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BPP-11-1286Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162106 Permit Number: BPP -7 -11 -1286 Scheduled Inspection Date: October 03, 2011 Inspector: Bruhn, Norman Owner: BANICH, ROSEMARIE Job Address: 521 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: MARS POOLS Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1122310140240 Phone: (954)214 -2844 Building Department Comments NEW INGROUND POOL, PAVER DECKING Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ec-- September 30, 2011 For Inspections please call: (305)762 -4949 Page 5 of 29 PERMIT # 6 F P° it- 12.5(19 CONTRACTOR: '4 ARs Poois lac SUBMITTAL DATE: jiA ( (5; Z01\ ADDRESS: 52.1 h1E jO5 NAME: KC 5 EMARAE NAN\C4 RESUBMITAL DATES: PROJECT TYPE: ZONING 6'14' teCr • ppL, STRUCTURAL IMPACT FEES �j ELECTRICAL HRS/DERM NOC rV MECHANICAL BLDG Gti j11 --1bX- . °l taln_U1 Miami Shores Village Building Department 1Q056.N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 p3MMYR11 CEP 0 13 2019 65r. Permit No.N 1)1 M Master Permit No. Permit Type: BUILDING ROOFING 04e 11-►A�', e pxkli.ch OWNER: Name (Fee Simple Titleholder): Address: SO? /t! L' Os St City: /1(a. ",/. e)/'C5 Phone #: State: / zip: 351313 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: c 21 /rig /64 5/ City: Folio/Parcel #: Miami Shores County: Miami Dade Zip: 3 ?/ 3 8 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: %1' / ✓ ` roe_ Phone #: Address: 51(6tt- Atli /22 ifre t/ 2 City: cier e, e , / �+ State: 1� Zip: 333 3 / Qualifier Name: 1771,6h �J ,� / , cJ4,°� .5/- Phone #: g,Sy 2/ if c.2e V V State Certification or Registration #: (Pe /41S79 22 Certificate of Competency #: 7 Contact Phone #: S7 ' L1 31' V Email Address: �v / "�/� 5gaS 4) ger, am DESIGNER: Architect/Engineer: Phone #: �l C' /' / M / /,., Value of Work for this Permit: $ �� P to it l AM; quare/Linear Footage of Work: (6" fil Type of Work: ❑Addition ❑Alteratiion/ �.�ew ❑Rep.' ' eplace ODemolition/ Des rip��'�°gof Work• Adele l/ G� ! �d�IY/. % _ e/15 /� !� f�G7`i'c�✓% / . veil J)/I.tie 1/a Pe, Ayt°P ******* * * ** * * * ** * *** * ** ** ** * ** * * * * * * ** *Fees** * ** ******* * ** * * ** * * *** * * * * * * * * * * * * * * * * * ** IT. Submittal Fee $ Permit Fee $- CF $ 0/CC $ AS n/d e-WeAL Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ ' Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent The foregoing instrument was acknowledged before me this The for of , 20 , by , day of who is personally known to me or who has produced who is pe As identification and who did take an oath. NOTARY PUBLIC: Contractor - oin_ instrument was acknow 4.416 ,2011 ,b nally known to me or who has produced as identification and who did take an oath. Sign: Sign: Print: Print: My Commission Expires: APPROVED BY / ` / pl "�j Pl. ns Examiner My Commission Expires: 1/ Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 / Permit Type: BUILDING / OOFING OWNER: Name (Fee Sim le Titleholder): case ►'1'1 °!f ! e 3q4 ! C ti Phone #: 3/0 - ? 7-850 3 Address: 521 A/ 05-4-2' 5/ l” City: Id l'4941 0 ;/ C' 't' State: 7 Zip: 3 313' Tenant/Lessee Name: Phone #: r.ba��cl�� 5he9 /ahq/,ne jui /On �;, „o�,f P II - age Master Permit No. Email: JOB ADDRESS: 21 //6. /o5- City: Folio/Parcel #: Miami Shores County: //-* o9a3/ ..-0/C/- 007e/0 Is the Building Historically Designated: Yes Miami Dade zip: 3 3/ 3 g NO Flood Zone: CONTRACTOR: Company Name: f�' ! /J �IA r.5 � e Phone #: 9 / , '/ 7/Z 1 5-V05-NO 11)Z M' a35 Address: City: e Zip: '3 r7� /�I Qualifier Name: l 'i e ' $e// C w 17- Phone #: g5! G / 7' T 2 ? ce V State Certification or Registration #: C /' ✓ 7 % Z � Certificate f Competency #: Contact Phone#: Email Address: /4107,^/D/50 `J ��, C4 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ❑Alteration ert . 9rot.4d Type of Work: ❑Addition Description of Work: . 3 OOOI o Squ • e/Linear Footage of Work: // 250 New CIRepair/Re,place l]Demolition a vCr be(v<l h ********** * * * * * *********** ****** ***** * Fees** x: ***** ** *+ x********** *******x: **********+x*** Submittal Fee $ ?O•. DO Permit Fee $__(0"J CCF $ 1 c Scanning Fee $ SID Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 41 41 x 4 4P-- -:. $ n TOTAL FEE NOW DUE $ 1 %issue Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 4\ `Q�/Y bN► J Signa Owner or Agent The foregoing instrument was acpowledged before m aq Contractor The for ' o in instrument was acknowled ted be ore day of Jn e , 20 t , by 05e/ i Ate n VC4 day of � :1ti , 201 ) , b t /A. 14, who is personall known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. who is personally known to me or who has produced L. / 4.- NOTARY PUBLIC: Sign: Print: My Commission Expires: GWENDOLYN B. STEWART MY COMMISSION k DD961586 + �k� EXPIRES: April 19, 2014 I4O .3- NOTARY Fl. Notary Discount Assoc. Co, +k>k+k**>#*** HEN= Ni *: Psk* * ** * ****>kshshik>k*ikNtik>k* ** *** APPROVED BY 4 5� - Plans Examiner ALL p /1- J (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Structural Review NOT Sign: Print: My Commission Expires: c, Y PUBLIC: - ° r 0. **** * * ***** * ** Zoning Clerk Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 WINNING POOL OWNER'S CERTIFICATION Date 06079 aod Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as , located at 5Z1 /(ICS /01/45-#451 x`4141 /ir95 /Z43irs. In accordance with Section 33- 12(f), Code of Metropolitan Dade County, I certify that understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting and approved barrier prior to final inspection and use of the pool. Legal Owner bk.,:4-‘ Note: This certification is to be submitted with a swimming pool permit application in duplicate. Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRE NTS: WHEREAS, the undersigned 05ef C ?ani-c-4 is /are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: Eg I (G /06 7' Whereas, the undersigned owner(s) g(% 5' /'C/'( ;310-1,-,e,4 desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows: I. That the property will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. II. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the required enclosure is not on the subject property where the pool is located. III. That if any of our adjoining neighbors remove any portion of their fence or wall, or if our /my property shall fail to meet code requirements for pool barriers, we, as owners will immediately install a protective enclosure to meet code requirements and will obtain a permit for such fence. IV. That, I/we, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is damaged or removed by any case. NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that he /she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant conceming the use, enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its successors, in accordance of said Village then in effect OWNER SIGN & PRINT eivvq.c.. GA). Ch OWNER SING & PRINT I Hereby Certify that on this day ►tify y personally appeared before me 'R 05PA r we A and has produced ID # as identification and he /she acknowledge that he /she executed the foregoing, freely and voluntarily, for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this ( day of (Revised 05/2209 v✓� • 1".• ARY P LIJ TAT FLORIDA k� �.. .GWEN pis ® B STEt4'.ART 1.46:3-NOMARa Fl. tour �' oc Co (MV, Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I � /a�� acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at Miami Shores, FL, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues and the Florida Building Code R4101.17. Please f itial the method(s) to be used: The pool will be equipped with an approved safety pool cover that comp lies with ASTM T 6-9 . (Submit Manufacturer's Specifications). A continuous, one -piece (child) barrier meeting the requirements of Florida Building Code R4101.17.1.15 will protect the pool perimeter. The plans shall show the fence location and method of attachment, including one end that shall not be removable without the aid of tools. (Submit Manufacturer's Specifications). A combination of non - dwelling walls and fences (screen enclosure, child fence, masonry fence walls, chain link or wood fence, etc.) will protect t he pool perimeter. The plans must specify t he type and location of all non dwelling walls. Florida Building Code, R4101.17.1 Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code, R4101.17.1.9 (Submit Manufacturer's Specifications). Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all doors will be equipped with a self - latching device with positive mechanical latching/locking installed a min. 54" above the threshold. If this option is selected, submit plans showing all types and location of all perimeter protection. The plans must also show the location and type of all openings, and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Code, the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements, and upon expiration of the permit, the pool shall be presumed to be unsafe . I understand that not having one of the above installed will constitute a violation of Chapter 515, F.S ., an d will be considered as committing a misdemeanor of the second degree, punishable as provided in Section 775.082 or Section 775.083 F.S . This form must be signed by the owner /agent and the prime contractor. CON�TRACIOR'SiSIG,TURF AND DATE r c e,e !// 11C® 5/64-'1," CONTRACTOR'S NAME (PLEASE PRINT) NOTARY PUBLIC OWNER'S SIGNATURE AND DATE CZ-vxy)A6.6e., 0,,rade‘ OWNER'S NAME (P. SE PRINT UBLIC GW NDOLYNB ST C0,141V11SS10N #DD 6 386 v C Pte: Apr019, 2014 FLORIDA DEPARTMENT OF HEALT Rick Scott Govemor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General July 11, 2011 Michael Stewart 521 NE 105 St Miami, FL 33175 RE: Contingency Letter Application Document No: API040685 Centrax Permit Number: 13 -SC- 1358188 OSTDS Number: 521 NE 105 St Miami, FL 33138 Lot:14 +15 Block: 110 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 07/05/2011 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced Proposed installation of a new pool at the back yard, septic system is at front. There is not increase in sewage flow, change sewage characteristic, or compromise the integrity or function of the system. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. If you have any questions on this matter, please call our office at (305) 623 -3500. Sincerely, Carlos Icaza, Enclosures cc: Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500. Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com Permit No: 11 -1286 Job Name: July 25, 2011 Miami Shores Vmage Building Department Building Critique Sheet 1) Provide structural approval. NB 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will doa complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. fill: Job Name 1 $dam. Date i1J°1,19? STRUCTURAL CRITIQUE SHEET 1! ,444 Areems+ Piotaiia' 41" $100, 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit NO. BPP -7 -11 -1286 Issue Date: Not Issued Expires:Not Issued Folio Number:1122310140240 Owner's Name: ROSEMARIE BANICH Job Address: 521 105 Street Miami Shores, FL Owner's Phone: Total Square Feet: 1250 Total Job Valuation: $ 35,00(100 Contractor(s) MARS POOLS Phone (954)214 -2844 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 7/18/2011: Yes Comments: PERMIT # TAX FOUO# 1 / - &; 3 1 V/ 1 : O NOTICE OF COMMENCEMENT STATE OF Fl of. I da COUNTY OF Dt-, THE UNDERSIGNED hereby gives notice that improvements wil 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: Property Address: 2. General description of improvement: 3. Owner Information Name a. Mailing Address: L Interest in property: c. Name .& Address of fee simple titleholder Of other than owner-): 4. 5. 6. 7. a. Contractor's Name: b. Contractor's Address: c Telephone & Fax a. Surety Roach Name Addresc c Telephone & Fax d Amount of Bond a. Lender Name b. Lender Addresz c Telephone & Fax LOT I 1 SUB • UM * liar,` �• AriNIUMMIE/21=111Y OP' lane 111111111111111111111111111111111111 FN 2011 1R0476350 OR Bk 27761 Fs 1521; (1PS) RECORDED 07/19/2011 14:17:28 HARVEY RUVIN, CLERK OF COURT MIAl1I -DADE COUNTY, FLORIDA LAST PAGE Th.. .ace reserve for recorder. Ce DL tracked law Pa /3. 4fffilW3272S. AI -WA rISMPv1: I TTT 1 1', 11. i' KTA Erl Persons within the State of Florida (name & addresses) deserted by runner upon whom notices or other documents may be served as provided by Section 713.13(1X47., Florida Statutes: Name Address: Telephone & Fax: 8. In addition to himself or herself owner designates the following person(s) to receive a copy of the !fences Notice as provided in Section 7I3.13(I)(b), Florida Statutes: Name Addresx Telephone & Fax g Expiration Date of this Notice: *Expires one year from the date recorded, unless otherwise noted. WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 7 3.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WO OR RECORIG YOUR NOTICE OF COMMENCEMENT. r Signature of Owner or Owner's Authorized - a� Title/Moe The for ' : instrument was advwwledged before me this 21st day of 3 t)l1 t ; 20 1i . by i or/L" rQe% e gini as to rw,k for 1, gnature Public - State of Florida Print, Type; or p Commissioned Name of Notary Public Personally Known OR Produced Identification I/ Type of ID Produced VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STA U f •. - of that l have read the foregoing and Signature of Owner or Owners Authorized Officer/Director/Partner/Manager who signed above. rePgred Turn Over for Instructio. T1ATE 4 s"T'b„B OF DADE copyofthe aatahaf ibAhtip s eke of WITNESS my head and Mehl Seal. RU 4, CLERK, m and County OM* D.C. Th.'G?4 e / K, 5kw .2" 1 50 i- a"f9iq Fe- �dt 33o j Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 162113 Scheduled Inspection Date: September 21, 2011 Inspector: Devaney, Michael Owner: BANICH, ROSEMARIE Job Address: 521 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: JACQUES ELECTRIC Permit Number: EL -7 -11 -1288 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1122310140240 Phone: (954)214 -8711 Building Department Comments Hookup Pool Equipment Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 20, 2011 For Inspections please call: (305)762 -4949 Page 8 of 34 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. E L - 11- 4a Master Permit No. B? - 1 !"z- 5C, Permit Type: Electrical ✓ ,, /^ OWNER: Name (Fee Simple Titleholder): Wose.ThIPi'e Vail) iC�/ / Phone#: 310-R7-Z50 Address: 2I AI IOS " 3 City: 0• W 4s / 34 o,neS State: FL- Zip: 33 ) 3 a Tenant/Lessee Name: Phone#: Email: ra'.l evil 6.6 0 5129 JOB ADDRESS: 521 City: Folio/Parcel #: Is the Building Historically Designated: Yes o9 1'!e_ /U6 /06-741 6-71 Miami Shores County: `J- 2231 - 0 /V --02 'fO Miami Dade Zip: 3 3/ "18 NO X- Flood Zone: CONTRACTOR: Company Name: Jac, 17UE' S cil ee-A'C Phone #: Address: 7V50 /-9 tt4� lJ T �7l City: Qualifier Name: State Certification or Registration #: Contact Phone #: DESIGNER: Architect/Engineer: Gi)DD Ste: �L o '09 / 2 Email Address: Zip: 330 z, /V Phone #: 7�a —2"J`� _p 7l1 Certificate of Competency #: �cO/72 3a Jaceedow /f-O/• eow! Phone #: Value of Work for this Permit: $ 4z)00i, (7 Square/Linear Footage of Work: Type of Work: UAddress ❑Alterationr) 6 clew Description of Work: 40KO / / i /Qth '/P!I p Ol pair/Replace ODemolition ***** x:+ x**+ x**** * * * ***** **** * ******+x** ** : Fees*************** x: ******** ** * * * ***x:*** ******** Submittal Fee $ SO. 012 Permit Fee $ ceero o Scanning Fee $ P�. t Q Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ lc)5 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature &.;41--% Owner or Agent Contractor The foregoing instrument was ac wledged before this — The foregoing instrument was acknowledged before me thi �� day of -SvM e , 20 / /, by /(0501Wif e 044/ f'� , day of ac)r1 e , 20 1 / , by Oho ifo Li deQ who is personally known to me or who has produced l L— who is ersonally known to a or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Prin v// My Commission Ex 6 MY COMMIS OBN # DD996 R 0maap" EXPIRES: April 19, 2014 1400.3•N0TARy n. Notary Discount ASSOC. CO. * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Iie Lfv // 72ay Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06110 /2009)(Revised 3/15/09) Sign: Print: My Co r T.3 . %E,b ' &OLYN B. STEW OMMISSION 4 DD9615S0 EXPIRES. April 19, 2014 Fl. Notary Discausu Assoc. CO. Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 11 -ice Inspection Number: INSP- 162107 Permit Number: PL -7 -11 -1287 Scheduled Inspection Date: September 21, 2011 Inspector: Hernandez, Rafael Owner: BANICH, ROSEMARIE Job Address: 521 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: MARS POOLS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1122310140240 Phone: (954)214 -2844 Building Department Comments Pool Main Drain and Pool piping Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 20, 2011 For Inspections please call: (305)762 -4949 Page 7 of 34 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 W° JUL 1 8 2011 I `1`'0 0_ ®___®____o______®_ Permit No. 12t-- 1- 11- t2 v 1 Master Permit No. PP - I l - i 2 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): RO./'L1c',e '31. l.CI Phone #3/0 - 4 j� 97" v 503 Address: f'S 2.1 ki r; l 0 Sth �4 City: I v l g� t Syl �r S State: Ft_ Zip: 39/ 3g Tenant/Lessee Name: r f Phone#: ss Email: 1 ,,bat'1'G�l Sbcgiob' toe f" JOB ADDRESS: 5 Z! /`-' V 105 t/ C� City: Miami Shho�res County: Miami Dade Folio/Parcel #: / /" ? 3/°' 01Y _. i3 IC Is the Building Historically Designated: Yes NO Flood Zone: Zip: 33 / 30 CONTRACTOR: Company Name: 114/9,5 g0 /S 42c 57/05- NO /�O2 /fr/c 0235 A , e Statee: �L aG �� Slit s/' Address: City: Qualifier Name: Phone #: QQV 2/V -2p V Zip: g 33 s/ Phone#: 915.- 2/ Sf^2 i4 V State Certification or Registration #: C �C /`1 57 / 2L Certificate of Competency #: / Contact Phone #: Email Address: /eS /%v �S /'t` 4 C4141 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 3 /aD g tJD Type of Work: ❑Address ❑ Iteratioij,"c, Description of Work: fool 1 > i / Square/Linear Footage of Work: URepair/Replace 4p „1)3 ❑Demolition ***************************************Fees************* ***************************** CCF $ CO /CC $ Submittal Fee $ 90 ,0 Permit Fee $ tp Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 161 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDmONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature/ 'W Owner or Agent Contractor The foregoing instrument was ackn edged before me • 29 The for .i : instrument wmacknow�dg- R before e d day of wJ4 e , 20 j , by 0`.)t°i?�'i/'r(' ��I1 C4 day of , 20 , b a g who is personally known to me or who has produced �lL who s ersonall known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Exp' ° +rte. .yev'n+'•��G•,r., �a % GWENDOLYN 13. STEWART MY COMMISSION # DD961586 ETP1RE5: April 19, 2014 1400.3- 11OTARY F1. Nutty Discount Assoc. CO. NOTA Sign: Print: My Commission Expires: as identification and who did take an oath. PUBLIC: *tkNt**ds> Kok+ ksk* Ar d }s***tktkak*+k***Na **** ******sAtk*= k*N N*+ k+ k*+ k+ k+ k+ k***ik**+ k***+ktk****tkNt******* APPROVED BY r Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) n b�i J i *fin 2��1 T� • 1 1 Zoning Clerk Permit Number: BPP -7 -11 -1286 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 164190 Inspection Date: September 06, 2011 Inspector: Bruhn, Norman Owner: BANICH, ROSEMARIE Job Address: 521 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: MARS POOLS Permit Type: PoolslWhirlpools/Hot Tubs Inspection Type: Survey Final Work Classification: New Phone Number Parcel Number 1122310140240 Phone: (954)214 -2844 Building Department Comments NEW INGROUND POOL, PAVER DECKING 77/97/7 Passed Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until September 06, 2011 For Inspections please call: (305)762 -4949 Page 1 of 1 LOCATIOV SKETCH SCALE: PATS 0 0 tn' 122.381(R &M N.E. 5th AVENUE w � 37.50' 33.35' 51.42' 7.85' 12.07' is 0 25.50' 34.63' 12.57' • nrn ■ ■�; ■L1L 10 ■i�i< ■L1[ IO E■II-j •o[gaii ME ■O[z]❑ ■■■ ■EC ■■■ • LL] ■■■ • ■ ■■ • ■ •• •■ ■ ■ •••■a ■■■ ■1•■ ■■I► 10.00' 90 °00'00' 37.50' 122.33' ( R&M) 4' C.L.F NOT VALID UNLESS EMBOSSED WITH SURVEYOR'S SEAL REVISED: ABBREVIATIONS: • SWi(= SIDEW4LK CBS = CONCRETE BLOCK STRUCTURE, CLF =CHAIN LINK FENCE, PL =PROPERTY LINE, DUE =DRAINAGE UTILITY EASEM ENT, IP =IRON F(PE, F= FOUND, ANC =AIR CONDITIONER PAD, PIC =PROPERTY CORNER, D/H=DRILLED HOLE, WlF= WOODEN FENCE, RES= RESIDENCE, CL- CLEAR, RB= REBAR, UE= UTILITY EASEMENT, CONC =CONCRETE SLAB. RA RIGHT OF WAY, DE= DRAINAGE EASEMENT, C/L= CENTER LINE, Q =DIAMTER, TYP =TYPICAL, M=MEASURED, R=RECORDED, ENCR —ENC ROA CHMENT COMP=COMPUTER, ASH — ASPHALT, N!D —NAIL & DISC S — SET FEE= FINISH FLOOR ELEVAT ON OIS= OFFSET, PIP =POWER POLE, OHP =OVERHEAD POWERLINE, WA =WA TER METER MMAASO RYWAL.L= ELEVATION BASED ON LOC. # ROOT CONCRETE= CBM# N -567 ELV. 10.54 TYPE OF SURVEY: BOUNDARY SURVEY MAINTENANCE & DRAINAGE EASEMENT= M & D. E. SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5) UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 9) CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY,AFFECTING THIS PROPERTY. 1 1 1 1 1 1 1 1 1 1 BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB 10 PAGE 47 A N.E. 6th AVENUE /// 42-Ed Miami Shores Viiirge APPROVED [DATE ZONING DEPT Sri / BLDG DEPT iSlJR,IFCT TO COMPLIANCE WITH ALL FEDERAL SURVEY FOR: 521 N.E. 105TH St,.? SHORES, FL. 33138. �A AND COUNTY RULES AND REGULATIONS LEGAL DESCRIPTION: EAST 1/2 OF LOT 14 & ALL OF LOT 15 BLOCK 110 OF AMENDED PLAT OF MIAMI SHORES SECTION 5 SUBDIVISION ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 AT PAGE 47 OF THE PUBLIC RECORDS MIAMI —DADE COUNTY, FLORIDA 1 HEREBY CERTIFY That the survey represented thereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. ADIS N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 SINCE 1987 . BLANCO SURVEYORS INC. Engineers • Land Surveyors . Planners . LB # 0007059 555 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 (305) 865 -1200 FLOOD ZONE: X PANEL: 0302 Email: blancosurveyorsInc @yahoo.com Fax: (305) 865 -7810 SCALE: 1 ", 20'_ SUFFIX: L DATE: 9 11/09 BASE: N/A COMMUNITY# 120652 DWN. BY: F. Blanco A3PI" Main Net Mesh Size: Braid: Net Braid Tension Lines Nylon Pulleys Net Strength: Expected life: Installation Fittings k;4i Safe Pool Nets Product Specifications 3.5 Inches (Required to meet ASTM 1346 -91 Standards) 100% Polyethylene with UV inhibitors built in. for prolonged lifespan %4 Inch 3/8 Inch 2'/4 Inch Body Length Pulley Wheel, 1 Inch diameter, 5/16 Inch width Tested up to 485 lbs for ASTM 1346 -91 standard B.etween 7 to 10 years Surface Mount Plates 3.5 inch plate with two anchor positions and two screw holes Glass filled nylon for increased resistance to sun and chemicals Available in Grey, Terra Cotta and Beige (cream) Flush Mount % inch diameter barrel with flanges 1.5 inch depth Brass or Glass filled nylon for increased resistance to sun and chemicals Available in Grey, Terra Cotta, Beige (cream) and Brass Anchor Hook 4mm Stainless Steel wire hook Alternate Anchors % inch x 2 inch Stainless Steel eye bolts 1/4 inch Stainless Steel drop anchors Stainless Steel S- hooks (Gate hook), min .141 x 1.5 inch 3101 SW 3RD AVENUE • FORT LAUDERDALE, Fl 33315 -3317 • TOLL FREE1. 866. 463 -5700 • FAX: 954760.9973 WEBStn : www.kidsafepoolnets.com r MAY -21 -2002 12:41 PM KIDSAFE APPLIED April 11, 2001 954 3234189 P.02 RESEARCH LABORATORIES--- - 5371 N.W. 181st STREET • MIAMI, FLORIDA 33014 -8223 Websits: www.arl- test.00m • Ernst aifestOed.com PH. (305) 824 -4x00 • FAX (305) 024.3652 Mr. Kim Nothard President Kid Safe Pool Nets 215SW14Way Fort Lauderdale, FL 33312 RE: L/N 30137 Dear Mr. Nothard: FAX: (954) 523.418%,: This letter is regarding the safety testing of your Pool Safety Net As you know, this test program has been successfully completed f The safety net was tested to assure compliance with ASTM P- 1344 -91, Standard Perfbrntance Specification for Safety Covers and Labeling Requirements for All Covers for Swimming Pools, Spas and Hot Tubs" and the work was performed under the above referenced ARL file number. The model that was tested and found to comply with the standard is trade - named "Kid Safe." This letter will serve as confirmation that these units are Listed by ARL effective March 20, 2001 and you are authorized to label your products with the ARL Listing Mark. Your Certification Report and Follow -up Service Procedure are in the process of being finalized and will be forwarded to you upon completion. If you have any questions, please do not hesitate to contact ARL. Cordially, Aian B. S `'err Director of Engineering ABS/tn TESTING FOR CONSUMER SAFETY Po* 1 Nets. THIS MANUAL SAFETY COVER COMPLIES WITH ALL S 1.866 3..570 wuna.kids ,3127-fst TO 41- 44. fs,-.4t • U.S.1pEPARTMENTOF HOMELANDSECURIT't ELEVATION CERTIFICATE • Federal Emergency ManagementAgency National Flood Insurance Program important; Read the instructions on .pages 1 -9. SECTION A - PROPERTY INFORMATION M. Building :RIE Name 11 -437 A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 521 N.E. 105TH ST. OMB No. 1680 -0008 Expires March 31, 2012 MIAMI SHORES FLIRIDAe • A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) THE EAST 1/2 OF LOT 14 & ALL LOT 15, BLOCK 110, AND PLAT OF MIAMI SHORES SEC.5, P.B. 10- ZIP Code 33138 A4. A5. A6. A7. A8. g (e.g., Residential Non- Residentia Addition, Accesso a t g. RESIDENTIAL Building (e R id tiat Latitude/Longitude :Lat. N2.°52119.36'1. Long. 1 14.11" Horizontal Datum: Attach at least 2 photographs of the building tithe Certificate is being used to obtain flood insurance. Building Diagram Number IA Fora building with a crawlspece.or enclosure(s): a) Square footage of crawlspace or enclosure(s) b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings In A8.b d) Engineered flood openings? Q Yes E No N/A N/A N/A sq In sq ft [� NAD 1927 ® NAD 1983 A9. 'Fora building with an attached garage: 400 a) Square footage of attached garage sq ft b) No. of permanent flood openings in the attach/vigil-age within 1_0 foot above adjacent grade c) Total net area of flood openings in A9.b � N/A sq in d) -Engineered flood openings? 0 Yes i� N0 . SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number VILLAGE OF MIAMI SHORES 120652 B2. County Name MIAMI -DADE B3. State FLORIDA B4. Map/Panel Number 12b86C0'302 B5. Suffix L B6. FIRM Index 9/1X/09 B7. FIRM Panel Effec 9/11709 ewi at� B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone Ao,N /A se flood depth) B10. indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in item 59. Q FIS Profile ® FIRM Community Determined 0 Other (Describe) I-9 B11. Indicate elevation datum used for BFE In Item B9: NGVD 1929 Q NAVD 1988 00ther (Describe) B12. Is the building located ig1Nv .�oastat Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Q Yes 3 No Designation Date [] CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 •Construction •Drawings* Q Building Under Construction* gj 'Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. 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 C2.a -h below aricording to the building diagram specffied 1n. Item A7. Use thesame datum as the BFE. Benchmark Utilized N -567 Vertical Datum NGVD 1929 Converston/Comments N /A. Check the - measurernentused. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 12 91 0 feat b) Top of the next higherfloor N/A _1* feet c) Bottom of the lowest horizontal structural member (V Zones only) N/A Q feet d) Attached garage (top of slab) 12 .25 Q feet e) Lowest elevation of machinery or equipment servicing the building 1 7 :.5.QZ feet (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 11alil feet g) Highest adjacent (finished) grade next to building (HAG) 12.40 TRI feet h) Lowest adjacent grade at lowest elevation of deck or stairs, Including N/A . @ feet structural support meters (Puerto Rico only) meters (Puerto Rico only) Q meters (Puerto Rico only) ❑ meters (Puerto Rico only) meters (Puerto Rico only) Q meters (Puerto Rico only) meters (Puerto Rico only) Q meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. l certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement. maybe punishable by fore or imprisonment under 18 U.S. Code, Section 1001. 13 Check here if comments are provided on back of form. Were' latitude and longitude in Section A. rovided by a licensed land surveyor? Yes A. No Certffier's Name ADIS N. NUNEZ Title R T RE Address R Company Name License Number 5924 11: J. :I: 1: "AM p 5/25/11 305Je865e 1200 ••° 81 -31 Signature City State ZIP Code 31 1 u W I O FEMA F Mar 09 See reverse side for continuation. Replaces all previous editions corresponding Information from Section Build ng Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 521 N.E. 105TH ST. City MIAMI SHORES FLORIDAtate ZIP Code 33138 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 C2.e A C ELEVATI NMI =ill •I o •: kI4I : •• BM# N -567 LOCATOR: 3100 • ►4' 10_i Signature i SEC 0 017. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete items E1 -E5. tf the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. in Puerto Rico only, enter meters. • El. Provide elevation information for the following and check the .appropriate boxes to show wimether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade•(LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is , Ofeet °meters above or belo* the HAG. b) Top of bottom floor (including basement, oraWlspace,or enclosure) is _ flfeet maters '[above or below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Sec n Items 8 and/or 9 (see a, gas 8-9 of instructions), the next higher floor (elevation C2.b in the diagrams ) of the building is ❑ feet LI meters ❑ above or LI below the HAG. E3. Attached garage (top of stab) is [] feet Q meters ] above or 0 below the HAG. E4. Top of platform of machinery and/orequipment servicing the building Is _ fl feet meters 9 above or 9 below the HAG. ES. 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? 0 Yes .0 No 0 Unknown. The loom official must cerliify this information in Section G. SECTION F - PROPERTY OWNER (6R OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA- Issued or community - Issued BFE) Or Zone AO must sign here. The statements In Sections A, B, and E are correct to the best of my knowledge. ELEV: 10.54' 5%15/11 If Check here if attachments Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Comments Date Telephone 0 Check here if attachments SECTIONS - 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, 8, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in hems G8 and G9. 01. 0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation Information. (Indicate the source and date of the elevation data In the Comments area below.) G2. 0 A community official completed Section E for a building located in Zone A (without a FEW ssued'oroo nuntty.4asued BFE) or Zone AO. G3. 0 The following information (Items G4-G9) Is provided for community floodpiatn aanagement purposes. G4. Permit Number G6. Date Permit issued G8. Date -Certificate Of Compliance /Occupancy issued G7. This permit has been issued for [] New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (Including basement) of the building 0 feet 0 meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site • 0 feet 0 meters (PR) Datum 010. Community's design flood elevation Q feet 0 meters (PR) Datum Local Official's Name Community Name Title Telephone Signature Date Comments Check here if attachments FEMA Form 81 -31, Mar 09 Replaces all previous editions ,o,E r, „ y-?...� t R a , -:z "� 's,�a"2°"""., i v - „,W.-*'^'..x *”; .ue"3'u ;4'"b' .�.,.: . <�,..a� �,� �, �..r n o. § 1 u=20' O p 0 0 ✓ 122.38`(R&M) 4'C.L.F I. • I IA 0 .-._.._._15• 1 - 0' CL o� 37.50' 90 °00'00" 0.15' 33.35' 51.42' I 10.0'. 7.85' 25.50' 34.63' ci N 12.57' ��u ■■ Zanno =PI] DEIE DO aDLIDO 12.07' MI: JLJULJLJ J C]C] r-� � ri n N F a a z 37.50' 122.33' (R&M) 4' C.L.F NOT VALID UNLESS EMBOSSED WITH . Y. SURVEYOR'S SEAL ABBREVIATIONS: SwK=SIDEVVALK CBS =CONCRETE BLOCK STRUCTURE, CLF=CHAIN UNK FENCE; PL =PROPERTY LINE, DUE =DRAINAGE UTILITYEASEM ENT, IP =IRON PIPE, F =FOUND, A/G AIR CONDRIONER PAD, P /C=PROPERTY CORNER. DIH =DRILLED HOLE, WF =VWODEN FENCE, RES=RESIDENCE, CL- CLEAR RB=REEAR, UE =UTILITY EASEMENT, CONC =CONCRETE SLAB. R!V1WRIGHT OF WAY, DE = DRAINAGE EASEMENT'CIL=CENTER LINE, O=DIAMTER, TYP =TYPICAL, M MEASURED.R _ RECORDED,ENCR = NCROACHM ENT COMP=COMPITER ASH _ A HAL T . N ID a NAIL & DISC S=S ET, FEE = FINISH F LOO R. ELEVATION. O!S =OFFSET, PIP=POwER POLE, OHP=OVERHEAD POWERLINE, V1,1=W4TER METER vv�ooFENCE= ELEVATION BASED ON LOC. "# HOOT MAS0NRYCE La 1■�� ® ®��•.a:•.•.i 1 CONCRETE= • +,�••• : :• �•ti•••r: ,t :• :e,tr CBM# N -567 ELV 10.. 54'iYPEOFSURVEY:BOUNDARYSURVEY MAINTENANCE& DRAINAGE EASEMENT= M &D.E. - SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5) UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL, GEODETIC VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY 9) CONTACT THE APPROPRIATE 'AUTHORITY PRIOR TO ANY DESIGN -WORK FOR BUILDING AND ZONING INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IFANY, AFFECTING THIS PROPERTY BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB 10 PAGE 47 3' F iSr m• `.`xC .�:.:,- `�.'..`� LOCATION SKETCH SCALE: NTS N.E. 5th AVENUE Cra V OD w 1 N.E. 6th AVENUE SURVEY FOR: 521 N.E. 105TH ST., MIAMI SHORES, FL. 33138. LEGAL DESCRIPTION: EAST 1/2 OF LOT 14 & ALL OF LOT 1S op AMENDED PLAT OF MIAMI SHORES SECTION 5 ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 OF THE. PUBLIC • RECORDS MIAMI'DADE COUNTY, FLORIDA BLOCK 110 SUBDIVISION AT PAGE 47 REVISED: 1 HEREBY CERTIFY That the survey represented thereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. ADIS N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 ;`�, kfi.�� 1"" -',a . = if�a•..aR.�.rk� 'z�- _'�, -,� ,'� s,:.�ar� .�4�.�"�'�..x -r. �`- ��'.r SINCE 1987 . BLANGO SURVEYORS INC. Engineers' Land Surveyors • Planners • LB # 0007059 555 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 (305) 865 -1200 Email: blancosurveyorsinc@yahoo.com Fax: (305) 865 -7810 FLOOD ZONE: PANEL: 0302 DATE: 5/25 111 SCALE 1 ° =20' SUFFIX: �•� L DA E: 9 71 09 BASE: N/A COMMUNITY # 120652 DWN BY: F Blanco • s.