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DS-15-1833 Permit Ftp DS-7 1833 . �gN°REs r, Miami Shores Village 1A 10050 N.E.2nd Avenue NW Miami Shores, FL 33138-0000 A004OV6 Phone: (305)795-2204 f �� fi40RtRp'' z %sue Expiration: 02/20/2016 Project Address Parcel Number Applicant 68 NW 97 Street 1131010330340 ��^...__.�._._..__...._..._____.,...._. Miami Shores, FL 33150- Block: Lot: MICHAEL MOREJON Owner Information AddressPhone Cell MICHAEL MOREJON 68 97 Street � (305)409-8587 MIAMI SHORES FL 33150- 68 97 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 ARTISTIC CONCRETE GROUP INC (305)888-9095 Total Sq Feet: 550 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final Date Denied: Foundation Type of Work:PLAIN CONCRETE SLABS IN PATIO AREA Additional Info: Review Planning Bond Return: Classification:Residential Review Building Scanning:3 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 CCF $2Invoice# DS-7-15-56428 .40 DBPR Fee $2.00 07/22/2015 Check#:4492 $50.00 $594.40 DCA Fee $2.00 08/24/2015 Check#:4340 $594.40 $0.00 Education Surcharge $0.80 Bond#:2816 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $644.40 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 accu ate nd that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contra or o the work stated. August 24, 2015 Authorized Signature:Owner / Applicant / Contractor / Age ate Building Department Copy August 24, 2015 1 1`rCA'� Miami Shores ores Village j g Buildin Department JUL 2 2 2015 , - p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 _-t4 FBC 201 k,,j BUILDING Permit No. PERMIT APPLICATION Master Permit No. -Ds S � Permit Type: BUILDING ROOFING JOB ADDRESS: 6% W 1L ' City: Miami Shores County: Miami Dade Zip: 33)5'0 Folio/Parcel#: Is the Building Historically Designated: Yes NO ✓ Flood Zone:-40- $l OWNER:Name(Fee Simple Title �older : A_,L\Jkov'�D4 Phone#: Address: 68 VW 11 City: 1 c State: cr-4-- Zip: 33150 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: m- CN Phone#: -;OS-% 0C1` Address: M5- Uw in 4CF-ice_ City: ruby+ State: fL zip: -j 16 6 Qualifier Name: Phone#: State Certification or Registration#: E01QOt cl Certificate of Compete cy#: Contact Phone#: 1119(1-36(0- aG c�) Email Address: l ex DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ i,GOO Square/Linear Footage of Work: .350 Type of Work: ❑Addition ❑Alteratioew ❑Repair/Replace ❑Demolition Description of Work: C� l `j5 ,\A -p AVe Color thru tile: Submittal Fee$� Permit Fee$ l L a7 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ ':; - 03 Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 1 q r L40 Lt_ qC) 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 t att chment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection w ich ccur se (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not e a rove a a r pection fee will be charged. Signature Signature - itk, Own or A nt Contractor 6� The fore oin instrument was acknowl d ed b fore m this (6 The fore o' instrument was acknowledged efore me this 6�1 g g g g 1— day of 11 206,by It; day of 206,by ttic C9, who is personally 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. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: All Print: MARIA DE BRUZOS Print: '• :+ MY uumml�sbll MARIA DE BRUZOS M Cissi EXPIRES:August 20,20 7 & s My "Bonded Thru Notary Public Underwriters My Co xpid' MMISSION#FF 044099 EXPIRES:August 20,2017 Bonded Thru Notary Public Underwriters z�T **�( APPROVED BY �l" r ` At?R1 dans Examiner Zoning Structural Review Clerk (Revised 5/2/2012)(Revised 3/12/2012)XRevised 06/10/2009XRevised 3/15/09)(Revised 7/10/2007) s SKoRs <c Miami shores Village ogle Building Department 10050 N.E.2nd Avenue FNra 110 Miami Shores, Florida 33138 �-na— Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT •••• STATE OF(FLORIDA) •••�•• •••••• .. . COUNTY OF(DADE) •t• . . 9999.. 9999 .. 9999.. The undersigned Affiant, 1 4 �Ibv Cc ,does hereby attest that ••••• 9999.• 9999.. (Pro a yown r) 90.99• •••• •••••• The attached survey, performed by 55cc� s TN�••�•: •. • 9999.. (Name of surveyor's company) .•. ;• ••; For address: cg Ll �`� S •00• Performed on `1211,v (date of survey)is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning uildipq code regulations. The Affiant further understands that the existence of any such structures y ect Vht as applicable to this or other permits. Furth t say t Propature �A Property Owner Print Name SWOR TO AND SUBSCRIBED before me this —day of V DOOS Affiant Ti personally known to me, produced as identification. A ^. –. --�h Notary Revised on 5/22A DE BRUZOS MY COMMISSION#FF 044099 EXPIRES:August 20,2017 Bonded Thru Notary Public Underwriters Ac<>RDi® CERTIFICATE OF LIABILITY INSURANCE DAT>_(MM,DD,Y 2/24/20155 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 ISSUINp INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 Ileu of such endorsement(s). PRODUCER CT GABLES INSURANCE AGENCY CORP 77ADD E: Anael Hoadley NE (305)446-4305 4206 Laguna St, Ste C N0 ER ac No:(305)982-8294 Coral Gables, FL 33146 REss,info@ ablesinsurance.com INSURERS) AFFORDING COVERAGE rAICr RER A:EsseX Insurance Company INSURED Artistic Concrete GroupInc. INSURER B 6945 NW 53 Terrace NSURERC: Miami, FL 33166 INSURER 0 (305)888-9095 INSURER E (786)426-0979 Cell INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSA LTA TYPE OF INSURANCE puD R POLICY NUMBER MM/DD F MM/DD E P LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 100,000 A 3DX4040 2/20/2015 2/20/2016 MED EXP(Any one person) $ 5 000 GENPERSONAL BADV INJURY $ 1,000,000 'L AGGREGATE LIMB APPLIES PER: ICY PGENERAL AGGREGATE $ 2,000,OOO POLRO- JECT [7 LOC ER: PRODUCTS-Co MP/OPAGG $ 1,000,000 OTH AUTOMOBILE LIABILITY $ ANYAUTO Ea accident NGL $ ALL OWNED F SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTONON-OWNED BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS Per accident AM E $ UMBRELLA LIAB OCCUR $ EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION$ AGGREGATE $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY ANY PROPRIER/PARTNER/EXEcLmVE V/N STATUTE ER TO OFFICER/MENSER EXCLUDED7 N/A E.L.EACH ACCIDENT $ (Mandatory In P" H es,descrlbeunder E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached It more space is required) 6945 NW 53 Terrace Miami, FL 33166 CERTIFICATE HOLDER CANCELLATION City of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS, Miami Shore Village, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD ,4lco/R0® CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) v 7/6/2015 5 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 CONTACT TriGen Insurance Solutions, Inc. NAME_ PHONE FAX 315 SE Mizner Blvd A/C.No ExtJ:__(877) 987-4436 Suite 213 E-MAIL - ---- - Boca Raton FL 33432 ADDRESS: certa�trigengroupinc.com INSURERS)AFFORDING COVERAGE NAIC# - - -- _ LINSURER RA: Technology Insurance Company, 42376 INSURED -- -- (866) 286-2747 -- R B: Oasis Outsourcing, Inc. L/C/F ARTISTIC CONCRETE GROUP INC. RC: 2054 Vista Parkway D:Suite 300 — West Palm Beach FL 33411 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 9991 REVISION 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR - -ADDL SUBR; -- ---- - .---- INSR TYPE OF INSURANCE ,— — POLICY EFF POLICY EXP POLICY NUMBER MMIDD/YYYY MM/OD/YYYY I LIMITS COMMERCIAL GENERAL LIABILITY -- --� ---. EACH OCCURRENCE $ CLAIMS-MADE _i OCCUR I DAMAGETORENTED PREMISES Ea occurrence) $ '- — -- -- --- --_ - � MED EXP(Any one person) PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE PRO-E LIMIT APPLIES PER. LGENERAL AGGREGATE_$- -- --- _ POLICY � JECT —_J LOC i �' � - ' PRODUCTS-COMP/OP AGG $ OTHER - -- $ --. AUTOMOBILE LIABILITY j L ANY AUTO COMBINED SINGLE LIMIT LIE a accident____ ALL OWNED BODILY INJURY(Per person) $ SCHEDULED t-- AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTO-OWNED i PROPERTY DAMAGE -- -_-- - dPeraccident - $ $ --UMBRELLA LIAB OCCUR MADE! EACH OCCURRENCE $ EXCESS LIAR -- ---- -- AGGREGATE $ - - DED RETENTION$ I - $ WORKERS COMPENSATION A ANDEMPLOYERS'LIABILITYY/N j TWC3485446 16/1/2015 ;6/1/2016 X STATUTE_PER PROPRIETOR/PARTNER/EXECUTIVE I � 'OFFICER/MEMBER EXCLUDED? ❑iNIA� EL EACH ACCIDENT _! $_ 1__000,000_ E (Mandatory in NH) E L DISEASE If yes,describe under ' i EA EMPLOYE_ $ 1,000,000 DESCRIPTION OF OPERATIONS below j E .DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage is provided for all leased employees but not subcontractors or non-leased employees of ARTISTIC CONCRETE GROUP INC. Location coverage effective 6/1/2015. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave A e Miami Shores FL 33138 Ce+ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Rick Scott Mission: Governor To protect,promote&improve the health of all people in Florida through integrated state,county&community efforts. John H.Armstrong, MD, FACS I" "'�' I State Surgeon General&Secretary HC/\ 4 Vision:To be the Healthiest State in the Nation v August 18, 2015 Artistic Concrete Group 6945 NW 97 Street Miami, FL 33175 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: AP1199365 Centrax Permit Number: 13-SC-1622821 68 NW 97 Street Miami, FL 33175 Lot: 8 Block: 130 Subdivision: Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 08/05/2015 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. Proposed concrete walkway and concrete pads in the back yard. No objection letter was issued by C. Icaza on 08/18/15. i This office has reviewed and verified the floor plan and site plan you submitted, for the proposed remodeling addition or modification to your single-family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessment, or modification, replacement, or upgrade authorization is required. Because an inspection or evaluation of the existing septic system was not conducted, the Department cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use. You may request a voluntary inspection and assessment of your system from a licensed septic tank contractor or plumber, or a person certified under section 381.0101, Florida Statutes. If you have any questions, please call our office at (305) 623-3500. Sincere) , Carlo 1 Engineer 11 Department of Health in Dade County Florida Department of Health www.floridahealth.gov in Dade County- -,Florida TWITTER:HealthyFLA PHONE: (305)623-3500 FACEBOOK:FLDepartmentofHealth YOUTUBE:fldoh YGO - � II . . .... ...... ...... .. ...... . ...... . . . .... ...... . . .. . ..... . .. .. . .. ....... . . . . ...... { JOHN MARRA & ASSOCIATES. INC. Professional Land Surveyors & Mappers " W W W.ISARRALANDSURVEYORS.00M 777 N.W.720d AVENUE 2804 DEL PRADO BLVD SOUTH SURE 9026 SUITE NO.202 UNIT 1 MOM,FLORIDA 33126 CAPE CORAL,FL 39804 PH2 4906)262-0400 PH: (238)640-2680 FAX:(306)282.0401 FAX:(230)640-2664 MAP OF. BOUNDARY SURVEY k 0 NW 97th STREET,MIAMI SHORES,FL 33150 NW 97TH STREET 75'TOTAL RIGHT-OFWAI� 1WASPHALT PVMT w w }� � v v 0.50'CURB < �. 24'Pwv JUL 2 201a .r. ....................... ............ F. . 1/2" alth Mlattil- ac.e F.N.D. _ = Florida H r ram T,D.S &W ? NO ID. te i N Applicaft No.� 16.08' 1,4�r'`J , ,•• .... ..0 0 0 .. ... cL 16.0x••• • . . ...... V. 15.5'X 1.15' 30.52' '..• •0.23'<;L', '• • • CHIMNEY • •• ••••• 1 ONE STORY •000 RES. 68 • LOT-90 # STEPS 1 BLOCK-930. 1 L'CK 130 'd K 130 B ......• y 1 • • • � q ` ,gyp • • � 3 $ ® E8AACC ' - • PAD PAD W 2"' 6.11' 4'C.L.F. REAWNDER OF 0.75'CL e;v► se iah sTV2 LOT OT-9 z1 S BLOCK 136 CK-130, (_ 1. 2 4'C.B.S. � 1 (MA.P.) • 2.1 . 1 F-• . 0.54'CL A Y A axg. 8' A k A - ` T HALF -3000 PS LOT-9 �I d 0.50'CL `�°O I a 5 (CY-tx , 4'C.B.S. R�Sw y„1 =sd ,61 C.S. Soca ?S BARBECUES n�d�►� I,M -+ 0.70'CL 0.70'CLc 15� I 5'W.F. (8) • C o :':•'.• 8f°48'312 .0T ENCR. 6'U.EJ 75.000 LIP.We 'No ' 'ALLEY(NAPJ%' QA" 18O CAP ,K IA1fiE ;A.10}1 t 9'ASPHALT PMWT. °D - -j - - - - - - - -.- -I- - -- - --- - - - - - LOT-20 BLOCK 20 LOT-21 T BLOCK-130 ENCRQAcmmmyT NOTES• A.NORTH SIDE OF THE 8L6JECT PROPERTY,BRICK RETURN IS ENCROACHING INTO THE RIGHT OF WAY OF NW 97th STREET. B.EAST SIDE OF THE SUBJECT PROPERTY,NE0100 S CFWN LINK FENCE IS ENCROACHING INTO THE SUBJECT PROPERTY. C. WEST SIDE OF THE SUBJECT PROPERTY,WOOD FENCE IS ENCROACHM INTO THE NEIGHBORS PROPERTY. 46ff&wompmw, DRAWN BY. E.M. J~ � LOT8AAiD THEEAST 1/2OFLOT9,BLOCK 130,M/AM/SHORESSECT/OIV '•. Ala 6,ACCORDING TO TMEM4P OR PLAT THEREOFAS RECORDED/NPU7" SCALE: NO.0770 BOOK 10,PAGE 39,PUBUCRECORDS OFMMM1_aWcCOUNTY,FLORIDA STATE OF rim FIELD DATE: 06/2412014 'OL .... 1AW0Ac10EAF/LOINA�A/WVEWSS,P.A. L I A1� O1LQA601/BUCNArAWU nTLEhVSURANCECOMPANr SURVEY NO: 14-002214-1 L/BERT YMORTGAGE L ENDING, L.B.O 780 SEAL 17S SUCCESSORSAND OR ASSIGNS,AS THEIR 1,VMWSTM4YAPPE4R SHEET: 2 OF 2