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DEMO-11-1503CA*190% 1 °":5 01A 10 IN BUILDING PERMIT APPLICATI FBC 20 iami Shores Village uilding Department 50 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PECTION'S PHONE NUMBER: (305) 762.4949 RECEIVED AUG 17 2011 BY: e1, Permit No. N Master Permit No. rein )1 0 -IS 0 3 t(eh-A (0 )4 p4or Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): ' �� (c �-f —� —/ !� c ' Ke13Gilphone#( 3O) —7-254990 Address: e_oiatiti o O / a .✓� �_ City: lam. t ► ' -eac State: Zip: 3314 ) Tenant/Lessee Name: \tba.)0„. b0,45 5 Email: Phone#: JOB ADDRESS: qi(p c' t City: Miami Shores County: Miami Dade Zip: 3`3 ` 3 R FoliolParcel #: Is the Building Historically Designated: es NO Flood Zone: CONTRACTOR: Company Name: K = h C 01►/,� t CL hit NEB 4, t k 1 C Q.S Phone#: c3,2. /.. vcs 4o�8c3 Address: gal W. 4l b t 5 ei A 1v cI 1 4/ 24' City: Me. l b pwr IA. e, State: P L Zip: 3 `t 0 1 Qualifier Name: KC, tL k e..,-E••L N. tk, SL frL L +l teb Phone#: 3 Z J - tiD3 - (Id/ State Certification or Registration #: C., t; C A 1 °6 g g7 Certificate of Competency #: Contact Phone#:3). i 1 2S-1 3.5* , Email Address: 517760 tnLa. 10, 9 k ir. b L K. « c, i7 W( DESIGNER: Architect/Engineer: M a i A . t Phone #: 30S — 75V-d3 1 C� Q Value of Work for this Permit: $ 1 S Square/Linear Footage of Work: 8/ VDU S , F. Type of Work: Addition °Alteration New ORepair/Replace 0lsmolition n 'Sir Q.1 d e , 1 c h a >� Description of Work: i� a lq, - ,�. Y\, �C'v � * **** ** * ****** ***** * *** ****** *** ** * *** s************* *** ** ****** * ** *** ** *** ******* ** „N, o0 Submittal Fee $ ��> Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ `"'T2_' S) Bonding Company's Name (if applicable) 'A-- Bonding Company's Address City Sta Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a pe commenced prior to the issuance of a construction in this jurisdiction. I unders WELLS, POOLS, FURNACES, BOILERS t to do the work and installations as indicated. I certify that no work or installation has rmit and that all work will be performed to meet the standards of all laws regulating d that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNE COMMENCEMENT MA IMPROVEMENTS TO Y FINANCING, CONSULT RECORDING YOUR NOTI Notice to Applicant: As a condition to the promise in good faith that a copy of the whose property is subject to attachment. for the first inspection which occurs seve inspection will not be approved and a reins Signature Owner or Agent The fore oing instrument was acknowledg • before me this36'd day of 20 �, by VI(; ,t- /ki 1 mob- , who is personally known to me or who has .roduceFl- H4)--"614- ?3 —i ?d nti ication an who did take an oath. YOUR FAILURE TO RECORD A NOTICE OF RESULT IN YOUR PAYING TWICE FOR UR PROPERTY. IF YOU INTEND TO OBTAIN TH YOUR LENDER OR AN ATTORNEY BEFORE E OF COMMENCEMENT." issuance of a building permit with an estimated value exceeding $2500, the applicant must tice of commencement and construction lien law brochure will be delivered to the person lso, a certified copy of the recorded notice of commencement must be posted at the job site (7) days after the building permit is issued. In the absence of such posted notice, the ection fee will be charged NOTARY PUBLIC: Sign: Print: P o A fI '1L My Commissio Rt. Notary Public Ste Sylvia A Percy AI My Commission E of ago Expires 10/15/201 * *M* of Florida 027516 Contractor ) �_ The foregoing instrument was acknowledged before me this Z day of A IA. t4,61—,, 20 1 (,, by Kg b` 1, t711• C 1,fb who is personally known to me or who has produced icic`� Up K as identification and who did take an oath. // NOTARY PUBLIC: Sign: Print: My Commiss My Commission EE027516 Expires 10/15/2014 NR •k* *** ***** *+b*+a ** *•b ** X88 ***sk•k+k d ** **+b**** ** •8*+b+N **•R+U * *+H **** * ** * APPROVED BY % Vr( Plans Examiner Structural Review (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15 09) Zoning Clerk '4LS(3RDro CERTIFICATE OF LIABILITY INSURANCE OP ID: KC1 DATE (MM/DDIYYYY) 08/10/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Waldorff Ins. & Bonding - GAI 45 Eglin Parkway NE Ste 202 Fort Walton Beach, FL 32548 Benjamin H. French 850 -581 -4925 850 -581 -4930 CONTACT NAME: PHONE INC. No. Ext): FAX No): E-MAIL DRESS: PRODUCER KENO -02 CUSTOMER ID*: INSURER(S) AFFORDING COVERAGE NAIC iR INSURED Ken Constantino Builders, Inc. 221 W. Hibiscus Blvd, #128 Melbourne, FL 32901 INSURER A : Amerisure Insurance 19488 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UM ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IN R TYPE OF INSURANCE ADDL )NSR SUER WVD POUCY NUMBER POUCY EFF (MM/DDNYYY) POLICY EXP (MIND DtYYW) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR GL204337202009 03/07/11 03/07/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 + CLAIMS-MADE MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT POLICY X APPUES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 LOC $ AUTOMOBILE — UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yea describe under DESCRIPTION OF OPERATIONS Y / N N IA WC204337402 03/07/11 03/07/ 2 X we STATU- OTH- TORY LIMITS ER EL. EACH ACCIDENT $ 100,000 EL. DISEASE - EA EMPLOYEE $ 100,000 below EL. DISEASE - POLICY LIMIT $ 500,000 A Rented/Leased Equipment CPP2043373020009 03/07/11 03/07/ 2 Limit: Ded: 20,000 1,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES ch CORD 101, Addlonal Remarks Schedule, If more space Is requlred) Ref: 11 -03 Dr. Keisch Cancer Center 9165 Park Drive, Miami Shores, FL 33138 CERTIFICATE HOLDER CANCELLATION l MIASH01 Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 26 (2008/09) © 1988 2009 A ORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACO C ,� ems¢ �qq pi j .L�_(ryC,+' .a"y, ENSIN YY!! 1 VAC _a 4 ag i7+4_'w�1}i '- Y DATE BATCH NUMBER ,:. c� P � O `.'0005 <F/ C.r:+.,. u.-rw. 'fi rt -A/ ± ° f 'Y- -^ "° • ,.. 1 b1�,a7F.�,fl+iFM. L�'� '.. i< } 1 R *+ffc yl �-t't� # 3 N%s dy #' yy �q}j! ry/�j gY d d TO` -` 4"t QF7, "'•p S" x k} ,.� t„ !Y'•,'�- },, .'J y.'g r" F j` GR ^'rJin- %,i � *� ��^�".je�r .;� �- -�';,° .v th 'T +F ona of f:4h t W. G �' titer .1i N zX .4 f i �y+ '+.T �,. E iL±S�M,.t "�4F zf ° at +! G 31,'. k 2012 e .. t'a k _tg °,y, '' •�'•:Y ., '�a{ .w 4 i _ '� i:�.a k'F i 4�'..r. ( i; ". '4'P '� £' (2�' ¢'� b°ti {�. .dt. .r "? i k'k ti. L" -� ":,''i$` ^Sj s14•.;4 -.a ?� ..:.'� -.•:✓ , &+ tia "'kid Ye , psyy p y"a f le !�i �^ � d^y'k' {` 5 �� idX rr, kY ,(. +r+1 'yT �a!°a. -'i.1 ✓�gµ-s4" ti �� t'.. `�',px-e_ ¢� 'i_�R>•iii .®i4^sd- % ".<L rUM !n aT aiH �`'kY `1}. r -if A E'4 Y^ �....i ,'er?�` ° 7 ,+�y,',<. d`. � } it Tw "''. - ..r _;~�t� f,, ebb.: �, a?; s'tn �'�. '�•,o.. '�? o �i, svr :.�3 �. �{.. tee ,tb �. �:� °�] �?'.'m° „'3is'rm`Y,`"u "fig, "..+`,$•tlr i�''; fu,'R�y.Y.�' ✓Ffv'ttf� -: •d. u.d�;u T'y C .tom A�,�'- :.�%,. Y --gip- . .yc "�. � s&` ,4b, .u_v. ,^'a-n e.x 4-m ., H°- a��.m..r •hF %e-'^�4., 't'>` -� ice` �<.,,- rp:.'%,��. �lia,',yta4�x .��, y.l Y�'vY +•», °i-.. i ,�.�t �9"P IY ?t'! aN � "f .5 } � � lay4 � w - . - � . '�� ,{'FS�`°�a.¢,�.. � } i= �"4 _ y ^" i� t ' y"i ts"g� � �_,.v ,�y �e � `' ff g,I . �i`�C . .�gy+.' i� � 3j'r 8e y4 '� , 1k,`'q ,.� ut .. , ¢ a, 'a�`is9�'T °# X''.'`o d '-,^� ,m�,�a".p <, :�$ {'>••, ?. 3 6 `� g! �vr {4!�'� :.�- a'bY f 1 ti � ' �< .�; � i. '.�,� da Y� � rj .>'.k x.i `4£ n'%'5t `.� . 63 G * u. 6 , yN 6°, 'k 't t'� \�^'". �} r:.. ,�y .'r` /. 5''2- ?' - svv.�t.�,t^ v a V : ' yt'" g<. �k a°te'�: n'�" J ,ya,*+•-, y pF. • :.a^ k4 d. x7+�= � ' PERMIT #: Miami Shores Viiiage Building Department RECEIPT [FtSQ DATE: 6) )II ¥'14 .c- A e MPa c - ❑ Contractor ❑ Owner rchitec Pi 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ad up 2 sets of plans and (oth Address: From the building department on this date in order to have corrections done to plans And /or get Co stamps. I und: ryd at - .Ians need to be brought back to Miami Shores PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: t 15 L 2011 - 2012 THE PERSON(S), OR ENTITY BELOW: LOCATION: REVARD COUNTY BUSINESSTAX RECEIPT UBJECT TO COUNTY ZONING RESTRICTIONS AX RECEIPT SHOULD BE DISPLAYED ON PREMISES KEN CONSTANTINO BUILDERS 1 C 221 W HIBISCUS BLVD SUITE 128 MELBOURNE FL 32901 221 W HIBISCUS BLVD STE 128 CITY OF MELBOURNE, FL 32901 OWNED BY: KEN CONSTANTINO BUILDERS I C KEN CONSTANTINO — QUALIFY BUSINESS CLASSIFICATIONS, DISCLAIMERS, AND RE TED FEES: BUSINESS PERIOD: ACCOUNT NO. 833000059 OCTOBER 1, 2011 - SEPTEMBER 30, 2012 EXPIRES: SEPTEMBER 30, 2012 ISSUED PURSUANT AND SUBJECT TO FLORIDA STATUTES AND BREVARD COUNTY CODE ISSUANCE DOES NOT CERTIFY COMPLIANCE WITH ZONING OR OTHER LAWS. BUSINESS TAX RECEIPT IS SUBJECT TO REVOCATION FOR ZONING VIOLATTONS, AND I OR FAILURE TO MAINTAIN REGULATORY PRE - REQUISITES AS REQUIRED FOR BUSINESS CLASSIRCATION(S), OR SUBSEQUENT ACTIVITIES. NOTIFY TAX COLLECTOR UPON CLOSING OF BUSINESS. A PERMIT IS REQUIRED TO ADVERTISE (Including with sign) °GOING OUT OF BUSINESS". LISA CULLEN, CFC, Brevard County Tax Collector P 0 Box 2500, Titusville, Ronda 32781 -2500 (321) 264-6910 PE LTY 300050 BUI a ING CONTR. - CERTIFIED 820005 2011 2012 RECEIPT AMT BRANCH OFFICES: Me Me Pal UPON A CHANGE OF OWNERSHIP OR LOCATION, BUSINESS TAX RECEIPT SHOULD BETRANSFERRED WITHIN 30 DAYS. EXEMPTIONS: NON EXEMPT 537.00 5.00 T PAID 01'1.42.00 Island Office, 1450 N. Courtenay Pkwy, Merritt Island, FL 32953 me Office, 1515 Sarno Road, Melbourne, FL 32935 Bay Office, 450 Cogan Dr. SE, Palm Bay, FL 32909 MAIN OFFICE: 400 South St., 6th Floor, Titusville, FL 32780 (321) 264 -6910, (321) 633 -2199, ext. 46910 BTR- TX/RCPT -04 Permit No: 11 -1503 Job Name: August 20, 2011 Miami Shores Vivage Building Department Building Critique Sheet 1) Provide approval from Miami Dade County DERM. 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 do a 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 Fix. 301-- 08/23/2011 11:14 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES II001 * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /R% NO 1701 RECIPIENT ADDRESS 3217251352 DESTINATION ID ST. TIME 08/23 11:13 TIME USE 00'30 PAGES SENT 1 RESULT OK 4 NO A MOMS OM PERMIT NO. SIRE OF Rllt COMITY OF •�. { OF COMMENCEMENT BEMIS ONINJOd> ATI BPFEST f fAiCh NO. j-- 32ob� -oN -�' 11-E gives l* �wi be made ac ttoa• Nal W plot dad in aids Notre of Ca�rencetront. 2. 3. Qemart* name and 4denet in property: it tote and witness of fee Contractor's streettaddresz 111111111111111111111111111111111111111111111 CF 1E 2011R0598184 OR 8k 27817 P9 00651 (1s ) RECORDED 0V►/07/2011 13tO8 %OS HARVEY RUM', CLERK OF COURT UA1fl -DADE COUMTYr FLORIDA LAST PAGE Saws above reserved for use of °Noe 54 2.6 WATT"; 01111EWIIIIIS 5. surety: i bond Name. address and Amount of bond $ e. Lender's name and 7. Persons wider 9* section 773.13(1)7„ None, eddaass and S. in addtii�rta 113.1 gin Fulda ,N add and St 4 /J7 !�'1 • titleholder: and phone by owner . 5 any) essnbew ofFiorMa � .:,= by Owner upon ethom notces or other documents ntaflbe served asprovidedby number himself. designates thefolowin9 psrsar(s) to receive a copy of Are Mere peas provided at Section Expiration WaRNINOTOOWNEttNIV SIROVBEN119 TO TOM IR ST91 PECOON. FYOU OR RECINIONIO YOtR • • Commencbrnant a, tfolebn.da*%tompso� eoado.td®aaaYneaNacs :B ntdevisepadl t *MIAi arriE NAREIIT OFVElBDMSOF CabNIONPOSIENr PPE CONSIDERED = a TERTIt PART 713:1 .. ANDQIN l T 1.YO R Was mom FD • a• • oF,Ct)fdM�Nr + 1WDPOSTRa liTE;3X9B.3ttk.'` CONSIOSIOPOR p.�ot c/eir -.� a • Reptefad By •4 ^ A ' . • . . .. BY .. .. _ - ... Ptkd Name -i Tie SONS OF F1. i- , NTYOF 11*, i umerd ;' before methds.su d - NY c�a .. ale- er 13 as tor . 0 Perabnagr Mown. or Rini Name Tit oo • r� pto duo od the tattooing type of Signaturci of Notary Pdarks • Prat Hamel • -lU akti N yoteovotoollifk•itpVkft �rearohNr olderP ctP Id 7e flotillas. that thefaata'stated kr h Gretna%tothe best of My knowiedge end Wel. •. _ ,ir 1 who sigeedebovat ey ... ..: SPATE OF FLORIDA; -Coij f OF DO - I FI REBY T1 `Y'M at tfr!S is a true copy oftiro original pile ifs ft 'an - clay of my hand and Midi! Seal. got' aegirig 151 ade County Buildi MUNICIPAL INSPECTION R MUNICIPAL NO.2011 -05772 JOB SITE ADDRESS 9165 P PROPOSED USE OFFICE - LEGAL MIAMI SHORES SE APPLICATION TYPE ALTER OWNER NAME DEVINELLA CONTRACTOR QUALIFIER PERMIT TYPE MUNICIPAL CATEGORIES 0001 MUNICI • DATE: 11/08/2011 PROCES' DERM 1 ASBESTOS REVI 1 DERM 1 MIN COMM REV( 9 FIRE 15000 FIRE UPFRT FE FRWK 1 1ST FIRE MINO 70. g Department Page 1 of 2 QUIREMENTS AND RECORD 11/08/2011 FOLIO: 1132060141350 RK DR - ROFESSIONAL BUILDINGS /INTERIOR DEMO 2 PB 10 -37 SWLY1 /2 LOT 24 & ALL LOTS 25 & 26 INTERIOR 8121 SOFT 1 UNITS 1 FLOORS LLC LOG AL GENERAL BUILDING NUMBER: M2011009263 NEW *AMOUNT PAID 517.00 5.00 DERM 1 UP FRONT FEE- 80.00 .00 FIRE 15000 ALTERATIONS & 104.00 32.00 FIRE 1 SRI PLAN REVI 190.00 0 UPMU 1 UPFRONT FEE F 25.00 9/13/2011 13:54 YDENIS 301109130105 CENTRAL 517.00 MUNICIPAL INSPECTION R MUNICIPAL NO.2011 -05772 JOB SITE ADDRESS 9165 P PROPOSED USE OFFICE - REQUIRED INSPECTIONS I FIRE 0001 FIRE INSPECTIONS R 200 FIRE HYDRANTS 208 FIRE TCO INSPECT! 211 PRELIMINARY 209 FIRE FINAL 1 QUIREMENTS AND RECORD 11/08/2011 PROCESS NO. M2011009263 FOLIO: 1132060141350 RK DR ROFESSIONAL BUILDINGS /INTERIOR DEMO IT DATE COMMENDED rN MUNICIPAL INSPECTION REQUIREMENTS AND RECORD 11/08/2011 MUNICIPAL NO.2011- 057725 PROCESS NO, M2011009263 FOLIO: 1132060141350 JOB SITE ADDRESS 9165 P RK DR PROPOSED USE OFFICE - P OFESSIONAL BUILDINGS /INTERIOR DEMO TO SCHEDULE A FIRE INSP CTION, PLEASE VISIT THE WEB AT http: / /egvsys.co.miarni -dade. T.us: 1608/ WWWS1?IZV/ ggvt /BNZA'W922.D1A'?1'1ZOS .—M20... 11/8/201.1 V /Z "a0Vd Z96TSZLTZE - sxaazinu- ONiImssMOO -N2x T7T:Ta TTOZ'80-AoN MIAMI -DADE FIRE RESCUE DEPARTZENT FIRE INSPECTION REPORT CONTINUATION DATE 1 � ► UPANT` •Qt tj(Y�(�- P�fA ADDRESS 9l L5 ? (Z K bs Cc), cA. ppre _( Page of 125_01-105 3/08 INSPECTOR 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 AUG 17 ZU1i 13Y: Permit No. m C- l t — 0 ri?S Master Permit No. l 1-- 1 S0c3 Permit Type: MECHANICAL q r OWNER: Name (Fee Simple Titleholder): e4 \ k 4i; .) / V i (-1 � Val; Phone( .:ICSY1AS Address: a (i'-I up, City: (.At, (° ' t. ;� State: (� Zip: 33 ) Tenant/Lessee Name: Phone#: Email: ei b C ,� 6 I�iw. `t ry � JOB ADDRESS: CMS- c r L toms 4-t City: Miami Shores County: Miami Dade Zip: 3 3 l 3 a? Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: MC Nl (ts-fe r N .i4t to. etiblt Cc'+t „1 Phone #: 3a 1- ?S3 - nl iy Address: L( v g a W . .11,,toA sc,“ - A Ii/J. City: Mmt Ibk,- V,,..r . 1 State: p L Zip: 3 ) r6 I Qualifier Name: Deia.AL S"I _R, -) Z I j n Phone#: 311 - ?S3 -0 V V) State Certification or Registration #: �7 C 1'I i d 2 / Certificate of Competency #: Contact Phone#: 3 a 1- i b3 • .� is- Email Address: l v 0 i .,� " f e C - 1 . �/t o /44. 4 DESIGNER: Architect/Engineer: Mat' K A e@, lk. e II A VC IL ( eGr Phone #: 30S- .S7 - g3 /O Value of Work for this Permit: $ 1 Poo Square/Linear Footage of Work: g i a b D Z. F Type of Work: OAddress OAlteration ONew ORepair/Replace demolition Description of Work: 1 k 1 e t 1'> r h 0 tk s fi r (Lc --t f 4 ro- 1 G: e lix I t - — `� K AID. I7, ********************************* : f 5 * * * * * * ** * ** * * * * * * * * * * * * * * * * * * * ***** ** * * ** Submittal Fee $ - Permit Fee $ 11 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Technology Fee $ Notary $ Training(Education Fee $ Double Fee $ Structural Review $ (6\\°o 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) T1 D' -- 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 Owner or Agent II The foregoing instrument was acknowledged before me this3a day of IA�u , 20 11 , by 1(16-+Dt i .- L/ t who is personally kno to me or who has produced FL bi- ' - Ina - identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissio 1 1 it Sylvia A Perry My Commission EE027516 40,0S 0S Expires 10/15/2014 APPROVED BY .4111■' w 1 Signature Contractor The foregoing instrument was acknowledged before me this day of �rr�G /� ' , 20 /C , by who pers y known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: o' ,44(, Notary Public State of riorlda My Conunissio ` ER y '. Anne Dirr q My Commission 9t—itii —cP Exp es 09/051201 DD711837 mix ** r*a ******************** ****** ** ********************rrx *** finer Structural Review (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 163427 Permit Number: MC -8 -11 -1508 Scheduled Inspection Date: November 07, 2011 Inspector: Perez, JanPierre Owner: LLC, DEVINELLA Job Address: 9165 PARK Drive Miami Shores, FL Project: <NONE> Contractor: MC MASTER CONSTRUCTION CORP Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)785 -8990 Parcel Number 1132060141350 Phone: (321)953 -2441 Building Department Comments REMOVE DUCT WORK AND 4 AC UNIT Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 04, 2011 For Inspections please call: (305)762 -4949 Page 14 of 42 { 1 • I. :ity of Melbourne Local Business Tax Receipt FY 2011 BTR 10491 Business Name: MCMASTER CONSTRUCTION CORPORATION Location: 1335 Gateway Dr Suite 2002 Classification: 118 Professional Office Comments / Restrictions: Issue Date 1/19/2011 Exp Date: 9/30/2011 TAX RECEIPT SHALL BE TRANSFERRED WITHIN 30 DAYS OF CHANGE OF OWNERSHIP OR LOCATION. NOTIFY REVENUE OFFICE UPON CLOSING BUSINESS :ity of Melbourne Local Business Tax Receipt FY 2011 BTR 10490 Business Name: CBASIN, ROBERT CHARLES Location: 1335 Gateway Dr Suite 2002 Classification: 117E Prof /contractor: General Comments / Restrictions: Certified General Contractor Issue Date 1/19/2011 Exp Date: 9/30/2011 TAX RECEIPT SHALL BE TRANSFERRED WITHIN 30 DAYS OF CHANGE OF OWNERSHIP OR LOCATION. NOTIFY REVENUE OFFICE UPON CLOSING BUSINESS DATE HATCH €WMFER Fron :JW Edens Insurance Melbourne To:7881030 09/19/2011 12:15 1049 P.001/001 OP ID: VF '�� ...-. Rt) CERTIFICATE OF LIABILITY INSURANCE DATE 9/111 m THIS CERTIFICATE 18188UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THB POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is en ADDITIONAL INSURED, the policy(ise) must be endorsed If SUBROGATION 18 WAIVED, subject to the terms and conditions of the policy. certain policies may require an endorsement. A statement on this certificate does not confer rights to the c ertflcete holder in lieu of such endoecement(a). PROOIJOER 321-726-7000 &W. Edens 8 Company 32i 726 T868 Commercial Imo? Onward, Inc 320 Fife Avenue, Suite 108 Indlalantl FL 32903 Scott M. S see Is f+;: t . e�x 1 . so. ; (1111rIDOVY % .�`', otkMCMC001 Ba s)AFFORDING COVERAGE NM s INSURED McMaster Construction Corp Anne Dirr 1335 Gateway Dr1ve Melbourne, FL 32901 ss$nm a AStl"Contlnent Casualty Co. mum a :Travelers Indemnity Company 25658 INSURER C : 05/01/12 DISUM D: a MUREX E I P s a ' I INN URBt F: 100,000 COVERAGE CERTIFICATE N REVISI THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED SY TI4E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIt LIR TYPE OFINSURANCE ttl�! JEm POLICYMUa6ER tMMtOWYYYYS (1111rIDOVY % UMITh A GENERAL X LABILITY COMMERCIAL GENERA. LIA IUTY l ^ 1 OCCUR 04-GL -000829095 05101/11 05/01/12 EACH OCCURRENCE a 1,000,000 P s a ' I a 100,000 i CLAM EMADE MED EXP Any a:s Pena,) $ EXCLUDED PERSONAL 8AOVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEP4 LAGGREGATE LIMRAPPLIES PER: Tl P01JCY El IP n LDC PRODUCTS • COMP/OP AGO $ 2,000,000 $ 13 AUTOMOBILE ^ X X X LIAIULITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NONDYMEDAUTOS BA1A156213 011101/11 05/01112 COMBINED SINGLE LIMIT a 1,000,000 BODILY INJURY (Per person) 1 BODILY INJURY (Persocdent) $ PROPERTY DAMAGE (Fa ) S 1 $ La1aRELLA LIAR EXCESS GAB OCCUR CLAIMs.MADE . EACH OCCURRENCE $ PUIGREGATE a _ DEDUCTELE RETENTION $ a WORKERS AND EMPLOYIEIW L IABIUTY Y/ N ANY PROPRIETOR:PARTNERSDIECUTWE OFFl�lMEU$EREXCLUDEDI (MendsMey In NH) OE34ORIPTIQ OF OPERATIONS below NIA I I *AA E L EACH ACCIDENT a EL DISEASE • EA EMPLOYEE 1 El. DISEASE - POLICY LIMIT $ DESCRIPTION OP OPERATIONS/ LOCATIONS /VIDUCLES IAessh ACORD 101 ,AdddooelRemedoieaedulo s mom spun Isrewind) CERTIFICATE HOLDER MIAMISV Mleml Shores VNlage Buliding Doparimonst 10060 N.E. 2nd Avenue Mlam1 Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUGIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE PATH PROVISIONS. AUTHORIZED Soon M. Steens le ACORD 25 (2009/09) L ®198B- 20138'ACORD CORP N. All rights reserved. The ACORD name and logo are registered marks of ACORD ® A� v CERTIFICATE OF LIABILITY INSURANCE DATE i) OS/19201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Mark van Wert c/o Willis of Florida, Inc. 3000 Bayport Drive; Suite 300 Tampa, FL 33607 CONTACT NAME: PHONE 800 353 5304 ext. 239 FAX Pad): ( ) WC, No): (888) 225 -4049 (E MAI�o• ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : American Zurich Insurance Company 40142 INSURED Employee Leasing Solutions, Inc. Alt. Emp: McMaster Construction Corp 1401 Manatee Avenue West Suite 600 Bradenton, FL 34205 -6708 INSURER B : INSURER C • INSURER D : $ INSURER E : $ INSURER F : $ COVERAGES CERTIFICATE NUMBER: 10FL079807624 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PRMMGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (My one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PRO- n JECT LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXC UDEED ?ECUTIVELi (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC 90-00-818-00 12/31/2010 12/31/2011 X TWC TAIUT- S OETR - E.L EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 12/31/2010 12/31/2011 Client# 052362 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Coverage is provided for McMaster Construction Corp only those employees 1335 Gateway Dr #2002 leased to but not Melbourne, FL 32901 subcontractors of: CERTIFICATE HOLDER CANCELLATION i MIAMI SHORES VILLAGE BUILDING DEPT 10050 N.E. 2nd AVENUE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t)anU ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 605 Inspection Number: INSP- 163398 Permit Number: ELC -8 -11 -1504 Scheduled Inspection Date: November 07, 2011 Inspector: Devaney, Michael Owner: LLC, DEVINELLA Job Address: 9165 PARK Drive Miami Shores, FL Project: <NONE> Contractor: VOLT -TECH Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)785 -8990 Parcel Number 1132060141350 Building Department Comments DISCONNECT INTERIOR PANELS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /1-/o, November 04, 2011 For Inspections please call: (305)762 -4949 Page 12 of 42 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. ELF 1 "' 039 Master Permit NODE I i D3 Permit Type: Electrical ((( j c� OWNER: Name (Fee Simple Titleholder):: t C1 U_C / V I C 10 katliPhone& 3O� 5 / Address: tat" qy LJk - c S0 . _ City: SA ► ► ' n State: Ft Tenant/L.essee Name: Email: ti(b Cd o. bD ,a a be I L- ',de* Zip: 33141 Phone#: JOB ADDRESS: 9/ tar Po I— Do t City: Miami Shores County: Miami Dade Zip: 3`3 Folio/Parcel #: Is the Building Historically Designated: Yes Flood Zone: CONTRACTOR: Company Name: V 0( H. 1 G G k Address: L(SSS C • CtOek Rb City: Titus v t State: FL Qualifier Name: a s N` c k\u U.. 43 . t Q LO State Certification or Registration #: EC. b) 18 0 $ Ce Phone#: 3pt.I —RID - y3 7 l) Contact Phone#: 341 1 • Io g• q 1 L( g ,Email /Address: _ DESIGNER: Architect/Engineer: K,Q , i1 • t a ► -G' I (�.,,,+Allone #: 3W' 7S V- q�3 ig 1 zip: 3011 : Phone#:4 1 11.1 - R 6 3 ° ertificate of Competency #: C.. (4) Value of Work for this Permit: $ 'I" ' Square/Linear Footage of Work: Type of Work: DAddresss I OAlteration DNew ORepair/Replace Description of Work: _t„ idec i o r ow • 51c- re. J de 1w D £ 1-tit. Y. bt> molition ***+ s+ x*,***** ********,x***** •************ pees*x: **********+ x*+ x**** ***+ x• x**+x**a**+x***+x******* Submittal Fee $ Permit Fee $ /e124:9" ei CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ (91' Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) f\ C 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 AFI IDAVIT: 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 Owner or Agent The foregoing instrument was acknowledged before me this3 Fc day of A 1A- k.81, 20 IL, by VVetb■T xe i fi e. who is personally known to me or who has produced FL as %. a -go • 73 -6As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission E Signature xav,b; Contractor The foregoing instrument was acknowledged before me this day of Hw ./tY tit, 20 IL, , by :iv ta_*4*41-1d Welt who is personally known to me or who has produced D-Al2,1 gAD U. u as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Exp' ' 4 / APPROVED BY i 9,14 g � 6° Plans Examiner Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 163422 Permit Number: PLC -8 -11 -1507 Scheduled Inspection Date: November 07, 2011 Inspector: Hernandez, Rafael Owner: LLC, DEVINELLA Job Address: 9165 PARK Drive Miami Shores, FL Project: <NONE> Contractor: BRIAN KIERSTEAD PLUMBING LLC Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)785 -8990 Parcel Number 1132060141350 Building Department Comments CAPPING OFF TOILETS 3 BATHROOMS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comme s November 04, 2011 For Inspections please call: (305)762 -4949 Page 13 of 42 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: PLUMBING RECEIVED AUG 17 2011 BY: n. Permit No. P-01 " Master Permit No.Druno I -- 1503 OWNER: Name (Fee Simple Titleholder):De4 I lam. u_e_/ V e f' ;® 1Le ISaPhone#: ( 3t) 1Os Address: 604 LI Cam./ lel et.sO r 1 eteNe City: W CeY1 i State: Zip: 3314i 1 Tenant/Lessee Name: Phone #: Email: 'Nsi \00-A Gt.100 0 be s v . JOB ADDRESS: / City: Miami Shores County: Miami Dade Zip: 3'3 13 g Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: lb C.IQ -k► k'l e P 57zet L eta 41 • ho e#: Address: SO N. salmi . P- d. 43 t f t 4 U. t -k I 'fS City: A 1+4.1..9 v.. . S t t ti-.1..r State: F L. i1 I L 4.. C t- td-c 4, - State Certification or Registration #: F e- 1 l a 6 I S Certificate of Competency #: Contact Phone#: �a %-' 4 °$ �+ 24 13 OIL Address: !abr. S i & 7 ) Low. eitAkAGc-�.6'c0144,. DESIGNER: Architect/Engineer: M 4 t• K A. t IL 14.-11 b 611 l A v _ .+e.d.' Phone #: 30S- %SY - .23q Value of Work for this Permit: $ 2. 0 Square/Linear Footage p q tage of Work: O , 0 D C`) S. P , Type of Work: DAddress 1OAlteration ONew ORepair/Replace ODemolition Description of Work: 11.4te r t 0 Y"'' IA 0 V1- s -f r W Gfij f r' a- l d e Ito 1 t�a t 1h, i —to b LFL.2-°i N 3 1r B -r i Qualifier Name: 77a -8'93� Zip: 3A 7/ y Phone#: ((D7 - 9Log - a 313 ********* * * * * * * * * * * * * * * * * *,, * * * * * * * * * * ** PPS`************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ �� f , Permit Fee $ - CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ C 00 • RO Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Y J 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 FLFCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and MR 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 Ls 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 Owner or Agent II The foregoing instrument was acknowledged before me this ,� 6d day of i [ " < ,20 f l,by Vv I 10— k. who is personally known to me or who has produced IF I_ t 1-4 01� b,) -73 As atif ation and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Exp' Contractor The foregoing instrument was acknowledged before me this ``8 -k- day of t�t1.� t t� , 20 , by 1D� �Q _ _ kC� �S �' 9 who is personally known to me or who has produced ie (; ILS rtfriagFentification and who did take an oath. NOTARY PUBLIC: joAt r Pitt Notary Public State of Ft,. Sylvia A Perry it My Commission EE027516 �'or noP Expires 10/15/2014 Sign: Print: My Commiss *W,P,k,k+k,b+b+k+ki,+b+h+k* ***P,b,d* ***, R, bM, A, N ****, b, bN„ b, B, P,h*****M,k+k,R,B,b *+MM,P,b*** ►*********** ** * M*** *****MM**** *,RM*** R,k+bd * * * APPROVED BY (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Zoning Structural Review Clerk OP ID: DO A °� CERTIFICATE OF LIABILITY INSURANCE 19!111 "' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER 407469 -0962 SIHLE INSURANCE GROUP, INC. 407- 7744936 P. O. BOX 160398 ALTAMONTE SPRINGS, FL 32716 Tom Knudsen NAME ACT Shelley Fans PHONE 407 - 389-3540 FAX LAIC. No. Ext): (AAC, No% 4074898440 E -MAIL BFane�sihle.COm PPRROODUCCE BRIAN27 CUSTOMER ID*: INSURER(S) AFFORDING COVERAGE NAIC i INSURED Brian Kierstead Plumbing, LLC 540 N SR 434, Suite 145 Altamonte Springs, FL 32714 INSURER A:Old Dominion Insurance Company 40231 INSURERS: RetallFirst Insurance Co INSURER C: 04/14111 INSURER D : EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : DAMAGE T ( Ea oc REN TED nce) PREMISES ( curre COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR VIVD POLICY NUMBER POUCY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY U OCCUR MPG95971 04/14111 04/14/12 EACH OCCURRENCE $ 1,000,000 X DAMAGE T ( Ea oc REN TED nce) PREMISES ( curre $ 500,000 CLAIMS -MADE MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. n LOC PRODUCTS- COMP /OP AGG $ 2,000,000 7 POLICY I ^ PRF $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ A X UMBRELLA UM EXCESSLIAB X OCCUR CLAIMS -MADE CUG95971 04/14/11 04/14112 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 X DEDUCTIBLE RETENTION $ 10,000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUIIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If DESCRIPTI N OF OPERATIONS YIN N/A 52048110 07/01/11 07101112 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 below E.L. DISEASE - POLICY LIMB' $ 500,000 A Inland Marine Contractors Equip. MPG95971 04 /14/11 04/14/12 Unsched. Ded. 25,000 250 DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space le required) Certificate Holder Is Included as Additional nsured with respects to General Liability when required by a written contract for work performed by the Named Insured for the Additional Insured. MIAMSHO Miami Shores Villages Building Dept 10050 NE 2nd Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y °g..�. . &0�'✓ ACORD 25 (2009108) ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A0# 4489247. STATE Of FLORIDA DEPARTmegialuM: HANARTAi 124: Anglamom SECO L090730001 The BUSINESS ORGANIZATION Named below IS QUALIFIED Under the provisions of Chapter 489 FS:- Expiration date: AUG 31, 2011 (TRIS IS NOT A LICENSE TO PERFORM WORM, THIS ALLOWS TEE COMPANY TO DO BUSINESS ONLY IF IT BAS A QUALIFIER.) BRIAN XIERSTEAD PLUMBING LLC 540 N STATE ROAD 434 #145 ALTAMONTE SPRINGS FL 32714 CHARLIE GRIST GOVERNOR D PLAY AeREQUIRED BY LAW CHARLES W. DRAGO SECRETARY x Ni' 44,td Investiy Today* Date; 8!312 Prepared For Monica Dayav C/o Humid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, F133138 Asbestos Survey — Project Summary Pursuant to your request; ARS Environmental, Inc., has performed an Asbestos Building Survey on 3/15/2011 and limited to the above referenced location. The Interior/Exterior of the above referenced location was visually inspected to identify building materials that may contain asbestos. Suspect materials were collected and samples sent to laboratory for analysis. The Roof was not sampled. If the Roof system will be disturbed by renovation or demolition samples of the materials that will be affected should be obtained and analyzed to determine asbestos content prior to any disturbance. Laboratory Results Based On The Laboratory Analysis, Asbestos Was Detected In Amounts Greater Than 1% In The Secured Bulk Samples. It has been a pleasure working with you. Please call on us again. Regards, ex Front, ARS Environmental, Inc. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954 - 227 -2402 • Fair: 866 - 816 -5110 WuJW arsenvironmentalcom • sates@arsenvironmentat.com ARS ENt'IIWNMEIVTAL, wc. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 8/3 /2011 Project Number: 20110307 Page 2 of 17 Prepared For Monica Dayav Go Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building - 1 Story - Built 1970 North And South Side Only 9165 Park Drive IVfiami Shores, F133138 Asbestos Survey — Certification I, Timothy F. Caughey, hereby certify that this asbestos survey was conducted at the above referenced Job Site on 3/15/2011, and performed by Alex Front, accredited by the EPA as AHERA Inspector(s), utilizing the code of the Federal Regulation Standards, C1-12, Part 763, Subpart E, Section 763.80 - 763.99 and the State Asbestos Regulations, Florida Statutes 469.003. 40 i� AC# 4593821 'STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ASBESTOS LICENSING UNIT $EQ#L09091fiO3fi87 DATE BATCH NUMBER 09/16/2009 098043726 LICENSE NBR - ZA0000164 The ASBESTOS BUSINESS ORGANIZATION Named below IS LICENSED Under the provisions of Chapter 469 FS. Expiration date: NOV 30, 2011 ARS ENVIRONMENTAL, INC. TIMOTHY CAUGHEY 10097 CLEARY BOULEVARD PLANTATION FL 33324 CHARLIE CRIST CHARLES W. DRAGO GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW 7 , 0- Timothy F. Caughey, M.P.H. Florida Licensed Consultant 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954- 227 -2402 • Fax: 866 - 816 -5110 tvu'cv.arsenvironmental.com • sales@arsenvironmental.com ARS EIVI"IIWIVMENTAL, iNC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 8/3 /2011 Project Number 20110307 Page 3 of 17 Prepared For: Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, F133138 Asbestos Survey` -- Technician Certification As 115 This is to Certify that l ails1si .1.1 25- Feat -11 TO 25-Feb-11 Irserktaftladms rem comitelodOe oximix telantamovigterom .ifiCA nom emu oft agotopenterei 3a8 W. gen tad Ra84301 tetAAC ProdoVr #489 Trail *4* 3313fla R Smolt . Tmiaing Adder 9130 NwtDCCSiRNhAse ...Hxt[aoderda@;R,7333 swweasfui- come ....,,..,: „., based mot mom= mataat,, tamely, Niambm. i"Vf'ppi 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954- 227 -2402 • Far: 866 -816 -5110 WWW arsenvironmentaLcom • sales@arsenvironmentat com /`1RS EIVC'IIWIVMEIVTAL, ',vc. Environmental Consulting Services Asbestos Business License #ZA -0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • indoor Air Quality Testing • Mold Investigations Today's Date: 8/3 /2011 Project Number. 20110307 Page 4 of 17 Prepared For Monica Dayav C!o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building - 1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, 1133138 Asbestos Survey - Bulk Sample Itemization le Sample Physical Water Material Sample Num Material Class / Sample Description / Location Condition Damage Damage Contact Friability Positive Approximate Size Stop Asbestos Detected Miscellaneous Good None None 1• -Tigh Friable Layer 2' X 4' Pinhole / Slotted Design Ceiling Tiles Offices Throughout North Side Of Building 3,7W Sq. Ft. Asbestos Not Detected Sample' 2 Layer Sample 3` Miscellaneous 2' X 4' Pinhole / Slotted Design Ceiling Tiles Miscellaneous Good None None High Friable Offices Throughout North Side Of Building Good None None High Friable Layer 2' X 4' Pinhole / Slotted Design Ceiling Tiles Offices Throughout North Side Of Building Asbestos Not Detected Asbestos Not Detected Sample 4, Surfacing Material Good None None High Non - friable Layer Wallboard / Joint Compound Throughout North Side Of Building 1,240 Sq. Ft. Asbestos Not Detected Sample?, 5 Layer Sample Surfacing Material Wallboard / Joint Compound Surfacing Material Good None None High Non - friable Throughout North Side Of Building Good None None High Non - friable Layer Wallboard / Joint Compound Throughout North Side Of Building Asbestos Not Detected Asbestos Not Detected The following non - suspect materials were observed during the survey (no samples were taken): A/C fiberglass duct insulation, ceramic tiles. North side of building renovated about 12 years ago. No insulation observed behind wallboard or plaster. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • phone: 954- 227 -2402 • Fax: 866 -816 -5110 cou arsenvironmental.com • sales@arsenvironmental.com APS EiVC'!ROIVMEIVTAL, INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • indoor Air Quality Testing • Mold Investigations Today's Date: 8/3/2011 Project Number. 20110307 Page 5 of 17 Prepared For: Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive 1VTiami Shores, F133138 Asbestos Survey -- Bulk Sample Itemization Sample Sample Physical Water Material Sample Numlxr Material Class 1 Sample Description 1 Location Condition Damage Damage Contact Friability Positive Approximate Size Stop Asbestos Detected Sample.' 7° Miscellaneous Good None None High Non - friable Layer 12" X 12" Aqua With Streaks Floor Tile And Mastic Copier Room, Break Room; North Side Of Building 280 Sq. Ft. Asbestos Not Detected Sample 8 Miscellaneous Good None None High Non- friable - Layer Sample's 9 Layer 12" X 12" Aqua With Streaks Floor Tile And Mastic Miscellaneous 12" X 12" Aqua With Streaks Floor Tile And Mastic Courier Room, Break Room; North Side Of Building Good None None High Non - friable Copier Room, Break Room; North Side Of Building Asbestos Not Detected Asbestos Not Detected Sample` 10 Nfiscellaneous Good None None High Non - friable Layer Aqua Vinyl Baseboard And Mastic Perimeter Of Office To Be Determined Asbestos Not Detected Sample 11` Miscellaneous Good None None High Non - friable Layer 12" X 12" Gray With White Flecks Floor Tiles And Mastic Filing Room; North Side Of Building 200 Sq. Ft. Asbestos Not Detected 12" X 12" Gray With White Flecks Floor Tiles And Mastic Filing Room; North Side Of Building Asbestos Not Detected The following non - suspect materials were observed during the survey (no samples were taken): A/C fiberglass duct insulation, ceramic tiles. North side of building renovated about 12 years ago. No insulation observed behind wallboard or plaster. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954 - 227 -2402 • Fax': 866 -816 -5110 www.arsenvironmentat com • sales@arsenvironmentaLcom 4PS ENUI120NMENTAL, ►N� Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Oua(itg Testing • Mold Investigations Today's Date: 8/3/2011 Project Number: 20110307 Page 6 of 17 Prepared For Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, Fl 33138 Asbestos Survey -- Bulk Sample Itemization Sample Sample Physical Water Material Sample Number Material Class / Sample Description / Location Condition Damage Damage Contact Friability Approximate Size Positive Stop Asbestos Detected Sample 1, 13 Miscellaneous Good None None High Non - friable Layer 12" X 12" Gray With White Flecks Floor Tiles And Mastic Filing Room; North Side Of Building Asbestos Not Detected Sample 14 Miscellaneous Good None None High Friable Layer 2' X 4' Wormlike Design Ceiling Tiles; Red Back Offices Throughout South Side Of Building 3,700 Sq. Ft. Sample;, 15 Miscellaneous Good None None High Friable Layer ample 16` 2' X 4' Wormlike Design Ceiling Tiles; Red Back MVfiscellaneous Offices Throughout South Side Of Building Good None None High Friable Layer Sample' 17, 2' X 4' Wormlike Design Ceiling Tiles; Red Back Miscellaneous Offices Throughout South Side Of Building Good None None High Friable Layer Sample, 18`'. 2' X 4' Wormlike Design Ceiling Tiles; Red Back Miscellaneous Offices Throughout South Side Of Building Good None None High Non - friable Layer 9" X 9" White With Brown Streaks Floor Tile And Mastic Offices Throughout South Side Of Building 3,700 Sq. Ft. Yes The following non - suspect materials were observed during the survey (no samples were taken): A/C fiberglass duct insulation, ceramic tiles. North side of building renovated about 12 years ago. No insulation observed behind wallboard or plaster. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954- 227 -2402 • Fax: 866 -816 -5110 WulW.arsenvironmentaLcom • safes@arsenvironmental.com . ARS EN(/IIWNMEI'JTA 4 INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 8/3/2011 Project Number: 20110307 Page 7 of 17 Prepared For Monica Dayav C/o Hamid Salehi Sa Consultants, Lk 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, F133138 Asbestos Survey -- Bulk Sample Itemization Sample Sample Physical Water Material Number Material Class / Sample Description / Location Condition Damage Damage Contact Sample 20 Layer. 9" X 9" White With Brown Streaks Floor The And Mastic Miscellaneous 9" X 9" White With Brown Streaks Floor Tile And Mastic Sample Friability Positive Approximate Size Stop Asbestos Detected Offices Throughout South Side Of Building Good None None }Tigh Non friable Offices Throughout South Side Of Building Sample 21 Surfacing Material Good None None Non - friable Layer Wall Plaster Behind Wood Panels Throughout South Side Office Hallway 2,800 Sq. Ft. Asbestos Not Detected Samples; 22 Surfacing Material Good None None High Non - friable Layer Sample 23 Layer Wall Plaster Behind Wood Panels Surfacing Material Wall Plaster Behind Wood Panels Throughout South Side Office Hallway None None High Non friable Throughout South Side Office Hallway Asbestos Not Detected Asbestos Not Detected Sample 24 Miscellaneous Good None None High Non - friable Layer Interior / Exterior Concrete Structure Throughout Building 8,100 Sq. Ft. Asbestos Not Detected The following non - suspect materials were observed during the survey (no samples were taken): A/C fiberglass duct insulation, ceramic tiles. North side of building renovated about 12 years ago. No insulation observed behind wallboard or plaster. W097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954 - 227 -2402 • Fax: 866-816-5110 wwcv.arsenvironmental.com • sales@arsenvironmentaLcom • An ENYIIWNMENTAL, ,m. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 8/3 /2011 Project Number. 20110307 Page 8 of 17 Prepared For. Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, F133138 Friable Asbestos Containing Material le Number Description / Material Class Location Sample Physical Water Material Sample Asbestos Approximate Size Condition Damage Damage Contact Friability Detected Sample 14 2' X 4' Wormlike Design Ceiling Tiles; Red Back Offices Throughout South Side Of Building 3,700 Sq. Ft. Good None None High Friable Yes Layer Miscellaneous Sample 15 ` 2' X 4' Wormlike Design Ceiling Tiles; Red Back Offices Throughout South Side Of Building Included Above Good None None High Friable Yes Layer Miscellaneous maple 16 2' X 4' Wormlike Design Ceiling Tiles; Red Back Offices Throughout South Side Of Building Included Above Good None None High Friable Yes Layer Miscellaneous Sample 17 2' X 4' Wormlike Design Ceiling Tiles; Red Back Offices Throughout South Side Of Building Included Above Good None None High Friable Yes Layer Miscellaneous Recommendations Friable: any material containing more than one percent asbestos which has been applied on ceilings, walls, structural members, piping, duct work, or any other part of a building, which when dry, may be crumbled, pulverized, or reduced to powder by hand pressure. The following work practice should be followed whenever demolition /renovation activities involving RACM occur. Notify EPA of intention to demolish/renovate, remove all RACM from a facility being demolished or renovated before any disruptive activity begins or before access to the material is precluded, keep RACM adequately wet before, during, and after removal operations, conduct demolition/renovation activities in a manner which produces no visible emissions to the outside air, and handle and dispose of all RACM in an approved manner. The above building material is considered friable and must be removed by a Florida Licensed Asbestos Abatement Contractor, prior to any disturbance caused by renovation or demolition. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. In the event that demolition or renovation is deemed necessary, parties shall comply with all applicable laws, ordinances, rules and regulations of Federal, State and Local Governmental Agencies, including any National Emissions Standard Hazardous Air Pollutants (N.ES.H.A.P.) Notification requirements 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954- 227 -2402 • Fair: 866-816-5110 tvtvcv.arsenvironmentaLcom • sales@arsenvironmentatcom Environmental Consulting Services . ARS Ek?(/JROItJMENT,4 L, /NC. Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 8/3/2011 Project Number: 20110307 Page 9 of 17 Prepared For. Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building - 1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, Fl 33138 Category I - Non - Friable Asbestos Containing Material Sample Number Description / Material Class Location Sample Physical Water Material Sample Asbestos Approximate Size Condition Damage Damage Contact Friability Detected Sample9" 1$ X 9" White With Brown Streaks Floor Tile And Mastic Offices Throughout South Side Of Building 3,700 Sq. Ft. Good None None High Non - friable Layer Miscellaneous S Pe9" 19 X 9" White With Brown Streaks Floor Tile And Mastic Offices Throughout South Side Of Building Included Above Good None None High Non- friable Layer Miscellaneous Sample9" AU X 9" White With Brown Streaks Floor Tile And Mastic Offices Throughout South Side Of Building Included Above Good None None High Non - friable YeS Layer Miscellaneous Recommendations The above referenced Asbestos Contained Building Materials may be left in place if deemed to be in good condition and no repairs or renovations are scheduled which would disturb them. Care should be taken to ensure that the materials not be disturbed during repair, renovation or remodelling activities which could possibly release fibers into the air. To reduce the intrinsic liability to the owners, the ultimate solution may be to have the material removed. However, at the minimum, a formal Operations and Maintenance (O &M) Program is recommended to minimize potential fiber releases, monitor any future deterioration, and to ensure proper record keeping. Under the FDEP regulations, Category I non - friable asbestos- containing materials may be left in place during demolition under wet conditions. However, OSHA regulations require that disposal of asbestos- containing materials and debris is disposed of in a leak -tight and labeled container. The container may be plastic bags so long as the holding is leak -tight. All materials must be disposed of in a Class I landfill and manifest as Category I Non - Friable Asbestos containing material. To meet the requirements of a wet demolition, it is the responsibility of the demolition contractor to control any visible emissions by adequately applying water on the structure. Furthermore, the work practices for the demolition of a building containing asbestos must be in regulatory compliance with OSHA 1926.1101. All materials must be kept thoroughly wet or saturated during the demolition to assist in preventing the release of asbestos fibers. A certified asbestos supervisor must perform or supervise the work. If during the demolition process visible emissions are observed, the asbestos - containing materials must then be abated. The regulations of the Occupational Safety and Health Administration (OSHA) applies to any detectable amount of asbestos in building materials or on facility components. This requirement covers worker training, work practices, and disposal methods. In summary, removing asbestos in a commercial setting requires training, specific work practices, and disposal methods for the asbestos and asbestos- containing debris. However, if Category I Materials have become friable or are in poor condition, they must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954- 227 -2402 • Fax: 866 -816 -5110 ahou arsenvironmentaLcom • sales@arsenvironmentaLcom AIDS EIVt'IIWNMEIVTAL, wc. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • indoor Air Ouatity Testing • Mold Investigations Today's Date: 8/3/2011 Project Nmnber. 20110307 Page 10 of 17 Prepared For Monica Dayav C/o Hamid Salehi Sa Consultants, Uc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building - 1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, Fl 33138 Category II - Non - Friable Asbestos Containing Material Sample Number Description / Material Class Location Sample Physical Water Material Sample Asbestos Approximate Size Condition Damage Damage Contact Friability Detected Recommendations The above referenced Asbestos Contained Building Materials may be left in place if deemed to be in good condition & no repairs or renovations are scheduled which would disturb them. Care should be taken to ensure that the materials not be disturbed during repair, renovation or remodelling activities which could possibly release fibers into the air. To reduce the intrinsic liability to the owners, the ultimate solution may be to have the material removed. The above building materials are considered Category II Non - Friable and are likely to become crushed, crumbled, pulverized or reduced to powder during demolition or renovation therefore must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. To meet the requirements of a wet demolition, it is the responsibility of the demolition contractor to control any visible emissions by adequately applying water on the structure. Furthermore, the work practices for the demolition of a building containing asbestos must be in regulatory compliance with OSHA 1926.1101. All materials must be kept thoroughly wet or saturated during the demolition to assist in preventing the release of asbestos fibers. A certified asbestos supervisor must perform or supervise the work. If during the demolition process visible emissions are observed, the asbestos- containing materials must then be abated. The regulations of the Occupational Safety and Health Administration (OSHA) applies to any detectable amount of asbestos in building materials or on facility components. This requirement covers worker training, work practices, and disposal methods. In summary, removing asbestos in a commercial setting requires training, specific work practices, and disposal methods for the asbestos and asbestos- containing debris. However, if Category II Materials have become friable or are in poor condition, they must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. 10097 Cleary boulevard • #305 • Plantation, FL 33324 • Phone: 954 -227 -2402 • Fax: 866- 816 -5110 www.arsenvironmenta(.com • sales@arsenvironmentatcom . ARS EIW,ROIVMENTAL, uvc. Ennironrnenta1 Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold InOestigations Today's Date: 8/3 /2011 Project Number. 20110307 Page 11 of 17 General Terms and Conditions Scope of Work ARS Environmental's inspections are limited and non - destructive in nature. Any conditions or materials which were not able to be visually observed on the surface, or in easily accessible areas, were not inspected and may differ from those observed. It was not within the scope of this investigation to remove surface materials to investigate portions of the structure or materials which lay beneath the surface. Our selection of sample locations and frequency is based upon our observations and the assumption that like materials in the same area are homogeneous. This inspection report is the result of a diligent search of the facility for Asbestos Containing Building Materials (ACBM). The purpose of this inspection was to identify those materials which may pose a health hazard to occupants of a building and impart future liability to the owners and insurers of the property. However, we do not claim to have identified all of the asbestos containing building materials present in the facility. Materials such as underground pipes, any material inside walls, ceilings, floors, or other enclosed and inaccessible areas were not sampled and are not covered in this report. This report is designed to aid the building owner, architect, construction manager, general contractor, and potential asbestos abatement contractor in locating asbestos containing building materials. Under no circumstances is this report to be utilized as a proposal or a project specification document. This report is based upon conditions and practices observed at the property and information made available to the surveyor. This report does not intend to identify all hazards or unsafe practices, nor to indicate that other hazards or unsafe practices do not exist at the premises. In the event that demolition or renovation is deemed necessary, parties shall comply with all applicable laws, ordinances, rules, and regulations of federal, state, and local governmental agencies, including any National Emissions Standard Hazardous Air Pollutants (NESHAP) notification requirements. Right of Entry The client will provide for right of entry to ARS Enviromnental's personnel in order to complete the above referenced work. Invoices - ARS Environmental will submit invoices to client upon completion of services. Ownership of Documents All reports, field data, field notes, laboratory tests data, calculations, estimates, and any other documents prepared by ARS Environmental as instruments of service shall remain the property of ARS Environmental. Assumptions and Limitations The results, finds, conclusions and recommendations expressed in this report are based only on conditions which were observed during inspections by this report. ARS Environmental makes no representation or assumptions as to past conditions or future occurrences. Assigns Neither the client nor ARS Environmental may delegate, assign, sublet or transfer his duties or interest in this agreement without the written consent of the other party. Roof Cuts To obtain accurate information in a roof investigation, roof cuts approximately four inch 4" squares, may be deemed necessary. It is the responsibility of our client to make appropriate repairs to these roof cuts, using materials consistent with the roofing system and in accordance with any existing material manufacturer's warranties. A roofing contractor or maintenance personnel selected by our client should be on the roof to make any necessary repairs at the time the samples are being obtained. Although, every attempt will be made to make these repaired areas water tight, ARS Environmental will in no way be responsible for any water damage to the roofing system, building, or it's contents resulting from ARS Environmental temporary repairs. Disclaimer If in the course of a renovation or demolition activity, suspect materials become exposed, ALL FURTHER ACTIVITY SHOULD IMMEDIATELY CEASE AND THE STATUS OF THE MATERIAL SHOULD BE DETERMINED BEFORE PROCEEDING. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954- 227 -2402 • Fax: 866 - 816 -5110 NWu'arsenvironmentaLcom • sales@arsennironmentaLcom ARS EIWJIIWNMEIVTAL, 1n1C. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Imiestigations Today's Date: 8/3/2011 Project Number: 20110307 Page 12 of 17 Prepared For. Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, Fl 33138 Asbestos Survey - Technician Chain of Custody Forms 5617479174 w ti cc ARS EMJIRONMEJJTAL, I CHAIN QF CUSTODn, . PLM Anal sls: Bulk iam es Poativa Stun Request d Turnaround Time Requested: Same Day • . 48 Hour • 7k Hour Point Count Requested On F` That Re)aorl Lessman 1% Sampling Date: 3/ 15 ail Project Location: I 31.091 1 C APLOiNG StOF Samples Taken By: P Rzzo,.;Y /� gUb5 PiR>z, D w Project Number:._ DC) 1-.Cl 3O 7 -As 6 :IMAM S b(Z.KS,. S(d MatGI:resial Sample Saw Milan Sample Locae on A ex. raztv.hod Da alcr Cnnt�t = } ! �� 4'11`q1 r I)1 1.�C ;G1'tT'C° v ,i 64 }�.��vf #l�S eta 3•t�t IS -y�i icc c Y T) �415tt 1 0 \ °itil�Jc,t, rS'��, Gi IT t^ 7 3 1- a vl S q ( lit l 3.*1 r.e;mj)a J '100\040,7f tv S! 11-13 1 ! : 5 t o p. iutlo c., -,` ZA j elj i P Jv P Y :CA t I (1 1�•'•yIa E- 0 9 t'N sA l 1 ty j,3 r,� ¢}�tAAvtdNLT�j7`4' i 'r1L. 40,v- fta„•rx. t(',c 789 `' \. lk.,1 Mass: Ramat Sottudadrto Materials To Thn n, Transfered By :_ 10097 CLEAR BOULEVARD • #305 • PLANTATION, K 24 • Tou. FREE: 877-227-2401 • PHONE: 954 -227 -2402 • Fax: 866416.5110 Date: for g that. whet dm. may vane . wr+rer+ t orwaw lo hand .)FAMdt&Fal that may be mmdiled puMerbml. or tattooed to powder by hand Pressure whondty.) 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954 -227 -2402 • Fair: 866416 -5110 wu'w.arsenvironmentat com • sates@arsenvironmental,com • ARS ENVIRONMENTAL, INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 8/3/2011 Project Number: 20110307 Page 13 of 17 Prepared For Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, F133138 Asbestos Survey Technician Chain of Custody Forms w rn ARS ENVIRONMENTAL, INC. CHAIN OF CUSTODY Page Of PLM Arutlysls� � Count Requ on Fr That Report Less Than 1% Turnaround Time Requested: Same Day Sampling Date: S (((5 3,0 Project Location: I we V cca,f )LO QcrK4 j ML J "C I Samples Taken By . 0,11.41* R L5 j liCa OWE. Project Number: a91 P - O3o7- F� j l'r' 1�Rn+ i sl% Rl S, !�� - os Sulk Samples • 48 Hour • 72 Hour r C i Semple Sample Sample Location Aez C 1 j' (aa Y�SKGfF a IG> a Na2i� Stle,octc. n 0 0 i C iv Cv ; V, . it : 1 % l 11 �3A ( 1 l'i VI' VS Pi`. w 1, A y 21A 1 it'd z4 ,3 s7'116 KS tent) e G +t�i"G i.. [vK7N 7 � '�U•�1,i1 DC K' S' a 51D .i o WL �n .�1 t 1 ' lj rt1 a Z. 4 1 T/ a i t i Iv 1 b ,,, N 3'Q r f iJ'c %c 1� Gill% coed $$i'2 /��y I1 1 I tic i i) 1� 0 a1 -, ia i P.c. Class: a=audadng Matmials Tn Mama: Transtered By: 10097 C • IJI.EVARO • #305 • PLANTATION, tort UyU NoMriable mmt,m#rendry, may wretlicced pressure.)F (MMertatOctoertm mumbled, puhedzaa mr to powder by bona Nereus taken dry.) 1 Received By: Date: 10097 Cleary Boulevard • #305 • plantation, FL 33324 • Phone: 954 - 227-2402 • Fair: 866- 816 -5110 mmul.arsenvironmentaLcom • sales@arsenvironmentaLcom AIOS EIVt'rnONMEIVTAL, ma Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Ouafittj Testing • Mold Investigations Today's Date: 8/3/2011 Project Number. 20110307 Page 14 of 17 Prepared For Monica Dayav C/o Hamid Salehi Sa Consultants, I1c 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, F133138 Asbestos Survey — Technician Chain of Custody Forms ARS E, ONMENTAL, INC CHAIN OF CUSTODY Page 3 Of PL.I Analysis: ; ,- tos Bulk Samples a Posttve Slop aequestud Turnaround Time Requested: Same Day • 48 Hour • 72 Hour Pont Count Requested On terms That Report Lt Than 1% Sampling Date: (5 doll Pro' location: sic / ,Ocit,LCl) oFC: ..,u;C "t, m � 1 II !» 9 >� t q1(, pma‹ 044- T 8 W 07 Samples Taken By:��,1 {Q.Qt"f �2 Project Number: . li - Q ' A J% r4tDtAl Tt.1$a Sare 11=a1 Semple Description Semple Location Le ==itliVw= 2 i U... r z P- +O\S tiacd `6 c4 r 5wita.$0 off es ' (.., 1Q fir „IF, ry >, 4 AiNt t 1 lr `,� t i ), 1 , Y4 !{ t 4 h 1� sc+GA. . ` 1 tl l' $taiiii, oioof AJ6 662a -4SS oixe .•,1/4-saftPtd : C1flrrrc y'rt6 -S Nt 1 S,t2C Qf' 030 Lox, &A011 o tlyetes icy© Pc z..34- 411104 P,, r. O & )I.1 w1CiLl 0 fit. pugs -T6A- 6.6tar,taias Materials r Ta al As;;, Transfered By: 10097 Materials to Date: ARD • #305 • PLANTATION, or RnNOn-F dam,mgrrur,mar .armty i%eseura)F.(totatorial that may be aumbtod, pub/4.1;04ot reduced to powder by hand pressure *ton dry.) Receives! By: Date: • Ton. FREE: 877 -227 -2401 • Pnoss: 054. 227.2402 • Fax: 886818.5110 10097 Cleary Z3oulet/ard • #305 • Plantation, FL 33324 • Phone: 954 -227 -2602 • Fax: 866 -816 -5110 wt W arsenVironmental.com • sales@arsenvironmentaLcom AFS EIVVIIWIVMEIVTAL, INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 8/3/2011 Project Number. 20110307 Page 15 of 17 Prepared For. Monica Dayav C/o Hamid Salehi Sa Consultants, Lk 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, F133138 Asbestos Survey - Laboratory Results ETS E4w'u>s41de44, 4,46. 12334 73 Court North West Palm Beads, FE 33412 (954) 235-0053 Arbedfcs t #2110000219 REPORT NUMBER: FL11-05413SA LAR CODE: 291 REPORT OF CLIENT SUBMAITTED BULK SAMPLE ANALYSIS CLIENT: ARS Eavinonniental, Inc. x11-0307 10097 Cleary Boulevard 0305 Plantation. Florida 33324 SAMPLING DATE: 03115/11 PROJECT: Office Building 9165 Park Drive 'M Iamt Shores, Florida ANALYSIS DATE: 03117/11 3-5 Fiberglass 7 -10 Cellulose 3-5 Fiberglass 7 -10 Cellulose 3-5 Fiberglass 7 -10 Cellulose Floor-Tile sr/Maeda Floor Tee WJMasUC Floor T IIe sr/Mastic 100 Matrix 100 Mahar 100 Mat x Dennis Emerson I.N. '= In Mastic Portion Only MiC0331)(076 12334 73 COORT MORTB, 95731. BALM 8076161, 97.. 33412 (954)236 -0093 (361)333 -0624 83X {961)933 -0664 Page 1 of 3 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954- 227 -2402 • Fax: 866- 816 -5110 wulw.arsenvironmental.com • sales@arsenvironmental.com Sic AIDS EIVWRONMEIVTAL, ma Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold lnoestigations Today's Date: 8/3/2011 Project Number. 20110307 Page 16 of 17 Prepared For Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miami Shores, Fl 33138 Asbestos Survey -- Laboratory Results ET$ &w4Ppo41PMse44 tpisc. 12334 73 Court Nom West Palm Beach, FL 33412 (954)236 -0053 t #2110000212 REPORT NUMBER: FL11_354BSA LAB CODE: 291 REPORT OF CLIENT SUBMITTED BULK SAMPLE ANALYSIS PROJECT: Mae BWidIng 9185 Park Wive Miami Shores, Flom (UE1T: ARS EJtvironmental, Ms. 820114307 10097 Cleary Boulevard #305 Plantation, Florida 33324 SAMPLING DATE: 03/15/11 ANALYSIS DATE: 03/17/11 Sample Number Anal. Sample Item.Dasalpton Asbestos Percentage & T y Identified Pge & Type Non, Asbestos Mee Percentage Non- FIberMat. 11 OKE Floor Tile w c NAD 1SO111aIrIx 12 DKE Floor Tile c NAD 100 Matrix 13 DKE Floor Tile vc NAD 100 Matrbc 14 OKE Ceiling Tie YES • 24 Moshe 23-27 Fiberglass 30.35 Cellulose 35-45 Matrix 15 DKE 16 OKE 17 DKE 18 DKE 19 DKE Cep Tile YES 2-3 Amosfe 23-27 F-Merglass 30-35 Cellulose 35.45 Matrix Ceiling Tile YES 2-3 Amaefto 23-27 Fiberglass 30-35 Cellulose 35-45 Matrbc Ceiling Tile YES 2-3 Amosita 2327 Fiberglass 30-35 Ceiluiaae 3545 Matt( Roar TIIewIA c YES 3-5 9547 Matrix Floor Tito sr/Mastic YES 3-5 C 95-97 Matrix Deeds Emerson LH. 1111aosoopist {•!:.11.L. * = In Mastic Portion Only Page 2 of 3 12334 73 coma NORM, 80301. HgZ3 833831, 8L. 33412 (954)236^0053 (561)333 -0624 FAX (561)333 -0684 10097 Cleary &oufeOard • #305 • Plantation, FL 33324 • Phone: 954 -227 -2402 • Fax: 86641651 i 0 WWW.arsennironmentaLcom • sales@arsentironmentaLcom a r ARS ENVIRONMENTAL, INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Imiestigations Today's Date: 8/3/2011 Project Number. 20110307 Page 17 of 17 Prepared For Monica Dayav C/o Hamid Salehi Sa Consultants, Llc 2150 Coral Way, Ste 7b Coral Gables, Fla 33145 Job Site: Office Building -1 Story - Built 1970 North And South Side Only 9165 Park Drive Miiaani Shores, F133138 Asbestos Survey Laboratory Results ET� E4u'Z'w4441s.e444 (40‘. 12334 73 Court North West Palm 9each, FI. 33412 (954) 236 -0053 Ittleatas$as:.woa btapea#2ADDDD211 REPORT NUflABER: FL11- 35493A LAB CODE: 291 REPORT OF CLIENT SUBMITTED BULK SAMPLE ANALYSIS WENT: ARS Enveranmestrd, Inc. S2011.0307 10097 Ctean+ Bo+devavd 9305 P on. Florida 33324 SAMPLING DATE: 03/15111 PRO.CT: Mee Banana 9165 Pak Drive Miami Stores, Fkttltta ANALYSIS DATE: 03117(11 Sample Number Anal. IRS. 21 22 23 24 DKE DKE Plaster NAD Percentage &Type Non - Asbestos Fibers NAD DKE DKE Concrete NAD NAD Percentage Non -Rbsr Mat. 100 Aatrbc 100 Matrix 100 metro( 100 Matrix • Dennis Emeraon I.H. microscopist "= In Mastic Paton Orly Page3ot3 12334 73 COMM ROMS, ROYAL PUN awes, L. 33412 (954) 236 -0053 (561)333 -0624 M (56E) 333 -0684 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954 - 227 -2402 • Fax: 866- 816 -5110 u/cvuLarsenvironmentat.com • sales@arsenvironmentaLcom Wdbz:ST '508 LS '.-+EW v PAVEMENT: LOCATION MAP: SECTION 6 TWP. 53 S. RGE 42 E. / SCALE 1n=100' D. POLE :.. FD. I N &D rl WD. POLE N 1- -4 N O —t U z M to N co M 1 r O CO M t- zQ - zoo,._. Owe ° t/l o a to• om Lij oN.E. TRACT B 92nd 191.08' STREET -t- z a NM 0 4 ' ' ' ' n CO D P - M viX co • va,i,r^, a ` ro z g 0) ci a irl .c Lo a E a av=i CU ► -4 4 4 0 0 LO LEGEND; CONC = CONCRETE C = CENTERUNE C.B. = CCA BASIN E R = EDGE OF ROAD RN. FLR. = FINISHED FLOOR ELEVATION I.P. = IRON PIPE LB = LAND SURVEYOR BUSINESS LP. = CONCRETE UGHT POLE N &D = NAIL & DISK M.N. = MANHOLE O.E. = OVERHEAD ELEC. P/L = PROPERTY LINE R = REGISTERED LAND SURVEYOR No. SWK = SIDEWALK WM = WATER METER 4i LEGAL DESCRTPTIO : SOUTHWESTERLY 1/2 LOT 24, LOT 25,LOT 26, AND THE NORTHEASTERLY 1/2 LOT 27, BLOCK 59, "MIAMI SHORES, SECTION 2 ", ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10 AT PAGE 37 OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA. 1 GRAPHIC SCALE: 20' 40' 60' AGE AINER 1.0' SCALE: 1 INCH = 20 FEET ELEVATIONS SHOWN REFER TO THE NATIONAL GEODETIC VERTICAL DATUM 1929,(NGVD29) ORDER #14660- REVISED SURVEY, MARCH 15, 2011 150.00' FD. LP. G yEYOR'S CERTWI A ON: WE HEREBY CERTIFY THAT THIS SKETCH OF SURVEY IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BEUEF AS RECENTLY SURVEYED AND PLATTED UNDER MY DIRECTION AND THAT THIS SURVEY COMPLIES WITH THE MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYING IN THE STATE OF FLORIDA, UNDER CHAPTER 61G17 -6 FLORIDA ADMINISTRATIVE CODE, CHAPTER 472.027 FLORIDA STATUTES. NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF THE REGISTERED LAND SURVEYOR SHOWN HEREON. THERE ARE NO ENCROACHMENTS UNLESS SHOWN HEREON. A.R. TOUSSAINT & ASSOCIATES, INC. BY: gli/et ALBERT R. TOUSSAINT REGISTERED ENGINEER NO. 8939 REGISTERED LAND SURVEYOR NO. 907 STATE OF FLORIDA FLORIDA CERTIFICATE OF AUTHORIZATION LB -273 fr PRES. DATE: MARCH 11, 2009 SCALE 1 " =20' 9165 PARK DRIVE MIAMI SHORES MIAMI -DADE COUNTY, FLORIDA DRAWING NUMBER 14660 / 14459 SHEET 1 OF 1 DRAWN BY: WT