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DS-19-1148Miami shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ntaL'__ A. r%_. U.uLI;�G «, %JVVilui — vvorKers, t;Ompensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage tinder 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 tinder this workers' compensation exemption and has acknowledge that he or she will not use day labor, pail -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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. I " Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of Q/tt�%r�' 20 By 06_(d P6 (cc 01, who is personally known to me or has produced +/ Wt{I�tl r j CD•�e. s identification. as Notary: ��"t ~ �t s*'K""S My��ItSSIONItGG219372 o? EXXPt9ES: May 17, 2tt22 SEAL. ? Y�' 9o"Toro►aANyK6kureW Scanned by CamScanner PREPARED BY: Land Surveyors, Inc. www.exactaland.com Toll Free 866-735-1916 • F 866-744-2882 PROPERTY ADDRESS: 9632 NE 5TH AVE STREET, MIAMI SHORES, FLORIDA 33138 FIELD WORK DATE: 1/15/2018 17121827 BOUNDARYSURI/EY MIAMI-DADE COUNTY LOOP, ELEVATIONS: 1AIN FLOOP, = 103 PPER FLOOR = 20.9 11DDLE ROOM = 9.45 ,ACK ROOM = 9.2 y r. a ra t 4i tih ,9632 Nonneusl SP Avenue e REVISION DATE(S): (REVO 1/16/2018) _ oL-T1_g Shr_lC' l cle BY DATE T I"FIP Gj �LI 1 Af_L 41 2 STY. RES#9632 �a LOT 2/ T -- BLK 86 f @STONENE PATH No I� 205. N 8913 1'43" W 2 4.38' (M) '- SURVEY NUMBER: 1712.1827-01 TABLE: _1 5 44°4942' W 31 .99' (M) L2 5 0°2923' W 22.58' (M) :2 -it CENEI- 213Y* 8IS AY21209 P EF NO ID @ P.C. NOTES: • LOT APPEARS TO BE SERVICED BY CITY WATER AND SEWER • • • • """ • FENCE AND WALL OWNERSHIP NOT DETERMINED • • • _ •I �•t • • • THE ELEVATIONS SHOWN HEREON WERE OBTAINED U51NG GPS IN CONJUNCTION WITH REAL TIME NETWORK L-NET NAVE) 88 DATUM / •••••• �' �w1 ' 1^ •� • • •••••• CONVERTED • V 1 �• • • AND TO NGVD 1 929 DATUM WITH A CONVERSION FACTOR OF + 1.541 �OTE5 EXISTING ELEVATION IN NGVD 1929 DATUM .Vl{ • • • • • • • •' • " ��l,�y��y�I l hereby certify that ary Survey of the • • • • • • • • • • • hereon described tk h en made under S ( 3�jU • .. .. • • • • • • . ...... • my direction, an o~ thq,4rfst�know/edge ;, �1 •..... • . and belief, it is a It e and acc to representation e I!'r "• •" • .. • • • of a survey tho felt rds of Practice set forth b the lorida Board y � rofessional ,����j `, •' • • •' Surveyors & Map it ; # rpte J-17 of the ` 40 0 • 20 • to �' �s �" Florida Administrate o ode. • N NqC / S"�V`oY GRAPHIC SCALE (In Feet) RONALD W. WALLING � ,6 State of Florida Professional Surveyor and Mapper a�v �cI�' ,\� 1 inch = 40' ft. License No. 6473 { ,�cT' D'�� `dt' k Use of This Survey for Purposes other than Intended, Without Written Verification, will beat the User's Sole Risk and Without Liability to the Surveyor. Nothing hereon shall be Construed to Give ANY Rights or Benefits to Anyone Other than those Certified. FLOOD INFORMATION: [POINTS OF INTEREST BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING ONE VISIBLE MUNICIPALITY OR WWW.FEMA.GOV, THE PROPERTY APPEARS TO BE LOCATED IN ZONE X. THIS PROPERTY WAS FOUND IN THE VILLAGE OF MIAMI SHORES, COMMUNITY NUMBER 120652, DATED 09/11/09. {-- — - - - - - - --- - -- - - 1 CLIENT NUMBER: DATE: 1/16/2018 BUYER: David Halabu SELLER: ESTATE OF MARY ALICE BLAKE CERTIFIED TO: DAVID HALABU; LEXIUM PLLC This is page 1 of 2 and is not valid without all pages. REPORT OF SURVEY 1712.1827-01 11 This is page 2 of 2 and is not valid without all pages. LEGAL DESCRIPTION: LOT 21, BLOCK 86, AMENDED PLAT OF MIAMI SHORES SECTION 4, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 15, PAGE 14, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. JOB SPECIFIC SURVEYOR NOTES: THE BEARING REFERENCE OF SOUTH 45 DEGREES 00' 00" W IS BASED ON THE NORTHWESTERLY RIGHT-OF-WAY LINE OF NE 5TH AVENUE EAST LOCATED IN AMENDED PLAT OF MIAMI SHORES SECTION 4, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 15, PAGE 14, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. GENERAL SURVEYOR NOTES: 1. The Legal Description used to perform this survey was supplied by others. This survey does not determine or imply ownership. 2. This survey only shows improvements found above ground. Underground footings, utilities and encroachments are not located on this survey map. 3. If there is aseptic tank, or drain field shown on this survey, the location is approximate as the location was either shown to Exacta by a third party or it was estimated by metal detection, probing rods, and visual above ground inspection only. No excavation was performed in order to determine the exact and accurate location. 4. This survey is exclusively for the use of the parties to whom it is certified. S. Additions or deletions to this survey map and report by other than the signing party or parties is prohibited without written consent of the signing party or parties. 6. Dimensions are in feet and decimals thereof. 7. Due to varying construction standards, house dimensions are approximate. 8. Any FEMA flood zone data contained on this survey is for informational purposes only. Research to obtain such data was performed at www.fema.gov. 9. All corners marked as set are at a minimum a'Wdiameter, 18' iron rebar with a cap stamped LB1i7337. 10. If you are reading this survey in an electronic format, the information contained on this document is only valid if this document is electronically signed as specified in Chapter 5J-17.062 (3) of the Florida Administrative Code and Florida Statute 472.025. The Electronic Signature File related to this document is prominently displayed on the invoice for this survey which is sent under separate cover. Manually signed and sealed logs of all survey signature files are kept in the office of the performing surveyor. If this document is in paper format, it is not valid without the signature and original raised seal of a Florida Licensed Surveyor. 11. Unless otherwise noted, an examination of the abstract of title was NOT performed by the signing surveyor to determine which instruments, if any, are affecting this property. 12. The symbols reflected in the legend and on this survey may have been enlarged or reduced for clarity. The symbols have been plotted at the center of the field location, and may not represent the actual shape or size of the feature. 13. Points of Interest (POI's) are selected above -ground improvements which may be in conflict with boundary, building setback or easement lines, as defined by the parameters of this survey. There may be additional POI's which are not shown, not called -out as POI's, or which are otherwise unknown to the surveyor. These POI's may not represent all items of interest to the viewer. 14. Utilities shown on the subject property may or may not indicate the existence of recorded or unrecorded utility easements. 15. The information contained on this survey has been performed exclusively, and is the sole responsibility, of Exacta Surveyors. Additional logo or references to third party firms are for informational purposes only. 16. Pursuant to F.S. 558.0035, an individual employee or agent may not be held individually liable for negligence. 17. House measurements should not be used for new construction or planning. Measurements should be verified prior to such activity. LEGEND: SURVEYOR'S LEGEND UNErYPE5:lu.neooeaee Nonni BOUNDARY UN[ IRON FENCE5YMBOL5:,-onaa+xwrmr 5URFAC[ TYPES: , ® BENCH MARK l7 FIRE HYDRANT 5TR11CTURE OVERHEAD UNC5 E CENTERLINE FND OR SET MONUME ASPHALT ® BRICK ® e CENTRAL ANGLE or DELTA GU1WIRt OR ANQ1gtM CENT[RUN[_ _ CHAIN UNK a WIRE PENCE 5URV[Y TIE UNE WALL OR PARTY WALL or TILL CONCRLR � COMMON OV/HCRSHIP AMAENHO� • CONTROL POINT UTILITY OR UGHT POLL eTet NT ........ WOOD PENCE WATER ® WOOD ® ■ CONCRETE MONUMENT © WELL EDGE Of WATER VINYL PENCE CATCH BANN ----------------- - ELEVATION E.O.W. EDGE OF WATER N.T.S. NOTTO SCALE R.P. RADIUS POINT A.E. ACCESS EASEMENT (C) CALCULATED ELEV. ELEVATION NAVD88 NORTH AMERICAN VERTICAL R/W RIGHTOFWAY AN.E, ANCHOR EASEMENT (D) DEED EM ELECTRIC METER DATUM OF 1988 RES. RESIDENCE C.M.E. CANAL MAINTENANCE ESMT. (F) FIELD ENCL. ENCLOSURE NGVD29 NATIONAL GEODETIC RGE. RANGE C.U.E. COUNTY Un TTY ESMT. IM M () MEASURED ENT. ENTRANCE VERTICAL DATUM OF 1929 S.B.L. SET BACK LINE D.E. DRAINAGE EASEMENT ( PLAT EUB ELECTRIC UTILITY BOX O.C.S. ON CONCRETE SLAB S.C.L. SURVEY CLOSURE LINE D.U.E. DRAINAGE AND UTILITY ESMT. (R) RECORD F.F. FINISHEDFLOOR O.G. ONGROUND S.T.L. SURVEY TIE LINE ESMT. EASEMENT (5) SURVEY F.O.P. EDGE OF PAVEMENT O.R.8 OFFICIAL RECORD BOOK S.W. SEAWALL LEIE.E. INGRESS/EGRESS ESMT A.5.8.L. ACCESSORY SETBACK LINE F/DH FOUND DRILL HOLE O.R.V. OFFICIAL RECORDVOLUME S/GD SET GLUE DISC IRR.E. IRRIGATION EASEMENT A/C AIR CONDFWW" FCM END. CONCRETE MONUMENT O/A OVERALL S/W SIDEWALK L.A.E. LIMITED ACCESS ESMT. B.C. BLOCK CORNER • P FOUND IRON PIPE O/S OFFSET SCR. SCREEN L.B.E. LANDSCAPE BUFFER ESMT. • •.� • • BACKFLOWIiV[KOR :OUND IRON PIPE&CAP OFF OUTSIDE OF SUBJECT PARCEL SEC. SECTION L.E. LANDSCAPE ESMT. B.R. •B.RL BEARING REFERENCE BUtLDIN@RCS�PoC RON LINE 0 • FIR • • FOUND IRON ROD OH. OVERHANG SEP. SEPTICTANK L.M.E. LAKE OR LANDSCAPE • BAYBONSOW • FIRC FOUND IRON ROD & CAP OHL OVERHEAD LINES SEW. SEWER MAINTENANCE EASEMENT • • •BLDG.• • • BUILD' • Ml• • • *FOUND NAIL ON INSIDE OF SUBJECT PARCEL SIRC SET IRON ROD &CAP M.E. MAINTENANCE EASEMENT • ELK. • BLOCK • FN•D FOUND NAILAND DISC • *A.• • •FOUND P.B. P.C. PLAT BOOK POINT OF CURVATURE SN&D SOFT. SET NAIL & DISC SQUARE FEET POE R.O.E. PUBLIC UTILITY EASEMENT ROOF OVERHANG ESMT • • •BTU• • BENCHMARK FPKN FOUND PARKER-KALON NAIL P.C.C. POINTOFCOMPOUND STY. STORY S.W.E. SIDEWALK EASEMENT • BSMT• BASEMENT* •• PPMd FOUND PK NAIL &DISC P.C.P. CURVATURE SV SEWERVALVE S.W.M.E. STORM WATER MANAGEMENT C CURVE • • • • •FOUND RAILROAD SPIKE PERMANENT CONTROL POINT T.O.B. TOP OF BANK EASEMENT " • Cd� • ■ CONCRETEILOCK • • A &KGARAGE P.I. POINT OF INTERSECTION TBM TEMPORARY BENCHMARK T.U.E. TECHNOLOGICAL UTILIT."ESMT. • • • .O. CHAIN LINK1FENCE • CLEAN0�1}�yy • iN • • *GAS METER • ID. IDENTIFICATION P.O.B. P.O.C. POINT OF BEGINNING POINT OF COMMENCEMENT TEL. TWP. TELEPHONE FACILITIES TOWNSHIP U.E. UTILITY EASEMENT V • •C• `'• CONCRETI:T/AtLt! :TITER • P.P. PINCHED PIPE TX TRANSFORMER • C/L CENTERLINE •.I• • •ILLEGIBLE INST. INSTRUMENT P.R.C. POINT OF REVERSE CURVATURE TYP. TYPICAL •C/P COVERED POWH • • • •INTERSECTION P.R.M. PERMANENT REFERENCE U.R. UTILITY RISER • C/S CONCRETE SLAB • L • •LENGTH MONUMENT UG UNDERGROUND �••CH CABLE R • • LB# •LICENSE II-BU51NESS P.T. POINT OF TANGENCY UR UTILITY RISER CHI�M'� CHORDAIRANs•• DIIIIE `SM •LICENSE II- SURVEYOR P/E POOL EQUIPMENT V.F. VINYL FENCE • • IV� CHIMNEY • MAP K PG. PAGE W.F. WOODEN FENCE CONCRETE • • �.T& • MITERED ND SECTION PLS PROFESSIONAL LAND SURVEYOR W/C WITNESS CORNER COR. CORNE M.F. METAL FENCE PLT PLANTER W/F WATER FILTER FSID�'iE� MES MITERED END SECTION PSM PROFESSIONAL SURVEYOR AND WM WATER METERIVALVE BOX DE D.F. DRAIN DRAIN FIELD MH MANHOLE MAPPER WV WATERVALVE D.H. D/W DRILL HOLE DRIVEWAY N.R. NON RADIAL R RADIUS or RADIAL ELECTRONIC SIGNATURE: In complete accordance with Florida Statute 472.025 and Pursuant to the Electronic Signature Act of 1996 or Florida Statute TITLE XXXIX, Chapter 668, if this document was received electronically via PDF, then it has been lawfully Electronically Signed. Therefore, this survey PDF, if authentic, is completely official and Insurable. In order to validate the'Electronic Signature`of PDF surveys sent via www.surveystars.com you must use a hash calculator. A free hash calculator is available for download at. www.softoed iacom/nevSvstemr Flle-ManaQementrHash-Calculawrxirlll.sh�ml In order to validate the Electronic Signature of any survey PDF sent via wwws(,rveystars.com: 1. Download the Hash Calculator available at. ��n�ac"mr�etSysccm:r�lc-Mana�c,r.��.: _ 2. Save the Survey PDF onto your computer from www.surveystars cam or from the email sent from www.surveystars cam. 3. Click the square Browse button in the upper right hand corner of the Hash Calculator to find and select the saved Survey PDF document, and click the COMPUTE button in the lower right hand corner of the Hash Calculator 4. Compare the 40 digit string of characters in the SHA-1 line to the 40 digit SHA-1 characters for the survey in the job file in www.surveystars com which Is also printed on the invoice for that survey. 5. If the 40 digit string of SHA-1 characters are exactly the same on the invoke (or In the survey file at www.surveystamcom) as they are in the Hash Calculator, then this PDF is authentic. If the 40 digit string of characters does not match exactly, then this PDF has been tampered with and it is not authentic. PRINTING INSTRUCTIONS: 1. While viewing the survey in Adobe Reader, select the "Print" button under the "File" tab. 2. Select a printer with legal sized paper. 3. Under"Print Range", click select the "All" toggle. 4. Under the "Page Handling" section, select the number of copies that you would like to print. 5. Under the "Page Scaling" selection drop down menu, select"None." 6. Uncheck the "Auto Rotate and Center" checkbox. 7. Check the "Choose Paper size by PDF" checkbox. 8. Click OK to print. TO PRINT IN BLACK+ WHITE 1. In the main print screen, choose "Properties". 2. Choose "Quality" from the options. 3. Change from "Auto Color" or "Full Color" to "Gray Scale". OFFER VALID ONLY FOR: David Halabu - - - - dWE EPA OFFI OF FUTURE SURVEYING SERVICES I ON THIS PROPERTY, `Offer valid for fence stakeouts and additions to the existing structures only. Valid only for the buyer as listed on the first page of this survey for up to one year after survey issuance date. Total discount not to exceed $500. - _ _ _ _ _ _ J Exacta Land Surveyo_ rsjnc._ LBJt7337 www.exactaland.com P.866-735-1916 • F.866-744-2882 11940 Fairway Lakes Drive, Suite 1 • Ft. Myers, FL 33913