HomeMy WebLinkAboutApplication & Supporting DocsVARIANCE APPLICATION
laeLuved
MIAMI 21
Welcome to the City of Miami! This application is intended to serve as a guide in assisting you
with our public hearing process. Please feel free to contact us, should you have any questions.
The deadline to file the complete application with supporting documents is the last five working
days of each month from 8:00 am until 3:00 pm, except on the fifth day, until 12:00 pm.
The application submittal date is the date stamped by Hearing Boards' staff on this page.
The responses to this application must be typed and signed in black ink. All pertinent and
accurate information/documentation; i.e., the plans, reports, exhibits, shall be presented at the
time of filing, in addition to the paid receipt. The applicant is responsible for the accuracy of the
information contained in the application and all supporting materials. Should you wish, you
could bring the materials to our office for review before the deadline to ensure completeness.
You will be responsible, if needed, to bring an interpreter for the English language to any
presentation before city boards, committees and the city commission. A valid power of attorney
will be required if neither applicant or legal counsel representing the applicant execute the
application or desire to make a presentation before city boards, committees and the city
commission. All documents, reports, studies, exhibits (8'hx11 ") or other materials submitted
during this process will be kept as part of the record. Any documents offered to the Planning,
Zoning and Appeals Board and the City Commission, which have not been provided fifteen (15)
days before the meeting as part of the agenda materials will be entered into the record at the
discretion of the aforementioned Board and Commission.
ORDINANCE NO. 11469, CODIFIED IN CHAPTER 2, ARTICLE VI OF THE CITY CODE
STATES THAT ANY PERSON WHO RECEIVES COMPENSATION, REMUNERATION OR
EXPENSES FOR CONDUCTING LOBBYING ACTIVITIES TO REGISTER AS A LOBBYIST
WITH THE CITY CLERK, PRIOR TO ENGAGING IN LOBBYING ACTIVITIES BEFORE CITY
STAFF, BOARDS, COMMITTEES AND THE CITY COMMISSION. A COPY OF SAID
ORDINANCE IS AVAILABLE IN THE OFFICE OF THE CITY `CLERK (MIAMI CITY HALL),
LOCATED AT 3500 PAN AMERICAN DRIVE, MIAMI, FLORIDA, 33133.
Ordinance No. 12918 states that each person or entity requesting approval, relief or other action
from the City Commission or any of its boards, authorities, agencies, councils or committees
regarding any issue, shall disclose at the commencement (or continuance) of the public
hearing(s) on the issue, any consideration provided or committed, directly or on its behalf, for an
agreement to support or withhold objection to the requested approval, relief or action. The
Disclosure of Consideration Provided or Committed for Agreement to Support or Withhold
Objection Affidavit included in this package must be submitted with the application. The
applicant must, at the commencement of any public hearing on the issue, if there is any
disclosure to report, read the disclosure into the record. Also, the applicant must supplement
the affidavit if there is any new information or additional information to disclose.
Copies of City Commission resolutions and ordinances can be obtained at our website through
the "Legislative Hub", or for certified copies, contact the City Clerk's Office at 305-250-5360.
Applications given to customers do not constitute action from the City of Miami without plans
review and written comments from the Office of Zoning.
Rev. 03-2011
CITY OF MIAMI
Hearing Boards
Ph: 305-416-2030
444 SW 2nd Ave 7di Floor Miami, FL 33130
wwwmiamigov.com/hearing_boards
2
VARIANCE APPLICATION
Please refer to Article 7.1.2.7 of the Miami 21 Code for Variance information.
. Applicant(s): PABLO BURGOS, ON BEHALF OF THERESA M. MATIAS AND JOHN RADU
. Subject property address(es) and folio number(s): FOLIO: 01-3127-053-0560,
ADDRESS: 1772 NW 30TH STREET, MIAMI, FLORIDA, 33142
3. One (1) original survey dated within six (6) months from the date of application prepared by a State
of Florida registered land surveyor.
4. One (1) original 24x36" plan, signed and sealed by a State of Florida registered architect or
engineer showing property boundaries and proposed structure(s), parking, landscaping, etc.;
building elevations and dimensions and computations of lot area and building spacing.
5. After all departments initial and date the plans, two (2) 11x17" and one (1) 8'/x11" copies of the
original plan, in addition to the survey.
6. Current Zoning Referral and Write -Up signed by the Office of Zoning designee.
7. A clear and legible copy of the recorded warranty deed and tax forms of the most current year
showing the present owner(s) and legal description of the property to match the legal description on
the survey.
8. A clear and legible copy of the subject property address(es) and legal description(s) on a separate
sheet, labeled as "Exhibit A", to match with the current survey's legal description.
9. At least two photographs showing the entire property showing land and improvements.
10. Copy of the lobbyist registration processed by the Office of the City Clerk, if applicable.
11. Affidavit of Authority to Act and the Disclosure of Ownership of all owner —and contract purchasers,
if applicable —of the subject property.
12. For all corporations and partnerships indicated:
a. Articles of Incorporation;
b. Certificate from Tallahassee showing good standing, less than one (1) year old;
c. Corporate Resolution or a Power of Attorney signed by the secretary of the Corporation
authorizing the person who signed the application to do so;
d. Non-profit organizations: A list of Board of Directors less than one (1) year old.
13. Certified list of owners of real estate within 500 feet of the subject property.
14. Original Disclosure of Consideration Provided or Committed for Agreement to Support or Withhold
Objection Affidavit.
15. Original Public School Concurrency Management System Entered Requirements form.
16. The subject property(ies) cannot have any open code enforcement/lien violations.
Rev. 03-2011
CITY OF MIAMI
Hearing Boards
Ph: 305-416-2030
41l SW 2nd Ave 7th Floor Miami, FL 33130
www miamigov.com/hearing_boards
3
VARIANCE APPLICATION
17. What is the acreage of the project/property site? 6,140 SF - 0.14 AC
18. What is the purpose of this application/nature of proposed use? DUPLEX LEGALIZATION
19. Is the property within the boundaries of a historic site, historic district or archeological zone?
Please contact the Planning Department on the 3rd Floor for information. NO
20. Is the property within the boundaries of an Environmental Preservation District? Please contact the
Planning Department on the 3rd Floor for information. NO
21. In support of the application, please supply the following evidence in Section 7.1.2.7(b) of the Miami
21 Code. Note: This application will not be accepted unless items (a) through (g) below are
complete. Please list evidence to be produced and use additional sheets, if applicable.
(a) Special conditions and circumstances exist which are peculiar to the land, structure or building
involved and which are not applicable to other lands, structures, or buildings in the same Transect.
No. ❑ Yes. If so, explain.
(b) The special conditions and circumstances do not result from actions of the applicant.
Q No. ❑ Yes. If so, explain.
(c) Literal interpretation of the provisions of the Miami 21 Code deprives the applicant of rights
commonly enjoyed by other properties in the same Transect Zone and results in unnecessary and
undue hardship on the applicant. Q No. ❑ Yes. If so, explain.
(d) Granting the Variance requested conveys the same treatment to the individual owner as to the
owner of other lands, buildings, or structures in the same Transect Zone.
Q No. ❑ Yes. If so, explain.
(e) The Variance, if granted, is the minimum Variance that makes possible the reasonable use of
the land, building or structure. QNo. ❑ Yes. If so, explain.
(f) The grant of the Variance is in harmony with the general intent and purpose of the Miami 21
Code, and is not injurious to the neighborhood, or otherwise detrimental to the public.
O. No. ❑ Yes. If so, explain.
(g) The Variance, if granted, is consistent with the applicable criteria as set forth in Article 4, Table
12 of the Miami 21 Code, as such, relates to the particular location for which the Variance is being
sought. ❑ No. Q Yes. If so, explain. RESPOND TO THE PHYSICAL CONTEXT TAKING INTO
CONSIDERATION EXISTING URBAN FORM AND TRANSECT ZONE INTENTIONS
Rev. 03-2011
CITY OF MIAMI
Hearing Boards
Ph: 305-416-2030
444 SW 2nd Ave 7th Floor Miami, FL 33130
www.miamigov.com/hearing_boards
4
VARIANCE APPLICATION
22. Cost of processing according to Section 62-156 of the Miami City Code*:
a. CS, T3, (Single -Family and Duplex Residential uses) $ 250.00
b. Piers, docks, wharves and the like, for each Variance from the ordinance,
per lineal foot $ 45.00
Minimum $ 700.00
c. All applications for Variances relating to the same structure shall be assessed
a single fee to be calculated per square foot of floor area of the proposed
structure or addition, based upon the definition of floor area found in Section
1.2 of Miami 21 Zoning Ordinance $ .10
Minimum $ 650.00
Application for Variance as a result of a change in approved plans or as a result of a violation
notice shall be charged an additional fee, per Variance:
a. CS, T3 $ 250.00
b. All other residential districts $ 450.00
c. All nonresidential districts $ 550.00
d. Extension of time for Variance $ 500.00
*Pursuant to Ordinance 12719, all planning and zoning fees in excess of $25, 000.00, shall be paid in
the form of a certified check, cashier's check, or money order.
XSignature
Name PABLO BURGOS
Telephone 786-554-9035
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
Address 475 BILTMORE WAY S-314
CORAL GABLES, FL 33134
E-mail pburgos@burgoslanza.com
The foregoing was acknowledged before me this 3 0 day of ti/Ai-/
20 // , by ?i& Lo 2,02Go S
a(n) individual/partner/agent/corporation of a(n)
individual/partnership/corporation. He/She is personally known to me or who has produced
as identification and who did (did not) t ke an oath.
(Stamp)
Rev. 03-2011
NOTARY PUBLIMPIT 7014-1 1
,,,,,.,r, Conswaga anttiDt
° „ A.Cammissimn tiVig4191
Expires: APR, 18., 2013
Bourn nTSRUATT,ANT1CBO4D i0ca:,Di r
ate
Signature
CITY OF MIAMI
Hearing Boards
Ph: 305-416-2030
444 SW 2nd Ave 7th Floor Miami, FL 33130
www.miamigov.com/hearing_boards
who is
5
VARIANCE APPLICATION
AFFIDAVIT OF AUTHORITY TO ACT
Before me this day, the undersigned personally appeared PABLO BURGOS, ON BEHALF OF
THERESA M. MATIAS, AND JOHN RADU who being by me first deposes and says:
That he/she is the owner or the legal representative of the owner, submitting the public hearing
application as required by the Code of the City of Miami, Florida, affecting the real property located in
the City of Miami, as listed on the foregoing pages.
2. That all owners who he/she represents, if any, have given his/her full and complete permission for
him/her to act in his/her behalf for the change or modification of a classification or regulation of zoning
as set out in the foregoing petition, 0 including or 0 not including responses to day to day staff
inquires.
3. That the foregoing and following pages are part of this affidavit and contain the current names, mailing
addresses, telephone numbers and legal descriptions of the real property of which he/she is the owner
or legal representative.
4. That the facts, as represented in the application and documents submitted in conjunction with this
affidavit, are true and correct.
Further Affiant sayeth not.
Applicant(s) Name �Applicant(s) Signature
PABLO BURGOS
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
0\4),,c) (
The foregoinvo.9s acknowledged before me this 3'O day of iC/Aec
20 // , by ✓/446LO 73dI2 OS who is
a(n) individual/partner/agent/corporation of a(n)
individual/partnership/corporation. He/She is personally known to me or who has produced
as identification and who did (did not) tyke an oath.
(Stamp)
NOTARY FUBLIC-STATE OF FLORIDA
Constaryza Manrique
Commission , DD s30097
' }T ,= Expires: APR. 13, 2013
BONDED THRU ATLANTIC BONDING CO., INC.
Rev. 03-2011
Signature
CITY OF MIAMI
Hearing Boards
Ph: 305-416-2030
444 SW 2^d Ave 7th Floor Miami, FL 33130
www.miamigov.com/hearing_boards
6
VARIANCE APPLICATION
DISCLOSURE OF OWNERSHIP
1 _ List the owner(s) of the subject property and percentage of ownership, Matz The Miami City Code
requires disclosure of .all parties having a financial interest, either direct or indirect, with respect to a
presentation, request or petition. Accordingly, disclosure of shareholders of corporations, .beneficiaries
of trusts, and/or any other interested parties, together with their address(es) and proportionate interest
are required. Please supply additional lists, if necessary.
Owner's Name(es) THERESA M. MATIAS AND JOHN RADU
Percentage of Ownership THI RESA„ M. MATIAS (5Q%) AND JOHN RADV (50%)
Subject Property Address(es) t772 NW 30TH STREET, MIAMI, FL 33142
2. List all street address(es) and legal de ription(s) of any property located within. 500 feet of the subject
property owned by any and all parties listed in question #1 above. Please supply additional lists, .if
necessary.
Street Address(es):
THERESA Lit. MATIAS
Owner(;) or Attorney Name
JOHN RADU
Owners) or Attorney Name
Legal i cription(s);
NIA
f ow
ignature
Owners) or Attorney Signature
STATE OF FLORIDA COUNTY OF MIAMI-DADE
The foregoinA lives acknowledged before me this rig clay of i .d.,dI
20 f t , by Qsesq MQ &cx dU who is
a(n) inrdlyiduai/partneriagentfcarporat1on of
individuallpartnership/corporation, He/She is pers
(- as identification and who did (did n
MARIO BAEZ
* c Notary Public - State of Florida
.9rRI! My Comm. Expires Apr20, 2013
',.F,nmai FTps' Commission # DD 881828
"
Roe. 03 2011
CITY OF MIAMI
H e a f i is g Boards
Plea (*AI5-416-203O
444 SW 2" Alec 7TY k•1nc Miami 17. 33130
ww ?4,404ritti .coal/hc ringtmard,
a(n)
to me or who has produced _._.
h.
7
b0/T0 3DVd
zl•nip ensai :word
b'D3SNOJ WVIT1IM
(1WJ) LL;4o:EL 8Z-co-6LOZ
9T08E5598L Lt:90 TT03/L /E0
b,o 4 aBed MIK:ol
BURGOS
LANZA
Architect & Planners
475. Biltmore.Way, Suite.3.14
Coral Gables, Florida 33134
(786) 554-9035.
(305) 661-2543 Fax
AA 20061519
March 01, 2011
City of Miami
Hearing Boards
Re: 1772 NW 30th St. Miami, FI
EXHIBIT .A
Property Address: 1772 NW 30th St. Miami, Fl
Legal Description: LOT 11, BLOCK 3, OF CENTRAL ALLAPATTAH SUBDIVISION _
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 39 AT PAGE 91 OF
THE PUBLIC RECORDS MIAMI-DADE COUNTY, FLORIDA
1
BURGOS LANZA AND ASSOCIATES
475 BILTMORE WAY SUITE 314
CORAL GABLE, FL 33146
T: (786)-554-9035
11/23/2010 18:56 3056757867
ASSETTR
Fr pea+ed 8y and Return'II%
Name: ROSE6MARIE, MARTS
WATSON TITLE YNBURANCF.,, INC.
1901 w. CYPRESS CRIB ROAD
Moor
PT. LAUDERDA.LX, FL 33309
WTI 28-01066-rt
Palo Number: 0131270570550
MG REAL ESTATE PAGE 01/02
CIF14I 201 Enna l 223 s is
ORsip ?In Pas i062 - 60931 1?tfs)
NBLEB IOCO0 10)74:01
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ws
Special Warranty Deed
Ti3I9 Ii1`DSi'i'jIME, male this 30 day of ocrosrR 2009, =EC SAVIE111841,AB
9 iEffir 'RE AO§ nnotnerrIER CORP, Ro1>tts EQUITY LOAN TRUST,
BERMS 6-0P1 ASSET BASED. PASSMIROUGR CERZUMICAVISS,
hereinafter, ecbsa the esantar, whose address is 9119 CORPORATE: LAKE
DRIVE, BM 300, TAMPA, FL 33634 and THERM& N. D1ATTAS, A SING
WOMAN MTh JGHIt RADV, A EGIllOLE MAR lensilnaflcr called the Derastec,
whose Address is 9101 It+ 1402ne CORAL SFRI,NO3, FL 2306.6.
jW1iaraver used heavin the term 'rotator extd Gsant e* include the Patties to
this instrument and their heit`tf., legalrepeeeentativese and cessi nee of
indiaiduat0 a.nd assigns of corporations)
WITIVESSIMS: the Grantor, for and in consideration of the sum ni TEN
AND 00/100 DOLLARS ($10.00) sad other geed and valuable
consideration, receipt mattertbf is hereby acknowledged by these prosonta does
grant, bargain and ogle alien. re Ise, release, convey end confirm "unto the
Grantee, all that certain land ablatein IVRAlte-DADS _sty, Florida, viz:
as 11C I
A Ki i. 1772 3QTtf it M14!t 33142
6ubjeet toertershollatdons, Dlm tatfonn, cosedltieses, sosereationa, espostreAtite
atid Wousaoleato of Rinsed, it any, ali agghealgs =sang ordisiorreas, and
Tams far year O and au traIntarprant reams,
A00010DING TOT MI PUS, TROcatetk,
TOGETHER with ell thetenements, heredirament and a pu tenances. thereto
lselonging or in otherwise appertaining,
AND the Grantor hereby meows with said Otantee that it is ierwfuilY seised
o7 said ;and in fee simple, that it has good dip and,lawlnl authority tee sett and
eenvey said land, that it hereby A Uy warrants tbe tide to said Wad and will
defend the same against the lawful Manna of all leers claiming by, through
or under the said Grantor..
9B/00 39ttd
VJ3SNQd WVITIIM 5I18E9698t 8S-:1Z BIBZ/1,Z/IL
41/L3/2W. 18:bb 3056757967 MG REAL ESTATE PAGE 02/02
3FC 'IISf4 2"2'v.; 40SZ
LAST PAGIC
the Grantor has canned these presents to be executed
in ite tuuoe, and its' corporate seal to'behuts dared, by las duper anima
thereu*to duly authorized, the day and ymo r first above iton.
Wherever the test In this Deed se require% the uss of any gender shall bo
deemed to include 411 genders, and the use of the singular shall include the
pltirai.
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1n ova psesessest
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HHSBC RANK. USA, AS TRUEFOR ACE
5tsQggrzaS CORP. UO114P EQUTIT LOAN
Twat SERIES 2006.OP1 ASSET
BACK PASS►Ti2OUGH CER'17P1CA:1133
air AMERMCJ N RIME MORTGrAOE
tifeWCING INC. AS A ToRNEY se mar
Th'L : R ton& Weal
ems.
The
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of AinnurAN RD= movricruakes ssitiMCING litc. AS Alrwrivarrj Mir
t e.1 ¢_gAenc �eA.
ism=. WATWIST. AMOS 2119600P1 giSNMPACOSIZZAPS4=0001
i ATh$. votrouradly kitowm to aro etud who did talcs oath
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11/24/2010 21:58 7869538415
11/25/2018 09:34 3056757867
WILLIAM FONSECA
MG REAL ESTATE
PAGE 81/05
PAGE 01/01
'JMIT D POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESBNTS:
Zhereby make and amulet , Iolm Rada wing art ass at 9101 Nw32 Street, Cori
C Drive, William Fonseca s 8 an �s FL 3at 205 Ardi do
and in. nzy behalf. 3281 my true and lam ey-in•fact for zne and in Y
My 4ent shall
ll power
Any and Iveths anda"tho yto otmthefo in the City of i and its re place
property located at 1772 NW 30 Stet, es estatereal :
is LOT 11, BLOCK 3, 031vTRAf, -ALLAPA TALI ACCORDING TO T
THEREOF, AS RECORDED WHAT .PLAT
RECORDS O DAl COUNTY,BQQX 39, PAGE 91 OF T. PUBLIC
o� permits and attend i ' xnclndin� but n
Option B —ilea-Dturehle
This power ofa9ttey £sue-idurabie. Tb
poweas, and &�. Power of,A
this The rights, � shall become effective immediately � of
force and effect thereafterand authority ®f tl� c%cut�t shalt in full
my deaf or ula my disability or incapacity.
.As used herein, "disability" or "i nev y" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, mayor tic, a,a,
fi namcial resources and affmay, '
I it by rally :sad confirm all acts that my Agent, or my Agent's substitute or
sue, shall lawfully do or cause to be done by virtue of this power off and
the rights hereby granted.
My Agent shall be entitled to reimbursemon of all reasonable expenses incurred as a
melt of canyittg out any provision ofthis Power of Attorney. If desired, myAgent shall
also be entitled to reasonable compensation for any services provided as my Agent
Ifso requested by myself ar toy atttlatoeized personal repraentative ar fiduciary a on
ray 1,64 my Agent shall psovide an amounting for all funds handled and all acts
perfansied as my Agent.
The listing of simile toms, headings, rights, acts or powers are not iatextded to restrict
or limit the definition or scope of powers granted herein in any moaner. ifaaypart of this
doewmon t is held to be invalid, filegal or anenfiat able under applicable law, then the
remaining unaffected parts of the documeat shall still leMabl izt full farce and offset and
not be affected by any partial invalidity,
11/24/2010 21:58 7869538415
WILLIAM FONSECA PAGE 02/05
No person needs to inquire as to the reasons for the use or issuance ofthis power -of
attorney or as to the disposition of any proceeds paid to my Agent based on this
document.
The powers granted to my Agent by this power -of -attorney arelimited to the extent
necessary to prevent (a) my income to be taxable to my Agent (b) my Agent to have any
rights or'ownership with respect to any life insurance policies I may own on the life of
my Agent; and/or (c) my assets to be subject to a general power of appointment by my
Agent.
Any third party who receives a copy of this document may act under it. Revocation of the
power of attorney is .not effective as to a third party tmtil, the third party has actual
knowledge of the revocation, I agree to indemnify the third party for any claims that arise
against the third party because of reliance on this power of attorney: If this Limited
Power of Attoruey is terminated by operation of law, any person relying in good faith on
the authority ofthis document, without notice of such termination, shalt be held harmless.
Agent shall not be liable for losses resulting from judgment errors made in good faith.
However, Agent will be liable for breach of fiduciary duty,. More to actin good faith
and/or willful misconduct, while acting under the authority of this Power of Attorney.
I may revoke this Power of Attorney at anytime by providing 'vv�ritten notice to my
Agent.
Sign $ i Nov ez x 8, 2010, at Miami, Florida.
Signatures df Principal
Witness 'Signature:
Nance:
City:
State;
Witness Signature:
Name:
City
State:
State of 70y-
County of \Jl"'n 1._J r
) S5
-2_
11/24/2t11h 21:bt3 /8b9b;38415
WILLIAM FONSECA
PAGE 03/05
The foregoing instrument was avknowledged before me this. _9 day of ` �t .
,•? [.� /!a by John Radii., who is personally known to me or who
has produced-L)-, M.-1 as identi£tcation.
04 a 43
(Notay R iatrouC-STATZ Or 1'IARIDA.
H Tracy Robbins
• e �3Comttlisslan #DD864186
rapirC8; MAR. 02, 2013
Naxnei515BniMit rI ai
n.
/ :4 ° ``'' ''a CITY OFMIAMI
`l ,,,,,� i,,,,,);-A ) DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
`�yY°, .--o¢`°j SUPPORT OR WITHHOLD OBJECTION
The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its
boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the
issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or
withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee,
commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or
implied, or any promise or agreement to provide any of the foregoing in the future.
Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653, and appearing before the City Commission or
any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners'
legal representative are not required to fill out this form.
NAME:
(First Name) (Middle) (Last Name)
HOME ADDRESS:
(Address Line 1)
(Address Line 2)
CITY: STATE: Florida ZIP:
HOME PHONE: CELL PHONE: FAX:
EMAIL:
BUSSINESS or APPLICANT or ENTITY NAME
PABLO BURGOS
BUSINESS ADDRESS: 4 75 BILTMORE WAY S . 314
(Address Line 1)
CORAL GABLES, FL 33134
(Address Line 2)
1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board,
authority, agency, council, or committee.
LEGALIZATION OF DUPLEX
2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to
support or withhold objection to the requested approval, relief or action?
YES .x NO
If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If
your answer to Question 2 is Yes, please answer questions 3, 4 & 5 and read and execute the Acknowledgement.
Doc. No.:86543
3. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided
or committed.
Name Address Phone#
a. N/A
b. N/A
c. N/A
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration.
N/A
5. Describe what is being requested in exchange for the consideration.
N/A
ACKNOWLEDGEMENT OF COMPLIANCE
I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of
Ordinance 12918 and such circumvention shall be deemed a violation of the Ordinance; and that in addition to the criminal
or civil penalties that may be imposed under the City Code, upon determination by the City Commission that the foregoing
disclosure requirement was not fully and timely satisfied the following may occur:
1. the application or order, as applicable, shall be deemed void without further force or
effect; and
2. no application from any person or entity for the same issue shall be reviewed or
considered by the applicable board(s) until expiration of a period of one year after the
nullification of the applicatio order.
PERSON SUBMITTING DISCLOSURE: 1/(0
Signature
PAB BURGOS
Print Name
Sworn to and subscribed before me this fit' day of AlA2 C f-/ , 200'/ . The foregoing
instrument was acknowledged before me by , who has produced
as identification and/or is personally known to me and who did/did not take an oath.
STATE OF FLORIDA
CITY OF MIAMI i P LIC-STATE OF
L ST OF FLORIDAFL e
MY COMMISSION NO i = � '=Commission#DD88O097
EXPIRES: -
(70/tiS4,(l
ZA / ,4�i1fe./ /( [.l ,�,,,.,-' Expires: APR. 13, 2013
Print Name BONDED TSIRO MIAMI'IC BONDING Lu.,1NC.
Enclosure(s)
Doc. No.:86543 Page 2
CITY OFMIAMI
oT i; DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
SUPPORT OR WITHHOLD OBJECTION
The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its
boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the
issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or
withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee,
commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or
implied, or any promise or agreement to provide any of the foregoing in the future.
Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653, and appearing before the City Commission or
any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners'
legal representative are not required to fill out this form.
NAME: THERESA M MATIAS
(First Name)
(Middle) (Last Name)
HOME ADDRESS: 901 NW 32nd STREET
(Address Line 1)
(Address Line 2)
CITY: CORAL SPRING STATE: Florida ZIP: 33065
HOME PHONE: CELL PHONE: FAX:
EMAIL:
BUSSINESS or APPLICANT or ENTITY NAME
BUSINESS ADDRESS:
(Address Line 1)
(Address Line 2)
1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board,
authority, agency, council, or committee.
2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to
support or withhold objection to the requested approval, relief or action?
YES ❑X NO
If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If
your answer to Question 2 is Yes, please answer questions 3, 4 & 5 and read and execute the Acknowledgement.
Doc. No::86543
S. *lease provide the name. address and phone number of the person(s) or entitles to whom consideration hes.been provided
or committed.
Nemo Address
a.
b.
c.
Phone#
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration.
le
5. Describe what is being requested in exehange fqr the consideration..
ACKNOWLEDGEMENT OF computArice
I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of
Ordinance 22928 and such clreumveudo8 shall be deemed a violation of the Ordinance; and that in addition to the criminal
or civil penalties that may be imposed under the City Code. upon determination by the City Commission that the foregoing
disclosure requirement was not fully and timely satisfied the following may occur:
1. the Stpplication or order, as applicable, shall be deemed void without further Force or
effect;; and
2. no application from any person or entity for tbo same issue shall be reviewed or
considered by the applicable board(s) until .expiration of a period of one year after the
nullification of the application or order.
PERSON SUBMITTING DISCLOSURE:
signature
THE1 ESA M. MATI.A$
Sworn to and subscribed before me this 0
PM; Mame
d �f 0,.01 2Q4) l ( ; `he fore sing
insttnon nt was acknowledge bsjbre me by „P- ,, who has produced
4 b. „Nit idenii icalion a/ 4r #s personally known to me and who didldid oat lake an oath.
STATE Of FLORIDA
CID( OF MIAMI
MY COMMISSION
EXPIRES:
nomicamo
Neteey
P4 ` 1,, MARIO BAEZ
J SPRY �.
: Notary PuhliC - State of Florida
My Comm. Expires Apr 20, 20
;r T�o?; Commission # DD 881828
Print Name
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CITY OFMIAMI
DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
SUPPORT OR WITHHOLD OBJECTION
The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its
boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the
issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or
withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee,
commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or
implied, or any promise or agreement to provide any of the foregoing in the future.
Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653, and appearing before the City Commission or
any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners'
legal representative are not required to fill out this form.
NAME:
JOHN RADU
(First Name)
(Middle) (Last Name)
HOME ADDRESS: 901 NW 32nd STREET
(Address Line 1)
(Address Line 2)
CITY: CORAL SPRING STATE: Florida ZIP: 33065
HOME PHONE: CELL PHONE: FAX:
EMAIL:
BUSSINESS or APPLICANT or ENTITY NAME
BUSINESS ADDRESS:
(Address Line 1)
(Address Line 2)
1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board,
authority, agency, council, or committee.
2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to
support or withhold objection to the requested approval, relief or action?
❑ YES NO
If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If
your answer to Question 2 is Yes, please answer questions 3, 4 & 5 and read and execute the Acknowledgement.
Doc. No.:86543
3. Please provide the name, address and phone number of the person(s) or entitle to Wi►om4 consideration has been prav;dest
or committed.
Name Address Pl1,Qne#
a,
b,
c.
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration.
5. Describe what Is being requested in exchange for the considerations.
ACKNOWLEDGEMENT Or COMPLIANCE
I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to eirc imvent the disclosure requirements of
Ordinance 12918 and such circumvention shail be deemed a violation of the Ordinance; and that in addition to the criminal
or civil penalties that may be imposed under the City Cade, upon determination by the City Commission that the foregoing
disclosure requirement vial not fully and timely satisfied the following may occur:
1. the application or order, as applicable, shall bedeemed void without farther force or
effect; and
2. no application from any person or entity for the same issue shalt be reviewed or
considered by the eAp%ienbie bo til e t of a period Of ntto year after the
nullification of the applicati
PERSON SUBMITTING AiSCL0SUI1E^
'Signature
at:1M RAM
Pt+nt Name
Sworn to and subsoribed before me this ___._.. day of /0.19:AN , 200 (.,......., The foregoing
Instrument was acknowledged( �ia are me by ' L.� g li d t) who has prorhmed
°F c_ s L �'ek`t . c c
is personalty known to me and who r/iti'did not take an oath.
STATE OF FLORIDA
CITY Y OF MIAMI
Mv' COMMISSION
EXPIRES:
"r'a"MARIO BAEZ
Notary Punitc
_ • "'" * •
My Comm. Expires Apr 20, 2013
o�.
P•• Commission # DD 881828
a1
Sif
Notary
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