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440 NE 92 St (8):CEL CE _ CGEG r. i E I (?C5. '• °� -__ - :?� :: ( ) ETJLLLD NG F ET /=N CT:ORS I5'I2.zTTCY C ST C zpv of STATE CF FLORIDA CELT~ICATICN (DDER) ._ STATE RE4ISTRATION »D DADE COUNTY CzHMENCY LICENSE. C of =rent CCCUPATICIhL LI _:c CAL:'. :_i � 1.j.:r:��in al- �y business is loco-_^_. Certificate of Insurance for LIABILITY Village). Certificate of Insurance for WCEKE 'S C (addressed to ShoresVillage) or if exempt State of Florida LEES. Form ECM-204, Criss muct`or. � d: st v Notice of Election to be Exempt. PLEASE SUBMIT DimanaNG Cr OFF Permit Application (signed by person perform ng the cart, licensed contractor and the property owner, both signatures notarized) . TWo sets of plans /drawings signed and sewed by registered architect or engineer. Occupancies by Group Classification must be on plants and cermit aooliction. All plats must include folio number and grocer - LT dress.. Amended plans, in addition to the above, nut also include the it number. Structural Calculations signed and sealed by architect or engineer when applicable. C.,:.- rent of the prop / Certificate of evation signed and sealed by S`veyor. Substantial Improvements Checklist (contractor c= owner) Four sets of energy calculations, signed and sealed sets of signed & sealed Tru=ss Plans (Engineer). DADE County or State of Florida Prods Approvals for roof materials, sheds, windows, exterior/garage4mg, aluminum carports, seenn nciosures, shutters awnings, skylights, french doors and etc. Approvals front HIES, DADE County Impact Fee Section, Fire Deparbrent & Health Department (when applicable) . DERM WariaamityDeed or Other Proof of Own°rh ;p if necessary. Struct ral Review fee 45 n Notice of Commencement 7Itia,ck. 0,2,4 4 4)40 eepiJt Miami Shores City:Viva - BUILDING AND ZONING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES. FLORIDA 33138 -2382 TELEPHONE (305) 795-2204 FAX (305) 758.8972 RECEIPT e �2 2 `� A.) contractor /owner, picked up 2 sets of plans for (adds) p AJS- 2 - from the Building and Zoning Department on (date) to have corrections done to plans and/or get County stamps. I understand that the plans need to be brought back to Miami Shores Building and Zoning to continue the permitting process. NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF 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. 1. Legal description of property and street address: ./ 't" 42 2. Description of improvement: c 0 .] G7u) 6 3. Owner(s) name � a / n / d � addresss: C C4,4 1 &`"7-04,/ �J� / 0 l L� ps / Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: ..s,�i a 6:(',il.:l .Pg.,1/, /•cJv - /609/ .049 e .efamr., ' . 5-3407 . 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of Owner Print Owners Name LELN LC./ PS Sworn to and subscribed bflioje me this 10 d of Notary Public Print Notary's Nam My Commission Expires: Viivf" "% G. MAFRTINEZ y ' MY CQMMISSInN a CC A5R298 di EXPIRES: November 19, 2003 Bonded TTru Notary Public Undeiwritere C.a:. R O 2 2 i 5 5 20C'2 JAN it 15:18 SYATG OF FLORIDA, COUNTY OF DADE HEREBY CERTIFY that this is a u co day of origin Pied m this office on A 0 20 _f 22.-- Official Seat. Courts of Circuit and County C. 123.ot -52 2193 /17tote4Tilla BUILDING AND ZONING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES. FLORIDA 33138-2382 TELEPHONE (305) 795-2204 FAX (305) 756 -8972 RECEIPT kj �. a fl x 1 contractor /owner, picked up 2 sets of plans for (address) 4 4 O (3 - from the Building and Zoning Department on (date) to have corrections done to plans and/or get County stamps I understand that the plans need to be brought back to Miami Shores Building and Zoning to continue the permitting process. Dec. 12, 2001 RE: Phillips plans Mr. Esher - (4 O c9 I am hesitant to release this permit to Phillips because it has to go to Dade County HRS to be signed off and stamped off. Even though work was done a couple of weeks ago permitted by us to abandon a septic tank, install a larger one and a drainfield that was signed off by HRS. I checked the file and the documents specify that this work is not for addition. The paperwork is attached if you care to see it. Plans have to be sent downtown for any addition whether it is a bedroom, bath or whatever. I can understand that he is anxious to get started, but he was told when these plans were brought in initially as well as the other times Gladstone has been here that they had to be taken downtown and his thought was he would have all our depts. sign off first and take it downtown before a permit was issued. This is the normal procedure. I also gave him the option at the beginning to take them there first, get signed off and then bring in here for our routing. By our releasing the permit to him now, he will get started and they will not be taken where they should be. I spoke with him this afternoon and explained this to him. I think you can see what I am talking about. This step should not be skipped even though he is anxious. It would only take a day or so to take care of what needs to be done. Also, we need license and insurance info on his contractor, whoever he is. Angie I am taking Thursday, Dec. 13 off because Meaghan has a doctor's appt. in Broward County. I mentioned it to you last week, but you might have forgotten and I hung up from you earlier and forgot to remind you. PLAN REVIEW COMMENTS `of \P `" _> OtkQt PROJECT NAME: /Pr Re0546,0,e- e PROJECT ADDRESS: 4/„.... A/A 9 "REVIEWER: rii■Yt,1/4oL �� ��d - � ° 6� ' SHEET NUMBER : GJ ‘? 9� COMMENTS ea 7L. r- � ce:%! .9 9 0,4- '>'"Yc4 t cal/ e/Je 7 O G', Ce,/ # .#01Q' 0,1/14_44 7 4/ / Y A 'A 9 .',G �. /c 5c 'co," 1c �'����' 14 ?$ ? � Date Signed Total Number of Hours (PLEASE TURN IN A COPY OF THIS FORM AS YOUR TIME SHEET' FOR ALL PLAN REVIEW) co\- )1(M 1 3 D s41y 1 ^- 01 �8 JOB ADDRESS 44o /v..6 APPLICANT c/, PHONE (( APPUCATION 0 SHEET 1 OF 7- MISCELLANEOUS DATE J 1 J.Z.i J P6/>V4/ vil�° //✓S'Yt < /P. s�Sc•lr v c%'ccr . P- �.�.�� r , (-r A- .. o: t`&• eQ C 4 Q // //c) C j - vr2.o 1 T8T NOZ * * * * * S �lr lr ei 2 =v�� • qz Si 7l 4n �:� /e C6 '7 Ca re / nn // ('' c-r �7P•ti - fi r //•> c.: er t ' / / /I S. ‘/e- NO „ 60, TO 0 ✓Z 3WI1 39tld 39Id 3Q00 1001 X21/X1 3210IS CRITIQUE SHEET COMMENTS * ** 1210d321 NOISSIWSNtRIl PERMIT NO. ADDRESS: STRUCTURAL 2 re-<ro ` ,i P KZ, / ea rip /7/fd l /4 /� r; y Gf ,� � ✓ .1 ( b...e• 4. J , C • MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT - SECTION BY DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS BUILDING OFFICIAL 1. Subject to cartptlenc4 with an Federal, State. Cocatty. Wlage rates end retpLetans. Village emmter no tesponslbllIty for accateey oUot resiNs Imo those plans 2. This copy at plans mutt be auelltbte as building cite at as inspection VII be conducted. /r G�cle✓ 1/ INITIALS e // c (k /? / e �� rt'S /e /o, f• . =39tid 21021213 180T9L99086 Xi 017:9T 90 /ZT 891 3WI1 ' °N NOIld007 3Q0W 121W.S 31I3 -- • -- =2134 I 1 ZL6899L908: Xti3 -- - - 39ti l l I 11 S3210HS I W t J I W : Q I 1 : 9 1 1 0 . 90✓ZT 3141 1N I 21d BUILDING / ZONING DEPARTMENT • SECTION BY DATE ZONING • ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL JOB AODRESS APPLICANT elyn . cia sr (1/1.,(l t_5 tb u O of O A r CRITIQUE SHEET PHONE tt APPLICATION 0 rn(97" SHEET OF MISCELLANEOUS DATE MUG • \ COMMENTS PERMIT NO. ADDRESS: MIAMI SHORES VILLAGE 1. Subject to compliance with aft Federal, State County.Villaeje rues end regvtaticrts. W1nCe essumc no responsibility for accuracy offor resutts fray these plans. 2. This copy of plans must ba extt(cbia o: buliding site or no inspection will be conductec INITIALS ivt). ���i t(7-QG/ -L ELEUti i5 fit 7€ 44S C ujs - C17 /fe-C.Olefe- cdj On- T (5 vPT,itI 6F pew /145 ,11-'T 7 114,0 e(e ) EIR 1 A /s / /./0 g fa 1< $iO&- SF is /o° lbw 61-TH 4vou f± 0 EiveA ff 0 i ttawise , o, k.. PERMIT NO. ADDRESS: , MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT' SECTION BY DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Sublad to compliance with eft Federal. State. County. Village rules end regulations. Village mums no responsibility tor accuracy otlor results from these plans. 2. This copy of plans meet be imitable on building cite or co inspection wait be conducted. JOB ADDRESS 44e)1/e" 40 57 • APPLICANT ma PHONE t# 3'0c 7 ‘. / . fZ, o; _, / 0 CRITIQUE SHEET C7 el r c167 6 APPLICATION (# SHEET d OF 7- MISCELLANEOUS DATE � OMMENTS INITIALS tb„ >r F //Y6 ,4 -q7 i1 AIL 7J � i� e .' �e_ 2 r -Cr o .te ( /- tom k 3/ C7 e /fie /ter, Cf .�a/ a 6: S4.-c,J �b H /p �i �� -1� c � �' i � � • , C4 r/ fr (7‘. //7 b�c c(4 4/ r TG� cQ s c J -� e (c) 04 -7 f l ) cr t / < � / //5.2 1 c(e Se-i - .( �c2/ . PW,,, . )vrcr eCz P -r 4) , g /a) l r, f/ 5 - igii -rogAJL 440 NE qz 5/. 56 5r4Y M T — /WAIL PRESO4 T/1/e L3 i'zI,i4 1/ 1..ue 15 2i, 006 ( ^Jo r 2,5 (AV ON 5 - 3) EOGliVirL - eF CORP ` s NM-16 10 8E Pgi1JiEA riCE f5Lo cx a 11 4As; orrw i. REa v 10E 5 At rc -t S!PE. t z ' ' r l - c o t . . 77 e eickar4 LI ea c 7pica/ (,°f/Jd, •/A let rerr does6'l rouide emoulil Seal .depth c-ar Me ruses a-5 Skown awe $ec, A /; &4 wail i lie ge nnev'e et " be/ 'eerl Di4;14, 4 Pdyw )y Peo45 efw,e.ar5 / be rriey at, 2 144 Near Roar Joc'ssuss 56,w Me 2,d fIoev rv4e441;4 1' sr-i6rn// e JcaaJ (15 ,- ?Ike ethilni. Tie 13ean, • Pr Appr®rrt/s /or ,441e P /x evir�d . 5 /'dfyi 11,40 doers am-1 store» ramie-if 1( n:0/ rerrad Resis fai 1• • moo ®p mg iwavg igw g lveed- `' ' 1' 1 7.5x 0 goview FA-,2e PERMIT NO. • ADDRESS: • MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT' SECTION BY DATE ZONING • ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL I. Subject to compliance with aft Federal. State. County.Yillage rules and regulations. Wage assumes no responsibility for accuracy of /or results from these plans, 2. Thls copy of plans mutt b• available on building site or no Inspection will be conducted. JOB ADDRESS � 9 � � 5 APPLICANT PHONE # APPUCATION t# SHEET / OF MISCELLANEOUS DATE . ./-i, e, / .& ( • ,L e /? Add c o fis - CRITIQUE SHEET COMMENTS INITIALS BUILDING AND ZONING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES. FLORIDA 33138 -2382 TELEPHONE (305) 795-2204 FAX (305) 756-8972 RECEIPT CLteAlsa I ' `" 1 .contfaeteeowner, picked up 2 sets of plans for (address) *- a=aM from the Building and Zoning Department on (date) to have corrections done to plans and/or get County stamps. I understand that the plans need to be brought back to Miami Shores Building and Zoning to continue the permitting process. -- . MIAM1-DADE PRODUCT CONTROL Caradco Windows & Doors 201 Evans Drive Rantoul • • •• • • • • • • NOTICE OF ACCEPTANCE IL 61866 Your application for Product Approval of: Aluminum Clad Wood Fixed Picture Window - Impact under Chapter 8 of the Code of Miami -Dade County governing the use of Alternate Materials and Types of Construction, and completely described herein, has been recommended for acceptance by the Miami -Dade County Building Code Compliance Office (BCCO) under the conditions specified herein. This approval shall not be valid after the expiration - date stated below. BCCO reserves the right to secure this product or material at anytime from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined BCCO that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the manufacturer. Acceptance No.:99- 0302.01 (Revises No.: 98- 1028.01) Expires:11 /30/2001 THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCT REVIEW COMMITTEE This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to be used in Dade County, Florida under the conditions set forth above. Approved: 07 /01/1999 Internet mail address: postmaster ®huildingcodeonline.com rancisco Quintana, R.A. Director 1 of 3 Miami -Dade County Building Code Compliance Office • • ••• • • ••• ••• •• •• • •• •• •• • • • • • • • • ' • •• E COUNTY. FLORIDA • •s• 'Mtl'kO -DADE FLAGLER BUILDING BUILDING CODE OOMPLIANCE OFFICE •' • lMEIRQ -Et1aE FLAGLER BUILDING 140 WEST FI• STREET. SUITE 1603 •••• ••• MtAM 'E 33130 -1563 (305) 375-2901 FAX (305) 375-2908 • • ••COrfr.RAef O4 LICENSING SECTION • •: • • • • • • • • 1501)'3 - 7 FAX (305) 375 -2558 • ••• •• •• • CON'CRACTOR ENFORCEMENT SECTION (305) 375 -2966 FAX (305) 375 -2908 PRODUCT CONTROL DIVISION (305) 375 -2902 FAX (305) 372 -6339 Raul Rodriguez Chief Product Control Division Homepage: http : / /www.huildingcodeonline.com Caradco • •• • • • • ' • ; • � •' • • • • • •• • • • • • • • • • • • • • • •• • • • . • • • • ••• • -- EXPIRES • •• November 30, 2001 • NOTICE OF ACCEPTANCE: STA1SI RD rQIypITibNS •• • • • 1. Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documentation, including test supporting data, engineering documents, are no older than eight (8) years. 2. Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the following statement: "Miami -Dade County Product Control Approved ", or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if: a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) If the Acceptance holder has not complied with all the requirements of this acceptance,_including the correct installation of the product; d) The engineer who originally prepared, signed and sealed the required documentation initially submitted is no longer practicing the engineering profession. 4. Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through the filing of a revision application with appropriate fee) and granted by this office. 5. Any of the following shall also be grounds for removal of this Acceptance: a) Unsatisfactory performance of this product or process. b) Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purpose. 6. The Notice of Acceptance number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7. A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all time. The engineer needs not reseal the copies. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Notice of Acceptance consists of pages 1, 2 and this last page 3. END OF THIS ACCEPTANCE 3 of 3 ACCEPTANCE, No,: 99- 0302.01 • •: • ••• :• • AI'P4O'ED • • .IIIL 0 t 1999 Manuel Pere , P.E., Product Control E Product Co ' trol s ivision er 2 of3 • . ••• • .• •� • • • . . • , • . • • • . ••• • ••• • • • • • Caradco ACCEPTANCE No.:• 99- 0302.01 • • • • • • • • • ••• • • . • • • • • • A PROVEb •.• :•••• JUL 0 1 1999 • ••• .•• EXPIRES • ►•November 30, 2001 NOTICE OF ACCEPTANCE: SPE4I 'IlC7C 1. SCOPE 1.1 This revises the Notice of Acceptance No. 98- 1028.01 which was issued on 02/25/99. It approves an aluminum clad wood fixed window, as described in Section 2 of this Notice of Acceptance, designed to comply with the South Florida Building Code (SFBC), 1994 Edition for Miami -Dade County, for the locations where the pressure requirements, as determined by SFBC Chapter 23, do not exceed the Design Pressure Rating values indicated in the approved drawings. 2. PRODUCT DESCRIPTION 2.1 The "Radius & Geometric Spandrel" Aluminum Clad Wood Fixed Picture Window — Non - Impact and Impact Resistant, and its components shall be constructed in strict compliance with the following documents: Drawing No W98 -80, titled "Car Clad Wood Fixed Window" Sheets 1 through 8 of 8, dated 10/10/98, signed and sealed by Humayoun Farooq, P.E., bearing the Miami - Dade County Product Control approval stamp with the Notice of Acceptance number and approval date by the Miami -Dade County Product Control Division. These documents shall hereinafter be referred to as the approved drawings. 3. LIMITATIONS 3.1 This approval applies to single unit applications and also side -by -side or top- and - bottom installations, as shown in approved drawings. 4. INSTALLATION 4.1 Hurricane protection system (shutters): to determine whether the installation requires a hurricane protection system or not, see corresponding table in approved drawing. 5. LABELING 5.1 Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Duplicate copies of the approved drawings, as identified in Section 2 of this Notice of Acceptance, clearly marked to show the components selected for the proposed installation. 6.1.3 Any other documents required by the Building Official or the South Florida Building Code (SFBC) in order to properly evaluate the installation of this system. Produ ntrol Division Manue Perez, P.E., Product Control- eaminer • a MIAMd.OAOE PRODUCT COIV R RQL OF ACCEPTANCE Almzr (USA), flnc, CONTTRACTOR L!CE SINC SECTION - ',1:)5: 375.3527 FAX (3051375-255)1 654$ NW °�v 'i7 Ave. Miami FL 33166; CONTRACTOR ENFi3#iCEi1Cv. =7 SECT1w 1�n3) 375.2966 FAX 005i 375-20S osikaDUC CONT'/AUL, inviSU()N Your application fur Product Appro ai JI; 1305) 375•29:;3 F..kX ;� s; 3; •533: Alt uvra Barrett under Chapter 8 of the Come of Miami -Dade County governing the use of Alternate iviateriais and Types of Constriction, 'in completely described, er n haN been recommended Miami-Dade cl e.. *rp,;,._ , h,.... ., - he„ e ttt^tr°I1ded far :1ccr�tz�-lt:e by the ,�9iami -Bade Cour.iv Building, Codi. Compliance ce Offlcc (BCCO) utt er the conditions specified herein. This approval shall rrotbe valid abterthe expiration date stated nelow. fiCCO reserves the right to secure this d pct mater et inytirn from ajchsite or manufacturer's plan fo. quality control testing ;iiv L_ �r material sr S r if this product or material fail> to perform iii ine approved manner, BCCO may revoke, modify, or suspend the use of such product material immediately. BCCO reserves the right to revoke this approval, if it is deters ini:4 BCC() that this product or material fails to the requirements of the South Florida Butlr'idn Code. The expense of such testing will be incurred by the manufacturer. Acceptance No.:99- U162_GS (k eviises ;` o.: 984)42&02) Ajiprove :}2fI6i Ntt;A ii!<Dat)t COUNTY. ELi1RFD� tiir "i &i; - E ELA(. LER BUILDING C:o1)tr corm T A .N.LE o FicE METRO.DADE FLAGLER HIj1#.Dt i( ! ;o WET FL..G1.EE STREET •SU;TF. ;673 90 Fak f,3353 3';5.2 P / t Raul Rodricuez Chief Product Control Divisint THIS IS COVFRSHE T, SEE ADDITIONAL PACES FOR SPECIFIC A,NO GENERAL CONDITIONS 1.411_!$1,DING CODE & PRODUCT RED'LEW COMMITTEE This apnliziatinr3 for Product Approval has been reviewed by the BCCO and approved by the Building, Code and ! P oL.IC'_ ".r C - ,a,-�. to b used i . Dade C .y Florida - I s e .d' forth a n C _ ;rr:i ... ;r � il ^�, . , i� under all conditions set vr. c3. L. re."9 i f r r _ �ranci�dC .. Quintana, R A, DircctOr t •• t o U ,Alan- ii..Dacte county OM Building Code C.u!ap :i;ince UM LNIA1t (JSA) 1N'c, ACCEPTANCE NQ.: 99- 1102.05 A1 &'•®VED :December 16, 1999 EXPIRES :December 16, 2002 A OT1C ' OF ACCEPTANCE: STANDARD CONDp ` IONS SCOPE Thi,L`. revises a rooting system using A!mat `Barrel' Cl Roof Tile manufactured ' a, dS f? 1rTiar .tUSA'1,.Inc. described in Section 2 of this Notice of Acceptance, designed to comply with the South Florida Building Code, 1994 Edition for Miami -Dade County. I.or the locations • where the - pressure requirements as determined by SFBC Chapter 23, coo not exceed the desip,n pressure values obtain by calculations in compliance with R_AS 137 using the values listed in sectic 4 :^gain The attachment :tc etc „r calculations shan he done as a moment based system. Category: Sub Category: 2. Pf Of ?CT DESCR>'PrION M.3.nun,ttgul'tt.9 by Fa€3.; tiC Uzn I ( 71e Trim Pieces Product Prepared Roofing High Profile Tile Ttse Dimensions ;S ieci entions !8 1/” w = S „ V:" thick nominal 1= varies 4� = varies vtir thickness PA 112 C"osript seaift or products rrx i,a fat tured by others Test pini psions s ;tcna?teations f cif NrrA ASTM M D 776 type 11 = ? Coated Base NIA ASTM D 2' 5 PA t ! 7 H profile, two-piece, clay roof tile. For mortar set or adhesive set applications. Accessory trim, clay roof- pieces for use at trips, ra-k es, r'd es aad valley terminations Manufactured for etch tile. profile. Product D�'3SrtETtif3t3 S turated organic felt to be used as a nailed anchor 5hcci S:st lett;ti and coated organic ease sheet f s or double lily +underlayrner,t, Prod +ucF Description nufaacturer generic generic t' v tttoaea, RRC Roofing Product Control Examiner A LM R (USA), INC. ACCEPTANCE No. 99-!1 Prodtact Mineral Surface Cap Sheet R? r nproo f /1 Roof Tile Adhesive ("Polypro�?7 A. H l 6Ot ") Tile-Bond APPROVED :Deetrmber 16, 1999 EXPIRES :December 16, 2002 PNO T QCE OF ACCOPTANCE: STAND 1R® CONDITIONS Test Product Di►aaera sit>irns SPte aficati nsDesc-ription N/A ASTM; J 249 30" x 75' roll 16" x roll or 60" x 75' roll Factory premiXed canisters sirQ Pr'1 M itral Surfactti asptt:3li roll roofrng for use os a top ply in a double ply underlayment system. Frank Zuloaga, RR.0 R.00fiing Product Control Exarruner Manufacturer ceneric PA 104 Simile ply, nail-on Protcct -Q -Wrap, unde.rint'ry ent tvith'7" iris. GA - adhering Cop edge. with current NOA Ice and Water 36" x 75' roll PA ! 03 Self - adhering Shield ur,derlayn er,t for use as a.top ply in a two ply underlayment system with Approved N30 or L'43 as the 4!4.34 layer. Roof "Fil Nlortar NiA PA 123 Pcztarzd mortar miC d ,� e �f".rrrFu�.a Roof ( "TileTit TM's 1 destined For mortar set Cornrpilny hc. root' tile applications. (with corre'.t NOA) Quickcrete Roof NIA PA 121 Prepared mortar prix . 1� Tile Mortar ��''a�hi �,t� i�9 (?dui designed for r°tv mcar set (with current roof tile applications. NQp) N/A See PCA Two component ij p01y20i% polyurethane adhesive Products, Inc, designed for adhesive set (with current °^OFtile applieatic,n §, NOA) W.R. Grace, Co. with current NOA Si component Flexible Ptodt cts polyurethane foam roof (with et;riretli tile adhesive NOM r 1 ALMAII (USA), INC ACCEPTANCE No. 99.110/.05 lBereet Tile eart-A Th LIMITATIONS 1 ] Fire classification is not part of this acneptance. 3.2 For mortar or ldhesive sel tile applications, a static field uplift test shalt performed accordance with RAC 106. 3.2 Applicant shall retain .the services of .a. lv•iarni-Dade County Certified Laboratory to perfOrm quarterly test -in accordance with PA n2, appendix 'A': Such testing shall be submitted to the Btnidine Code Compliance Office for review 3.4 Minimum underlayments shall be in compliance with the applicable Roofing Applications - Standatds listed sec-ticn 4.1 herein,. 3.5 30/90 hot mopped underlayrnent applications may be installf--d perpendiculat to the roof 3i0Pe IMICS5 slated otherwise by the underlayment ma.tertal manufacturers published literature. .3.6 This acecp.rance is for - wood deck applications. Minimum deck requirements shall be in compliance with chapter 29 orthe SEBC. 4. INSTAL/....A1ION 4 A!rnar 'Barrel' Cray Roof Tile and its components shall be fi Sr compliance with Miami Dade r.....ottrity R-onfirtg Application Standard RAS 120. 4.2 Data For .A.ttachrnent Calculations AMOVED 7 Ncernht , zr 14, 1999 EXPMES :December 16, 2002 NOTICE OF ACCF.PtANCE: STANDARD CONDMOrsis Profile • Table 1: Aerodycnic Muitipliers - (ft Tile kW) Profile eck App '..ton Table 2: Rest() Tile c re, 4 95 ;le Profile Barret Ti lQ PolyPro t_ the to Gravity-1VI (ft.4 4":12" 5 __ ":12" •_ 7:12" or etreger 4 .65 0161 Tablis 3: Attachment Resistance_ Expressed as Moment - W (ft-lb for Single l'-'t1 AcIliesive Set Systems The Appl:cation 4 77 450 "i‘^`91.1.1111 AttZChME-.ilt ONV (1.a n ce 77 (Clay tlle) 11.5 $iCiay ute)` Flexible ciono pl 2.3 .9t,arn5 per pan ana 25 grams per cap Of P aC e 1 .3 sarns.per pan arrIsitf nieSoncl. RR, Roofine Product Control Fvnminer A1�i�✓fi - R(USA), INC, B Fr rel Tile NOTICE 'OF ACCEI'TA -NCE: STANDARD CONMT!ONS Table 3A:• t* list nce npssed as a Moment - #t�.dg4 =Pb9} for ikflortai Set Systems Tile Attachment Application Resistance Tile - Profile . 3 Bermuda Pcat Tit;gT e rn ^tip•. 4 Quickcrete' Roof Tile Mort?+r u' 1 140 LARI vC All tiles shall bear the imprint o'r il:'.• , -ntifibl° m2rktrig , r r s f,t•t. t \• t \ 1 lt_LiJ:� or following statement- "Mlami-Dade Cot„ l .. r t n tati t Control Approved". E. BMITIANNG PkIRMIST 'l''�EQU REMMENTS 6.1 Application for b.u:idi. g ppem tt shall be accoiipianied b .copies of the following: 6.1.1 This Notice .o i Acceptance. 6,1.2 Any-other da urrtents required by the Building Official or. the South Florida Building Code (SFBC) in erder to properly e.v7.11u ete the installation of this system. y � .- % ice i .i i y M:-..'mar set' 2i C 1 ?�^ a4 PRO WiNGS BARREL CLAY Roof TILE ACCEPTANCE TA No. 99- 1102M5 APPROVED :1 e erra.her 16, 1999 EXPIRES :fle: 16, 2002 Ff;11 ; ZulOW RRC P nil fin a Prnrforr f nnrrnl F v,n,,nov ALMA) (USA), INC. ACCEPTANCE No. : 99- 1102.05' APPRO4'» 1) :December 16, 1999 EXPIRES .: 16 2007 NOTICE ACCEPTANCE: STAN CONDITIONS Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submired 'documents, including rest - supporting data. engineering ' m r - g - .,r,._., 5 documents, :s, are no older that eight (8) yeas. Any and all approved products shall be permanently labeled - .,:h the manufacturer's' nam , city, state, and the following statement "Miami -Dade County Product Control Approval or a.0 specifically stated in the specific conditions of this Acceptance Renewals of Acceptance will not be considered if• a. There has been a chance in the South Florida Building Code affecting the evaluation of this product And the product is not in compliance 1Yith the code chanite`: b. The product is n^ render the saint, product ( ider,ricall as 'ti p r t' � r the enc. Griyii?ri��y approved c. If the Acceptance holder has rot complied with all the requirements of this acceptance, including the correct installation of the product. d. The engineer who originally prepared, signed and sealed the required ' initially r >; dd �ocumenti3tion iniri�.� ti• submitted, is no lonzcr practicing the enginCering prof; salon. 4 Any revision or change i th rnateri! un'r /ur manufacture. the n �' $, use, ro Of rl`, product or process, shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through the ding of a revision application with appropriate fee) and granted by this otice 5. Any of the foilowintg Shrill also be grounds for removal of this Acceptance a. Unsatisfactory performance of thin produce nr r:rocess Misuse of' this Acceptance as an endorsement of any product_ for sales, P.d"crtisine or tin other purposes G. The Acceptance number t e of A c_ preceded by the Ivor„ a "Riarri -lade County. Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notiee of Acceptance is displayed. then it shall be done in its entirety. 9. A copy of this Acceptance , s wcll as approved drawire; and other documents, , AI:f:re it opptics, shall be provided to the user by the manufacturer or its ;4ie_r,btttr.rs and 5111'1 be avil;!:ihlc for inspection at the rob site ar all time The engineer need not reseal the copies ` ailora to comply with any suction of this Acceptance siid',i be cause for tcr'nt■nation and removal of Acceptance. This Notice of Acceptance consists of pas-r t ihrcolic 1 5 and this last page 6 END OF THIS ACCEPTkN rrenk foaRa. RP,� Rool'ir,g Product Control Examiner /!/1.?7 ( SzhAnaTilia BUILDING AND ZONING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES, FLORIDA 33138.2382 TELEPHONE (305) 795.2204 FAX (305) 756.8972 RECEIPT I, ��L 1--Q S 70 �`t C P /-f c 1/1 contractor /owner, picked up 2 sets of plans for (address) 4-Lf 0 N ` l L PT' from the Building and Zoning Department on (date) to have corrections done to plans and/or get County stamps. I understand that the plans need to be brought back to Miami Shores Building and Zoning to continue the permitting process. GREGOR'f NICHOLS and ELEONUKry NILHULS, n►s wire whose post office address is c/o 600 301 BLVD WEST, SUITE 202, BRADENTON, Florida 34205 hereinafter called the Grantor *, and GLADSTC►NE PHILLIPS and KATHLEEN PHILLIPS, his wife whose post,office address is 440 N.E. 92 STREET MIAMI SHORES, Florida 33138 hereinafter called the grantee *. WITNESSETH: That said grantor, for and in consideration of the sum of TEN AND NO /100 ($10.00) Dollars, and other good and valuable consideration in hand paid by the grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold, to the grantee's heirs and assigns forever, the following described land, situate, lying and being in MIAMI -DADE County, Florida to wit: Property Folio No.: 11- 3206 - 014 -0050 The West 6 inches of Lot 6 all of Lot 7 and all of Lot 8, in Block 49, of MIAMI SHORES, SEPTION 2, according to the Plat thereof, as recorded in Plat Book 10, Page 37, of the Public Records of MIAMI -DADE County, Florida. Subject to restrictions, reservations, easements and limitations of record, if any, provided that this shall not serve to reimpose same, zoning ordinances, and taxes for the current year and subsequent years. I Said grantor does hereby fully warrant the title to the above described property, and will defend that same against the lawful claims of all persons whomsoever. * "Grantor" and "Grantee" are used for singular or plural, as context requires. IN WITNESS WHEREOF, Grantor has hereunto set grantor's hand and seal the day and, year first above written. Signed, ,uealed and de ivered in the presen 6 of: . // ,lnature of fitness / Printed I N me: Si!S"d,✓ 1 - fire e”- � ' / (? Signature of Witn s Printed Name: /-1 fad h ,' 1 -a State of Florida County of,. / (Sig,Y ture) Starnped) My Commission Expires: Tax Identification Number Information GL4DSTONE PHILLIPS KATHLEEN PHILLIPS —� HOLS ELEONORE NICHOLS ■ The foregoing instrument w - cknowledged before me this / day oVi 2001 by GRE..ORY NICHOL d ELEONORE NICHOLS, his wife , who are personally known to me who have p uced A VALID DRIVER'S LICENSE, as identification and who did take an bath. Notary Public, Commission No. (Name of Notary, Typed, Printed or {,c1i.Ir:.It (.!'.1141 ;•,:<sil'C ? �.t. t �, 2003 ,\1I' !lc iir; :ins Go., Inc. (SEAL) (SEAL) 1 No. 2072 BUILDING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES, FLORIDA 33138-2382 TELEPHONE (305) 795-2204 FAX (305) 758-8972 CERTIFICATE OF COMPLETION Date: February 13, 2003 Owner, Agent or Tenant of Building: Gladstone Phillips Miami Shores Section 2 W 5 in of Lot 6 and all of lots 7 & 8, Block 49 Street Address: 440 N. E. 92 Street Approved Use: Single Family Home Remarks: BP 2002 -369 EL 2002 -129 PL 2002 -70 ME 2002 -166 This CERTIFICATE OF COMPLETION is issued to Gladstone Phillips for work done in a single family home residence at the above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of building or structures. - 4 1 GEORGE DESHARNAIS Building Official MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp n aieLt—e&I Permit No / ! Name Address Company Phone # For Inspector: / _ ._ / f) Name & D . Time Correction Re- Insp'n Fee 7 60 ( ce 0%! MEI !mow /_A Type Insp nsp'n Compan ' m - Phone # Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT . 305- 795 -2204 Building Inspection Request Date — Time .X� Permit No. Namef '� y� Address's Re- Insp'n Fee ❑ N For Inspector: / :5 2 ame &' Date Approved ❑ 1)E : <;ir Type Insp' Permit No. Name Address Compan Phone # For Inspector: Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Time Re- Insp'n Fee ame & Date �-- t. Company -"Z 771a MIAMI SHORES VILLAGE • . BUILDING DEPARTMENT 305-795-2204 • Building Inspection Request Date Type Insp'n Permit No. _ - _Name ftt:LC- Address A CG c , PG9 002.- * 0 - 7:- Phone it • -For Inspector: iti & Date Approved Correction p'n Fee . - • Time -- . . • Pewit No. e I 2 0 17 - 1 NaMe Address 4 • Company , nti Eh" _al- le '-- Phone #. .30 S 7. '772*- MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date4r: / 7 02.. Time . - Correction -For IitSpector: 20-0a. Name & Date Approyed . - • Re-.insp'p Fee .. • fi • • , • ; , TY )- c , Name - Address y ri : ;Phone For Inspector: • MIAMI SHORES VILLAGE BUILDING DEPARTMENT . 305-795-2204 Building. InspectioncRequest ,Approved C ti orrec on Date Ti : - '_•1-7.',Ite-Insp'n Fee • 6 41 Name . • ' MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date 3- /- d 1 Time Type Insp'n Permit No. BP.-2 a0a4 Name Th Address 0 _St c fed Pho )3/ cM For Inspector: 3 _ y Name & . Date Approved Correction Re-Insp'n Fee ' MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Datfl ) Time . Type XiipiA.A...k.ry 19 A 1,Kio PernijO. . gl-?00.7 . - Name r f, k ( i n . Address Phone #3 -CS 1 . 3 For Inspector:( Nam e-- , h 3 i9A 1 — Approved Correction • se-Insp'n Fee r e Vow 7 1:;■ 7 1/4. / •=:9"" 4' V4' /■.-- 4 1 1 T. MIAMI SHORES VILLAGE BUILDING DEPARTMENT • 305-795-2204 Building Inspection Request Date 3 - -Time Type Insp'n " Permit No. P L ,2e02 Name IC 4 X7eiae Address 44'o e 72 sr • MIAMI SHORES VILLAGE BUILDING DEPARTMENT -- 305-795-2204 Building Inspection Request Date/CIA= 0 " -2 .- Time, Type Insp'n Permit No. • Name - Address 11 ‘' - e" 41 Company ?FY ,EXicr .73 • C- Phone # For Inspector: Name & Date Approved : ,4 Correction - j - „ - Re-Insp'n Fee - . . _ • . - ■•■ Date Type Insp'n MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Time pernii poo Name 1 zilyoAlRya_SY rice Phone # 30J gkSk For Inspector: 7 2 2 , e2 Name & Date • - .....Approved dorreciion 0 Z-Z-. 1 4 - 17/ Re-Insp' n Fee 0 I t`7"••• * - Address Approved • - Con • MIAMI SHORES VILLAGE BUILDING DEPARTMENT . 345-795-2204 Building Inspection Request , Date: Time Type hug' • .Permit r fo - Name .. . Company .::---..... +.:.t..;• / f . ---) 1 - - ... - ... ,_ ., -- , ,„, : t —. • MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date..24PP Time T•Ifls p'n . . Permit No. / ..1 Zel° • . Company /4-0 • Phone # •"- t - - For InSpectar: Name & Date Approved Address Name ri Correction Re-Insp'n Fee • • Address ---• Company MIAMI SHORES VILLA SE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request l• Date Time Phone # 1 i j a ° 1 For Inspecto Name & bate 1 1 App t _ &II . i- ' Correctio +s- 0 .„ 2_ /Ad 0•41/e::: 'z Re-Insp'niee ' 0 >" _ • _ -ric re / - €./.€-'./ 1P/2.- z / cz ;2 7Y.404e-Al . 4 e,2 • - • . Date rime nsp' No. iS :ion MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request ,'n Fee eine & Date / 390d eL689SLS0S:Xtid 1 r• Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n Permit No. n , Name 01 1 / 5 7D Time Address ' 'l 0 r n. l Company ` 9 (A Q , Phone # b j " 0 0R F Inspector) l I l /so . r FORM 6000 -97 FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION Residential Component Prescriptive Method R Department of Community Affairs I ` Compuariee with Method 8 Chapter 6 of the Florida Energy Efficiency Code may be demonstrated by Me use of Form 60CB -g7 for single and multifamily residences of 3 stories or less In height additions to existing residentire.buildings. To comply, a building must meet or exceed ea of the energy efficiency prescr'piives in any gpp of the prescriptive component packages eog compry *In Ine prescriptive measures listed in Table 613-1 of this form An alternative method Is provided for additions of s00 s^uere feet or less by use of Form nO0C•97. It a building does not comply wdh th c method i1 me still wrier other sections in Cho er 6 of the Code. 1 PROJECT NAME: BUILDER: AND ADDRESS: •a' . . �(" PERMITTING -� ' OFFICE: OWNER: MR ; / r r . �` PERMIT NO. 1 i s. GENERAL DIRECTIONS 1. New construction including additions which incorporates any of the lollowing features cannot comply using this method: steel stud walls, single assembly roof /ceiling construction, or skylights or other non-verlicai roof glass. 2. Choose one of the component packages "A" through "F" from Table 6B -1 by which you intend to comply with the Code. Circle the column of the package you have chose 3. Fill in all the applicable spaces of the "To Be Installed' column on Table 68-1 with the information requested. All "To Be Installed" values must be equal to or more efficient than the required levels. 4 Complete page 1 based on the "To Be Installed" column information. 5 Read "Minimum Requirements for Ail Packages ", Table 6B-2 and check each box to indicate your intent to comply with all applicable items. 6. Read, sign and date the 'Prepared By' certification statement at the bottom of page 1. The owner or owner's agent must also sign and date the form. 1. Compliance package chosen (A -F) 2. New construction or addition 3. Single family detached or Multifamily attached 4. N.Multffamily -No. of units covered by this submission 5. Is this a worst case? (yes / no) 6. Conditioned floor area (sq. ft.) 7. Predominant save overhang (ft.) 8. Glass type and area : a. Clear glass b. Tint, film or solar screen 9. Percentage of glass to floor area 10. Floor type, area or perimeter, and Insulation: a. Slab on grade (R- value) b. Wood, raised (R- value) c. Wood, common (R- value) d. • Concrete, raised (R- value) e. Concrete, common (R- value) 11. Wall type, area and insulation: a. Exterior: 1. Masonry (Insulation R- value) 2. Wood frame (Insulation R- value) b. Adjacent: 1. Masonry (Insulation R- value) 2. Wood frame (Insulation R- value) 12. Ceiling type, area and insulation: a. Under attic (Insulation 8 b. Single assembly (Insulation R- value) 13. Air Distribution System: Duct insulation, location 14. Cooling system (Types: central, room unit, package terminal A C., gas, none) - 15. Hating system: (Types: heat pump, elec. strip. nal. gas, L.P. gas, gas h.p.. room or PTAC, none) - 16. Hot water system: (Types: elec., nat. gas, L.P. gas, sol.j'reat rec.. ded heat pump, other, none) hfreoy cenlly that 'he as FIOr:0e Enn73 Code PAEPAAED eV: I MIOby Cerny That :hie OWNER AGENT: e caICWHron we in corn) ice with the DATE: paence w4T l Ir:e FF IOIIda E ner g l OAT CLIM - . ZONE: 7 SOUTH 7 8 9 Please Print CK 1- 2. 3. 4. 5. 6. 7. 1Oa. 1Ob. 10c. 10d. 10e. _ -L tmT �°- O Single Rome Double Pane 8a. -- sq. ft. sq. ft. Bb. . sq. tt. )4 sq. ft. 9. „2.5 % Z lin. ft. sq. ft. sq. ft. sq. ft. sq. ft. 11a -1 R= S_ _. ..4_0 sq. ft. 11a -2 R= � Q sq. ft. 11b -1 R= sq. ft. 11b -2 Ft= _ sq. ft. 12a. R_ _ 54_1__ sq. ft. 12b. R= - ______ sq. ft. 13. R= _ • D 14a. Type: 14b. SEER/EER: - . ...1A. t _ 14c. Capacity: _I14ZQ 5"» 15a. Type: .G._ _._p 15b. HSPF /COP /AFUE: 15c. Capacity: --° 16a. Type: ,15,4T/54 � 4 - 16b. EF: ___...__.._ .. q t' - - -_._ . --- Review o1 plans end Spe ,m aI,OnS covered by roil calm/anon m ^.ic ^alas corn. ance wnh he Fiona, Energy Cdov aetcre theist ructinn is completed this hulloing will ice -nspecteo to compliance in accrodance w,1! Sector 553,908, F.S. WILDING OFFICIAL: - - .. ..___.. _ -... JURISDICTION NO.: [ 1 l t l Revised 1998 64. MAP AND PANEL 85. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 12025C0093 J 7 -17 -95 3 -2 -94 x Not Availahl? • FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. 1 2 9 h h 9 SECTION f °'^ rTERTY O`q17\17,Ft INFORMAT1OM ° 'c • !nsrranc<3 Cowan.; C VNER'o rJ.,..c Policy Number Phillips BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number ; 440 N.E. 92nd Street + ,ITY STATE . ZIP CODE Miami Shores, Florida ROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 4 BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use Comments section if necessary.) . Residential LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: Li GPS (Type): ( ##° - ##' - ##.##° or ##.#a /##' LI NAD 1927 Li NAD 1983 81. NFIP COMMUNITY NAME & COMMUNITY NUMBER Miami Shores /120652 SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B2. COUNTY NAME Dade O.M.B. No. 3067 -0077 Expires July 31, 2002 • L1 USGS Quad Map L_I Other. B3. STATE Florida B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. 1_1 FIS Profile 11_C1 FIRM U Community Determined 1J Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: Ll NGVD 1929 Ll NAVD 1988 1 Other (Describe): B12. Is the building located in a Coastal_ Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1J Yes 1 No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: L1Construction Drawings* 1JBuilding Under Construction* JJFinished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO Complete Items C3a -i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the 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 Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum NGVD 2 9 _ Conversion/Comments NONE lC�' 0 Elevation reference mark used ,'i 5 i pi-A-- Does the elevation reference mark used appear on the FIRM? Ll Yes 411 No ❑ a) Top of bottom floor (including basement or enclosure) 1/ / ft.(m) Ti; O b) Top of next higher floor Z ,7lc' ft.(m) O c) Bottom of lowest horizontal structural member (V zones only) Ail_ ft.(m) o ❑ d Attached garage (top of slab) ! ft.(m) g O e) Lowest elevation of machinery and/or equipment / ' m servicing the building ,,il �� �D s € ft.(m) 8 = . ❑ f) Lowest adjacent grade (LAG) 7 ft.(m) z s ❑ g) Highest adjacent grade (HAG) 9,r ft.(m) O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 7 E . ❑ i) Total area of all permanent openings (flood vents) in C3h /312 • 5/ s . in. (sq. cm) 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. / certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER COMPANY NAME 'OFESSIONAL SURVEYOR & MAPPER LANNES AND GARCIA, INC. RESS CITY STATE ZIP CM �9 Alcazar Avenue Coral�Gables, Flor 33 da 3 4 GNATUR� DATE„� ac' (305)666-7909 r'EMA Fo m 81 -31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 440 N.E. 92nd Street 9 CITY STATE Miami Shores, Florida SECTION D - SURVEYOR, ENGINEER, CM Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS / � �/�• C,ia /0E`‘/UCt/n! Z Xi ry Gal/A/c c- l — / � � — .0e1 Z E Drto /'cry X044/472 - v= A7o . 41- t114' 4D44/67f $ /° ,e) A-0,,E� jf �4dil'�JL / I —I Check here if attachment& SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Section C must be completed. El. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is I I I ft•(m) I 1 Iin.(cm) LI above or L1 below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is I I 1 ft•(m) LLIin.(cm) above the highest adjacent grade. E4. For 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? LI Yes I,1 No 1_1 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. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTAT FAME ADDRESS SIGNATURE COMMENTS CITY DATE TELEPHONE 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. G1. L1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. L1 A community official completed Section E for a building located in Zone A (without a FEMA- issued or community-issued BFE) or l one AO. G3. L1 The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been.issued.for L1 New Construction L1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: . G9. BFE or (in Zone AO) depth of flooding at the building site is: LOCAL OFFICIAL'S NAME I COMMUNITY NAME SIGNATURE COMMENTS FEMA Form 81 - 31, AUG 99 TITLE TELEPHONE DATE ZIP CODE Policy Number Company NAIC Number: Sr' STATE ZIP CODE For Insurance Company .Use: : LI Check here if attachments . ft.(m) Datum: . ft.(m) Datum: 1 Check here if attachmerii REPLACES ALL PREVIOUS EDITIONS FAIRS 111-1 MINIMUM MUNIMENTS COMPONENTS CEILINGS SabQ►dirsds %MA Wood ROW Caw* DUCTS SPACE COOLING (SEER) YtliolOwbRorke Mowry YAW Awe Gee/ON (AFUE) Electric Resistance" G al te N Other MI PACKAGES FOR NEW CONSTRUCTION B 0, E F 20% 25% snot TM (8T) $ Tint {8T) single TW (8T) OOtbr IDT) Itotte TIM (DT) 2 ' 2 r EXTERIOR AND ADJACENT MASONRY WALLS R4 COMMON MASONRY WALLS R-3 EACH SIDE. A 15% Dauer ow cm 15% 20% 2 1'4• EXTERIOR, ADJACENT, AND COMMON WOOD FRAME WALLS R -11 CEILINGS UNDER ATTIC R-39. FRAME COMMON CEILINGS R-11 (NO SINGLE ASSEMBLY CEILINGS ALLOWED) R -0, R•11 (ONLY STEM WALL CONSTRUCTION ALLOWED EXCEPT PACKAGE B) R•6 R4 R4 R4 COND. R4 10.0' 12.0 10.5 12.0 10.5 STRIP STRIP STRIP STRIP __j;_, STRIP EF .80 MINIMUM OF .73 (Ding heathg) Of .78 (C• EF .94 NOT *LIMED MEd 118.0W) EF .90 EF .00 NOT ALLOWED (WE BROM MINIMUM EF OF .54 Any of She foffowing are allowed: dedicated heat pump, heat recovery unit or solar system. ROW halve ette w SWAT • Msdrar shoveler for to and eeaele hot water 'ppy to to 40 poet war Noma Rater to TWA 1.12 for arras Cade aldendes ter of err heelers ad also ahn. 18110//1100100 MKOMO COr01MIl"/ 6N11m rhreraer Farr Is Reel Awe ThN percent r cel4lehd try deg the bas errs sap stns by its bed botdMasd boo ass. co TMowbhntpbb calm therod orsoli pleas or roAmn * taerte hoe atsdes► Ail plus sees adbe war ano bgaM I1Wt ooreEdd1lrl�bddtOaMoroi I) Oa re ride d a how and 2) Ps ails h re bow stones a s mtasssry hour Ma ere Prep ho erase %Wm The R-wues Indlceled report the 'ohn th Wasp able Insulation la* arse to ths sbufl a tea ark odal or b«. TTN R'ysUs a rs Mani trial mortals Mpssraanot be hel4s4In No alo�lo+. 'Con+more pompons* we are sepanilnl condhbhsd tsnenales In a mWdfamfy told np.� components n era cpdbasd opera flan umendrl -.s lfu Plow: io err l a doors rep arcs iron uncontir sd ad tavoreed spec, Plow: •OOPC hdlat that the ducts mute be rat sd bas sad has winnow stall bsltt>M Marion pr01d on We are eel or under Ws lour amsp Poloist E Cooing epee; that Id is ouctwotk shall tea locale on We warred We a Ws i erallon, traps In ortAlor spew an raw* ter any lam NIA" 0 rim Sid ido s Se m E �, Rsto (t3EGq for canna sale or Erato Mangy Arab (try for room tab or PTAC's are to or WNW Oen lr tsawa yasaa assay b enrol a orlon K0a t A11C 12 No wane rasrurt a era ISM r �rfri to «vallsr rstt As steward MVP. NeXT sums M' s or cram soma* marl ewer Awrw Mot Maw Opra Fbr pelages OaMAnme tyol Moose% an wank resistance ha water skean may be Welded any In mryutaeon wale one of the TiMar nit Warr Sohn Groans•. Ora bare. Odor lest Miler Opelwr Oilers Any daalaeed host pimp, rase recovery � T . w . aalr hot loner rat may be Ward. War yam rat Mae an EF a t,1 or 167.r, Eon° odium sons homy en EF a.M «sores or rasa gee pearls tab EF ./n or water Troy be Job h xrameion trlh opera Nom TABLE SS-2 MINIMUM REQUIREMENTS FOR ALL PACKAGES Exterior Joints a Creeks Extorter Windows & Doors Sole • Top Piste* Roomed Max .3 cfmiq.ft. window era; .5 c i' q.R door arse. Sole plates and pensPstttons through top plates of exterior walls must be sealed. Type IC rated with no penetrators (two alternatives allowed). Air bsrfer an perimeter of floor cavity beawsn Awls. Exhaust fans vented to unoondllioned space shall have dampers. except for combustion tints' with integral exhaust ductwork Comply with efliciency requirements in Table 6-12. Switch or (lery marked circuit breaker (electric) or cutoff teas) must be provided. External or bultan heat tap required. tiluld-elory Houser Exhaust Pardo Water Nesters n0 Pooh i1 Sees Not Water Pipes 612.1 612.1 Snots. Heeds NVAC Duet Conetruotion, Insoletion & Inst lletlen NVAC Contras 806.1 606.1 606.1 «08.1 606.1 606.1 81 612.1 610.1 807.1 To be caulked, 9asketed, weather-stripped or ott»rwMe sealed. Spas & heated pooh must have covers (except sots heated). Non pods must hole* _pump nsr. Gas spa S pool Maters must hive nt rimtxn themal eflfciernCit of 78%. Insulation is required for hot water dreuladng systems (Including heat recovery units). Water flow must be restricted to no more than 2.5 gallons per minute at 60 PSIG. NI In Menge. mechanism equipment end hasped accordance vel thh the criteria of Section 610.1. Ducts In Mica must be Insulated to a minimum of R -0. Separate readily accessible manual or automatic thermostat for each system. v tr -2- Masts Zones 7 S 11 TO MI INSTALLED L5 oc 0T: o • E cT: R. 20 AOJ OM R . EXT R ADJ: R . 001t R UNDER ATTIC: R . 30 COMMON: R. R. 0 R. R. j r R • Sr !p . OOND. SEER. 12.0 coi AFUE • EF • ,90 EF • HRU ❑ SOLAR Ef• CER1itiCATE OF RE- OCCUPANCY. On behalf of vliami Shores Village, Florida, the undersigned certifies that the property described in the above application has been inspected for purposes of re- occupancy pursuant to Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such property may be re- occupied by the above applicant for single- family residential purposes. r THIS CER 1 "1t-ICATE VERIFIES THAT THE REFERENCED PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE MIA M[ SHORES LAND AND DEVELOPMENT CODE PERTAINING SOLELY TO THE REQUIREMENT THAT EACH ONE -FAQ ELY DWELLING IS USED AND INTENDED TO BE USED FOR A ONE- FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR WARRANTY AS TO THE CONDITION OF THE DWELLING OR OTHER STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH CONDITION, AND INTERES 11✓L) PERSONS ARE ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE PREMISES IN ORDER TO DETERS THE CONDITION, THEREOF. PAGE 2 OF 2 MIAMI SHORE , FLORIDA By: Date of Certification: 0, Q I APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY to re-occupy the single family residence known as : (address) V q2 S\ 1M L, � Miami Shores, Florida. Legal Description: Lot: BIock PB &PG: hereby apply for certificate - I hereby certify that I understand that the zoning. of the property is for single - family residential use and that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re :Occupancy that may be issued by Miami Shores Village, certifies only that the referenced property is being used for single-family purposes and that such Certificate does not constitute any repre - a: on, warranty or certification as to the condition of the dwelling or other structures on such Applicant Print Name **************************************_******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** For purposes of conducting the inspection required by Section 902 of the Miami Shores Land Development and Zoning Code, please contact: Telephone: - Z OO R 1 Contact Name: 0 YN) I IijO\ Buyer Application Fee ($50) paid: Cash Inspected by: Comments: Seller Realtor Approved Company Name Check No. PAGE 1 OF 2 Denied Date 6/I. STATE OF FLORIDA DEPARTMENT OF STATE Division of Archives, History and Records Management DS- HSP.3AAA Rev. 3.79 Site No. Site Name 830= = Survey Date 8505_ 820= = Address of Site 440 NE 92 St., Miami Shores, F1 33138 905= = Instruction for locating on S side of NE 92 St. between NF. 4 n,vP. & NE 5 Ave. 813= = Location- Miami Shores Sec. 2 49 W 5' blk.6, all 70368= _ subdivision name block no. lot no. County Dade 808= = Owner of Site: Name: Henderson, Thomas M. Address 440 NE 92 St., Miami Shores, Fl 33138 902 = = Type of Ownership private • 848= = Recording Date Recorder: Name & Title Stofik, Marty Address. MSHPB Condition of Site: Threats to Site: none Check One or More ❑ Zoning( )( ❑ Development ( )( ❑ Deterioration( K ❑ Borrowing ( )( ❑ Other (See Remarks Below): Areas of Significance Significance: FLORIDA MASTER SITE FILE Site Inventory Form FDAHRM 802= = 1009= = 832= = 818 = = Integrity of Site: Original UsePrivate resider= = Check One Check One or More ❑ Excellent 863= = Altered • 858= = EX Good 863= = ❑ Unaltered 858= = ❑ Fair , 863 = = 6 Original Site 858 = = ❑ Deteriorated 863 = = ❑ Restored( ) (Date: )( ) 858 = = ❑ Moved ( ) (Date: )( ) 858 = _ NR Classification Category- Building )( )878= = )( ) 878 = )( )878= = X )878= = Present Use private resid.850= = Dates: Beginning + 1925 844 = Culture /Phase American 840= = Period 20th Century 845 = = ❑ Transportation( ❑ Fill( )( ❑ Dredge( )( 878 = = 1( Architecture; Community Planning Structure is an example of the Mediterranean Revival style used for homes in the original Miami Shores subdivision. It is significant for its size and irregular massing. The home is in scale and character with the surrounding neighborhood. 911 = = 916= = )( ) 878 = _ )( ) 878 = = )( )878 == 910 = = Township Range Section 812 = _ 53S 42E 6 ARCHITECT __._._.__ ...__ 872 = = BUILDER --- 874 = _ STYLE AND /OR PERIOD Mediterranean Revival 964 = = PLAN TYPE irregular; irregular 966= = EXTERIOR FABRIC(S) rough textured stucco 854= = STRUCTURAL SYSTEM(S) concrete block 856= = PORCHES none 942 = = FOUNDATION: concrete block 942 = _ ROOF TYPE: multiple gable 942 = _ SECONDARY ROOF STRUCTURE(S): gable & shed, barrel tile 942 - - CHIMNEY LOCATION: offset, rear slope 942 = _ WINDOW TYPE: alum. awning ,& jalousie 942 = = 882 = 882 = = CHIMNEY: CBS ROOF SURFACING: ORNAMENT EXTERIOR: wood _ 882 = = NO. OF CHIMNEYS 1 952 = = NO. OF STORIES 2 950 = = NO. OF DORMERS none 954 - = Map Reference (incl. scale & date) Miami Shores Village Plat 1980 Latitude and Longitude: Site Size (Approx. Acreage of Property): LT1 LOCATION SKETCH OR MAP ■t= a5 5r. �m0000u�� 811.0111111 r !a y z 11 NE c2s— a 9 e 'e rl o. n r. rr 41S _$4 .. .. .. .. Jo l ' St ST 4 r rr , 09 A 7 r q V(LIAGE L(M (7 barrel tile 3 Contact Print 440 is Photographic Records Numbers _85N103HG44/85N104HG27 860= = 0 UTM Coordinates: — EisEng NiThino :aiaarvmsons.:En. 809 = = 800 = = 833 = = 890 = = STATE OF FLORIDA DEPARTMENT OF'STATE Division of Archives, History and Records Management DS-HSP -3E 9 -74 CONTINUATION SHEET Site No, Site Name 440 NE 92nd Street Miami Shores, FL 'Physical' description: Structure has two -story main mass on E with single -story wing on W. Entry door on W of central mass before single -story section, and windows on single -story have wood timber lintels. Garage attached E, similar style. ma�luI, 1a�o�11 a 'f't I i!II iI /emom IIIUI Nb IIII r 3N e a 1 ' .•m u • mdCamaam� - oommp dC0�dA6ml 1. a ir. .mmll�mlllmm ��.:111od1111� ,y 9s a 3N mmpmammmm "mmm" •A 4 � °OAS a a Ada y�m� �mmcm �AG0009Am� �A:.00rocmm* �1 u 3 H V 1 • .u. 91w 0 ♦r F D W mmzmms msmz �AO01�dG0A '4 , 1 S v 81 111 .. , mlaaQo i oomml mmma 1 1o1md'11 1 m9oa1 mao��� 2 m000��� S S S ° ;d•im:Qamllc �coco �c a m m,�.,Qmdmm m�ca� aoaoll S m�mmm�m ® ©mm. I�O�C�aooc� a 1 S s�eo�9�smm. �pacoae�al 1 9 �cooa�daa�c ;IIr aooa-" r �c •o�a•dmmp l� �6tiE'sQml , ., m raa �aao�m� '1 S 3��IAI6� mm�aoaoomcm mo��alm111 Ip r ammm� f 1C •.101 '/F H)A'fN) > 7OOwr VW/7 10 3C9' 10 Vb r♦ OG b' level 1 S L 6 r '9 , n .S moms I , I 1. Is s Z 6 6 �mp�moam s6 �mdcm� •.. 9 6 � mAR��RO mcRavdaa -J 6 6 ��mmm mm� ma o�aaa e r of F t '1 , r O 2 4 O O I dAmD��JI :.poamod m 101 I 0 �mecm�oa .IHL p cc co�doa mina o�oa 01 z... ID� i aaedom s° _ T J I/ r„ �erF r r C 4 0 "k -.a f, LL I 0 l$� O s 1'' j'' '3 i 3'N �mmdm� amm11� :3 OIu om.: ® mom Ao • i•ommmm mmmml� 61 / r 'IV v 9. • S 1S 1S •N ' N 3 N mmRC� �:i I�GdmD�CB �aoamdmm� o r c � acp 1 'mAAAm l i �RIRA 3 'r.i i�mmro� amoIDm� 3'N p�amocd rA�1�11� m'oaaomA 3'N IRpaRORI� ,G ° aAOml� c,-9 471 '_��m "'mmm odmm • 3'N I 1 LJI111I comodm 9 or .l ®p ii u O mmm ®a�mm 111/ m ° °mmoo�m�• � 1m10 = owm •II° d ©d� .IIQOiao� ' mm dcc� ��GrE� GR Illlap� p�cm�dp M 4,901 .L01 1./ 7 Y '.n601 3N r /r T 1 11 1 S l N Y ' yr 011 3 N a r a ,_ u .rkr '9 r 9 4. a 1 S H196 .9 .r J oY z 7 ,• 10 ;i sue, c 1 1 =1 '1G . r 1S ;. i. mmmmc 10� mmm�� '-44.0 11�am • 1s1 D 1 S FrII�� v�mmlmm oo`avmmmm � BoaG0A1Rr; s po�saRmmm� c wl ��mmmm� Iccommmm 1 9 .1 IR1paAl� ml�amammp -L 6 S S ''D LO! � md�mom� ©R _ II «I Iooe�aoao L .4 9 AGENT; APPLICANT; PROPERTY ADDRESS: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL /-/` /D A/. 2 � LOT:� BLOCK: 1 /7 SUBDIVISION; CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE TANK INSTALLATION [01] TANK SIZE (1),(35 [2] [02] TANK MATERIAL [03] OUTLET DEVICE [04] MULTI - CHAMBERED [ Y / N ] [05] OUTLET FILTER Z. [06] LEGEND [07] WATERTIGHT [08] LEVEL [09] DEPTH `'1'O LID / [15] [16] (17] [18] [19] [20] [21] DRAINFIELD INS ION [10 AREA (1)a. �1'4� /[ [11] DISTRIBUTION B3 X _ dZCS HEADER [ [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE DEPTH OF COVER 42 ELEVATION [ABO = BELOW SYSTEM LOCATION DOSING PUMPS A/ AGGREGATE SIZE / S — 0.0, AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH /2 J, FILL / EXCAVATION MATERIAL [22] FILL AMOUNT .Z /) [23] FILE. TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ [ [ [ CONSTRUCTIC i�[APPRO PROVED]: FINAL 8YS [APPROVED ISAPPROVED]8 H 4016, 10/97 (Previous Editions May Be Used) PERMIT NO. DATE PAID; FEE PAID; RECEIPT 1: ,p `ROPERTY ID 1; OR RULE AND MUST BE CORRECTED. SETBACKS FT [28] DITCHES 77/ Y '4, / FT [29] PRIVATE WEL'YS FT [30] PUBLIC WELLS _ [31] IRRIGATION WELLS ,,e- , [32] POTABLE WATER LINES 30 FT [33] BUILDING FOUNDATION f S FT [34] PROPERTY LINES ' 3 FT [35] OTHER FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL [40] [41] [42] [43] [44] [45] [46] [47] [48] INFORMATION UNOBSTRUCTED AREA STORMWATER RUNOFF ALARMS MAINTENANCE AGREEMENT BUILDING AREA LOCATION CONFORMS WITH SITE PLAN FINAL SITE GRADING CONTRACTOR 7 77„e---c, ( )0-4. OTHER ABANDONMENT l (49] TANK PUMPED ] [50] TANI CRUS = = 7).c1 /Zj/_Li , & FILLED 4L/". // l l l l CND DATEZ' / _ 7 -6 j CHD DATE d) - 027 - O Page 2 of 3