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DEMO-13-1767a k p', �� 4I � tir°' "';"�� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-196652 Permit Number. DEMO -8-13-1767 Scheduled Inspection Date: July 29, 2014 Permit Type: Demolition Inspector. Diaz, Osvaldo Inspection Type: Final Owner: WILLIAM J. JURBERG, R. ANDREW DE Work Classification: Plumbing onee Job Address: 9350 NE 12 Avenue Miami Shores, FL 33138- Phone Number (305)609-3851 Parcel Number 1132050070150 Project: <NONE> Contractor: JZ PLUMBING CORPORATION Phone: (305)218-8078 tsuuaing Uepartment Comments DISCONNECT HOUSE SUPPLY LINE FROM WATER Infractio Passed Comments METER INSPECTOR COMMENTS False July 28, 2014 For Inspections please call: (305)762-4949 Page 2 of 40 Inspector Comments Passed Failed---�-� Correction Needed ❑ Z �- Re-Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid July 28, 2014 For Inspections please call: (305)762-4949 Page 2 of 40 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 Permit Type: PLUMBING JOB ADDRESS: c i� M it T AUG 0 5 ea B �U Yo�ooaaoo�� FBC 20 Permit No.)'�Rt qz 7 I Master Permit No, City: Miami Shored County: Miami Dade Zip: F,holParcel#: /l' 32,02-002" 0/:50 Is the Building Historically Designated: Yes Zone: OWNER: Name (Fee Simple Titleholder):Phone#: Address: -?3115-0 IVC-- / -'L City: A%/ /91u/ 5� State: �'� zip: Tenant/La;see Name: A Phone#: E-mail: CONTRACTOR: Company Name_: Address: 7�Q City: Qualifier Name: _ State Certification Contact Phone#: DES Valu of Work for. this Permit: $ Type of.WQr:.::QAddress OAlteration Description of Work: .A7) QI �1►xy% r >b I Certificate of Competency #: Address: _ F\� c�Qly b� 2 ' c --00,N _Squarel:� ear Footage,of Work.! ONew ❑ReDair/Reolace- �,�,�,�,�,�,r�a�,�,�,x�,�,r�,�+�,ger,�,r�,�,�,�,�,�,�,x�,�,t�,a,�,�,�F��rrz�,t,��,r��,xr�,�,�,x*,rr,�,�,s�x,�,�*a�,�,�,�*,�,�,�,��r Submittal Fee $ Permit Fee $�, 5 r CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Stmetaral Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ADS Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State zip 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 IMTROVEMENTS 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 arel ection fee will be charged. Signature C4._ L' Signature Owner or Agent ontractor The fore oing instrument was ac o led g before e day of&7 201 by who ' personally a or who has produced As identification and who did take an oath. NOTARY P •�i �'Y P��ii�� MARTIN J. PALMER Notary Public - State of Florida Sign: ;' • 'r MY Comm. Expires May 23, 2011 ;9, ¢ . omm salon # EE 173842 Print 1 ��;°�`� Band atary Assn My Commission Expire The foregoing instrument was acknowl fore me this day of 2Q/3 by wh is personally known me or who has produced APPROVED BY 9..(-- . I_3 Plans Examiner Structural Review (Revised3/1212012)(Revised 07/10/07)(11evised 06/10/2009)(Reviud 3/15/09) as identification and who did take an oath. NOT MARTIN J. PALMER Notary Public - State of Florida '• . My Comm. Expires May 23, 2016 Commission # EE 173842 Sign: -111110 Buyided Assn. Print: My Commissi C Zoning Clerk Miami Shores Village Building Department CONTRACTORS' REGISTRATION 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. `� COPY OF QUALIFIER'S STATE LICENCES B. 1O COPY OF LOCAL BUSINESS TAX RECEIPT C.COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION JEITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: elU►-Ab- Co0C)QiS:1 U tJ BUSINESS ADDRESS: 17?,?l tiw 9Z'! C7L CITY j STATE ZIP CODE 3 I BUSINESS PHONE: (S ) �f g� ��� FAX NUMBER (S) �Z Z 29 CELL PHONE (5) �rS�Gr - �6 � © QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: C Cc 4- 1 A- Z(P 3 g-7 E-MAIL ADDRESS (IF APPLICABLE): `O Se Corn Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS 11-14-2012 * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers Compensation law EFFECTIVE DATE: PERSON: FEIN: 11/14/2012 EXPIRATION DATE: 11114/2014 ZEPEDA JOSE N 760764201 BUSINESS NAME AND ADDRESS: JZ PUIMING CORPORATION DBA JOSE ZEPEDA 17921 NN 82CT HIALEAH FL 33015 SCOPES OF BUSINESS OR TRADE: 1- PUOIBING NDC AND DRIVERS ........ —&- 9de {AAPORTdift: pnraosm' to tha)Oer 440 . OW141, F.S« as officer of a corporation who elects exemption from lies mer eY gums - `l section may �t recover benefits or compeasatioo ender this chapter. Pursuant to Chapter 440.05112% F.S. Certifi of election to M axe VL.. ePp1Y only w{thin the scope of the hasioess or trade listed on the notice of election to be exempt Parsanat to Chapter 440 051131 F.S , tiaZica of election to Im anc�e� or election to be exempt shall be s�ject to revocation its seam for tsrasace of a fc�Niraie- The of the idepa�nt ce Or the a certificate at any t1w far faOf &a cer"lle" Me Person namedilure of the person certificate no longer meets the requMaseots WES11OMS? (850) 413-1609 named on the certificate to meet the regeirements of . this "Wen' DWC-252 CERTIFICATE OF ELECTIOM TO BE EXEMPT REVISEO 01-11 543358'6 THIS IS NCYT A BILL — DO NOT PAY RENEWAL '3TW"iw,ftP STATEMEN2.6387 567317-4 17921 NW 82 CT 33015 UNIN BADE COUNTY PLUMBING CORP WORICEI/S 81WOMMIS CONTRACTOR THIS IS ONLY A LOCAL HUSNESS TAX AeCWT IT DOES NOT PERMm HOLDER TO VIOLATE ANY MOWING MKG LAM O THTOW E DO NOT FORWARD MUM OR cr*7 B. mm now IT Mumvy OTMR J Z PLUMBING CORP By ', JOSE N ZEPEDA PRES w D LAW. NOT A CERTW=T Of 17921 NW 82 CT TM , ;g 'A!'FtCA- MIAMI FL 33015 PAYMBIT MCE1YED F WZ-DADE COUM" TAX "i*%9/19/2012 09010036001 ilfil1fliijij if!l11tfijj#!! lfitiy[[ jjjj }} p ii hill) 1 It til 000075.00 sae ' i R &4a E J u 1.19. 2013 11; 53AM No. 5925 P. 1 /', E Pollcy Number, =-0504009534-00 Data Entered: 07/19/2013 CORD CERTIFICATE OF LIABILITY INSURANCE�muft 3 THIS CERTIFICATE 19 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 CONSMTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. if the cartificato holder is an ADDITIONAL INSURED, the policy(ies) must be andoraad If SUBROGATION IS WANED, subject to the ternts and conditions of the policy, cwWn policies may require an endorsement A statement on this cardlicata does not confer rights to the certificate holder In lieu of such andomemantlse. PROwx" FLORIDA BANKERS iNsu -al= 1631 W FLAGM ST XXANX FL 33135 INiRM 17921 NW 82 CT i =11AB, I -L 33015 .. 2dAML8fioridabankewsinm=ance . com VERAGES etr12rte19+A9M ununen. _ — __- - - - - - -- __ __ -- 643-9413 CITY OF rand¢ SaORES BDSDZriG >O pA 10050 = 2ND AVE. bUADtl 611101015,SL 33139 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED B8POR8 THE EXPIRATION DATE THEREOF, *NOTICE WILL 9E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ALUNDFUED RM&SIMAING ®198&2010 ACORD CORPORATION. All rights reserved, Rrwfalm v rrvmorm; 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. L1A TYPE or- M=RAWM ADDL Rm yyyp PQUGY NUMflER Yf:Y EFF PO LBAn3 °"` "'�""' 0O1ff& CIALGENERAI.LW91LI Y CLA=44ADE ®OCCUR sr/� $250 DED A7mpfKMJCY GL -0504009534-0 /21/2012 /21/2013 EACHOCGURRENCE 01,000,000 $100,000 MED E*{Aryonaaeraon> 95,000 PERSOnwLanavDLluRY 61,000,000 GEWJULAGMQATfi 92, 000, 000 LACME�iATELOrRiAPPL PER; P LOC PRODUCTS-COMPIOPAGG 91,000,000 9 AUr0M0EILR LIABILITY ANYAUTO b&AWD S EDULE6 COMBWED 9 B�ILYIHWRY(PMpEr�) $ BOQ11Y11�UWiY{Pu�RidWtR) S HIREDAUrOS gLMOS 9 S U LL LAB HCLA.S.A.,X�EbS LIAR OCCUR EACH OCCURRENCE $ AC•,L3REGNTE $ 00 S WORKERS COMPEH9AT18M AND E6lPLOYERS' LuwLn7 ANY �1�E NIA If daftv*umw OF OPEPATIONS 9 STYIN A O7H L EACH ACCT NT S E.LDISEASE-EAEMPLOYEE 9 E� bt3PA4E - POLICY LIWT S ePscRlPnoN oR OPERATtM) LOCAM= I VEHIOLE9 {Attach ACORD TOt, addnrons Renmre senedwe aurae �,aoe is requl� CERTIFICATE Wnl non CITY OF rand¢ SaORES BDSDZriG >O pA 10050 = 2ND AVE. bUADtl 611101015,SL 33139 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED B8POR8 THE EXPIRATION DATE THEREOF, *NOTICE WILL 9E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ALUNDFUED RM&SIMAING ®198&2010 ACORD CORPORATION. All rights reserved, E E b G Environmental Services, LLC June 18, 2013 EE&G Project No. 2013-2484 Mr. Martin Palmer Palmer Holdings, Inc. 1900 South Bayshore Drive Miami, FL 33133 Subject: Limited Asbestos Pre -Demolition Survey Former One -Story Residence 9350 NE 12th Avenue Miami Shores, Florida 33138 Dear Mr. Palmer: 5751 Miami Lakes Drive Miami Lakes, Florida 33014 Tel (305) 374-8300 Fax (305) 374-9004 www.eeandg.com 8� 0 JUL 3 eta i3 act A PWA,0 15 y14� EE&G Environmental Services, LLC (EE&G) conducted a pre -demolition asbestos survey at the one story residence located at the above referenced address in Miami Shores, Florida. The purpose of this asbestos survey was to identify the presence, extent, and condition of asbestos - containing materials (ACM) in the surveyed areas of this facility. The area surveyed during this inspection was limited to the interior and exterior areas, and the roof scheduled for demolition. Observed suspect materials were either sampled to determine asbestos content or assumed to contain asbestos. SUMMARY On June 10, 2013, Mr. Warren Adams, and Mr. Rey Garcia of EE&G collected a total of 21 bulk samples of white drywall system, white plaster, and black field membrane, black edge flashing cement, gray exterior stucco, black vent through roof cement (VTR), black pitch pan, gray sink coat, and white HVAC mastic. Asbestos was detected in several of the roof samples collected during this inspection. SURVEY METHODS The interior, exterior and roof areas of the building to be demolished where inspected for suspect ACM, unless otherwise noted. Each observed suspect material was assigned a homogenous area number, described, and measured. Each observed suspect material was either sampled or assumed to be asbestos -containing. Samples of suspect ACM were collected using procedures established by the United States (US) Environmental Protection Agency (EPA) Code of Federal Regulations (CFR) Title 40 Part 763 Subpart E, Asbestos -Containing Materials in Schools. Samples were sent to AAL in Tampa, Florida for analysis. Upon arrival at the laboratory, the samples were logged -in and stored for analysis. Analyses were performed using the polarized light microscopy (PLM) method of asbestos detection using guidelines and procedures established in the Method for the Determination of Asbestos in Bulk Building Materials (EPA - 600/R -93-116 July, 1993). Miami Melbourne Orlando Tampa Mr. Martin Palmer June 18, 2013 Page 2 LIMITATIONS OF SURVEY This asbestos inspection report has been prepared by EE&G in a manner consistent with industry standards exercised by members of the profession practicing under similar conditions. No other warranty, expressed or implied is made. The intent of this survey report is to assist the owner or client in locating ACM. Under no circumstances is this survey to be utilized as a proposal or a project specification document without the expressed written consent of EE&G. The survey was conducted to identify suspect ACM in accessible interior and exterior areas. If other areas at this location are to be impacted during planned or future renovations, a separate asbestos survey of these areas will be required. Any suspect materials discovered subsequent to the issue of this survey report should be sampled and analyzed to determine asbestos content and to initiate appropriate responses. Analyses were carried out by PLM. While the most commonly accepted analytical method for detecting asbestos in bulk materials, PLM is known to have limited resolution and may not detect extremely small asbestos fibers. Certain materials, notably vinyl floor tiles, may contain extremely fine asbestos fibers that are beyond the resolution of PLM. EE&G's interpretations and recommendations are based upon the results of sample collection and analyses in compliance with environmental regulations, quality control and assurance standards, and the scope of work as indicated in EE&G's proposal. The results, conclusions, and recommendations contained in this report pertain to conditions observed at the time of the survey. Other conditions elsewhere in the subject building(s) may differ from those in the inspected/surveyed locations and, such conditions are unknown, may change over time, and have not been considered. This report was prepared solely for the use of EE&G's client, and is not intended for use by third party beneficiaries. The client shall indemnify and hold EE&G harmless against any liability for any loss arising out of or relating to reliance by any third party on any work performed thereunder, or the contents of this report. EE&G will not be held responsible for the interpretation or use by others of data developed pursuant to the compilation of this report, or for use of segregated portions of this report. SURVEY AREA DESCRIPTION AND OBSERVATIONS The structure was observed to be constructed of concrete on a concrete slab foundation. Ceilings were finished with drywall. The floor was observed to be terrazzo. The roofs were constructed of built-up roof membrane with edge flashing and vent penetration cements. No fireproofing was observed during this survey. RESULTS The results of the PLM analyses and assessment of suspect ACM are as follows: Asbestos-containina materials Asbestos was identified in amounts greater than 1 percent in the following materials: Black pitch pan flashing — Approx. 10 SF total. Black edge flashing cement - Approx.250LF/SF total 9350 NE 12 AVE SURVEY Mr. Martin Palmer June 18, 2013 Page 3 Black VTR flashing — Approx. 10 SF total. Nonasbestos-containing materials • White drywall system. • White plaster. • Black field membrane. • Grey exterior stucco. • Grey sink coat. • White HVAC mastic. The original laboratory report is included as Appendix A. CONCLUSIONS AND RECOMMENDATIONS The black VTR flashing, black pitch pan flashing, and black edge flashing cement were found to be Category I Nonfriable ACM. Suspect materials discovered after this inspection should be sampled and analyzed to determine asbestos content and to initiate appropriate responses. These materials may remain on the structure during wet demolition provided they remain nonfriable. However, they must be removed prior to any activities that would release asbestos fibers. Specifically, any demolition activity that will crush, abrade, or dissolve the matrix of these materials must be performed by a Florida -licensed Asbestos Contractor. The Miami -Dade County Department of Regulatory and Economic Resources (DRER) requires notification of intent demolish. Notification must be sent at least 10 working days prior to the start of any demolition activities. The contractor should also keep a copy of this survey at the site during the entire project as proof of compliance with 40 CFR 61 (NESHAP). EE&G appreciates the opportunity to provide Palmer Holdings Inc. with environmental consulting services. If you have any questions or require further clarifications, please do not hesitate to contact me at (305) 710-6124. Sincerely, Richard Grupenhoff Sr. Project Manager EE&G Attachments: Appendix A: Laboratory Report Appendix B: Figures Appendix C: Photographs Appendix D: Certificates 9350 NE 12 AVE SURVEY Reviewed by DZV_"Z 1_6�1 � Daniel J. Cottrel , Ph.D., P.G. Senior Technical Advisor, EE&G Asbestos Consultant #DD0000010 Mr. Martin Palmer June 18, 2013 Appendices APPENDIX A PLM LABORATORY RESULTS 9350 NE 12 AVE SURVEY AAL Friday, Jun 14 2013, 3:31 PM American Asbestos Laboratories REPORT SENT PALMER HOLDINGS INC. TO: 1900 SOUTH RAYSHORE DRIVE MIAMI, FL 33133 MARTIN PALMER Phone: 303-3104673 Fax: Email.. mpalgt@aoLtom Thank you for your business. PREPARED AAL BY: Asbestos Department 5005 WEST LAUREL STREET SUITE 110 TAMPA, FL 33607 NVLAP Lab Code 101775 (813)287-1005 Analysis: Polarized Light Microscopy (PLM) with dispersion staining techniques according to the United States (Us) Environmental Protection Agency (EPA) Method for the Determination of Asbestos in Bulk Building Materials", EPA 600/R-93-116, July 1993. Sample Type: BULK # or Samples: 21 Work Order# T1306043 AAL Project# 2013-2484 Project 9350 NE 12TH AVENUE, MIAMI, FL /4", y" Aulhoriwd Analyst KHANDAKERANAM Date in: Wednesday, June 12, 2013 Date out: Friday, Jun 14 2013 Transported: FEDEX Sampled by: REY G ROCeivsd by: KlA /"11 01 1" 1999 - Laboratory Maftager KHANDAKER ANAM Due to the small size ofasbestoe fibers associated with vinyl floor Wax, TOM analysis is recommended torah 0wrOn containing M% or no detectable asbestos by visual eatbaedon. This report may not be reproduced except In full, without the written approval of AAL. AAL will not be held responsible for the use of as reports issued In part to third parties or au#wrlmd agents of fire client This report shall notbe used by the diem to claim product endorsement by NV/AP nor any agency of the united States Oovenr cwt Ali NVLAP reports dfsptaying NVLAP logo must have at least we siguatera to be valid. The following analygcst results presented M tins report peAain only to the samples analyzed. American Asbestos Laboratories assumes no respweibihty, for whether the osmoles acsumtely represent th material in question Friday, Jun 14 2013, 3:31 PM AAL Pagel of 3 LABORATORY BULK SAMPLE ANALYSIS REPORT CUEw. PALMERHOLDINGS W. PROJECT: 9350 NE 12TH AVENUE, MIAMI, FL Samples were analyzed in accordance with the Interim Method Work Order: T13OW3 as described in 40 CFR, Part 753, Vol. 52, No. 210 Dari PERCEN7ASSESTOSFIBERS Na ANA DESCRIPTION LOC47ION Saeip/eNo, I CLARY AMOS CROC TREM ANM OTHER FIBERS 01A KIA WHITE DRYWALL SYSTEM LNNG ROOM 1 NO ASBESTOS DETECTED 10-15 I.ayal-NO ASBESTOS DETECTED IN TAN DRYWALL Layal NO ASBESTOS DETECTED IN WHITE JONT COMPOUND 01 B KLA WHITE DRYWALL SYSTEM BATHROOM 2 NO ASBESTOS DETECTED 1.2 •Commem: NO DRYWALUJOINF COMPOUND PRESENT, THIS 1S A PIASTER SAMPLE 01 C KIA WHITE DRYWALL SYSTEM MASTER BED 3 NO ASBESTOS DETECTED 10-15 Layal: NO ASBESTOS DEFECTED IN TAN DRYWALL Layal NO ASBESTOS DETECTED IN WHITE JUNT COMPOUND 01 D KLA WHITE DRYWALL SYSTEM BREAKFAST 4 NO ASBESTOS DETECTED 12-0 •Commeats: NO DRYWALUJOINT COMPOUND PRESENT, THIS IS A PLASTER SAMPLE O1 E KLA WHITE DRYWALL SYSTEM FAMILY ROOM 5 NO ASBESTOS DETECTED 1p. 15 Loyal:NO ASBESTOS DETECTED IN TAN DRYWALL Layal NO ASBESTOS DETECTED IN WHITE JOINT COMPOUND 02 A KIA WHITE PLASTER NW BEDROOM SOUTH 6 NO ASBESTOS DETECTED 1-2 02B K1A WHITE PLASTER NW BEDROOM WEST 7 NO ASBESTOS DETECTED 1-2 Report Continued on Next Page Frldey, June 94, 2093 Page 2 of 3 CLIENT: PALMER HOLDINGS INC. PROJECT: 9350 NE 12TH AVENUE, MIAML, PL LABORATORY BULK SAMPLE ANALYSIS REPORT CON77MUED Work Order: T1306043 Dash PERCENTASBESTOS FIBERS %.WN -ASB Na ANA DESCRIPTION LOCATION Sample Na I CHRY AMOS CROC TREM AN771 O771ER FIBERS 02 C KLA WHITE PLASTER NW BEDROOM NORTH 8 NO ASBESTOS DETECTED 1 - 2 M A KIA BLACK FIELD MEMBRANE NORTH 9 NO ASBESTOS DETECTED 5-10 03 B KIA BLACK REM MEMBRANE SOUTH 10 NO ASBESTOS DETECTED 5- 10 03 C KIA BLACK REED MEMBRANE CAR PORT I/ NO ASBESTOS DETECTED 5-10 04A KIA BLACK EDGE FLASHING CEAgNT NORTH 12 .5-10 5 -10 048 KIA BLACK EDGE FLASHING CEMENT SOUTH 13 - STOP AT FIRST POSITIVE, NOTANALYZED 0.0 04C KIA BLACK IDG£ FLASHING CEMENT WEST 14 _ STOP AT FIRST POSITIVE, NOTANALYZED 0-0 05 A KLA OREY EXTERIOR STUCCO NORTH 15 NO ASBESTOS DETECTED 1 - 2 058 KIA GREY EXTERIOR STUCCO EAST 16 NO ASBESTOS DETECTED 1 - 2 050 KIA GREY EXTERIOR STUCCO WEST 17 NO ASBESTOS DETECTED 1-2 06A ICA BLACK VTR SOUTH 18 5-10 5-10 07 A ICA BLACK PITCH PAN MID 19 2-5 5 -10 Report Continued on Next Page Friday, June 14, 2013 CLIENT: PALM" HOLDINGS INC. PROJECT: 9350 NE 12TH AVENUE, MIAMI, FL W01* Order: T130M3 Page 3 of 3 LABORATORY BULK SAMPLE ANALYSIS REPORT CONTINUED Dark I PERCENT ASBESTOS FIBERS 916NO -ASB Na ANA DESCRIPTION LOCATION Saalple No. CHRY ANDIS CROC TRElN ANTE OTBER FTBERS 08A KIA GREY SM COAT ICTCHEN 20 NO ASBESTOS DETECTED 1.2 09 A KIA WIBTEHVAC MASDC HVAC CLOSET 2/ NO ASBESTOS DETECTED 1 - 2 eaff y CO -01 Or— Analytical resales perfain only to the sample(s) analyzed. All Sampbs altalyzed were acceptable for armlysbr. ABBREVIATIONS: ANA = Analyst ASB - Asbestos: CHRY - Chryaotiie; AMOS - Amosite. CROC - Crocidolite: TERM - TemNAct ANTH = AMhophylite; ACT = Actinolite; AL= Aluminum; BLK - Black, BACK = Backlog; BL = Blue; BRN - Brown; C - Cellulose; CALC - Calcareous; CPT - Carpet CTL - Ce" Tile; CEM - Cement COV - Cover, DEB = Debris: FG = Fiberglass; FIB - Fibrous: MAS - Mastic: MAT - Material: MIC - Mitacecus: MW = Mineral Woot ORG = Orange: PAI - Paint; PAP - Paper PL = Plaster, PLAS - Nestle; PWDR - Powder: RCF = Refractory Ceramse Fiber, RUB = Rubber; SIL - Silver, SR - Shad Rork: S - SyMhetr; SUB = Substance: TEXT - Tortured: TR= Trace: TRAM = Transite: TREM = Trenrolfte; VERM = Ve+micugte: VYL = Vinyl; W - Viotlastomte; WH — White: YEL - Yellow. `� EEG� BULK TRANSMITTAL FORM �/� CHAIN OF CUSTODY moff,� J- /"/ — PRoeFCT 935- .,.0 is Adm CLIENT CONTACT PROJECT j DATE COLLECTED. -__j .. 13 BS.I.oRDuemRASE S� ,, DATE SENT: /v /3 DATE VERBAL NEEDED: Vis_ -,- STOP rSTOP AT FIRST POW r* : Y N (Pude Me) DATE VAVA EN NEEDED: 'Is A,. SAMPLE PREM SAMPLEIBJMBER COLOR 1. !Al7 SAMPLE DESCRIP7'�N v w,� /'c A 3 7F/Z- 1 ee V. 1 1uc c q v�rz tg) zi a.T _ w!<iT_�,C"• �_ rVV.LG ;UA>7_(' r�. CHAIN OF CUSTODY: DATEAIME PRINT NAMWSIONATURE SAMPLE LOCATWN z rw'd t, 'u— -c' -.shed ,3F srt-a�rAa-r MJ /1 G�try <•r 3.ss.•ri .VO.r7K C.ts'T door^.: K�7•[r1r^ti' Hv<G C. t��c7 PURPOSE -,r-•3 ��,F C ® A C T A CoUedbn T- Trerepwtatton Aa J t ) 2013 Mr. Martin Palmer June 18, 2013 Appendices APPENDIX B FIGURES 9360 NE 12 AVE SURVEY Property Search - Report Property Information: Folio 11-3205-007-0150 Property Address 9350 NE 12 AVE Owner Name(s) R ANDREW DE PASS JTRS Exemption/ Exemption/ Taxable Taxable WILLIAM J JURBERG JTRS Mailing Address 9350 NE 12 AVE $25,000/$199,076 $25,000/$192,550 MIAMI SHORES FL $50,000/$174,076 $50,000/$167,550 33138 Primary Zone 1400 SGL FAMILY - 3001-3250 SQ Use Code 0001 RESIDENTIAL -SINGLE Amount FAMILY Beds/Baths/Half 5/3/1 Floors 1 Living Units 1 Adj. Sq. Footage 3,621 Lot Size 19,166 SQ FT Year Built 1957 Full Legal Description 5-6 53 42.44 AC PL OF GOVT LOT 4 PB 5-90 2/1993 BEG 20OFTE OF NW COR OF S80FT 15803-0275 LOT Sales which are disqualified as a result of examination of the deed K TH S TO S/L OF LOT L El20.80FT NELY151.8FT W TO POB LOT SIZE 19166 SQUARE FEET OR 16575-1968 0794 5 (CORR DEED) IMPORTANT NOTICE: The 2013 exemption and assessment values currently shown are preliminary and are subject to change until they are certified on July 1. Assessment Information: Current Previous Previous 2 Year 2013 2012 2011 Land Value $349,780 $331,188 $275,990 Building Value $232,967 $267,656 $269,328 Market Value $582,747 $598,844 $545,318 Assessed Value $582,747 $224,076 $217,550 Benefits Information: Current Previous Previous 2 Benefit Type 2013 2012 2011 Save Our Assessment $0 $374,768 $327,768 Homes Reduction Homestead Exemption $25,000 $25,000 $25,000 Second Exemption $25,000 $25,000 $25,000 Homestead Note: not all benefits are applicable to all Taxable Values (ie County, School Board, City, Regional). Disclaimer: Page 1 of 1 MIAMI-DADE COUNTY OFFICE OF THE PROPERTY APPRAISER PROPERTY SEARCH SUMMARY REPORT Carlos Lopez-Cantera Property Appraiser AAerial Photography 2012 N Taxable Value Information: Current Previous Previous 2 Year 2013 2012 2011 Exemption/ Taxable Exemption/ Exemption/ Taxable Taxable County $50,000/$532,747 $50,000/$174,076 $50,000/$167,550 School Board $25,000/$557,747 $25,000/$199,076 $25,000/$192,550 city $50,000/$532,747 $50,000/$174,076 $50,000/$167,550 Regional $50,000/$532,747 $50,000/$174,076 $50,000/$167,550 Sale Information: Date Amount OR Book -Page Qualification Code 10/2012 $756,100 28335-0257 Sales qualified as a result of examination of the deed 7/1994 $0 16575-1968 Sales which are disqualified as a result of examination of the deed 10/1993 $145,500 16094-3669 Sales which are qualified 2/1993 $0 15803-0275 Sales which are disqualified as a result of examination of the deed The Office of the Property Appraiser and Miami -Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property information and GIS positional accuracy. No warranties, expressed or implied, are provided for data and the positional or thematic accuracy of the data herein, its use, or its interpretation. Although this website is periodically updated, this information may not reflect the data currently on file at Miami -Dade County's systems of record. The Property Appraiser and Miami -Dade County assumes no liability either for any errors, omissions, or inaccuracies in the information provided regardless of the cause of such or for any decision made, action taken, or action not taken by the user in reliance upon any information provided herein. See Miami -Dade County full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp. Property information inquiries, comments, and suggestions email: pawebmail@miamidadc.gov GIS inquiries, comments, and suggestions email: gis@miamidade.gov Generated on: Fri Jun 7 2013 http://gisweb.miamidade.gov/PropertySearch/printMap.htm 6/7/2013 Mr. Martin Palmer June 18, 2013 Appendices APPENDIX C SURVEY PHOTOGRAPHS 9350 NE 12 AVE SURVEY Mr. Martin Palmer June 18, 2013 Appendices Photo 1: Exterior view of residence at 9350 NE 12 Avenue. 9350 NE 12 AVE SURVEY Mr. Martin Palmer June 18, 2013 Appendices Photo 4: Typical ACM black pitch pan. 9350 NE 12 AVE SURVEY Mr. Martin Palmer June 18, 2013 Appendices Photo 6: Typical ACM black VTR. 9350 NE 12 AVE SURVEY Mr. Martin Palmer June 18, 2013 Appendices .U]VIA 91 CERTIFICATES 9350 NE 12 AVE SURVEY United States Department of Commerce National Institute of Standards and Technology NvIQ ° Certificate of Accreditation to ISOAEC 17025:2005 NVLAP LAB CODE: 101775-0 American Asbestos Laboratories, Inc. Tampa, FL is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation, for: BULK ASBESTOS FIBER ANALYSIS This laboratory is accredited in accordance with the recognized International Standard 1S0/IEC 17025:2005. This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality management system (refer to joint ISO-ILAC-IAF Communique dated January 2009). 2012-04-01 through 2013-03-31 Effective dates A NT 4F CO QPQ ��o p� t� For the National Institute of Standards and Technology Scares ov NVLAP-01C (REV. 2009-01-28) O 4PQ��ONT OF CO MM R National Voluntary O m L1�1� Q Laboratory Accreditation Program z ST4TES OF P��e SCOPE OF ACCREDITATION TO ISO/IEC 17025:2005 American Asbestos Laboratories, Inc. 5005 W. Laurel St., Suite 110 Tampa, FL 33607 Dr. Daniel J. Cottrell Phone: 813-287-1005 Fax: 813-285-8545 E -Mail: dcottrell@eeandg.com BULK ASBESTOS FIBER ANALYSIS (PLM) N_VL4P Code 18/A01 Designation /Description NVLAP LAB CODE 101775-0 EPA-60ON4-82-020: Interim Method for the Determination of Asbestos in Bulk Insulation Samples 2012-04-01 through 2013-03-31 Effective dates For the National Institute of Standards and Technology Page 1 of 1 NVLAP-01 S (REV. 2005-05-19) 39749.6357CERTBI 900 N.W. 5TH Avenue, Fort Lauderdale, Florida 33311 F) 524-7208 This is to Certify that Processed E Rawmtla����tlilV.A ae e IIIII IIIII IIIII IIIA VIII VIII 111111 VIII VIII IIIII III ` X X X— X X— 0 3 2 74: z- 11774 SW 37 St., Miami .FL has successfully completed an English AHIBRA 1Buillffing 1nGVtCt®Tr coume 13 -Aug -12 TO 15 -Aug -12 Individual above has completed the requsite training for accreditation under TSCA Title It A Meets state requirements of FL49-0001020/CN-0006272. -A NDAAC Provider #451 Trainer(s): lames F. Stump 11 TEST SCORE: 92 % Training Address: 900 Northwest Fifth Ave., Fort Lauderdale, Fl, 3331 Successful course completion based on exam score on: 15 -Aug -12 This Certificate Expires: 111111111111111111111111111111111111111111111 15 Aue 13 WAKING OR R ). I /Tames F. Stump, Course Spon Certificate Number....... 111111111 Course Number SE1233 OOOES 442 - -- AN RKY4. Rammed ^ UTHO t; Asbestos Consulting . ng Tnin ftg Systems 39645.5928CERTBIR 900 N.W. 5TH Avenue, Fort Lauderdale, Florida 33311)524-7208 7- �) 524-7208 / Processed By: Tltls is to cerury rnar WITT(tM kftMO, IIIII Ifll! IIIII Illll Illll 11111 lil{11 II{II IIIII ����� II1 X X X— X X— 4 8 5 9 1455 NE 2nd Cour-t, Boca Raton,FL has successfully completed an English 1 i 6 -Jul -12 TO 6 -Jul -12 Individual above has completed the requisite training for accreditation under TSCA Title II Meets state requirements of FL49-0001020/CN-0006273. NDAAC Provider #451 Trainer(s): Mark Knick Training Address: 900 NW 5th Ave, Fort Lauderdale, FL, 33311 Successful course completion based on exam score on: 6 -Jul -12 This Certificate Expires: To Authenticate Certificate www.seagulltraini ng.com tt i 1-800-966-9933 j OR I m, 40 CF FEDERAL, /names F. Stump, Course Sponsof 111111111111111111111111111111 Certificate Number....... i Course Number SE1227 9GOES 442 LITHO, IN U.S,A. All RiaMs Reserved ACS 6 3 7 6,$ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ASBESTOS LICENSING UNIT SEQ# L12100303316 DATE 13ATCH NUMBER LICENSE NBR 10103/201211203-22432 IDD0000010 The ASBESTOS CONSULTANT Under below wrIS LICRNSEDiv& the provisions of Chapt#r '469 FS.; Expiration date: NOV 30, 2 014t 3?. COTTRELL, DANIEL JOSEPH -�- 6367 SW 44 ST MIAMI FL 33155-5142 RICK SCOTT KEN LAWSON 00',V$RNOR DISPLAY AS REQUIRED BY LAW SECRETARY