DS-18-2094Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. DSS-8-18-2094
PPermit Type: Driveways/Sidewalks/Slabs
e r m Work Classification: Addition/Alteration
`atlon
Permit Status: APPROVED
Parcel Number
Issue Date: 9/10/2018
Expiration: 03/09/2019
Applicant
158 NE 110 Street
Miami Shores, FL 33138-
1121360040450
Block: Lot:
WILFREDO ACOSTA
Owner Information
Address
Phone
Cell
WILFREDO ACOSTA
158 N. E. 110 ST.
MIAMI SHORES FL
Contractor(s)
ONE STOP PAVING
Phone
(786)299-1354
Cell Phone
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Work: PLAIN CONCRETE DRIVEWAY
Bond Return :
Scanning: 3
Additional Info: PLAIN CONCRETE DRIVEWAY
Classification: Residential
Fees Due
Bond Type - Contractors Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
P&Z Review Fee
Permit Fee
Scanning Fee
Technology Fee
Amount ,.
$500.00
$4.20
$2.63
$2.00
$1.40
$35.00
$175.00
$9.00
$5.60
Total: $734.83
Pay Date Pay Type
Invoice # DS-8-18-68462
08/07/2018 Check #: 2098 $ 50.00 $ 684.83
09/10/2018 Check #: 2137 $ 684.83 $ 0.00
Bond #: 3885
Amt Paid Amt Due
Available Inspections:
Inspection Type:
Final
Foundation
Review Building
Review Building
Review Planning
Review Planning
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 certi
construction and zoning. Futh
rthat all th foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
11ore, I au14rize the above -named contractor to do the work stated.
tQ�
Authorized Signatur?: Owner Applicant / Contractor / Agent
September 10, 2018
Date
Building Department Copy
September 10, 2018 1
BUILDING
PERMIT APPLICATION
hDING ❑ ELECTRIC
El PLUMBING ❑ MECHANICAL
JOB ADDRESS:
City:
Folio/Parcel#:
Occupancy Type:
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
❑ ROOFING
RECEIVED
AUG 0 7 2018
ceh
FBC 2019
Master Permit No. OS `8 ~ 2 °Gig
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
/S 110 sf
Miami Shores
// 245 G oo4 o¢5 o
Load:
OWNER: Name (Fee Simple Titleholder):
County:
Construction Type:
Miami Dade Zip: 3/6/
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
Address: I,S NE /0
/
//
City: �`'i t c '7 / rtLU /es
State:
Phone#: 3 0 g 43 Z 7oz3
Zip:
33/6/
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 014e 3 N f �1
Pac/e e7 2 `L"`c
e r7i 2
Address: (4 6
City: It) • U-( _ / o/c 4/� State: --. Zip: 3 3/6 2
Qualifier Name: cot,/di 6 ! (tf e s i.. Phone#: 713G Ziv7 RP%
State Certification or Registration #: C6C /573 7/c1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
nd /7rrO .
Type of Work: ❑ Addition 0 Alteration ❑ New El Repair/Replace ❑ Demolition
Description of Work:
23/see
Value of Work for this Permit: $ / Sg .
(, zqg / 3S�/
Phone#: 7$
Square/Linear Footage of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for 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
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
O
,q / , 20 / �' by
(A), %f)-do /J eGo s A , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBUC:
2 day of
Sign:
Print:
Seal:
Or
APPROVED BY
BARBARA SOBRiNO
MY COMMISSION # FF 195634
EXPIRES: February 3, 2019
Bonded Thru Notary Pubrc Underwriters
f�l
Signature
CONTRACTOR
The foregoing instrument was acknowledged beforeme this
a day of /�A'Svse / ,20 `y ,by
c„les �f t L.
. , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
.>'�;at Py' •,, BAP.BARd SOBRi:
r'=
MY COMMISSION # Fr
EXPIRES: February
R�y7V Bonded Thru NotaryPublic
!
(Revised02/24/2014)
Structural Review Clerk
OFFICE OF THE PROPERTY APPRAISER
Summary Report
Property Information
Folio:
11-2136-004-0450
Property Address:
158 NE 110 ST
Miami Shores, FL 33161-7046
Owner
WILFREDO M ACOSTA
Mailing Address
158 NE 110 ST
MIAMI SHORES, FL 33161-7046
PA Primary Zone
1000 SGL FAMILY - 2101-2300 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY : 1 UNIT
Beds / Baths !Half
3/2/1
Floors
1
Living Units
1
Actual Area
2,372 Sq.Ft
Living Area
2,160 Sq.Ft
Adjusted Area
2,166 Sq.Ft
Lot Size
9,300 Sq.Ft
Year Buift
1950
Assessment Information
Year
2018
2017
2016
Land Value
$232,690
$232,690
$199,874
Building Value
$152,974
$153,567
$154,161
XF Value
$1,063
$1,079
$1,095
Market Value
$386,727
$387,336
$355,130
Assessed Value
$258,148
$252,839
$247,639
Benefits Information
Benefit
Type
2018
2017
2016
Save Our Homes
Cap
Assessment
Reduction
$128,579
$134,497
$107,491
Homestead
Exemption
$25,000
$25,000
$25,000
Second
Homestead
Exemption
$25,000
$25,000
$25,000
Civilian Disability
Exemption
$500
$500
$500
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
36 52 41
COLLEGE HEIGHTS PB 42-8
LOT 14 BLK 2
LOT SIZE 75.000 X 124
OR 21026-3194 01 2003 1
Generated On : 8/1/2018
Taxable Value Information
2018
2017
2016
County
Exemption Value
$50,500
$50,500
$50,500
Taxable Value
$207,648
$202,339
$197,139
School Board
Exemption Value
$25,500
$25,500
$25,500
Taxable Value
$232,648
$227,339
$222,139
City
Exemption Value
$50,500
$50,500
$50,500
Taxable Value
$207,648
$202,339
$197,139
Regional
Exemption Value
$50,500
$50,500
$50,500
Taxable Value
$207,648
$202,339
$197,139
Sales Information
Previous Sale
Price
OR Book -Page
Qualification Description
01/01/2003
$247,000
21026-3194
Sales which are qualified
11/01/2001
$122,000
20027-0817
Sales which are qualified
05/01/1996
$97,000
17205-4094
Sales which are qualified
08/01/1995
$77,000
16906-1497
Sales which are qualified
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
hores
iiiage
Wilding Departevil
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner o Worker' Compensation insurance Exemption
Pbr.y.'7 'add
;�.4: ftt:-..
.j.,77,t,l•th, a.+ A 3 , raw., r+4fa# { o ,% �•
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 construction 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 hull -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 hasprovided 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
ttorkers' 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 . ff
The foregoing was acknowledge before me this Z day of 4 J. I v sT , 20 1. 6 ,
By U) ! 1 f d A. C. o c[-. who is personally known to me or has produced
Notary.
SEAL:
riyt5,
s identification.
BARBARO SOBRINO
MY COMMISSION # FF 195634
, EXPIRES: February 3, 2019
°P' 6onded Thru Notary Public Underwriters
One
TO: r i Olvn `
NAME:
ADDRESS:
PHONE:
FAX:
Thu 1
Paving Inc.
s\Aote , 01 1\a`i,e PROJECT:
NAME:
ADDRESS:
q/
Yr i
DATE
f
-� (0de
Q0,7
4
J;; c 7p J w! lst3
��i£
//i
vs7' Zol$
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61
- 3-05:
c,e/v'-t `// f
a 1 f
/'� 5"� Z`f ! —o
avic A'Q%,-
DATE: S�Z��a
1e
S-Cs
e
"i••; RBARA SOBRINO
� + MY COMMISSION # FF 195634
EXTRES�February
6 nde 1 Underwriters
One
Paving Inc. Proposal/Contract
CGC 1513719
TO: f-re
PROJECT: �Dr►Noe.c.v r-1NAME: IA . 13 < o dA NAME:
ADDRESS: ADDRESS: VG-S. ►J € 110
PHONE:
FAX: DATE 7/$/ !i)
DESCRIPTION
WE PROPOSE PERFORM ALL MATERIALS, LABOR AND EQUIPMENT NECESSARY FOR THE FOLLOWIG SCOPE OF
WORK -Nv \76 s ` u .?G.i h vl cf-fi ( v' '1 (� LQC V7 c lI�r
1
VJ0O
Parr
- 40 "l� - -to `l
The work and performed by the co may result in a lien being placed on the premises described above, in case the owner or contractor default its in any
payment under this contract owner hereby agrees to accept full responsibility for all fences, sidewalks, all underground pipes, wires septic tanks, drain linos,
wells, eta unless stated above. Owner is liable in full amount of contract in the event owner cancels after work has started. The co shall not be responsible
for damage or delays do to strikes, fires, accidents, or the others cause beyond its control, not for inherent defects in the premises on which work to be done.
In the event of any default of this contract by owner -owner agrees to pay all cost and reasonable attomeys fees incurred by One Stop Paving, Inc. as a result
of said default. All materials are guaranteed to be as specified. All work to be completed in a workman like manner according to standard practices. Any
alteration or deviation from above specifications invohring extra cost will be executed only upon written orders and will become an extra charge over and
above the estimate. This proposal subject to acceptance within_- days and is void thereafter at the option of the under signed work shall begin within 10
days of this contract being signed by all parties here and retum to the co. On stamp concrete work contractor will not be responsible for variation results on
the color select by Owner.
TOTAL PROPOSAL
SUBMITTED BY: Carlos Aco
Dtance of contract
The above prices, s ifi lions and «� ditions aje hereby accepted. You are to do the work as
specified payment wil bade as ou
APPROVED BY:
DATE:
1463 NE 173 ST N. MIAMI BCH FL 33162
PHONE: 786 2991354
FAX: 305 947 3233
111111111111111111111111111111111111111111101
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. Ds ZJ gt(TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
C F= N 2e o f 6 -a a-3-34-90
OR E.K. .31094 Pc 362? (1Pas'
H,'tRVEY `;lid IN! CLERK OF COURT
M AN--LiADE COUNTY? Ya FLORIDA
Spaco above reserved for use of recording office
1. Legal d scriptionlef propprty and street/address: /5--- AJ //0 S7( a- sIc< FL 33/6 /
Cp fie o Her, 4 fS ?e 40-g £ / fir (iL4 Z
2. Description of improvement:
,.en Co , cede e ,,,et
3. Owner(s) name and address: f."& ALE (/0 si ,r,-t. Slid S T6 33 /6/
Gt�f flz,'co Sig
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name, address and pho e number: t�vlo 9.7`1 � N / 'J &r
( 460 3 alb 173 s' c.4 3 /pZ
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated b
Section 713.13(1)(a)7., Florida Statutes,
Name, address and phone number:
8. In addition to himself, Owners designates the fa
713.13(1)(b), Florida Statutes.
Name, address and phone number: B
f26 •ZcCf 1351
y Owner upon whomgrylti( C6rFdtf atteV 1 ��}�- e e ':AI,edas
�y CERTIFY fit tic is d
original filed in this office
s t1111d �K7 aD. 2U _.-•--.sue —
Hawing person(s) to re aks 'b' t'Of.t,tr ,� ��r JI J ya, de
HARVEY Ru rv, uu�
9. Expiration date of this Notice of Commencement:
(the expiration date is 1 ye:.' rom the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN 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 NO110E OF COMMENCEMENT.
Signatures) of 0
Prepared By
Print Name
Title/Office
Lvv7g Y'—
or Owner(/' AuthorizJ• Officer/Director/Partner/Manager
Prepared By
Print Name
Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foreego`r o instrumentwas apknowledged before me this day of
❑ Individually! or Q as for
❑ Personacla„aE d ,,.;,cudr t„ g
BARB/4110*W of
MY COMMISSION 11 FF 195634
EXPIRES: February 3, 2019
j. ° bonded Thou Notary Public Undswriters
VERIFICATFLORIDA STATUTES
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in it are true, to the best of my knowledge and belief.
Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above:
By By
12301-52 PAGE3 6112
type of identification:
ry Public:
int Name:
(SEAL)
AC.Y]R�JQ°
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD1YYYY)
08/06/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lithe certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
First Class Insurance Market
4101 NW 9th Street
Miami, FL 33126
Phone (305) 441-2997
Fax (305) 441-6443
CONTACT
NAME:
PHONE
(305) 441-2997 FAX No):
(305) 441-6443
DRESS:
icimc@aol.com
INSURER(S) AFFORDING COVERAGE
NAIC d
INSURERA:
ATLANTIC CASUALTY INS COMPANY
INSURED
ONE STOP PAVING INC.
1463 NE 173 STREET
NORTH MIAMI BEACH, FL 33162
INSURER B :
INSURERC:
INSURER D :
INSURER E :
INSURERF:
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
PERIOD
WHICH THIS
TERMS,
IN
R
TYPE OF INSURANCE
ILAWIL
POLICY NUMBER
(MMMIUDCYDJYYYY)
p
(MNireo YYYY)_
UNITS
A
5 COMMERCIAL GENERAL LIABILITY
N
L196000387
07/17/2018
07/17/2019
EACH OCCURRENCE
$ 1,000,000.00
TO
PS(RENTED
PRREMIEMI ESES (Ea occurrence)
MED EXP (Any one person)
$ 100,000.00
• CLAIMS -MADE 5 OCCUR
❑
$ 5,000.00
mNo
PERSONAL&ADVINJURY
$ 1,000,000.00
GEN'L AGGREGATE LIMITAPPUES PER:
• POLICY • JECT • LOC
GENERAL AGGREGATE
$ 2,000,000.00
PRODUCTS -COMP/OP AGG
$ 1,000,000.00
III OTHER
$
AUTOMOBILE LIABILITY
-
CEOs aBD�) SINGLE LIMITf
$
BODILY INJURY (Per person)
$
• ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
• AUTOS - AUTOS
pp20PERTY AMAGE
@
$
NON -OWNED
• HIRED AUTOS • AUTOS
$
• ■
❑ UMBRELLA LIAB •OCCUR
EACH OCCURRENCE
S
AGGREGATE
$
EXCESS LIAB III CLAIMS -MADE
❑ DED II RETENTIONS
s
WORKERS COMPENSATION
AND EMPLOYERS' UABILITY Y 1 N
ANY PROPRIETORIPARTNEWEXECUTIVEn
OFFICEPJMEMBER EXCLUDED?
(Mandatory In NH)
If yes, descnbe under
N 1 A
II l rkUT£ • ER
EL EACH ACCIDENT
$
E.L DISEASE - EA EMPLOYEE
$
EL DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required)
CGC 1513719
E 231500
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2ND AVENUE
MIAMI SHORES, FL 33138
SHOULD ANY OF THE ABOVE DE
THE EXPIRATION DATE THEREOF
ACCORDANCE WITH THE POUC
AUTHORIZED REPRESENTATIVE
ACORD 26 (2014/01) QF
SC BED POLICIE
OTICE WILL BE
PROVISIONS.
E CANCELLED BEFORE
LIVERED IN
ORATION. All rights reserved.
are registered marks of ACORD
e •
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER)
BOARD AND CODE ADMINISTRATION DIVISION
NOTICE OF ACCEPTANCE (NOA)
Buckeye Technologies, Inc.
1001 Tillman Avenue
Memphis, TN 38112
MIAMI-DADE COUNTY
PRODUCT CONTROL SECTION
11805 SW 26 Street, Room 208
Miami, Florida 33175-2474
T (786) 315-2590 1' (786) 3152599
www.miamidade aav/econon v
•••.
•
•
SCOPE:• •••• •••.•.
This NOA is being issued under the applicable rules and regulations governing• use dt; Ft Struction •.
materials. The documentation submitted has been reviewed and accepted by MininiLDade Coauity RE- • • :
Product Control Section to be used in Miami Dade County and other areas whoa alkwed by he.Authoilty • •:
Having Jurisdiction (AHJ). .... � � � • �
This NOA shall not be valid after the expiration date stated below. The 14liami-Dade '' nnty i*8du•t Con4ygj• • •
Section (In Miami Dade County) and/or the AHJ (in.areas other than Miami 17gtjg County) reserte the rtglit...
to have this product or material tested for quality assurance purposes. If thin pr8dct or rnaterial fails toe
perform in the accepted manner, the manufacturer will incur the expense of such testing apd•tibe.A137 u??}* • •
immediately revoke, modify, or suspend the use of such product or material within £heir jtic.iid fiction. ti .,
reserves the right to revoke this acceptance, if It is determined by Miami -Dade County'Plociitet Control '
Section that this product or material fails to meet the requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the Florida Building
Code, including the High Velocity Hurricane Zone.
DESCRtr1IO1V: UltraFiber 500 Concrete Reinforcing Fiber
APPROVAL DOCUMENT: Drawing No. 1, titled "IJltraFiber 500 Concrete Reinforcing Fiber", sheet 1 of
1. rrnteci 11/24/200R, rr prn...et by D..eico • Tooi.noto5ioe, Ir o, oisu U and cualcd by Thomas. A_ Kolden,
bearing the Miami -Dade County Product Control renewal stamp with the Notice of Acceptance number and
approval date by the Miami -Dade County Product Control Section.
MISSILE IMPACT RATING: None
LABEL ING: Each unit/bag shall bear a permanent label with the manufacturer's name or logo, city, state
and following statement: Miami -Dade County Product Control Approved", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been
no change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change
in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of
any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to
comply with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT; The NOA number preceded by the words Miami -Dade County, Florida, and followed
by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then
it shall be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its
distributors and shall be available for inspection at the job site at the request of the Building Official.
This NOA revises NOA // 06-0501.12 and consists of this page 1 and evidence page E-1, as well as approval
document mentioned above.
The submitted documentation was reviewed by Carlos M. jitrera, P.E.
Expiration DaNA No.
tEaJa t ar 14-0728.02
Approval Date; October 16, , 2 019
..014
Page 1
Buckeye Technologies, Inc.
NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED -
A. DRAWINGS "Submitted iinderNOA # 06,0501.12"
1. Drawing No. 1, titled "UltraFiber 500 Concrete Reinforcing Fibeir", speet 1 of 1; tlated
11/24/2008, prepared by Buckeye Technologies, Inc, signed and'seale4 b as A. .' • •
Kolden, P.E. y Th4m. "
... • • •
•
..
•... ......
B. TESTS "Submitted under NOA # 06-OSOLI2» • •' • • . ' • • • • • `
•1. Test report on Concrete Residual Strength per ASTM C1399 0 .... • fiber Sa..: . •
Concrete Reinforcing Fiber, prepared by Stork Twin City Testifg.Corporation, rest .. •
•
Reports No. 308195.1 and 308195.2, both dated 10/24/2008, signed by Thomas,A. .... ..
Kolden, P.E. •
....
. . • ••
• .
• •••ll.
• ••• .
. •
• ..
C. CALCULATIONS
1. None.
D. QUALITY ASSURANCE
1. Miami -Dade Department of Regulatory and Economic Resources (RER)
E. MATERIAL CERTIFICATIONS "Submitted under NOA # 06-0501.12"
1. Engineering Evaluation Report and Addendum per ASTM C1399 of Buckeye
UltraFiber 500, prepared by Ardaman & Associates, Inc., dated on 01/10/2006 and
01/04/2007 respectively signed and sealed by Joseph A. Amon, P.E.
F. STATEMENTS
1. Statement letter of code conformance to 2010 FBC issued by Element Materials
Technology, dated 07/15/2014, signed and sealed by Thomas A. Kolden, P_E.
E -1
Carlos M. Utrera, P.E.
Product Control Examificr
NOA No. 14-0728.02
Expiration Date: January 28, 2019
Approval Date: October 16, 2014
General Notes:
Buckeye Ultrariber 50019
Buckeye Technologies, Inc.
1001 Tillman
Memphis, Tennessee 38112
(901) 320-8100
www.ultrafiber500.com
er500.com
1.0 Description:
Buckeye UltraFiber 500 is made from virgin cellulose fibers that have been
chemically processed and then treated with a mineral -based chemical that
results in an alkaline -resistant fiber. The fibers are used in normal weight and
light weight concrete. The fibers are used as a concrete admixture to assist in
controlling plastic sbainkage of reinforced concrete and structural plain
concrete. The fibers are also used to reduce shrinkage and temperature
cracking in structural plain concrete slabs on grade. Structural plain concrete
provisions are found in Chapter 22 of AC1318 and section 1910 of the FBC.
2.0 Installations:
Buckeye UltraFiber 500 virgin cellulose fibers must be dispersed uniformly
through the concrete mixture in accordance with ASTM C1116.
The fibers must be blended into the concrete mix at a minimum rate of 1.0
pounds per cubic yard (0.59 lcg/m3) of concrete. The dosage must not exceed
1.5 pounds per cubic yard (0.89 kg/m3).
Buckeye's published installation instructions using either a dispersible bag
system or a bulk time metric dispenser must be strictly adhered to.
3.0 Specifications:
Buckeye UltraFiber 500 meets or exceeds the following specifications:
A. ASTM C1116 — Standard Specification for Fiber Reinforced
Concrete.
B. ,ATM D7357 — Standard Specification for Cellulose Fibers for
Fiber Reinforced Concrete.
4.0 Evidence Submitted:
o ICC Evaluation Services, Inc. Report ESR-1032.
o Data in accordance with ASTM C1399 — Average Residual Strength
of Fiber Reinforced Concrete from Stork Twin Cities Testing, St.
Paul, MN.
o Underwriters Laboratories, Inc. CBXQ.R25038 and BXUV.D973
.r
moot= ROWED
axspayize with eas Reside
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• Date
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Sheet 1 of 1
elfiucfceyoe TP,c$T101ogtes, c.
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Lnbrr,l:T1UN NUTt$: • Reinforcing steel for pavers concrete edge will be checked at __
rock inspection.
f NO REINF..IN PUBLIC.R.O.W.
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RECEIVED
AUG 0 7 2018
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BOUNDARY SURVEY
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SCALE: 1"-= 20'
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LEGEND
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LOT 14 BLOCK 2
RES/I 158 NE 110 ST.
FF ELEV=12.70'
GARAGE ELEV=11.70'
75.00' R & M
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I.P. BLOCK-2
Se\
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2'x2 6')
- - Overheod Wire Line
- - Wood Fence
- x - Choin Link Fence
0 =Light Pole
=Woter Meter
=Catch Bosin
U.E=Utility Easement
P.C.=Point of Curvature
® =Found 1/2- Iron PIN
(14)=Meosured (P)Plot
Page 2 of 2
BOUNDARY SURVEY
PROPERTY ADDRESS:
158 NE 110 STREET, MIAMI SHORES, FL 33161
LEGAL DESCRIPTION:
LOT 14 BLOCK 2 of "COLLEGE HEIGHTS" according to the plat thereof''as recorded in Plat
Book 42 at Page 8 of the Public Records of Miami -Dade County, Florida.
SURVEYOR'S NOTES:
•••-
1) The above captioned _ Property was surveyed and described based on the `agOv¢ Lega1'D�scripthM•;
Provided by Client. •••••• ••••••
2) This Certification is only for the lands as described. It is not a certification of Titie!4oning, Eabements•on'•
•
Freedom of Encumbrances. ABSTRACT NOT REVIEWED. •••••
•
3) There may be additional Restrictions not shown on this survey that may be foun8'iffthe PulskPftecordsol.
this County, Examination of ABSTRACT OF TITLE will have to be main: detentr e; recoroled.'
instruments, if any affecting this property. •• •..•.•
4) Accuracy: •
: •":•':
• •
•
The expected use of the land, as classified in the Minimum Technical Stand§rd 1 {5J-17:,•i5•'Residinfi��'
High Risk". The minimum relative distance accuracy for this type of boundary•survey is 1•foct in 114,000•
feet. The accuracy obtained by measurement and calculation of a closed geometric figure• woes found to
exceed this requirement.
5) Foundations and/or footings that may cross beyond the boundary lines of the parcel -herein described are
not shown hereon.
6) Not valid without the signature and the original raised seal of a Florida Licensed Surveyor and Mapper.
Additions or deletions to survey maps or reports by other than the signing party or parties are prohibited
without written consent of the signing party or parties.
7) Contact the appropriate authority prior to any design work on the herein -described parcel for Building and
Zoning information.
8) Underground utilities are not depicted hereon, contact the appropriate authority_ prior to any design work or
construction on the property herein described. Surveyor shall be notified as to any deviation from utilities
shown hereon..
9) The surveyor does not determine fence and/or wall ownership.
10) Ownership subjects to OPINION OF TITLE.
11) Type of Survey: BOUNDARY SURVEY
12) North arrow direction and bearings are based on Recorded Plat Book 42 at Page 8 of the Public Records
of Miami -Dade County, Florida..
13) Elevations are based on the National Geodetic Vertical Datum of 1929.
14) Bench Mark Used: # N-566 of Miami -Dade County, FL Elev. = 10.78'
15) Flood Zone: X Base Flood Elev = N/A as per Miami -Dade County, Florida. FEMA Panel Number:
12086C0139-L-September 11, 2009.
16) This PLAN OF SURVEY has been prepared for the exclusive use of the entities named hereon. The
Certificate does not extend to any unnamed party:
SURVEYOR'S CERTIFICATE:
I Hereby Certify to the best of my knowledge and belief that this drawing is a true and correct
representation of the BOUNDARY SURVEY of the real property described hereon.
I further certify that this survey was prepared in accordance with the applicable provisions of
Chapter 5J-17, Florida Administrative Code. Copies of the Boundary Survey are not valid without
the signature and the original raised seal of a Florida Licensed surveyor and mapper.
Sergio Redondo & Associates, Inc.
LB No. 4474
Field Date: 7/16/2018
Field Book: File
Prepared By: NR
Sergio "edondo P.S.M.
Professional Surveyor & Mapper
State of Florida Reg_ No_3162
SERGIO REDONDO & ASSOCIATES, INC.
Professional Land Surveyors and Mappers
13800 SW_145th COURT, MIAMI, FL 33186
Phone 305-378-4443 Fax: 305-378-4582
info(c�miamilandsurveyors.com