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BP-05-560Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT AP LIGATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) VOID?. Owner's Address Permit No. Master Permit No. Plumbing Mechanical Roofing ONI Phone # ° 773 S City4t 1 S' Tenant/Lessee Name State j- 1 Zip i8 Phone # Job Address (where the work is being done) City Miami Shires Vill Is Building Historically Designated Contractor's Company Name Contractor's Address City Qualifier YES County Miami -Dade NO is Phone # Zip State Zip State Certificate or Registration NO. Architect/Engineer's Name (if applicable) $ Value of Work For this Certificate of Competency No. Phone # Permit',4 ,2�1 50 Type of Work: ❑Addis' Describe Work: oo ['Alteration New Square Footage Of Work: �xis�inb Repair. Repair/Replac * *j ** * * * * *,�,�,�*** *+�'I�e�t** *****Fees ** *,�,�**** **** ** *,�,� *,�,a,� * ,�a� Submittal -/� Permit Fee $ Notary " Training/Education Fee $ Scannin Radon Code Enforcement $ Total Fee Now Due $ CCF $ Technology Fee $ $ Zoning Bond $ Structural Plan Review. $ (Continued on opposite side) CO /CC 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 thata copy of the notice of commencement and construction lien law brochure will be delivered to the person whose propeetra subject to at,, chment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whi occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ip . ov 'd and a reinspection fee will be charged 1 Signature Signature Owner or Agent Contractor The foregoing in ment was acknowledged before me this 19 The foregoing instrument was acknowledged before me this day of a ,1 2 1 by day of , 20 , by who is persoA 1 known o me +r 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. NOTAR a LIC: NOTARY PUBLIC: Sign: r��9 v 4 Q$4 Sign: Print: o p Print: Pviabet yiJ S My Co + ission xpires: s,; OF ft, Ex p,e'Ju, .5,'L 0 - Annc Bonding Cr, My Commission Expires: APPLICATION APPROVED BY Plans Examiner Engineer chc 05/13/03 Zoning 08- 18- 10;08:24AM; # 1/ �` °" CERTIFICATE OF LIABILITY INSURANCE 1 DA 8/ie;o PRODUCER Government Insuianoe Corp. 320 Hialeah Drive Hialeah, FL 33010 Phone (305) 883_ - 93_98 _ _ Fa x (305) 885-1936 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND JA4'[E.R1:y,L'„CONERAGE AFFQA,DELLEY THE POUC INSURERS AFFORDING COVERAGE OR ESfEL01V._ NAIC 5 INSURED United General Building Corp 3274 MN 38 St MIamI, FL 33142 I INSURSRA; APPALACHIAN UNDERWRITERS INSURER INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING 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 POUCIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, OCCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADD'L n i r g TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE mg CMMI IYYl POLICY EXPIRATION DATE maivvYJ man GENERAL LIABILITY L J COMMERCIAL GENERAL. LIABlLrnr 00 NS1208689 07/17/10 07/17/11 EACH OCCURRENCE $1,000,000 PREMISES E( ae)� $50,000 _a __ MED EXP (Any one person) $5,000 • 0 GEN'L • CLAIMS MADE R OCCUR PERSONAL & ACV INJURY $1,000,000 $2,000,000 GENERAL AGGREGATE may = • COMP/OP AGG $2,000,000 APPU AGGREGATE LIMIT 1:8 PER POLICY CJ PROJECT 0 LOC B AUTOMOBILE LIABILITY N/A COMBINED SINGLE LIMIT (Ea rr • ANY AUTO • ALL OWNED AUTOS • I SCHEDULED AUTOS El HIRED AUTOS • NON OWNED AUTOS BODILY INJURY (Per pet�a 80D11.Y INJURY (Peraccident) • D GARAGE • • PROPERTY DAMAGE ,Spar acclaenU AUTO ONLY - EA ACCIDENT — , • LIABILI1Y ANY AUTO C • OTHER THAN FA ACC AUTO ONLY: AGO D 0 EXCESS/UMBRELLA • EACH OCCURRENCE LIABILITY OCCUR • CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE • RETENTION $ N/A ETA Y t tM § • . E F WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR / PARTNER 1 EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under PROVISIONS below EL EACH ACCIDENT E.L. DISEASE - EA > MPLOYEE EL DISEASE • POLICY LIMIT SPECIAL OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS GENERAL CONTRACTOR CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES FL 33138 ACORD 2$ (2001108) G F .CANCELLATION ATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR 70 MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE EFT, BUT FAILURE TO DO 130 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPREBEaTIVE ACORD CORPORATION 1988 • Charlie Crist Governor 10 -135 Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General August 17, 2010 Jose A Castro 15362 SW 36 Ter Miami, FL 33188 RE: Contingency Letter Application Document No: AP975363 Centrax Permit Number: 13-SC- 1272748 OSTDS Number: 9950 NE 4 Ave Miami, FL 33138 Lot: 1 -2 -3 Block: 95 Subdivision: Miami Shores Dear Applicant: This will acknowledge receipt of an application dated 08/11/2010 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. Existing system will not interfiere with drive way If you have any questions on this matter, please call our office at (305) 623 - 3500. Sincerely, Wal Enclosures cc: Specialist II Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 Fax: (305) 623 -3645 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number V rSgi3 Scale: Each block Notes: WNW 11- SOEEPLAN 10 feet and 1 Inch = 40 feet. ammummum•ilmmi•mimmumma•mummam •mummummommiggimpummommumma maimaripmFmr.pm,....mememmismamm Alimearmyrommummeannunum ••nnuto Ensamilliiiiri inziamu•n MMIE75-rc147.4f!' renTITMEOMTMITFAMMEMMEM Wg I MIUMFAmamignimumKNOWIWI EMMEN 111 MUMWMPIMaigamm-MMMTMEMM •11111111111 11 IVilttdiUUU mum r:i i. 111V&ItElOk;,411VAIVAIMMEMINI MIMEO RI sgm:ARIMINSAIMMON4IMMOIMMEM MOM= WI mrIAIMWMIWZMAVISIMMINIMME MIMEO ji M IldrAMMPWMFLOES4MMEMMEM inn Ni INIMME 111 M VmakornalumdarAlmamm MIIMME MB Mit ,5AMOYAIVIMINTANIMMOM 111.12 MB MI6" AAKMMINIMMIPEMEMMEM •EMIN•VI VIMIIIMEMPUMWSOMPRIMMEM 1110111111111'i AWMEMMNIMMEM MEMMILIVAL 111 IMMIMMEMMIVAMM••ME• MINIMMIP!'\ 1M2d11111,12WIMMINIMMEMOM IVksv‘-4-- AMMNIP"' 4111111.••••■■••••■•010010.* ' • TP sT,I 'I • Site Plan submitted by: Plan Approved By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 1019e (Replaceslifl&H Form 4010 which may be used} (Stock Number: 5744402-40184) Page Z al4 .46 , •• vel4 • /••;,/ i• • te. * STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PEWIT,. Permit Application Number 7 Scale: Each bl 0,1h1 ":411 PART SITEPL.AN merits 10 feet and 1 Inch 40 feet. 1111111111111111111111111111111111111111111111111111111111110111111 111111111111111111111111111111111111111111111111111111111111111111111111•111111111 lUNIlI mumgr-L-4-771%,MCIMP'17-7Zimmiammilffill111111111111111 arriA141`. 1 A 'a," IIT:i 1:1111M0ific3imirientil091E1411111 •11111111111111 iii 11) 111t1111111111112okTEE-LIME 11111111111111111111 111111111111111 ,AL-ritifillillkaraiimrwaimmans annumn ri 1 111.1,1111LiolI111111!1� 411111111111111111111111 11111111111111 •111111111111111 Phi 111111MiligriiiMEAR,12111111111111111111111111111 111•111111 1111 1,1111VIIIIVAIELS7lE210111111111111111111111 IIIMUMMEr ii Ia ill VIIIIIiiitnalifillindlarA11111111111111 111 auluorsimPrceiwomaima 111111111111111112 Eli IL simantenrairinumilums aummuriot n. uiai"aaui 1111111111111111Ellik: 11111111111111111111EtT• lnitigaimmorsammummoun aummmeadovi *Dr NMI-DADE COUNTY HEALTH DEPARTMENT Notes: Site Plan submitted by: Plan Approved By County Health Department ALL CHANGES MUST BE APPROVED SY THE COUNTY HEALTH DEPARTMENT DH 4015.10MS (Replaces HAIM Faun 4018 which may be um) (Stock Number: 5744-0024018-8) Page 2 al4 aloneepea • ,T • dwon.... .1.1%.10-.•0111,":17. NAME: PAYMENT FORM: RECEIVED FROM: PAYING ON: Miami -Dade County Health Department 1725 NW 167 St Opa Locka, FL 33056 Victor Orteoon CHECK 1048 Jose A Castro PERMIT #:13 -SC- 1272748 PAYMENT DATE: 08/11/2010 AMOUNT PAID: $ 70.00 BILL ooc #:13-BID-1508424 CONSTRUCTION APPLICATION #: AP875383 PROPERTY LOCATION: 9950 NE 4 Ave Miami, FL 33138 Lot: 1 -2 -3 Property ID: 11- 3206 - 017 -1160 Block: 95 EXPLANATION or DESCRIPTION: QUANTITY FEE 139 - OSTDS Application Approval Existing, No Insp 1 $ 35.00 -1 - County Application and Approval for Existing Syste 1 $ 35.00 RECEIVED BY: BoveaME AUDIT CONTROL NO. 13 -PID- 1451785 Note: x2010125976 • • ••• •• •• • • • •• •• • • • • • • • ••• tam Basta=•e tax 49=1 ram • •,::4 • • • • • • • • •••lb JUL 2 7 2010 ligackt • PERMIT # Miami Shor ZONING DEPT BLDG DEPT SUBJECT iO CCMPLIANCE WITH ALL FEDERAL SHIS DEDPESTI DESCRIBED DS: TATS 1, 2 D. x, Sim 9S, moots saccr m f °, ilaxamors 90 MD DIA2 SOP, IS IN "UDE BOO / S, MS 14, 0£ TEN POID.TC Roams of DADS COMM LZOBIDA. - raL Pai-vek, rD/Krew oqi VrCYOB OER8GOB mw NOWA &MOVE= ATIOREED20 =LS iws1IBTIIICB ' , DTC- canssmarm N a roe marm NA 2 % ecasso s 9NOm trjealteate eioosple,..gs ca! "arm..teT - BMW $U LOWS DanercoSO U:4Uir lemy mil GSt6ssea 8E/t.EDVIBW Weld SUM* as ird *oar 6tl Boit amd et DER EA , Op co 2 W fl dm SEAi.OF Yea. el - — sitc ataffivm i��..,,..��sw or a ,Vra tet Atm Profess 823? Ct a i3 •• •• • • •. • •_ • • • • • • • • • •.• • •• • •.• 0• • • • • • • • •. • •• •••• • • • ° • • •• • •••• • •••• • • •• • • •• •• • - • • • • • • • ••s;•• • • • • • • • • • • •••• • •• • • Miami Shores Viiiage Building Department RECEIPT PERMIT #: 1`-' DATE: I, iti■G1oe MJN-v/__ 'Contractor o Owner o Architect 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Address: 4lA010 rv�r iryv-40Axri-t2.) er) 1-0 )130,-C) 61d 4 pop a�� d �'I � 4 From the building department on this date in order to have corrections done to plans And /or get County stamp I understand i . ' he plans need to be brought back to Miami Shores Village Buildin De. rtment to permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Folio Number:1132060171160 Owner's Name: VICTOR ORTEGON Job Address: 9950 4 Avenue Road Miami Shores, FL 33138 -2451 Owner's Phone: Total Square Feet: 5000 Total Job Valuation: $ 16,000.00 Contractor(s) MIAMICRETE INC Phone Primary Contractor (786)853 -7454 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 8/18/2010 : Yes Comments: 10 FOOT SIDE YARD SETBACK IS REQUIRED. PLEASE NOTE SETBACK ON PLAN. DRIVEWAY CAN NOT BE LOCATED WITHIN 10 FEET OF SIDE LOT LINE. 8/18/10 FLARES CAN NOT EXCEED 2 FOOT IN WIDTH WHERE THE DRIVEWAY MEETS THE ROAD. 10 FOOT SETBACK TO BE MAINTAINED BETWEEN DRIVEWAY AND SIDE YARD LOT LINE. APPLICANT SHOULD VERIFY THIS DISTANCE TO DETERMINE IF THE DRIVEWAY CAN BE BUILD AS SHOWN ON THE PLANS. 10� fr ,"-:f pAo4k- eruvzc 1�b y 1 1 Penn tNO. DS -7 -10 -1353 Issue Date: Not Issued 08/03/2010 15:18 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES W001 * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /R% NO 0364 RECIPIENT ADDRESS 97863602918 DESTINATION ID ST. TINE TIME USE PAGES SENT RESULT 08/03 15:18 00'29 1 OK Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax (305)756 -8972 Expires:NOt Issued Folio Number:1132060171160 Owner's Name: VICTOR ORTEGON Job Address: 9950 4 Avenue Road Miami Shores, FL 33138 -2451 Owner's Phone: Total Square Feet: 5000 Total Job Valuation: $ 16,000.00 Contractor(s) MIAMICRETE INC Phone (786)853 -7454 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 7/27/2010 Comments: 10 FOOT SIDE YARD SETBACK IS REQUIRED. PLEASE NOTE SETBACK ON PLAN. DRIVEWAY CAN NOT BE LOCATED WITHIN 10 FEET OF SIDE LOT LINE. 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax (305)756 -8972 Folio Number:1132060171160 Owner's Name: VICTOR ORTEGON Job Address: 9950 4 Avenue Road Miami Shores, FL 33138 -2451 Owner's Phone: Total Square Feet: 5000 Total Job Valuation: $ 16,000.00 Contractor(s) MIAMICRETE INC Phone (786)853 -7454 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 7/27/2010 Comments: 10 FOOT SIDE YARD SETBACK IS REQUIRED. PLEASE NOTE SETBACK ON PLAN. DRIVEWAY CAN NOT BE LOCATED WITHIN 10 FEET OF SIDE LOT LINE. c.)( lefa. 24,A. coal At.a.itctrt. FPc-k. 75ko -" D -2`ll� STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Viiiage Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affient, (407UX _ 1 OA] does hereby attest that The attached survey, performed by X11, 5-� (Name survey •, s company) For address: Performed on ;t2/h ketd' (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 Tess 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 viola e _ r building code regulations. The Affiant further understands that the existence of any such structures ma ;'• `x= nal inspections as applicable to this or other permits. Further, A t j�th naught Prope Owner Signature SWO N TO AND SUBSCRIBED before me this day of Affiant is _personally known to me, produced Revised on 5122/2009/ Revd on 6/12/09 Ditker Print Name (407)3PN•+!': 1111111 11111111111111111111 11111 11 1 111111 1111 Whereas, (owner) FN . 201: WM -914-3 r OR Bk 27364 Fos 2223 - 2224; (2a9s) RECORDED 07/26/2010 12:08:45 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OKCONSTRUCTION WITHIN RIGHT OF WAY InMPU Utt,ft90 the following described property (address): hereinafter referred to as the owner of ? o /ye, LI- t, Legal Description Lot 1 Block g6-- Subdivision l": 50 4' er-IM et Folio # Requests permission to install (describe work): -131/Ca---- P itl'f Y k MA-4514-c41-'6 C Within the public right of way of (address) Me' 7 4-11`e ` ""`' N, 10/'1 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. 1 y 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). Vl 11 W 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land N C and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until 0. CO I- C time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, CFlorida by the Village Manager of Miami Shores Village (or his fully authorized representative). OJ 1i 0.41; 5.i'_4ilitmaiiiIYu.b.gw3.tiev Xi6411:3 /1/1/1 �IgfIP•B �F:G ‘0,/E10°197, ..5WET SIGNED, SEALED, • DELIVERED in the presence of: 2 00683640 June 07, 2011 'An71on4,n rif12,0,11enrCer .com STATE OF FLORIDA, COUNTY OF DADE 1 HEREBY CERTIFY that this is a it e erthe original flied this Noe on s' y of WITNESS HARVEY By A.D. 20 hand and Uncial Seal. VIN, CLERK, d County Courts vi/_Aal Q (Owner's Signature ) NOTICE OF COMMENCEMENT 1 11111 11111 11111 gni 11111 1111 1111 1111 11 11 A RECORDED COPY MUST DE POSTED ON TIM JOB SITE AT THE OF KIST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY uF iviWivii vAGc: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement CFN 201.0R04984-88 OR Bk 27364 Ps 2225; tips) RECORDED 07/26/2010 12:08:45 HARVEY RUVIN, CLERK OF COURT MIAMI —DADE COUNTY, FLORIDA LAST.. PAGE 1. Legal deVixif ilaropfttsdiaegadd erff/ 4'Q' Atev` a 7 abarTe e4 ds J a of re "rdig 2. Description of improvement 3. Owner(s) name and address: Name and address of fee simple titleholder 4. Contractor's name, address and phone number 5. Surety: (Payment bond required by owner from contractor; if arty) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be as provided by Section 713.13(1)(a)7., Florida Statutes, STATE OF FLORIDA, COUNTY OF DADE Name, address and phone number. 1 HEREBY CERTIFY that this is a t e of the In this v onginal13 8. In addition to himself, Owners designates the foil 713.13(1Xb), Florida Statutes. WITNESS my Name, address and phone number: HARVEY R By 9. Expiration date of this Notice of Commencement the explratioh date Is 1 year from ,the date of recording orgasm a different date Is specified) PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND RESULT IN YOUR PAYING-TWICE FOR OPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED ON THE JOB SITE BEFORE THE D TO OBTAIN FINANCING; CONSULT WITH YOUR LENDER O' AN I RNEY BEFORE COMMENCING WORK E OF COMMENCEMENT WARNING TO 0 IMPROPER PAYM IMPROVEMENTS TO YOUR FIRST INSPECTION. IF Y OR RECORDING Y =. Signature(s) By Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE a Owner(s)' Authorized Officer/Director/Partner/Man By Print Name Title/Office The f<vrefilnstrument was acltnowledged before me this By Te616761 • Q lndivklual cr s Individually, for ❑ Personally known, or Q produced the following type of identification: Signature of Notary Public: Print Name: (SEAL) IFIOATION PURSUANT TO SECTION f 24 FLORIDA STATUTES Under penalties of perjury, l declare that 1 have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authors Officer/Director/Partner/Manager who signed above: clay of A. , II ;%"• ' lift „` 7, 2011 BY By Property Information Map My Home Miami -Dade County, Florida Property Information Map Aerial Photography - 2009 0 This map was created on 7/27/2010 9:29:03 AM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. Close 27 ft Page 1 of 1 MIAMI•DADE Summary Details: Folio No.: 1200 SINGLE FAMILY RESIDENCE Property: 9950 NE 4 AVE RD Mailing VICTOR ORTEGON &W Address: AMANDA Living Units: 9550 NE 4 AVE RD MIAMI Adj Sq Footage: SHORES FL Lot Size: 33138 -2451 Propert y Information: Primary Zone: 1200 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 4/5 Floors: 1 Living Units: 1 Adj Sq Footage: 4,844 Lot Size: 34,007 SQ FT Year Built: 1953 $50,000/ $610,965 MIAMI SHORES SEC 4 City: PB 15 -14 LOTS 1 -2 -3 Legal BLK 95 LOT SIZE SITE Description: VALUE OR 20501 -4846 07 2002 1 OR 20501- 4846 0702 00 Assessment Information: Year: 2009 2008 Land Value: $559,611 $1,031,989 Building Value: $418,320 $413,086 Market Value: $977,931 $1,445,075 Assessed Value: $660,965 $652,513 Exemption Information: Year: _ 2009 2008 1;_,,, :c1 r— $25,000 $25,000 2nc H�n,�;,:ec - YES YES Taxable Value Information: Year: 2009 2008 $525,000 Applied Applied Taxing Authority: Exemption/ Taxable Exemption/ Taxable Sales which are qualified Value: Value: Regional: $50,000/ $610,965 $50,000/ $602,513 County: $50,000/ $610,965 $50,000/ $602,513 City: $50,000/ $610,965 $50,000/ $602,513 School Board: $25,000/ $635,965 $25,000/ $627,513 Sale Information: Sale Date: 7/2002 Sale Amount: $525,000 Sale O /R: 20501-4S46 Sales Qualification Sales which are qualified Description: Viev, Adoitional Sales http: / /gi sim s2.miamidade. gov /myhome /printm ap.asp ?m apurl= http: / /gi sims2.miamidade. go... 7/27/2010