DS-15-1426ry
ty
Miami Shores Village
CCF
10050 N.E. 2nd Avenue NE
DBPR Fee
Miami Shores, FL 33138-0000
DCA Fee
Phone: (305)795-2204
Project Address Parcel Number Applicant
9969 NE 4 Avenue Road 1132060171230
JOEL 8: ANDREA MINSKI
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
JOEL & ANDREA MINSKI 543 MIN Street (305)510-0916
NEW ROCHELLE NY 10801-
543 MIN Street
NEW ROCHELLE NY 10801-
Contractor(s) Phone Cell Phone
ALRALI CONSTRUCTION CORP (305)866-4700
In Review
Approved:: In Review
Denied:
of Work: NEW TILE IN POOL DECK AND CONCRET Additional Info:
Retum : Classification: Residential
ning: 3
Fees Due
Amount
CCF
$4.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$1.40
Permit Fee
$125.00
Scanning Fee
$9.00
Technology Fee
$5.60
Total:
$149.20
Valuation: $ 6,770.00
Total Sq Feet: 680
Pav Date Pav Tvne Amt Paid Amt Due I
Invoice # DS -6-15-55931
06/18/2015 Check #: 1279
$ 149.20 $ 0.00
Avaname
Inspection Type:
Final
In consideration of the issuace to rre of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict form
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assumg responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PL MBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I cert' that all the fo oing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futh ore rize a above-named contractor to do the work stated.
June 18, 2015
Authorized Slgnat re. _n r / Applicant / Contractor / Agent Date
Building Department Copy
June 18, 2015 1
�\ \b\\,; Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. o _
PERMIT APPLICATION Sub Permit NOEG tS7-N2G
41.11LDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION CN7
NEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �) �d/ 1j L) �o a D
City: Miami Shores County: Miami Dade Zip: -3-3 1-5 &
Folio/Parcel#: 1 1 �2 2 0 (,2 -0 l :7 l ',7 _�5 0 Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder) 4dp 1 jPFt f* A% J< ) Phone#:
Address: t2 tV 6: A t/ 9� ,Am 90 A a
City: State: Zip: J
Tenant/Lessee Name: — Phone#:
Email:
CONTRACTOR: Company Name: 4 L-AiR LI C, � ��TRt%GT1®A1 GAAP Phone#: 3o5 -a'66- "00
Address: 1 ?_DOO t9157C6) ynJ�- L�!)Lt/b u 17- �D�J
City: M i,a 44) State: rt Zip: z5a f 1
Qualifier Name: —FRO ate= -r® c)_ �A.AoIq ,4 &6 Phone#: -5®5- V7190
State Certification or Registration M C & (!. 1A 0 113 1 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Ad
Value of Work for this Permit: S G
Type of Work: ❑ Addition
Description of Work:
»A i
51
City: State::����jj�� Zip:
Square/Linear Footage of Work: 6CJ_
❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
'-- - 4 . n n A _ _ I I _
Specify color of color thru tile:
Submittal Fee $ (6Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(RevisedO2/24/2014)
Radon Fee $
Training/Education Fee $
CCF
DBPR $
VS— I?--
CO/CC $ _
Notary $_
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
2
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 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 OWNER: i U R FAILURE TO RECORD e, NOTICE OF COMMENCEMENTi
CONSULTRESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEN
TO OBTAIN FINANCING, AN ATTORNEY BEFOREMJ
YOUR OOM
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.
ER or AGENT
Signature�-
CONTRACTOR
The foregoing inst ur ent was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 f by Y(P day of _ 20 G by
who is personallv known to ho is personally known to
me or who has producedL as me or who has produced r as
identification and Arho
NOTARY PUBLIC:
Sign:
Print:
Seal:
pWD. RUBINOVICH
MY COMMISSION # FF048094
EXPIRES: October 13, 2019
0
identification and ho did
NOTARY PUBLIC:
Sign.
Print: v 0 --1 " F
Seal:
ABEL D. RUBINOVICH
MY COMMISSION # PF048084
EXPIRES: October 13, 2019
�L c�
APPROVED BY Plans Examiner Zoning
Structural Review
(RevisedO2/24/2014)
Clerk
12
GAMBACH, ROBERTO J
ALRALI CONSTRUCTION CORPORATION
12000 BISCAYNE BLVD
SUITE 704
MIAMI FL 33181
Congratulationsl With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque restaurants,
and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to
serve you better. For information about our services, please log onto
www.miyfloridalicense.com. There you can find more information
about our divisions and the regulations that impact you, subscribe
to department newsletters and learn more about the Department's
initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly.
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida,
and congratulations on your new license!
DETACH HERE
RICK SCOTT, GOVERNOR
LICENSE NUMBER
(850) 487-1395
0.,4STATE OF FLORIDA
DEPARTMENT OF -BUSINESS AND
PROFESSIONAL REGULATION
CGCA01131 ISSUED: '06/01/2014
CERTIFIED GENERAL CONTRACTOR
GAMBACH, ROBERT,O J
ALRALI CONSTRUCTION.CORPORATION
IS CERTIFIED under the provisions of Ch.489 FS.
Expiraflon date : AUG 31, 2016 L1406010002646
------ _ __ ...
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION'. INDUSTRY LICENSING BOARD
I ne UtNtKAL SUN I KAL; I UK
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
GAMBACH, ROBERTO J
ALRALI CONSTRUCTION'CORRORATION
12000 BISCAYNE BLVD
SUITE 704
MIAMI FL 33181
91
.5
ISSUED: 06/01/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1406010002646
0077,49
Local Business Tax Receipt
Miami -Dade County, State of FloridaLRT.1
-THIS IS NOTA BILL - DO NOT PAY
7153109
BUSINESS NAME/LOCATION
ALRALI CONSTRUCTION CORPORATION
12000 BISCAYNE BLVD 704
MIAMI FL 33181
RECEIPT NO. EXPIRES
RENEWAL
�asoo�o SEPTEMBER 30, 2015
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art 9 & 10
OWNER SEC. TYPE OF BUSINESS
196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED
ALKALI CONSTRUCTION CORPORATION BY TAX col;LEcroq
Worker(s) 1 CGCA01131 $75.00 08/11/2014
CHECK21-14-047781
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.`
The RECEIPT N0. above must be displayed on all commercial vehicles Miami -Dade Code Sec 6a-276.
For more information, visit www.miamidade.govRaxcollector
Ell
rroma.J u n. 1 O. 2 0151. 12:3 8 P M rage .& OT z No. 6 8 8 01zu7 P. 11 "m rage:z or z
ALRAC01 OP ID: cK
CERTIFICATE OF LIABILITY INSURANCE
a.UVr-MAuea CERTIFICATE NUMBER' RFVICIAA1m1111ARRR•
THIS IS TO CERTIFY THAT THE POLECIE8 OF INSURANCE LISTED BELOW HAVE BEEN ISSUI=D 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 61: 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.
DATE /2015
o51zs/2o1s
THIS CERTIFICATE 1S 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 OETWEEN THE ISSUING INSURER(S), AUTHORIZED
REP1RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the p011cy(les) must be endorsed. If SUBROr3AMON 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).
Pane
Tanenbaum Harbor of Florida
2900 SW 149th Avenue
Mlrarnar FL 33027.6605
Joseph 3. Klertekles
UUNTAGY
NAME; Carol Klertekles
P ° GA .954.883 2996 Na ; 954.517.7496
aDDREss: ekiertekles thOorida.com
INSURERIS) AFFORDING COVERAGE NAICw
GENERaLLIAB1uTY
X COMMERCIALGENSUL UABIUTY
CLAIMS.MADE EKOCCUR
INSURGRA.-Mid-Continent Casualty Co,
INSURED A Irall Con ruction,vorli.
Camila LLC
INSURERB ;
INOURERC:
Attn: Roberto Gambach
12000 Biscayne Blvd ste 704
Miami, FL 33181
INSURERD;
INPURER E:
INSURER F '
a.UVr-MAuea CERTIFICATE NUMBER' RFVICIAA1m1111ARRR•
THIS IS TO CERTIFY THAT THE POLECIE8 OF INSURANCE LISTED BELOW HAVE BEEN ISSUI=D 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 61: 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.
LTR
TYPE OF WSURANCG
POLICY NUMBER
(IAUIWNYYYI
lumfuAgAywyVI
Lfum
A
GENERaLLIAB1uTY
X COMMERCIALGENSUL UABIUTY
CLAIMS.MADE EKOCCUR
04GL000S19510
1211912014
12120/2015
EACH OCCURRENCE 3 1,000,000
PREMISES ER, I: I i T E Tfteal 100,000
acoirre
MEOEXP(Anyoneyereot* S Excluded
PERSONAL&AOVINJURY S 11000,000
OENERALASORE"TE S 2,000,000
CiEN'LAGGREGATEUMITAPPLIESPER:
Pou"Y FRI P o Loc
PRODUCTS-COMPIOPAGG S 2,000,000
S
AU70MOBIWLIABILITY
OecadeolSINGL UM wa-
ANY AUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
NON
HIREOAUTOS ED
AUTOS
BODILY INJURY (Per Dentin) S "la
BODILY INJURY (Petzeddenq S n/a
0 E GE
PER ACCIDENT = tileAUTOS
S
UMMMLL A LIA11OCCUR
EXCESSLIAB
HCLAIMS-MADE
N I A
EACH OCCURRENCE S n1
A(it3RE0ATE S h/q
DEO RETENTION S
WOWER3 cOMPENSAT1oN
AND EWLOYERS' LIABILITY
ANY PROPW ErORrPART1dERlExEcuTivE Y / N
(� I "ER O(CLUDED9
11P
PTION OEOPERATfONS taloa
E
WC STATU-
PSI
EL EACH ACCIDENT S rda
ELDISEASE -EAEMPLOY S n/asdo
EL DISEASE -POLICY LIMIT s n/a
DESCRIPTION OP OPERA710NSI LOCATIO Not VENIGLES W IGD ACORD101, A90118MI Remerka Sailadule, Ifinere apnea Is eagUlredl
lral]i C0l15txUCEi0U CGal!11131
CERTIFICATE "MI
VILLMIA
SHOULD ANY OF THE ABOVE OESCIRIBEO POLICIES se CANCELLED BEFORE
Village of Miami Shares THE EXPIRATION DATE THEREOF, NO11C% WILL BE PRIJIVERED IN
10050 N.B. 2nd Avenue ACCORDANCE W17H THE POLICY PROVISIONS.
Miami Shores, FL 33138
AUTHORIZED REPRESENTATIVE
^��•�– <—,.,,...,f I ne A"VKP name and logo are registered marks of ACORD
May. 29. 2015 1; 06PM No. 6854 P. 1
PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE
-------------------
-------
-------.
IMPORTANT
STATE OF FLORIDA
I
I
Pursuant to Cha&M40.05(14), F.S., an officer of a eorporarvah
DEPARTMENT OF FINANCIAL SERVICES
who elects exemption from lhls chapter by fdng a oertfflcAte or
DIVISION OF WORKERS' COMPENSATION��
elecnohunderthisaedfonMYrvatreemerbwarilsor
CONSTRUCTION INDUSTRY EXEMPTION
I O
cnmpettsA4on undergds chapter 1I
WATFROATE OF FWCUQNTO IMUENPT FROUFLOWoA
WORKERS'COMPENSATION
L
Fufsuant (o Chapler440.05(12), F.S., Cerdflotes of eledlon to
LAWI
D
be exempt,., apply only wilhln the scope of the bualnesa or trade I
I EFFECTM CATS. I2W414 MIRAIWW RAYE:
tr4mle
listed on the noGca of election to be exempt.
GAMB H
Pa:asorr c�wadeCN gRosERro
,t 'H
I
FEIN:
E
Pursuant to Chapter440,05(% F.S.. Notices of election to be
I BUSINESS NAME AND ADDRESS:
exempt and cerBftcatee of eledtoa to be exempt -hail be
I R
subleot to revocallon K at any time atter the. filing of the nouoa
ALRALI CONSTRUCTION CORPORATI,
of the 1"' once of the caAfteta, the petsm herded on the I
I
notice or kale no longer meets tho requtramenta of thla
112000 BISCAYNE BLVD SUITE 704
I
section for Issuance of a oartdreale. The department shun reWM I
MIAMI
a cortit[cals at any time for (Apure of (ho person named on the
FL 33161
I
cerdfloale to meet the regofremenla of Ihla aectlop.
SCOPES OF BUSINESS OR TRA
I
VICENSED GENERAL
CO
, w NTRACTOR
-- .
DFS-FZ DWC-262 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07.12 QUESTIONS? (850)413-1809
Jun. 10. 2015 1:14PM
ALRALI CONSTRUCTION CORPORATION
12000 Biscayne Boulevard's Suite 704
Miami, FL 33181
305-866-4700
arkitekts@aol.com
June 10, 2015
State of Florida
County of Miami Dade
No, 6882 P. 1
Before me this day personally appeared ROBERTO J. GAM BACH who, beim duly sworn, deposes and
says:
That he will be the only person working on the project located at 9969 NE 411, Avenue Rd., Miami Shores,
FL.
Sworn to (or affirmed) and subscribed before me this'wl day o June, 2015 y Roberto J. Gambach.
Personally know
ABEL D. RUBIN10'r
My COMMISSION 0 FF042!
I EXPIRES: OmW 13,20t7
Abel Rubinovich
Miami shores 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 and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature: 91J.__X /
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this /43
day of r!� - ,20 /.k
personally known to me or has produced
Ir2}
f
WMIMMLOIR�-MWFIOI VE
R
.,
c�
qlj�-
N
ffm
M
1
N
CL -535B -Sl
Product Specification Sheet
HOUSING:
Die-cast solid brass. Easy turn
& lock shroud with silicone "O"
.
ring gasket.
FINISH:
SI -Silver. Also available in
-Natural Brass and also
AB -Antique Bronze.
AVAILABLE
Antique Bronze finish will vary
due to artistic natural process.
/—v
o
LENS:
Clear and heat resistant convex
shape glass.
See accessories & parts for
GX-839
special effect lenses and
CL -535B -Si
CORONA UNIVERSAL
honeycomb louver.
CONNECTOR AVAILABLE
LAMP PE:
12V, MR -16 halogen, 50W max.
i
°'1_� R2/2'v
See lamp guide for LED and
4
color MR -16 lamps.
_
MOUNTING:
Adjustable cast brass knuckle
with 1/2" NPT, including ABS
,�
21/2
ground spike. ire connector
excluded.
_
C RONA
@1/22g
See accessories &arts for
p
I
Lighting
optional mounting hardware.
WW.CORONAUGHTING.COM
Tel: 800-727-9262
213-747.4500
WIRING:
Fixture is prewired with a 3 -foot
pigtail of direct burial cable.
Fax:800-727-9957
213-7473234
® Fixture is supplied with 20W MR -16 lamp.
® Remote 12 Volt transformer is required.
® See transformers and accessories for variety of options and choices.
Eurofase - Browse Products
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4/15/13 1:20 PM
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NEWS&EVENTS WISHUST ? ABOUT CONTACT
Product Specifications
Model No.:
IG -01
Height
4.5'
Diameter
5.25'
EstShlppingWelght
2.51bs
No. ofBulbs:
LANTERNS (18)
Bulb Wattage:
35 watts
CATEGORY
rtA Bulb"Type, MR16iC
----------- -- - --- ----------- -- ---------------------------- ---
Chandelier&Hanging-
Bulb Base: GU5.3
---------------- ---------
CHANDELIERS (404)
Bulb Vol tage: 12volts
PENDANTS (760)
Printable Specifications Sheet
FLUSHMOUNTS(8)
Circular MR16 up -light, shal low mounting depth. 12V
LANTERNS (18)
input remote transformer required, sold separately. Glass
Wall&Celllng
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FLUSHMOUNTS 12321
Polycarbonate mounting housing included.
Page 1 of 2
NUMBER OF BULBS
1-3(2422)
3-5(750)
C:! 6-12(546)
Options Available
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19-24(59)
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Finish: SATINNICKEL
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37-50(44)
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AGED IRON (13)
AGEDTAUPE (6)
7 ALUMINUM (39)
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AGED CHAMPAGNE (3)
ALABASTER (4)
ALUMINUM (20)
Zj ALUMINUM & WHITE
INSIDE (1)
Amber (119)
AMBERCHIFFONW1
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AMBER CRYSTAL (12)
t HEIGHT
Under S' (860)
5' -10" (1166)
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Bulb Included: No
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http://www.eglolightinglights.com/product/eglo-lighting-calgary-outdoor-lamps-86389a.htmi Page 2 of 3
U.S. DEPARTMPNT OF HOMELAND SECURITY ELEVATION CERTIFICATE QMB N0, 9660-0008
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program important Read the instructions Ogg pages 1-9e Expiration Date: July 81, 2016
SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Buildira Owner's Name Policy Number.
JOEL MINSKI 13-229
A2. Building Street Address. (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number.
9969 N.E. 4TH AVE. RD.
C' State ZIP Code
MIAMI SHORES FLORIDA 33138
A3. Properly Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOTS 1 & 2, BLOCK 96, P.B. 15, PAGE 14. _
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat.N25°52' 03.23'Long. W80011'08.77" Horizontal Datum: ❑ NAD 1927 0 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number ..8
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: 660
a) Square footage of crawlspace or enclosure(s) 1,530 sq ft a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the crawlspace 14 b) Number of permanent flood openings In �rached garage
or enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8,b F7 9'2 sq in c) Total net area of flood openings in A9.b NTT_ sq in
d) Engineered flood openings? Fl Yes 0 No. d) Engineered flood openings? ❑ Yes ® No
SECTION IB FLOOD INSURANCE GATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name
CITY OF MIAMI SHORES 120652 1 MIAMI-DADE
B3. State
FLORIDA
B4. Map/Panel Number
B5. Suffix
B6. FIRM Index Date
B7. FIRM Panel
Effective/Revised Date
38. Flood
Zone(s)
B9, Base Flood Elevation(s) (Zone
AO, use base flood depth)
12086CO306
L
9/11/09
9/11/09
X
BfO. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile ® FIRM j] Community Determined ❑ Other/Source:
B 0. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ OtherlSource:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? (] Yes ® No
Designation Date: N/A ❑ CBRS ❑ OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings" ❑ Building Under Construction' ® Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations -Zones Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, ARAE, AR/Al-A30, AR/AH, AR/AO. Complete Items C2.a-h
below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: N-802 Vertical Datum: NGVD 1929
Indicate eievation datum used.forthe elevations in items a) through h) below. 0 NGVD 1929 ❑ NAVD 1988 13 Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)10 20 0 feet E]meters
b) Top of the next higher floor -13 20 ® feet _ ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N A. ® feet] meters
d) Attached garage (top of slab) 9 90 ® feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building ITT. -03— N feet ❑ meters
(Describe type of equipment and location in Comments)
D Lowest adjacent (finished) grade next to building (LAG) 9 O 1 0 feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) —� 30— ® feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support =NA._ ® feet ❑ meters
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
Information. i certify that the information on this Curate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by frne or imprisonment under 18 U. S. Code, Section 1009.
® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
)� Check here if attachments. licensed land surveyor? ® Yes [ No
Certifiees Name Adis N. Nunez License Number 5924
Title Reg. Land Surveyor Company Name Blanco Surveyors, Inc.
Address 555/9'/'hore Dr. City Miami Beach State FL ZIP Code 33141
Signature Date 3 / 8 /13 Telephone 305-865-1200
PLS#5924
ELEVATION CERTIFICATE page z
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCP- COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Polio Number.
City Cad'MIAMI SHORES FLORIDA 33f.F38 a company I 1C N�rmber.
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments LATITUDE &LONGITUDE OBTAINED BY GOOGLE.
CROWN OF THE ROAD ELEVATION: 10.03' ON CENTERLINE ON CNETER OF ROAD;
N-802 LOCATOR: 3250 W ELEV: 8.97'
Signature 3/8/13 to
SECTION - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E9 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,
and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation Is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement crawlspace, or enclosure) is feet meters0 above or � below the FL4G:
b) Top of bottom floor (including basement, crawispece, or enclosure) is ] feet meters E above or $ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is feet 0 meters 0 above or below the H.
E3. Attached garage (top of slab) is Q feet 0 meters Q above or [I below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is _ [3 feet 0 meters 0 above or [j below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? [3 yes 0 No [ Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA4ssued or community -issued BFE)
or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State • ZIP Code
Signature Date Telephone
Comments
Check here if attachment.,
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who Is authorized bylaw or ordinance to administer the community s floodplain management ordinance can complete Sections A, B, C (or E), and G
Of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 -G10. In Puerto Rico only, enter meters.
G1. [I The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation: information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. j A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO.
G3. The following information (Items G4 -G10) is provided for community floodplain management purposes.
G4. Permit plumber
G5. Date Permit Issued
G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: [I New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building: ( feet
G9. BFE or (in Zone AO) depth of flooding at the building site: feet
G10. Community's design flood elevation: feet
Local Official's .Name Title
Community Name Telephone
Signature Date
Comments
[I meters
Datum
r] meters
Datum
EJ meters
Datum
Check here if attachment:
Building Photographs
See Instructions for Item A6.
F�r�nsl�ranc� Compaily�Js�
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy �EurTrberr d
9969 N.E. 4TH AVE. RD. 13-229
City
State ZIP Code Com�enyNR�cNWoo-
MIAMI SHORES FLORIDA 33138
__.. .
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to
*the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View; and, if, required, "Right
Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page on the
reverse.
DATE TAKEN: 3/8/13
r
Ilk
a
i�
FRONT VIEW
w
REAR VIEW
PINNELL SURVEY, INC.
• 4855 W. HILLSBORO BLVD., SUITE B-1 COCONUT CREEK, FLORIDA 33073
PHONE(954)418-4940 FAX(954)418-4941 EMAIL: order@sfland net
CERTIFICATE NO.: LB6857
SURVEY ADDRESS:
9969 N.E. 4TH AVENUE ROAD
MLA"YII SHORES, FLORIDA 33138
FLOOD ZONE & ELEVATIONS:
FLOOD ZONE: X
BASE FLOOD ELEVATION: N/A
CONTROL PANEL NO.: 120652-0306-L
DATE OF FIRM INDEX: 09/11/09
CERTIFY TO:
1. WEST CENTRAL LEGAL SERVICES, P.A.
2. FIDELi i Y NAT 01-4AL TITLE 1SUMANCE COMPANY
3. JOEL MINSKI AND ANDREA M NSKI
4. BRANCH BANKING AND TRUST COMPANY, ITS SUCCESSORS AND/OR ASSIGNS, AS
THEIR INTEREST MAY APPEAR
POTENTIAL ENCROACEMENTS:
1.4 FOOT CHAIN LINK FENCE AND C.B.S. WALLS CROSS OVER THE WESTERLY
PROPERTY LINE.
LEGAL DESCRIPTION:
LOTS 1 AND 2, BLOCK 96, OF "AMENDED PLAT OF MIAMI SHORES SECTION NO. 4- ACCORDING TO THE PLAT THEREOF, AS RECORDED
IN PLAT BOOK 15, AT PAGE 14, OF THE PUBLIC RECORDS OF MIAMI -DARE COUNTY, FLORIDA.
LEGEND & ABBREVIATIONS:
A = AR D.E. = DRAINAGE EASEMENT
- _ A/C = AIR ONDTITONER ELEV. =ELEVATION
AE. = AN OR EASEMENT E.M. = ELECTRIC METER
— ASPH. = ASP !ALT F.P. & L. = FLORIDA POWER & LIGHT
B.M. = BENCHMARK L.B. = LICENSED BUSINESS
—JJ B.C.R. = BROWARD COUNTY RECORDS L.P. = LIGHT POLE
1 e� C.B.S. = CONCRETE BLOCK STRUCTURE MIL = MANHOLE
CHATT. = CHATTAHOOCHEE
(M) =MEASURED
CONC.
= CONCRETE
MAINT. = MAINTENANCE
C.L.F.
= CHAIN LINK FENCE
NO. =NUMBER
C.L.P.
= CONCRETE LIGHT POLE
N.G.V.D. = NATIONAL GEODETIC VERTICAL DATUM
(C)
= CALCULATED
O.H. = OVERHANG
C.B.
= CHORD BEARING
O.R.B. = OFFICIAL RECORDS BOOK
C.R.
= CABLE RISER
O/S = OFFSET
(D)
=DEED
(P) = PLAT
D.B.
= DEED BOOK
PB.C.R. = PALM BEACH COUNTY RECORDS
M D.C.R.= MIAMI -DARE COUNTY RECORDS P.B. = PLAT BOOK
GENERAL NOTES:
1. TYPE OF SURVEY: BOUNDARY
2. IF THIS SURVEY HAS BEEN REVISED AS INDICATED IN THE REVISION
BOX SHOWN HEREON, THEN ANY AND ALL PREVIOUS VERSIONS OF
THIS SURVEY PREPARED BY PINNELL SURVEY, INC. ARE NULL & VOID.
3. THE PROPERTY SHOWN HEREON WAS NOT ABSTRACTED FOR
OWNERSHIP, RIGHTS-OF-WAY, EASEMENTS OR OTHER MATTERS OF
REWRI)13Y PWNEI.L SURY-i , uvC. iMRE MAY BE ADDIT11ONAi
RESTRICTIONS THAT ARE NOT DEPICTED ON THIS SURVEY THAT MAY
BE FOUND IN THE PUBLIC RECORDS OF THE COUNTY, FOR WHICH THE
SUBJECT PROPERTY IS LOCATED IN.
4. UNLESS OTHERWISE NOTED, FIELD MEASUREMENTS ARE IN
AGREEMENT WITH RECORD MEASUREMENTS.
5. ELEVATIONS SHOWN HEREON (IF ANY) ARE BASED ON THE NATIONAL
GEODETIC VERTICAL DATUM OF 1929, UNLESS OTHERWISE NOTED.
6. UNDERGROUND IMPROVEN ENTS AND UTH ITIRS ARE NOT LOCATED.
7. FENCE AND WALL OWNERSHIP IS NOT DETERMINED.
8. THIS DRAWING IS THE PROPERTY OF PINNELL SURVEY, INC. AND SHALL
NOT BE USED OR REPRODUCED, WHOLE OR IN PART WITHOUT
WRITTEN PERMISSION & AUTHORIZATION FROM PINNELL SURVEY, INC.
9. ALL EASEMENTS SHOWN ON THE ATTACHED DRAWING ARE PER THE
RECORD PLAT (UNLESS OTHERWISE NOTED).
10. THIS SURVEY IS FOR MORTGAGE AND TITLE PURPOSES ONLY.
11. BEARINGS SHOWN HEREON ARE BASED ON AN ASSUMED BEARING
OF SOUTH 00008'58"E ALONG THE EASTERLY LINE OF LOT 1, BLOCK
96, P.B.15, PG. 14 M-D.C.R.
CERTIFICATION:
P.C.
= POINT OF CURVATURE
P.I.
= POINT OF INTERSECTION
P.R.C.
=POINT OF REVERSE CURVE
P.O.B.
= POINT OF BEGINNING
P.O.C.
= POINT OF COMMENCEMENT
P.P.
= POWER POLE
R
=RADIUS
RES.
=RESIDENCE
R/W
=RIGHT-OF-WAY
T
=TANGENT
(M.)
=TYPICAL
U.E.
= UlU TTY EASEMENT
W.F.
= WOOD FENCE
W.M.
= WATER METER
= DELTA OR CENTRAL ANGLE
= CENTERLINE
= ELEVATION
THIS IS TO CERTIFY THAT I HAVE RECENTLY SURVEYED THE
PROPERTY DESCRIBED IN THE FOREGOING TITLE CAPTION AND
HAVE SET OR FOUND MONUMENTS AS INDICATED ON THIS
SKETCH AND THAT SAID ABOVE GROUND SURVEY AND SKETCH
ARE ACCURATE AND CORRECT TO THE BEST OF MY KNOWLEDGE !,
AND BELIEF. I FURTHER CERTIFY THAT THIS SURVEY MEETS
MINHVIUM TECHNICAL STANDARDS UNDER RULE 5J-17,
FLORIDA ADMINISTRATIVE CODE, ADOPTED BY THE FLORIDA
STATE BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS.
THIS SURVEY IS NOT VALID WITHOUT THE SIGNATURE AND THE
ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR
AND MAPPER
JASON H. P
PROFESSIONAL SURVEYOR & MAPPER
LICENSE NO. 5734, STATE OF FLORIDA
SKETCH NO.: 12-1418
DATE OF SURVEY: 09/21/12
CHECKED BY: J.P.
FIELD BOOKIPAGE: 425/27
SIDE 1 OF 2
CD
U
0
m
M
O
J
C-1
R = 2,224.79'
= 02'54'53"(C)
A = 113.18'(C)
C.B. = N69'11101"E(C)
C-2
R = 2,094.79'
A = 02'38'16"(C)
A = 96.44'(C)
C.B. = S69'02'43"W(C)
C-3
R = 25.00'
= 109'12'35"(C)
A = 47.65'(C)
C.B. = S54'45'15"E(C)
_ N.E. 4th_ AVE_ WA)
NU_E ROAD
'(75' RIGHT OF Y
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19.5 ASPHALT PAVEMENT :CATCH
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ENTRY & DISC E, '
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TWO STORY C 1.65'
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RESIDENCE ,#9969 ^Oil
1.65 wALL(TYP.)to
21.58' M/ 28.37'
3TILED
0.05' 0 L ?9 84, ^
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E.
A=46'(P) 3' WALL'
— 0.70' N.� / •
WALL/4' C.L.F. P :.0,00' W.
SCALE: 1" = 30'
SKETCH NO.: 12 -
,,DRAWN BY: SP
SIDE 2 OF 2