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DEMO-10-60Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 133458 Permit Number: DEMO- 1 -10 -60 Scheduled Inspection Date: February 26, 2013 Inspector: Bruhn, Norman Owner: KOTALIK, KENNY Job Address: 950 NE 100 Street Miami Shores, FL 33138- Project <NONE> Contractor: HOME OWNER Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1132060340200 Building Department Comments AS PER CONVERSATION WITH PL CONTRACTOR, OK TO EXTEND THEM 60 DAYS. NB Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 25, 2013 For Inspections please call: (305)762 -4949 Page 1 of 7 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FEB^ N013 FBC 20 (a, Permit No. Master Permit No ° Permit Type: BUILDING ROOFING JOB ADDRESS: q 50 OC ¶ \-- City: Miami Shores County: Miami Dade Zip: 3 ,' L J� Folio/Parcel #: 11 )Z0 CO 06 go ZOO Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 1 d << Phone#: 3 l t' LLI 4 Address: Gt 0 LA--- (op 4s4- City: �``tl a INA '5hor State: F C- zip: ')Dv 2f Tenant/Lessee Name: Phone#: Email: frEppLurn1,41 ( (.1O (• C..o'y CONTRACTOR: Company Name: (Y Phone#: 3 Yis ° t t b5 Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ONew ❑Repair/Replace emolition Description of Work: —1,1-V4 d a ro Color thru tile: ********* �i �i *00* * +k****Nc**sb******** Fees***** *gs*********+ N****Ks***M+ N*ak*******+k******* Submittal Fee $ Permit Fee $ k. 00 ° CCF $ CO /CC $ Scanning Fee $ 5- G Radon Fee $ DBPR $ Bond $ Notary $ ..S-. , rJ-D Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ °�� 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 FT.F.CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDMONERS, ETC OWNER'S A}'N'IDAVIT: 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 such posted notice, the inspection will not be proved and a reinspection fee will be charged. �f 4 Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this "- t The foregoing instrument was acknowledged before me this day of _ � , 20 3 by E 5(S (Thi - if 11C-c51164,-10'tay of , 20 _, by who is personally known to me or who has produced k D who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: � \\.o j j 0 311 NOTARY PUBLIC: ` 6 Sign: = u Sign: Print: 5118C1d 014 = Print: g4pZl8 My Commission Expires: My Commission Expires: APPROVED BY S j! S1 g\00 Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) s Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Honda 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 MAR 2 A. 2011 BY: BUILDING Permit No.Q 'SAO O-(d3 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): i-eArNLj B. 404c-ilk K- Phone #: )OS •75 1.144 Address: CA 00 N W 0'4 5 I City: M k U11M 1 State: F1 Zip: 3 31G g Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: %o NE 1 00 S City: Miami Shores County: Miami Dade Zip: 3313 8 Folio/Parcel #: `k°' 32.06 - 03 4 - 0100 Is the Building Historically Designated: Yes NO ✓` Flood Zone: CONTRACTOR: Company Name: 'v y O W (1,2 C Phone #: Address: I City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2,400 Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration I New ❑1Repair/Replace Per Description of Work: Q. e i 13ut\d�v\9 Dewto1`hor t"errr tT ** i%Fx, :k3:Aa*** ::3:scxsaxs. >::k4" ::'-:kx:<:YtE>F* . * .*** *Fees *ski*ak$::k******* : Raaas: Axsk $x:k*re:FUe:'- #::;:::::i::: _::: * A:r.->;a*** Submittal Fee $ Permit Fee $ /00 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged befor me this u4 The foregoing instrument was acknowledged before me this day of d 20 t , by h Vl, l kink , day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTA ' P LIC: NOTARY PUBLIC: who is Aersonally known to me or who has produced As identification and who did take an oath. Sign Print: My Commission E ..*E. MY COMMISSION # DD753565 EXPIRES March 16, 2012 (40 398-0153 FlorideNotarySeroice.com Sign: Print: My Commission Expires: ******** *# ****k*******,isgebtp*** ****r,n$:ae$e****** k***#**+k***sk**** huh +ksh****wsk*Ai+k******* : *****n r;:*** * *****Ns******** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Miami Shores Village Building Department /0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. l \O—(oO Master Permit No. BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Roofing �/ Owner's Name (Fee Simple Titleholder) 1"-erinkyI -O b 1(k— Phone # 3c6 - 75 1244 G Owner's Address q00 N U� t 4 4- S+ City t` l t 1'I 1 State f 1 Zip 33(68 Tenant/Lessee Name Phone # Job Address (where the work is being done) al 3® NE 100 S-r- City Miami Shores Village County Miami -Dade Zip FOLIO /PARCEL# it-32O6 - 034 - Ozo Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address PS OWnet Phone # City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ❑New El Repair/R lace Describe Work: 'Dar,° Ct ?er . ? `G�1 S • ut &:4r�g -� J Demolition Submittal Fee $ .60 Permit Fee $ 1 00 - 00 CCF $ / ' CO /CC Notary $ Training/Education Fee $ 0 400 Technology Fee $ ( !! `40 Scanning $ •' ° Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ ce 6' See Reverse side -4 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject 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 such posted notice, the inspection.will nit be approved and q reinspection fee will be charged. Signature 1//i Signature Pwner or Agent Contractor The foregoing instrument was acknowledged before me this 13 The foregoing instrument was acknowledged before me this day of car;v J.,:i■ o'' i 20 IM., •, by ell n 1 )4-1, t 1 . , day of , 20 , by ' who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC Sign: Print: ovk ='s MEN A. RIVERA MISSION # DD753565 S a, h 16,.2012 521 -.1= .•A f'I4 NOTARY PUBLIC: Sign: Print: My Commission Expires: o // 647 My Commission Expires: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 07/10/07) Plans Examiner Engineer Zoning Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER ISCLOSURE STATEMENT NAME: Ys.t...) 1 ll.� DATE: ( l 1 ADDRESS: S f V € Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disdosure statement, which entitles me to work as my own contractor, I further understand That 1 as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied fora permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the Initial I, 3. I understand that, as an owner builder, I am the responsible party of record on a permit I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. construction and is not hiring a licensed contractor to assume responsibility. Initial 4. I understand that I may build or improve a one family or two - family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the Iaw will presume that I built r ¢ 44 r daily improved it for sale or lease, which violates the exemption. /V Initial 5. I understand that, as the owner-builder, I must provide direct onsite supervision of the construction. Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial V 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner- builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �� Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial ) G 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner - builders as well as employers.) also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. �� Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850 .487.1395 or htto://www.mvfloridalicense.com/dbodoro/cilbtinlahbinl Initial IC 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party lega)y and financially responsible for the p ' ..:., construction activity at the following address: Initial )1 V 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information ghat I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial Toss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 1 day of- , 20 ( (.) By W/A�\ i1� k- U V'Who was personally known to me or who has Produced there License or as iden ' nation. OWNER NOTARY Permit No: 10 -/92 Job Name Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Buildin Critique Sheet �`� ,4 �� c / ��e 66 ��c -4 ® 42", its Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305- 795 -2204 HUD-1° U.S. Department of Housing A. Settlement Statement and Urban Development 8. Type of Loan ( 1. FHA ( 4,VA. OMB No. 2502 -0265 Q 2. FmHA O 5. Conv Ins Q 3 Conv Urnns 6. File Number P09 -021 ID: 7. Loan Number { 8. Mortg. Ins. Case Num. C. NOTE: This farm is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown Items marked "(p 0 c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals D. NAME OF BORROWER: Address of Borrower: E. NAME OF SELLER: Address of Seiler: Kenny 8. Kotalik, a single man 900 NW 144th Street, Miami, Flonda 33168 John P. Sydow, a single man 10800 Biscayne Boulevard, Suite 520, Miami, Florida 33161 F. NAME OF LENDER: John P. Sydow Address of Lender: 10800 Biscayne Boulevard, Suite 520, Miami, Florida 33161 G. PROPERTY LOCATION: 950 NE 100 Street, Miami Shores, Florida 33138 H. SETTLEMENT AGENT: Law Office of Norman C. Powell Place of Settlement: 17100 N E 19th Avenue, North Miami Beach, Florida 33162 I. SETTLEMENT DATE: 1/8110 DISBURSEMENT DATE: 1/8110 TIN. 267 - 24.6127 TIN 32- 0125647 Phone 786 - 279 -1603 3. Summary of borrower's transaction .- ,, K• Summary of seller's transaction: a} -;. 400- Gross amount due to setter ice' >ri :;z* 100. Gross amount due from borrower: 101. Contract sates price - 435,000.00 401 Contract sates price 435,000,00 102, Personal property 402 Personal property 103. Settlement charges to borrower (Lane 1400) 6,532.75 403. 104. 404 105 405. Adjustments for Items paid by seller in advance: i Adjustments items paid by seller in advance: 106. Cily/town taxes 406. City/town taxes 107. County taxes 407 County taxes 108 Assessments 408. Assessments 109. 409 110, 410. 14.1, 411 112. 412 120. Gross amount due from borrower: 441,532 75 420. Gross amount due to seller: 435,000.00 _ 1 200. Amounts paid or in behalf of borrower: 201. Deposit or earnest money 500. Reductions in amount duo 1,S-seller; 10,000 00 501. Excess deposit (see instructions) 202 Pnncipat amount of new loan(s) 502. Settlement charges to seller (line 1400) 4,125 00 203 Existing toan(s) taken subject to 503 Existing toan(s) taken subject to , 204. Principal amount of second mortgage 504. Payoff of first mortgage loan 205. _ 505. Payoff of second mortgage loan 206 506 Deposits held by seller 207. Principal amt of mortgage held by seller 350.000 00 507. Principal amt of mortgage held by seller 350,000.00 208. 508. 209 509 Adjustments for items unpaid by seller: 1 Adjustments for Items unpaid by seller: _ 210 City /town taxes 510 City/town taxes 211 County taxes (01/01/10 - 01/08/10) 99.36 511 County taxes (01/01/10 -01/08/10) 99 36 212. Assessments 512. Assessments 213. 513 214 514. 2i5 515 216 516, 217. 517. 218. 518 1 519 220. Total bylfor borrower: : P Y 360,099.36 520. Total reductions in amount due seller: 354,224 36 435.000•00 at borrower: 0.... rower: - + 301 Gross amount due from borrower (line 120) 600. Cash at settlement tolfrom seller: 441,532 75 601 Gross amount due to seller (line 420) 302. Less amount paid by /for the borrower (line 220) (360,099 36) 602. Less total reductions in amount due seller (line 520) (354.224 36) 303. Cash ( L!' From ..J To ) Borrower _. 81,433 39 603 Cash ( ✓ To � From ) Setter: 80,775 ti4 Substitute Form el ler Statement: The information contained in blocks E, G, H, and 1 and on line 401 is important tax information and is being furnished to the IRS, If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this Item is required to be reported and the IRS determines that it has not been reported. Seller Instructions: If this real estate was your principal residence, fife Form 2119, Sate Or Exchange of Principal Residence, for any gain, with your tax return: for other transactions, complete the applicable parts of Form 4797, Form 6262 and /or Schedule 0 (Form 1040). Borrower's Initial(s) L Sellers Initiat(s): Double11mee HUD -1 L. Settlement charges 700. Total Sales/Brokers Com. based on price 701 ,102. S. Department of Housing and Urban Development $435,000.00 @ 0 Borrovier'POCSellec POC % to 10 Page 2 Paid from Borrower's Funds at Settlement Paid from Seller's Funds at Settlement 703. Commission paid at settlement 104. to 800 Items payable in connection with loan` "ems r- 801. Loan origination fee % to 802 Loan discount % to 803. Appraisal fee to 804. Credit report to 805 Lender's inspection fee to 806 Mortgage insurance application fee to 807. Assumption Fee to 808 to to 81U. to to { 900 Items required by lender to:. = paid,trradiiance: 901 Interest from to @ 902. Mortgage insurance premium for months to 903. Ham insurance premium for year to 904. flood Insurance premium for years to Sv3 /day Borrower POC POC 1000 - Reserves deposited Jvrtta 1001. Hazard insurance ''fears t', 1002. Mortgage insurarce 1033 City property taxes months @ months @ per month per month r County property taxes months @ months t ,, per month per month Releases 79.50 005 Annual assessments :- 1 me e,....r .- .....-__ 1007 008 1009 Aggregate accounting adjustment 100. Title charge & "9 `i 1101. Settlement or closing ree 1102 Abstract or title search 1103. Title examination 1104 Tula insurance binder 1105 Document prep Nation 1106. Notary fees months Cd? per month months @ per month months @t per month Bcrroxer POCSeiler POC 1,1107 A ttor rev's Fees r` tinetudes above item numbers: 1108 Title Insurance to i id Republic National Title Insurance Companyl rinc trot, abo +e item numbers. 1139 :.er,;ier a average (Premium). $350 000 00 ($25.00) 1.110. Owner's coverage (Premium) $435.000 CO ($2.250.001 111 t. Endorse 3;1- 25,F9- 227.50 to Lao' Olfitc;c' uP,4':irr ?fall C. Pci:44Y: to law Office of Norman C Powell to to Law Office of Norman C Powell to to to Law Office of Norman C Powell 295 00 150 00 650.00 1112. 1113. to 6o ernment recording and tran rer "chi ripe R cta •iii [ 2,275,00 •..... e r IV ee, Deed $18 50 Mortgages) $61.00 - Releases 79.50 1202 City/county tax/stamps Deed Mortgage(s) $700.00 700 00 1203 State tax/stamps Deed 52.610 00 Mortgage(s) $1.225.00 1204. 1,225 00 2,610.00 to 1205 to 13 1.,A ditioral settlemen `chanaas ' :° ~r � , ". ; . ;rr? e:!t :' -, Borrower POC ! r OO betef' .. " s a�:;�„ 1_30'; 5uetirey to p,R :IG 1 l$ Vii1 WG, j,,L, 295 00 1302 Lieri Sea= i to One -Step Lien Search, Inc 120.00 1303. Post r„soing/Cost to Law Office of, Norman C. Powell 555.75 1304 Attorney's Fees to Law Offices of Jermet-1011A 750 00 1305 to 1306 to 1307. to 1108 to 1309. Additional expenses ( Set-Attached Addendum) ``. 40 .i`7iiitat c.. •r -1' '. . r .. •._�: - my,,_+x1. �!a:- ci�rw, .. ....w,.• >.v. _... _._. .._ -- -- - - ( E'er on fines 103, Section J and 502 Section K } 'newt carefully reviewed the HUD -1 SetuemenISiatement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and isb ursernents made on my ac t or by me in thi 1 section further certify that I have received a copy of the HUD -1 Settlement Statem Kenny J Kotahk Borrower Borrower dow Seiter Seller The HUD -1 Settlement Statement which I have prepared is a true and accurate account of this transaction I have caused, or will cause, the funds to be disbursed in accordance with this statement La • .:. =r'Norinan C Pow By: As Its Authorized Repre ntative Date WARNING 11 s a cane to knolvingly m : - e false Statements to the United States on this or any other similar form Penalties upon conviction can Include a fine and rmpnsonment For details see 15 a 18 U S Code Section 1 001 and Section 1010 DoubfeTIme® Permit No: 10 -60 Job Name: January 19, 2010 Building Critique Sheet Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 1) Prior to any demolition work a permit for the renovation must be submitted. 2) Planning a zoning Board approval is required prior to review. STOPPED REVIEW )-6114Dis-1104,4e)5 G Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 • • Notb BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS 4761' -vA Page 1 of 2 544 0z 56' U 5p' /o sal y 60 gt fk F - . +, 5t ti -\ 2 a 5 0 2. 9 3 AI IP This property described as: Lots 5, 6 and 7, Block 170, SECTION-NO. 8. OFMIAMI .SHORES, according to the Plat thereof, as recorded in Plat Book 14, Page 33 of the Public Records of #10711- Dade County, Florida. PROPERTY OF• • Kenny A. Kotali and Kenny B. Kota i , Not valid unless embossed with Surveyor's Seal. ‘/3 /4 /S k �i• k /7 *? !o '1 /7 .[ 2 a Z., +t LL i4 MERIDIAN. 1 BEARINGS, IF ANY SHOWN, BASED ON _ 950 N.E. 100th Street, Miami Shores, A BOUNDARY SURVEY 1 hereby certify that the survey repre- sented hereon meets the minimum technical standards set forth by the Board of Land Surveyors pursuant to Section 472.027, Fla. Statutes. There are no encroachments, overlaps, ease_ ments appearing on the Plat, other shown hereto. Fla. Reg. Land Surveyor NoVS berr7abel4. %-JEr'i-w'2t . Florida.33138 PROFESSIONAL SURFING AND MAPPING LANNFS & GARCIA, INC. LE* 2096 FRANCIS R O PSM #4767 ALCAZAR Ake, COIL. GABLES, FLOMA?34 PH (306) 66.7 FAX (3051 DATE 1 SCALE 3 —Z� -90 / =Zo' 1 DRAWN BY is. e &" 1244-09 Recertified, Certified To, Name and Flood Info Revised. r767 DRWG. NO. 190 -2522 215846 1 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address 950 100 Street Miami Shores, FL 33138- Owner Information Address Parcel Number 1132060340200 Block: Lot: Expiration: 08/09/2010 Applicant KENNY KOTALIK Phone CeII KENNY KOTALIK 950 100 Street MIAMI SHORES FL 33138 -2513 Type of Demo: Building Additional Info: INTERIOR AND GARAGE Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $1.80 $0.60 $5.00 $100.00 $9.00 $50.00 ($50.00) $2.40 $118.80 Invoice # Total Amt Paid Amt Due DEMO -1 -10 -36819 $ 118.80 $ 50.00 DEMO -1 -10 -36819 $ 118.80 $ 118.80 Check #: 4923 $ 0.00 For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. February 11, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date February 11, 2010 1