* ** ************* * **** * ***** * *** * ********* * * **** Submittal Fee $ Permit Fee $ t� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 Bonding Company's Name (if applicable) a ceding 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 FT.F,CTRICAL 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 / t .sip Owner or Agent Contractor The foreg.. g instrument was a •� wledged befo ='� a thisrfl��' The foregoing instrument was acknowledged before me this day o �_ �� , 2015 by �_ �t / d k • day of , 20 _, by who is pe : o�nal kno to me or who has produced �~ ced � �L � ho is personally known to me or who has produced fication and who did take an oath. as identification and who did take an oath. NOTAR LIC: , ° NOTARY PUBLIC: ILO Signature Sign: Print: My Commission Expires: Sign: Print: My Commission Expires: * **+x *s<***+x******* * * * * * *** ********+ x************* **** ** *********s:**** * **+x+x****s<***** ** ** ** ** ****** APPROVED BY ■:JAC Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /l0 /07)(Revised 06/10/2009)(Revised 3/15/09) ( ?Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: r\ r a( a YI it t t DATE: 5 9-0 J ADDRESS: SOO N 0 I 2th St ct r S (.) Y F2, 3. ? 69 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two -family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for yourown use and occupancy. It may not be built for sale or lease. if you sell or lease a building you have built yourself within one year after the construction is Complete, this law will presume thatyou built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.LCA and with - holdings tax and provide workers' compensation for that employee, all as prescribed bylaw. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial V t 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit I understand that 1 may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. l also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial V V. 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial L( Initial )/L 6. I understand that 1 may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial V 7. I understand that It is frequent practices of unlicensed persons to have the properly owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder) maybe held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial �f 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is notIicensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk Initial V 9. 1 agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial V 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or httpJAv ww. mvtioridatcense .com/dborloro%ilbAndex.html initial 1/ c 11. 1 am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party Nally and financially responsible for the proposed construction activity at the following address: Initial vr?., 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial V 6-- Licensed contractors are regulated by laws designed to protect the public. If you contract wth a person who does not have a license, the Constr4uction Industry Ucensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner- builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the kcal permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this '1". C' day of MCI )f, 20 By 0) orr akwho was personally known to me or who has Produced there License or T1 OWNER A) zi identification. , \)Iskrt NOTARY ____ __ ( , CLAUDIA V. CUBILLOS _ / ��'Y � P,� Notary Publir - State of Florida My Comm. Expires Sep 23, 2015 , Commission # EE 128810 "'err. o°s Bonded Through National Notary Assn. • 4,.. /Ve.a. //2TAIS7 . ,1 , . t.0 t j 2.7 i iu LacAried Hottp =D AV.: 95-9-389 DAIS: Nov. 27, 1995 LEGAL DESCRIPrIal: The North 86 feet of Lot 10, in Block 4 cl;UTST.SHORES, according to the Plat thereof as recorded in Plat Book 42 at Page 18 of the Public Records of Dade Couney,'Florida. Property Street Address: 500 N.W. 112th. St., unincorporated Areas of Dade County, Florida. /11=70,61 -Magt- cc....azut °Akan, ser ErcopEtualai Crac..Cogatuz UN t 42amit UM /IBM 41tien•r UM ain.C.L.tiratil"..41".04agratEaleg:414:41:=2R)121114212E12121=UNICS1142NCial • 11474.04111r1/2" MS PIM .:.azoinJUU-saLiftenz.Cra% 4, C.41141affge tnIpwr GM • orairfatO I / • e n= Pam mm.ommon IV= • MAUR= Onaig (c)00MIKEED L.F.A.4Zoont Mate TUMULI • CaAcreairialagatagan iounKar821020111 niantat anee.aannieeteeee $.0.arassza c.a.A.C=B =l 11..r.inzazgy Wilma P.C.P.APERNANEN! MuSelk IOW PA-N-4010Meittlellifing mom +6•Ceptp& Nalre Lion= women* - A.-111C MIMIC, It al.CUORD rannege P.C.•1033& CV CuRVASIC P.T.NVOINT CV MO= ILILX04:111M2VCE ISISIENAMC BMW, N.C.V.D.etikISCM GICGRAPIUM WICITCM MUM -. D.C.8.11.•Due COM 1001 WAX • This Survey is Certified to: - Vilmar Candio and Acelia Candio; , Attorneys' Title Insurance Fund, Inc.; =TRUST BANK/MIAMI, N.A., Its Successors. and/or Assigns; Metropolitan Dade County, Florida; Law Offices of Richard R. Deutch, Jr., P.A. 1 FLOOD INFORMATION: FLOOD ZONE u: X FLOODDISMANCEMATEAUP= 120635-0090 J (3/2/1994). Not 1.- Not valid unless Imprinted with on embossed Surveyor's Seal 2.-Elevritions shown Was refer to N.G./. Datum (1929) 3.. This Is a Boundary Serve` • • 41-Fence ownership essumed according to the position of its eh:mon:BA :salsa; otherwise noted ) 5.North Arrow ihOwn is as per Plat Book 42, at Page 18, Dade County Public Records. I HEREBY CERTIFY:Met the attached PLAN OF SURVEY of the above dermered props% is true and correct to the best of my knowledge und belief as Sy surveyedond platted muter ray direction; also that there are not aboVe und encroachments other than those shown. I further that this meets the Minimum Technical Standards set forth_ bytheflorida Board of Professional Lund Surveyors pursuant to Seetio Chap- • •• • ter 21-HH-6, Florida Administrative *aft BY BARMIELTA, P.S.M. • Professional SamaYar and .Itegistration M34263 - State of Firadds. • mailing Address: P.O.BOX 55-7152, Miami, Fl. 33255-7152.1. Al LAND SURVEYING CO., Inc. LAND PLANNERS. SURVEYORS 4811 N.W. 7. Ave. Suite 1 3, idami, Fl. 33166 Pas- 3.05416-8686 Ms 305-594-3399 otzt/i.e. AINI100 (AV aLV1S • - . • 7 lvivi . WildINO0 01 log re s • idi1C DO18 ONINOk: