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BPP-15-2181Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO.BPP-8-15-2181 Permit Type: Pools/Whirlpools/Hot Tubs e'' ,Worts Classification: New Permit Status: APPROVED Issue Date: 9/1812011 Expiration: 03/16/2016 Parcel Number Applicant 1050 NE 107 Street Miami Shores, FL 33161-7374 1122320280520 Block: Lot: GABRIEL MARTIN KUSKUNOV Owner Information Address Phone Cell GABRIEL MARTIN KUSKUNOV 1050 NE 107 Street MIAMI SHORES FL 33161-7374 1050 NE 107 Street MIAMI SHORES FL 33161-7374 Contractor(s) SUNSET POOL AND SPA Phone (305)804-1068 CeII Phone Valuation: Total Sq Feet: $ 18,000.00 538 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Work: Swimming Pool Additional Info: BUILD A NEW POOL Classification: Residential 04, Occupancy: Bond Return : Scanning: 3 Fees Due Bond Type - Contractors Bond CCF CO/CC Fee DBPR Fee DBPR Fee DCA Fee Education Surcharge Permit Fee Plan Review Fee (Engineer) Scanning Fee Technology Fee Total: �nt�o $01 e$8.10 $8.10 $3.60 $540.00 $80.00 $9.00 $14.40 $1,224.00 Pay Date Pay Type Invoice # BPP-8-15-56860 08/25/2015 Check #: 2787 9/18/2015 Check #: 2839 �� #: 2842 Amt Paid Amt Due $ 50.00 $ 1,174.00 $ 1,174.00 $ 0.00 Available Inspections: Inspection Type: Fence Final Pool Deck Wall Steel Review Planning Review Planning Review Plumbing Review Plumbing Review Electrical Review Structural Review Building Review Building Review Building 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 ccurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named ntractor to do the work stated. September 18, 2015 Authorized Signature: Owner / Applicant / Cont actor / Agent Date Building Department Copy September 18, 2015 1 ?pc L • 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 FBC 20 " Master Permit No. — I S — 2 ( 8 4 Sub Permit No. It_ABUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL El PLUMBING ❑ MECHANICAL 0PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I D e 107 5T City: Miami Shores County: Miami Dade Zip: 3 16 1 Folio/Parcel#: I, - Z7-3 Z 0520 Is the Building Historically Designated: Yes NO Occupancy Type: S F rZ.. Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): GIL 1r i e.t c r t i r kLIS I li „, V Address: I bSb N Phone#: City: IV\ i1w t J�O`l e S State: Ids i Uq Zip: -3 I(,, ) Tenant/Lessee Name: Phone#: m Email: e� l e0c\olrCia p L,Oj MCA; l . i Crnae: Sly NS`ei� P 1 k 1='�41 Phone#: `7%L- ZSS— (I�'2 Address: S3SS BUJ 33 c t- City: `t`1 Qualifier Name: State: -rl O r ; (A C\ Zip: 3 3 I 7 ' Vo (Gr.. A Gso' ltz Phone#: State Certification or Registration #: C p C - 0 44k 0 g cl Certificate of Competency #: DESIGNER: Architect/Engineer: 11.tJ+a tJ i 0 C.ot ,J tI A s Phone#: OS - 2.6,I r O 3 Z 1 Address: % SOS St13 - Z4- s-- Su life, 11 I City: V\;aW1 i State: 1( Zip: 3 3IS (,,, Value of Work for this Permit: $ ) ► 00©. 0 Q Square/Linear Footage of Work: S--3 8 S >t Type of Work: ❑ Addition ❑ Alteration �,� " New ElRepair/Replace [—] Demolition Description of Work: ►;S U i I A Q (� �" .k IT .pO t % l Y. F , Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ • W Scanning Fee$ Radon Fee $ I D DBPR $ e • /3 Notary $ Technology Fee $ " Training/Education Fee $ Double Fee $ Structural Reviews $ AO • C.C) Bond $ S UO ` "V TOTAL FEE NOW DUE $CP • CO (Revised02/24/2014) 4 , t a P ";`" {. a Bonding Company's Name (if applicable) a t h E , �� i.a• F1 Bonding Company's Address `• City t.. State , s Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City .1 • 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 IMPROVEMENTSTOYOUR 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 bg.Qpproved and a reinspection fee will be charged. Signature WNER or AGENT The foregoing instrument was acknowledged before me this /94' day of , 20 /5 , by s//anm✓ me or who has produced , who is personally known to (kW," //Cefi/Se identification and who did take an oath. NOTARY PUBLIC: Sign: Print:' Seal: • r P Signature The foregoing i /Vie' day of CONTRACTOR nt was acknowledged befor one - , 20' /5 this by 5 �2q1;='lz= , who is personally known to as •me or who has produced as — identification and who did'tekean oath. --_ ,y., CARY M-RODRIGUEZ No ary Public - State of Florida • : ► My Comm. Expires Aug 18, 2015 F�� RA' ' Commission # EE 106632 Bonded Through National Notary Assn: NOTARY PUBLIC: Sign: int: al: CARY.M. RODRIGUEZ a e of Florida '; My Comm. Expires Aug 18, 2015 a�iitupQ: Commission # EE 106632 j i0`.`. .. Bonded Through National Notary Assn. ********************************** * �s*{*s* ii*************************'****4********* *** APPROVED BY %) \1 LI1'° Plans Examiner (Revised02/24/2014) *************** (, Zoning Structural Review Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any constructibn'project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 1, day of , 20 \. By Cielocye\ 1-4)5ko v C`r‘N.e, \ICY who is personally known to me or has produced as identification. Notary: •...� SEAL: CARY M. RODRIGUEZ - Notary Public - State of Florida r. E• •= My Comm. Expires Aug 18, 2015 , �: ��:' Commission # EE 106632 ;�'Ass •, ,+ ,,,, Bonded Through National Notary Assn SUNSET POOL & SPA, INC 5355 SW 133 CT Miami FL 33175-6151 August 10, 2015 State of r-1O C" c 9' County of Wiq,viA; Coci„Al Before me this day personally appearecf"\OYe- CM/2011.1Qwho, being duly sworn, despises and says: That he or she will be the only person working on this project located at: IUSO N•107 Ste. VWct^44 , S ‘,,r%ye5 rz- 33 16 1 Sworn to (or affirmed) and subscribed before me this ► t day of Personally know / OR Produced Identification Type of Identification Produced .,,;nV P ., CARY M RODRIGUEZ "-. Notary Public - State of Florida Commission • FF 225758 My Comm. Expires Aug 18, 2019 Bonded through National Notary Assn. Print, Type or Stamp Name of Notary Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) acknowledge that new swimming pool, spa or hot tub will be constructed or installed at )C S( tJ 2 101 St . rni c wx Sucre Miami Shores, FL, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues and the Florida Building Code R4101.17. Please initial the method(s) to be used: GThe pool will be equipped with an approved safety pool cover that comp lies with ASTM F1346-91. (Submit Manufacturer's Specifications). A continuous, one-piece (child) barrier meeting the requirements of Florida Building Code R4101.17.1.15 will protect the pool perimeter. The plans shall show the fence location and method of attachment, including one end that shall not be removable without the aid of tools. (Submit Manufacturer's Specifications). Q 14 A combination of non -dwelling walls and fences (screen enclosure, child fence, masonry fence walls, chain link or wood fence, etc.) will protect t he pool perimeter. The plans must specify t he type and location of all non dwelling walls. Florida Building Code, R4101.17.1 Gv_ Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code, R4101.17.1.9 (Submit Manufacturer's Specifications). GP— Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all doors will be equipped with a self -latching device with positive mechanical latching/locking installed a min. 54" above the threshold. If this option is selected, submit plans showing all types and location of all perimeter protection. The plans must also show the location and type of all openings, and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Code, the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements, and upon expiration of the permit, the pool shall be presumed to be unsafe . I understand that not having one of the above installed will constitute a violation Chapter 515, F.S ., an d + be consider as committing a misdemeanor of the second degree, ishable ash ovided +' . 5.082 0 Si scon 775.083 F.S This form must be signed by the - /agent -'OWNEfS'S URE AND DATE OWNER'S NAME (PLEASEORINT) •�""'••. CARY M. RODRIGU ? * "t.`'. Notary Public - State of Florida 2 • • c My Comm. Expires Aug 18, 2015 ..9l=i'p0: Commission # EE 106632 %° ,t ,o'•. Bonded Through National Notary Assn. „""'• CARY M. RODRIGUEZ lo Notary Public - State of Florida ) • E My Comm. Expires Aug 18, 2015 0 Commission # EE 106632 FO ,,,, Bonded Through National Notary Assn. Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned GGzr , �` '< US \Co r4OV is/are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: IDso N e. 10-7 IM:rirh; SFlpies ,� 1. 3 31(oj Whereas, the undersigned owner(s) Sq r ; e \ %K O >J O i desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows: That the property will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. 11. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the required enclosure is not on the subject property where the pod is located. III. That if any of our adjoining neighbors remove any portion of their fence or wall, or if our/my property shall fail to meet code requirements for pool barriers, we, as owners will immediately install a protective enclosure to meet code requirements and will obtain a permit for such fence. IV. That, I/we, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is damaged or removed try any rasp. NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned dedare(s) that this covenant is intended and shall constitute a restrictive covenant conceming the use, enjoyment and title to the above property and shall constit a covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns and may only ' ' by Miami Shore Village, or its successors, in accordance of said Village then in effect. OWNER SIGN & PRINT OWNE SING & ` -7 NT I Hereby Certify that on this day personally appeared before me or%c\ k S k-rov . and has produced ID # kzs 1 z ,its 3So as identification and he/she acknowledge that he/she executed the foregoing, freely and voluntarily, for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this / day of 3ure.— , 20 IS - (Revised 05/2209 ARyt1BLIC STATE OF FLORIDA CARY M. RODRIGUEZ Notary Public - State of Florida My Comm. Expires Aug 18, 2015 9; Commission # EE 106632 Bonded Through National Notary Assn. Date Miami Shores Vivage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION 17 7\s )Je Zcr Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as Liz+ i. , t ( oci< 4- , located at JOScb7 r ` ikm Sure In accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting and approved barrier prior ta(fittral inspection and use of the pool. Legal 'Owner_ Note: This certification is to be submitted with a swimming pool permit application in duplicate. U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EKERGENCY MANAGEMENT AGENCY 'National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION 'FOR INSURANCE COMPANY USE: Al. Building Owner's Name GABRIEL MARTIN KUSKUNOV PolicyyNuniber: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1050 NE 107TH STREET ,Company NAIONumber. City MIAMI SHORES State FL ZIP Code 33161 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 1, BLOCK 4 OF MIAMI SHORES ESTATES„ PB 47, PG 58, DCR, FOLIO#11-2232-028-0520 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. N25°52'26.4" Long. W80°10'33.2" A6. Attach at least 2 photographs of the building if the Certificate is being use 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 0 c) Total net area of flood openings in A8.b 0 sq in d) Engineered flood openings? ❑ Yes Z No Horizontal Datum: ❑ NAD 1927 ® NAD 1983 d to obtain flood insurance. A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? 0 Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number MIAMI SHORES 120652 B2. County Name MIAMI-DADE B3. State FLORIDA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12086C0306 L 9/11/09 Effective/Revised Date 9/11/09 Zone(s) X AO, use base flood depth) N/A B10. Indicate the source of he Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM 0 Community Determined 0 Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 0 NAVD 1988 0 Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: N/A 0 CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* 0 Building Under Construction* ® 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/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: DCBM#B-26-RA EL:17.23' Vertical Datum: NGVD Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 0 NAVD 1988 0 Other/Source: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher 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 9.92 N/A. N/A. N/A. 9.29 8.37 9.04 N/A. Check the measurement used. ® feet ❑ feet ❑ feet fget. ®•feet• ❑ meters ❑ meters ❑ g*T61 S ❑ rrtb? •• • ❑ meters 0 Mel • ❑ fheteFS • •.• •. • • • 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. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. •' Z Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a • • ® Check here if attachments. licensed land surveyor? Z Yes 0 No Certifier's Name ROBERT L. THOMPSON License Number 3869 Title PROF. LAND SURVEYOR Company Name ACCURATE LAND SURVEYORS Address 1150 E ATLANTIC BOULEVARD City POMPANO BEACH State FL ZIP Code 33060 SignatDate 6/30/15 Telephone 954-782-1441 • FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. LLL V PI I IV11 VLI 111 IV/'1 I L VGIUG IMPORTANT: In these spaces, copy the corresponding information from Section A. • Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1050 NE 107TH STREET City MIAMI SHbRES ' State FL ZIP Code 33161 FOR INSURANCE COMPANY USE Policy Number: 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 JOB NO 14-1278 15-2215 A5: Lat and Long was obtained using a hand held GPS unit. C2E: A/C PAD Signature ROBERT L. THOMPSON Date 6/30/15 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 El—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 ❑ feet El meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is El feet ❑ meters 0 above or 0 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 ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters 0 above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is . ❑ feet 0 meters 0 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 0 No 0 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 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's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments 0 Check here if attachments. 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. El 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 InIQ4.1 G2. 0 A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) dr•Zoin AO. G3. 0 The following information (Items G4—G10) is provided for community floodplain management purposes. • • •• •• • • • • • • • G4. Permit Number G5. Date Permit Issued •yam-•-f� N • G6. Date Certificate Of Compliance/Occupancy Issued • G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: 0 feet 0 meters G9. BFE or (in Zone AO) depth of flooding at the building site: 0 feet ❑ meters G10. Community's design flood elevation: ❑ feet 0 meters • • • • • •••• • •• Dstu•r►• • ••• • • • • Datufrf • • • • • • catui; :• • • • • • • Local Official's Name Title • • • • • •• • • • ••• • • Community Name Telephone •• • Signature Date Comments 0 Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. 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. 1050 NE 107TH STREET Policy Number: City MIAMI SHORES State FL ZIP Code 33161 Company NAIC Number: 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. FRONT VIEW 6/30/15 FRONT DOOR 6/30/15 REAR VIEW 6/30/15 .... . . • . .... • • .. . .. • • • ..• . .... .. . • . . .• .... ... . • • . • ,. • . . • .• • .. • • ..• .. . .. • ..... ..... • �. .... • • • .... .. ..••, • •: • ... .. . • • • • t • FEMA Form 086-0-33 (7/12) Replaces all previous editions. 1150E. ATLANTIC BLVD. POMPANO BEACH FL()RIDA 33060 ACCURATE LAND SURVEYORS, INC. L.B. #3635 I I SHEET 1 OF 2 TEL. (954) 782-1441 FAX. (954) 782-1442 TYPE OF SURVEY: BOUNDARY 14-2450,TOPO,15-2215 JOB NUMBER: SU-14-1278 LEGAL DESCRIPTION: LOT 1, BLOCK 4, OF MIAMI SHORES ESTATES, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 47, PAGE 58, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. ADDRESS: 1050 NE 107TH STREET MIAMI SHORES, FL 33161 FLOOD ZONE: X BASE FLOOD ELEVATION: N/A CONTROL PANEL NUMBER: 120652-0306-L EFFECTIVE: 9/11/2009 REVISED: 9/11/2009 LOWEST FLOOR ELEVATION: "SEE SKETCH" GARAGE FLOOR ELEVATION: N/A LOWEST ADJACENT GRADE : "SEE SKETCH" HIGHEST ADJACENT GRADE : "SEE SKETCH" REFERENCE BENCH MARK: DCBM#B-26-RA ELEV:17.23'NGVD CERTIFY TO: 1. GABRIEL MARTIN KUSKUNOV 2. 3. 4. 5. NOTES: 1. 2. 3. A A CB R R/W P.C. P.T. WM OH N s B.M. FH o/s SEC. TWP. RGE. THIS SURVEY CONSISTS OF A MAP AND A TEXT REPORT. ONE IS NOT VALID WITHOUT THE OTHER. OWNERSHIP OF FENCE AND WALLS IF ANY, NOT DETERMINED. THIS SURVEY IS MADE FOR THE EXCLUSIVE USE OF THE CERTIFIED HEREON. TO BE VALID ONE YEAR FROM CENTRAL ANGLE ARC LENGTH = CHORD BEARING RADIUS RIGHT OF WAY POINT OF CURVATURE POINT OF TANGENCY = WATER METER = OVERHANG = NORTH = SOUTH EAST WEST = BENCHMARK = FIRE HYDRANT OFFSET = SECTION = TOWNSHIP RANGE 0 % 0o LEGEND OF ABBREVIATIONS: 1' OR + = ELEVATIONS BASED ON NGVD 1929 SQ. FT. = SQUARE FEET MAIM'. = MAINTENANCE P.C.P. = PERMANENT CONTROL POINT B.C.R. = BROWARD COUNTY RECORDS P.B.C.R. = PALM BEACH COUNTY RECORDS D.C.R. = DADE COUNTY RECORDS P = PLAT P.B. = PLAT BOOK = NAIL & DISC O.R.B. = OFFICIAL RECORDS BOOK = POINT OF COMMENCEMENT F.F. = FINISHED FLOOR = POINT OF BEGINNING ENCH. • ENCROACH = AIR CONDITIONER = FOUND = CHATTAHOOCHEE = FLORIDA POWER & LIGHT N&D P.O.C. P.O.B. aC FND. CHATT. ELEV. MH ESMT. ELEC. ELEVATION MANHOLE EASEMENT ELECTRIC — %—X—X—X— = — //-- /A— //— //— = — II—II—I1-1 I— = CHAIN LINK FENCE WOOD FENCE METAL FENCE PVC FENCE CONCRETE FENCE CONCRETE WALL WIRE FENCE • • • • • • • • •••• • • • • •• • •• • • • • • • •.1 • • • • • • • • • •• • • • • • • • • •i•• • •• • • • ••• • • • • • •• •• •• • • • • • • • • • • • • • • • • • • • •• • • • • • • • • • • THE DATE OF SURVEY AS SHOWN HEREON. MIAMI—DADE COUNTY NGVD1929 CLF WF BLVD. AD I.M. I.R. GAR. C/L (M) LP U.E. D.E. A.E. P.R.M. = DEED BOOK = CHAIN LINK FENCE = WOOD FENCE = BOULEVARD = ASSUMED DATUM = IRON PIPE = IRON ROD = GARAGE = CENTERLINE = MEASURED = LIGHT POLE = UTILITY EASEMENT = DRAINAGE EASEMENT = ANCHOR EASEMENT = PERMANENT REFERENCE MONUMENT • NORTH GEODETIC VERTICAL DATUM E A / NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 1150 E. ATLANTIC BLVD. ACCURATE LAND SURVEYORS, INC. POMPANO BEACH FLORIDA 33060 L.B. #3635 I SHEET 2 OF 21 TEL. (954) 782-1441 FAX. (954) 782-1442 z 20 w W z z A z Cl RADIUS=25.00' DELTA=75'51'26" ARC=32.99' TAN=19.39' 0 10 GRAPHIC SCALE 1 "=20' FOUND 1/2" IRON PIPE NO ID LOT 21 BLOCK 4 p� AS 9g rye. �9, " ' SET 1/2" .+ IRON ROD & CAP LB 3635 FOUND 1/2" IRON PIPE NO ID o/s 2.95'—S 7.07'—E + 0 0 POWER POLE Oi -y0 • SITE & SETDISC NAIL:®.:°�..4 'SeJRF0UNDONROD 5/8" 9 NO ID SET 1/2" °p IRON ROD ' LB3635 0 LOT 1 BLOCK 4 27.95' • • enen �N0 4' CHAIN) LINK FENCE • • •• air• ••pt••• n• •4••• r•� • • • • • • •••• 47.44° • • • •• • •• • 2Q' ASPHALT PAVEMENT x ,1 • • • • • • • • • • •• • • • • •• • • •• • • • • ▪ • • •• 0' • ••• w •••(9p: ;:.. N. E. 10TH PLACE 0• • • FOUND 17 " • • IRON* QIQG: • NO ID o/s 1.23'E 0.62'S FENCE 5.4'W 0.5'S FENCE OA%••• • • • • • • • • • • 10 • • • .•• •+1b' • • • • e • N NOTES: 1. Unless otherwise noted field measurements are in agreement with record measurement. 2. Bearings shown hereon are based on a bearing of N/A 3. The lands shown hereon were not abstracted for ownership, rights of way, easements, or other matters of records by Accurate Land Surveyors, Inc. 4. Ownership of fences and walls if any are not determined. 5. This survey is the property of Accurate Land Surveyors, Inc. and shall not he used or reproduced in whole or in part without written authorization. 6. This survey is made for the exclusive use of the certified hereon, to be valid one year from the date of survey as shown hereon. 7. This survey consists on a map and text report. one is not valid without the other. REVISIONS DATE BY UPDATE/TOPO SU-15-2215 07-02-15 AL/JMS UPDATE/TOPO SU-14-2450 08-07-14 AL/MLW CERTIFICATION: This is to certify that I have recently surveyed the property described in the foregoing title caption and have set or found monuments as indicated on this sketch and that said above ground survey and sketch are accurate and correct to the hest of my knowledge and belief. I further certify that this survey meets Minimum Technical Standards under Rule 5J-17 adopted by the Florida Board of Land Surveyors, January I Ith 2010. EA( NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ROBERT L. THOMPSON (PRESIDENT) PROFESSIONAL SURVEYOR AND MAPPER No.3869 — STATE OF FLORIDA DATE OF SURVEY 05/02/14 DRAWN BY QDI CHECKED BY JMS FIELD BOOK 14-1278 I SCALE 1 "= 20' I N M E SU-14-1278