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PL-14-677 (2) Miami Shores Village C jN7F -� Building Department SEP 23 2014 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 I PECTION LINE PHONE NUMBER:(305)762-4949 N FBC 20 BUILDING Master Permit No. et, 44V- (cl-�u PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL �LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Cr L[ &-- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO �/(� r/' Occupancy Type: �J -r Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): A-OVt-k—PA(L+ hone#: 304'6T 04 6cY J__7 Address: ;;z ' "o CSD ®� ff City: State: Zip: �J7 Tenant/Lessee Name: Phone#: S 0�r-9©tr�2( � Email: J-ta, ik- ire 0 lq CONTRACTOR:Company Name: h®7E� H A-VAMOVIG C®jeP Phone#: Address: /`7JU7 /VW CS' C446CI AAW City: /L/tA.11.// State: ICEDAID4 Zip: MO--1'Lr Qualifier Name: Mme,' A' 77M/JO� Phone#: State Certification or Registration#: C44r, /q.,;7J 6254Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: 4 Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New _ F-1 Repair/Replace ❑ Demolition Description of Work: PL LY Aj 6/A i 4e(�-e LY t R. Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ - (Revised02/24/2014) 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. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. � Signature k--�-Q' --,, °`r — Signature OWNER or AGENT _ CONTRACTOR Theyforegoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 5cov20 by 9L' day of 20 IV , by MAIOH s personally kno to J11 7/�1�QS who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: jig Sign: Printtgm6ppom Print: �- =op ::'fin PEDRC L CASTRO Seal: Seal: MY COMMISSION#EE 024272 1�P"'`6BILENA ROMERO ¢ 'r' ''°= Notary Public-State of Florida . EXPIRES:October 8,2014 My Comm.Expires Oct 24,2017 °Fnr ,oP` RyWedThruBudget NotarySeMces P. "9 f A e *****s<* ** �'h�***�>rr4lkl�kl�dteF��6WQ * APPROVED BY - � Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Phgne:(305)562-7504 IFu URO 1&1 Ll O �.��� 14317 S.W.45th Terr. 170:(305)229-8068 Professional Land Surveyor&Mapper Miami, Florida 33175 PROPERTY ADDRE55: 9425 NW 2nd Ct. Miami 5hore5, FL. 33150 LEGAL DE5CRIF'TI0N: Loot 10, Block 3, of O'DELL MANORS, according to the plat thereof a5 recorded In Plat Book 41 , at Page 57, of the Public Records of Miami Dade County, Florida. SKETCH OF SURVEY (Boundary Survey) Scale:l'=2a SCALE 1"=20' BLOCK-3 BLOCK-3 BLOCK-3 LOT-B LOT- 7 b •EGaT. 6 • N 6'W.F. N _ _ _ _ — — — • 0000 0000 • 110I.P. 75.00'(R) (M) —•• 0- 0 I/2'1.F. —.— •• • • • • `y° l 23. ��.5•• • • i••••i VU � a 'YTS. • • • 00 C w.51ab 23.55' X 0000 0000 00:00 j 23.60 • onP/!•••• •••••• Metal Shed (Q 0000 0000 0 0000•• 0 M B.ax10. N ••• • • •• 4'C.LP. • • � • BLOCK-3 � LOT- O 4'G!#..:. •••••. l • 0 • • .0000• mlwshed •• • •••• 23.10 • / I ••0• N 17.09' 46./0' N ONE STORY X x BLOCK-3 v BLOCK-3 LOT-9 I 4 Res.#9425 p o '! F F Elev: 13.47' O LOT- 1 1 ao, O III 9.96' 20.20 O Pprrih •� I 13.017 14.90' 16.85' °j o 3 0 n N iV N 9` b O �F ° � 9\ m fo. P0.° B.C.0L&9 I/2'LP. ,�•Ir 9 s� marl 75.00. a a° d° a 75.00'(R) (M) a 5'rOW. a a ° Q A Corrc 1/.5a ParhW N d N NW 2nd,l.y5' Ct. l r Asphalt Pavement — 50' TOTAL R/W NOTE: ELEVATIONS ARE REFERRED TO MIAMI DADE COUNTY BM# N-5G8 ELEV.= 9.G5' OF N.G.V.D. OF 1929 BASED ON THE FLOOD INSURENCE RATE MAP OF THE FEDERAL EMERGENCY AGENCY DATE OF FIELD woRK Feb. l 3, 20/4 CERTIFIED TO: REVISED ON-9-//-09 THE HEREIN DESCRIBED PROPERTY IS SITUADED WITHIN: REVISED ON: ELITE HOME PARTNERS LLC ZONE X BASE FLOOD ELEV. N/A COMMUNITY NUMBER:/206.x72 1 hereby certify that the attached Sketch of Survey of the herein PANEL NUMBER 0302 SUFFDC L described property is to the best of my knowledge and ballet,awe and correct representation,of a field survey performed under my LEGAL NOTES direction.And also meets the Minivan Technical Standards as set forth by the Florida Board of Professional Surveyors and Mappers in THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP.EXAMINATION OF THE ABSTRACT OF chapter 5J-17.050 thru 5J-17.052 FA.C.pursuard to Section 472.027 TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS,IF ANY.AFFECTING THE F.S. PROPERTY.THIS SURVEY IS SUBJECT TO DEDICATION.LIMITATIONS,RESTRICTIONS.RESERVATIONS OR EASEMENTS OF RECORDS.LEGAL.DESCRIPTION PROVIDED BY CLIENT.THE LIABILITY OF THIS SURVEY IS LIMITED TO THE COST OF THE SURVEY.UNDERGROUND ENCROACHMENTS.IF ANY,ARE ARTURO R.TOIRAC P.S.M.3102 NOT SHOWN.THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTING ANDIOR FOUNDATIONS AND/OR UNDERGROUND IMPROVEMENTS OF ANY NATURE.IF SHOWN BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN.IF SHOWN ELEVATIONS ARE REFERRED TO N.G.V.D.OF 1929 THE CLOSURE W THE Not valid without the signature and the original embosed sea]of a BOUNDARY SURVEY IS ABOVE 1:10000 Florida Licensed Surveyor and Mapper. LEGEND AND ABBREVIATIONS JOB No. /4022 I =CENTER LINE FD. =FOUND IRON PIPE TYP.=TYPICAL ENC. =ENCROACHMENT AC =AIR CONDITIONED UNIT P/L =PROPERTY LINE O.H.L.=OVERHEAD UTILITIES .0P=ELEVATION C.B.S.=CONCRETE BLOCK STRUCTURE RES. =RESIDENCE MIL =MONUMENT LINE (C) =CALCULATED R =RADIUS CONC.=CONCRETE W.M. =WATER METER R/W=RIGHT OF WAY (R) =RECORD A =ARC DISTANCE 0 =DIAMETER U.E. =UTILITY EASEMENT C.L.F=CHAIN LINK FENCE (M)=MEASURED C.B.=CATCH BASIN D.M.E.=DRAINAGE MAINT.EASEMENT P.C.P.=PERMANENT CONTROL POINT W.F.=WOODEN FENCE CL.=CLEAR B.C.=BLOCK CORNER I.F. =IRON FENCE P.O.B.=POINT OF BEGINNING MIAMI• AMME MIAMIDADECOUNTY mn�� L PRODUCT CONTROL SECTION DEPARTMENT OF REGULATORY AND EC ) 11805 SW 26 Street,Room 208 BOARD AND CODE ADMINISTRATION DI I T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE www.m1am1dedegff/eeonAm_j Florida Window Systems,Corp. 7191 NW 77 Terr. Medley,FL 33166 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami-Dade Coups.RER - Product Control Section to be used in Miami Dade County and other areas where allowed by tea Authority...... Having Jurisdiction(AHJ). : This NOA shall not be valid after the expiration date stated below.The Miami-Dade E;WAy Proclaet Control.... • Section(In Miami Dade County)and/or the AHJ(in areas other than Miami Dade Cbtht f)reserve the right;. to have this product or material tested for quality assurance purposes. If this product or mateffif Fails to' perform in the accepted manner, the manufacturer will incur the expense of such tejcj and the AVJ may* • immediately revolve,modify, or suspend the use of such product or material within jh*jurisdit1ton.;RER; reserves the right to revoke this acceptance, if it is determined by Miami-Dade,CQuuW Product.Control �• Section that this product or material fails to meet the requirements of the applicable buirdidg coda. 6696:0 This product is approved as described herein, and has been designed to comply Njith the Florida$uilding� 6•• Code,including the High Velocity Hurricane Zone. •9 . :**a • DESCRIPTION:Series"FWS-300"Aluminum Horizontal Sliding Window-L.M.I. #S o APPROVAL DOCUMENT:Drawing No.W07-80,titled"Series FWS-300 Alum.Horiz.Sliding Wdw. (I..M.I.)",sheets 1 through 7 of 7,dated 10/15/07,with revision A dated 03/05/12,prepared by Al-Farooq Corporation,signed and sealed by Javad Ahmad,P.E.,bearing the Miami-Dade County Product Control Renewal stamp with the Notice of Acceptance number and expiration date by the Miami-Dade County Product Control Section. MISSILE IMPACT RATING:Large and Small Missile Impact Resistant LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state, model/series,and following statement: "Miami-Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials,use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales,advertising or any other purposes shall automatically terminate this NOA.Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed,then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to-the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA#12-0315.08 and consists of this page 1 and evidence pages E-1 and E-2,as well as approval document mentioned above. The submitted documentation was reviewed by Manuel Perez,P.E. NOA No.13-0402.01 II bo�ADE CCl! Expiration Date: May 01,2018 Y-61111 5 Approval Date: May 16,2013 Page 1 r Florida Window Systems,Corp. NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Manufacturer's die drawings and sections. 2. Drawing No W07-80,Sheets 1 through 7 of 7,titled"Series FWS-300 Alum.Horiz. Sliding Wdw.(L.M.I.)",dated 10/15/07,with revision A dated 03/05/12,prepared by Al-Farooq Corporation,signed and sealed by davad Ahmad,P.E. (Submitted under previous NOA#12-0315.05) .... . B. TESTS .006 0600•0. 0 1. Test reports on: 1)Large Missile Impact Test per FBC,TAS 20JR40, 0,6.6: 0 0 0,:0 2)Cyclic Wind Pressure Loading per FBC,TA&203.94 0 0 0 along with marked up drawings and installation diagram of an glvmqum h9rizgtal •••••• sliding window,prepared by Hurricane Engineering&Testing,nfe,Test R di't No. 09:0% HETI-07-4417 dated 12/13/07 signed and sealed b .V0 Candido P.Fi. 66:0 0 00... (Submitted under NOA#07-1025.09) 0..... 0 0 2. Test reports on: l)Large Missile Impact Test per FBC,TAS 211-94 - ;...:. 0000:0 2)Cyclic Wind Pressure Loading per FBC,TAS 205M 0 :0000: along with marked-up drawings and installation diagram of an aluminum hori�orital 0 sliding window,prepared by Hurricane Engineering&Testing,Inc.,Test Report No. HETI-OS-1944,dated 12/13/07,signed and sealed by Candido F.Font,P.E. (Subutltted under NOA#07-1025.09) 3. Test reports on: l)Air Infiltration Test,per FBC,TAS 202-94 2)Uniform Static Air Pressure Test,Loading per FBC TAS 202-94 3)Water Resistance Test,per FBC,TAS 202-94 4)Forced Entry Test,per FBC 24113.2.1,TAS 202-94 along with marked up drawings and installation diagram of an aluminum horizontal sliding window,prepared by Hurricane Engineering&Testing,Inc.,Test Report No. HETI-05-1439,dated 12/13/07,signed and sealed by Candido F.Font,P.E. (Submitted under NOA#07-1025.09) C. CALCULATIONS 1. Anchor verification calculations and structural analysis,complying with FBC-2004, prepared by AI Farooq Corporation,dated 10/17/07,signed and sealed by Humayoun Farooq,P.E. (Submitted under NOA#07-1025.09) 2. Glazing complies with ASTM B1300-04 D. QUALITY ASSURANCE 1. Miami-Dade Department of Regulatory and Economic Resources(RER) Mansel Pe E. Product Control 19kamAer NOA No.13-0402.01 Expiration Date: May 01,2018 Approval Date: May 16,2013 Florida Window Systems,Corp.. NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED E. MATERIAL CERTIFICATIONS 1. Notice of Acceptance No. 12-1231-08 issued to Eastern Chemical Company(MA) for their"Saflex CP--Saflex and Saflex HP•Composite Glass Interlayers with PET Core"dated 03/28/13,expiring on 12/11/18. 2. Notice of Acceptance No. 12-1231.10 issued to Eastern Chemical Company(MA) for their"Saflex Clear and Color Glass Interlayers"dated 03/28/13,expiring on 05/21/16. .e.0 . . 0000 0000.. F. STATEMENTS 1. Statement letter of conformance,complying with FBC-2010,add U"do finaddiat' ••''•• interest,dated February O1,2013,signed and sealed by 7avad P.E. 0000 :0000 0900 sees 96.e0 0000.. G. OTHER s 00. 1. Notice of Acceptance No. 12-0315.08,issued to Florida WindoW Systems, o0000 00rp for ••••;• their Series"FWS-300"Aluminum Horizontal Sliding Windoq appeqed on e• 06/07/12 and expiring on 05/01/13. •••••' . . 0000.. 17,.. 0000 Manuel Perez, Product Control ExadqUV NOA No.13-0402.01 Expiratton Date: May 01,2018 Approval Date: May 16,2013 E-Z i 76 111 1/4' •••• �V 4W1 Y!l'AO1N 996V� 11 • • SSSS ••• 13 1/8'HA& • ZZ • 13 1/Y MAXW!D • • • O • a'VOL 9069 ""n • B'W1' FA�SH{'IaAOtts 0.WDG • •••• W ••• 8'ALOL (p�161U�' • •••• Sege y f• • 0000 00 4 IE$ • A D o is 1,, 9 � � •aas -an ••- • � ••• b � $ � as � �J � S 0 � ��� a ••g�a • � d�� • yy d s • • auaagpaeav .a o —aa�vanc oa -- =n 000 uu & SSSS• • � • • 33 11r 33 IN 33 71W ILL • 6 u O E 8 ° • • � • •g• 331/8' as of b 37 I/e i F�-Soo • ASSrLttum►A aoHtzorrrAL• .mnv__� a wamow � DOMN LOAD REM FOR THOW IMMOSS m BE AS PER CWVMSH MON S10EM Z A3. e APPFOX APPLES To$MSE LOOM LO SOM Of SIDE Q OOHS OF Ha,/"OR RORRMtM.SLIDMO 8181 O*Ot DOD Matvgw Q 8DIDG8 ITM OI 1 10 OF IM OR 1HRE 8HOxi5S ISMO a=+fteAaODIwFmd& 10A18-UM=DOY APED a8ALH3s M fit. �4a16� LOWER DMN PRgsS=FRM L9 MM OR MUUM APPMAL WILL APPLY m ENDRE SAQM L M= WAS r 0@t 9 Atm LESIlI W 0018411 LOIH lls oP iNE Ft01a0a Wm�m uoE O•,93mOm IWaI W3oCOY HLQUMM ZMM ORIAIL $ MW BLUS AAS sauLOADS to JW 8rta+c� I�IPM VACM As 9/0oe1 aR ISUIaS.A 71OSSE 81�AS ARE RN®NR IARC 1658E RWAM. 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MIAMNDME MIAMI-DADECOUNTY PRODUCT CONTROL SECTION DEPARTMENT OF PERMITTING,ENVIRONMENT,AND REGULATORY 11005 SW 26 Stret,Room 208 AFFAIRS(PERM Miami,Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (NOA) wwR►.mlamldade.aavrpera Pino's Window Corporation 6860 NW 77 Terrace Medley,FL 33166 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials.The documentation submitted has been reviewed and accepted by Miami-Dade County PERA- Product Control Section to be used in Miami Dade County and other areas where allowed by thezAarity ...... Having Jurisdiction(AHJ). •• •• This NOA shall not be valid after the expiration date stated below.The Miami-Dade d31wgty Pradudt-ControJ...% Section(In Miami Dade County)and/or the AHJ(in areas other than Miami Dade'Atty)reserve,the right to have this product or material tested for quality assurance purposes. If this preail8f or maWd?fails t® 0 • perform in the accepted manner, the manufacturer will incur the expense of such t2stin and the mu mar:•• immediately revoke, modify,or suspend the use of such product or material within,Q&sdie ofi•PERA ego reserves the right to revolve this acceptance, if it is determined by Miami-Dade Cwtity Produgt bontrU Section that this product or material fails to meet the requirements of the applicablebuitdiag cods. **Go:* This product is approved as described herein,and has been designed to comply wit%the.FloridaUt ildung Code,including the High Velocity Hurricane Zone. '• • DESCRIPTION:Aluminum Tube Mullion—L.M.I. •0 APPROVAL DOCUMENT: Drawing No.M95-18A,titled"Aluminum Tube Mullions",sheets 1 through 4 of 4,dated 12/07/1995,with last revision D dated 02/20/2012,prepared by Al-Farooq Corporation,signed and sealed by Javad Ahmad,P.E.,bearing the Miami-Dade County Product Control renewal stamp with the Notice of Acceptance number and expiration date by the Miami-Dade CountyProduct Control Section. MISSILE IMPACT RATING:Large and Small Missile Impact Resisthnt LABELING:Each unit shall bear a permanent label with the manufactute?s name or logo,city,state, model/series,and following statement:"Miami-Dade County Product Control Approved",unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials,use,and/or manufacture of the product or process.Misuse of this NOA as an endorsement of any product,for sales,advertising or any other purposes shall automatically terminate this NOA.Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT:The NOA number preceded by the words Miami-Dade County,Florida,and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed,then it shall be done in its entirety. INSPECTION:A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA#08-0514.10 and consists of this page 1 and evidence page E-1,as well as approval document mentioned above. The submitted documentation was reviewed by Carlos M.Utrera,P.E. NOA No.12-0314.02 acaut Expiration Date: Marcie 28,2017 Approval Date: July 12,2012 0119*1140, Page 1 PhWs Window Corporation NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Drawing No.M95-18A,titled"Aluminum Tube Mullions",sheets 1 through 4 of 4, dated 12/07/1995,with last revision D dated 02/20/2012,prepared by Al-Farooq Corporation,signed and sealed by Javad Ahmad,P.E. B. TESTS "Submitted under NDA #08-0514.10" 1. Test reports on 1)Uniform Static Air Pressure Test,Loading per FBC TAS 202.94 2)Large Missile Impact Test per FBC,TAS 201P94.'. •••• •••••• 3 clic Wind Pressure Loading FBC,TA •' }Cy gQ�:p4 0000.. 00 along with marked up drawings and installation diagram of AlummUm.Fixed . • Windows Mulled Together,prepared by Fenestration Testing Lgberatory,ToOlReport:"": No. FTL-5562,dated 03/29/2008,signed and sealed by Carlos S:Rfonda,P%e.• 09:00" 00.00. 6666 60646 0000.. . 6• C. CALCULATIONS • • 0000.. 1. Anchor and mullion calculations,prepared by Al-Farooq Corporati6on., dates••• %see. 01/30/2012,signed and sealed by Javad Ahmad,P.E. 00 64 . 00 . 4 00 "Submitted under NOA #07-0322.12" 2. Anchor and mullion calculations,prepared by AI-Farooq Corporation.,dated 02/24/2007,signed and sealed by Humayoun Farooq,P.E. D. QUALITY ASSURANCE 1. Miami-Dade Department of Permitting,Environment,and Regulatory Affairs(PERA) E. MATERIAL CERTIFICATIONS 1. None. F STATEMENTS 1. Statement letter of code conformance to 2010 FBC and no financial interest issued by AI-Farooq Corporation,dated 01/30/2012,signed and sealed by Javad Ahmad,P.E. "Submitted under NOA #08-0514.10" 2. Laboratory compliance statement issued by Fenestration Testing Laboratory,Inc., dated 03/29/2008,signed and sealed by Carlos S.Rionda,P.E. ?P� ypl2 Carlos M Utrera,P.E. Product Control Examiner NOA No.12-031402 Expiration Date: March A 2017 Approval Date: July 12,2012 E-1 .� �PRS .... .... •; ANGLE d IP(0w7-78) e¢�1• •••• �' d • rdpmFL • •CLIP Lo • • • 30.Qs volowr•a •• •• •• •LT •• aaw • • • • • • • ••• • ••so 0000 • •••• MULLIONS IONS COMAINMO TMCA GLAZING PROIYICTS IR7LLION CLIP LEGS ftE1d6VED $ . 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ILIIt. d• 1 ANCHM TYPE'A2' T. 012IIiOL TWA 1 1 PA a ou slot 1aL roue • - (1)a LPP021R Sw 1 1 g 1 1 1 I ANCHOR DETAIL /) A y �® 1 �'� 1 1 Iv1AlaY1M f1Y''n M'V.177 aR F"Im 160 66 11tt MR)2BYWAPDOD SLACKS OR MOOD SIRUCiURES 2 z 2 z t/!1' 1 2 AXU2 IA ' 1-318 VIN.PDORPOI IN INTO ROOD �pwjcr� aliLl wIC16 /tt 81L6 Iain N1AC TIRU 1DY&7X6 OW COMC.OR MASONRY �!!MJ_tij�r2Ydi _ __—___� I 2/Iri®E ; __1 ___ 1 7✓I116IE 1-1/4 MOi.EMBED BOO COMO.OR MASONRY t l 11M. 1 I I IM I +i 1 "mm NOES TO 'i 1 IIOIW I.nzi 10 1 I 1 MM•2 SLE 'I 1 WMIE SILL Oow CORCRM AND MASONRY-2-1/r MIL y 1 1 a 12n 1 1 1 on INA ROO HOOD SR11c RE V MOI. . 1 KW METAL SIRUCIOItE m S/w hoL .. . ... --. : . r 4 1-304• 1727 "m"16 NOT BY PR7o wn s Y95-18A • ref GtlL • - ! f cam i-,/Y IR O® 9C ,/p®g SLE I/rcl[ MUST SUSfNN LMDS OPOS�. ahM 4 SCALE In=2(r &OCK-3 BLOCK LOT-6 d j BLOCK-3 Owe LOT- 7 4%1 LOT-C 75.001(R)s(M) rip. sbb gq /0 .Va.u. WT- 129q !47, ,Mfg L ONE STORY LOT-9 Ras.3f.9425 ixocK-3 A F.FB%-. 13.47' 9 LOT- I I C Sam tq L J1 MOV U) 41 K 14.87 "n 3DOO q PP. 1WA*4 P 7 4, 75.00`(M (M)' 70 g• el ........ .. .. NW 2nd Ct. 5a TonqwVY 51 '�V4^ L S 4-T KAJ. A NO OBJECTION Florida Health Miami-Dade County O.S.TD.S. & Well Program Application No - I Y- Date: d0j I Signature Lo r U.S.DEPnRTMENTOFHOMELAND stcURrry ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood insurance Program Important: Read the instructions on pages Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name ELITE HOME PARTNERS LLC Policy Number. - A2. Building Street Address(including Apt,Unit,Suds,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number. 9425 NW 2 COURT City MIAMI SHORES State FL ZIP Code 33150 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,eta) LOT 10,BLOCK 3,ODELL MANORS,PLAT BOOK 41,PAGE 57 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:LaL 25°51'42.09"N Long.80012'07.73"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. AT Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 1095 sq It a) Square footage of attached garage WA sq it b) Number of permanent flood openings In the crawispace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 That above adjacent grade 10 within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 1564 sq in c) Total net area of flood openings in A9.b WA sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name 8 Community Number B2.County Name 63.State VILLAGE OF MIAMI SHORES 120652 MIAMI-DADE FLORIDA -7 B4.Map/Panel Number 85.Suffix I B6.FIRM Index DateB7.FIRM Panel B8.Flood B9.Base Flood Elevations)(Zone 12086C 0302 L 09-11-09 rEfbcttv~sed Date Zone(s) AO,use base flood depth) 09-11-09 X WA 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FiS Profile ® FIRM ❑ Community Determined ❑ OthedSource: B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: 812. Is the building located Ina Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No Designation Data:WA ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. 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 AT In Puerto Rico only,enter meters. Benchmark Utilized:g N-568 ELEV=9.65' Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. IR 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) 11.20 ®feet ❑meters b)Top of the next higher floor 13.47 ®feet ❑meters c)Bottom of the lowest horizontal structural member(V Zones only) NIA ❑feet ❑meters d)Attached garage(top of stab) NLA ❑feet ❑meters e)Lowest elevation of machinery or equipment servicing the building VA. ❑feet ❑meters (Describe type of equipment and location In Comments) Q Lowest adjacent(finished)grade next to building(LAG) 11.�Q OR feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) 11.50 ®feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs.Including structural support WA. ❑feet ❑meters SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification Is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.i ca:rtfly that the infomration on this Certlilio to 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 CftWs Name ARTURO R TOIRAC License Number 3102 _ - Title LAND SURVEYOR Company Name 16 Address 14317 SW 45 TERRACE City MIAMI State FL ZIP Code 33175 Signature Date 02-13-14 Telephone (305)552 7504 Cit - FEMA Form 086-0-33(7112) See reverse side for continuation. Replaces all previous editions. _ r -IMPORTANT:In these spaces,copy the c--asponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt,Unit,Suit.,.,nd/or Bldg.No.)or P.O.Route and Box No. Policy Number. 9425 NW 2 COURT City MIAMI SHORES State FL ZIP Code 33150 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 CROWN OF ROAD ELEV.= 11.76' LAT/LONG OBTAINED BY GPS Signature Date 02-13-14 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 Was to show whether the elevation is above or below the highest ad)acent grade(HAG)and the lowest ad)acent 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) ❑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 to al 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 Owners or Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments 0 Check hare 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 ftem(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 communkyy--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 G8. Date Certificate Of Comptlance/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 CA' . BFE or On Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum 1310.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Community Name Telephone Slanature Date Comments ❑Sieh ck 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. 9425 NW 2 COURT City MIAMI SHORES State FL ZIP Code 33160 Company MAIC Number If using the Elevation Certificate to obtain NFIP flood insurance,aft at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken;"Front Uel'and"Rear Vie*% 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 AS.If submitting more photographs than will fit on this page,use the Continuation Page. "Front Vieve Date: 02-13-14 "Rear View"Date:02-13-14 IN Am A Z -10 5M 31 YF4 k 41 SWlk "Additional Front View" Date: 02-13-14 "Additional Rearview"Date:02-13-14 'R 'a rg", r4p V, AN I ww�mlll 4 0 KTI FEMA Form 086-0-33(7112) Replaces all previous editions. Phone:(305)552-7504 �,� 14317 S.W.45th Teff. Fax:(305)221a-eM Professional Land Surveyor 81 Mapper Miami,Florida 33175 PROPERTY ADDRE55: 9425 NW 2nd Ct. Miami 5hores, FL.33150 LEGAL DESCRIPTION: Lot 10, Block 3,of O'DELL MANOR5,according to the Flat thereof a5 recorded in Plat Book 41,at Page 57,of the Public Records of Miami Dade County,Flonda. SKETCH OF SURVEY (Boundary Survey) SCALE 1"=20' &OCK'3 BLOCK 3 a BLOCK-3 LOT B d LOT-7 d HI LOT-6 !rrlr. parr. s9.5.T o PA N. ss.ea ro rr.ra � 4'C-F. BLOcx-3 LOT 10 V"F. way sled 2s.la � aas• ��� o NIl l owe5TORY X� BLOT-93 $I Res-if 9425 BLOCK 3 FF-5dw 13.47 LOT- 1 t 9.9C 20.20 yn .yj PO�B1 /9.00' 8 11'J 14.9V /6.eT o a a e 75.00'() (M) ° 3'Caw u $ ca lr.sarA*Aay 't NW 2nd,(. ' CC. ITATylWLP�— 50' TOTAL R/41 -- NOTE: ELEVATION5 ARE REFERRED TO MIAMI DADE COUNTY BM9 N-568 ELEV.—9.65'OF N.G.V.D.OF 1929 BASED ON THE FLOOD INSURENCE RATE MAP OF THE FEDERAL EMERGENCY AGENCY PATE OFFMO WORK Feb. /3,2014 CERTIFIED TO: REVISED ON j-:�THE HEREIN DESCRIBED PROPERTY IS 89UADED WmiIM NOMI PARTNERS LLC ZONE X BASE FLOOD ELEV. WA CDMMLjNmr NUMBER:/20652 Iduamw peDeMbmmaemna� ma�lmm.-tme PANEL NUMBER_ 0302 SUFFIX L OWN.Ow"o-WI .m-me,Y--Ta1�NNm+ar-e 0 0o0 LEGAL Nam AW.ft POHe IMMimmT.&AWS aW mAM N 0m Hama EevN of PNmuleM OtOMtepPNO m 7108 EORV,!=NDTIUWIECTORC&T W KE .MWMATWNOPTH8AWWACTCF WgmN.F17.0700W ML1T,pS2 FA.C.pmgw11m8egbp�TtN7 T1118flOL NA VETO8""DETOWTERMN REWI I W8 FRLWWE,E•ANV.AFFW=THE F.S. PROPERTY.YM MOtMY DI M B.ECT T0019XCATMN.LDCTATtCNB.RMiTWCifONB,iI�MtyATtOHE OR EAEEM@N1E OFRECCROS.IEWL CEBCFQ•IIWiPROgDEDBYCLO'M.OIE LUIPoLHYOF 1HB ✓�/3✓L(� SURVEY IS Lamm TO Die COST OFTHE away.UasRaR 1PMENCRac"A"S.WANY.ARE Y NARTURORTOIRAC PJLNN.STLQ ORa90tYv.M8 PEDIHASNOTAT7l�O70LOCATBFCOfWONUMPaRMATWFOAImOR UCERGROUMDWROVM@RSOFANY KARA .IF$HUMGMRRMARE RIFORMTDAN ASSUMED MOMUN(F MEVATG7NSARSREFMEEOTO NAND.OP ISH THE Q0SWHWTHU HHr®OrMaq um HHYLtla.0 failpfnm=6.w"w to BOURDMY aW11EY EABD$1:10000 FlmiOe LmweO 8OI11TOIBGC N0T00t. LEGEND AND ABOREVIATIM JOB ND.140221 -CENTER LINE FD. =FOUND ICON PIPE TYP.-TYPICAL ENC.-ENCROACHMENT AC -AIR CONDITIONED UNI' M ft =PROPERTY LINE O.H.L-OVERHEAD UTILITIES -ELEVATION C.B.S.-CONCRETE BLOCK STRUCTURE RES.-REBMENCE MIL-MONIMNENr LINE (C)o CALCULATED R -RADIUS CONC.-CONCRETE WAL-WATER METER RIVE-RIGHT OF WAY (R)-RECORD A -ARC DISTANCE a -DIAMETER U.E. -UTILITY EASEMENT C.LF.=CHAIN LINK FENCE (M)"MEASURED C.B.-CATCH BASIN O.M.E.=DRAINAGE MAINT.EASEMENT P.C.P.-PERMANENT CONTROL POINT W.F.-WOODEN FENCE CL-CLEAR B.C.-BLOCK CORNER LF. -IRON FENCE P.O.M.POINT OF BEOwNw. STATE OF FLORIDA PST , DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS wa n APPLICANT: t,� e �o�ne `i"a.��Yt2a s AGENT: l'L/� Gas -� --� �-►�. LOT: l o BLOCK: -3 susDIVISION: ��� 1 Ala No rs PROPERTY ID #: i � r 3 �O o► .7 - 0 3 [Section/Township/Parcel No. or Tax ID Number] TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMLNT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLPA: [\10 YES [ ] NO NET USABLE AREA AVAILABLE: 0' i'1 ACRES TOTAL ESTIMATED SEWAGE FLOW: n06 GALLONS PER - /OTHER-TABLE21 AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD/ACRE OR SOD UNOBSTRUCTED AREA AVAILABLE: � SQFT UNOBSTRUCTED AREA REQUIRED: sQFT 1 BENCHMARK/REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS N /FT] [ABOVE LO BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PkOPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: N er- FT DITCHES/SWALES: /J V7-- FT NORMALLY WET? [ ] YESNO WELLS: PUBLIC: FT LIMITED USE: FT PRI TE: 0 N-FT NON-POTABLE:��FT . BUILDING FOUNDATIONS: ✓cf FT PROPERTY LINES: � FT POTABLE WATER LINES:—J--I FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [A NO 10 YEAR FLOODING? [ ] YES pe-) NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MS /NGVD SITE ELEVATION: {( '� FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE DEPTH MUNSELL #/COLOR TEXTURE �EPTH To o � > s � y 61A az + loge 514 9l� Sa"a ,e �'� To TO TOtjl,e) Lq561tc .2 If 4 To lc>Ljie 5414- TO TO TO TO TO USDA SOIL SERIES: ' J tUSDA SOIL SERIES: _ OBSERVED WATER TABLE INCHES [ABOVE / BE , EXISTING GRADE. TY ,�PPAREI ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES �a NO MOTTLING: [ ] YES [�p NO DEPTH:__L 'A=CHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: b '�,. DEPTH OF EXCAVATION:_ INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [)d BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: DATE: 61 t(-,1, 4 DS 4015, 10/96 (Replaces MRS-H Form 4015 [page 31 which may be used) Page 3 of 4 _ r STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENTDISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION APPLICANT* Ne P -Cl. %. CONTRACMR f kAr Cg, fUL q\i1.�~Yj,-'s,, 4- lCJ LOT: ._ BLOCK: `^- ° SUBDIV: °--� i i , " t •(° i. x V 4 TO BE CCMVnZT= BY FLORIDA REGISTERED ENGI R, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSCM. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. CONPLETE, ALL APPLICABLE ITEMS. COMPLETE CERTIFICATION BELOW OR NOTE IN S My THE TA14KS CANNOT BE CERTIFIED. EXISTINGTANK --LTIO GALLON •1�'T�IC GPD ATU LEGEND: �`1 MATERIAL: ' FLED: EY f tGALLONS SEPTIC '1' /GPD ATU LEMATERIAL: FLED: [Y j N] E ] GALLONS GREASE INTERCEPTOR LEMATERIAL: tGALLONS DOSING TANK LE MATERIAL: # PUHPS: [ I CERTIFY T H AT THE LISTED 1dL9 a- / If l By 1THE ticrj a VO S SPECIFIED AS BY--T` NSION.8 / FILLING f LEGEND1rARE FREE OF OBSERVABLt DEFECTS OR iS, E CTT D . ET FILTER QCT; ] INS SIGNATURE OF L 456NTRACTOR BUSINESS xpbm DATE ISTING DRAINFLD INFORMATION t 3001 SQUARE FEET PRn4Wy DR&nWIELD SysTEM No. OF TRENCHES [ ] D SIONS: �'� x !� I ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: x TYPIC Or SYS [ T STANDARD [ ] FILLED [ ] 1,0 t i CONFIGURATION, CH BED [ ] DESI : C ] HEADER D- t CITY SYSTEMt i DO SYSTEM E TI OF BO OFD IELD IN RELATION EXISTING GRADE INCHES [ ABOVE / LO _ SYSTEM FAILURE AND REPAIR INFORMATION t 1 135 1 SYSTEM ntsvmLATiom DATE TYPE OF WASTE t i .DCbdESTIC t ] COMMERCIAL C ] GPD EST3MTED SEWAGE FLOW BASED ON [ ] METERED WATER TABLE 1, 64E-6, FAC; SITE t i DRAINAGE STRUCTURES [ ] POOL C ] PATIO / DECK tjC] P G CONDITIONS: [ ] SLOPING PROPERTY t ] NATURE OF t ] RAUI.xC O t ] OI [ ] CE t ] SYS a'M FAILURE. t / OFF' C i S t ] > , C ] FAIT. t GE OAt GR [ ] t ] D EO /SER t ] D INFIELD S C : [ ] PLUMBING BACKVPt ] REMARKS/ADDITIONAL CRITERIA ' { "' ) L^- : C7 LA) SUBMITTED BY: TITLE/LICENSE 0cp P DATE: t ' ; i t DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 648-6.001, FAC Page 4 of 4