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DS-16-30 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250522 Permit Number: DS-1-16-30 Scheduled Inspection Date: December 16, 2016 Permit Type: Driveways/Sidewalks/Slabs Inspector: ,,,. SA Inspection Type: Final Owner: TOMMIE,QUENTIN Work Classification: Addition/Alteration Job Address:124 NE 111 Street Miami Shores, FL Phone Number (772)237-9346 Project: <NONE> Parcel Number 1121360040101 Contractor: STAR ISLAND CONCRETE DESIGN CORP Phone: (305)776-7916 Building Department Comments REPLACE CURRENT ASPHALT DRIVEWAY WITH 18FT Infractio Passed Comments CONCRETE DRIVEWAY INSPECTOR COMMENTS False Inspector Comments Passed 1'�p 1� Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. 5 December 15,2016 For Inspections please call: (305)762-4949 Page 2 of 30 } 3 5jj T , Miami Shores Village PSI,7„)m 0wowsid 11:11i, 10050 N.E.2nd Avenue NE �, IN/rtacti Addition/A[te�on Miami Shores,FL 33138-0000 %j Phone: (305)795-2204 Y ; � , 6%21t2t3 Expiration: 03/20/2017 {, Project Address Parcel Number Applicant 124 NE 111 Street 1121360040101 QUENTIN TOMMIE Miami Shores, FL Block: Lot: Owner information Address Phone Cell QUENTIN TOMMIE 124 NE 111 Street (772)237-9346 MIAMI SHORES FL 33161- 124 NE 111 Street MIAMI SHORES FL 33161- Contractor(s) Phone Cell Phone Valuation: $ 7,200.00 STAR ISLAND CONCRETE DESIGN C( 305-253-5151 ... _..__.. _..w.,._. .. Total Sq Feet: 1600 u Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:REPLACE CURRENT ASPHALT DRIVEWA Additional Info: Review Planning Bond Return: Classification:Residential Review Planning Scanning:3 Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# DS-1-16-58249 CCF $4.60 01/07/2016 Check* 1698 $50.00 $652.06 DBPR Fee $2.63 DCA Fee $2.63 09/21/2016 Credit Card $652.06 $0.00 Education Surcharge $1.60 Bond*3218 Permit Fee $175.00 Scanning Fee $9.00 Technology Fee $6.40 Total: $702.06 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 boy either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING, ,WIND ,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: rtify oing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and g. p authorize the above-named contractor to do the work stated. September 21,2016 Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy September 21,2016 1 \1� Miami Shores Village • Building Department JAN 07 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 t Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 �C,( A F BC 201"t* BUILDING Master Permit No. ` S1 (o PE MIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP y ' f� CONTRACTOR DRAWINGS JOBADDRESS: f?—Li 1 I CIT City° AA Miami Shores County Miami Dade zip: 3 3�-6 5. Folio/Parcel#: 11-21?z—U0 •- 09.01 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Q I)E iiy a I NI I). TD M M L IF Phone#: Address: �,ZLA Ne �,11 S'T City: $A i m d Q State: L— Zip: 33-4 &1 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#: 30-9=P77 `7�I � Address: 2-199 WiZ 163 Sia City: State: _Ft- Zip: X31 6 2- Qualifier Name: fA I(A)CL 6�30_PNS Phone#: 3®,�S---7.7 G- -2111 State Certification or Registration#: Certificate of Competency#: E 2®'-9 03 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Foo ge of Work: Type of Work: El Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: ecE�3VL P-GF_ l,^J MIA 4V 1 w O Specify color ofcolorthru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 2 GDBPR$ Notary$ Technology Fee$ bra. (# 0 Training/Education Fee$ I Double Fee$_CA Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 11E: 0 Co (Revised02/24/2014) G E;2 0�b 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. 1 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 sucly pasted notice, the inspection will not be approved and a reinspection fee will be charged. // Signature ~ ' Signature1` 2f OWNER or AGENT I / CO RACTOR The forego'ng instrume was acknowledged b ore is The fore ing ins me t, as acknowledged bef is oda of• '.' by 2 by b w4 n to a �, f �iF oaaklio�i� nown to 7` EXPIRES April 30,2019 %", d;�°•' EXPIRES April 30,2019 f me or who has coda�seCb as me or w ' ff gduced N ways_ft as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ; Sign: Sign: Print: Print: Seal: Seal: APPROVED BY Plans Examiner / 2 ` Zoning Structural Review Clerk (Revised02/24/2014) Local Businew Tax Receipt Miami-Dade County,State of Florida JSWWABtI.tr-O MWPAY 71S8B17 � LBT.) BUSM 1ss NAMEnA"InCM A¢cum"ao EXPIRES STAR ISLAND CONCRETE DESIGN CORP SEPTEMBER 30, 2096 741102 901 NDN 55 ST be,Wsptord at off'►ws*"" MIAMI FL 35927 pum"ne to 6�n1v Cc" CbapW SA-AM 9&10 STAR ISLAW ECRM oESM 196 SPE MTY Cos MRP ENGOODMG 4&00 OMOIS M,AI Un IR A 1 EMSM CONTRACT 02WISaOS19 11�tt+�ai Y� �rdflnlocst Tar. bl�4 par ,ara �ei�mrl3 ��1 'I �l �' tbl'esmd ft19�8 . d�0 la�e�1bl �s9 - 1 Pie � Municipal C®nfactofs Tax Receipt Miami—Mole County,State of Florida TWW WrA 8MM-W WrPAY —-CC NOFEWjS03 sirAR �► + '�D` EXPIRES W1 loss sr 7472M SEPTEMBER 309 2046 A9tAP4 FL 33127 PWmant 1*courAl+Qoft • " i�-24 ms Cw ra � SYIFAX' Cts MW t1W29/2015 VOCOOMMOaA 0200-154=19 T61sr €t��1a���toUo+�to9 A� � I l�11�F �4 P�O�i.Sig�Osa�4 Tm�of C1R�0a� . ENDts�monr�m�om�,.t�a COB �, a W%* mjsmm CERTIFICATE OF CommSem E201993 STAR SLAM C00% �c D.8A.: to Ing offlnnW by Cert ner ,�-zN ( G 1 1✓E 2- APPt_1CATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION#G13000111078 mous(acne to be : DRMWAYS BY DEMN iMaNing Address of Busness: 815 NW 24CT MIAMI.FL 33125 Fiorrda County of Principal Puce of : MIAMI-BADE FILED FE Number: NOV 129 2013 Secretary of State mss,of Fid tie: STAR ISLAND CRETE DESIGN,CORP 8`16 NW 24 CT MAK Fl. 33125 Florida Document Number P13000086294 FFJ Num Applied for I the undersigned,beft an owner in the atm ficffious name,certify that the inFcrrnation indicated an this form is true and accurate.I further certify that the fictitious name to be registered has been advertised at lest once in a newspaper as defined in Chapter 50,Florida in the county where the principal place of business is locarte& t understand that the electronic wgriature below shall have the same fegal effect as d made under oath and t am amre that Ulse information submitted In a document to the Department of State oorMtutes a third degree felony as proves for in s_817.155,Ronde Statutes. MIGUEL CORPAS 11/1212013 8ectronic Skmature(s) Daft date of States Requested( ' Certified Copy Requested( ) ARI CERTIFICATE OF LIABILITY INSURANCE ' DATE'M ' j 01105!2016 '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: N the certificate taller is an ADDITIONAL INSURED,the poticy(les)must be endorsed. K SUBROGATION IS WAIVED,subject to the terms and conditions of the polft certain policies may mquim an andweement. A statement on this cortiticate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCERCONTACT- All Insurance Services MM&a 305)822-4472 1 F . (305)558.4354 1548 W.37 St. jfemandy,cwn Hialeah,FL 33012 INSUIRERM AFFORDING COVERAGE NAIC e Phone (305)822.4472 Fax 305)5564354 INSURER A: FUSA INSURED INSURER 0. Star Island Concrete Design Corp 901 NW 55 ST D MIAMI FL 33127E: SURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:- THIS UMBER: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 RESPECTTO 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 SEEN REDUCED BY PAID CLAIMS, rTRR TYPE OF INSURANCE ADD UBR !f WPWp Kwim_._ NUMBER LIMITS GENERAL UABILITY ® COMMERCIAL GENERAL LIABILITY DAMAGE M O C D asraam e S A ❑ ❑ cwMsamAm ❑ OCCUR MED eXP(Any ore ermn s ❑ PERSONAL S ADV INJURY S ❑ GENERALAGGREGATE $ GEN'L AGGREGATE LUT APPLES PER: PRODUCTS-COMPMP AGG S ❑ POLICY ❑ Pfh ❑ LOC s AUTOMOBILE LIABILITY SMOLE LIMIT ❑ ANY AUTO MMY INJURY(Per person) S ❑❑ D pHEgULEO� ❑ pBODILY INJURY(Per sodden! $ %OSD HIREDAUTOS ❑ AU Pte ` S $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE S ❑ excess LUM ❑CLAIMS-MADE AGGREGATE S ❑ s s WORKERS COMPENSATION ® OTH. AND EMPLOYEW LIABUJTY Y i N - R ANY A OFFICERIM R EXCLUDED? UT NIA E L EACH ACCIDENT $ 500.00000. (� in NH) 10657001 08h 512015 08/15/2016 B yam,describe under E.L.DISEASE-EA EMPLOYE 6W,0W.00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,OW.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Aftch ACORD 101,AEdWanal Remmks Schedule.N mme apace is regWred) job Address.124 NE 111 Street Miami Shares,FI 33138 License Number E201903 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRISED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDG.DEPT. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE.2ND AVE. ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL.33138 AUS REPRESENTATIVE 01OW2014 A CORP6"TW All rights reserved. ACORD 25(2014101)OF The ACORD name and logo we regillffiered nt vM of ACORD Page 1 of 1 rift Date: Round: Gun: Weather Cond.: Your hunt starts here Distance: Powder Load: http://www.rihunts.com/images/hunting/targets/l.inch.round.gif 4/26/2012 CERTIFICATIItTA' NLtnTi tSURANCE e o1�7ns THM CERTt>=tCA A MATTER OF IIIFORMA NO MGM UPON THE CORTWICATE HOLDER THIS CERTWICATE DOLS NOT AFFOMTMELY OR NEGATlV&Y AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES REPRESENTATNE OR PRODUCER.AND THE CERTIFICATE COLDER. I TANT: Irthecerifflede how ban ADWICN►L INSURED.the poUey(les)must be eruiorsed, N SUBROGATM ISVamm.subject to the tarots and ca d0wis of the Policy.cattalo poUdes may require an mulwasmeft A statemard on dit certMeate does not cmdo rWft to the cultMc to hoMw in lieu of such endonwnwd(sj. PRODtuER MANUEL GASTRO Chaplan&Cmtro It anno® 1.4009 459WI513 2552 NW 7 Street Miend,FL 33125 INSURERM AFFORDING COVERAGE NAIL s Ptaarte PPW14009 Fox 1513 GRANADA INStJRANCE CO. INSURED STAR ISLAND CONCRETE DESIGN CORP INSURERC: 815NW24CT O: MM,FLORIDA 33125 INSURCRE. I P: COVERAGES C®tTF=TE NUMBER, REVISION NUMBER: THUS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD =ICATED NOTWITmSTANDING ANY REQUIREIMU.TERRA OR CONO TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSM OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HES IS SUBJECT TO ALL THE TERMS. EXCLLISIONS AND OODWITIO NS OF 81"POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM. TYPE OP INSURANCEADM MISR Pou"NUMMIR Oman &WA& LIMITS GOAL LIABILITY 5 1000.00.00 ® COMMERCIAL GENERAL LIABILITY DAMAGETOD S 100.000.00 ❑ ® 0185FL00052004 MED EXP are s 5,000.00 A13 06114=5 08H4P1W 8 PERSONAL a ADV KIUR r s 1000.000.00 ❑ GENERAL AGGREGATE s 2,o00 000.00 GENT.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2.000.000.00 ❑POLICY ❑ M ❑ Loc I $ AUTOMOBILE LIABILITY WarleftSLwr ❑ ANY AUTO BODLY OWURY(Pw pmm) S ❑ ALL Au OWNED ❑ OBD N Y MLIURY ft If $ ❑ HIRED AUTOS ❑ �® s El s ❑ UMSRELLALIAB ❑OCCUR EACH ONCE s pw r I I LIAB cloAmmmom AGGREGATE 4 OW [I RVENTIONS $ VIORICERSCOMPENSATION VifC A OTH AND EM+LOYIW LIABILITY Y 1 N N�1f PROPt . EXCLUDED? �� N f A EL EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYE S Ider OF OPERATIONS below E.L.DISEASE-POLM'SY LIMIT s QESCWPTION OP OPETRATIONSI LOCATIONS 1 VBNICLES(Atfash AODRD 101,AddflIwW RSl03 is SIM ,11=00 @PUBIS r*11911001 DRIVE,PARKING AREA OR SIDEWALK-PAVING OR REPAVING JOB ADDRESS: 124 NE 111 ST MIAMI SHORES,FLORIDA 33138 CONTRACTORS LICENSE 0 E2M 9W CERTfFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AAIAM!SHORES VILLAGE BUILDING DEPARTMENT THE ORATION DATE THS,NOTICE VALL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE VKfff f TWF0LfC Fk&A#tai& MIAMI,FLORIDA 33138 AUTHOR REPIUISONTATWE ' 01888-2010 ACORD CORPORATION. All HBhts reserved. t"O 28 PMS)QF The ACORD now and logo ata regisbuid marks of ACORD http://www.hcarears.com/seeker/search/view?jobAdid=45C65D583D5EBB28&type=partner&source=indeedorganic 9/10/15,11:16 PM Page 3 of 3 y 1 111111 1111111111 11111 1111[Ifllf III11 1111 1111 OR BY 29814 F9s 1677-1679 QPss) DOCUMENT COVER PAGE RECORDED 01/05/2016 15:52:21 HARVEY RUVINY CLERK OF COURT MIAMI-DADE COUNTYr FLORIDA For those documents not providing the required 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) Document Title: rapcxe_ .*r CSS a� cps (Mortgage,Deed, Construction Lien,Etc.) Executing Party: Legal Description: L// 131 (IfApplicable) 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 corner on the first page and a 1-inch by 3- inch space atthe top right-hand corneron each subsequentpage shall be leftblank and reserved for use by the clerk of court. F.S.695.26 Requirements for recording instruments affecting real property— (1)No instrument by which the title to real property or any interest therein is conveyed,assigned, encumbered,or otherwise disposed of shall be recorded by the clerk of the circuit court unless: coUyy ®`t CLERK C% (e)A 3-inch by 3-inch space at the top right-hand corner on the first page and a 1-inch by 3-inchgry space at the top right-hand corner on each subsequent page are reserved for use by the clerk of the v ti court... O� Re 60D WE TRU91 Q� q v CLK/CT 155 Rev.04/15 Clerk's web address:www.miami-dadeclerk.com z.S OR' s(? Miami shores Village I... MUM Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 �lpRlpA Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OFJWNSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) z M he�reeinafter referred to as the owner of the following described property(address): 12-4 N ��1 1 `"` �- 3siC� � Legal Descriptiontoi ie-ye- (16T5P6t(L"9Lot Block 1 Subdivision cot-l.i:c-re �T Folio# 11- Z_ksG- 00L-I -0 01 Requests permission to install (describe work): Co W Ge�i� A-OVLAct-} -2.161 Within the public right of way of(address) :LZy N� 1.9-� S-3 3L 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. �a coulUry Cosy � Q 4 Goo WE �'°' Coy+ ° OR BK 29914 PG 1679 LAST PAGE m 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 onthi, day of 201 ,/ )A - (Owner's Signature) SIGNED, SEALED,AND DELIVERED in the presence of: LARRY E TENORI MY COMMISSION#FF225 '.!o:.�,,•` EXPIRES AprU 30,2019 9 ' n1t� 399 t1'Sd rkWKW*8'yServke.00W 1 STATE OF FLOR NTY OF DADE I HERC1 RIC EBY CERTIF is a true copy of the �N®colrkjrc Jed hr.t* day of +N 0 AD20 N l�lirlss rt>tr ot>I �seg HARVE1f hcimul awC7U*Cowfs. , � 0� _� 7 2 Rick ERR I To proved promote inptae the heath GUM= of all people In Florida through irdegraWd Cal WdRA in, MM HEALTH SIal SzWon Gerleral and S mfty Hldm*To bethe Heaftldest Main the Na fon July 07,2016 Rene Verlaat,Driveways by Design mT(-FTV 2199 NE 163 Street Miami, FL 33138 AUG ® 2096 j RE:Modification to a Single Family Residence-No Bedroom Addition -— Application Document Number: AP1223209 Centrax Permit Number. 13-SC-1658377 124 NE 111 Street Miami,FL 33161 Lot:11 Block: 1 Subdivision:College Heights Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 02/03/2016 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. Proposed Driveway. 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. Since y, Carlos I aza Engineer ill Department of Health in Dade County of Kona in Dade County• •.Florida TWTTER:HeaithyFLA PHONE: (305)623-3500 FACEBOOKTI-DepartmentofHealth YOUTUBE:fldoh Ac R® CERTIFICATE OF LIABILITY INSURANCE DATE(NMlDDlYY1fY) 9/16/2016 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 have ADDITIONAL INSURED provisions or 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 endomement(s). PRODUCER SUNZ Insurance Solutions, LLC. ID: (TLR) CONTACT Workers'Comp Department c/o TLR of Bonita, Inc PHONE FAx 700 Central Ave Suite 500 E-MaIL 727-520-7676 x 3 A/c No): 727-525-3862 St. Petersburg, k 33701 ADDRESS: certs encorehr.com INSURERS AFFORDING COVERAGE NAIC i INSURER A: SUNZ Insurance Company 34762 INSURED INSURER 8: Aspen Re-London-Best Ratin "A+" TLR of Bonita, Inc EnteMriseHR INSURER C: Chaucer Syndicate-Lloyds-Best Rating"A+" 700 Central Avenue Suite 500 INSURER D: Faraday Syndicate-Lloyds-Best Rating"A+" St. Petersburg FL 33701 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 31800567 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. INSRR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER MPOLIDY EFF FOLIC(MMIDD � LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 1:1 OCCUR PREMISES Ea $ MED EXP(Any one person) $ PERSONAL HADV INJURY $ _ GEN'L AGGREGATE LIMIT APPLIES PER: {�1 �. GENERAL AGGREGATE $ POLICY PET U LOC PRODUCTS-COMP/OP AGG $ OTHER: AUG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per parson) $ OWNED SCHEDULED {{ BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED :, — PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LJAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WCPE0000000112 6/1/2016 6/1/2017 ,/ STATUTE EORTH- AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN NIA E.L.EACH ACCIDENT $ 1,000,000.00 OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1 000 000.00 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000.00 B Workers Compensation This is for informational purposes C Excess Coverage and nothing shall create any right D under such reinsurance. DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I more space is required) Coverage Provided for all leased employees but not subcontractors of.Star Island Concrete Design,Corp Client Effective:5/9/2016 Installation of a Brick Paver Driveway in the Swell CERTIFICATE HOLDER CANCELLATION 1326 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd St. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 31800567 I Master Certificate I Andrea Delucchi 1 9/16/2016 11:44:58 AM (CDT) Page 1 of 1 . . ... . . . ... .. .. . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . ... ... . �Qy: 0 . . . .Columbia Title"% :0: . .. . . . . . ... .. of Florida, Inc. Since 1962 . . . . . . . . . . . . . . . . . , . . . . ♦ , . . . . .. e. .-. . ._.,. . . . . .... . . . . . . . . . e . • ♦ . r . . . • . . . . s . s s • . e . • • • • a • . w . e . . • . f . i • . \ • • . • • • e •'•'- -'•N•E. 111th /1 STREET'. ::.'.- . . . . . . . . . . . . . . . . . . . . . . . . . . . . o . . . . . . . . . e . . . e . . . . . . . . . . . • . . . . . . . . . . . . . . • • . . • . . . . e . . . , . .. . • • • . • • • . dT4�i�9 der a e'i"ytT'C"P"TTQ •�9". TONT 7'� . P� ,T�3�PTT eT•r e a • • o . • e • . ♦ • • • ♦ • r • • e • • • a e • • YL/� o • e s e \ • . . t • • a s . t • e ry °40- HALF 1 1F-0E—WAY(BY PLAT),• - • . . . . a a e . . s e e w e• • e s • . o • \ ♦ • . • ♦• . . . . , . . • . . . . . . . . . . . . 23'f AS'HAL r PA 1T;. , . . . . . . . . . dq ;- -;• 75JW (R8M) s� ���1�Y ��el p��`� Cm -a A • ,. e . s �/� pp �N 13.40 7. 12." d L ��I��� �� 6101_ ;� � "' taee�' 43 . tQa6' CHIC3.SS' 12.1 CHIC � SJ ONE STORY CBS , ,wolumbia Title of Florida, Inc. Since 1962 000000 0000.. .. .. • 0000.. 00 0 0000 0000.. • .. • 0000.. 0000 0000 . . 0000 90066000 00000000 0000.. 000000 . .. 0 000110 . 0 .....'..'..'....'... .'..'..'. .. ... ...' 0 0 0 • .. .. ...... ...... .......... ....: 0000.. :..............N.E. 111th STREET'..,.'.'..'.'.'.'.'..::..'.'..- ... ........... . . 0000.. HALF iaW-C w,iY(BY P11iT�..:.:.. • • 0 ..... .2- ASPHIIL T PA 4EI/1•]!!T. . • 2940'PAIBfWAY 0' 15' 30' 1 Inch = 30' ft. 71LOW (R&M) 40C,• F.LP 1/2" to 110 FLP J/2" as .'g."� � FLP. 1/2' >9 P. H.. A• •T• 1 18.90' 1 b D• LJB 15J5 '... 1•�; 13. 1 lzzeyg 43 a _x 'ct T1LE *"% �•CdrC 1Z1 SNC CITY S Alf V I ONE STORY CBS I N-0 LOT 12 LOT 10 a1+• RESIDENCE ,. BLOC!! 1 w #124 r, BLOCK 1 1a'zo' 2178' IMAf M! TaE M 0 P N tar N r 1Z78' I s a d 14.55' a I 1dfi cm LL FLP 1/2' ' °• b5.00' (R&M) IASL F.LP :.:•..' `1 :.':.':.'..:.:?Pi A HALT Pli4fili Alj....a....'.'.'.'.'.'.'.'.':.':.'. G ..... ......0.000..................... ................. _ LOT 23 LOT 22 LOT 21 6 BLOCK 1 BLOCK f BLOCK 1 _ ',7 li "O�2 BY otos: PHALT DRIVEWAY EXTENDS ONTO 40'HALF RNV(BY PLAT). MAP OF BOUNDARY SURVEY PMaR $14RTIFY 774AT THIS EYPRBAREDL DERHYSURVEYISATRUE AND CORREcrREPREs6Vr a VEYPREPAREDUNDERMYDIRECnON.THrs COMPLIES WITH THE�Adbg STyy11YYDARDS AS SET FORTH BY THE STATE OF Pro Address' FLORIDA BOARD OFF VEYORS IN CHAPTER 8rG17-6,FLORIDA IPertY ADMINISTRATIVECQD � 19FWASTATUES. 124 NE 111 STREET ; �'�� MIAMI SHORE, FL 33161 = 0. 5z 95` v. •• STATE OF Q nlineLand FLORIDA SIGNED 0000•• '• FOR THE FIRM FERNANDO V.if ••URV0 ��1% F. N.No.5259 SURVEYORS,INC.(I STATEOFFLORIDA r I I I I' 15271 NW 60 AVE,Suite 208 NOT VALID WITHOUT AN AUTHENTIC ELECTRONIC SIGNATURE AND AUTHENTICATED Miami Lakes,FL 33014 ELECTRONIC SEAL,AND/OR THE SIGNATURE AND/OR THE ORIGINAL RAISED SEAL OF A LICENSED SURVEYOR AND MAPPER.THE SEAL APPEARING ON THIS DOCUMENT WAS W W W.OniineLandSurveyoTs.Com AUTHORIZED BY FERNANDO V.GOMEZ,P.S.M.NO.5269 ON THE SURVEY DATE NOTED I HEREON. Survey Date:10/31/2014 Survey Code:0-13746 Page 1 of 2 Not valid without all pages. V y 1 NE 1 00 •••• .. NE I)Otn St 014 Google Map data 02014 Google LOCATION MAP N.T.S. PROPERTY FRONT VIEW CERTIFIED TO: FLOOD INFORMATION: QUENTIN D. TOMMIE Community Number: VILLAGE OF MIAMI SHORES COLUMBIA TITILE OF FLORIDA, INC, DBA EWM TITLE 120652 WFG NATIONAL TITLE INSURANCE COMPANY Panel Number: 12086CO139L MID AMERICA MORTGAGE, INC. Suffix: L ITS'SUCCESSORS AND/OR ASSIGNS AS THEIR Date of Firm Index: 9/11/2009 INTEREST MAY APPEAR. Flood Zone: X Base Flood Elevation: N/A Date of Survey: 10/31/2014 LEGAL DESCRIPTION: LOT 11, BLOCK 1, OF SUBDIVISION COLLEGE HEIGHTS, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 42, PAGE 8, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA PROPERTY UNE Surveyor's Legend ( TI STRUCTURE ® GOING. BLOCK WALL �` TREE L.M.E. LAKE or LANDSCAPE MAINT.ESMT. ESMT. EASEMENT X— CHAIN—LINK or PARE FENCE P.P. POWER POLE R.O.E. ROOF OVERHANG EASEMENT D.E. DRAINAGE EASEMENT P.P. POOL PUMP LB.E. LANDSCAPE BUFFER ESMT. WOOD ®C.B. CATCH BASIN FENCE C.U.E. COUNTY UTILITY ESMT. PL PLANTER PROPERTY UNE LIMITED ACCESS EASEMENT I.D. IDENTIFICATION TEL.TEL. TELEPHONE FACILITIES b--�� IRON FENCE I.E.A.E INGRESS/EGRESS ESMT. B.C. BLOCK CORNER V.P. UTILITY POLE — — — — EASEMENT U.E. UTILITY EASEMENT B.R. BEARING REFERENCE E.U.B. ELECTRIC UTILITY BOX FND. OR F FOUND IRON PIPE/ CENTRAL ANGLE or DELTA SEP. SEPTIC TANK CENTER UNE PIN AS NOTED ON PLAT LB/ LICENSE III— BUSINESS R RECORD OR RADIUS D.F. DRAIN FIELD LS# LICENSE #— SURVEYOR RAD. RADIAL AC AIR CONDITIONER WOOD DECK CALC CALCULATED POINT N.R. NON RADIAL CSW CONC SIDEWALK SET SET MONUMENT TYP. TYPICAL DWY DRIVEWAY e CONCRETE A CONTROL POINT I.R. IRON ROD SCR. SCREEN � ■ CONCRETE MONUMENT I.P. IRON PIPE GAR. GARAGE N&D NAIL @ DISK ENCL ENCLOSURE ASPHALT ELEV ELEVATION P.T. POINT OF TANGENCY PK NAIL PARKER—KALON NAIL N.T.S. NOT TO SCALE P.C. POINT OF CURVATURE D.H. DRILL HOLE F.F.O FINISHED FLOOR BRICK/TILE P.R.M. PERMANENT REFERENCE MONUMENT WELL T.O.B. TOP OF BANK P.C.C. POINT OF COMPOUND CURVATURE FIRE HYDRANT E.O.W. EDGE OF WATER P.R.C. POINT OF REVERSE CURVATURE 0 M.H. MAN HOLE E/P OR E.O.P. EDGE OF PAVEMENT WATER O.H.L. OVERHEAD LINES C.V.G. CONCRETE VALLEY GUTTER P.O.B. POINT OF BEGINNING P.O.C. POINT OF COMMENCEMENT TX TRANSFORMER B.S.L. BUILDING SETBACK LINE ---�� APPROXIMATE EDGE OF WATER P.C.P. PERMANENT CONTROL POINT CAN CABLE TV. RISER S.T.L. SURVEY TIE LINE M FIELD MEASURED W.M. WATER METER CENTER LINE P PLATTED MEASURMENT P/E POOL EQUIPMENT R/W RIGHT OF WAY CONC CONCRETE SLAB R.O.E. PUBLIC UTILITY EASEMENT ® COVERED AREA D DEED C.M.E CANAL MAINTENANCE EASEMENT C CALCULATED A.E. ANCHOR EASEMENT U GENERAL NOTES: `o 0 0 1) LEGAL DESCRIPTION PROVIDED BY OTHERS. o 2) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO • ' , DETERMINE RECORDED INSTRUMENTS,IF ANY,AFFECTING PROPERTY. LTA f 3) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENT OR OTHER RECORDED ENCUMBERANCES NOT SHOWN ON THE PLAT. Affiliate� IL A e 4) THE PURPOSE OF THIS SURVEY IS FOR USE IN OBTAINING TITLE INSURANCE A M Mba AND FINANCING AND SHOULD NOT BE USED FOR CONSTRUCTION,PERMITTING -- IPLgl DESIGN,OR ANY OTHER PURPOSE WITHOUT THE WRITTEN CONSENT OF Printing to Scale: waft: ONLINE LAND SURVEYORS INC. 5) UNDERGROUND PORTIONS OF FOOTINGS,FOUNDATIONS OR OTHER 1. Select"None"from Page Scaling Paged°�tane IMPROVEMENTS WERE NOT LOCATED. 2. Deselect"Auto-Rotate and Center" 2�(.)A„m�wax,ndcewer 6) ONLY VISIBLE AND ABOVE GROUND ENCROACHMENTS LOCATED. 7 FENCE OWNERSHIP NOT DETERMINED. 3. Select"Choose paper source by 0.,Jl Onroe Dom+soya 1W PDF DaOe site 8) WALL TIES ARE TO THE FACE OF THE WALL. PDF page size" 9) BEARINGS ARE BASE ON AN ASSUMED MERIDIAN. 10) BOUNDARY SURVEY MEANS A DRAWING AND/OR GRAPHIC REPRESENTATION OF THE SURVEY WORK PERFORMED IN THE FIELD,COULD BE DRAWN AT AIELD WORK: 10/23/2014 SHOWN SCALE ANC/OR NOT TO SCALE. 0 11) NO IDENTIFICATION FOUND ON PROPERTY CORNERS UNLESS NOTED. RA WN BY.' C.S. PND' V GO 12) NOT VALID UNLESS SEALED WITH THE SIGNING SURVEYORS EMBOSSED OR `� �Q . SSE No 'Lim ELEcroNlc SEAL. HECKED BY: F.V.G. - :' C 13) DIMENSIONS SHOWN ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN. _ •, 14) ELEVATIONS IF SHOWN ARE BASED UPON N.G.V.D. 1929 UNLESS OTHERWISE _ D O 5259;-.�+ NOTED. INAL REVISION. 10/31/2014 _ w _ 15) THIS IS A BOUNDARY SURVEY UNLESS OTHERWISE NOTED. Q 16) THIS BOUNDARY SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF OMPLETED: 10/31/2014 STATE OF :• Q THE ENTITIES NAMED HEREON,THE CERTIFICATIONS DO NOT EXTEND TO ANY FLORIDA UNNAMED PARTIES. CALF. I"=30' 6�,,q OR, SUR [SURVEY CODE. 0-13746 t'L8#vi78idd ` 15271 NW 60 AVE, Suite 208 n l i n e La n d33014 91 Miami Lakes, -0123 Phone: (305)910-0123 SURVEYORSONIC. Fax: (305)675-0999 www.OnlineLandSurveyors.Com Survey Date:10/31/2014 Survey Code:0-13746 Page 2 of 2 Not valid without all pages.