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DEMO-14-204 (2) �:M h �` ��` � Miami Shores Village . ..... ... .. Building Department �� ° 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 T el: 305 795.2204 Fax: (305)756.8972 INS ER:(305)762.4949 ® 2014 FBC 20 BUILDING BY: Permit No. PERMIT APPLICATION Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: 30 N W 10'01N "9MK1 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: tyl&Ai-poor_ coLm*r Is the Building Historically Designated:Yes NO ✓ Flood Zone: OWNER:Name(Fee Simple Titleholder):J'1'WK*- V A'tAZ+ Sulu TA-sMuU'rt"&&Phone#: _S &J7-Cya ycy Address: B q0 "6- /// 57A6-e') City: A:Nix; 51,14 C-C State: 11(• Zip: 3 31 b 1 TenantUssee Name: Phone#: Email: CONTRACTOR:Company Name: (_(/1k6t% -/-Ale'. Phone#: ?9(0 30-343 Address: 8'q S' /y-W- PC4-e,9 City: 11:2c:•, 6A^g ._-s State: - Zip: Qualifier Name: Phone#: State Certification or Registration#: CSC # �S��yleG Certificate of Competency#: Contact Phone#: !N. .3!(V-6 x/63 Email Address: Aeo i 4Lt e. eotb&q xi-,C• cen DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$ r^ Square/Linear Footage of Work: 44E--5,Sg Type of Work: ❑Addition ❑Alteration ONew Wiepair/Replace ODemolition Description of Work: � � 1 C--"1"*,) ., ^ rv\'epx � r Color thru tile: Submittal Fee$ v o Permit Fee$ -�� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ ' J Bonding Company's Name(if applicable) a . Bonding,,Company's Address > City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hefty made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and on ee will be charged. Signature Signature ill Aer or Agent ® Contractor The foregoing instrument was acknowledged before me this I The foregoing ins ent was acknowledged before me this day of ,fAU[J�I ,20 IA- by 6,bX .� All L LEk day of JA�uA ,20� ,by A�AIr[, �''g who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: S L/ Print: ".S Al "AAJJel My Commission Expires: 'CONSTANZA MANRIQUE My Commission Expir V0A0`^^ MY COMMISSION 0 FFM61 a ' 'CONSTANZA MANRIQUE FJ0? M:Aril 13,2017 MY COMMISSION i""111 EXPIRES:April 13,2017 APPROVED BY 1 Plans Examiner Zoning Structural Review Clerk (Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) STATE OF FLORIDA DBPARTKW OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD q1940 NORTH MONROE STREET (850) 487-1395 °B0- TALLABASSEN FL 32399-0783 GIAMPETRUZZI, RAFAEL EDUARDO COMERT INC 3845 NW 57 PLACE VIRGINIA GARDENS FL 33166 Congratuistionsl With this license you become one of the nearly one million w ' '► 9 AC � 5 � ment of Business and Professional Regulation tl fl Ii S$ Our profeeslonals and business range from architects to Floridians licensed by the Departyacht brokers,from I B _ To�Y" boxers to barbeque restaurants,and they keep Florida's economy strong. , 3 Every day we work to improve thebetter., CGC1$146$ fl � 128.Q76214 way we do business in order to serve you better r For lnfiormation about our services.please log onto wwwjft flaridallcerrse.ca= There you can find more Inform Mon about our divisions and the regulatlons that G • �.; . , impact you,subwAbs to department newsletters and learn mons about the �yg C ,, Department's britlatives k; 4 Our mission at the Department Ir Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. ThanYou i1or doing business in Florida,and congratulations on your new lic,"Isel F IRD under the provieiq�s oil cfam$89 ss sas9nn. r`XW 31, 2 014 1 91YA 184 n DETACH HERE ACt.,6. 5 5 38 91-- . STATE OF FLORIDA DEPART UBUSM-INETND TRY LICIHWGL R TION SE( L12091102184 LICI3NSE NB1Z t .0!9111!2012. 128076114 C=3.512466 The GENERAL CONTRACTOR j Named*-bel0w 'IS CERTIFIED Under the provisions of Chapter 41,9 FS, Expiration dates AUG 31, 2014. t t GIAMPETRUZZI,� RAFAEL LDDARI)O 30LBSRT INC 3845% 45 NW 57.'PLACE VIRGINIA GARDENS FL 33166 ! 1 RICK SCOTT GOV KEN LAWSON ' . GO'VSRNOR DISPLAY AS REQUIRED BY LAW SECRETARY 006327 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL-i20 NOT PAY � LBT_) 6236376 p6)BINWS NANAIULOCATION RECEIPT NO. EXPIRES COLBERT INC ROJEWA.• SEPTEMBER 3®, 2®14 3845 NW 57 PL 66010" Must be displayed at piece of business VIRGINIA GARDENS FL 33166 Pursuant to County Cafe Chapter SA-Art.8 IN 10 OdVNESR W'TYPE OF EtUSWSS PAYMENT RECEIVED GOL leenERT INC 188 CaENEM BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 3 CGC1512406 $45.00 07/11/2013 TWS1-13-023099 WS ins,BtoitM Tax Racoaffnos' d th LOW @ssiasme Tot.The� is Not a license, perm((.or a aedifl n of the a 9uel� to d � atipl6i mRoldw c*M*whb=V Bpi or reguletery f�aM rageirmaeate The RECEIPT No.Wxwa mud be dhtpfaved on aR cemmeroial vWc%$-Wfimmi4lade Cade See se-& for more information visit 10-08-2012 .EFF ATWATER STATE OF FLORIDA I�NareCInL DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CMWICATE OF ELECTION TO IN EXONT FROM FLORIDA WORKERS' COLIPENSATM LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE 11/09/2012 EXPIRATION DATE: 11/09/2014 PERSON: GIAMPETRUZZI RAFAEL E FEIN: 201782049 BUSINESS NAME AND ADDRESS. COLBERT INC 3845 NYi, 57 PLACE VIRGINIA OMENS FL 33166 SCOPES OF BUSINESS OR TRADE 1- LICENSED GENERAL CONrRACTOR aiMPMA1tr: Por$0a2t to a 440 . 01514) F.S.. as oBlssr d a terli"Stlae arhs elects axempti11a (erne tis by tmt� ® cetifica% of eiediOn tarts sectloe msY not recnaer benefits ar co�$0xsitm md�MIS diaper. P t4 Chapter 440.01512L F.S., CaMICStes of al�an to Be San . apply o0!/ w� d� scope of the besiaeas or vada listed on the nonce of eisaton to he stempt Pmsamt to chapter 440-85113% F S Hattees 111 election tobe "GNP 10 torUttc� of election to be exempt nam be soled to rem aden it. at mfr tma otter the Haag of the aoneft or the tsmm►ce of rho csrnneate, am PoSmis arced an the mote ar ce"Itate $0 lei meas the reciairements of BMs section for isa>taow d a cerdnede. The deParIM0111 OW reaatts a cartok to at $0Y time toDere of fAihe �� 413-1$09 mend on the cartincee to meet the rmirements of ma $0,11112- OWC-252 CERIIHCATE OF ELECTION TO BE F.XE11t" REVlSEO 01-11 ----- PLEASE CUT OUT THE CARD BELOiAi AND RETAIN FOR FUTURE REFERENCE STATE OF OF ww►NCIAL SERVICES F IMPORTANT t»toN OF VMRKOW COMPENSATIONPursuant to CMM 440.05(14}, F.S., an officer of o corporation who CpNSTRIICTION INDUSTRY O elects exemption from er m this cfhEP by tiling a certificate of election CESMFMTE OF ELECTION TO 9E EXEMPT FRM FLORIDA 1-tinder this section may rat recover 6etref""Rs or compensation toil this VNIRKO s'COMPEL SATRIN LAW D chapter. EFFECTNE 11/09/2012 EXPIRATION DATE: 11/08/2014 Pursuw to Chapter 441LOM12). F.S., Certificates of election to be PERSON: RAFAEL E GIAIPETRUZZI H exempt_ aVapiv only ttdthin ttre scope of the business or true listed an FEIN: 201782048 E the notice of elect= m be exempt R BUSINESS NARAE ARID ADDRESS E Purstmit to Chapter 44&06(13). RS.., Noticesof election to be exempt COLBERT INC and certificates of election to be exempt 3111!11 be subject to revocation 3M NW. E7 PLACE if, at any dire after the filing of the Notice or tim ISSUE= of fire VIRGINIA GAFraM FL Men certificate. the person tatted on tira troths or 6ertifieath3 fro Imtger insets the requirements of this section for ism of a certificAlL Tyre depertmett shill revoke a certificate at airy time for failure of the SCOPE OF BiJSBVESS OR TRADE parson named on the certificate to meet the requirements of this 1-LICENSED GENERAL CONTRACTOR I1IRSTIONS7 (850) 413-1609 CUT HERE Carry bottom portion on the Job, keep upplar Portion for Yow retaordsi. MNC- x252 CERTIFICATE OF ELECTION TO HE EXENFT REVISED 01-11 ••. a�.� MiamishoresVillage %7 o--* . Building Department �OR10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption 4 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 personally liable for the worker compensation iai es 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 bo �� ContractPrint Name: P Print Name: L ef'+12j u Signature: Signature: .✓r State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Sworn to and subscribed before me this �S Sworn to and bscribed before me thi day of ,20 day of ,20 By l `s 41 � B ' r Y 7E RICARDO IRIARTE (S ( ) MY COMMISSION#FF088738 SEAL :m. ;Q= Te. ceduln T e of Id n ,n pu Fe in�Y p 8736 (407)398 0153 Florida otaryce.com (407)398.0153 FloridallotarySerAwmom IJ �. AC40RV CERTIFICATE OF LIABILITY INSURANCE DATE � 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 pollcy(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 endomement(s). PRODUCER COE"CT Jon Rock The Contractors Choice Agency PHONE (800)918-3584 C. o:(877)684-9951 PO Box 13645 !E L .Jon@nginsuranceonline.com INSURERIS)AFFORDING COVERAGE NAIC @ Chandler AZ 85248 INSURERANat'1 Contractors Insurance 12293 INSURED INSURER 8: Colbert Inc. INSURER C: 3645 NW 57th Place INSURER D: INSURER E: Virginia Gardens FL 33166 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1251616553 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE SUBR POLICY EFF POLICY LIMITS L POLICY NUMBER D MM1D GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO ncom MERCIAL GENERAL LIABILITY PREMISES aENTED occurrence) $ 50,000 A CLAIMS-MADE �OCCUR 000014513-01 /15/2013 /15/2014 MED EXP(An one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIT Me accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $ AUTOS AUTOS PROPERTY DAMAGE $ HIRED AUTOS AL90S ED PeraWdent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC LIMITS OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-FA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Robert Rock/JDA - ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN9026 r7nirnsi m Tho Arngn name anA Innn aro ronla4or el mance of Ar`nRn Super Pest Control " P.O.Box 452933 LETTER DATE: 1/10/2014 Miami,Florida 33245-2933 (305) 505-9113 INITIAL INSPECTION: 1/10/2014 (786) 234-5861 PRE-DEMOLITION INSPECTION: REQUIRED E-mail:information@spcservicesllc.com START DATE: TBD Website:http.lAvww.spcservicesllc.com END DATE: TBD ON-SITE INSPECTION Service Site Contact Information Miami Property Solutions LLC Miami Property Solutions LLC c/o Amparo Mejia 38 NW 108 Street 190 NE 1 I 1 Street Miami Shores,Florida 33168 Miami Shores,Florida 33161 Folio# 11-2136-011-0120 786-395-6261 On-Site Inspection &Service Notes The above stated service site was inspected on Friday,January 10,2014. There was no evidence of any vermon inhabiting the location. Service technicians will be on-site the day of the demolition to confirm that there is no evidence of vermon inhabiting the location before the process of demolition begins. If you have any questions-Please feel free to contact me. Best Regards, G�ristcv &aw"dez Cristy Fernandez Authorized Agent "Big Enough To Meet Your Needs... Small Enough To Give Personalized Attention" U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMWGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name MIAMI PROPERTIES Policy Number. A2. Buildin Street Address(including Apt.,Unit,Suite,andlor Bldg.No.)or P.O.Route and Box No. Company MAIC Number: 38 NW 108 STREET City MIAMI SHORES State FL ZIP Code 33168 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) FOLIO#11-2135-011-0120 MIAMI-DADECOUNTY A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latkude/Longitude:Let 25*5726"N Long.80*11'S61NHorizontal Datum: ❑ NAD 1927 N NAD 1983 A6. Attach at least 2 photographs of the budding if the Certificate is being used to obtain flood insurance_ AT Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 3.391 sq ft a) Square footage of attached garage 169.0 sq It b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 15 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 2.593 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION Name&Community Number B2.County Name 63.State [VB,1�.NFIPCommunfty AGE OF MIAMI SHORES /120652 MIAMI-DADE FLORIDA B4.Map/Panel Number B5.Suffix I B6.FIRM Index Date B7.FIRM Panel B8.Flood B9 Base Flood Elevation(s)(Zone 12086 0302L L 09/11/2009 Effective/Revised Date Zone(s) AO,use base flood depth) 09/11/2009 X N/A 1310. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile N FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: N NGVD 1929 ❑ NAVD 1988 ❑ OthedSource: B12. Is the building located Ina Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes N 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* N Finished Construction *A new Elevation Certificate will be required when construction of the budding is complete. C2. Elevations—Zones Al—A30,AE,AH,A(with BFE),VE,V1 V30,V(WO BFE),AR,ARIA,ARIAE,AR/A1—A3D,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-567 Vertical Datum: NGVD-1929 Indicate elevation datum used for the elevations in items a)through h)below. N NGVD 1929 0 NAVD 1988 0 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) 11.2T N feet ❑meters b)Top of the next higher floor 13.05' N feet ❑meters C) Bottom of the lowest horizontal structural member(V Zones only) N/A. N feet ❑meters d)Attached garage(top of slab) 10.95' N feet ❑meters e) Lowest elevation of machinery or equipment servicing the building 11.13' N feet ❑meters (Describe type of equipment and location in Comments) 0 Lowest adjacent(finished)grade next to building(LAG) I I.Q5' N feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 11.15 N feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support WA. ®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 Cerbf'tcate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine orimprisonment under 18 U.S.Code,Section 1001. N 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? N Yes ❑ No Certifler's Name GINO FURLANO License Number 5044 Title LAND SURVEYOR Company Name J.A.F.SURVEYING INC Address 2492 WEST 72ND STREET City HIALEAH State FL ZIP Code 33016 � �� Signature ' Date 10-17-13 Telephone 786-416-1018 G' r FEMA Form 080W33(7/12) See reverse side for continuation. Replaces all previous editions. IMPORTANT:In these spaces,copy the correspon ing information from Section A. Building Street Address(including Apt.,Unit,Suite,and/or Bldg_No.)or P.O.Route and Box No. FOR INS!NAIC !Num:ber ANY USE 38 NW 108'"STgEET Policy Nu City MIAMI SHORES State FL ZIP Code 33166 . Company 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 CROWN OF ROAD ELEVATION=10.73' Miami-Dade County Benchmark:#N-567 Elevation=10.54 datum NGVD 1929 Descriptio C2 e): slab=11.13 LEFT BLDG Descrip. n o A5): r inates Obtain GPS c Signat re Date 10-17-13 SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5.If the Certficate is intended to su and C.For Items E1-E4,use natural grade,if available.Check the measurement used.In Puerto Rico onrt a ly, it m or LOMR-F request,complete Sections A,B, E1. Provide elevation informs. ation for the follow and check the appropriate boxes to shown 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,crawrlspace,or enclosure)is b)Top of bottom floor(including basement,crawrls ❑feet ❑meters ❑above or❑below the HAG. E2. For Building Diagrams 6-9 with Pie,or enclosure)is ❑feet ❑meters 0 above or❑ below the LAG. (elevation C2.b in the diagrams)of the permanent Provided in �f°n A ttem 8�Oi 9(�pages"oT instructione),the next higher,floor E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or [I below the HAG. ❑feet E4. Top of platform of machinery and/or equipment servicing the❑meters El above or 11 below the HAG. building is ❑feet E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elev0eters 0 above with the con 0 below e owP��management 11 the HAG. ordinance? ❑Yes No ❑ Unknown.The local official must certify this informataionted in accordance in Section G. SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The Property owner or owner's authorized representative who cosnptet�Sections A,B,and E fen Zone A or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge a FEMA rssued or community-issued BFE) Property Owner's or Owner's Authorized Representative's Name Address Signature City State ZIP Code Date Telephone Comments ❑Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community s floodplain management ordinance can complete Sections A,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.❑ 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.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or commun' G3.❑ The following information(Items G4-G10)is provided for community floodplain management BFE)or Zone AO. 9 purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-buiit lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: G10.Community's d ❑feet El meters Datum ity' design flood elevation: ❑feet ❑meters Datum Local Official's Name Tree Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. 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.Route and Box No. Policy Number: 38 NW 108TH STREET City MIAMI SHORES State FL ZIP Code 33168 Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 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." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. DATE:10-17-13 FRONT VIEW / LEFT VIEW BACK VIEW/RIGHT VIEW r £ � I f � _ k C' S. � 1 $sir ,. a t � FEMA Form 086-0-33(7/12) Replaces all previous editions.