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534 NE 95 St (5)1330 Street and Number where work is to be done Council Approved MCA[i 0 SHORES VBLLAGE DING INSPECTION DEPArTMENT APPLMI TA®N F®R BUIL®IL G PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address Fred R. Lang No 534 street N. E. 95th St. Registered Architect and /or Engineer ...... ....... Obenour Roofing Co. 7357 N W. idiami Ct. Name and address of licensed contractor Location and legal description of lot to be built on: Lot__ _ Block Subdivision 534 N. E, 95th St State work to be done and purpose of building (by floors) __ _. Remove the existing r o o f and np 1 a c e with 1 =30 lb. felt,. 1390 lb. slate and white shingle tile. and for no other purpose. New Building Remodeling _.._ ._ ___ Addition Repairs_ ___ No. of Stories To be constructed of Kind of foundation Roof Covering_ Estimated Total cost of improvements $ 1 n 973.00 Amount of Permit $ 5.00 20 s q s. Zone cubage required _Plan Cubage__ Distance to next nearest building.__ ____ _ Size of Building Lot Maximum live load to be borne by each floor___ I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to - - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen s Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only s actors, on work to be rformed under this permit, as are licensed by Miami Shores Village. Remarks //�j - - n ®/-" --- - -� - �� " __ (Sig ed) - „ STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared - — - - to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. /� G Permit No 13'I 30 Date__O% ft.1 I 1 _5 1 11 1 Read, Sworn to and Subscribed before me. Disapproved . n Date_ _ _____ ( Signed) U.,,_ tl; - V� D ca.__ - DD Buildin Inspector My Commission Expires__ __ _.. Notary Public, State of Florida PLANNING BOARD__ __ _ DATE Chairman Member Member __ _ _ __ Member . _ .. . Member _ ._ _ Member Date_.. P r y -1- 7 ,19 71 Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has bre* obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper not z• tor inso ..,on or faulty materials and /or workmanship. ;UILDING , LECTRICAL ' LUMBING GOOFING )weer of ; uilding 0 ❑ PERMIT 11TQ 3324 Contractor s ❑ License No 0 ❑ Work to be performed under this Permit .rchitect ontractor T Builder f, I .egai Lot )escription Iddress of r wilding L ,/, /` CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA DATE .� Bi. Signed' Subdi- vision Value of Project $ - �-- I I Amount of II Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any me if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ortaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work one by his agents, servants or employees. f r' / BY -'a .rte ji 195.- x s: 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 ortaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- opting this permit I assume respons' for all work done by either, myself, my agent, servant or employee. BY AUTHORITY 6 a55/w Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address.. APPLICATION FOR BUILDING PERMIT Registered Architect and /or Engineer _ Name and address of licensed contractor Location and legal description of lot to be built on;. Lot ;' / Block r% Subdivision Street and Number where work is to be done MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT _ ✓ �.y , 19 '/L Date �` , I� - + °�`"�� ' No � ° � Street A : State work to be done and purpose of building (by floors) ✓I<,� f 7 and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $ Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No Date Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Legal Description State # 0Phd0 Architect /Engineer Bonding Company t• !j at / , PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date ��� �'7 Job Address `7 ,J y5 S 6--0 T $) cute- 61 Owner / Lessee / Tenant AIL. A- 1 Owner's Address S 95 5 7 Contracting Co. O /3CNOJ,- AcriA) �9 Qualifier - avke , O {0 )L)✓ ss#24 -; - Phone Municipal # 04 `C- 'T Competency # IL) tfr Mortgagor Address Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expi r s . 071.7,1;; C ?1-'.lC., N3'a:4i3Y S "AL 11 SAN21A D O8 EN :TJR NC fA`IY PUEUC STATE OF FLORIDA cc C.D : :: Gi �T NO. Ca65272 !I ** * * * 1 1ACOMMiS'ICN Wit. N .l , s,7;; Mechanical Plumbing Tax Folio // k 41 7- 6- g ®o4 CCWSTie)GY'soN Master Permit IP .355 7' Phone Address /3?-.S PAik 4m/ S4O( S 7 S Ins.Co. oN r:( LAS i euc_ao W Address 94 N � A Address pl Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ING AVING PENCE SIGN WORK DESCRIPTION 0S4a N.2 4 -o( ©,G k_ +J (2 ® n V\ (Ar ,&G at LA-10N) G -X51 Square Ft. 706 s? Estimated Cost(value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. 00 c; 71.14 gnature of Contractor or Owner- Builder Date: cUOGiza f .-12e,cdt. Notary as to Contractor or Owner-Builder My Commission Expires: FEES: PERMIT il RADON C.C.F. 3s NOTARY APPROVED: Fire Zoning Buildi ** TOTAL DUE Other Electrical Engineering_ TO WHOM IT MAY CONCERN Coma Cast Corp. has fled with this office a request to renew their Notice of Acceptance #89- 0526.8 for their Flat Shingle Cement.Roof Tile u a mortar -set system and which expired on July 10, 1991 Rimini and• acceptable test reports have been evaluated approving the'continued use of this tile, u a mortar-set system. The tile shall be Installed on a 'minimum 2 1/2":12 sloped solid nailable deck of 5/8" thick plywood for all new construction or to 1/2' plywood deck on re- roofing. ,• GDrco • BUILDING CODILCOMPLIANCS DEPARTMENT SUITE 1509 MSTRO •DAOE PLAGLER 6UQA�No 140 WEST FLAOLER STREET MIAMI, FLORIDA 93190.1559 (305) 3752901 MX ON 375'2901 July 27, 1993 The nailable deck shall be covered with a 30 typ e II (ASTM , D - 226 � anchor sheet and tip capped 6" o.c. on laps, 12" 0.0. in the field and 4" on the drip strip: • Over this, a hot- mopped 90 type II (ASTM D -249) roll roofing cap sheet using hot steep . asphalt type I`/ conforming to ASTM D- 312.89, shall be applied. The tiles maintaining a 2 1/2" head lap shall be applied to the prepared deck With a type M mortar consisting of one 781b. of Lonestar Roof Tile Cement mixed with 2.25 to 3 parts ASTM C 144 sand by volume, approximately 14 shovels. Due to Hurricane Andrew, this office has been inundated with requests for both new products iiitd renewals of those to expire which has caused a large back log in responding with an official Notice of Acceptance. In the interim period, please accept this letter in allowing this products to be installed by a licensed roofing contractor in accordance with the manufacturer's further specifications and Chapter 34 of the South Florida Building Code, until an official Notice of Acceptance is issued. GifDiamond, P.E. Product Control Division Supervisor 4 0 ACCEPTANCE Nos 89-0526.8 I A •—• :1711',er )1t.. • • • 's • • • . • ' THIS IS THE COVERSHEET. • . .i• • APPROVED $ • July 10. 1989 'EXPIRES s July 10. 1992 1. OUNTY, FLORIDA **nun non** SEE ADDITION CQUILITIQ This application for Product Approval hai been acce Metropolitan Dade County Board of Rules and Appeals InCorporated and Unincorporated area of Dade Count conditions set forth above. -1- omas M. B ac ; • Deputy Secretait1 t0(t4.4*. metropolitan Dade404nty.t. Board of Rules'Ana'APPeils ' , VI/ -a 40 1. V:••• • :l qn•;t1.! ;1. i i - . 0 4.1• • • - ti.. P • • .. cl , • •,:''-' '. , -, i' ,•: ,e1;.4,.4....r!?,..t roduct Control. bupervisoeT.V0P) of ic Metropolitan Dade_Ouilty Cj)±A'..:k. l ik % 1-4 Building & Zoning Depart 1. ment 41 - 1. ••t's" l jt• IA i .. — • ., ' .,:■Qt•$ "t'4 1 '.4 l ' • ' Po 1 U '.. • . r •.% ... •{) i.. .,... , • 'IL' 03 1/4 • ' .!! .:; • .. I "' 14 BOARD OF RULES AND APPEALS NOT/CE OF ACCEPTANd4.1.4:0i!.....,e0;.0T " • .:/i pted:by4hei to be it ndepo .ui. ‚ . 4 :414. • "• ;“ • ..-APpROVEDs. July 10. 1989 • • • Coma Caet Co • sta Sri oar p eavg+ swepr • RAN VIE w• 1. This approves the Coma Cast flat shingle cement tile, includin accessories (whole end half starter, whole and half finisher, ridg tile, etc.). • Fs i *w*. TO 111 , $ ACCEPTANCE No., 89- 05264_ • APPROVED t July 10. 1989 EXPIRES s Jul 10. 1992 c. I 9' 1 /d" C IZMS fec.Tl ON G 1 Diamond, Poduct Control Supervisor Metropolitan Dade County Building & Zoning Department •JU TROPOLITAN DADECOUNTY, FLORIDA, NOTICE OF ACCEPTANCE: STANDARD CONDITIONS -3- vevrqui METRO•DADE CENTER BUILDING & ZONING DEPARTMENT METRO•DADE CENTER 111 N.W. FIRST STREET SUITE 1010 MIAMI, FLORIDA 33128.1974 (305) 375 -2612 1. Extension of Acceptance may be considered after a new application has been filed and the supporting data, test reports no older than ten (,10) years, have been re- evaluated. All reports of re- testing shall bear the seal, signature and date of an engineer registered in the Stat 2. Any revision or change in the materials, use, or manufacture of the product or process shall automatically be cause for termination, unless prior approval is granted for revisions or change. • 3'. Any unsatisfactory performance of this product or process or a change in Code provisions shall be grou.nds for re- evaluation. 4. This acceptance shall not be used as an endorsement of any product for sales or advertising purposes. 5. The Notice of Acceptance number pr,eceded.• by the words "t)ade County, Florida, and followed by the expiration date may be displayed in advertising literature. 6. Product approval ' drawings, where required for permit applications, shall he provided to the applicant by the manufacturer or his distributors; unless otherwise noted in the Notice of Acceptance. The prints need not be re sealed by an engineer. Cil Diamond, P. Product Control Supervisor Metropolitan Dade County Building & Zoning Department Co iss — CA at Co - ACCEPTANCE No. s• 89_- 05?.4.8' . • • • APPROVED • : July 10. X1989•! • EXPIRES • : July 10''i992 jlOTICS OF ACCEPTANCE: SPECIFTC CONDITIONR 'Y' ',.. I '►: ;:; , ". ..!';• ill tr : r • 2. The tile shall be installed over solid wood sheathing '• } nailable decks with and underlayment consisting of an anchor,; and a cap sheet of mineral surfaced roofing as described :10.4h( South Florida Building Code, paragraphs 3402.2 (b) and 3402)(41;4k • • .• I, ? . t 3. Roof tiles shall be set in a bed of type M or• S 'mortar; "`a { '.set forth in paragraph 2702.10 (b) and the mortar shall be between all laps, at all butts and along the sides of.the tile :s� ' Additional means needed for securing tho tiles on of . • 5" 1 12" or.greater,,shall be in conformance with ectio: 3403.3. : ,. .. 4. The tiles shall be manufactured to the following specifications..•' • a) Overall maximum dimensions : 16.1/8" x 1 � :. Minimum thickness : 3/8" '• �' l • Minimum headlap : t •l�t''�� !� 'i:" " 1'i Minimum sidAlap 1 1 1/4" .. ' �j' ' � '1'' b) The eave ends of the roof Ulf: shall be cemented and.providec with weep holes for adequate drainage. , . ,.. 5. All tile shall bit identified by the name or logo of the • . 4?1 manufacturer permanently marked on each tile. , : • .ii ;.,), :,. • 6. Cuali y Control _ . , �� ��, : The manufacturer shall retain the services of an'•'independent testing laboratory to maintain quality control. Test' 1 •shaLl'iR•be performed • on a minimum of five (5) tiles periodically,°iduring production for domestic, local manufacturer for strengthi'according to Section 3403 .South Florida Building Code and . for'• :• roisu absorption according to ASTM C -4. Test samples shall be•selected�by a laboratory according to ASTM D- 3665 -82. Results shall be•serit'•to Date County Product Control Section ,every 90 days. . ' .';' • 7. T h i s renewal supersedes Notice of Acceptance No 86- 0130.,1• da ted t f. : : � Fe' )ruary 10,.19.86. i `' :r•t : :;'; n n n � •; ;1:1} � : ., Gil Diamond, P.E. .s : ;4 • ,;4.;x Product Control r .,, °'•' ct Control Superyisor, :. :u Metropolitan Dade County: ••.7, :i . Building Zoning Department 1. • . A 1. 1 B4. MAP AND PANEL B5. 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) 1206520093 "J" 7/17/95 3/2/94 "X" N/A C.O.R. 8.80 BUILDING OWNER'S NAME BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 534 NE 95th Street Miami, FL CITY WORTH MIAMI �. PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: ( ##° - ##' - (#.##" or ##.##t!# # ° ) 1_1 NAD 1927 NAD 1983 TITLE P ofes -ional Land Surveyor ADDRESS 855 West Fl. Street SIGNATURAW, :1.7// FFMA F 1 -11 AI In qq FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION Mr_ Charles Watson For Insurance Company Use: Policy Number Company NAIC Number COMPANY NAME DATE 10/28/02 STATE FL BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use Comments section if necessary.) SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION O.M.B. No. 3067 -0077 Expires July 31, 2002 ZIP CODE SOURCE: I —i GPS (Type): I_I USGS Quad Map IX I Other. B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER VILLAGE OF MIAMI SHORES 120652 82. COUNTY NAME Miami –Dade B3. STATE FL B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. FIS Profile 1�1 FIRM 1_1 Community Determined LI Other (Qescribe): B11. Indicate the elevation datum used for the BFE in B9: IX I NGVD 1929 I 1 NAVD 1988 II Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I - I Yes $I No Designation Date: C1. Building elevations are based on: 1_IConstruction Drawings* 1 'Building Under Corstruction* [X Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1 (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 Conversion /Comments Elevation reference mark used X Does the elevation reference mark used appear • IRM? 1_1 Yes 1X_I No ❑ a) Top of bottom floor (including basement or enclosure) 10 ,65 ft.(m) Ti; ❑ b) Top of next higher floor 10 .65 ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) N/ _ ft.(m) ❑ d) Attached garage (top of slab) N /.A ft.(m) ❑ e) Lowest elevation of machinery and /or equipment u, `° servicing the building N/A__ ft.(m) ❑ f) Lowest adjacent grade (LAG) R 85._ ft.(m) z' ❑ g) Highest adjacent grade (HAG) 8 85— ft.(m) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade P4 / ❑ i) Total area of all permanent openings (flood vents) in C3h N/A sq. in. (sq. cm) This certification is to be signed and sealed by a and 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. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME Juan R. Martinez LICENSE NUMBER 2160 .Than R. Mart IS, Aasoriates, IMC CITY STATE ZIP CODE TELEPHONE (305)552 -7007 SFF PF \ /FRSF SIfF Fr1R (`f1NTINl IATION PFPI Ar:FS Al 1 PRP \ /I(N IS FIIITIf1NC 534 WE 95th Street For Insurance Company Use: Policy Number Company NAIC Number 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. CITY North Miami SIGNATURE COMMENTS G4. PERMIT NUMBER LOCAL OFFICIAL'S NAME COMMUNITY NAME SIGNATURE COMMENTS FFMA Fnrm R1 -11 Al in QQ STATE FL ZIP CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE NAME ADDRESS CITY' STATE ZIP CODE DATE TELEPHONE SECTION G - COMMUNITY INFORMATION (OPTIONAL) G7. This permit has been issued for. 1_1 New Construction 1_1 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: TITLE TELEPHONE DATE I - 1 Check here if attachments 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 E3. 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— I— Iin.(cm) I —I above or 1_1 below (check one) the highest adjacent grade. -E3. 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? I —I Yes 1_1 No I I Unknown.. The local official must■certiy 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 forZone A (without a FEMA - issued or community- issued BFE) or Zone AO must sign here. 1 1 Check here if attachments The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C ()::)r E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. 1_1 The information in Section C,was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect whiiis authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation-datain the Comments area below.)„ G2. 1_1 A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zonr AO' - . G3. 1_1 The following,iriformation (Items•G4 -G9) is provided for community floodplain management' purposes.: G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED ft.(m) Datum: ft.(m) Datum: I.C#teGk- More`if attachments RPPI A(`FG Al I PRF\ /I(lI IC Fr1ITInnis ch. _CC:J N. _. 1!,' ='S f_. (305 1 c1 E e= /CrNr cas Rmismar..ai C:.py of STATE CF FLORIDA ax _ _CATION (DPB.q) STA"'E REGISL°.ATION A1rD DACE MINTY c =2 NCY LI`_ '-' •- Coy of current CCCUPATIOML LICENSE from — bu✓iress is located. Certificate of Insurance for Village). LIABILITY 'ad-Tr...cc. ` W. a Certificate of Insur for KE;'S COMP (addressed to u, ami S:.oresVillage) or if exempt State of Florida LE"S.. Fort ECf -204, Cons`zc .'or, 7 %dstrti Notice of Election to be Exempt. where PLEASE SUBMIT EvEarzim rtmrKED OFF Penult Apolication (signed by person performing the work, licensed contractor and the property owner, both signatures notarized) . 1.4Z 3s:4 sets of plans /drarincs signed and sealed y i registered arci tect or engineer. Ccc panci es by GI Classification tra:st be on plans and permit application. All plans must include folio number and property address.. Amended plants, in addition to the above, mast also include the remit number. Stzuctisal C3lailations si r.ed and se ed by == &? tent c_ engineer when applicable. Current survey of the property. Certificate of Elevation signed and sealed by Surveyor. Sths Tntoveaents Cellist (contractor c= owner). 1 4 - ` 9 Four sets of energy calculations, signed and sealed g e T ?o sets of signed a sealed Tress Plans (Engineer). WM DADS County or State of Florida Prods pl S for roof materials, sheds, windows, exterior/garage deers, al3iinum carports, screen enclosures, shutters awnings, skylights, franc: doors rd etc. Asprova? s from IRS, LADE County Impact Fee Section, Fire Deparbment a Health Department When acoz i b :e) . DERM W arranty Deed or Other Proof of Q.Pe hip if necessary. Structural Revi es i fee Notice of Commencement 534