EL-16-1099•
Project Address _
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Parcel Number
Permit NO. EL -4-16-1099
Permit Type: Electrical - Residential
Work Classification: Pool - Private
Permit Status: APPROVED
Issue Date 7/28/2016
Expiration: 01/24/2017
Applicant
33 NE 93 Street
Miami Shores, FL 33138-
1132060130380
Block: Lot:
JOHN ZELINSKI
Owner Information
Address
Phone
CeII
JOHN ZELINSKI
t•
33 NE 93 Street
MIAMI SHORES FL 33132=
(786)515-5716
33 NE 93 Street
MIAMI SHORES FL 33132-'
Contractor(s)
NHTC LLC
Phone
(305)546-8674
CeII Phone
Valuation:
Total Sq Feet:
$ 2,500.00
0
Type of Work: NEW ELECTRICAL FOR POOL
Additional Info:
Classification: Residential
Scanning: 1
Fees Due
CCF I
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$4.50
$4.50
$0.60
$300.00
$3.00
$2.40
$316.80
Pay Date
Invoice #
04/22/2016
07/28/2016
Pay Type
EL -4-16-59516
Credit Card 1
Credit Card
Amt Paid Amt Due
$ 50.00 $ 266.80
$ 266.80 $ 0.00
Available Inspections:
Inspection Type:
Final
Light Niche
Bonding
Review Electrical
Alarms
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 tha •I wor Will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-named contractor to d. e .rted.
Authorized Signature: Owner / Applicant / ° Contractor / A
Buildings Department Copy
July 28, 2016
Date
July 28, 2016
1
a
1
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC20il`-tS
Master Permit No.. `� 1
Sub Permit No.—1 �� 1( 1 1
❑BUILDING+ NI ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
i
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 33 r('& (pr) g-1
City: Miami Shores County: :Miami Dade Zip: 3313,1
i
Folio/Parcel#: ll-- 3206 0/3-0300 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNVER: Name (Fee Simple Titleholder): John oh n 2C t' o s ik1 Phone#:
i
Address: 33 AI 6- q3 rS ,.1 1
city': //4,'m .55®r's
State: l67/ Zip: 33/38
Tennt/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: _ 6Z/5
City: irl aril! /
Qualifier Name:
/at&
ibp/
Lu/s &ohZer t Z -
Phone#:
State:
P1
State Certification or Registration #: GC, %.300 6931
DESIGNER: Architect/Engineer:
Phone#:
Certificate of Competency #:
Zip: eve
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 45w0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: NVNLC/ r'tA
New ❑ Repair/Replace ❑ Demolition
/,if/0 0 el
v1
Specify color of color
thru tile:
Submittal Fee $ �. D "v Permit Fee $ 3 4(3 t6 Q CCF $ 1 • & 0 CO/CC $
Scanning Fee $ 3 • Ck> Radon Fee $ (-f �6 DBPR $ 6D Notary $
Technology Fee $ cD• LI Q Training/Education Fee $ ' ` ( Double Fee $ 01)
Structural Reviews $ Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ iaG G
.B9ndingCompany's Name (if applicable)
t f
Bonding Company's Address
r
City" State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Cityt 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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information,is accurate and that all work. will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TOOBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
4
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
WNER or AGENT
The foregoing instrument was acknowledged before me this
day ofrd
II -- �i , 20 by
JOkk i y\ , k , who is personally known to
me or who has producedQ—D
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Signature
The foregoing instrume t was acknowledged before me this
Z/ day of I , 20' ( , by
L—(/(4 / �' ` • r2�•0,0 is personally known to
as me or who has produced G524 533?(/o 2,If3-01s
identification and who did take an oath.
NOTARY PUBLIC:
:,,n`'pY �:&••• IJe
ARL*. Y OJEDA
• • t MY COMMISSION # FF 963289
?*s11411 EXPIRES: February 22, 2020
4' Cop ' Bonded Thu Notary Pubic Undenwdtara
Sign:
Print:
Seal:
MY COMMISSION # FF 963
EXPIRES: February 22, 2fD
Bonded Thu Notary Pubic Un(,
**********s***s*****ss**************s*s****s**s*fir s*************s*s*ss*****sss**s*******s**s*s*s**********s**'
APPROVED BY �%%f4 ;'4X. 7z41-T7Z// Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
• Clerk
,.
STATE OF FLORIDA
RECET' �.
j N 17. 2016
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND D SPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
1
APPLICATION FOR:
[ ] New System
( ] Repair
APPLICANT: John Zelinski
[x] Existing System
[ ] Abandonment
1
[ ] Holding Tank
[ ] Temporary
APP DOC # AP1238588
PERMIT #: 13 -SC -1680773
DATE PAID 05/06/2016
FEE PAID: 70.00
RECEIPT #:13 -PID -2938811
[ ] Innovative
AGENT: Luis Rivas
MAILING ADDRESS: 33 NE 93 St Miami, FL 33138
TELEPHONE: 1(786)515-5716
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY
A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED
(MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
LOT: 15
SUBDIVISION:
PROPERTY ID #:
Miami Shores Section 1
11-3206-013-0380
PROPERTY SIZE: 0.22
IS SEWER AVAILABLE AS PER 381.0065, FS?
PROPERTY ADDRESS: 33 NE 93 St Miami, FL 33138
BLOCK: 3
PLATTED: 01/01/1945
••••
ZONING: I/M OR EQUIVALENT: ••L•ir / N •]•••••
• •
.• • •••• •
ACRES WATER SUPPLY: [ ]PRIVATE (x]<=444AGi'i) •[•JS2Q00GPr •
[ Y
N
•
•
DISTANCE TO SEWER
i.•• •H7.00
• • • •
• •
•••• •
• •
-1 DIRECTIONS TO PROPERTY:
I-95 North, Exit 103 Street, Left on N Miami Avenue, Left at 93 Street
• • • •
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• • •
•• •
•
•.••
• • •
• • •
•
•
•
•
•
BUILDING INFORMATION:
Type of
Establishment
[x] RESIDENTIAL [ ] COMMERCIAL
No. of Building # Persons Total Design Flow
Bedrooms Area Ft Served For This Unit
{
f
[ ] Floor/Equipment Drains [ ] Other (Specify)
SIGNATURE:
3 1677 6 300
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
11 f
85£3i3 .. Z1^.68O 7t
DATE: 05/06/2016
Page 1 of 4
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Additional Notes and Continents:
County Notes Fields:
, County Process #:
APP .DOC# : AP 12 ;8538
PERMIT NO. 13 -SC -1680773
DATE PAID: 05/06/2016
FEE PAID: 70.00
RECEIPT #: 13 -PID -2938811
Sent To Legal for Outstanding Balance Enforcement:
I Box # sent to storage:
I Zone:
{
Agency Name:
Payment Status:
Sent to Collections("Y"=Yes, blank=no):
Special Program(i.e. After School Meal Program):
1 Government Entity(City, County, State, Federal):
J Last Exemption Renewal / Approved Date:
•
• • ••
• •
1 General Comments:
• • •
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••••O•
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•• •
•
••
No Objection: swimming pool. Issued by E. Omisca on 06/15/2016.
• •
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•• ••
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.,P1235595 EID'_630 773
• •
•
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•
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•.
•
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•
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•••• • •
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•. •
a
YHdSV oZ
9.60' ASPHALT
PAVEMENT 127.50'(P)(M)
15' ALLEY
.50'
7.60'
0
A6
•Q • w.: . EONG.
24.14'
(11
• 31.89'
69.34'
6.18
b : CO*
t1.00',a
GOF C: k
Ch
p 5.20'
.30 y:
03N
13.35' "
24.20'
12.35
��
zoo N
4f
28.40'
1 /30 T 4'
127.50'L'P)(M)
.. ... .
• . .
• i PiIQ 11\IMF3..OF LOT 16
6.13' 00
2.80'" s:�.•
1.10".1.
. ; . ... -
27.10'
P30
N�� H.
CO
• . . •
.. . . •
• .. .
.. . ..f
BLOCK 3
• . •
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•...
. ....
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.... ••••••• •
•.• •• . . .
• • . . •... •. •• .
• •. . .
. .•.• .. . •....•
.•. •. . .• .•. •
. .
0.36'
x
0.05L__
O
a
2.00-
—xix—
A
7/////i
WMXA
C.U.E.
I.E./E.E.
U.E.'
PROPERTY LINE
STRUCTURE
CONC. BLOCK WALL
CHAIN-LINK FENCE OR WIRE FENCE
WOOD FENCE
IRON FENCE
EASEMENT
CENTER LINE
WOOD DECK
CONCRETE
ASPHALT
BRICK / TILE
WATER
APPROXIMATE EDGE OF WATER
COVERED AREA
TREE
POWER POLE
CATCH BASIN
COUNTY UTILITY EASEMENT
INGRESS / EGRESS EASEMENT
UTILITY EASEMENT
FND
LB#
LS/
CALC
SET
•
•
ELEV
P.T.
P.C.
P.R.M.
P.C.C.
P.R.C.
P.O.B.
P.O.C.
P.C.P.
M
P
D
C
L.M.E.
R.O.E.
Surveyor's Legend
FOUND IRON PIPE /
PIN AS NOTED ON PLAT
LICENSE # - BUSINESS
LICENSE # - SURVEYOR
CALCULATED POINT
SET PIN
CONTROL POINT
CONCRETE MONUMENT
BENCHMARK
ELEVATION
POINT OF TANGENCY
POINT OF CURVATURE
PERMANENT REFERENCE MONUMENT
POINT OF
POINT OF
POINT OF
POINT OF
COMPOUND CURVATURE
REVERSE CURVATURE
BEGINNING
COMMENCEMENT
PERMANENT CONTROL POINT
FIELD MEASURED
PLATTED MEASUREMENT
DEED
CALCULATED
LAKE OR LANDSCAPE MAINT. ESMT.
ROOF OVERHANG EASEMENT
B.R.
A
R
RAD.
N.R.
TYP.
I.R.
I.P.
N&D
PK NAIL
D.H.
0
1.1
® M.H.
O.H.L.
TX
CATV
W.M.
P/E
CONC.
ESMT
D.E.
L.B.E.
L.A.E.
BEARING REFERENCE
CENTRAL ANGLE OR DELTA
RADIUS OR RADIAL
RADIAL TIE
NON RADIAL
TYPICAL
IRON ROD
IRON PIPE
NAIL & DISK
PARKER-KALON NAIL
DRILL HOLE
WELL
FIRE HYDRANT
MANHOLE
OVERHEAD LINES
TRANSFORMER
CABLE TV RISER
WATER METER
POOL EQUIPMENT
CONCRETE SLAB
EASEMENT
DRAINAGE EASEMENT
LANDSCAPE BUFFER EASEMENT
LIMITED ACCESS EASEMENT
TEL.
U.P.
E.U.B.
SEP.
D.F.
A/C
S/W
DWY
SCR.
GAR
ENCL.
N.T.S.
F.F.
T.O.B.
E.O.W.
E.O.P
C.V.G.
B.S.I.
S.T.L.
R/W
P.U.E.
C.M.E.
A.E.
TELEPHONE FACILITIES
UTILITY POLE
ELECTRIC UTILITY BOX
SEPTIC TANK
DRAINFIELD
AIR CONDITIONER
SIDEWALK
DRIVEWAY
SCREEN
GARAGE
ENCLOSURE
NOT TO SCALE
FINNISHED FLOOR
TOP OF BANK
EDGE OF WATER
EDGE OF PAVEMENT
CONCRETE VALLEY GUTTER
BUILDING SETBACK LINE
SURVEY TIE LINE
CENTER LINE
RIGHT-OF-WAY
PUBLIC UTILITY EASEMENT
CANAL MAINTENANCE EASEMENT
ANCHOR EASEMENT
Property Address:
33 N.E. 93 STREET
MIAMI SHORES, FL 33138
Flood Information:
Community Number:
Panel Number:
Suffix:
Date of Firm Index:
Flood Zone:
Base' Flood Elevation:
Date of Field Work:
Date of Completion:
120652
12086C0302L
L
9/11/2009
X
N/A
7/30/2015
7/31/2015
General Notes:
1. The Legal Description used to perform this survey was supplied by others.
This survey does not determine or is not to imply ownership.
2. This survey only shows above ground improvements. Underground utilities,
footings, or encroachments are not located on this survey map.
3. If there is a septic tank, well, or drain field on this survey, the location of such
items was shown to us by others and the information was not verified.
4. Examination of the abstract of title will have to be made to determine recordec
instruments, if any, effect this property. The Inds sho4rl been were pot....
abstracted for easement or other recorded eicunbrances i shown on they plat.
5. Wall ties are done to the face of the 0411.• • • • •
6. Fence ownership is not determined. •
••• •
7. Bearings referenced to line noted 13.110.•••• •
8. Dimensions shown are platted and meaauced unless otherwise shown. •
9. No identification found on property rlJ % finless ry�ieci • •
10. Not valid unless sealed with the sigv izgg• , eyors gpiposvd seal..;.. •
11. Boundary survey means a drawing anal/or graphic repres.eration Qf trg • •
survey work performed in the field, could& drawn at a shown scale and/or net to
scale. • • • ' • •
12. Elevations if shown are based uporwNGVD•1929 •
u�lg�s•cnerwiserfbLrlti' •
13. This is a BOUNDARY SURVEY unless otherwise noted. • •
14. This survey is exclusive for the use �tt♦T2 'Vies to wbprp it is cert+f'ed. The
certifications do not extend to any unnamed parties. • • • •
15. This survey shall not be used for construction/permitting purposes without
written consent from Miguel Espinosa.
•
•
Legal Description:
LOT 15 AND THE WEST HALF (1/2) OF LOT 16, BLOCK 3, OF SUBDIVISION MIAMI SHORES SECTION ONE,
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10, PAGE 70, OF THE PUBLIC RECORDS OF
MIAMI-DADE COUNTY, FLORIDA
PRINTING INSTRUCTIONS:
Whilef viewing the survey in any Acrobat Reader,
select the File Drop-down and select "Print"
Select a color printer, if available, or at least one with
8.5" x 14" paper.
Cclarf Al 1 fnr Print Panna anti fha ff of rnniae vni I
Certified To: JOHN ZELINSKI; LEGACY TITLE SERVICES, INC.;
ATTORNEY'S TITLE INSURANCE FUND, INC.; ; . Its'successors
and/or assigns as their interest may appear.
ALS. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-9
OMB No. 1660-0008
Expires July 31, 2015
SECTION A - PROPERTY INFORMATION
For Insurance Company Use
Al. Building Owner's Name
John Zelinski
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
33 N.E. 93 Street
City State ZIP Code
Miami Shores Florida 33138
Policy Number
Company NAIC Number
A3.
A4.
A5.
A6.
A7.
A8.
Property Description (Lot and Block numbers, Tax Parcel Number, Legal Description, etc.)
Building Use (e.g., Residential, Non -Residential, Addition, Accessory, Etc.)
Lattitude/Longitude: Lat. 2551'37 Long. 8011'48 Horizontal Datum: [
Attach at least 2 photographs of the building if the Certificate is being used
Building Diagram number lA
For a building with a crawlspace or enclosure(s): A9.
a) Square footage of crawlspace or enclosure(s) 1363 Sq. Ft.
b) No. of permanent flood openings in the 13
crawlspace or enclosure(s) within 1.0 foot
above adjacent grade
c) Total net area of flood openings in A8.b 1797 Sq. Ft.
d) Engineered flood openings? [] Yes [X] No
residential
] NAD 1927 [X] NAD 1983
to obtain flood insurance
For a building with an attached garage:
a) Square footage of attached garage 279 Sq. Ft.
b) No. of permanent flood openings in the 0
attached garage within 1.0 foot above
adjacent grade
c) Total net area of flood openings in A9.b
d) Engineered flood openings?
0 ,Sq. Ft.
[ ] Yes [X] No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
120652
B2. County Name
Miami -Dade County
B3. State
Florida
B4. Map/Panel
Number
12086C0302L
B5. Suffix
L
B6. FIRM Index Date
09/11/2009
B7. FIRM Panel
Effective/Revised Date
09/11/2009
B8. Flood Zone(s)
X
B9. Base Flood elevation(s)
(Zone AO, use base flood
depth)
N/A
B10. 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 (Describe)
B11. Indicate elevation datum used for BFE in Item B9 [X] NGVD 1929 [ ] NAVD 1988 [ ] Other (Describe)
B12. Is the building locaed in a Costal Barrier Resources System (CBRS) area or Otherwise protected Area (OPA)? [ ] Yes [X] No
Designation Date N/A [ I CBRS [] OPA
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 A1 -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/A0. Complete items C2.a-h
below according to the building diagram specified in item A7. IN Puerto Rico only, enter meters.
Benchmark Utilized Vertical Datum NGVD 1929
Conversion/Comments N/A
a)Top of bottom floor (Including basement, crawlspace, or enclosure floor)
b)Top of the next highest floor
c)Bottom of the lowest horizontal structural member (V Zones only)
d)Attached Garage (top of slab)
e)Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG)
g)Highest adjacent (finished) grade next to building (HAG)
h)Lowest adjacent grade at lowest elevation of deck or stairs including structural support N/A • iK}FeeF
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATIO •
• Chac ehe measurement used.
•
10.65 PI Feel [�] "'Wars
13.19 • It1/411:8A [']Tnetees
N/A • pg Gaol [ ] meters
10.87 [A igpt •[ ] meters
10.83 • [j(1 ?n e?s
10.47 '[IC=leee: ••[1 meteors
10.65 •[X] I' t [] mere&s
[] m0ters
• • •
•-•••-
•
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized bylaw to certify elevation
information. !certify that the information on this Certificate represents my best efforts to interpret the dale available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
® Check here if comments are provided on back of form, Were latitude and longitude in Section A provided by a
0 Check here if attachments, licensed land surveyor ® Yes 0 No
Certifiers Name
EFRAIN LOPEZ
License Number 6792
TrtOFESS1ONk1L SURVEYOR & MAPPERCanpany Neme ME LAND SURVEYING
ANEgSW190
EET SUITE 3110 Coy MIAMI
stft ZIP CO 3157
Signature
Oe e10/12/2015 Telephone(3o-740-3319
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FEMA Form 0-86-0-33 (7/12) See reverse side for continuation
1 of 4 I
Andrew D. Tarr,13.A. - Elevation Certificate
Replaces all previous editions
•
F..
IMPORTANT: In these spaces, copy the corresponding information from Section A.
•i. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
• 33 N.E:93 Street
City
Miami Shores
For Insurance Company Use
Policy Number
State ZIP Code
Florida 33138
Company NAIC Number
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments LATITUDE LONGTITUDE PER GOOGLE, ATTACHMENTS = BUILDING PICTURES
C2E= AC UNIT EAST CROWN 10.95 WEST CROWN 11.02
Signature
Date
10/08/2015
[X] Check here if attachments
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 El -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.
El. 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 N/A [X] Feet [ ] Meters [X] Above or [ ] Below the HAG
b) Top of bottom floor (including basement, crawlspace, or enclosure) is N/A [X] Feet [ ] Meters [X] 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 8-9 of instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is N/A [X] Feet [ ] Meters [X] Above or [ ] Below the HAG
E3. Attached garage (top of slab) is N/A [X] Feet [ ] Meters [X] Above or [ ] Below the HAG
E4. Top of platform of machinery and/or equipment servicing the building is N/A [X] Feet [ ] Meters [X] 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 [X] Unknown . The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Section 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, abd E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature
Date Telephone
Comments
• •
SECTION G -COMMUNITY INFORMATION (OPTIONAL) ••••• .•• •
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance c�'h complete Se•t onsbA,•B, C (or Ei?, • •
and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check measurement used in items GE•t5:t3.1n Puertoti?co oily, ente?
meters.. • • `
G1. [ ] The information in Section C was taken from other documentation that has been signed and sealed by a lic8ved surveyoo engineer, or • •
architect who is authorized by law to certify elevation information. (Indicate the source and date of the elesi[iQrl gala in the;Comrrlents are....
below.)
A community official completed Section E for a building located in Zone A (without a FEMA -issued or commu•t•'•ssued Bt -E) •o•Zone AO.
The following information (Items G4 -G8) is provided for community floodplain management purposes. • • • • • ` •
• •
•••
•
G2. []
G3. [
•
•
G4. Permit Number
G5. Date Permit Issued
G6. Date Certificate Of Complicance/Occransy Issued
• • •••
G7. This permit has been issued fo : [ ] New Construction [ ] Substantial Improvement
G8. Elevation of as -built lowest floo (including basement) of the building:
G9. BFE or (in Zone AO) depth of flooding at the building site:
G10. Community's design flood elevation
•
•
•
• • •
•• • i••• • •
[X] Feet [ ] Met211 • • D:tum _
[X] Feet [ ] Meters Datum _
[X] Feet [ ] Meters Datum
Local Official's Name
Title
Community Name
Telephone
Signature
Date
Comments
[ ] Check here if attachments.
' FEMA Form 0-86-0-33 (7/12)
2 of 4
Andrew D. Tarr, P.A. - Elevation Certificate
Replaces all previous editions