14-335t Miami Shores Village
v,�tt Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
�d ��� Tel: (305) 795.2204 Fax: (305) 756.8972
\iOe INSPECTION'S PHONE NUMBER. (305) 762.4949
44 FBC 201®
BUILDING '-314111 Permit No. 1(4-33-S
PERMIT APPLICATIO Master Permit No.
Permit Typ . BUILDING ROOFING
JOB ADDRESS:— (0
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee
City:
TenantlLessee Name: Phone #:
Email:
CONTRACTOR: Company Name:
Address: .'�5 3_k ,-N t u >
City
C� State: , Zip:
Qualifier Name: A4 kl--C— Phone #: 6 Lf rZ
State Certification or Registration #: Certificate of Competency #: eg— C7 S 6 oEW9(_T'
Contact Phone #: Email Address:'- E/'wC�11-o-'Q vA4-et0. "c
DESIGNER: Architect /Engineer: Phone #:
Value of Work for this Permit: $ quare/Linear Footage of Work: 6 ODO vAP(
Type of Work: DAddition OAlteration ONew ORepair/Replace Demolition
Description of Work:
Color thru td1e: "
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 10 500 rbord
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 t be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absen a of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of te� 20 by IZQ C 1'4 '
who is personally known to me or who has produ G'J
6 7eepG/is identification and who did take an oath.
NOTARY PUBLIC:
Sign:
2-"1 rfopu tb Ste* Artda
Joanna M Fend,0 o/�
ExPlnea 01111"n.. FF 082753
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20& by j _ j �
who is personally known to me or who has produced y,�l
VS 1 •6 3 10A& identification and who did take an oath.
NOTARY PUBLIC:
Sign:
!n fk Vift1ple sues of Florkle
Joanna M Feffolano
My CommWakm FF 082753
Expires 01/12/2018
APPROVED BY Z �/e Plans Examiner l �1 �I Zoning
Structural Review Clerk
(Revised 5/2/2012 )(Revised 3/12/2012) )(Revised 06 /10 /2009)(Revised 3 /15 /09)(Revised 7/10/2007)
is
1
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i
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NOTICE OFCOMMENCEMENT
A RECORDED Copy MUST BE POSTED ON THE JOB SITE AT TIME FIRST INSPECTION
OF F INSPECTION
PERMIT NO.1 4 b 43 -�: TAX FOLIO NO
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 of property and sbeeVaddress:. ®j —9
111111 1111111111 11111 1!11111 11111 loll 11
CiF•N 2e � 1L 4RO 16iii 16
CIE Bk 29053 F's 3225; (Ips )
RECORDED 03/04/2014 13!53352,
HARVEY RUV'INr CLERK OF COURT
MIAMI—DADE COUNTYP FLORIDA
LAST PAGE
Space above reserved for use Of recxirdi^9 °fM*
2. Description. of Improvement: 'v% c 7 �•"• " „° v
3 Owner(s) name and address:r
Interest In property:
Name and address of fee simple titleholder
4. Contractor's name, address and phone number.
5. Surety: (Payment bond required 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., Florida Statutes,
Name, address and phone number.
S. 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.
8. Expiration date of this Notice of Commencement:
(#te exp(ratlon date is 1 year from the date of reo09Ul9 unless a d{ffetent date is GpeciQed)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
gnaue) of wn(s)' Althoried ier/irtr/PartIM /Manager
Prop Prepared By
Print Nam - Print Name
Title /Offlos Titie/Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE I day of--
The foregoing instrument was acknowledged before me this r)
By e-- ,
• Individually, or ❑ as for
• Personally known, or roduced the following type of identification:
Signature of Notary Public:
Print Name: °- "9 ®0' �� ` • G
rh nRtrfa STATU CES r ECTION A2i?.Es ;8 Joanna M Feliciano
Under penalties of perjury, I declare that I have read the foregoing artd My Commission FF 0827,53
that the facts stated In it are true, to the best of my knowledge and belief. W Aa ExpWq.0111212018
Signatures) of Owner(s) or Owner(s)'s Authorized 0ficer/Director/Partner/Manager Be g
"7
12301-52 PAGE 3 8n2
Miami Shores Village
`Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
%nCOVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner)JL (7 Cn w CDPU e, hereinafter referred to as the owner of
the following described property (address):
Legal Description Lot Block Subdivision
Folio #
Requests permission to install (describe work): 6W E � e4n_4,2!!�
Within the public right of way of (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 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.
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 day of 201
(Owner's Signature)
SIGNED, SEALED, AND DELIVERED in the presence of:
2
0212112014 15:15
fAXQ P.0011001
"OA . CERTIFICATE OF LIABILITY INSURANCE FDA 5(M N°WM -0
1/14
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRI 0312
CATE 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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANTr If me cardffcate holder Ip an AD01710MAL WSURED, the p011cy goo) must tts aniRie -d. If 08— OQATION IS WAIVED, subject to
the farms and conditions of the policy, carton policies may re"re an andarssmant A statement an this certificate does not confer rrghta to the
cortlAcata holder In 11w of such endorsoment(e).
PRODUCER 1522wr Ludy Estrella
Aoaulate PHONE wov. (306722648727 Na (305)228-8767
8300 West Fla0ler Suite 114 bslieauth fist
Miami, FL 33W IMsuaenM ArrfMBIVR eaveea" Mme a
PnOtie OS )226-8727 Fax (308)225.8787 IN8IIR R A I QtanaCa InKnnOl Company _
INSURED
INSURER 0; Nay Hadw Co.
Jamie Basillo Corp dbe Champion Concrete MNSURRRC:__. „
11001 NW 83 Street Sulte 103 Ia URERD:
Doral, FL 33178- (305) 252 -8055 INSURER E I
INaI1 F a
COVERAORS /_f:RTICII_A -M LH IRAM120• bdnc,r.►, ►,. a,wn�,v.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE VOL-r-Y PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, T9 M OR CONDITION OF ANY CONTRACTOR 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 POLICIES, LhNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
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TYPE OF INSURAN08
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068cRIpTION OF OPERATIONS f LOCATIONS f VE MAS (Atteah AOORD t0% AdAN-- r aw rfa Sahadwa, If mw apace is tagldratl)
Concrete & Pavers Contractor
fiCaTlalrr -ATe unr now -- - --__ -- - _ —_ --
Miami Shares Village
10050 NE 2nd Ave
Miami Shares, FL 33138
SHOULD ANY OF THE A90VE DESCRIBED POLICIES BB CANCELLED BEFORE
THE EXPIRATION DATE TWEIREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCIff WITH THE POUCWRIMSIONS.
Lucia Estrella
01988.2010 ACORD CORPnRATrnIN An 01-hfa .mn..,a.l
•- ,.rv,�v a" taw -I w1var %w The ACORD name and logo are registered merles of ACORD
FYI
BLOCK CORNER AT NW 99 STREET
The North 18.5 feet of Lot 17
Block 1
:t and Lot 18,less the
BONMAR PARK,
s recorded in Plat Book
Property Address: 9818 NW 1 AVENUE
Miami Shores FL 33150
Folio No.: 11- 3101 -024 -0070
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CMT'P j; Community number: 120652
c� Village of Miami Shores
mP.3nel: 12086 C 0302
�- Sufflh: L
F.I.R.tiI. Date: 09 -11 -2009
Date Revised. 09 -11 -2009
x Date of field work: 02 -17 -2014
Completion date: 02-18-2014
Flood zone: X
%B,,,se flood elevation.N /A
o — �D j agram: 8A
,Latitude: 25 °51'55 " N
p� Longitude: 80°11'60" W
LOCaMUV SKET T TO SCALE
0
SURVEYNOTES
' 1 Bearings and coordinates refer to
� recorded Plat or NAD83.
16
h�
�
!
2 Legal Description provided by
others.
3 The lands shown hereon, were not
abstracted for easement or other
encumbrances not shown on plat.
4 Underground portions of footings,
LEGEND
foundations or other improvements
were not located.
FN &D
Found Nail and Disk 5 Elevations are based on National
Concrete
Geodetic vertical Datum 1929.
6 Fence ownership not determined.
Asphalt
7 Wall ties are to the face of the wall.
p
Property Comer
8 Not valid unless sealed with an
(R�
Recorded
Recor
embossed surveyor's 's seal.
9 No identification found on
(1Vl)
Field Measured
property corners unless noted
Centerline
10 Only visible encroachments
Found Iron Pipe
located.
11 The survey depicted here is not
FIP 1 /2"
Y2" diameter
covered by professional liability
Covered Area
insurance, liability limited to the
cost of the survey.
co,
Utility Pole
12 This survey is intended for the use
Fire Hydrant
by those to whom it is certified
m
Catch Basin
and for one building permit or real
estate closing only.
®
Water Meter
13The attached survey materials are the
—'"�—
Wood Fence
original work product of the surveyor
and are subject to the copyright laws
—"—
Chain Link Fence
of the USA. Mdagemew occurs if
n.. i.,.,,.. Ul-- a...:-
this same survev is re -used in a later