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PL-14-1746Ile Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-217634 Permit Number: PL -6-14-1746 Scheduled Inspection Date: November 12, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: ALEXANDER, DAVID Work Classification: Repair Job Address: 1640 NE 104 Street Miami Shores, FL Phone Number (646)675-3489 Parcel Number 1122320320430 Project <NONE> Contractor: NORTHWEST PLUMBING INC Phone: (786)586-5203 tiu t;ommencs RELOCATE KITCHEN SINK, REPLACE 2 LAVATORY, INSPECTOR COMMENTS False REPLACE 2 TOILETS, NEW 4 LAVATORY, 3 TOILET, 2 SHOWER WITH DIVERTER AND 1 TUB WITH DIVERTER. November 10, 2014 For Inspections please call: (305)762-4949 Page 15 of 49 nspector Comments Passed Eg/ Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 10, 2014 For Inspections please call: (305)762-4949 Page 15 of 49 I Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING ®PLUMBING ❑ MECHANICAL ❑PUBLICWORKS JOB ADDRESS: 1640 NE 104 St WG rMqll FBC 2 Master Permit No. RQ- 1 `-i _ ' Sub Permit NO—PU Y — I ❑ REVISION ❑ EXTENSION ❑ RENEWAL CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City Miami Shores County: Miami Dade Zia: Folio/Parcel#:11-2232-032-0430 Is the Building Historically Designated: Yes NO X SF IIB AE 10.0 8.19 Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): D. ALEXANDER/V. AGUIRREBEITIA Phone#:646-675-3489 Address: 1640 NE 104 ST CRY: MIAMI SHORES State: FL zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR: Company Name: Address: City: ./�®,�or9 y// State: /C� Zip: -33/.� 9 Qualifier Name: "" :r 41',1.4 Phone#: State Certification or Registration #: G r—C Certificate of Competency #: DEN ARCHITECTURE LLC 305-335-6085 DESIGNER: Architect/Engineer: Phone#: Address:1477 SW 14 TERRACE City: MIAMI State: FL Zip: 33145 Value of Work for this Permit: $ 9.7-50.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition Description of Work: /Cf, /ems 75✓ kj Actftn-TAm/c t gAeEC-E WL 1-"-1 VA Specify color of color thru Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ ;'Y CCF $ CO/CC $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Reviseedo2/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ � � • cGj Bonding Company's Name (if applicable) N/A Bonding Company's Address city State zip Mortgage Lender's Name (if applicable) CITIBANK NA 1000 TECHNOLOGY DR Mortgage Lender's Address City O'FALLON State MD 63368-2240 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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. Signatu?' �/ Signature ci-c �: l OWNER or AGENT The foregoing instrument was acknowledged before me this 2 day of ' ✓ Ke 20 r Y by 10*,-% J who is personally known to me or who has produced P4 -19L as identification and who did take an oath. NOTARY PUBLIQ.4 / P) Notary PUbIIC - State o1 Flonoa IBy Comm. Expires Aug 11. 2017 Colnnlisslon 0 FF 044383 APPROVED BY (Revised02/24/2014) CONTRACTOR The foregoing instrument was acknowledged before me this day of// j/ 3 20 /-9 by �c�i�B�flU .</J; -'n4 , who is personally known to me or who has produced 5 /5/ —68 -Q99-Q as identification and who did take an oath. NOTARY PUBLIC: P.. Sign: Pri t: ��/ �® l Seal:KIREP 1A NIETO NOTARY PUBLIC O*wr;s IMM17 STATE OF FLORIDA Comm# EE88 Plans Examiner Structural Review Zoning Clerk Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOT A BILL - DO NOT PAY 6632351 BUSUMS INAMEMOCATtord NORTHWEST PLUMBING INC 10820 SW 200 DR 281 5 MIAMI FL 33157 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2014 6130312E must be displayed at place of business Pursuant to County Code Chapter 8A — ArL 9 & 10 ER SEC. TYPE OF BUSINESS NORTHWEST PLUMBING INC 196 PLUMBING CONTRACTOR BY TAX COLLECTORYNEW Worker(s) 1 CFC1428177 $75.00 07/08/2013 TXH51-13-014606 this Laces Business Taz Rese4d a* Cotdrtms of the Local Basics Tax. The is mat a Reuse, t►angav mawal raliddery lavas andcoMmdan of the sre� eats app ailans. to do budam Holder must comPty� anP 9� � to the httsiness. The RECBPT 1A aboa mad he dbphq d on Nit l vakisla -Miami-Bads Coke See SM -EL Far amus hilarmatkm vet aesl M+ -Bestir - - - - -- "" FIS. 33157 3tIGRR ='EOTT R8N LAWSOiO Gt?�TBRPTt?R - ' SECRETARYDISPLAY AS REQUIRED BY LAW �R©® CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 08/11/2014 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(les) 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 CONTACT NAME: Sara! Medina Emmanuel Insurance & Associates, Inc. 2370E 8TH AVE AR No. Ext): (305) 693-0003 AI No : (305) 691-4381 ELsarai emmanuelinsurance.com AD DRESS: INSURER(S) AFFORDING COVERAGE NAIC # 07/22/2015 HIALEAH FL 33013-4236 INSURERA: PREFERRED CONTRACTORS INSURANCE 12497 INSURED INSURERS: RETAILFIRST INSURANCE CO 10700 NORTHWEST PLUMBING, INC. INSURER C : EDUARDO SABINA INSURER D : 10820 SW 200TH DR APT 281 INSURER E : CUTLER BAY FL 33157-8436 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iLTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER MMID Y EFF MMM1uDD EXP 1JMrrS A GENERAL LIABILnY1,000,000.00 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR PCIC5043-PCA502184-02 07/22/2014 07/22/2015 EACH OCCURRENCE $ PREMISES Ea occurrence $ 50,000.00 MED EXP (Any one person) $ 5,000.00 &ADV INJURY $ 1,000,000.00 -PERSONAL GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PECO LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE 11 LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Perao dent $ $ UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATIONNIC AND EMPLOYERS' YIN LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 0520-44652-0 05/10/2014 05/10/2015 STATU- OTH- TORY LIMITS ER E.LEACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) COMMERCIAL & RESIDENTIAL PLUMBING CONTRACTOR. Any Changes or alterations Done to this document after being issued shall constitute it null and void CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 Tel:305 795-2204 Fax 305.756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE" OTICE ILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Saga,' Awti w riahts reserved ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD Miami s Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. in these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be nersonallv liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: 01 A � Signature: State of Florida ) County of Miami -Dade) Sworn to and subscribed before me this 2-7 day of V he_ P20 I y . Notaryt Pabtfa . Ste of ,l rw 9o!atd TWO4 t�tio+rat Contractor j Print Name: Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed bef r day 7/ -0 -O (SEAL) IMM17 Tvne of Identification nroduced -4f.8.006MR*MTOFNW MANDSECURITY ELEVATION CEJRTfl4;- AT.E•:• :..: OVa No. 1660 -MM 'oFEDMALEMMOSiCYNANAtEITACMCY --- • • • 0 • • • • • x400 tel F1WW I+iWWW Pmram brip aftant: Read tMins 4meom bIC 14gegi-M : Expiration Date: July 31, 2015 SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE,: Al 130chg Owners Name policy Number: DAM ALEXANDER AND VIRGINIA AGUIRREBEITIA : :. : • • . • . • • • _ A2 Mukling Brest Address (including Apt., Unit, SuRo, ander Bldg. No.)414r.0. Flouterar^xv • . •: : : " Compalty 1640 N.E 104 STREET • • Cly State ZIP Code R3 MparlyUescriptcon (Lot and Muck Nuntsers. Tax Parcel Nunher. Legal an, W.0)• 9 • • • A4 lidding Use to g., Residential. Non -Residers t, Addition. Accessory, etc,! &W • A5. Latitudekorigdude: Let. Long. Horimftl Datum: ❑ NAD 1927 ® NAD 1983 AB_ Attach at least 2 photographs atthe building d the Certificate Is being used to obtain flood insurance. A7 Btttldmg Diagram Number 8 ASB_ For a bufty with a crawaspace or enclosure(s): A9. For a budtBng with an attached garage: a) Square footage of cravvispe e or enclosure(s) 1151 sq ft a) Square footage of attached garage 400 sq It b) Number of permanent flood openings in the c rawlspace b) Number d permanent flood openings in the attached garage or enclostue(s) within 1.0 foot above aAacent grade 11 within 1.0 foot above adjacent grade 0 c) Total net area of stood openings in A8b 936 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered float openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes 29 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name rt Carrmunity Number 82. County Name 63. State 120652 I MIAMI-DADE COUNTY I FLORIDA B4. Map0landIVntmber 85. SufAar Btu. FIRM Index Date 87. FIRM Panel B8. Flood 69. Basis Road Gevabonts) i.Zono ❑ meters LL ® feet ❑ meters Effective/Revised Date Zone(s) AO, use base flood depth) 1204i6CO3,6 L 9/1112009 9011/2009 AE 10.0 1310 indicate the source ofthe Base f=lood Elevation (13FE) date or base flood depth entered in kern 139 ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: 1311. Indicate elevation datum used for SFE in Item B9: ® NGVD 1529 ❑ NAVD 1988 ❑ OtherSource: 812. Isthe building located Ina Coastal Barrer Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: AM— ❑ CERS ® OPA SECTION C — BUILDING, ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations aro based on: ❑ Construction Drawings' ❑ BuDftg Undue Construction' 91 Fit Med Construction 'Anew Elevation Certificate will be required when construction dthe building is complete. C2. Elevatimsi- Zones Al -A30, AE. All. A (with E). VE, Vi -V30. V (wan SFE). AR. ARIA. AR1AE, AR/Al­A30, ARIAh1. AR/AO- Complexe items C2a-h blow according to the budding diagram specl6ed In Reim A7 In Puerto Rico only, enter meters. Benchmark Utilized: Vertical Datum: Ncb'D 1929 Indicate elevation datum used for the elevations in Items a) through h) below 23 NGV01929 O NAVD 1981) ❑ Other/Source Dntum used for building elemboris must be the same as that used far the BFE a) Top d bottom Noor (Including basement, fawlspaee, or enclosure floor) b) Top ofthe next higher floor W Bottom of the lowest horizontal structural member (V Zones orilyy) d) Attached garage (top d slab) e) Lowest elevation d machinery or equipment servicing the building (Describe type of equitntent and location in Comments) f) Lowest adjacent (finished) grade nerd to eudding (LA0) g) Highest adjacent (finished) grade nen to twltding 1HAG) h) Lowest e0cent grab at lowest elevation of deck or stairs. Including structural support Check the measurement used 492 ® feet ❑ meters A.I!L— 0 feet ❑ meters �ylg_ E feet ❑ meters LL ® feet ❑ meters wa IM feet ❑ meters _4 Z2_ E feet ❑ meters 492 ®feet ❑ meters WA ® feet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification Is to tri signed and seated by a land sunreyw, engineer, or archaw authorized by law to certify eurvation Infom etion. I certify Unit the frdtim akin an Ws Ceriffibefe repesents my best efforts b lrrterpret Etre dais avarlbble_ I understand that any /else staterment may be punottie tote by fine or amp 1sarmernt under 18 U. S. C.oare, Sft*Wn 1001, Check here if comments are pmvmd on back or tarn Were latitude and longitude in Section A provided by a�S N ❑ Check here if attachments licensed land su veW W Yes [3 No Ce'"ers Name MIGUEL ESPINOSA LicenseNumber 5101 TI%WESSIONAL SURVEYOR & MAppaqCompany NameBonow caw, Carew, a rac,,rre e�aa Cili ■nwwn SW zIpCodJ06., N Signature Telephone FEMA Form OW -0-33 (7112) See reverse side for contmuation. Replaces all previous editions. 2 .• IMPORTANT: In these spaces, copy the corresponding Informato A i - ----; FOR INSURANCE COMPANY USE Building Street Address (Including Apt, Unit. Suite. andfor Bldg_ No.) or P.O. Roar aid B=CME. 9:0 . : Policy Number- 1640 umber1640 IWE-104 STREET te ���pp City MIASHORES Fi• A • • • Company MAIC Number: SECTION D - SURVEYOR, Copy bcm sides or ttus Elevation CeKftate for (Z) tn3urendb%eM'�cotthpa ViM ( ) bueldntg owner. Comments LATITUDE LONGTITUDE PER GOGGLE, ATTACHMENTS = BUILDING PICTURES •• ••• •• • • • •• �xuratil i i • i i • • SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT SFE) For Zones AO and A (without BFE). complete Hems E7 -ES, d the Ce dificate Is intended to support a LOMA or LOMR-F rawest, complete Sectim A. B, and C. For Item E1 -E4. use natural grade. d Salable Check tte measurement used. In Puerto Rlco only, enter meters. El ProWde elevation trnformaton for the falloong and check the appropriate boxes to sham whether the etevaton Is above or below the hhghesl adjacent grade (HAG) and the lowest a4acent grade fLAG)_ a) Top of bottom fbar (including basement, crawlspace. or enclosure) is ® feet ❑ meters ❑ above or ❑ below the HAG_ b) Top at bottom flaw (mcludimg basement, crawlspece, or enclosure) is ® feet ❑ meters ❑ above or [3. below the LAG. E2- Fw Building Diagrams 6-9 with permanent food openings provided in Seton A items 8 andfor 9 (see pages 8-9 d Instruction), the next higher door (elevation C2.b In the diagrams) a( the bullding Is ®tzet ❑ meters ❑ atmve ar ❑ bekm the NAG_ E3 Attached garage (top of slab) is W feet ®mteters ❑ above or ❑ befvu the FLAG. E4. Top of platlarn of machinery and br equipment servicing the building is ® feet ❑ meters ❑ above or ❑ belga the HAG. E5, Zane AO only It no flood depth number is available, is the top of the bottom floor elevated In accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ol Unknown The local of elal moist Cedily this tnfommahon In 510Cn G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property reamer or owners, authorized representative who completes Sections A. B. and E for Zone A (without a FEMA -issued or communesred SFE) CC Zone AO must sign here. The statements In Sections A. B, and E are correct tothe best of my knowledge, Property earner's or Owner's AtRhwazed Re resemted%Ws Name Address CRY State ZIP Code Signature Date Telephone Iff SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offal vAno is atilherved by law or ordinance to aftaster the community'sftodplain management ordinance can complete Sections A, S. C (or E). and G of this Elevation Certcate_ Complete the app icebte ftm(s) and sign mow_ Check the measurement used in Items GS -1310. In Puerto loco ordy enter meters. - Gi ® The WormalW In Seciarh C was taken from other documenfatlori that has been signed area sealed bye licensed surveyor. engineer, or ardhiteed who is authorized by law to certify elevation information_ (indicate the source and date of the elevation data in the Comments area Mart_) G2 ® A community official cornpleted Secton E for a buiftg located In Zone A (without a FEMA -eared w cammun*lssued BFE) or Zan AO. G3 ❑ The fallovAng information 41terns G4 -G10) isprovided for community floodplain management peugmses Nun'd er I G5 Date Permit Issued I G6, Date Certificate Of ComptanceiOccupancy Issued G7 This permit has been issued for: ❑ New Constnicbon ❑ Substantial Improvement G8. Elevation of as-t>uilt best floor (mcludeng basement) of the bun": ® feed ❑ meters Datum G9. BF E w (in Zone AO) depth of flooding at the building site: ® feet ® meters Datum Gi 0. Comrnundy's desert flood elevation_ ® feet ❑ meters Datum FEMA Foran 086-0-33 (7112) Replaces all previous editions. . ae AnoNCERTtFICaTE, page 3 Building RmlVographs• :...: See Instructior& fc: ttej 4P: : ... . ... .... . IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address ( including Apt, Unit, Suite, and/or Bldg. No.) or P.O. J2oute and Bpi loo. Policy Number. 1640 N.E_ 104 STREET : • • • • • • • City SO; . ZI'p Gode . : : : : Company NAIC Number MIAMI SHORES Ft • • • 3313$9 • • • • If using the Elevation Certificate to obtain NFIP flood insurance, attic pt IqM 2 tjtldinp p qotographs below according to the instructions for Item A8 Identify all photographs with date taken, "Front View" ape "Rgtr Y�w: asrd: :requited, "Right Side VwAr and "Left Side View_" When applicable, photographs must show the foundation:with re&e&A8t4v4 ***s of the flood openings or vents, as indicated in Section AB. If submitting more photographs than will fit ori this page, use tAe Con$nuillon Pages FEMA Form 086-0-33 (7112) Replaces all previous editions. ELEyAMON CERWICATE, page 4 Building Photapnpjist• :..: Continuahon Hage: IMPORTANT: to these spaces, copy the corresponding informatihfl'frbm Sect1oA At • • FOR INSURANCE COMPANY USE Building Street Address (inducing Apt.. Unit, Sute. and/or Bldg_ No.) or P.O. Route and Box No_ Policy Number. 1640 N.E. 104 STREET • • • • • • • • • City Sth: : 'ZleICodie ' •': : : Comp" NAIL Number MIAMI SHORES F( ' 39 38 ' • • • • If submitting more photographs than will fit on the preceding page, affix the additional photographs below_ Identify all photographs with date taken; "Front VieW and 'Rear Vier+, and, if required,•'R41 Side Vi-/'•aqd;deft Side View." When applicable, photographs must show the foundation with representative examples orthe" cW&i4s:w3tenl;? as indicated in Section A8_ FEMA Form 086-0-33 (7/12) Replaces all previous editions a _ t � a - { { k fi i X FEMA Form 086-0-33 (7/12) Replaces all previous editions By: Rothman Tbin o ATTORNEYS AT LAA) t N. E. 104th STREET 20 ASPHALT PA VEMENT o ASPMAL r 10' PARKWAY c4 DRIVEWAY ...... .. .. 4' Ct?NC. WALK .o0'Cp)CM) 3m.0o F.I.P. 1/2" 9a,, �_ •lF ccs , �.y� l[�T 17 0 Q Phacr� 4 ' O 9.93' 25.00' M Vj 1: L�ss MY 0.43'- F.I.P.1/2 By: Address: 1640 N.E. 104 STREET MIAMI SHORES, Fl 33138 5.0 30.50' rWO STORY RESIDENCE 11640 75.00 f(P)(A P .'Q ..•. 00 a . 4600 • • • • 404• �1 Vj 1: L�ss MY 0.43'- F.I.P.1/2 By: Address: 1640 N.E. 104 STREET MIAMI SHORES, Fl 33138 5.0 30.50' rWO STORY RESIDENCE 11640 75.00 f(P)(A P .'Q NOTES- NO NOTES FtWDNN?Crsm TmCGkf%ASww7f4Tmuf4wJw M.E. Land Services, Inc. PROFEBSKMAL LAW COM FLVW.WJTTOOT" s res 10665 SW 190TH STREET SUITE 3110 FOR THE FIM MIAMI, FL 33157 PHONE: (305) 740-3319 P.S-m- No. 5101 FAX: (305) 669-3190 in AbV T N rrAxrW� SEAL ""°''°'a LB t: 6463 M� Tf iAL RNED WEAL OF A JCBVSE+ SJIi4EYOR SurveyA-46784 Chent File #: 14-045 ftlpv Page 1 Of 2 Not Vand Without all pages. ..•. s• • 4600 • • • • 404• 4 4.•.. .00-0000 • 6 6 6 6 4 . 4 669999 06:0 '0000: NAIL4•••46 06 6.4 •4. . :00 . 4.•4 000000 0 00:0 .000 •• . .... • . . .... 0100 4.•• .•.• NOTES- NO NOTES FtWDNN?Crsm TmCGkf%ASww7f4Tmuf4wJw M.E. Land Services, Inc. PROFEBSKMAL LAW COM FLVW.WJTTOOT" s res 10665 SW 190TH STREET SUITE 3110 FOR THE FIM MIAMI, FL 33157 PHONE: (305) 740-3319 P.S-m- No. 5101 FAX: (305) 669-3190 in AbV T N rrAxrW� SEAL ""°''°'a LB t: 6463 M� Tf iAL RNED WEAL OF A JCBVSE+ SJIi4EYOR SurveyA-46784 Chent File #: 14-045 ftlpv Page 1 Of 2 Not Vand Without all pages. _0.07' Q .J �I ao m NOTES- NO NOTES FtWDNN?Crsm TmCGkf%ASww7f4Tmuf4wJw M.E. Land Services, Inc. PROFEBSKMAL LAW COM FLVW.WJTTOOT" s res 10665 SW 190TH STREET SUITE 3110 FOR THE FIM MIAMI, FL 33157 PHONE: (305) 740-3319 P.S-m- No. 5101 FAX: (305) 669-3190 in AbV T N rrAxrW� SEAL ""°''°'a LB t: 6463 M� Tf iAL RNED WEAL OF A JCBVSE+ SJIi4EYOR SurveyA-46784 Chent File #: 14-045 ftlpv Page 1 Of 2 Not Vand Without all pages. Surveyor's Legend Property Address: 1640 N.E. 104 STREET MIAMI SHORES, FL 33138 Flood Information: Community Number: 120652 Panel Number: 1208600306 Suffix: L Date of Firm Index: 9/11/2009 Flood Zone: AE Base Flood Elevation: 10.0 Date of Field Work- 3/10/2014 Date of Completion: 3/1712014 D.0 P*', P(RIT LINE TEL TELE0I; NE FACILITIES i STRUCTURE VA {JTILIEY OW R RAD?LS OR RADIA- FNO FOL040 IRON PIPE Yrs r;rrrrf CONC. BLOCK WALT. SEP, PN/ AS 1407ED ON PLAT —9—k— CNA01-UNK rENCS OR WIRE 9TACE LB♦ LICENSE E - 9V51WE35 TYr>, WOW FENCE LSP LICENSE i - U*VEY00. —�^--- MON rEMCE CALC CALCULATED PCIN' I.P. EASEYi(AT ut SET PIN — - — CENTER LINE SCR, CO3~TROL POINT PK om PAW.ER-{ALCM NAL CAN( CONCRETE MONJMENT C.H. *000 OCCK ENOL ENCLCS IR£ 49 WELL R.T.S. NS�iCN+•iAARK CONCRETE ELEY ELEVATIGM Y.M YANK1LE F. PCiNT OF TA%CENCY O.N.I. ASPHALT E.D.M. EDGE OF WATLR TX TRANSFORYFR P C PCINT Or CURVATURE CATV BRICK / TILE P•R.y PERYANERT REFEP.EN_E 00NUMENr W.M. raiER P.C.C. PCINT Or COMFOLMD CJR'vA%RE P/( PODL EGUPKW F.R.C. :L'iNT O: RE'OERSf CU'n'sTURf -�, APPROXIMATE EDGE OF WATER P.0-0. CC/NT 09 AEUNNNG ESMT EASEMENT P.C.C. PPCINI Or COYY(w("NT - CD'VERED AREA 9999 • •• 0X_ DRAMACE EASEMENT P C: p PERMANEKT CO%TROL POINT LA.E. TREE V FIELZ MEASURED T. POWER POLE F P-ATTED NE4SUREYEN- CATCH BASIN D DEED cvl, COUNTY UTIL11Y EASEMENT C CALCULA'iEO L.E./El. INGRESS / COKSS WNW LM.E LAKE OR LANDSCAPE WANT. ESWU U.E_ UTILITY EASIEWNT Ff. O..E. Poor Ove RNANC EASEk"T Property Address: 1640 N.E. 104 STREET MIAMI SHORES, FL 33138 Flood Information: Community Number: 120652 Panel Number: 1208600306 Suffix: L Date of Firm Index: 9/11/2009 Flood Zone: AE Base Flood Elevation: 10.0 Date of Field Work- 3/10/2014 Date of Completion: 3/1712014 D.0 AFAPNG RrrF.RENCE TEL TELE0I; NE FACILITIES i CENTRAL ANGLE OR CELTA VA {JTILIEY OW R RAD?LS OR RADIA- E,tl.L EUCTR/C UTIUTV 901 RAD. PAD AL 'E SEP, SEPTIC TANK NA, kON PA31AL D.F. DRIUMnELD TYr>, TYPICA. AJC AN CONDTIONER i_R. {RON R0.11 51w S` XWA_K I.P. {ROM PIPr DVN DVIVLWA+ Mi0 %Aa A DISK SCR, "C(N PK om PAW.ER-{ALCM NAL CAN( f ARAGf C.H. DRILL H?LE ENOL ENCLCS IR£ 49 WELL R.T.S. NCT TO SCALE Ir9F HYD004141 Cr, FMNISHEC FLOCK Y.M YANK1LE T.O.R. TOP OF BANK O.N.I. OVFRMFAD LIMES E.D.M. EDGE OF WATLR TX TRANSFORYFR E.O.P EDGE Of rAVLMb?6'• • • CATV CABLE TV BSER C.V.C.: j:~4Vf:F vAllr P:PI•P^ W.M. WATER METER B.S.L BUliitli,t: SETBAirr • •1i • P/( PODL EGUPKW S.t.L 1.19*9.*TIE LINE • CONC, CONCRETE 3LAB t%TER . NE • s • • • ESMT EASEMENT R/1I RIGs•IT ©F -MAT • • 9999 • •• 0X_ DRAMACE EASEMENT P.U.E. • 0,;LIr uTY • • • • LA.E. LANDSCAPE BUFFER EASEMENT C-M.E. • • •�•NAfN'IEW • • N.A.E. UNITED .ACCESS EASEMENT A_E •'9SC W EASEM%* • • i 0• • 9000 General Notes: • • • • 1. The Legal Oescripten used to perform this survey was supplied by others. This survey does not determine or is not to imply ownership. 2. This survey only shows above ground improvements_ Underground unities, footings, or encroachments are not located on this survey map. 3. If there is a septic tank, well, or drain field on this survey, the location of such sterns was shown to us by others and the information was not verified. 4. Examination of the abstract of title will have to be made to determine recorded instruments, if any, effect this property. The lands shown herein were not abstracted for easement or other recorded encumbrances not shown or the plat. 5, Waal ties are done to the face of the wall. 6. Ferce ownership is not determined. 7. Bearings referenced to line noted B.R. B. Dimensions shown are platted and measured unless otherwise shown. 9. No identification found on property comers unless noted. 10. Not valid unless sealed with the signing surveyors embossed seal. 11. Boundary survey means a drawing and?or graphic representation of the survey work performed in the field, could be drawn at a shown scale andfor not to scale. 12. Elevations if shown are based upon NGVD 1926 unless otherwise noted_ 13. This is a BOUNDARY SURVEY unless otherwise noted. 14. This survey is exclusive for the use of the parties to whom it is certified. The certifications do not extend to any unnamed parties. Legal Description: LOT 22, BLOCK 4, OF SUBDIVISION RIVER -BAY PARK ADDITION, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 40, PAGE 72, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA PRINTING INSTRUCTIONS: While viewing the survey in any Acrobat Reader, select the File Drop-down and select `Print" Select a color printer, if available, or at least one with 8.5"x 14" paper. Select ALL for Print Range, and the # of copies you would like to print out. Under the 'Page Scaling` please make sure you have selected "None." Do not check the "AutoRotate and Center' button. Check the "Choose Paper size by PDF"checkbox. Click OK to Print. Gertltled 10: UAViU ALtAANUtK ANU VIRUINIiA A1aU1KKrMt1 I IN ROTHMAN & TOBIN, P.A.: OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY ISSUED THROUGH ATTORNEY'S TITLE FUND SERVICES, LLC; CITIBANK, N_A_ :. its'successors and/or assigns as their interest may appear - 1 .rio.7'c %.%Jt y vG[vR ,.,, . L„�.� ■ I ... r,..,.avv —Illy, This poficy does not insure against loss or damage by reason of the following exceptions Any rights, easements, interests or claims which may exist by reason of. or reflected by, the following facts shown on the survey prepared by MIGUEL ESPINOSA dated 0311 7/2 0 1 4 beating .lob # A46784 a) NO NOTES b! cr M.E. Land Services, Inc. ' 10665 SW 190TH Street, Suite 3110 MIAMI, FL 33157 PHONE -.(305) 740-3319 FAX #:(305) 669-3190 LB # 6463 WWW.MELANDSERVICES.COM "E`er SurvevA-46764 Client File #: 14-045 Page 2 of 2 Not valid without all pages. m1