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BP-03-1257 (2)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 - 795 -2204 Building Inspection Request Date _3 e \ec Type Insp'n k �1 r� �� A T Permit No. Name OA-4 V' Address 1 1 3 0 0 Ng- 404 Company Phone # Inspection Date Approved Correction Re- Insp'n Fee Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 12/16 /2003 Applicant: BARRY Owner: JOB ADDRESS: 11300 NE 2 Building Permit Permit Number: BP2003 -1257 UNIVERSITY AVE Contractor COLEMAN GOODEMOTE CONSTRUCTION Contractor's Address: 619 N. BEACH ST. Local Phone: 386 257 - 3570 Parcel # Page 1 of 1 Legal Description: 36 52 41 40 AC SE1 /4 OF NE1 /4 LESS E35FT & LESS W4OFT LOT SIZE 1740400 Fees: Description Amount FEE2003 -8380 Building Fee $750.00 FEE2003 -8381 CCF $15.00 FEE2003 -8382 CO /CC $200.00 FEE2003 -8383 Training and Education Fee $5.00 FEE2003 -8384 Technology Fee $18.75 FEE2003 -8385 Scanning Fee $45.00 FEE2003 -8386 Structural Fee $50.00 Total Fees: $1,083.75 Total Feeda1,083.75 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 1/27/2004 Construction Value$175,000.00 Work: RENOVATE FOOD COURT 'THE BUC STOP' AND CASEWORK AS PER PANS AND SPECIFICATIONS Signed: (INSPECTOR) 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: B4. MAP AND PANEL NUMBER 12025C0093 B5. SUFFIX J B6. FIRM INDEX DATE 7 -17 -95 B7. FIRM PANEL EFFECTIVEIREVISED DATE 3-02-94 B8. FLOOD ZONE(S) X B9. BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) N/A PROCESS # FOUO # CROWN OF ROAD 11.06 Ft. NGVD BUILDING OWNER'S NAME BARRY UNIVERSITY (THOMPSON HALL) STUDENT SNACK AREA BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 11300 N.E 2 AVENUE Crry MIAMI SHORES PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) SE 1/4, NE 1/4, SECTION 36, T 52S R41, MIAMI DADE COUNTY LATITUDE/LONGITUDE (OPTIONAL) ( - #1F - ##.W or 0.##/fat ) TITLE ADDRESS 620 N.E. 126 STREET SIGNATURE 4 p FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important Read the instructions on pages 1-7. SECTION A - PROPERTY OWNER INFORMATION HORIZONTAL DATUM ® NAD 1927 ID NAD 1983 la a) Top of bottom floor (including basement or enclosure) 15. 1 ft(m) ❑ b) Top of next higherfloor 27.0fl.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) N/A . tt(m) ❑ d) Attired garage (tap of slab) WA it(m) ❑ e) Lowest elevation of machinery and/or equipment servicing the bating (Describe in a Comments area) 12.3 tt(m) ❑ f) Lowest adjacent (finished) grade (LAG) 11.9 tt.(m) ❑ g) Highest (finished) grade (HAG) 12 1 it(m) withi ❑ h) No. of permanent openings (flood vents) n 1 R above adacent grade TWA ❑ ) Total area of all permanent openings (flood vents) in C3.h N/A sq. in. (sq. cm) STATE ZIP CODE FL 33161 BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use a Comments area, if necessary.) CLASSROOMS/OFFICES/COFEE SHOP SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Policy Number SOURCE ID GPS (Type) ❑ USGS Quad Map El Other B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER VILLAGE OF IMAM SHORES 120652 B2 COUNTY NAME MIAMI-DADE B3. STATE FL B10. Indicatethe source _ theBaseFoodElevation (BFE) dataorb eflood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Comm* Determined ❑ Other (Describer B11. Indicate the elevation datum used forte BFE in B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): B12. Is the bui♦dug !waled in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Constnxfion Drawings* ❑ Building Under Construction* Ilan* ® Finished Construction *A new Elevation Certificate wl be required when construction ofthe bidding is complete. C2. Building Diagram Number 1(Select the brddmg diagram most surrlarto the burg for which His cerWk to is being completed - see pages 6 and 7. If no dagram accurately represents the building, provide asketch orphoto h.) C3. Eevations —Zones A1-A30, AE, AH, A (with BFE), VE, V1 V30, V (wfih BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3. -a-i be according to the building diagram specfied in Item C2. State the datum used. If the datum is different from the datum used forte BFE in Section B, convert the datum to that used for the BFE Show field measurements and datum conversion calculation. Use the space provided or the Comnnents area of Section D or Section G, as appropriate, to document the datum conversion. Datum 1929 Conversion/Convnents Elevation reference mark used N-566 Does the elevation rdeence mak used appear on the FIRM? ❑ Yes ® No 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. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprfsmment under 18 U.S Code, Section 1001. CERTIFIER'S NAME HOWARD C. GAMBLE UCENSE NUMBER 1683 VICE PRESIDENT COMPANY NAME A R TOUSSAINT &ASSOCIATES, INC. DATE TELEPHONE 06/06/03 (305) 891 -7340 O.M.B. No. 3067-0077 Expires December 31,200! For Insurance Company Company NAIC Number Howard C. Gamble 1683 June 6, 2003 CITY STATE ZIP CODE NORTH MAMA FL 33161 For Instance ce Comparny Use Poky Number Canpany NAIC Number IMPORTANT: In these spaces, copy the corresponding information from Section A. BUILDING STREET ADDRESS (Including Apt., Unit Suites aria Bldg. Na) OR P.O. ROUTE AND BOX NO. 11300 N.E 2 AVENUE CITY STATE ZIP CODE MIAMI SHORES FL 33161 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy bath sides of this Elevation Cer6ficatefor (1) communky oiridai, (2) insurance agenticampany, and (3) building owner. COMMENTS C3 (e) A/C PAD SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (wlhout BFE), complete Items El through E4. If the EIevation Certificate is intended for use as supporting information fora LOMA or LOMR -F, Section C must be completed. El. Burling Diagram Number_(Select the balding diagram most simdarto the building forwfrch this ms's being completed —see pages 6 and 7. If no divan accurately repents the building, provide a sketch or photograph.) E2. The top of the bottom floor (inducing basement or enclosure) of bullring is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grate. (Use natural Cade, if avalabfe). E3. For Building Diagrarns 6S with openings (see page 7), the next higher floor orelevated floor (elevation b) of the building is _ fl.(m) _in.(c m) above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the budding is _ tt(m) _in.(an) ❑ above or ❑ below (chedc one) the trghest adjacent grade. (Use natural grade, l avalabfe). E5. For Zone AO only: If no flood depth numbs is available, is the top of the bottom floor elevaked in as ordance will the commrnly's floodpla n management ordinance? ❑ Yes ❑ No ❑ Urdcnown. The local ofd 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, C (Items C3.h and C3.i oily), and E for Zone A (without a FEMA -issued conununlly- issued ed BFE) or Zone AO mustsfgn her Thestafemedsin Sedions4 Q (; and Earecarectbthebestofmyly e PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVES NAME ADDRESS SIGNATURE COMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is aihorized by law or ordnane to adrmm>isterthe communky's flaodpfa n management ordinance can complete Seaford A B, C (or E), and G of tits Elevation Ce ticat9. Complete the apple lem(s) and sign below. G1. ❑ The information in Section C vas taken from other doaaresntetion that has been signed and embossed by a Ifcersed surveyor; engineer, or architect who is authorized by state or local law to certify eievat in information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E fora budding located in Zone A (without a FEMA ued orcoranurti ssued BFE) or Zone AO. G3. ❑ The following information (Items G4 G9) is provided for con minity floo plain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCE/OCCUPANCY ISSUED G7. This permit has been issued for ❑ New Construction ❑ Substantial Improvement G8. E l e v a t i o n o f as-but Io st floor (inducting basement) of the budding is: G9. BFE or (m Zone AO) depth of flooring at the build ng ale is: LOCAL OFFICIAL'S NAME COMMUNITY NAME SIGNATURE COMMENTS CITY DATE TELEPHONE TffLE TELEPHONE DATE (m) ❑ check here if attachments STATE ZIP CODE Datum: Datum: ❑ Check here if attachments 84. MAP AND PANEL 97. FIRM PANEL 139. BASE FLOOD ELEVATION(S) NUMBER 135. SUFFIX 136. FIRM INDEX DATE EFFECTTVEIREVISED DATE ::. FLOOD ZONE(S) (Zone AO, use depth offloodmg) 12025C0093 J 7 -17 -95 3-02 -94 X N/A PROCESS # FOLIO # CROWN OF ROAD 11.06 Ft. NGVD LATITUDE/LONGITUDE (OPTIONAL) ( -tar - ##.#!r a ##.1/fltlfmff) FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important Read the instructions on pages 1-7. For kaftan Company Use Policy Number Company NAIC Number SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME BARRY UNIVERSITY (THOMPSON HALL) STUDENT SNACK AREA BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 11300 N.E 2 AVENUE CITY MIAMI SHORES HORIZONTAL DATUM NAD 1927 ❑ NAD 1983 STATE FL PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) SE 1/4, NE 1/4, SECTION 36, T 52S R41, MIAMI DADE COUNTY BUILDING USE (e.g., Residential, Non- residential, Adddion, Accessory, etc. Use a Comments area, if necessary.) CLASSROOMS/OFFICES/COFEE SHOP SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION O.M.B. No. 3067 -0077 Expires December 31, 200f ZIP CODE 33161 SOURCE: CI GPS (Type): ❑ USGS Quad Map ❑ Other B1. NRP COMMUNITY NAME & COMMUNITY NUMBER VILLAGE OF MIAMI SHORES 120652 B2. COUNTY NAME MIAMI -DADE B3. STATE FL 810. IrxCCabe the sauce of the Base Flood Bevztbn (BFE) data or base flood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Comm* Determined ❑ other (Desc ribek B11. Indite the elevation datum used forthe BFE in B9: ►14 NGVD 1929 ❑ NAVD 1988 ❑ Other (Desalts): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Constnrctbn Drawings* ❑ &d'mg Under Consbuctiore 0 Finished Cans n than *A new Elwatiar Certikate MI be required when corstn dbn oft the bidding is complete. C 2 . B u i l d i n g Diagcan Number 1(Select t h e buffing d i a g r a m most suMarto t h e building forwhidm this c edd a is being completed - see pages 6 and 7. If no diagram aoc urately repiesents the but dkg, provide asketch or h.) C3. Bev-dims — Zones A1 -A30, AE, AH, A (with BFE), VE, V1 -V30, V (wflh BFE), Ali, AR/A, AR/AE, AR/A1- A30, AR/AH,ARIAO Complete Items C3. -a-i be a cording to the building dlagran spec'ied in Item C2. State the datum used tithe datum is cfl ferenthum the datum used for the BFE in Section B, convert the datum to that used forte BFE Sham field measunaments and datum cOrnrersion ca culatian. Use Mesa= a or the Corm eats area of Section D or Section G, as appropriate, to document the datum conversion. Datum 1929 Conversion/Comments Elevation reference mak used N-566 Does the ele�ration refers= mark used appear on the FIRM? ❑ Yes 0 No ❑ a) Top of batten floor (mcludng basement or enclosure) 15. 1 t.(m) O b) Top of next higher floor 27.0ft(m) O c) Bottom of Wiest horizontal atruchrral member (V zones only) NIA . _t(m) c ❑ d) Attached garage (top of slab) NIA it(m) W ❑ e) Lowest elevation of machinery and/or equipment servicing the buffing (Desch* in a Comm area) 12.3 ft(m) ❑ f) Lowest adacentt (finished) grade (LAG) 11.9 ft(m) ❑ g) Highest ailment (frnished) tip (HAG) 12 1 ft(m) ❑ h) No. of permanent openings (flood vents) Mtn 1 ft above adjacent grade N/A ❑ i) Total area of al permanent openi gs (flood vends) in C3.h N/A sq. in. (sq. cm) TITLE ADDRESS 620 N.E 126 STREET 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 in SedionsA, B, and C on this certificate represents my best efforts to interpret the data avallabla 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIERS NAME HOWARD C. GAMBLE UCENSE NUMBER 1683 VICE PRESIDENT COMPANY NAME A R TOUSSAINT & ASSOCIATES, INC. CITY STATE ZIP CODE NORTH MIAMI FL 33161 SIGNATURE ' DATE TELEPHONE C . 06106103 (305) 8917340 Howard C. Gamble 1683 June 6, 2003 For beware Company Use Pdicy Number Company NAIC Number IMPORTANT: In these spaces, copy the corresponding information from Section A. BUILDING STREET ADDRESS pnc Apt., Unt Suite ard/a Bldg. Na) OR P.O. ROUTE AND BOX NO. 11300 N.E 2ND AVENUE CITY STATE ZIP CODE MIAMI SHORES FL 33161 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy bath sides of this Elevation Catikete for (1) community official, (2) insurance agenUcompany, ad (3) Wilding owner. COMMENTS C3 (e) A/C PAD ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zane A (without BFE), complete Items El through E4. If the Elevation Certficate is Intended for use as supporting information fora LOMA or LOMR -F, Section C must be completed. El. Building Diagram Number (Select the bulling dI am most sf Marto the balling for which this certdicate is being completed —see pages 6 and 7. If no diagram aaurately represents the bulling, provide sketch or photograph.) E2. The top of the bottom floor (induc basement or enclosure) of the balding is _ IL(m) _in.(am) ❑ above or ❑ below (check one) the highest adjaa rt grade. (Use natural grade, ff available). B. For Bulling Diagrams 6-8 with openings (see page 7), the next Ngher floor oreta/abed floor (elevation b) of the building is _ It(m) s m.(cm) above the highest adjacent grade. Complete Items C3.h and Car on frond of form. E4. The top of the platform of madhmery and/or equipment servicing the building is _ ft(m) _ar.(an) ❑ above or ❑ below (dhedc the) the Vest at scent grade. (Use natural grade, ff available). B. For Zone AO only If no flood depth number is available, is the top of the bottom floor elevated in as ordare All the communlly's ffoodpfa n management ordnance? ❑ Yes ❑ No ❑ Unknown. The local official must cagy this information In Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The properly owner or mere authorized r ative who oanptetes Sediors A, B, C (Items C3.h and C31 only), and E for Zone A (without a FEMA- issued or continuity- issued BFE) orZareAO must sigrr here Thad:teener* in SectionsA, Q Q End Eaeconedbthebesfofnvjknahledga PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME ADDRESS SIGNATURE CONiVIENTS CITY DATE TELEPHONE STATE ZIP CODE ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The focal official who Is athalzed by law or ordinance to ado irrsterthe conmunly's floodplain management ordnance can complete Sections A, B, C (or E), and G of this Elevation CerttCate. Complete he appiathle iem(s) and sign below. GI. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a fib surveyor, engineer, or actlbect who is authorized by state or local law to daffy elevation information. (Intricate the source and date of the elevation data ii the Comments area below) G2. ❑ A community official comply Section E for a building located in Zone A (without a FEMA-Issued orcommunity-issued BFE) or Zone AO. G3. ❑ The following infomPtion (Items G4-G9) is provkled for corms* management paper G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for ❑ Now Construction ❑ Substantial Improvement G8. Elevaticn of ash lowest floor (inducting basement) of the building is G9. BFE or (in Zone AO) depth of flooding at the bucking ale is: LOCAL OFFICIAL'S NAME COMMUNITY NAME SIGNATURE COMMENTS TILE TELEPHONE DATE fL(m) — _ft(m) Datum: Datum: 64. MAP AND PANEL B7. FIRM PANEL I39. BASE FLOOD ELEVATION(S) NUMBER 65. SUFFIX B6. FIRM INDEX DATE EFFECTIVEIREVISED DATE . FLOOD ZONE(S) (Zone AO, use depth offloodi g) 12025C0093 J 7 -17 -95 3-02 -94 X N/A PROCESS # FOLIO # CROWN OF ROAD 11.06 Ft. NGVD WC 1 1 SECTION A - PROPERTY OWNER INFORMATION For Insurance Canpay Use Pd'ay Number Confpany NAIC Number BUILDING OWNER'S BARRY UNIVERSITY (THOMPSON HALL) STUDENT SNACK AREA BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 11300 N.E 2 143 AVENUE CITY MIAMI SHORES PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Desaiption, etc.) SE 1/4, NE 1/4, SECTION 36, T 52S R41, MIAMI DADE COUNTY BUILDING USE (e.g., Residential, Nan - residential, Addition, Accessory, etc. Use a Comments area, if necessary. CLASSROOMS/OFFICES/COFEE SHOP LATITUDE/LONGITUDE (OPTIONAL) ( AV" - #tf -###!F ar MAW) FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important Read the instructions on pages 1- 7. HORIZONTAL DATUM NAD 1927 ❑ NAD 1983 STATE FL SOURCE SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION O.M.B. No. 3067 -0077 Expires December 31, 200f ZIP CODE 33161 ❑ GPS (Type): ❑ USGS Quad Map ❑ Other 131. NFIP COMMUNITY NAME & COMMUNITY NUMBER VILLAGE OF MIAMI SHORES 120652 B2. COUNTY NAME MIAMI -DADE B3. STATE FL B10. e sauce of the Base Flood Elevatnon (BFE) data or base flood depth entered in B9. ❑ FIS Profile ARM ❑ Comma* Detemined ❑ Other (Dsec bed B11. Inmate the elevation Man used forte BFE in B9: ►_� NGVD 1929 ❑ NAVD 1988 ❑ Other (Desasbe): B12. Is the Witting located in a Coastal Bonier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based at ❑ Construction D►av gs• ❑ Buffing Uri Construction* ►5 Finished Construction *A new Elevation Cetikate vw8 be required when construction of the building is canpleta C2. Building Diagram Nuanber 1(Seleot the bulldog diagram most Ito the bolding forwhich the mates being completed - see pages 6 and 7. If no duagram accurately represents the buffing, provide a sketch or photograph.) C3. Deva ions —Zones A1.A30, AE, AH, A (with BFE), VE, V1 V30, V (wfih BFE), AR, AR/A, AR/AE, AR/A1-A30, ARIAH, AR/AO Complete Items C3. -a-i below according to the building diagram specified in Item C2. State the datum used. lithe datums different from the datum used for the BFE in Section B, convert the datum to that used for the BFE Sham field meaumane is and datun conversion calculation. Use the space proves orthe Comments area of Section D or Section G, as probate, to document the datum conversion. Datum 1929 Conversion/Canmens Elevation reference mak used N-566 Does the elevation reference mark used appear on the FIRM? ❑ Yes Ci No ❑ a) Top of bottom floor (including basement or enclosure) 15. :LW) ❑ b) Top of reset higher floor 27. Ott(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) NIA . ft(m) ❑ Attached garage (top eta) NIA 1L(m) ❑ e) Lowest elevation of machinery avl/or equipment servicing the baring (Describe in a Comments area) 12.3 ft(m) ❑ f) Lowest adjacent (finished) grade (LAG) 11.9 ft-(m) ❑ g) Highest a$a ent (finished) grade (HAG) 12. it(m) ❑ h) No. of permanent openings (flood vends) win 1 R above Await grade N/A ❑ 1) Total area of all permanent openings (flood vents) in C3.h N/A sq. an. (sq. cm) TITLE ADDRESS 620 N.E 126 STREET SIGNATURE calk CITY NORTH MIAMI DATE 06106/03 Z' 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 in Sections A B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIERS NAME HOWARD C. GAMBLE LICENSE NUMBER 1683 VICE PRESIDENT COMPANY NAME A R TOUSSAINT &ASSOCIATES, INC. STATE R. TELEPHONE (305) 891 -7340 Howard C. Gamble 1683 June 6, 2003 BP CODE 33161 IMPORTANT: In these spaces, copy the corresponding infomtation from Section A. BUILDING STREET ADDRESS (Including Apt, Una, Suite, andla Bldg. Na) OR P.O. ROUTE AND BOX NO. 11300 N.E 2ND AVENUE CITY STATE ZIP CODE MIAMI SHORES FL 33161 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certfcake for (1) community offldal, (2) insurance agentcanpany, aid (3) balding caviler. COMMENTS C3 (e) A/C PAD ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and ZoneA (without BFE), complete Items El hough E4. tithe Elevation Certificate is Intended for use as supporting infoimation for a LOMAorLOMR F, Section C must be completed. El. Building Diagram Number_(Selec tthe building diagram most stinlarto the buldingfor which this mote is burg completed –see pages 6 and 7. If no diagram accurately represents the burg, provide a sketch or photograph.) E2. The trap of the bottom floor (including basement or enclosure) of the bolding is — ft.(m) — in.(an) ❑ above or ❑ below (chedc one) the highest adjacett grade. (Use natural grade, It available). E3. For Building Diag a s 6S with openings (see page 7), the next ttigherfloor orelevated floor (elevation b) of the building is — ft(m) _in.(an) above the highest adjacent grade. Complete items C3.h and C3i on front elf form. E4. The lop of the platform of machinery and/or equipment servicing the buding is — it_(m) — in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, It awatiablo). E5. For Zone AO only: If no flood depth number is avalabie, is the top et the bottom floor elevated In accordance with the commur ty's floodplain management ortfinaice? ❑ Yes ❑ No ❑ Unknown. The local official must ce.tly this itfornation in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or MAWS authorized representative who c o m p e t e s Sections A, B, C (Items C3.h and C 3 . 1 only), and E for Zone A ( w i t h o u t a FEMA- Issued o r c a n m u n d y - i s s u e d B F E ) or Zone A O m u s t sign here T h e s t a t e m e n ( s i n Sections A, Q C and E weoarred blhe knoviedge PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVES NAME ADDRESS SIGNATURE COMMENTS SECTION G - COMMUNITY INFORMATION (OPTIONAL) The boat Ode who is authorized by I ►or ordna ce to adman erthe commwdy'sfloodplain management ordnance can complete Sections A, B, C (or E), and G of this Elevation Cede Complete tha fe (s)andsign below. G1. ❑ The itfoima io+i in Section C was taken from other doctsnentalcm that has been signed and embossed by a Ocersed surveyor, engineer, or architect who is authorized by state or local leak) certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community a f F c + i l c o m p l e t e d S e c t i o n E fora budding located i n Zone A ( w i t h o u t a FEMA-issued or con Tru ity-issued BFE) or Zone AO. G3. ❑ The fodowig information (Items G4-G9) Is provided for cowardly floodptan management purposes. G4. PERMIT NUMBER 65. DATE PERMIT ISSUED G6. DATE CERTIFICATE CF COMPUANCE/OCCUPANCY ISSUED G7. This pent has been issued for ❑ New Construction ❑ Substantial Improvement G8. Elevation of astitalt lowest floor (mdudug basement) of the btrtidng G9. BFE or (m Zone AO) depth offloodi g at the buldug de is: LOCAL OFFICIAL'S NAME COMMUNITY NAME SIGNATURE COMMENTS CITY DATE TELEPHONE TIRE TELEPHONE DATE 1L(m) — — ft(m) For Insurance Company User Polar Number Company NA!C Number STATE ZIP CODE ❑ Check here if attachments Datwn: Datum ❑ Check here if attachments