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DS-15-3193
Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250092 Permit Number: DS-12-15-3193 Scheduled Inspection Date: February 09,2016 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: DOLLE,JOHN R Work Classification: New Job Address:280 NE 107 Street Miami Shores, FL 33161- Phone Number (646)648-1126 Parcel Number 1122310130460 Project: <NONE> Contractor: ONE STOP PAVERS, INC Phone: (954)607-8761 Building Department Comments INSTALLING BRICK PAVERS ON RIGHT OF WAY AND Infractio Passed Comments INSTALLING BRICK PAVERS ON WALKWAY ON RIGHT INSPECTOR COMMENTS False OF WAY. Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 08,2016 For Inspections please call: (305)762-4949 Page 13 of 31 . Permit tvo. DS- 2.15-3193 Miami Shores Village Pejn*t.7"ype I,�Mr ItlFFtt )t t3W+rtNk r(+ (iS 10050 N.E.2nd Avenue NE �... n.-� 'Work ClassificetrArt;Now Pe n Miami Shores,FL 33138-0000 , Permit Shiti1s:.APPROVED Phone: (305)795-2204 lsse 12129015 Expiration: 06/26/2016 Project Address Parcel Number Applicant 280 NE 107 Street 1122310130460 Miami Shores, FL 33161- Block: Lot: JOHN R DOLLE Owner Information Address Phone Cell JOHN R DOLLE 280 NE 107 Street MIAMI SHORES FL 33138-7063 (646)648-1126 280 NE 107 Street MIAMI SHORES FL 33138-7063 Contractor(s) Phone Cell Phone Valuation: $ 2,100.00 ONE STOP PAVERS, INC (954)607-8761 Total Sq Feet: 400 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:INSTALLING BRICK PAVERS ON RIGHT O Additional Info: Review Planning Bond Return: Classification:Residential Review Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 CCF Invoice# DS-12-15-58174 $1.80 12/29/2015 Credit Card $617.80 $0.00 DBPR Fee $2.00 DCA Fee $2.00 Bond#:2936 Education Surcharge $0.60 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $617.80 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 myse agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOW , OOR OOFN and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing info is curate a that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abo ed ntract o the work stated. December 29, 2015 Authorized Signature:Owner / App' / Contractor / Agent ate Building Department Copt December 29,2015 1 Miami Shores Village 04C 2 9 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC � r20l BUILDING Master Permit No.��l�' "�C PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF CANCELLATION ❑ SHOP /� CONTRACTOR DRAWINGS JOB ADDRESS: --7Q10 '"e / 0 � cS�'�`L City: Miami Shores County: Miami Dade Zip: 33 /) Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: 'J Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple wTitleholder): \_i Phone#: Address: 17ri M 0-7 s � City: rhmu n S S State: Zip: Tenant/Lessee Name: Phone#: Email: JJ�� �t-� p,�� Q J/ / CONTRACTOR:Company Name: Vie- AVRP5 _ CAC- Phone#: LJ'�r �107�0 / ! / Address: 3 OW) A' City: 't"jte, I t x`{I State: i— Zip: 3 3 V Z L Qualifier Name: J� Phone#: State Certification or Registration#: Certificate of Competency#: 4-1 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ c-211 0 V•OD Square/Linear Footage of Work: UQ S� Type of Work: ❑ Addition ❑ Alteration X New ❑ Repair/Replace ❑ Demolition Description of Work: 4�4-cc AR4,3- 0 Lt &L4- 4W o4 Specify color of color thru tile: Submittal Fee$ 0 Permit Fee$ CCF$ °�i 0 CO/CC$ Scanning Fee$ °C-0 Radon Fee$ `� DBPR$ Notary$ Technology Fee$ 9 -, Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ X430 TOTAL FEE NOW DUE$ I �:3 (Revised02/24/2014) 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,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 s ch posted notice, the inspection will not be approved and a reinspection fee will be charged. �4 A Signature Signature 67 OWNER or AGENT CONTRA 0 The foregoing instrument was acknowledged before me this The foregoing i t men was acknowledged before me this lii/b day of Ae Cie u b-ocv 20 /-f— , byL� day of jdp. 20 /J by � �J�IA{s ®!�� who is personally known to ,7p6rZ9 1 1!!°24 who is personale known to— me or who has produced asme or who has produced as identification and who did take an oath. gds identification and who did take an oath. NOTARY PUBLIC: `\\NN11111JNJJ/ ���Q\\.�Q.FERNq,j,���ii� NOTA LIC: `\\\\Nt11H11Hllyy���' �`'`' \jJ9SI0Iy'•Oc�•//i/ Q,FEp • .• I `� �••......���/// Sign: • s Sign: SSIOk�r,�A.�•' Print: ����• Ver ••• Print: .� yr # Seal: /i' ;A';�nl d�c�y •�F � Seal: IWO, �4'; •N:iu1 of 0 � ``. ��I//Jlllls11111t\\\\ 1C,3111 \\\\�� APPROVED BY Plans Examiner ( Zoning Structural Review Clerk (Revised02/24/2014) Miami-Dade Official Records - Print Document Page 1 of 1 Prepared by and Return to: Maria E.dross CFN:20150773756 BOOK 29880 PAGE 1750 Thomas G.Sherman.P.A. DATE:12/08/2015 08:44:15 AM 90 Almeria Avenue DEED DOC 2,955.00 Coral Gables,Fl 33134 HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY File Number. 15.10-03 b General Warranty Deed - Made this day of December,2015 A.D.By Martin G.Prego,a married man joined by his legal spouse Gustavo Cadena,whose address is: 131 NE 93 Street_Miami ehoter,Florida331311.hereinafter called the grantor,to John R Dade.whose post office address is: 200 BisrAyne Blvd 4 2603_MiantL Florrda„_ 161 hereinafter caped the grant”: (Whenovae used bo-the tarn-Sranim-and-liraatee-Itxlude all tho pwios to this1118trttittaal drat the heirs.regal rcparsemativas end assigns of individuals,and the successmaadd asaisaenrrarparatlrata) Witnesseth,that the grantor,for and in consideration of the sum of Ten Dollars,($10.00)and other valuable considerations, receipt whereof Is hereby acknowledged,hereby grants,bargains,sells„aliens,remises,releases,conveys and confirms unto the grantee, all that certain land situate in Miami-Dade County,Florida,viz: Lot 11 and West 112 of Lot 10,Block 13,First Addition to Pasadena Park,according to the map or plat thereof,as recorded in Plat,`book 6,Page(s)82,of the Public Records of Miami-Dade C"nty,Florida. Parcel 1110 Number:tt-2 31-013-04&0 Together with all the tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and,to Hold, the sante in fee simple forever. And the grantor hereby covenants with said grantee that the grantor I$lawfully seized of said land in fee simple;that the grantor has good tight and IUWIUI authority to sell and convey said land;that the grantor hereby fully warrants the title to said land and will defend the same against the lawful chrhns of all persons whomsoever,and that said land is fteo of all encumbrances except taxes accruing subsequent to December 31,2015. In Witness Whereof, tate said grantor has signed and sealed these presents the day and year first above written. Signed sealed and delivered in our presence: Ist WitnessSignatu Martin1st Whrtesslarmtad Name �Ri'"tf�a '�.'. '�..2nd Witness Signature (Seal) Gus 2nd witnaata Pahited Nanta State of Florida County of Miami-Dade The foregoing instrument was acknowledged before me this_'.day of December,2015 by Martin G. Prego and Gustavo Cadens,who are personally known to me or who have produced as identification. RE. 7Q UM.Naaraebw tZ 2M ®rrrttanaur,P�tat Notary�Pab crit tare No Naauet my commission Espirm DEED Individual warranty Dead-LxSal on Face Closets Choice https://www2.miami-dadeclerk.com/officialrecords/PrintDocument.aspx?QS=MwKnucJ... 12/29/2015 !illiii!Illi ilii!illll!Illi illll illll Illi Illi ORES CCN `fie 155 515194 OR et.. 29904 Ps 2685 ( Pss) Miami Shores Village ►►►► ® nenM RECORDED 12'/28/2015 15:56:12 Building Department i iAr.I-C� �_DE C OUHTY, ELQI:,TD j 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY r Whereas, (owner) : 1 O6tt h 101 r ev, hereinafter ref rred to as the owner of the following de..cribed roperty (address): _?2Q /� 7 Legal Description$� , 1�Lot Block t.�_Subdivisionas ecs 14 Folio # Requests permission to install (describe work): Ivo Within the public right of way of(address) Z� IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: �cA do, 1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the 9%01- dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County y9q to make repairs or maintain said items within public right of way including restoration of a street by reason of the Owners failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. ._ The owner does hereby agree to indemnify and hold Miami Shores Village or Dade �ounty harmless from any and all liability, which may rise by virtue of permitting the 80 installation of these items within the public right of way. 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 <- , k I I I ih 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 o tie item(s). LL The undersigned further agrees that these conditions shall be deemed a covenant �7 Z 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 L}Jt�Lceled 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). Signature Gni Owner or Agent .The foregoing instrument was acknowledged before me this day of . , ,,,, , 20 y J-0-4K rJo 6t,el who is personally known to me or who has produced _�dt„ k�,� �,6 -- as identification and who did ke an oath. NOTAR PUB IC: \`\ FE\���a�►n�ny�'q�, i Print: c� c�, \ ��+0�d119'p�fo•.�'/i My Commission Expires: AFF 22 r1on4 •-� • �glederN• �: ����,r,;Ue.ny�,•sw,�.�p;�. /��f���IIISTAT N�``\ GRES C'1% 9968am Miami shores Village res I Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756,8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C.—COPY OF LIABILITY INSURANCE* D, COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADECOUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* _T (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. _(4 014'ef 0 O BUSINESS NAME: 6 -0 d 04-W— S 61 BUSINESS ADDRESS: CITY �L STATE ZIP 3.30 BUSINESS PHONE: FAX NUMBER CELLPHONE 07'_P�tQUALIFIER'S NAME: _eto"'l 60(01-24 1P2___ QUALIFIER'S LIC NUMBER: r 0 0 CTQB 9 Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY E1500582 'ff ONE STOP PAVERS, INC "'Aftw. .i D.B.A.: ELOY Is certified under the provisions of Chapter 10 of Miami-Dade County 0 co oc;p-%�Tc- r O.EE::O- Local Business Tax Receipt , Miami—Dade County, State of Florida- -THIS IS NOT ABILL-DO NOT PAY LBT 7194741 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ONE STOP PAVERS INC NEW BUSINESS SEPTEMBER S 2016 DOING BUSINESS IN DADE 7476874 COUNTY Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS ONE STOP PAVERS INC 196 SPECIALTY PAYMENT RECEIVED BY TAX COLLECTOR C/O ELOY GONZALEZ PRES ENGINEERING 75.00 12/03/2015 Worker(s) 3 E1500582CONTRACT 0224-16-001633 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 6a-276. MIMI®1 For more information,visit wwwmiamidadegov/taxcollector Municipal Contractors Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY M C CC NO: E 1500582 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ONE STOP PAVERS INC SEPTEMBER 30 2016 DOING BUSINESS IN DADE COUNTY 7477735 Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS PAYMENT RECEIVED ONE STOP PAVERS INC SPECIALTY ENGINEERING BY TAX COLLECTOR C/O ELOY GONZALEZ PRES CONTRACTOR 37.50 12/28/2015 0223-16-002019 Restricted to City of Miami Shores MIAMOME For more information,visit www.miamidade.aov/toxcollector IM t t � DAT /Y E(MMIDDYYY) CERTIFICATE OF LIABILITY INSURANCE 12/28/2015 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 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 lieu of such endorsement(s). PRODUCER CONTACT NAME: Edna Sanchez American Trust Insurance PHONE,/coExt: (305)270 2220 A/c No; (305)270-2496 9360 Sunset Drive Suite 240 -MAIL ednas@americantrustins.com Miami,FL 33173 INSURERS AFFORDING COVERAGE NAIC# Phone (305)270-2220 Fax (305)270-2496 INSURER A: AmTrust North America INSURED INSURER B: One Stop Pavers Corp INSURER C: 1231 NW 123 Terrace INSURER D: INSURER E: Pembroke Pines FL 33026 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. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MM/DDI EFF MWDD EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS-MADE OCCUR RENTE PREM SESOEa occu snce $ 100,000.00 ❑ MED EXP(Any one person $ 5,000.00 A ❑ 215-423 07/07/2015 07/07/2016 PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 ❑ POLICY ❑ JE 0. ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED — SCHEDULED BODILY INJURY(Per accident) $ -_� AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS El AUTOS AUTOS Per accident U ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑ PTT T ❑ PITM AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXE CUTIV� E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ti—I LJ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space Is required) Pavers Installations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE ATT:Building Dept. ' FAX:305-756-8972 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)QF The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/28/15 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(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 lieu of such endorsement(s). PRODUCER CONTACT NAME: Edna Sanchez American Trust Insurance A/C,No Ell: (305)270 2220 C No): (305)270-2496 9360 Sunset Drive Suite 240 -MAIL ednas@americantrustins.com Miami,FL 33173 INSURERS AFFORDING COVERAGE NAIC# Phone (305)270-2220 Fax (305)270-2496 INSURER A: Technology Insurance Company INSURED INSURER B One Stop Pavers Corp. INSURER C: 1231 NW 123 Terrace INSURER D: Pembroke Pines,FI.33026 (954)607-8761 INSURER E: 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 MAYBE 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. INSR TYPE OF INSURANCE ADDL UB POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD (MMIDDIYYYYJ GENERAL LIABILITY EACH OCCURRENCE $ AMAGE L] COMMERCIAL GENERAL LIABILITY PREM SESOEa occu RENTEante $ A ❑ ❑ CLAIMS-MADE ❑ OCCUR MED EXP(Any one person $ ❑ PERSONAL&ADV INJURY $ ❑ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ❑ POLICY ❑ PRO- ❑ LOC $ OMBINED SINGLE LIMIT AUTOMOBILE LIABILITY C Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ❑ AUTOS ❑ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident ❑ UMBRELLA UAB —]OCCUR EACH OCCURRENCE $ ❑ EXCESS UAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION © WC RY L M T ❑ ORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE 215-528 E.L.EACH ACCIDENT $ 100,000.00 A OFFICER/MEMBER EXCLUDED? ❑ N/A 09/04/2015 09/04/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K more space Is required) Pavers installation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE ATT:Building Dept. F `) FAX:305-756-8972 y._., ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD r ` z NEj0tl5' "�„D"91 Proudly Serving i ; • 'y' NE 1080,91� NE IQBU St the Florida Real 2 ""° S`sz _ Estate Community 2 d %• 6. m NEfO5th91 �6+ for Over 20 Years -•Y--. q K NE tONh St '.�r �•. NE103tdst . . - WWW,MELAN0SERV10ES.00M / � '�"' -" _ htTp tlatD�CCOtSCoeyle Y_ 22'ASPHAL T PAVEMENT Zq N 60'RIGHT-OF-WAY I 9 r� 19'PARKW 1� 7, F.,Rall 8e 25' M) F..P,' i 20.00' d' e �` o `,'• o I 'I I> N CL Li 9 oa 16.88' 0avrf • 13.50' SIEo i6j) 17.6 � PORT x o ONE STORY RESMENCE o 11 v j s o #280 ( PIZ > ... 24.89' d O to Q � '� � l3.�0• _16,73' N Q F� _U Poo � 5i••• l[1 I • • •••••• • CO • }\ • 0000• z � �• • 0000•• ' . 0000 : .0 • • O • • 67J m p lLT.pp' • as 0000• -J� O • • 01 f I rr� I o • �y 0000• lt.00'°�=tet A • 1/C 0 0 0 0•• - OA PL o p .2/`• vC -_•• (h •• o • • ',g — 0.00' AA- F.f.PX/2' • ^• • F.LP.1/2' uoi t 0 � - 0 86.25 (R8 M) o 0.0.00 LOT 12 LOT 7 m P/n0k, Rt O K 1.3 .0 Accepted By: Property Address: Notes: FENCES ENCROACH OVER SOUTH LOT LINE. 280 N.E.107 Street Miami,Florida 33161 e's[IIMCA3idtr11iMMaRTIFY7NATTN69QCAMYSM%VYMA7RLGMDCONPECr M.E.Land Surveying,W-RESUMT10h OF A%AR t"Mw Dat=CN`1145 COF7Afe8 Y71Tt11Yl'FmmAn,egraCAt y 9,Inc. r STANDARDS,AS SET TIESTA CR 60U of MCFSSIOWL LAND RAVEVRS IN CHWnat 10665 SW 190th Street d 57-07,FLOIUDf Au" NCCffS T04MG2?.ft0A10A91'ATUrM O t State 3110 GNED FOR THE PIRM cV �- Miami,FL 33157 SE � EFRAIN to z t Phone:(305)740-3319 STATE OF OA y'1 D.S.M.No.6792 Fax:(305)669-3190 C<l 'MAPF IIS,=Y wmttartMF AAOT a(XUW&ki RA MM O00 F A u� SXXZveTaa Aroma�s LB#:7989 MAPPER. «.. L, n L_LJ Survey#:0.12403 Client File 0:DOLLE Page 1 of 2 Not valid without all pages Surveyor's Legend PROP[PT/LLN[ • SIRYCIURE CII TND 0.4. BEAR=RUTRENCC TCI_ TELCPNONC rACiuTRS / CONC.BLOWALL PIN PW AA IRON PIPE S NOlCO ON PUT L CENTRAL AKGLE OR DELTA U.P. YIIUIY DOLE —X—X— CRAW-LINK reRCC OR WIRE rENCE I" ucvtsr I-BUSINESS a RADIUS OR RAOUL C.U.9. ELECTRIC Mary Box �f--//— WOW FENCE W LICENSE/-SWMYOR RAO, RAOUL RC SCP. SEPTET TANK UION fENU CALC CALODUTEO POD" UJL NON RACIAL O8. CRAW AILD ———— EASEMENT SET SET PIN To. TYPICAL A/C AIR CORamONEa ----- CENTER LINE ♦ CONTROL POWs I.R. IRON ROO S/W SIDr1VALK WOOD DECK CONCRETE MOKUYCNT I.D. IRON M DRY DRIVEWAY Q BENCHMARK R&D KAM O DISK SCR. 3CNE[N CONCRETE CLIV ELCVATIDN PK am PARKER-KALON NXIL CAR GARAGE ® ASPHALT P.T. POINT Of TANGENCY D.N. ORu umr INCL. ENCLOSURE P.C. PONT Or CURVATURE NOT TO SCALE KrLI N.TS. aiucx/TUE P.R.M. PERMANENT RUCKER"MONUNENT FIRE WDRWT r.r. rINNISNEO FLOOR P.C.C. POINT Or COMPOUND CURVATURE 0 Y.H. MAMNOEE T.O.a. TOP Of BANK WATER P.R.C. POINT Of REVERSE CURVATURE O.H.L. OVERHEAD UN[E C.O.W. CODE Or WATER APPRO111M.1TC EOOE Or WATER P.O.B. DOUh or BCOINKM TIC TRAN40RMER C.O.P EDGE OF PAVEMENT �. P.O.C. POOf COMUENCENCHr CAIN CABLE TV RLSER C.Y.G. CONCRUC VALLEY CUTTER LOY[REO ARPOWP.C.P. PERMANENT caNIROL POINT K.Y. WATER Y[TCR &gL BURaWO SETBACK UNC Q TREE Y FIELD MEAWREO P/C POOL ELi1RPUrin S.T.L SURVCT TIE LINE POKER POLE P PUTTED MEASUREMENT CONE. CONCRETE SLAB Ck erMfER LWE CAICN BASIN D me CSYT EASEMrNI R/q RIGHT-Cf-WAY C.U.C. COUNTY UPUIY EASEMENT C eALCUUTEO OZ DFMNLGE EASEMENTP.U.E. PUBLIC UTILITY CASUICNT I.E./Ex. INGRESS/EGRESS CAALTUKK1 L.M.E. UXE OR UNaBCAPC MAINT,CSMT. LDC, LI=APC oumra CASEMENTCATUL Y41wnunCE EASENLM C.Y.C. U.C. UTIUIY CASEUCNT R.O.E. ROOF OVERIYNG CASCUENT LAE. LIMRLD ACCESS CASCUE10A.C. ANCHOR CASCYCNr Property Address: General Notes: 1.)The Legal Description used to perform this survey was supplied by others. 280 N.E.107 Street This survey does not determine or Is not to imply ownership Miami,Florida 33161 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,web,or drain field on this survey, Flood Information: the location of such items was shown to us by others and the Information was not verified. 4.)Examination of the abstract of titre will have to be made to determine recorded instruments,If any,effect this prope Community Number: 120652 rty.The lands shown herein were rtol abstracted for easement or other recorded encumbrances not shown on the plat Panel Number: 12086CO302L 6.)Wall ties are done to the face of the wag. 6,)Fence ownership is not determined. Suffix: L 7.)Bearings referenced to line noted B.R Date of Firm Index: 09/11/2009 8.)Dimensions shown are platted and measured unless otherwise shown. Flood Zone: X 9,)No Identification found on property comers unless noted. Base Flood Elevation N/A 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 Date of Field Work: 11/20/2015 be drawn at a shown scale and/or not to scale Date of Completion: 11/25/2015 12.)Elevations if shown are based upon NGVD 1929 unless otherwise noted 13.)This is a BOUNDARY SURVEY urdess otherwise noted. 14.)This survey Is exclusive for the use of the parties to whom it is cerg9ed The certifications do not extend to any un named parties. 16.)This survey shall not be used for constructiontpermitting purposes without written consent from the land surveyor who has signed and sealed this survey. Legal Description: • • Lot 11 and the West 1/2 of Lot 10,of Block 13,of First Addition to Pasadena Park,according to the);tat ttMof,as • ••••:• recorded in Plat Book 6,Page 82,of the public records of Miami-Dade County,Florida •0 • 6• 0 6 9999•• Printing Instructions: Certified To: •••••• • • • While viewing the survey in any PDF Reader,select the File John R.Dolle •... .. . ;""; Drop-down and select"Print".Select a color printer,if Union Title Services,Inc. • • • • )p ••69 • 6 99990 available;or at least one with 8.5'x 14"(legal) leg al paper. Commonwealth Land Title Insuranc Co ny Select ALL for Print Range,and the#of copies you would MERS(Mortgage Electronic Registratt i System,lvc4,• 09:00's •• •6 • • 9690•• like to print out. solely as nominee for TD Bank,N.A. 6 Under the"Page Scaling"please make sure you have its successors and/or assigns as their jVV ay appear.•f •6 selected"None". Please copy below for policy preparation eurpose l••• 6• 000 Do not check the"Auto-rotate and Center box. Check the"Choose Paper size by PDF"checkbox,then only: 6 0 0 6 0 6 6 0 0 This policy does not insure against loss or damage by mason oRhe follol dge • • • • click OK to print. exceptions:Any rights,easements.Interests,or claims which may exist by r dV of,or reflected by,the following raps shown on the survey prepared by_ EFRAIN LOPEZ dated 11125/2015 beating Job is B-12403: a. FENCES ENCROACH OV R SOUTH LOT UNE. M.E. Land Surveying, Inc. 10665 SW 190th Street,Suite 3110 Miami,FL 33157 Phone:(305)740-3319 Fax:(305)669-3190 , LB#:7989 Survey 4:0-12403 Client File d:DOLLE Page 2 of 2 Not valid without all pages