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RC-13-1656 (3) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-195797 Permit Number: RC-7-13-1656 Inspection Date: September 15, 2015 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Inspection Type: Final Building Owner: WILLIAM J.JURBERG, R.ANDREW DE Work Classification: Addition/Alteration 0A00 Job Address:9350 NE 12 Avenue Miami Shores, FL 33138- Phone Number (305)609-3851 Parcel Number 1132050070150 Project: <NONE> Contractor: PALMER HOLDINGS, INC Phone: 305-310-4673 Building Department Comments CONSTRUCTION OF NEW SINGLE FAMILY HOME infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 4�1 Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 September 15, 2015 Page 1 of 1 / ��r7r-tl�T� off` G�� 9� '�1 �°,�, 33�3d . �, _ __ POST ON SITECTION REQ R r-~ PeritNO. RC-7-1 3'1 6o rr lage -___ _-_ z ,-= Pere TO 10050 onstrciction t� 10050 N.E.2nd Avenue Miami Shoes,FL 33138 0000 048sif,-cation:Now i-, -' ob Phone: (305)795-2204 Fax: (305),'56-6972 �oRiv� Issue Date: 12/27/2013 06/2512014 Expires: INSPECTION REQUESTS: (305)762-4949 or Log on at https-//bldg.miamishoresviIlage.com/cap REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. _ Residential Construction Parcel #1132050070150 Owner's Name: R. ANDREW DE PASS WILLIAM J. JURBERG Owner's Phone: (305)609-3851 ,fob Address: 9350 NE 12 AvenueTotal Square Feet: 5600 Miami Shores FL 33138- Total Job Valuation: $ 795,000.00 Bond Number: WORK IS ALLOWED MONDAY THROUGH SATURDAY, 7:30AM-6:OOPM.NO WORK IS ALLOWED ON SUNDAY Contractor(s) Phone Primary Contractor OR HOLIDAYS. PALMER MOLDINGS, INC 305-310-4673 Yes BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO BUILDING i--------. _�� INSPECTIONS DONE ON FRIDAY. e-Ty THIS MUST BE ON j0B AT TIME OF ECTION Ni INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE=THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NETHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL WARNING 'TO OWNER: YOUR F=AILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE: FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. a INSPECTION RECORD STRUCTURAL PLUMBING \ INSPECTION DATE IINSPECTIONDATE INSP INSPECTION DATEINSP y Foundation Zonin Final A T-t o _ _g Stemwall ZONING COMMENTS lRough Slab Columns 1 st LiftService 2"d Water terRough Columns 2nd Lift Top Out Tie Beam Fire Sprinklers Truss/Rafters Se tic Tank Roof Sheathing Sewer Hook-up P Roof Drains Windows/DoorsELECTRICALGas L �f Interior Framing INSPECTION IDATE I INSP LP Tank Insulation Temporary Pole _ Well Ceiling Grid 30 Day Ternpora r Lawn Sprinklers ,Drywall Pool Bonding Main Drain Firewall Pool Deck Bondin Pool Piping Wire Lath 14 Pool Wet Nich Backflow Prevento Pool Steel Under roup y Interceptor Pool Deck Footer Ground Catch Basins Final Poo! Slab Condensate Drains Final Fence Wall Rough HRS Final Screen Enclosure Ceiling Ro � - Driveway Rough PLUMBING COMMENYS ,Driveway Base TeleplioWe Rough lulri crc F-cilL Tin Ca Tele hone Final Roof in Pro ress TV Rou h Mo in Progress TV Final Final RoofCable Rou h Shuders Attachment Cable Final final Shutters m Rough Rails and Guardrails Interco FinalMECHANICAL ADA com lianc Alarm ou h INSPECTION DATE INSP Alar inal Underground Pipe OCUMWe Alarm Rough Soil Bearing ert Fire Alarm Final _• 1`30;9h Soil Treatment Service Work Witl �I�' Floor Elevation Surve o-p/ $ entilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate C� le t Surve Pressure Test d/ ' oi- Final Hood Final Surveyw Final Ventilation Truss Certification -�r Final Pool He r STRUCTURAL COMMENTS y y- Final Vacuum V 2111— MECHANICAL M ENTS INSPECTION DATE INSP ANQt Final S rinkler Final Alarm 42'7•r!', 1a 1 �_ _ _ F .5 �j�, y r. _ f 1 iti,} _ +, ,Ir', i' r,, ,; - "�4L• dt 7K .l,�i 1i -.J ;b•- 1-r.,{'1' r '�i. <• Lf�,�' r1 + a. 1'H .Ri ..".r� ''-t �. $.♦ �'Y.'. rTi'. �''t.•ht .p. 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',,i.,',tl. ;Y' J.t. �'1" ,�y..�1 ;4r. .}{'. .i;: ,, � �.' k, �I.`,k"_.' 9}t i � X��r .u..ir'7 a �Ti- y` `"»t' F• .✓ `�:, Z:�. .< }t.r, 111 ;.8,+;y�•L'••�11pi:r{r}da«�x+Cr^^�i +f3•J �.'k! w' ;,(p•},1,.s'�,�r •� -r� 1�-` }. s J+Y4;,i:j �� "}�tgvt .�:k ,kt :� .s•►^ $ ,y 4.. "'t 4 .{�' "v� ;�i's�t +�h� �ST: i .. �+1f:A h'i�•.Y+,,•d'y'k � �y�.it.•�',r� 0 � �T�,. + � �s; 5'r 5 �L ''{�`itN ;d1.,Y '�i.��- (-Y6,{��i �[�t�¢•IQ.S':�^ ��: �a >1!;;y,.' ,ah:{�R•�#�j �M.e+F _ -�..t}.k,f-. { w�. .,r�.. ;.Sr 9�1 4 e.M1Y. � 'k 'rt..�";�:-y.. a ,i.• ++.s^'}�.,,.-.«. w=�.::.+;. ..••. '{r...�.1 `$ �' •. ..}� ,1, i ,;i,.. 1 w... "=�tF1`f� t f � 't?; � t;� � �,'.. ^I' M 4 .r �3 � #? {: 9{�� Mtt'fa # 'r i ,J +�`k s3{-via°`• • - _ _ }. s..v.• r � :tilY•. ti �•-�� i• '�,� .s. i.„it '4� 4'tij� � t_'tS;, i� �.i�: s�rt-j•`;a JrF '�p-�' 3 PALMER HOLDINGS INCORPORATED JUN 04 015 GENERAL CONTRACTORS STATE LICENSED CGCO59420 Miami Shores Village Building Department 10050 N. E. Avenue, Miami Shores, Florida. 33138 June 4, 2015 Building Permit: Rc-7-13-1656 Reference Project: 9350 NE12 Avenue, Miami Shores. 33138. To Whom it may concern, Please accept this letter as our TCO request by the qualifier/general contractor. We are requesting a TCO due to hardship situation as follows: The owner must vacate current rental premises and move into new residence. We are requesting that the owner be allowed under approval of Miami Shores building official to move into the residence on June 12/2015. We are requesting a TCO for the period of 60 days to finish minimal work to cabana buildings and landscaping details. We hereby hold harmless and release Miami Shores Village Department and Miami- Dade Fire Department from any liability that may arise during the use of designated areas in the aforementioned facility while under the limitation of the Temporary Certificate of Occupancy. We hereby certify that all means of egress shall be kept clear and accessible and that all like safety systems will be maintained and operable at all times while the building is being occupied. Please contact the undersigned qualifier Martin J. Palmer 305-310-4673 for any additional information. Mart . Palmer Palmer Holdings Inc 1900 S.Bayshore Drive,Miami,Fl.33133 T.305-310-4673 F 305-856-8266 C.305-310-4673 mpalmgc@aol.com Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 UNIFORM MUNICIPAL TCO/TCC INSPECTION REPORTING FORM Master Permit No. l Miami-Dade County from Municipality: C. Is—^ (lo'j<p Municipal Permit No. (MBLD): JobAddress:q:96-U dej-2 A\rM6• ----Unit:---- Project Name: p� f��I TACE Qualifier's Name: M/kINI OkL� 6-44-, Qualifier's PhoneS2 ,310A 3 Email:_�T�a��M� Ac,. Curt\ Owner's Name: Owner's Phone: 2• Email:f aAt Pegs as,5e"G, Com This Uniform Municipal TCO/TCC Inspection Reporting Form is used to gather trade approvals for Temporary Certificate of Occupancy(TCO) or Completion (TCC). Once validated by the Municipal Building Department personnel,the form must be present at the job site for the field inspectors. When all approvals have been obtained, take the signed form back to the Municipal Building Department for TCO/TCC issuance. OForm Validated by Date: Bldg Dept Personnel: Print Name Signature 0 All"Required"TCO/TCC inspections indicated below must be signed "Approved" before certificate issuance. Inspector's Approval Req'd. Trade Name Signature Date Comments ❑ Building ❑ Electrical ❑ Fire ❑ Mechanical ❑ Plumbing ❑ Public Works ❑ Zoning ❑ Other Important Note: The TCO/TCC is not valid and building and/or space may not be occupied unless signed by the Building Official. Occupying the building and/or space without obtaining a TCO/TCC issued by the Municipal Building Department is prohibited and is in violation of the Florida Building Code Section 110.3. OBuilding Official's Approval: Date: ❑ 1"TCO/TCC ❑ Extension TCC/TCO Duration: Conditions of TCO/TCC: • If Master Permit expires,the TCO/TCC will automatically be revoked and the space must be vacated. • A TCO/TCC may be revoked if any action by the contractor, owner or tenant creates any code violation affecting the proper occupancy of the area. • Any TCO/TCC that expires without renewal or has been revoked can result in a notice of violation, civil violation and/or disconnection of utility services. • Other conditions: 04/09D I.OSFBOA Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 Website:www.miamishoresvillape.com TEMPORARY CERTIFICATE OF OCCUPANCY APPLICATION (T.C.0) Please be advised that the TCO expiration date is based on conditions from Miami-Dade County Fire Dept. Date: t-57 Folio#: 11 �2D�dC�7D�SO Master Building Permit#: e_— 7—i Square Footage of Space: AC Miami-Dade Municipal Proce��sss//#: / Miami-Dade Municipal Permit#: Contracting Company: W ftb(645 INC. Owner/Tenant: E, ANbREFw be� s Lot: Block: Subdivision: Street Address: 1350 dF lZ AVE. MIAM1 SHoR>S. 33138 Signature of applicant verifies the above information is true and correct.The Temporary Certificate of Occupancy is issued to the above named for building at the above location only upon the express provisions that the applicant will be able by and comply with all conditions of the Zoning ordinances and all ordinances of Miami Shores Village and/or Florida Building Code pertaining to erection,construction or remodeling of buildings or structures. This also certifies that the electrical wiring and or equipment,and the plumbing work has been inspected and approved. vv, .4 -'- Print Name of Applicant or Qualifi�e gnature of Applicant or Qualifier FOR OFFICE USE ONLY TCO Number: Fee: Expiration Date: Technology Fee: Approved Use for Occupancy: Total: Remarks: Building Official/Designee: Inspections: Zoning Yes/No Plumbing Yes/No Building Yes/No Fire Sprinkler Yes/No Electrical Yes/No Fire Yes/No Mechanical Yes/No INSPECTION RE ' IRD POST ON SITE Permit NO. RC-7-13-1666 Miami Shores Villageonstruction 10050 N.E.2nd Avenue Miami Shoes.FL !33138-0000 C Clessiftafton.NOW Phone: (305)795-2204 Fax: (305)756-8972 issue Date: 12/27/2013 01 06/25124 Expires: INSPECTION REQUESTS: (305)762-4949 or Log on at https-1/bidg.miamishoresvillage.com/cap REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction Parcel#:1132050070150 Owner's Name: R. ANDREW DE PASS WILLIAM J. JURBERGOwner's Phone: (305)609-3851 Job Address: 9350 NE 12 Avenue Total Square Feet: 5600 Miami Shores. FL 33138- ; Bond Number: Total Job Valuation: $ 795,000.00 . itcu?'#del ' ... �tft�."tt�t:➢c•.. 4Yili�'iiWar'NP�;,%t = .. _ --aa .,�..wt��a i s. WORK IS ALLOWED MONDAY THROUGH SATURDAY, Contractor/sl Phone Prima Contractor 7:30AM-6:OOPM.NO WORK IS ALLOWED ON SUNDAY Primary OR HOLIDAYS. PALMER MOLDINGS, INC 305-310-4673 Yes BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO BUILDING _ INSPECTIONS DONE ON FRIDAY. HIS BE ON j0B AT TIME OF INSPECTION NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NETHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE:REMOVAL OR REPLACEMENT OF ANY MATERIAL WARNING TO OWNER: YOUR f=AILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENT'S TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTION RECORD STRUCTURAL 1 ZONING INSPECTION DATE INSP INSPECTION DATE INSP INSPECTION DATE INSP Foundation Zonin Final A -t•t�'fL_ o -9 s Stemwall J7 <-I/ ZONING C M ENTS Rough Slab Water Service Columns 1st Lift Columns 2nd Lift 2nd Rough Tie Beam Top Out Fire Sprinklers Truss/Ratters Septic Tank Roof Sheathing Bucks Sewer Hook-up Windows/Doors ELECTRICAL Roof Drains Gas Interior Framin INSPECTION DATE I-INSP-1 LP Tank Insulation Tem ora Pole _ Well Ceilin Grid 30 Da Tem ra Lawn Sprinklers Drywall 1 ,(� Pool Bondin Main Drain Firewall Pool Deck BondingPool Piping Wire Lath �l� Pool Wet Nich Backflow Preventor Pool Steel Under roup Interce for Pool Deck Footer Ground Catch Basins Final Pool Slab Condensate Drains Final Fence Wall Rou h HRS Final Screen Enclosure Ceiling Ro Driveway Rough PLUMBING COMMENTS Driveway Base Tele o e Rou h Tin Cap Tele hone Fina Roof in Progress TV Rou h Mo in Progress TV Final Final Roof Cable Rou h Shutters Attachment Cable Final final Shutters lintercom Rough Rails and Guardrails Intercom Final ADA com liance Alarm Rou h INSPECTION MECHANICAL INSP Alarm Final Underground Pipe DOCUMENTS Fire Alarm Rough Soil Bead Cert Fire Alarm Final Rou h Soil Treatment Cert Service Work With ale Floor Elevation Surve r•j/ entilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate CP �2 Pressure Test S t Survey �!i r l �- Final Hood Final Survey Final Ventilation Truss Certification Final Pool Heater STRUCTURAL COMMENTS p Final Vacuum FIRE INSPECTION DATE INSP MECHANICAL COMMENTS Final Sprinkler AAA Final Alarm `� U.S.DEPARTMENT OF HOMELAND SECURITY LEVATION CERTIFICATE FEDERAL 16MERGENCY 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 R.ANDREW DE PASS Job 10-490-13-H(1)(AVI) Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number: 9350 NE 12th Avenue. (Folio No.11-3205-007-0150) City MIAMI SHORES State FL ZIP Code 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) POB El20.80ft,then N12dl6'40"E,run 151.79ft,then W184.74ft,then S12d02'l5"E,run 151.76ft to POB A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL(HOUSE) A5. Latitude/Longitude:Lat.25°51'42.59"N Long.80°10'29.96" Horizontal Datum: ❑ NAD 1927 ® 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 11_A A8. For a building with a crawlspace or endosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage NIA sq ft 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 N/A within 1.0 foot above adjacent grade /A c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes 0 No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State VILLAGE OF MIAMI SHORES 120652 MIAMI-DADE FLORIDA B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12086CO306 L 09/11/2009 Effective/Revised Date Zone(s) AO,use base flood depth) 09/11/2009 AE 8.00' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: 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,ARIA,ARAE,AR/A1-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:B-62 Elev.=8.67' Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 ❑NAVD 1988 ❑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) 10.00 ®feet ❑meters b)Top of the next higher floor 21.50 ®feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters d)Attached garage(top of slab) NLA. ❑feet ❑meters e)Lowest elevation of machinery or equipment servicing the building 9.92 ❑feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 7.40 ®feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) 7.79 ®feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support N/A. ❑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 Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. ® 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 -� Certifier's Name GARY B.CASTEL,P.L.S. License Number 4129 Title PROF.SURVA MAPPER Company Name Address 8567 CORAL WAY City MIAMI State FL ZIP Code 33155 Signature Date 04-24-2015 Telephone 786-290-4184 0CAZ -15 FEMA Forrn 0864- See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 IMPORTANT:In these spaces,copy the c_ -sponding 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. 9350 NE 12th Avenue. Job #10-490-13-H(1)(AV[) City MIAMI SHORES State FL ZIP Code 33138 Company NAIC Number. 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 C.O.R. Elevation=9.13' C2 e)A/C UNITS CONC.PAD LOCATED BESIDES HOUSE RIGHT SIDE FAgADE WALL A5 OBTAINED BY GOOGLE CONVERSION FROM ADDRESS TO LONGITUDE/LATITUDE Signature Date 04-24-2015 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 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 ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑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 ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑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? ❑Yes ❑ 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 FEMA-Issued 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 ❑Checlk 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 community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G10)is provided for community floodplain management 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-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title 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: 9350 NE 12th Avenue. Job #10-490-13-H(1)(AVI) City MIAMI SHORES State FL ZIP Code 33138 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. x` "J fit 04-24-2015 HOUSE FRONT VIEW 04-24-2015 HOUSE FRONT VIEW 1 3 G 04-24-2015 HOUSE LEFT SIDE VIEW 04-24-2015 HOUSE RIGHT SIDE VIEW 04-24-2015 HOUSE No. VIEW FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page 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: 9350 NE 12th Avenue. Job #10-490-13-H(1)(AVI) City MIAMI SHORES State FL ZIP Code 33138 Company NAIC Number. 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 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. t 04-24-15 A/C UNITS VIEW AT RIGHT SIDE 04-24-2015 HOUSE REAR VIEW Al s 04-24-2015 HOUSE REAR VIEW 04-24-2015 HOUSE REAR VIEW FEMA Form 086-0-33(7/12) Replaces all previous editions. t U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY 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 R.ANDREW DE PASS Job 10-490-13-H(3)(AVI) Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number: 9350 NE 12th Avenue. (Folio No.11-3205-007-0150) City MIAMI SHORES State FL ZIP Code 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) POB E120.80ft,then N12dl6'40"E,run 151.79ft,then W184.74ft,then S12d02'l5"E,run 151.76ft to POB A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL(CABANA 1) A5. Latitude/Longitude:Lat.25°51'42.59"N Long.80°10'29.96"W Horizontal Datum: ❑ NAD 1927 N 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 11=A 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) N/A sq ft a) Square footage of attached garage N/A sq ft 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 N/A within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes N No d) Engineered flood openings? ❑ Yes N No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State VILLAGE OF MIAMI SHORES 120652 MIAMI-DADE FLORIDA B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12086CO306 L 09/11/2009 Effective/Revised Date Zone(s) AO,use base flood depth) 09/11/2009 AE 8.00' B10. 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: Bl 1. Indicate elevation datum used for BFE in Item 69: N NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: 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,AR/AE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only,enter meters. Benchmark Utilized:B-62 Elev.=8.67' Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. N NGVD 1929 ❑NAVD 1988 ❑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) 10.00 N feet ❑meters b)Top of the next higher floor N/A. ❑feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters d)Attached garage(top of slab) N/A. ❑feet ❑meters e) Lowest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 7.40 N feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 7.79 N feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support N/A. ❑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 Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment 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 Certifier's Name GARY B.CASTEL,P.L.S. License Number 4129 Title PROF.SURV.&MAPPER Company Name Address 8567 CORAL WAY City MIAMI State FL ZIP Code 33155 Signature Date 04-24-2015 Telephone 786-290-4184 _ O 4 _ FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 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: 9350 NE 12th Avenue. Job #10-490-13-H(3)(AVI) City MIAMI SHORES State FL ZIP Code 33138 Company NAIL Number: 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 C.O.R. Elevation=9.13' A5 OBTAINED BY GOOGLE CONVERSION FROM ADDRESS TO LONGITUDE/LATITUDE Signature Date 04-24-2015 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 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 ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑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 ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑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? ❑Yes ❑ 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 FEMA-issued 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 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 community-issued BFE)or Zone AO. G3.❑ The following information(Items G4—G10)is provided for community floodplain management 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-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 086-0-33(7/12) Replaces all previous editions. r ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. I AIPORTANT: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: 9350 NE 12th Avenue. Job #10-490-13-H(3)(AVI) City MIAMI SHORES �- State FL "ZIP Code 33138 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. i 04-24-2015 CABANA 1 FRONT VIEW 1 is 04-24-2015 CABANA 1 LEFT SIDE VIEW FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page 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: 9350 NE 12th Avenue. Job #10-490-13-H(3)(AV[) City MIAMI SHORES State FL ZIP node 33138 Company MAIC Number- If umberIf 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 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. t L l 04-24-2015 CABANA 1 REAR VIEW FROM LEFT SIDE an 1 I t 1 04-24-2015 CABANA 1 REAR VIEW FROM RIGHT SIDE FEMA Form 086 33(7/12) Replaces all previous editi;Dns. U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY 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 R.ANDREW DE PASS Job 10-490-13-H(4)(AVI) Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIL Number: 9350 NE 12th Avenue. (Folio No.11-3205-007-0150) City MIAMI SHORES State FL ZIP Code 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) POB E120.80ft,then N12dl6'40"E,run 151.79ft,then W184.74ft,then S1202'15"E,run 151.76ft to POB A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL(CABANA 2) A5. Latitude/Longitude:Lat.25°51'42.59"N Long.80°10'29.96"W Horizontal Datum: ❑ NAD 1927 ® 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 11=A 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) N/A sq ft a) Square footage of attached garage N/A sq ft 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 N/A within 1.0 foot above adjacent grade NIA c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes E No d) Engineered flood openings? ❑ Yes E No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State VILLAGE OF MIAMI SHORES 120652 MIAMI-DADE FLORIDA B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12086CO306 L 09/11/2009 Effective/Revised Date Zone(s) AO,use base flood depth) 09/11/2009 AE 8.00' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile E FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: E NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes E 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* E 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,AR/AE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only,enter meters. Benchmark Utilized:B-62 Elev.=8.67' Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 ❑NAVD 1988 ❑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) 10.00 E feet ❑meters b)Top of the next higher floor N/A. ❑feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters d)Attached garage(top of slab) N/A. ❑feet ❑meters e) Lowest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 6.20 E feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 7.65 E feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support N/A. ❑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.l certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. E 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? E Yes ❑ No _ Certifier's Name GARY B.CASTEL,P.L.S. License Number 4129 Title PROF.SURV.&MAPPER Company Name Address 8567 CORAL WAY City MIAMI State FL ZIP Code 33155 Signature - Date 04-24-2015 Telephone 786-290-4184 FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 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: 9350 NE 12th Avenue. Job #10-490-13-H(4)(AVI) City MIAMI SHORES State FL ZIP Code 33138 Company NAIL-Number: 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 C.O.R. Elevation=9.13' A5 OBTAINED BY GOOGLE CONVERSION FROM ADDRESS TO LONGITUDE/LATITUDE Signature - Date 04-24-2015 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 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 El meters EI above or E]below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑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 ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑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? ❑Yes ❑ 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 FEMA-issued 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 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 community-issued BFE)or Zone AO. G3.❑ The following information(Items G4—G10)is provided for community floodplain management 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-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title 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,ropy the corresperdirg 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: 9350 NE 12th Avenue. Job #10-490-13-H(4)(AVI) City MIAMI SHORES State FL ZIP Code 33138 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. E Aw r 04-24-2015 CABANA 2 FRONT/LEFT VIEW BESIDE POOL 04-24-201,55 CAB^Wti 2 RIGHT SIDE AND REAR VIEW FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page 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: 9350 NE 12th Avenue. Job #10-490-13-H(4)(AVI) City MIAMI SHORES State FL ZIP Code 33138 Company NAIC Number: 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 View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation ,Mth representative examples of the flood openings or vents,as indicated in Section A8. x 04-24-2015 CABANA 2 REAR VIEW FROM LEFT SIDE 1- r M,Y y E Wes Rf 04-24-2015 CABANA 2 REAR VIEW FROM RIGHT SIDE FEMA Form 086-0-33(7112) Replaces all previous editions. " U.S.DEPARTMENT OF HOMELAND SECURITY LEVATION CERTIFICATE FEDERAL EMERGENCY 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 R.ANDREW DE PASS Job 10-490-13-H(2)(AVI) Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number. 9350 NE 12th Avenue. (Folio No.11-3205-007-0150) City MIAMI SHORES State FL ZIP Code 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) POB E120.80ft,then N12dl6'40"E,run 151.79ft,then W184.74ft,then S12d02'15"E,run 151.76ft to POB A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL(GARAGE) A5. Latitude/Longitude:Lat.25°51'42.59"N Long.80°10'29-96" Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number 1_A 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) NIA sq It a) Square footage of attached garage NIA sq ft 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 N/A within 1.0 foot above adjacent grade NIA c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b NIA sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B7.NFIP Community Name&Community Number B2.County Name B3.State VILLAGE OF MIAMI SHORES 120652 MIAMI-DADE FLORIDA B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12086CO306 L 09/11/2009 Effective/Revised Date Zone(s) AO,use base flood depth) 09/11/2009 AE 8.00' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: 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,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only,enter meters. Benchmark Utilized:B-62 Elev.=8.67' Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 ❑NAVD 1988 ❑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) 9.31 ®feet ❑meters b)Top of the next higher floor NIA. ❑feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters d)Attached garage(top of slab) N/A. ❑feet ❑meters e)Lowest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 7.40 ®feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) 7.79 ®feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support NIA. ❑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.1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. ® 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 Certifier's Name GARY B.CASTEL,P.L.S. License Number 4129 Title PROF.SURV.&MAPPER Company Name Address 8567 CORAL WAY City MIAMI State FL ZIP Code 33155 Signature -- ate 04-24-2015 Telephone 786-290-4184 O S FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. FELEVATION CERTIFICATE, page 2 IMPORTANT:In these spaces,copy the �sponding 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. 9350 NE 12th Avenue. Job *10-490-13-H(2)(AVI) City MIAMI SHORES State FL ZIP Code 33138 Company NAIC Number. 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 C.O.R. Elevation=9.13' A5 OBTAINED BY GOOGLE CONVERSION FROM ADDRESS TO LONGITUDE/LATITUDE Signature Date 04-24-2015 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 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 ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑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 ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑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? ❑Yes ❑ 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 FEMA-issued 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 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 FEMA4ssued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4—G10)is provided for community floodplain management 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-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title 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. 9350 NE 12th Avenue. Job #10-490-13-H(2)(AVI) City MIAMI SHORES State FL ZIP Code 33138 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. s Fr Kj�ri �p 04-24-2015 GARAGE FRONT VIEW f bi. �l t _ ti5.i•r.- f' 04-24-2015 GARAGE LEFT SIDE VIEW FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page 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. 9350 NE 12th Avenue. Job *10-490-13-H(2)(AVI) City MIAMI SHORES State FL ZIP Code 33138 Company NAIC Number: 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 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. i' r fiA: • ie, -• n ltd.: `,�t �,a, c^ �� , 04-24-2015 GARAGE REAR VIEW ,2- f 04-24-2015 GARAGE REAR-RIGHT VIEW FEMA Form 086-0-33(7/12) Replaces all previous editions. GALE INSULATION S/O#401907690 CERTIFICATE OF INSULATION —INSTALLATION BUILDING PERMIT# JOB ADDRESS: 9350 NE 12 AVE MIAMI SHORES, FL STATEMENT OF COMPLIANCE: We, the undersigned, hereby certify that the thermal insulation has been installed in the referenced building in compliance with the Florida Model Energy Efficiency Building Code and the approved plans and specifications, and in accordance with good construction practice. The insulation furnished is of the type, thickness and R-value as set forth below: AREA TYPE THICKNESS R-VALUE MANUFACTURER ATTIC/ FIBERGLASS 10" R-30 KNAUF GARAGE BATT CEILING AREA INTERIOR FIBERGLASS 3.5" R-11 KNAUF PARTITIONS BATT GARAGE REFLECTIVE 75" R-4.1 FI-FOIL COMPANY COMMON WALL FOIL EXTERIOR REFLECTIVE .75" R-4.1 FI-FOIL COMPANY MASONRY FOIL I WALLS MULTIFAMILY RESIDENTIAL CONSTRUCTION: The COMMON(PARTY)walls separating different tenants shall be insulated as follows: Frame/Metal Stud Walls R-I 1 (min);CBS or Concrete Walls R-3 (min)by Energy Code requirements. See FBC-2001 CHAPTR 13-ENERGY EFFICIENCY,latest edition. These"minimum levels of insulation"are not included in the Energy Calculations,but shall be installed in the field. INSULATION CGC1512179 ,,--7TIFICATION DATE: DECEMBER 9, 2014 l INSULATION CONTRACTOR'S SIGNATURE: BUILDER: PALMER HOLDINGS INC : SIGNATURE: I PERSONALLY KNOW THE AFFIANT, PAMELA FENTON. Sworn to and subscribed before me this day of u ' 2014 Notary Public, State of Florida ] ..........o`,... =o ... ; MARLIS C SMITH-DOBLER _•' MY COMMISSION#FF1 12303 ••.,�eF��i EXPIRES May 9, 2018 (407)396-0153 Floridallotarysemice.com A 4035 S.W. 98 Avenue, Miami Florida 33165 P.O. Box 650213 Miami, FL 33165-0213 Tel. (305)552-0141 / 1-800 782-9284 FAX(305)227-1797 Web Page: www.alflexexterminators.com/ Email: alflex@belisouth.net CONFIRMATION OF COMPLETION OF NATIVE SUBTERRANEAN TERMITE PRETREATMENT AND CERTIFICATE OF COMPLIANCE Purchaser: Address of Treated Premises PALMER HOLDINGS RESIDENTIAL Address 1900 S BAY SHORE DR/COCONUT GROVE, F Lot-0 Block-0 Phone (305) 310-4673 9350 NE 12 AVE/MIAMI, FL Number of Structure(s)to be treated : ONE Product Used Square Footage : 600 Gallons Used : 60 DOMINION 2L Linear Footage : 96 Gallons Used : 38 IMIDACLOPRID ( 0.05 ) Permit#: Date Initial Treatment : 2/11/2014 4:00 PM Date of Completion : 2/26/2015 7:00 AM Technician : MAURICIO AI-Flex Exterminators hereby confirms that the structures described above have received a complete treatment for the prevention of NATIVE SUBTERRANEAN TERMITE infestation.Treatment has been made in accordance with the rules and laws as establishedby the Florida Department of Agriculture and Consumer Services. Exterior perimeter treatment was completed upon final grade.AI-Flex's limited warranty is presently in full force and effect. (WARRANTY EXCLUDES FORMOSAN&ASIAN TERMITES) Al-Flex Exterminators, Inc. by r'gp�gteHIgt*: President �OQ-•.=• :f.. Dated: 2/25/2015 This is npd wu[ 'orrany Seal 7 y _ �i ............./Jlll;lllllHIIIUIIINNNVN\N11\ APPLICATION #:AN123086 y: STATE OF FLORIDA PERMIT #:13-SC-1499972 DEPARTMENT OF HEALTH DOCUMENT #:F1974715 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:04/09/2014 FEE PAID:110.00 RECEIPT #:13-PID-2371839 APPLICANT: R ANDREW DE PASS JTRS WILLIAM J JURBERG JTRS AGENT: Cherokee Consulting, Inc PROPERTY ADDRESS: 9350 NE 12 Ave Miami, FL 33138 LOT: BLOCK: SUBDIVISION: ID#: 11-3025-007-0150 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [1] 1500.00 [2] [ ] [27] SURFACE WATER FT [ ] [02] TANK MATERIAL Concrete [ ] [28] DITCHES FT [ ] [03] OUTLET DEVICE [ ] [29] PRIVATE WELLS FT [ ] [04] MULTI-CHAMBERED [ Y / N ] [ ] [30] PUBLIC WELLS FT [ ] [05] OUTLET FILTER [ ] [31] IRRIGATION WELLS FT [ ] [06] LEGEND 1. 01-011-20SC3 2. [ ] [32] POTABLE WATER 70 FT [ ] [07] WATERTIGHT [ ] [33] BUILDING FOUNDATIONS 12 FT [ ] [08] LEVEL [ ] [34] PROPERTY LINES 25 FT [ ] [09] DEPTH TO LID [ ] [35] OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ ] [10] AREA (1] 735 [2] SQFT [ ] (36] DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX HEADER X [ ] [37] SHOULDERS [ ] [12] NUMBER OF DRAINLINES 1 7.00 2. [ ] [38] SLOPES [ ] [13] DRAINLINE SEPARATION [ ] [39] STABILIZATION [ ] [14] DRAINLINE SLOPE [ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / 13ELOW ]BM 28.20 [ ] [40] UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF [ ] [18] DOSING PUMPS [ l [42] ALARMS [ ] [19] AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT [ l [20] AGGREGATE EXCESSIVE FINES //��r [ ] [44] BUILDING AREA [ ] [21] AGGREGATE DEPTH CC'',,� Copy v'n y ( ] [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING FILL / EXCAVATION MATERIA71�r1(�a }�ea+th [ ] [ ] [22] FILL AMOUNT M)am)-Dade�ojnty[48] CONTRACTOR Chapman(Chapman) O.S.T.D.S. & W ]i Pro ADS ARC 24 [ ] (23] FILL TEXTURE �gra m [ ] [24] EXCAVATION DEPTH Z3 IS ABANDONMENT [ ] [25] AREA REPLACED [49] TANK PUMPED [ ] (26] REPLACEMENT MATERIAL [ ] (50] TANK CRUSHED 6 FILLED Comments: Comments are on page 2. CONSTRUCTION ( APPROVED / Dade CHD DATE: 11/03/2014 I�F.PPRr'JEG ]` Engineering Specialist II Betsy Lange•Olmino(Department of Health in Mia FINAL. SYSTEM ( AppROVED / DISe'.PPROVEu Dade CHD DATE: 11/03/2014 ngineering Specialist 11 BetsyLange- mmo(Deparbrnent of Health in Mia (Explanation of Violations on following page) DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 2 of 3 EH Database 1.6.? t P1 2SQ86 E101499972 APPLICATION #:AP1123086 STATE OF FLORIDA PERMIT #:13-SC-1499972 t DEPARTMENT OF HEALTH DOCUMENT #:F1974715 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID;04/09/2014 FEE PAID:110.00 RECEIPT #:13-PID-2371839 Violation Number Comment Comments Tank is 1500 Gal,Tuftite EF 4. DF, 7 lines with 7 chambers each for a total of 735 SQ FT in trench configuration. The system is sized for 5 bedrooms with a maximum occupancy of 10 persons(2 per bedroom),for a total estimated flow of 580 gpd. DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 2 of 3 EH Database v 1.6.1 API?23080 EtDi4995't'< P'll APPLICATION #:APS{1 23089 STATE OF FLORIDA PERMIT #:13-SC-1499977 DEPARTMENT OF HEALTH DOCUMENT #:F1974208 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM ' CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:10/11/2013 FEE PAID:375.00 RECEIPT #:13-PID-2295565 APPLICANT: R ANDREW DE PASS JTRS WILLIAM J JURBERG JTRS AGENT: Ken W Groce(Cherokee Consulting,Inc) PROPERTY ADDRESS: 9350 NE 12 Ave Miami, FL 33138 LOT: BLOCK: SUBDIVISION: ID#: 11-3025-007.0150 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [1] 900.00 [2] [ 1 [271 SURFACE WATER FT [ ] [02] TANK MATERIAL Concrete [ ] [281 DITCHES FT [ ] [031 OUTLET DEVICE [ j [29] PRIVATE WELLS FT [ 1 [041 MULTI-CHAMBERED [ Y N ] ^_ ( 1 [301 PUBLIC WELLS FT [ 1 (051 OUTLET FILTER Polylok PL-68 [ 1 [311 IRRIGATION WELLS FT [ 1 [06] LEGEND 1. 01-011-04DC3 2. ( ] [321 POTABLE WATER 40 FT [ 1 (071 WATERTIGHT [ 1 [331 BUILDING FOUNDATIONS 6 FT [ 1 [081 LEVEL [ ] [341 PROPERTY LINES 5 FT [ 1 (09] DEPTH TO LID [ 1 [35] OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ 1 [101 AREA (1) 270 [2] SQFT [ 1 1361 DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX HEADER X [ 1 (371 SHOULDERS [ ] [12] NUMBER OF DRAINLINES 1. 3.00 2. [ 1 [381 SLOPES [ 1 (13] DRAINLINE SEPARATION [ 1 [391 STABILIZATION [ 1 [14] DRAINLINE SLOPE [ 1 [15] DEPTH OF COVER ADDITIONAL INFORMATION [ 1 [161 ELEVATION [ ABOVE / SEI OSP IBM 32.64 [ 1 [401 UNOBSTRUCTED AREA [ 1 [171 SYSTEM LOCATION [ 1 [411 STORMWATER RUNOFF [ 1 (181 DOSING PUMPS [ 1 [421 ALARMS ( 1 [19] AGGREGATE SIZE [ 1 [431 MAINTENANCE AGREEMENT [ 1 [201 AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA ( 1 [211 AGGREGATE DEPTH [ 1 (45; LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL COPY ( 1 (461 FINAL SITE GRADING [ j [47] CONTRACTOR Charles J Chapman(Chapma [ 1 [221 FILL AMOUNT Florida Health Miami-Dade County [48] OTHER ADS ARC 24 [ 1 [231 FILL TEXTURE O,S,T.D.S. & eU rogram [ 1 (241 EXCAVATION DEPTH ABANDONMENT ( 1 [251 AREA REPLACED [ 7 [491 TANK PUMPED [ 1 [261 REPLACEMENT MATERIAL [ (501 TANK CRUSHED 6 FILLED Comments: Comments are on page 2. ( APPROVED / Dade CHD DATE: 10/28/2014 CONSTRUCTION DISAPPROVED 1: Engineer Specialist II Joseph R Piverger(Department of Heskh in Dade COU FINAL SYSTEM ( AppROVED / DISAPPROVED 1: Dade CHD DATE: 10/28/2014 Engineer Specialist sep merger(Diprtment(Departmentof Healthn Dade Co (Explanation of violations on following page) DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 2 of 3 Incorporated: 64E-6.003, FAC EH Database v 1,0.1 APl123089 E01499977 APPLICATION #:AP 1123089 ._ STATE OF FLORIDA PERMIT #:13-SC-1499977 DEPARTMENT OF HEALTH DOCUMENT #:F1974208 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:10/11/2013 M1�O FEE PAID:375.00 RECEIPT #:13-PID-2295565 Violation Number Comment Comments 18 Arc-24 DF. The system is sized for 1 bedrooms with a maximum occupancy of 2 persons(2 per bedroom),for a total estimated flow of 100 gpd. DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 2 of 3 Incorporated: 64E-6.003, FAC EH Database v 101 AP?123089 E101499977 GEOTL�HNICAL' MATERIAL TESTING ENVIRONMENTAL DRILLING SERVICES HYDROGEOLOGY INSPECTION SERVICES ASBESTOS ROOF TESTING DYNATECH ENGINEERING CORP. Miami, February 25, 2014 Mr. Martin Palmer PALMER HOLDINGS 190613ay Shore Drive Coconut Grove, FL 33133 Re: Addition @ 9350 NE 12th Avenue Miami Shores, FL Dear Mr. Palmer: Pursuant to your request; DYNATECH ENGINEERING CORP. (DEC) inspected the soils at the above reference property. Based on our site inspection, soil borings and soil density tests; it is our professional opinion that the existing inspected soil is suitable for support of the proposed construction and that the bearing capacity of the soils found meet or exceed 3000 PSF. Enclosed find copies of our field testing logs. It has been a pleasure working with you at this phase of your project and look forward to do so in the near future. Sincerely yours, Wissa Naamani, P.E. , DYNATECH ENGINEERING CORP. Florida Reg. No. 39584 Special Inspection No. 757 Certificate of Authorization No.: CA 5491 �� 750 West 84 Street, Hialeah, FL 33014-3618• Phone: (305) 828-7499• Fax: (305) 828-9598 E-Mail: Dynatech@bellsouth.net i��PM1getl m Rwytl.E P.pw DYNATECH ENGINEERING CORP. 750 WEST 84T" STREET HIALEAH,FLORIDA 33014 (305)828-7499 MOISTURE-DENSITY RELATIONS OF SOILS PROCTOR COMPACTION TEST DATE: February 21, 2014 CLIENT: PALMER HOLDING PROJECT: Addition (a, ADDRESS: 9350 NE 12th Avenue, Miami Shores, FL CONTRACTOR: Palmer Holding MATERIAL DESCRIPTION: Tan sandy limerock SAMPLED BY: RN TESTED BY: RN TEST RESULTS Sample Number 5 The following compaction test was conducted in accordance with the Standard Methods for Moisture Density Relations of soil using a 10 lb. Hammer and an 18"drop ASTM D-1557. % MOISTURE DRY DENSITY 6.0 110.1 6.9 111.2 7.8 112.4 114 11.8 107.8 D R 112 Y 110 D E Optimum Moisture 8.4 Percent N 100%Maximum Dry Density 112.8 lbs./cu.ft. 108 S %Passing'W'Sieve 89 Percent I 106 T Y 104 Sampled By:RN Checked By:WN = 6 8 10 12 14 % MOISTURE .:Respectively subm't ed, As a mutual protection to clients,the public and ourselves,all reports are submitted as the confidential property of clients,and authorization for use,publication of statements,conclusions or extracts from or regarding Wit. _�x1. Wlssam 7aamani,P.E. our reports is reserved pending our written approval. t!t ?,.` DYNATECH ENGINEERING CORP. Florida Reg.No. 39584 Certificate of Authorization No.: CA 5491 DYNATECH ENGINEERING CORP. 750 WEST 84TH STREET HIALEAH,FLORIDA 33014 (305)828-7499 FIELD DENSITY TEST OF COMPACTED SOILS DATE: February 21, 2014 CLIENT: PALMER HOLDING PROJECT: Addition 2 ADDRESS: 9350 NE 12`h Avenue Miami Shores FL CONTRACTOR: Palmer Holdinl? Test No. 23 Location: West side of building pad proof rolling Test No. 24 Location: Center of building pad proof rolling Test No. Location: Test No. Location: Test No. Location: Description of Material: Tan sandy limerock TEST NO. 23 24 DEPTH 12" 12" FIELD DENSITY 111.4 110.9 MOISTURE CONTENT % 6.8 7.1 MAX. DENSITY IN THE FIELD % 98.7 98.3 COMPACTION REQUIREMENTS 98% 98% OF MAXIMUM DENSITY 100% MAXIMUM DENSITY (LAB) 112.8 112.8 REMARKS: ALL ABOVE TEST RESULTS COMPLY WITH COMPACTION REQUIREMENTS f,,:Aes ectfully µbmitted, Sampled By:RN Checked By:WN rssNaamani,P.E. DYNA MCH ENGINEERING CORP. Flor•.ida:Aeg.No.39584 Cg6ficXe of Authorization No.: CA 5491 *A density test determines the degree of compaction of the tested layer of iWtrrial only;A shall a density test replace a soil bearing capacity determination. A soil boring test must be provided by client, prior to construction to verify subsoil As a mutual protection,to the clients,the public and ourselves, all reports are submitted as the confidential property of clients, and authorization fgt:ob�a Y n of statement conclusions or extracts from or regarding our reports is reserved pending on our written approval. STRUCTURAL DESIGN TC ENGINEERING,INC. CA uc.No 30288 CONSULTING ENG NEERS ANTONIO CANELAS,P.E. UC.No.74099 7805 SW 24 ST SUITE 106 MIAMI,FL.33155 PNONE.(305)261-0321 � I May 5, 2015 Village of Miami Shore Building and Zoning Department Miami, Florida. Reference: Special Inspector's Completion Statement William Jurberg&Andrew de Pass Residence 9350 NE 12 Avenue Miami FL, 33138 To whom it may concern: I, Antonio Canelas, having been retained as Special Inspector for the remodeling of William Jurberg&Andrew de Pass Residence located at 9350 NE 12 Ave, hereby state after conducting the required inspections, that to the best of my knowledge and belief, the construction of all structural load-bearing components including reinforced CMU Walls, Pre-Engineer Wood Trusses, Steel Members and Connections of the above described project complies with the permitted documents plans submitted to the Building Department. Note: I have reviewed the stairs and railings shop drawings and stamped and sealed them along with the specialty engineer for the city's review and approval. Upon approval from the city, I will inspect the construction when it has been completed in compliance with the approved drawings. Sincerely, \o CA tV �'`•,�,\C E N SF ••'9cs - Q • q o• 7*0 • N Y Antonio Canelas, P.E. * • l 5 Lic#: 74099 •:5/61 l TE �F -o STA .. � �O� FC O R\OP••�\