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PL-15-2314 (2) (a tQ s +C' Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795.2204 Fax: (305)756-8972 Inspection Number: INSP-243308 Permit Number. PL-9-15-2314 Scheduled Inspection Date: November 25,2015 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: NUNES,ALINA Work Classification: Addition/Alteration Job Address:775 NE 97 Street Miami Shores,FL 33138- Phone Number Parcel Number 1132060142330 Project: <NONE> Contractor: DIAL PLUMBING CORP Phone:(305)229-8569 Building Department Comments ADD SHOWER TO EXISTING BATHROOM nfractio passed Comments INSPECTOR COMMENTS f=alse Inspector Comments Passed15 , S r Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 24,2015 For Inspections please call:(305)752-4949 Page 13 of 42 C EI VE� Miami Shores Village SEP 112015 Building Department BY: 41-41-71740% 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20I ' BUILDING Master Permit No2 31 - - -- PERMIT APPLICATION Sub Permit No.,. ' ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:—1 -45 !V c ( -f!�&4 City: Miami Shores County: Miami Dade Zip: 3 31 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: //Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): 'A C I fJ A �j j N`��" Phone#: J DS- �D Address: I v City: f�k State: Zip: Tenant/Lesse Name: p Phone#: Email: e m CONTRACTOR:Company Name: Phone#: 3o�; / r`'5,67 Address: City: State: Zip: Qualifier Name: P��t _ �Cj" � � Phone#: State Certification or Registration#: � �� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ t Square/Linear Footage of Work: Type of Work: ❑ Addition '19 Alteration ❑ New ❑ Re air/Replace ❑ Demolition 1 Description of Work: e,9 A1 //b /1 ills) gp ygyyxyy'�`6ee $5 �!`ii7 �j J1�F/'lYP�7t.-� gf9MMe, Specify color of color thru tile: kt rt $ $ ZZ �- CCF$ rttA�'de p .�J �7 . Submittal Fee TE -�-= Permit Fee Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ D}c yrC> Structural Reviews$ Bond$ _ TOTAL FEE NOW DUE (Revised02/24/2014) t r Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. Int e a ence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. a� Signatur Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged befo e m t is The foregoing instrument was acknowledged before me this _6.( inday of 20 by _ dayA09 st , 20 1 `-�� by // who is personally known to /``r "Cisco k->C2 4,wha is personally known to me or who has produced s me or who has produced D 2 Li �'-- as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si Sign: �-�— Print: Print: Gt r r c STEMIJE 11ER �.: 'w, Seal: Ypyd11�_ ftt�Plorida. Seal: " "'- PATRICIA ELEN CEPERO 4 IpPY P4Bt'4i A. #Ay� 0NO5.2 5 .: Commission# n Expires gpppp 110l� My Commission Expires IIS Thi Ibi�t�AW '�% � November 14, 2015 APPROVED 13Y ( - Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR >• ._� �_:__, KEN LAWSON,SECRETARY :. SPATE OF FLORIDA - � DEPARTMENTOF°BUSI IESS AND PROFESSIONAL_RE'GULATTQI - ^ CONSTRUCT1t�I�.�NbUSTR�f`LLCEN�INGB:OARD" ° ` •s. CF,G142§207 The PLLJMBI_It CC7NTftACT U�ndithey�ovlsl®ns Ghptelr, #39 Exp.xariion„tlat M yd 4 �'°FFON,TE$,VA;EIZAC�t 4 _ ❑UMBI "4 J IAMQQr �'" � � �n �¢��.,,.,, �� % *fit+ 4y �"4'°� • t �,"*,^x„�+ rx ..„ „�„- 5 h �"i��'1. ,.�; �• � • fir; ISSUED: 01/20/2015 �a DISPLAY AS REQUIRED BY LAW SEQ# L15012000006'r7 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA QEARTMENT OF BUSIES$AND PROFESSIdNAL;REGULATION .� mCONSTRUCTf, f�IDUSTRY,LfCEISINC BC ►FD ", a.. 4 M, RFA042876- N s TbeP,LUMBrlvc�cortTRACIT R •�`.Na�,ra�r� below HA��RE'GISTtiER""EQ< _ � nr 0}lxha er Cfwnder tl,e .bvlsions . -'-459"F pisba r oldap AUS 31, 2017 n. ,,r:' I DI IDUAA MUSl"IVJEETALL- LC SING h" REQUIRMEN "PR1LT 1NAY'AREA ,�,„ NN I=`3NTC�6A,kFRA GLS . �. . , r X40 ISSUED: 06/25/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1506250000377 1 I � I a ""'tot � Ij DA W' uri y, State.6f Flc�fl a � kTMISI'SNOTABILL DO,NbTPAY � s rNth b0i1014319 _7 t fn r r BU IJ�IEES N/CME/t OCATION RECEIPT NO kr { x R S z 0-AV,PL�, ND CORP NIRW BUflJ}NN�� E� SER s3 �� rsc�R�4wa�r "x } 1*JliAlb11P1. X5165 74!44997 * M.fat'i)84tlaj?ayt{ to' C4�.4t`krrae� • � Piitsctarittd'�dunty�f�a�a°"`�t,; 1 Chapter 8A Art 8&ft} ` '0�NER \ TYPE OP BUSINESS i 44PLUM��NG CORFI �' PLUM1614dtONTRACTO�t PAYMEN RECEIVED _ t t BY TAX CECTOR .,y, x . 200.00 ( 19/19/2 -4 022514d5653 I� , Fotmore informstioa visit'v Mae. 000864 �i 000864 1 , alusiask1'ax. et±e�p�h � a � eurr, St e" o 4 fiiliS 1S NOTA BiIL DO NOT PAY aQ x j BUl31NE89'NAME/LOCATION REC914P"[NO wt, ts. DIAL PLUMSINGCORP RENEWAL SEPTMB° � X940 Ct I L'WAY'" 1004888 i1lIu0 tie displayed at place of business jMIAMI FL'33165- , PsuarrYtci;Cnunty COde EfSapteK$rA; Art:J.&1TL Ij� w DOWNER,' �� SEC.TXPE d BU NESS i N AYME RECEI 'I DIAL PLUMBING CORP f` V 96 PLOWING COI�TRAC'1DR,` BY TAXi06LLEC-rj •Q00�014319 r'' 1Naiker 5}" �10 1 j ,75.00107/15/2014 �� -{ CHECK ii-14-018312 This airAllBusiness Tax Receipt only denhrms payment of the Lobel Business Tax.The Recaipi is not a 066,41 `- } ' petmit;or a ceruhoatiori f the holder s tivaliflcatinos,to do business Holder toast comply14m any govemmalit�l dr nongovevrnmental regulatory iaims`andlrequirements which apply to the bush" The-RECEIPT'NQ.-above mustbedi�spiayed onall oommet ial vehidias�`AAiami—DPds tie Sec ga 3�6. For more inle'rmation visit vvvfiw mrainidade ov/taxcollactor _w, a ; �. _... J AUG-26-2015 07:41 From: To:3057568972 Page:2/2 ACO v® CERTIFICATE OF LIABILITY INSURANCE DATEIM012015 Y) �r RANCE oarzaz4ls THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed- If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement,A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT HAY • Barbra Gonzalez Rodriguez Insurance Agency IncP"oNE 9120 345 553-1760 Ne); (305)553-1762 9120 SW 40 St E-MAIL ADDRESS: tadeoinsuranoe Iive.CDm INSURERS AFFORDING CQVFRA09 Miami FL 33165 INSURERA: GRANADA INSURANCE COMPANY 16870 INSURED INSURER 8: Dial Plumbing Corp INSURER C 9940 Sw 22 St INSURER D: INSURER E: Miami FL 33165 INSURER P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICrES OR 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 T81S 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. {NSR `F �ExI Y LIMITS T TYPE OF WSURANCE MMroDnrv POLICY GENERAL LIABILITY POLICY NUMBER EACH OCCURRIINCE S $1,000,000 X COMMERCIAL GENERAL LIABILITY �gEp�3E_S,(Es,c�currencel` f $100,000 CLAMS-MAOE E]OCCUR MED EXP one lean $ $5.000 A 0185FLOOD61941 -2 08/15/2015 08/15/2016 PERSONAL&ADV INJURY s $1,000,ODO -- GENGRALAGGRrGATE S $2,000,000 [3EN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO S $0 X POt,ICv PR - LOC t AUTOYDBII.E LIABILITY COMBINED SI GLIMIT ANY AUTO Ira wz dent) S ALL OWNED SCHEDULED BODILY INJURY(Per person) S AUYOb AUTOS BODILY INJURY(For aC ddeno S HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS $ Por occident UMBRELLA LIAR $ OCCUR EACH occuAACmce f exCESb LIAR CLAIMS•MADE AGGREGATE f OED RETENTION$ `— WORKERS COMPENSATION S AND EMPLOYERS'LIA@ILmYY/N WCC SSLATU. OTH- ANY PROPRIETOR)PARTNERrtXECuT1vE OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ (Mandstoly in NH) Ir a,describe under E.L DISEASE-EA EMPLOYE S DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Ramarta So)%edyle,If more space is required) Plumbing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCIELLEO BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS, Miarni Shares FL 33138 Fax:305-756-8972 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) ®1988.2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD a� JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "*CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the Individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 10/27/2013 EXPIRATION DATE: 10/27/2015 PERSON: FONTEBOA FRANCISCO A FEIN: . 592248413 BUSINESS NAME AND ADDRESS: I0AL PLUMBING CORP 9940 SW 22 STREET MIAMI FL 33165 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440.0.5(14),F.S.,an officer of a corporation who eieds exemption from this chapter by filkhp a cermoste of election under this section may rat recover benefits or compensation under this Chapter.Pursuant to Chapter440.05(12),F.S.,Cenificales oT electton a be exempt..aPPIY only within the scope , of t11e Wshheas or bade ilstetl on Ithe notice d eledbn to ba exempt.PurgUanl to Cheptef 440.0.5(13).F.9.,Notices of eladbn to be exempt end cerlifieates of • etadion ro be exempt shall be aubled to revocation if,at arty brr>e aHer the tiling of the notice or ihs issuance of the certificate,the person named on the ndi�or certifieare ra bryer meets the requaements of[this aedbn for issuance of a cerofirate.The deparunenf shad revoke a Certifihate at any oma for(allure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 S. �NOREs e- ' lNG 1932 Yf� mail Miami shores Village Building Department RmA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt i£ 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. � �� t iiii p . AtM -`l Ai Signature:, ��`�•.•� •••O" OwnerMy Q"••' Y •; State of Florida • COmm'Expires = September 9,2018 '. � No.FF 158152 County of Miami-Dade (j1 ,• •. The foregoing was acknowledge before me this f day of 20 T 000 By 6IV\C Nwho is personally known to me or has produced //111111 Roy-ocoL Dr(v-er as identification. Notary: AWCkA., T �l SEAL: roo -{� Dial Plumbing 0C a�o Corporation September 9, 2015 State of Florida County of Dade Before me this day personally appeared Francisco Fonteboa, who, being duly sworn, deposes and says: That he will be the only person working on the project located at Miami Shores Village. Sworn to and subscribed before me this 9th day of September, 2015 by Francisco Fonteboa, personally known to me. _ l Franbisco Fonteboa Patricia"E. Cepero Notary Public, State of Florida ,•"a.":�' PATRICIA ELENA CEPERO + n' ° Commission#EE 141550 aF My Commission Expires November 14, 2015 "qon,•• 9940 Southwest 22nd Street Miami, FL. 33165 (305) 221-8569 October 26,2015 Miami Shores Village �.. GVIE�N ELECTRICAi- R Michael Devaney, Electrical Inspector APPR®v�� Permit#RC15-2312 Dear Michael, I did not get an electrical permit for this legalization,because no electrical was touched during this project. Ismael,the building manager,told me just to put a note on the plans regarding the smoke detectors, which I had the architects do and then I reiterated the same on the building permit critique. Ismael approved the building permit with this note. Either way, I have attached an existing drawing of the house and have indicated where the 10 year non- replaceable battery operated smoke detectors are,which are in all the bedrooms of the house. Thanking you in advance for your prompt approval. j Best rards, Alina Nunez-305-807-8 W5 Owner 775 NE 97"'street 9999.. 9999.. • 9999 '. 9999.. 9999 9999.. 9999.. • 9999.. 9999 • • •• 9999 606 9999.. • • 9. 69 9999.. 6 9660.. 9999.. 0 6. • 6.996. 0000 . 0 909 0 • '. LSV SAV ' w S- p ! i Ly �- 1 .. _ Ji L fl 1 i y••••• •••••• • • e 0000 •i 0000•• 000:00 00*90: 0000 0000•• 000000. i • • •.... f 0000 0 of 0 • • • ••• • 0000• •• 0• • • • • 00 00.000 •• •• • -' 0 0 0000•• • • • 0000•0 • • � • • • 0000•• 0000 � • ••• • • i • • P o\ KK t ry Q✓ - cx2xoa�+a oa a/r1 \+\.•riyc+. \cc.. 1 i •' -- - 1`-- .." -mss_ � � �_,--_� w '• . - e C5 23 i2- 10- U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION C �F OMB No. 1650-0008 FEDERAL EMERGENCY MANAGEMENT AGENCY + V E, Nptiond Flood In�mncc Program IMPORTANT:Follow the instluctid4 6l Pa;� 3'"�» �piTa#iori Date:July 31,201 SECTION A-PROPERTU*01MANON INSURANCE COMPANY USE M. A1. Building Owner's NameALINAf� r. Polity Number: I In A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P0.Rout nd B Company NAIL Number: 775 NE 97 STREET City MIAMI SHORES Stat ID ZIP Code 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) FOLIO#11-3206-014-2330 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL A5. Latitude/Longitude:Lat. N25°51'54.33" Long. W080°10'53.79" Horizontal Datum. IAD 1927 rWhAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood'insurance. ■ A A7. Building Diagram Number 1B A8. For a building with a crawlspace or enclosure(s): A9.For a building with an attached garage: a) Square footage of crawispace or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No.of permanent flood openings in the crawispace or b) Number of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? r-'kes FIVo d) Engineered flood openings? Yes ®i No SECTION 8 FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP Community Name&Community Number 82.County Name B3.State LAGE OF MIAMI SHORES 19(1652 MIAM!-DADS B4. Map/Panel Number B5.Suffix B6.FIRM index Date 87.FIRM Panel Effective/ 68.Flood Zone(s) B9.Base Flood Elevation(s)(Zone Revised Date A0,use base flood depth) 12086CO306 I L 9111109 9111109 x N.A. B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69: FIS ProfileFIRM Community Determined Other/Source: B11.Indicate elevation datum used for BFE in Item B9: rol NGVD 1929 rJNAVD 1988 they/Source: B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? Yes 0 Designation Date: J J BRS LOPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: Construction Drawings* wlding Under Construction* Fs-]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/A1-130,AR/AH,AR/A0.Complete Items C2.a-h below according to the building diagram specified in item A7. In Puerto Rico only,enter meters. Benchmark Utilized: vIDBW4N-800ELEV.9.3µ Vertical Datum: NGvD sz9 000:0• Indicate elevation datum used for the elevations in items a)through h)below. �NGVD 1929 [3NAVD 1988 gOthe*Source:• •••••• Datum used for building elevations must be the same as that used for the BFE. Check the measdrt%;t used....... • a1 Top of bottom floor(including basement,crawlspace,or enclosure floor) 10 25 [1111feet •�'ISi�trs •••• •••••• b) Top of the next higher floor 11 . 05 Ofeet •LJ Ialeters :•••• cl Bottom of the lowest horizontal structural member(V Zones only) N A� [Deet •Umeters •••••• • • d) Attached garage(top of slab) •• •••• ••••• N A nfeet tTrneteTS • • ••0000 • •• 0000• e) Lowest elevation of machinery or equipment servicing the building 9 6feet Jmettrs ••••••• • •• 0000•• (Describe type of equipment and location in Comments) t-f • f) Lowest adjacent(finished)grade next to building(LAG) 9 . 2 (Peet :Meatier. � �• • • • • 0000•• g) Highest adjacent(finished)grade next to building(HAG) 9 . 6 eet meters •••••• • • • :0000: h) Lowest adjacent grade at lowest elevation of deck or stairs,including N A n°eet • rAet�rs • 0 0 structural support • • • 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 Certiricate represents my best efforts to interpret the data avaiiable. I understand that ary false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. M✓ Check here if comments are provided on back of form. Were latitude and longitude'SSection A provided by a Check here if attachments. licensed land surveyor? ✓ es O No Pl__4f'F Certifier's Name HENRYJOHNSTON License Number LS6843 C 17 A,I Title Company Name LAND SURVEYOR JOHNSTON&JOHNSTON LAND SURVEYING SERVICES,INC.LB7689 i Address City State ZIP Code 7081 TAFT STREET#160 HOLLYWOOD FLORIDA 33724 Signature / Date Telephone T 1016115 954-296-9516 FEMA Form 086-0.33(7 ) 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 RO.Route and Box No. }PoWy Number. 775 NE 97 STREET city State ZIP Code Comiximl NA14C Number: MIAMI SHORES FLORIDA 33138 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 A5).LATITUDE AND LONGITUDE WERE OBTAINED THROUGH USE OF GOGGLE EARTH C2.e)IS AN A/C SLAB THE BATHROOM FLOOR IS REFERENCED iN C2.a AS THE BOTTOM FLOOR THE HIGHEST CROWN OF ROAD IS 9.50'(NGVD 1929) Signature Date 1018115 SECTION E- UILI3 ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT OFE) 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 EI-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,cr enc!osure)is feet ❑meters Qabove or Obelow the MAG. b)up of botton;Boor(including basement,crawlspace,or enclosure)is [Meet ❑meters Clabove or Elbelow 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 Qbetow the HAG. E3.Attached garage(top of slab)is 'feet Ci meters r above or below the HAG. E4.Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters Ebbove or EDbeiow 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?Ekes �iNo Ullnknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA4ssued or community-issued BFE)or Zone AO must sigh here.The staterrients in Sections A,8,and E are correct to the best of illy knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments 00..00 • • 0000•• •• 1M Check•1WV'i}attachments+• 000.0. W" SECTION G-COMMUNITY INFORMATION(OPTIONAL) ,,.:.. . . • The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance cancompiete Sections ApB,C(or Ej,and • G of tris.Elevation Certificate.Complete the applicable items)and sign below.Check the measurement used in Items GR t4p.19 puerto}tl"WVenter TWgrsw • • G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensari surveyor,>en inner,or aroiiiteot• who is authorized by law to certify elevation information.(Indicate the source and date of the elevation data j%1hrVbmbmmen?%,f#4 Below.).... G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community js1W,BFE)or Zona•AO. •• G3. ❑ The following information(Items G4-G9)is provided for community floodplain management purposes. : • : . . ••06: • 0004•• G4. Permit Number G5.Date Permit issued G6.Date Certificate Of Co:ipIi4n%/Occup%ncy 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 G1Q.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments d Chock here if attachrnents. FEMA Form 086-0-33(7/12) Replaces ail previous editions.