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RC-19-655Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 269 NW 111TH TER, Miami Shores, FL 33168 Contacts C= t�CG�ni9� Issue Date: 07/09/2019 Parcel Number 1121360010360 Permit NO.: RC -0349-655 Permit Type: Building (Residential) Mork Classification. Garage: Enclosure Permit Status: Approved Expiration: 09/23/2019 Blessed Management Group Owner EDDIE CONTRACTOR CORP Contractor 269 111 EDELSO SILOS LAVADO 27925 SW 26 ST, MIAMI, FL 33133 Business: 5613196883 Inspection Re guests: Description: ADDING A BATHROOM IN GARAGE ( GARAGE Valuation: $ 4,500.00 Inspe tion IR CONVERSION) Total Sq Feet: 646.00 Fees Amount Application Fee - Other $50.00 CCF $3.00 DBPR Fee $2.03 DCA Fee $2.00 Education Surcharge $1.00 Permit Fee $85.00 Planning and Zoning Review Fee $35.00 Scanning Fee $15.00 Structural Review ($90) $90.00 Technology Fee $3.38 Total: $286.41 Payments Date Paid Amt Paid Total Fees $286.41 Check # 2238 07/09/2019 $236.41 Check # 615 03/27/2019 $50.00 Amount Due: $0.00 Building Department Copy 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 that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. i ignature: Owner / Applicant / Contractor / Agent Date July 09, 2019 Page 2 of 2 ON ON 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 BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL F-] PUBLIC WORKS JOB ADDRESS: Z fort " It l-1- I -e r mm C MAR 2 7 1019 \'_A&I - FBC 2011 104) Master Permit No. l � 3- I — (05 Sub Permit No ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: t 1'-2 I'S G" 001-b 3 & 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 3les°�d �� la► 4�'►�� C` t3 w� Phone#: Address -7(02-71 nJ F, 70- 3'``0� S-+' *t7 Z 1'g 41 City: A x -ex -A "r"_ State: 4:7(' Zip: 3 31 Tenant/Lessee Name: Email: mo: 1. L o ✓►', /OcS, US e#: CONTRACTOR: Company Name: AA Phone#: Address::" "3V�op� O3 City: V w<-� > State: F—(— Zip: Qualifier Name: Phone#: 3 64_y2_16 66 State Certification or Registration #: C �v C /�� J� C% Certificate of Competency #: DESIGNER: Architect/Engineer: Value of Work for this Permit: 41-1 7 $O 0 Type of Work: Addition A teration Description of Work: uGlrAevz 'CjDm RrSi' nn Phone#: State: Zip: quare/Linear Footage of Work: G t 6 ` 36 3jy ape New ❑ Repair Replace 1:1 Demolition Monona on o n l I nS i cls q ayck c` -e Specify color of color thru tile: Submittal Fee $ `J G1► Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $, (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ i TOTAL FEE NOW DUE $ 2-3� • Li 1 Bonding Company's Name (if applicable) Bonding Company's Address Cityy� /_ State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 b p ted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence ofuch p sted notice, the inspection will not be approved and a reinspection fee will be charged. I—) Sign atu re OWNER or AGENT The foregoing instrument was acknowledged before me this I a1 qday of 0 t -t- 20 ) ? by 6r,�d2, 0.l1u-GL_- , who is personaUy known to 'm_e_r who has produced identification and who did take an oath. ,F NOTARY PUBLIC: Sign: Print: Seal: BRITTAWS= • •„ MYCOMM0101 (i23 o i »RES: dune 25, 2022 Pu6Ac Undmb APPROVED BY (A.11 (Revised02/24/2014) Signatu The foregoing instrument was a_ackn�iwledged before me this day of tit / , 20 Q by Ebb sD ! AS Ly o ,,dho is personally kno�,wr�tn as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: � n Print: �' �''`1 S 0 C -C, Seal: Plans Examiner 71 i Structural Review 6R1T•fAWSOCOL W COMN►1168" P 06 232035 V0W,A e20,2022 T a 41 LS as Zoning Clerk EDDIE CONTRACTOR CORP. STATE GENERAL CONTRACTOR cgc* 1815049 3470 nw 183 st Miami mgardens (1 33050 EDDIE CELL 305 926 6638 ode ive.com Date � 1 vl State F1, County Before me this day personally appeared ?,::S&� Who beging duly sworn,depose and say: That he or she will be a only person workingon project located at: .2 G f rs w /// 416' N •; c"-' W v/ � Sworn to ( r a Tod) nd subscribed before me this days o 2019 By Personally know Or produced Identification F -,044i- Tipe of identification produced P`♦"",, �`f MGUER RA SIONaGEM92 r��,� Zu,z�zl Print type or stamp na a of notary ,www.swift *" Pape 1 of 2 SSAIM-MO • a«. OW4 CONTRACT PROPOSAL for BLESSED MANAGEMENT GROUP 1. Bathroom Addition in Garage 2. Managing permit and approval process Total Price for project - $4,500 Regards, Ew4s sd" z Edelso Silos Lavado Eddie Contractor Corp RECEIVEID J L 05'20'3 BY: t r�leSS � 6-eb y -? c -03- iq- SSSS Eddie Contractor Corp �::::• 0000.. .•. .r . 26' St 27925 SW . Z .... 0000 0200 100.4 Miami FI. 33133 •..0.1 . 1 " •.•00• • . . • • r . Tel. 305-926-6638 • , s • • • • . • . March 25, 2019 CONTRACT PROPOSAL for BLESSED MANAGEMENT GROUP 1. Bathroom Addition in Garage 2. Managing permit and approval process Total Price for project - $4,500 Regards, Ew4s sd" z Edelso Silos Lavado Eddie Contractor Corp RECEIVEID J L 05'20'3 BY: t r�leSS � 6-eb y -? c -03- iq- SSSS `//� �2LGdl2fi J�OhP,6 li G! "PAVIS & DEVELOPMENT ORDER 13050 N.E. SECONED AVENNJE, M? AMI�4401RES. FLORID-"� 23�E32, JE Tc LEPHONF (305] 795-22,07 FAX [3051 756-8972 File Number: DO-STPL-000001 -2019 Property Address: 269 Ni W I I Vh Terrace, Miami Shores. FL 33 ) 168 Property Owner: Blessed Management Group Add ress: 26`?? N E 203rd St r e, e t. X218, A v e n t u r a, PI, 33180 Applicant: Jesus Lopez Address: 1.608 NW 26'h Avenue,. Miami. FL Agent: Eddie Contractor Corp. Address: 3470 NW 183 Street., Miami Gardens, FL 33056 Whereas. the applicant Jesus Lopez (owner.), has filed an application for site plan review before the Planning Board on the above properiv. The applicant sought approval as w follows: Pursuant to Articles IV, V and VI of Appendix A Zoning, Sec. 400 Schedule of Regulations and Sec. 600. Site Plan Review and approval required for a garage Z-1 conversion. Where -as, a public hearing was held on Februan, 28, 2019 and the Board, after having considered the application and after hearing testimony and reviewing the evidence entered, finds - I . The application was made in amanner consistent with the requirements of the Land Development Code of Miami Shores Village. 2. The conditions on the property and the representations made at the hearing merit consideration and are consistent with the requirements of the Land Development Code, T'he Board requires that all further development of the property shall be performed in a manner consistent with the site plan, drawings.. and the conditions agreed upon at the hearing: I ) Approval is granted as shown on the plans submitted and made a part of this approval. 2) Applicant to maintain two (2) legal parking spaces on site. Page I of 2 VISITuj mians-hosv reOlage.mco 3) applicant to apple for and obtain all required building permits from the Building Department before beginning work. 4) applicant to apple for and obtain all necessary permits and approvals from outside agencies. 51 applicant to obtain all required permits and approvals from the Miami -Dade Department of Regulatory and Economic Resources. Environmental Plan. Review Division (DRER, EPRD) and the Miami -Dade Department of Health (DOHIIHRS) as required. b) Applicant to meet all applicable code provisions at the time ofpermitting. i) This zoning permit will lapse and become invalid unless the work for which it was approved is started within one (1) year of the signing of the development order by the board chair, or if the work authorized by it is suspended or abandoned for a period of at least one (1) year. Additionally, the applicant must, satisfy all applicable Miami Shores Village Codes. Nliami-lade County Godes, the applicable building and life safety codes required for development. and provide a copy ofthe development order to the Building Dept. The application with conditions was passed and adopted this 28"" day of February, 2019 by the Planning and Zoning Board as follows: Motion to approve subject to Staffs recommendations made by Mr. Harrison Bergman, seconded by Mr. Daniel Brady and the Motion was approved 4-0. Mr. Snow absent Mr. Ber�Inan Yes Ms. fleiedus t"mss Mr. f3QV Yes Chairman Busta Yes Date John Busty Chairman, Planning Board Page 2 of 2 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 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 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: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this �� day of —N V) , 20f? . By a" � pp �,,�_ who is personally known to me or has produced as identification. Notary: SEAL: 1 BRITTANYS0006 ., MYCOMM MION#00232OX =x EXPM June 26,2M Ir Ir A40Y 'N 0 Nvt J4104rs V6 File Number: DO-STPL-000001 -2019 Property Address: 269 NMk' I I I "'Terrace. Miam]'Shores. FL 33168 Property Owner: Blessed Management Group Address: 2627 NE 203 ) Street. #2 IS. Aventura. Ff. 33180 Applicant: Jesus Lopez Address: 1608 :tilt/ 201' Avenue. Miami. Ff, Anent: L-ddie Contractor Corp. "n Address: '1470 NW 19' ) Street. Miami Gardens. Fl, 33056' Whel-CaS,. The applicant.lesus Lopez (owner). has filed an -Opplication for site plan review before the Planning Board on the above proper y. The applicant sought approval as follows: Pursuant t.) Articles IV, V and VI of Appendix A Zonin."� Sec. 400 Schedule (11' Reoulations and iec. 600. Site Plan Review and opprovat reqLlil-Cd for a garage convers', Whereas. a publie hearing -was held on February 28, 2019 and the Board. after having considered the ap).lication and after hearing testimony and rte entered. finds: I t _ -)r the evidence Thelapplication N�as made in a manner consistent with tile requirements oi' the 1[.and Development Code of :Miami Shores Village. 2. The ,wilditions on the propertvand the representations made at the )tearing W -- merit consideration and are consistent %p1th the r1equirernents of the I -and I I Dcvlopnient Gide. The Board require� thitt all further development of the property shall be performed in a manner consistent �vith the site plan. dra%vings, and the conditions agreed upon at the hearin-: Approval is granted as sho-,vn on the plans submitted and made a part ot'i is approval. 2) Applica I to maintain two (2" legal parking spaces Oil site. Pate I of 2 ViSIT US DEVELOPMENi ORDFR File Number: DO-STPL-000001 -2019 Property Address: 269 NMk' I I I "'Terrace. Miam]'Shores. FL 33168 Property Owner: Blessed Management Group Address: 2627 NE 203 ) Street. #2 IS. Aventura. Ff. 33180 Applicant: Jesus Lopez Address: 1608 :tilt/ 201' Avenue. Miami. Ff, Anent: L-ddie Contractor Corp. "n Address: '1470 NW 19' ) Street. Miami Gardens. Fl, 33056' Whel-CaS,. The applicant.lesus Lopez (owner). has filed an -Opplication for site plan review before the Planning Board on the above proper y. The applicant sought approval as follows: Pursuant t.) Articles IV, V and VI of Appendix A Zonin."� Sec. 400 Schedule (11' Reoulations and iec. 600. Site Plan Review and opprovat reqLlil-Cd for a garage convers', Whereas. a publie hearing -was held on February 28, 2019 and the Board. after having considered the ap).lication and after hearing testimony and rte entered. finds: I t _ -)r the evidence Thelapplication N�as made in a manner consistent with tile requirements oi' the 1[.and Development Code of :Miami Shores Village. 2. The ,wilditions on the propertvand the representations made at the )tearing W -- merit consideration and are consistent %p1th the r1equirernents of the I -and I I Dcvlopnient Gide. The Board require� thitt all further development of the property shall be performed in a manner consistent �vith the site plan. dra%vings, and the conditions agreed upon at the hearin-: Approval is granted as sho-,vn on the plans submitted and made a part ot'i is approval. 2) Applica I to maintain two (2" legal parking spaces Oil site. Pate I of 2 ViSIT US 3) Applicint to apply for and obtain all required building permits froin. the Building Department before be -inning xvork. 4) Appliefflit to apply fir and obtain all necessary permits and approvals from outside agencies. 5) Applic4tnt to obtain all required permits and approvals from the Miami -Dade Department of Reizulatory and E'conoinic Resources. Environmental Plan Revie� .Division (DRER. El)RD) and the Miami -Dade Department offlealth (I)OHI/1-IRS) as required. 6) Applicint to meet all applicable code provisions at the time of permitting. 7) This zoninCrt� permit will lapse and become invalid unless the work for which it was approved is started Nvithin one (I) year cal` the signing, Of the development order tty the board chair. or if the work authorizCd b.v it it-, suspended or ahand_ed for a peri 00, ot',,It leas,, one I ) y-ejjr. Additionally. thePi I Plcant must. satisfy all applicable Miarni Shores Village Codes. Miami -bade Coto lY Codes, the applicable building and lite safety- codes required for' c, development, and �rovide a cOPY 01P the development order to the BuIldin., Dept. The application wi�h conditions was passed and adopted this 28111 day of Februar. 2019 bv the Planning allcl Zoning Board as fbllmvs: Motion to Ber�-,man. -Mr. Snow Mr. Bergman Ms. Heuedus Mr. Brady Chairinan Busta Date e subject to Staff's recommendations made by Mr. Harrison d by -Mr. Daniel Brady and the Motion was approved roved 4-0. Absent Yes Yes Yes Yes k1- =... . - z . ............. . . John Busta Chairman, Planning Board Page 2 of2 Miami shores Village RECEIPT PERMIT #. I — S DATE: 1. 43 __a Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �J (Name) ❑ Co n e r ❑ Architect 1 Picked up 2 sets of plans and (other) Address: Z&! 1, t 1 ( -1 61rL From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Signature: (SIGNATURE) PERMIT CLERK INITIAL: �1 RESUBMITTED DATE: PERMIT CLERK INITIAL: ECO -TECH PLUMBING G CORP. LIC# CFC 1428624 Friday, May 3rd, 2019 To: Miami Dade County Building Department Water and Sewer Department In Reference To: 269 NW 111th. Terrace, Miami Shores, Fl Process No. M-2019010827 I was. retained by BLESSED MANAGEMENT GROUP LLC, owner of the property located at 269 NW 111th. Terrace, Miami Shores; to perform a WATER PRESSURE TEST to the water line of the Property. On 05/03/2019 we went to perform. the Test,_ giving as results 60_ pounds of pressure, which complies with the code. (Pictures attached) Please, if e any question, do not hesitate to contact me at 786-255-3425 Maria . imiraos ECO TECH PLUMBING CFC1428624 19507 NW 55 CIRCLE PLACE, MIAMI, FLORIDA 33055 PHONE: 305-969-5486 - FAX: 305-718-0650 E-MAIL: INFO @ECOTECHPLUMBING.NET ECO-TECH td�rk - -tl PLUAIBI\G CORP. LIC# CFC 1428624 In Reference To: 269 NW 111th. Terrace, Miami Shores, Fl Process No. M-2019010827 t - 19507 NW 55 CIRCLE PLACE, MIAMI, FLORIDA 33055 PHONE: 305-969-5486 - FAX: 305-718-0650 E-MAIL: INFO@ECOTECHPLUMBING.NET ECO -TECH PLUMBING CORP. LIC# CFC 1428624 19507 NW 55 CIRCLE PLACE, MIAMI, FLORIDA 33055 PHONE: 305-969-5486 • FAX: 305-718-0650 E-MAIL: INFO@a ECOTECHPLUMBING.NET 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: BLESSED MANAGEMENT GROUP LLC. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 269 NW 111 TERRACE JOB #18815-B (JV) • City State ZIPCoda • • • • ... MIAMI SHORES Florida 33108-• • 316'8A3. A3.Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 20, B-2 "NEW MIAMI SHORES ESTATES", PB 51, P 80, of the public records MIAMI DADE County �F�ol f11 -2136-.02.1-P360 • • A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL •��• "" "" A5. Latitude/Longitude: Lat. 25° 87' 76.60" N Long. 80° 20'31.80" W Horizontal Datum: [•}W1927 MAID 1983 •. A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insuranc;. • • • .•.. AT 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 It 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 Z No A9. For a building with an attached garage: a) Square footage of attached garage 200.00 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 CITY OF MIAMI SHORES 120655 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 12086CO139 L 09-11-2009 09-11-2009 X N/A B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: ❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 139: ❑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 ❑x No Designation Date: N/A ❑ CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 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: 269 NW 111 TERRACE JOB #18815-B (JV) City State ZIP Code Company NAIC Number MIAMI SHORES Florida 33168 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* Z 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, ARAE, AR/Al—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter nelgr%.•. Benchmark Utilized: N-566 Vertical Datum: Elev.= 10.78' ( NGVD4929 j • • • • • • • • 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. • • • • • • • • • �wec�4crthe measarernent used... a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 12.53• a ®� *feet � meters • • b) Top of the next higher floor N/A • p feet b T eters • • • c) Bottom of the lowest horizontal structural member (V Zones only) N/A [] Meet .❑ meters ... d) Attached garage (top of slab) 11.3: • • ® Meet •❑ .eters :604 e) Lowest elevation of machinery or equipment servicing the building 11.55 ❑ x feet • •meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 11.41 x❑ feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 11.51 x❑ feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including ❑ feet ❑ meters N/A structural support 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. l certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement maybe 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. Certifier's Name License Number ARTURO TOIRAC, P.L.S. 3102 Title PROFFESIONAL. SURVEYOR & MAPPER - Company Name VIZCAYA SURVEYING AND MAPPING, INC. ere Address 13217 SW 46 LANE 3102 - City State ZIP Code MIAMI Florida 33175 G � Signature Date Telephone Ext. 06-26-2019 (786) 290-4184 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) C.O.R. Elevation = 11.38' C2. e) A/C CONC. UNIT ON THE NORTH WALL FACADE A5. CONVERTING ADDRESS TO LATITUDE/ LONGITUDE BY Stephen P. Morse PROGRAM FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 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: 269 NW 111 TERRACE JOB #18815-13 (JV) City State ZIP Code Company NAIC Number MIAMI SHORES Florida 33168 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 ore pelow the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). ; .0. •"' a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters Q54M or ❑ belowthe HAW b) Top of bottom floor (including basement, """ ' ,.. crawlspace, or enclosure) is ❑ feet ❑ meters 0 d'v� or [] b2fb0�the LAG. .... .... ... E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (s(ZaA8 1-2 of Instructions)..; the next higher floor (elevation C2.b in • ' 000000 the diagrams) of the building is ❑ feet ❑ meters 1� above or d below the HAG E3. Attached garage (top of slab) is ❑ feet ❑ meters n abode or [::" ppv�the HAK3.• E4. Top of platform of machinery and/or equipment* ; �, .. ;' • d servicing the building is El feet El meters above or L; br"o*rthe 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 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 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 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: 269 NW 111 TERRACE JOB #18815-B (JV) City State ZIP Code. Company NAIC Number MIAMI SHORES Florida 33168 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 IicenseciMweyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source 4rfd date of flfb•2levation• • • data in the Comments area below.) • • 000 • G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA-iss4fW,0.q mmunity-issued BFF or Zone AO. • • • G3. ❑ The following information (Items G4—G10) is provided for community floodplain management pur' bgdgs. • so 00 G4. Permit Number G5. Date Permit Issued G6. Date QerlifiWe of Comp,ance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) ❑ feet ❑ meters of the building: 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 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. 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: 269 NW 111 TERRACE JOB #18815-B (JV) City State ZIP Code Company NAIC Number MIAMI SHORES Florida 33168 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. Photo One Photo One Caption HOUSE FRONT VIEW 06-25-2019 Clear Photo One Photo Two Caption HOUSE LEFT VIEW Photo Two 06-25-2019 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. 269 NW 111 TERRACE JOB #18815-B (JV) City State ZIP Code Company NAIC Number MIAMI SHORES Florida 33168 Photo Three I Photo Three Caption HOUSE A/C VIEW 06-25-2019 Clear Photo Three Photo Four Photo Four Caption HOUSE BACK VIEW 06-25-2019 Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 N Scale 1"=20' go M �J 1 0 FJ U it V - +�' PROPERTY ADDRESS: BENCH MARK USED o w 'J'' �I �! �+1 269 N.W. 111 TERRACE m o Z BM #N-566 Elev.= 10.78' MIAMI SHORES, FI. 33168 � W � � z ( FOLIO No. 11-2136-001-0360) converted to NGVD 1929 -,-Q z w WZ W > Inca �z ,y, wQ wJw HOUSE FRONT VIEW 06-26-19 HOUSE FRONT VIEW 06-26-19 LOT -12 BLOCK -2 10' ALLEY FIP 1/2 NO I.D. LU U Z w a 0 0 N LOT -21 BLOCK -2 0.80' FIP 1/2" NO I.D. 5' CONIC SIDEWALK \\o� II' PARKWAY LOT -13 BLOCK -2 LOT -14 BLOCK -2 _"co .4 _ N. W. 1 1 1 t h T E R R. 18' ASPHALT PAVEMENT 50' PLBLIC RIGHT-OF-WAY EDGE OF PAVEMENT DESCRIPTION Lot 20, Block 2, of "NEW MIAMI SHORES ESTATES" according to the Plat thereof as recorded in Plat Book 51, at Page 80, of the Public Records of Miami -Dade County, Florida. There may be legal restrictions on the subject property that are not shown on the Map of Survey that may be found in the Public Records of Miami -Dade County, or the records of any other public and private entities as their jurisdictions may appear. Th M f - --- B 1 /O // /2 a /3 ,♦ Z /e /G - 4 N.n 12th TERR. 8' ASPHALT PAVEMENT rn o�\1) 1 0' A L L E Y (� It m ° • measurement. Attention is brought to the fact that - OE OE T-iiE--�r-GES—GE,� 7/J Z ,� „ OE OE N w sr r r R�•',K -'K6:'�l1/ �-f-a -t-h S -T. Nw N_VttaR1 1 1 t TERR : ••. 6' WOOD FENCE 9S FIP 1/2" y yrs •° _00 — ?`10 NO I.D. %