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DGT-17-69
INSPECTION RECORD __ POST ON SITE yNORE Permit NO. DGT-1 -17-69 �s '"" �� Miami Shores Village s„ ►►► 7� of eC)CS/Gazebos/�'Itell�ses ' �•: nu�� . 10050 N.E.2nd Avenue Kk }t_ . Miami Shores,FL 33138-0000RS _ %r ° Phone: (305)795-2204 Fax: (305)756-8972 FLORIDA Issue Date: 1/24/2017 Expires: 07/23/201 7 14SPECTION REQUESTS: (305)762-4949 or Log on at https://bidg.miamisho�esvillage.convcap REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PNPR--THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day 1pspectfort_A—, Decks/Gaze.bos/Trellises Parcel #:1132050270560 Owner's Name:GUY &SELIN KURLANDSKI. .....;i Owner's Phone: Job Address: �. Total Square Feet: 100 Miami Shores, FL Total Job Valuation: $ 6,000.00 Bond Number: Ln_ ;'� WORK IS ALLOWED: MONDAY THROUGH FRIDAY,8:OOAM-7:OOPM. Contractors Phone _ Prim'ary'Cantractor SATURDAY 8:OOAM-6:OOPM. CONSTRUSERVE CORP (786)380=06191 - s+— NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. BUILDING AND ROOFING INSPECTIONS ARE DONE - MONDAY THROUGH FRIDAY. NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED: PLANS ARE READLY AVAILABLE ITIS; THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER':;, THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED.IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTION RECORD IISSTRUCTURAL ZONING INSPECTION DATE INSP INSPECTION DATE INSP INSPECTION . DATE INSP F.;undation Zoning Final Stemwall ZONING COMMENTS Rough =Slab Water Service Columns(1st Lift) 2nd Rough Columns(2nd Lift) Top Out Tie Beam Fire Sprinklers Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Roof Drains Windows/Doors, Gas I4ftniw Framing INSPECTION DATE INSP LP Tank Insulation Temporary Pole Well Ceiling Grid 30 Day Temporary Lawn Sprinklers Drywall Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Preventor Pool Steel Underground Interceptor Pool Deck Footer Ground Catch Basins Final Pool Slab Condensate Drains Final Fence Wall Rough HRS Final Screen Enclosure Ceiling Rough nni Driveway Rough PLUMBING COMMENTS Driveway Base Telephone Rough Tin Cap Telephone Final Roof in Progress TV Rough Mop in Progress TV Final Final Roof Cable Rough Shutters Attachment Cable Final ,Final Shutters Intercom Rough .Rails and Guardrails Intercom Final MECHANICAL ADA compliance Alarm Rough INSPECTION [SATE INSP Alarm Final Underground Pipe DOCUME Fire Alarm Rough Soil Bearing Cert Fire Alarm Final Rough Soil Treatment Cert Service Work With Floor Elevation Survey Ventilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS _Hood Rough Insulation Certificate Pressure Test Spot Survey Final Hood Final Survey final Ventilation Truss Certification Final Pool Heater STRUCTURAL COMMENTS Final Vacuum d r- MECHANICAL COMMENTS INSPECTION JDATE INSP Final Sprinkler Final Alarm ARCHT R 1 0 ITECTU RE April 17, 2017 The City of Miami Shores 10050 Northeast 2nd Avenue Miami Shores, Florida 33138 Re: Letter of Compliance Address: 9301 N. Bayshore Drive, Miami Shores, FL. Permit: 15-3127 Dear Sirs: I, a Professional Engineer with the State of Florida, having performed and approved the required inspection on the above referenced project, hereby attest that to the best of my knowledge, belief and professional judgment, the building and the structural and envelope components of the structure, are in compliance with the approved permit documents and the Florida Building Code 2014 Edition. also hereby attest that to the best of my knowledge, belief and professional judgment, the approved permit plans were prepared in accordance with the Florida Building Code and the Florida Accessibility Code for Building Construction 2014 Edition, and all other local building code requirements. I also hereby attest that to the best of my knowledge, belief and professional judgment, the approved permit plans and the approved revisions to the permit plans represent the as-built condition of the structural and envelope components of the structure and all of the comments and corrections requested by the City of Miami Shores, Building Department have been accomplished by the contractor. Sincerely, W a David B. Rog s P.E. Florida Reg. 54981 USA CAYMAN ISLANDS 17100 Collins Ave. Ste. 220 6104 Forum Lane Sunny Isles Beach. FI 33160 Camana Bay.Grand Cayman 1.305.940.0555 1.345.525.0777 TRIO DESIGN CONSULTANTS Miami Shores Village, Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ATTN: Building Official SPECIAL O. LOG JOB NAME: KLIRLANDSKI RESIDENCE ADDRESS: 9301 N BAYSHORE DRIVE MIAMI SHORES, FLORIDA PERMIT NO. SPECIAL INSPECTOR: DAVID B. ROGERS, P.E TRIO DESIGN FL LICENSED ENG.#54981 DATE ITEMS INSPECTED i- IG x a David B. Rogers, P.E. Licensed Engineer#54981 State of Florida 1 7100 COLLINS AVE. SUITE 220 SUNNY ISLES BEACH, FLORIDA 33160 T: 1 .305.940.0555 F: 1 .866.295.3579 WWW.TRIO-DESIGN.NET a TRIO D E S I G N C ON S U LTA N T S Miami Shores Village, Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ATTN: Building Official SPECIAL O. LOG JOB NAME: KURLANDSKI RESIDENCE ADDRESS: 9301 N BAYSHORE DRIVE MIAMI SHORES, FLORIDA PERMIT NO. SPECIAL INSPECTOR: DAVID B. ROGERS, P.E TRIO DESIGN FL LICENSED ENG.#54981 DATE ITEMS INSPECTED 6/20/16 Grade Beam Reinforcing, Residence Approved 8/1/16 Grade Beam Reinforcing, Site Walls Approved 8/23/16 151 Floor Column & Filled Cells Approved 8/23/16 211 Floor Beam &Slab Reinforcing Approved �F G� David B. Rogers, P.E. Licensed Engineer#54981 State of Florida 1 7100 COLLINS AVE. SUITE 220 SUNNY ISLES BEACH, FLORIDA 33160 T. 1 .305.940.0555 F: 1 .866.295.3579 WWW.TRIO-DESIGN.NET ovv TRIO D E S I G N C ON S U L T ANTS Miami Shores Village, Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ATTN: Building Official SPECIAL O. LOG JOB NAME: KURLANDSKI RESIDENCE ADDRESS: 9301 N BAYSHORE DRIVE MIAMI SHORES, FLORIDA PERMIT NO. SPECIAL INSPECTOR: DAVID B. ROGERS, P.E TRIO DESIGN FL LICENSED ENG.#54981 DATE ITEMS INSPECTED Zu 2ND �' M t S 9 L 1411 - PLO* COWA'o t attq David B. Rogers, P.E. Licensed Engineer#54981 5 ITE uAU, eEA)f, State of Florida 4 Ftw`LY - q[Z-9(16 � s� t s 1 7100 COLLINS AVE. SUITE 220 SUNNY ISLES BEACH, FLORIDA 33160 T: 1 .305.940.0555 F. 1 .866.295.3579 WWW.TRIO-DESIGN.NET t � U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30,2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner. SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: Guy Kurlandski; Selin Kurlandski A2. Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Company NAIC Number: Box No. 9301 N. Bayshore Drive City State ZIP Code Miami Shores Florida 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) Folio#11-3205-027-0560 Lot 3, Block 4, BAY LURE, PB 44, PG 63 A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Residential A5. Latitude/Longitude: Lat.25051'41.13"N Long.80°10'17.11"W Horizontal Datum: ❑ NAD 1927 © NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1A A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑Yes ❑x No A9. For a building with an attached garage: a) Square footage of attached garage 400.00 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑Yes ❑x No - SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP Community-Name&Community Number B2. County Name B3. State Village of Miami Shores 120552 y Miami-Dade Florida B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12086C 0306 L 09-11-2009 09-11-2009 AE/VE 10/11 1310. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9: ❑ FIS Profile ❑X FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑x NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes © No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6 e OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ❑X Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations—Zones Al—A30,AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/Al—A30,AR/AH,AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters. Benchmark Utilized: MDCBM No. B-62 Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ❑x NGVD 1929 ❑ NAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor(including basement,crawlspace, or enclosure floor) 5.90 Z feet ❑ meters b) Top of the next higher floor 7.72 H feet ❑ meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A 0 feet ❑meters d) Attached garage(top of slab) 5.96 Z feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 7.58 Z feet ❑ meters f) Lowest adjacent(finished)grade next to building(LAG) 7.10 feet ❑ meters g) Highest adjacent(finished)grade next to building(HAG) 7.69 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.90 ❑X feet ❑ meters SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. /certify that the information on this Certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑X Yes ❑No ❑Check here if attachments. Certifiers Name License Number Odalys C. Bello Iznaga LS 6169 Title Professional Land Surveyor and Mapper # Company Name Ptace Bello&Bello Land Surveying Corp. Address 12230 SW 131 Avenue, Suite 201 re City State ZIP Code Miami Florida 33186 sic i tur D e Telephone Ext. Q Dr ZQ/? (305)251-9606 Co al pages of this Elevation Certificate and all attachmen s for(1f community official,(2)insurance agent/company,and(3)building owner. Comments(including type of equipment and location,per C2(e), if applicable) For A5: Long.and Lat. determined by GNSS RTK GPS Survey No. 17192 C2 e)Denotes Elevation of A/C Unit located on the North side of the existing structure. Next higher Floor Elev. =18.80' Highest Crown of Road Elev.=4.08' FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6 r r OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30,2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 SECTION E—BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a) Top of bottom floor(including basement, crawlspace,or enclosure)is ©feet ❑meters ❑above or ❑below the HAG. b) Top of bottom floor(including basement, crawlspace, or enclosure)is ©feet ❑meters ❑above or ❑below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions), the next higher floor(elevation C2.b in the diagrams)of the building is ©feet [:]meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ®feet [:]meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑X feet ❑meters ❑above or ❑below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must sign here.The statements in Sections A, B,and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30,2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 SECTION G—COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only,enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following information(Items G4—G10)is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor(including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments(including type of equipment and location,per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and'Rear View" and, if required, "Right Side View"and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. ,,;•�-,r�,v��4/.`.:T•+ }" w ni Iwai,�„•s�r '�` -v. "" 3I -�.4, y� ''j<<. Photo One Photo One Caption Front View: 04/19/2017 Clear Photo One r Ale f _ .. a.d Photo Two Photo Two Caption Rear View: 04/05/2017 Clear Photo Two FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, 'Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. i i y.. I '.. Photo Three Photo Three Caption Side View: 04/05/2017 Clear Photo Three i Photo Four Photo Four Caption Side View: 04/05/2017 Clear Photo Four FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6 e Z U.S. DEPARTMENT OF HOMELAND SECURITYOMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30,2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner. SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: Guy Kurlandski; Selin Kurlandski A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number: Box No. 9301 N. Bayshore Drive City State ZIP Code Miami Shores Florida 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) Folio#11-3205-027-0560 Lot 3, Block 4, BAY LURE, PB 44, PG 63 A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Residential A5. Latitude/Longitude: Lat.25051'41.13"N Long.80010'17.1 VW Horizontal Datum: ❑ NAD 1927 © NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1A A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑Yes ❑x No A9. For a building with an attached garage: a) Square footage of attached garage 400.00 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net'area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑Yes ❑x No f SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP Community Name&Community Number B2.County Name B3. State Village of Miami Shores 120652 Miami-Dade Florida ti B4. Map/Panel B5.Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12086C 0306 L 09-11-2009 09-11-2009 AE/VE 10/11 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69: ❑ FIS Profile ❑x FIRM ❑Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑x NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes © No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6 f � ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30,2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑Building Under Construction* ❑X Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations—Zones Al—A30,AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters. Benchmark Utilized: MDCBM No. B-62 Vertical Datum:NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ❑x NGVD 1929 ❑ NAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 5.90 Z feet ❑ meters b) Top of the next higher floor 7.72 Z feet ❑ meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A 0 feet ❑meters d) Attached garage(top of slab) 5.96 Z feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 7.58 Z feet ❑ meters f) Lowest adjacent(finished)grade next to building(LAG) 7.10 Z feet ❑ meters g) Highest adjacent(finished)grade next to building(HAG) 7.69 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.90 0 feet ❑ meters SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. /certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑No ❑Check here if attachments. Certifier's Name License Number Odalys C. Bello Iznaga LS 6169 Title Professional Land Surveyor and Mapper Place Company Name Bello&Bello Land Surveying Corp. - I�l�v Address H7 �,� t� 12230 SW 131 Avenue, Suite 201 City State ZIP Code 041j0-51 2,01-7 0/-7 Miami Florida 33186 tet/ Si tur De Telephone Ext. Q JJ?' f) 2O�? (305)251-9606 Co al pages of this Elevation Certificate and all attachmen s for(IJ community official,(2)insurance agent/company,and(3)building owner. Comments(including type of equipment and location,per C2(e), if applicable) For A5: Long. and Lat. determined by GNSS RTK GPS Survey No. 17192 C2 e)Denotes Elevation of A/C Unit located on the North side of the existing structure. Next higher Floor Elev. = 18.80' Highest Crown of Road Elev.=4.08' FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30,2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 SECTION E—BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a) Top of bottom floor(including basement, crawlspace, or enclosure)is ©feet ❑meters ❑above or ❑below the HAG. b) Top of bottom floor(including basement, crawlspace, or enclosure)is ©feet [:]meters ❑above or ❑below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions), the next higher floor(elevation C2.b in the diagrams)of the building is ©feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ®feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ®feet ❑meters ❑above or ❑below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must sign here.The statements in Sections A, B,and E are correct to the best of my knowledge. Property Owner or Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30,2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 SECTION G—COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only,enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following information(Items G4—G10)is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor(including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments(including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View"and "Rear View"; and, if required, "Right Side View"and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. V �A..: ��5iy;r SSS e Photo One Photo One Caption Front View: 04/19/2017 Clear Photo One '+ Photo Two Photo Two Caption Rear View: 04/05/2017 Clear Photo Two FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9301 N. Bayshore Drive City State ZIP Code Company NAIC Number Miami Shores Florida 33138 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. I w' a „ ',+',' .fit' • l'4.. ,' _._. I... K: -x Photo Three Photo Three Caption Side View: 04/05/2017 Clear Photo Three w tk = f.� t � Photo Four Photo Four Caption Side View: 04/05/2017 Clear Photo Four FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6