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DS-16-1006 Inspection Worksheet Miami Shores Village 0 N.E.2nd Avenue Miami Shores FL 10 50 , Phone: (305)795-2204 Fax:(305)758.8872 Inspection Number: INSP-256942 Permit Number: DS-4-16-1006 Scheduled Inspection Date: May 12,2016 Permit Type: Driveways/Sidewalks/Slabs Inspector:Mesa,Michael Inspection Type: Final Owner: ALAN CORONADO,LISA AYUSO Work Classification: Addition/Alteration Job Address:461 NE 101 Street Miami Shores,FL 33138-2448 Phone Number Parcel Number 1132060170670 Project: <NONE> Contractor. RETOS SERVICE PLUS LLC Phone:(954)58841468 Building Department Comments PAVERS DRIVEWAY REPLACE EXISTING PAVED InIft ° - passed Comments DRIVEWAY AND ADDING NEW AREA INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re4nspec ion fee is paid May 11,2016 For inspections please calk(305)762-4849 Page 15 of 27 Miami Shores Village r,,n h 10050 N.E.2nd Avenue NE i Miami Shores,FL 33138-0000 4 6 Phone: (305)795-2204 yU !ration: 10119/2016 Project Address Parcel Number Applicant 461 NE 101 Street 1132060170670 LISA AYUSO ALAN CORONADO Miami Shores, FL 33138-2448 Block: Lot: Owner Information Address Phone Cell LISA"USO ALAN CORONADO 461 NE 101 Street MIAMI SHORES FL 33138-2448 461 NE 101 Street MIAMI SHORES FL 33138-2448 Contractor(s) Phone Cell Phone Valuation: $ 3,440.00�� RETOS SERVICE PLUS LLC (954)588-8468 --�--- --�--------- ..�--- Total Sq Feet: 860 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:PAVERS DRIVEWAY REPLACE EXISTING Additional Info: Review Building Bond Return: Classification:Residential Review Building Scanning:3 Review Planning Review Planning Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee $2.00 Invoice# DS-4-16-59414 DCA Fee 2.00 04/22/2016 Check#:2249 $94.40 $50.00 Check#:2244 50.00 Education Surcharge 04/14/2016 $ $0.00 rg $0.80 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $144.40 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS 00 ,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information s r e and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-nam a to do the work stated. April 22,2016 Authorized Signature:Owner / Applicant / C ra r / Agent ate 9 PP 9 Building Department Copy April 22,2016 1 • ��� Miami Shores Village Building Department �® � g p APR 14 FI'2 fl] 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax: (305)756.8972 7BY: INSPECTION'S PHONE NUMBER:(305)762.4949 5W FBC 2014 BUILDING Permit No. ,SLS 16 PERMIT APPLICATION Master Permit No. Permit Type: Electrical JOB ADDRESS: /*/ IVY /0/-sr- S f City: Miami Shores County: Miami Dade Zip: _!511 :b Folio/Parcel#: //" 3 W6 `01-7` elk7(2 Is the Building Historically Designated:Yes NO ✓ Flood Zone: OWNER:Name(Fee Simple Titleholder): �c5 `7�S O Phone#: 3 U 5 03 =V0 J:3- Address: ��� vrb City: a State: Zip: 3'31?3;? Tenant/Lessee Name: Phone#: Email: (�� CONTRACTOR:Company Name: e' 7�� Phone#:1?5`i _1Se-'F&Y6? Address: 16q7 0 4<-) S7' /ze mac( 2`f c{. City: " ✓l`e S�tattte�:� ppt_ zip: `��3 2,4%Qualifier Name: 70(,-.-,L �Q/ Phone#: State Certification or Registration#: 66C `5L91TI59 Certificate of Competency#: Contact Phone#: 'q5k-Sg'8�&g Email Address: r-e—toss e r V1`::e P" &.c,- rn.c4[ c c-s m DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ .?I 4LID I ON.'> Square/Linear Footage of Work: g Type of Work: ❑Address E61teration ONew ORepair/Replace ❑Deemo�lition Description of Work: �f ��ib -P�C,f s a 1�aV,¢c� -11 tre10171_ _. Submittal Fee$ " Permit Fee$ CCF$ • '1 CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ ' ()0 Bond$ RCH Notary$ 5 Training/Education Fee$0---?D--Technology Fee$ Double Fee$ Structural Review$—19� TOTAL FEE NOW DUE$ , t T ' VD 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 sub'ect to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first ins ection hich ccurs s ven (7) days after the building permit is issued. In the a ence of s posted notice, the inspection 'Y's not be op ro d and a r inspection fee will be charged. Signature — Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 0'-�l The foregoing instrument was acknowledged before me this "7 day of Y L ,20 (�o,by L1^-A- �� �� day of �3 ,201(0,by who is personally known to me or who has produced EL 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. NOTA PUBLIC: NOTARY Sign: Sign: ANT01% -RODRIGUFZ MY CONVA,SSION#FF189443 Print: s(�1j71� P � Print: My Commission Expires: L Notary Public State of Florida My Commissi Flo-i:,rJotsryServlce.com Sindia Alvarez My Commission FF 156750 Expires 09/03/2018 shakdadaak�aalsffiaaRsk�kak�+sksk&skaIasksknb�akakdasNsR sIasIasIasRsk�sksksR�aaIa�k�a&��a�lak�kak�kK+sksk8askskskskskak aA�a��s nk �skskskakak�Rik�a APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) RICK SCOTT,GOVERNORKEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION, ' NDUSTRY LICENSING BOARD CGq The`GENERAL CONTRACTOR Named below'IS CERTIFIED Under ft,, af,Chapter 489 FS E*raW' date: AUG M:'20.96 aY BAl Bl, HILA..MARIA § � • RFTOS )S-SER SLiIRIWESl°S�T h r av � � s � f i z' ��1; �3�' �, , «z. £ �......,�. ,.,..., .., .....:.z,.� .ate A", ISSUED: 07/24/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407240001135 ...... - __.._..,. _............. _,_...__...... ...._..... .. .............._.. ...___...... _.. ..... ................. .... . ..._._... „.... _.._..... BROWARQ COUNTY LOCAL BUSINESS TAX RECEIPT , i 115 S.Andrews Ave. Rm.A-1 00, Ft. Lauderdale, FL 33301-1895—954831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 Rea eip t : 0-245458DBA: ONT RALTO RRETCS SERVICE PLUS LLC A BusinessName: Business Owner Name :HYLl)A MARIA BALBI Business ned:12/01/2011 ATE RD 84 244 :CGC1508959 •15970 W ST # t@I{:Oufi1 ICert1R on. Sta Business Location: tY e9 I strNR sE Exemption Code: Business Phone:954-588-8468 h Professionals Room Beate- Employees @Aac Mes 3 ForVendHig ausstsss only Type: Number of Machines: Vending Tax Amount Transfer Fee NSF bee Penalty Prior Years Ccliection Cost Total Paid 7. 0.00 0.00 0.00 0.00 0.00 21.00 2 00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS in Brow County and is PT This tax is levied for the privilege of dol business with and THIS BECOMEt3 A TAX RECEIPT tY p � n9 non-regulatory in nature.You must meet'ati County y andtor Municipalityplanning ns WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be ha ferrel when t business is sold business has changed or you have moved the he name . nged ' n. t does not Indicate that the business is i or that business locabo ,This receipt i is�compliance with State or local laws and regulations. t Mailing Address: RETOS SERVICE PLUS LLC Receipt # -14-00127034 it #244 Paid 0 25 15970 W STATE RD 84 a3 8j 2015 27.00/ SUNRISE FL 33326 2015 - 2016 CERTIFICATE OF LIABILITY INSURANCE DATE*wD°"""' 04/ 416 0 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 INSURANCEDOES 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(tes)must be endorsed. B SUBROGATION M WAIVED,subject to the terms and conditions of the policy,certain Policies may require an endorsemerd. A statement on this owdlicate does not confer rights to the certificate holder in Iteu of such endorsementM, PRODUCER ACT MARTA M ALONSO Florida Bankers Irsumnoe PHONE 305 2W4493-. FAx 305 262-w79 7278 SW 8 Street kemk urance.com Mimi,FL 33144 Phone (305)266-6493 Fax (305)262-0679 AFF NG COVERAGE NAIO# INSURED INSURERA: UNITED SPECIALTY INSURANCE COMPANY ReIDS Services PIIS LLC INSURER B: 15970 West St Rd 84 Ste.2" INSURER C: - SUNRISE,FL 33326- INSURER D 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 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. ADDL SUB I TYPE OF DANCE POLICY NUMBER LIMITS GENERAL L.IABIM EACH OCCURRENCE $ 11000.000.00 DAMAGE TO Fwj"EO ® CODAL GENERAL WASILITy PREMISES $ 50.000.00 ❑ p CLAIM"ADE © OCCUR CGDO0004343-01 MED EXP(AW one Lmn) $ 51000.00 A p N N 06/23!2015 Oer=16 PERSONAL&ADV INJURY $ 1,000.000.00 F1 GENERAL.AGGREGATE $ 2,000.000.00 GEITL AGGREGATE LIMIT APPLIES FWt PRODUCTS-COMP/OP AGS, $ 2,000.000.00 ® POLICY ❑ M ® Loc $ AUTOMOBILE LL48 L ITY COMBINED SINGLE LIMIT $ (Ea ) p ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OW NED AUTOS BODILY INJURY(Per aaddeMl $ ❑ SCHEDULED AUTOS PROPERTY DAMAGE El HamAUTOS (Per acddent) $ ❑ NON40WNEDAUTOS $ ❑ $ p UMBRELLA uas ®OCCUR EACH OCCURRENCE $ EXCESS L.IAB SMS-MADE n AGGREGATE $ ❑ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATIONWTATU- AND EMPLOYERS'LIAI MM Y L -- ANY PROPR1ErORlP XDtlEXECUTNE El-FACH ACCIDENT $ OFFI�EXCLUCLUDED? N/A (Meadewy q)NN) E.L.DISEASE-EA EMPLOYE $ 9MAMtoww OFOPERATIONSbalm E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES'(Attaoh MORD 101,AddM oral Rernmft Sdieftle,I more space b re9&ed) License No.CGC-1508959 CERTIFICATE HOLIER CANCELLATION Miami Shores Village QLD ANY OF THE ABOVE DESCRIBED PSS BE CANCELLED SORE Building Department - THE EXPIRATION DATE THEREOF,NOTICE WILL 13E DELIVERED IN 10050 NE god AV. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,Fl.33138 AUTHOfM=REPRESENTATNE MARTA ALONSO I 0 IMI-2009 ACORD CORPORATION. A8 rights reserved. ACORD 25(200M)GF The ACORD name and logo are registered marks of ACORD 9.�1� . JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 11/28/2015 EXPIRATION DATE: 11/27/2017 PERSON: BALBI HILDA M FEIN: 272362246 BUSINESS NAME AND ADDRESS: RETOS SERVICE PLUS LLC 15970 W ST RD 84#244 SUNRISE FL 33326 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the Bing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 sus am Miami shores Village Building Department CpR 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756,8972 Notice to Owner - Workers' Compensation Insurance Exemption ME SO , PRO Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if-. 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of III State,Division of Corporations, No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' ' ti =Rverage from the contractor's company for day labor,part-time employees or subcontractors. compe-ME 1 BY SIqGN —" s u r POU A' KNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTS. Signature— Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of A:-?t;u L. 20 (C Byj�l- who is personally known to me or has produced as identification. Notary: SEAL: Notary Public State of Florida Sindia Alvarez my commission FF 156750 Expires 09103/2018 RETOS SERVICE PLUS 15970 W ST.RD.84 STE.244 GENERAL CONTRACTOR SUNRISE,FL.33326 Lic.#CGC 1508959 Ph.95458841468 April 12,2016 State of Florida County of Miami Dade Before me this day personally appeared HILDA BALBI,who being duly sworn,depose and say: That she will be the only person working on the project located at 461 NE 101St St.Miami Shores,Fl.33138 Sworn to and subscribed fore me t is 12 day of April,2016,by Hilda Balbi,personally know. "Bob ANTONIO MARIMROMMUEZ iq= MY COMMISSION#FF789443 EXPIRES January 13,2019 (407)398-0163 FloHdallotaryServioe•com lots Miami Shores Village 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.-----�LCOPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Worker's Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY 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* (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. BUSINESS NAME: -,-,. BUSINESS ADDRESS: t`&0(70 U-) S-r (USPK CITY S- -OnylV STATE f.-IrZIP 333zG — BUSINESS PHONE: (0? '51 FAX NUMBER CELL PHONE(95 QUALIFIER'S NAME: vcl- QUALIFIER'S LIC NUMBER: C&C I5099 4 � �' f fllfff 1ff1 fff�ff �f fNff Iff1 f�fff Ifif f��f CFH 2016R0228494 OR BK 30042 Fss 3566-356; (2P9s) RECORDED 04/19/2016 11:11:1:: DOCUMENT COVER PAGE HARVEY RUVINs CLERK OF COURT MIAMI-OADE COUNTY, FLORIDA For those documents not providing the,rewired 3 x 3 inch space on the first page,this cover page must be attached. It must describe the document in sufficient detail to prohibit its transference to another document. An additional recording fee for this page must be remitted. ------------------------------------ (Space above this line reserved for recording office use) L Document Title: CB y aha A f C�r&-XV C-�-,`rZAz LU 1" 6,1 211ci fi Of aj 61-1 (Mortgage,Deed,Construction Lien,Etc.) Executing Party: Legal Description: (If Applicable) As more fully described in above described document. Return Document To/Prepared By: (Relevant excerpts) Rule 2.520(d)On all..documents prepared......which are to be recorded in the public records of any county...a 3-inch by 3-inch space at the top right-hand comer on the first page and a 1-inch by 3- inchspaceatthetop right-handcorneroneachsubsequentpageshallbe leftblankandreservedfor use by the clerk of court. F.S.695.26 Requirements for recording instruments affecting real property— (1) roperty(1)No instrument by which the title to real property or any interest therein is conveyed,assign encumbered,or otherwise disposed of shall be recorded by the clerk of the circuit court unless: e• U 711 (e)A 34nch by 3-inch space at the top right-hand corner on the first page and a 1-inch by space at the top right-hand corner on each subsequent page are reserved for use by the clerk oe court... io oe F�oUNT1 CLK/CT 155 Rev.04/15 Clerk's web address:www.miami-dadeclerk.com OR BK 30042 PG 3567 pg LASS" PAGE Miami Shores Village •a �° Building Department +,�� 10050 N.E.2nd Avenue �p Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) �1l�t,/� hereinafter referred to as the owner of the following described property(addr ) t0t 3'S T- .Hfah.ci tv"YeSN Legal Description Lot 1 ock Subdivision -FL 3303 Folio# [r - tom/ - 067 Requests permission to install (describe work):_ 'JC.c -tet Pwaa� Within the public right of way of(address) DG' 1 © S 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 cancel"'Aar an al ii filed in the Public Records of Dade County, Florida by the Villag ger of iam' Shores Village (or his fully authorized representative). Signature Owner or Agent L'"� A'kj OSA -The foregoing trument was acknowledged before me this ©) day of AR Qt 20Lre--, by L I-e N A who is personally known to me or who has produced-Fu -rte.\_e. I- as identification and who did take an oath. I WEE OF FLORIDA pew i f fERSY CERTFy 8 is a#W copy , 11" NOTARY BLIC: on fiW in tis'a, on of Sign: A.D.20 Print: my hand t . My Commission Expires:—I(-,?' � � Notary Public State of Flora 321 Sindia Alvarez My %c the ExpireeCommission 09/03/201 B 156750 i i Miami Shcres Village _ 20 AP b'ED BY ATE ZO DEP-( ESLD EPT �1 t Y ��U1Y emG2 �ccULQJ� SUBJ CT "O CCNIPLL AlCE WITH ALL F C)ERAL 1 t �T, No CC-1-IN)Y r3(;L'S AND REGULATIONS .00E' 1—STORY F.F.EE-+M4wW 1 LOT Z0° CIOPLASM �x �auo' BLOCK QST 1/2 U AV ti3.9 ^ LOT 21, BLOC 7 I x c; OF SEPT C MOM zo 4! GAx 32.E 11 AX LOT 19. i w.o' ' t� EST 1 LOT 21° t 13. BLOCK 7 1STO , Y tea R—4J46 d 70 4': GAIE �1' 1 3 �J' "t [V v Sava WOM �• ? k V K 35 i6 ` /\ap.. X3:0'�► Ai' APR 14 tole Y: � k _ tt • • • ••• i A j�•CaneBBmtet f LEGM •• �� •• • • • • 4 •• • mtosm a !eashl•• i 97m moa Fw= db Alattr klaW FJP.=FwW bon fte)ft FA 60I • • •, 4FJWoWmd LAND BWRVSr0Jgv.MZMC6. — •• ee ml M 6775 iw 15N SWM sm m R� t FL. 3M4 ... . 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