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BPP-15-1664 r , Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-258279 Permit Number: BPP-7-15-1664 Inspection Date: May 05, 2016 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Dacquisto, David Inspection Type: Survey Final Owner: TAVARES,TIERES Work Classification: New Job Address:10050 NE 12 Avenue Miami Shores, FL Phone Number (305)244-2356 Parcel Number 1132050190370 Project: <NONE> Contractor: ROSMEL POOL INC Phone: (305)592-7900 Building Department Comments NEW POOL& DECK Infractio Passed Comments INSPECTOR COMMENTS False Passed Inspector Comments l./" l 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 May 05,2016 Page 1 of 1 PREPARED BY: u I"E; A Land Surveyors,Inc. w www.exactaland.com Toll Free 866-73s-1916• F 866.744.2862 f PROPERTY ADDRESS:10050 NE 12 AVENUE MIAMI SHORES,FLORIDA 33138 SURVEY NUMBER:FL1502.0707-02 FIELDWORK DATE:sm/=6 REVISION DATE(S):(REVA 5/4216) (REV.3 5!3/2016)(REV2 5/3/2016) (REV.1 5/3/2016) N.E. 1015T STREET FL15020707-02 10 PIP BOUNDARYSURVEY NO ID / M14MOADECOUW o 0 0. NOT-f5: $ 5ETBACK INFORMATION BY MIAMI SHORES VILLAGE S SS e BOT 1 177 112'PIP LOT APPEAR5 TO BE SERVICED BY CITY WATER AND 5EWERS6g S j�'Q�S NO ID FENCE OWNERSHIP NOT DETERMINED ,. O' S�2°���F @ P.C. 5'ACCE55ORY 5.B.L. I/2'PIP slyF d of � J L 1/2'PIP NO ID , 8s2�(MJ °� 3 < C O G II 1 W. j0J d ?sem LL: .r '9 15'ALLEY 0.s&N j I7337 r4 SB � C LB -----78_59------� < cs J 1 "4 s �: Q I 1 , 112, IR @ 5'W NO ID LOT l 6 w� 1 0 r . L LL: LL I $�, �� e / ^, j BILK 177 1LA bo / Q If Sp �°�° THE WEST 5'of i LOT 15s C /r 51-K 177 0.e°� 1 a W W LL. I- Br Z 1 � 0 W Imo-• REMAINDER OF 1 O (r} ® U C -� LOT 15 1 Z (3 i LOT 1477 177 Z ® C 13M177 (NOT INCLUDED) 106. Gro) 5IRC —J LW3337 G2 a N U ( ------------ Gl L=136.54(P)136.54(M) R—245.00'(PdM) A=31 5551(P)3l°555/(M) L=52.42'(P)52.66(M) 5 49°1238°W, 134.76YP) e=12°153 '09 5YP)l2*19 °(M) S49°/238°W, 134.78(M) AB N 27°06'55°E 52.32(P) Ll 99.42'(P) N 26°532/'F.52.58'(M) 5 21*0519'W 99.13'(M) ®��c SE r8 N.E. I O l ST STREET , L2 5 89°52�10° E 5.2G(M) l hereby-rll/y this B6/ deq ofthe hereon _ L3 62.I T±(P) desabW u dlrectlon, N 20°48'20°E 62.16'(M) and to the l ,Rise bue and accurate n rrve meets the / Standards of y the Board of Professional peers rapter5,1-17ofthe 40 0 20 40 FMrida Admin a N KITH A BTEPHENSON GRAPHIC SCALE (In Feet) 66te of Fbrlde Pro6seonaI 6mveyor end Mapper 1 inch = 40' ft .. , Limse No.6621 Ikeo1ThisSmiwrmvurPoseaaumtmn immnded,vviu uaWrittenVeffWton.wm be attre Uwe sole M*andWUhou[UWOWmmasurveym Nothhg hmean andi beC—Uued mGkeANY 1110to m Bert Po toArW*06Wdw 11 s CeMRed. FLOOD INFORMATION: POINTS OF INTEREST ' BY PERFORMING A SEARCH WITH THE LOCALGOVERNING 1.RESIDENCE OVER BUILDING LINE MUNICIPALITY OR WWW.FEMA.GOV,THE PROPERTYAPPEARS TO BE LOCATED IN ZONE X SHADED AND AE WITH A BASE FLOOD ELEVATION OF 8).THIS PROPERTY WAS FOUND IN THE VILLAGE OF MIAMI SHORES,COMMUNITY NUMBER 120652,DATED 09/11/09. 1 1 a a AFFILI CLIENT NUMBER: DATE:S/4/2016 , BUYER:BEYOND ALL REVOCABLE TRUST ' MEMBERS .............. SELLER: CERTIFIED TO:BEYOND ALL REVOCABLE TRUST = ACTA m q1 Land Surveyors, Inc. ➢.866.135.1 6•F.8*7442= This is page 1 of 2 and is not valid without all pages. LBO 7337 11940 Fatrwey Lakes Drive,SuHe Ft Myem FL 313 0 5 016 I BY: REPORT OF SURVEY FL7502.0707-OZ Th s is page 2 of 2 and is not valid without all pages. e 46 LEGAL DESCRIPTION: LOT 16,BLOCK 177,MIAMI SHORES SECTION 8,ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 43,PAGE 67,OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY,FLORIDA, AND THE EASTERLY 5 FEET OF LOT 15,BLOCK 177,MIAMI SHORES SECTION 8,ACCORDING TO THE PIAT THEREOF,RECORDED IN PLAT BOOK 43,PAGE 67,OF THE PUBLIC RECORDS OF MIAMI- DADE COUMY,FLORIDA,DESCRIBED AS FOLLOWS: BEGIN AT THE NORTHEAST CORNER OF SAID LOT 15 FOR POINT OF BEGINNING;THENCE RUN WEST ALONG THE NORTH LINE OF SAID LOT 15 A DISTANCE OF 5 FEET TO A POINT;THENCE RUN SOUTHEASTERLY PARALLEL TO AND 5 FEET FROM THE EASTERLY UNE OF SAID LOT 15 TO A POINT ON THE SOUTHERLY UNE OF SAID LOT 15;THENCE RUN IN AN EASTERLY DIRECTION ALONG THE SOUTHERLY LINE OF LOT 15 A DISTANCE OF 5 FEET TO THE SOUTHEASTERLY CORNER OF SAID LOT 15:THENCE RUN NORTHWESTERLY ALONG THE EASTERLY LINE OF SAID LOT 15 A DISTANCE OF 95.89 FEET,MORE OR LESS,TO THE PLACE OF BEGINNING. SAID LAND SITUATED LYING AND BEING IN MIAMI-DADE COUNTY,FLORIDA JOB SPECIFIC SURVEYOR NOTES: THE ASSUMED BEARING REFERENCE OF SOUTH 56 DEGREES 45 MINUTES 12 SECONDS EAST IS BASED ON THE NORTHEASTERLY PROPERTY LINE OF LOT 16,BLOCK 177,LOCATED WITHIN MIAMI SHORES SECTION 8,ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 43,PAGE 67,OF THE PUBLIC RECORDS OF MIAMI-DARE COUNTY,FLORIDA. REV SA-16 TO SHOW 5'WITNESS CORNER SET AT THE NORTHWEST CORNER GENERAL SURVEYOR NOTES: 1.The Legal Description used to perform this survey waswpplied byothms.This wrwydoes rot detumine or imply ownership. 2.This survey only shows improvements found abwewowxLUndagroundfoorings,uteitiesand encroachments are not located on this wrwy map. 3. Ifthereis a septictank.ordrain field shown on this surr f,thei«ation is appamamateasthe location waseithw shownto ExcubyathcdpmtyornwasesBmate<IbymetaiceWUm. probing rods,andvisual abowground inspection only.Noexcavation was performed in order to determine the exact and accurate location. 4.This survey isexdusively for the useofthe parties to whom it is certified 5. Addifionsordeletions wthissurvey map aril report by otherthan the sighing pmtyorparties is prohibited without written consentofthe signing party or parties. 6. D retsionsarernfartancidedmalsthereof. 7. Duawvatyirg catstnlction standards,housedimensionsare approsdmate. a. Any FEMABood mnedatacattarned on this survey is for informational purposes only.Research to obtain such daawas performed atwww.femagov. 9. Allcomersmadreciessetareatamfnbmsma R"dmmeter,l8"Ironrebwwahampstamped LBW337. IM Ifyou are reading this survey in anelectronic format,the information concerned on thisdocurrrentisonly nilid ifthisdo ument iseketronicaliy signed asspecrfie i in Chapter SJ-17.062(3)ofthe Flodda AdMnbuatiw Godeand FWda Sutute472.025.The Electronic Signature File related wthis document is prominently displayed on the invokefor this staveywhich is sentunder separate<ovec Manually signed and staked logs ofall survey signature files anakept in theofficeofthe performs g surveyonifthis document ism paper format, it is not valid without the stgnaturearid original raised seal ofa FlorrdaLkensed Surveyor. I t.Unless otherwise noted,an examination of the abstract of title was NOT performed by the signing surveyor to detenmirte which Inatiumerhts,Reny.are affecting tars property. 1ZThe symbols su reflected ah the and onthis survey may have beds enlarged orreduced for darhy.Thesymbols have been piotredat thecernerof the told location,and may not represent the acusal shape or rim of the frame. 13.Pointsofinterest(PCTs)are selected aboveground vnprovemersa which may be in conflict with boundary,building setback oreasemant lines, wdefined by thepammetersofthis stwey.Thera may beadditional POI'swhkh aranot shown,nota8edroutas POfs,orwhich arsotherwise unkrhowntodamrveym.Thm PW'smayrsotrepte tankemsofintereawthewewec 14.Utilities shown on thewbjectpropesty,mayor maytwt irsdr®tetheexrst oofre<orciedorunrecoded utility easements. IS.The infomation contained on this survey has been perfomud etdustrely,and isthesderespondbBity,of bracts Surveyon.Ackbonal logo or rafaresxesuthird partyfimtsarefor rnfonnab-1 purposesonly. 16.Psrsuar4w FS.558.0035,anindd[Wemploye magetnmeynotbeheldmdmduagy4ablefornegliger e. 17.Housemeeknxemena should not be used fornewconssruction wplannrng.Measuwments should be verified priorto such activity. LEGEND: SURVEYOR'S LEGEND UNMY•5:rw<aswmxaolm we AatcrormnrowxG ar. tD,,n ca— BPC. Sarna B.R RARING aL n PmwP W. Silmc W. BOOCCOWa7t raTr. WSTRI1k1eNt star. seats, f� .11 5aCK110w IT/HIfOR 9W WrG ons: CNI,aoR BR BOCx L 1EaY.M SPC Ser—,c0{CPP _ _ Buie,. BIWLWG IBI UCOtst a-BUBItS_49 9NID 9CFNM{DCtG BI BCCta1PFA t3I ➢CC19ee-SURVept tlwalla�aCwltflE tB!¢ BILL BIAILWG RCBiWLr[CN laO fA9 MCAAW[D SPI. S,0k,Pe8 etwr. BA9D.01I M.B. to a0Ck. S.TL SUWIPP108S IDGeQ WAIBt BW BAYAOMWeek- M.B.S. "T"eD@m9eCnON SV Stscai— f4 CNLt1UT® M.P. hQCALPtaxit S'M BICLWAV. 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GM GrV MPIBR 9CR 9CR®1 u.e. ,ri..nr Pns[uett ELECTRONIC SIGNATURE: PRINTING INSTRUCTIONS: OFFER VALID ONLY FOR: BEYOND ALL REVOCABLE TRUST Incompete arc«dWRevad,Floska Statsneanozs arm lk,—to 1.While viewing the survey in Adobe Reader select the the aecronit$19ntmre Mt o tela«Florida Smtu MRE xxxlx, •print button under the"FlIe"tab. Chapter W.if this document was recefwd ee,imnlCaliy Wa PDF, then it has been bwfully ElettronWily Signd.TI—sc,etnit coney - '•"1 IaDF.raulrMmlc is c«ndelely dhdalMd msvralxe.ln«der—Ikfsre 2.Selecta porter with legal sized paper. the'Beca Skii—e cPDFwweysser:twa cow,,.tan cora. 3.Urder"Print Range...click select the"Allt Ie I '' ' '"r ✓' you mun v'e a hash cilculat«A free hash calculator ie a 11sWe for D99 downbaa at 4.Under the•Page Handirng"section,select the number u I." - 1 of copes that you would like to print in ortlerro nrtdore[Iw ElttnonlC S'grotureolony survey ADFsmrvo wneysto¢c«n: 5.Under the•Page Scaling"selecnon drop down menu, I r.cwauoadu,erraancakssat«avalwse seletct•None" I �O/Q O zsavetne w,Iq DFonm ,ceniprhfi—wwwstaYevstarsc«n 6. Uncheck the'Auto Rotate and Center'dheckbm ff 1 1 (UP 70$500) «eontr e eman sentfmm www.wrvessrsc«n. 7.Check the•choose Paper size by PDF•checkbox. 3.Cllck the.euare D—limon in the uppe,right had—ofti» ANY FUTURE uta.nceN:us«wMdanaseknmeawd5unwv0F<bnmwrt.andd 8.Click OK to pant. vecawv E xaw mmew<r 9(a a<«a anew a wa«. row + I SURVEYINGSERVICES 4.Comrere the40diglt stNpo(Aaractxsinihe SFVw,MetatM40dfg[ I 1 1dwa<tersrorda wlwymuapbnle m.wm:.wwrnMuem vMwt 1.In the main print screen,choose"Properties". I ON THIS PROPERTY I ISNso gNrcd on the Irwice f«thatwney. 5.an iurtgtaagd9a>•i wractersmem zytnasama`nhC.Wgce 2.Change^Qufrom"A"oom theor"options. I oma_ y i«InDee,veyNeat.nw,snelswscomra.tlMyaremtl»wN+cnlnmtoc 3.Change from"Auto Color"or"Full Color"to t MtlY.FOF hautlp,Wc'.tl1he40diptt sbag C(dYrdCiersd08inot match ser.tnen[hh PDF nes been tamperer wlsn andnlsratamnennc. •Gray y fray Exacta Land Surve o,Inc,_ www.e actaala dcDm LrPM6-735-1916•R866.744-288] LBG 7337 11940 Fairway Lakes OrNe,Suite t•Fc Myers,FL 33913 iT Miami Shores Village V 4MPetrrtt � �� #1 )oowou uW 10050 N.E.2nd Avenue NE IMP � Iy Miami Shores,FL 33138-0000 - Phone: (305)795-2204 p Ex iratlon: 0 /03/2016 3 Iasus Project Address Parcel Number Applicant 10050 NE 12 Avenue 1132050190370 Miami Shores, FL Block: Lot: BEYOND ALL REVOCABLE TRU Owner Information Address Phone Cell BEYOND ALL REVOCABLE TRUST 10050 NE 12 Avenue (305)244-2356 (786)709-3909 - --- - --- MIAMI SHORES FL 33138- 10050 NE 12 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 45,500.00 ROSMEL POOL INC (305)592-7900 ...... _..__ Total Sq Feet: 700 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fence Date Denied: Final Type of Work:Swimming Pool Occupancy:Private Pool Deck Additional Info:NEW POOL&DECK Bond Return: Wall Steel Classification:Residential Scanning:4 Review Electrical Review Planning Review Planning Review Plumbing Review Building Review Mechanical Review Structural Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $27.60 Invoice# BPP-7-15-56208 CO/CC Fee $50.00 DBPR Fee $20.48 07/06/2015 Check#:12874 $50.00 $1,651.56 DCA Fee $20.48 08/07/2015 Check#:12936 $ 1,651.56 $0.00 Education Surcharge $9.20 Permit Fee $1,365.00 Plan Review Fee(Engineer) $160.00 Scanning Fee $12.00 Technology Fee $36.80 Total: $1,701.56 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing in ation is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the ab v na a tractor do the work stated. August 07, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent ate Building Department Copy August 07,2015 1 Miami Shores Village RECEWIF-D Building Department ��� o � �0�5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: 640:2= Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20j� ��• BUILDING Master Permit No. PE IT APPLICATION Sub Permit No. BUILDING F-'] ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I L-jo IYt 1). -p�Ne YeR E City: Miami Shores County: Miami Dade Z'io• 15119 Folio/Parcel#: ®i dl . D-2 .>-1 Is the Building Historically Designated:Yes NO I/ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1 IG'1�e_5 6.V QIe_S Phone#: Address: d -Ave- City:— o 0 A.Ajop(£"Z, State: Zip: 3a13C� Tenant/Lessee Name: I" i Q Phone#: Email: CONTRACTOR:Company Name: 12oner3e1 Poo 15 I rti, Phone#•_ v-5g,;Z-111003 Address: _ TSnLAS 1jNjLx3 "_-Ilk 3t ##- S"b City: D0 r"-1 State: f=j , Zip: 331 to 6 Qualifier Name: Wi r_—Vk)0. Unre_le— Phone#: State Certification or Registration#: e'2ce_ I L-i 5l Cly Certificate of Competency#: DESIGNER:Architect/Engineer:War�c4. V je4 rlfi✓ e_q a PE "l 1 lo-3 Phone#: 3CFzJ©!;-J-1 y% Address:_ 1514 H I SVJ c 2'R Tea-- City:Ai a1 State:_EL_,Zip: _630 Value of Work for this Permit: Ll n, 50® - Square/Unear Footage of Work: �?�I C7 56 'VT. 50 Type of Work: El Addition ❑ Alteration E] New ❑ Repair/Replace `� Demolition .VT' Description of Work: N e_"o iD 0'�:') �ee QL Specify color of color thru tile: Submittal Fee$ __g ,Permit Fee$ t0, CCF$ CO/�C$ 150 , (j�) Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ / Training/Education Fee$ Double Fee$ Structural Reviews$.,. 6Q cj;:�) Bond$ I�o 2— TOTAL FEE NOW DUE$ 1 5 (Revised02/24/2014) Bonding Company's Name(If applicable) N 1 Bonding Company's Address city State Zip Mortgage Lender's Name(if applicable)_� f Mortgage Lender's Address f� a A - —' 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 OBTI�IN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N TICE 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 certifled copy of the recorded notice of commencement must be posted at the job site for the flrst inspe hick occu even (7) days after the building permit Is issued. in the absence of such posted notice, the inspection wlll t be approve nd a reinspection fee will be charged. Signature Signature \ e�— OWNER or AGENT CONTRACTOR The foregoing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this a day of M►-te� ,20 S by day of _1 v o 1 Z- 2015 by `g c IQs—t S who is ersonally known �l i�� _ �JQ v I ca .who is ersonally kno Oto 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: Le Sign: Print: f c� ?_ ��� _ ri u. Print: �LJ ��� �-1 -. tea►®� Seal: eeaoR:.w• r Guz Heema A !n Seal: c.$1o%:4:ipPli Gf,-WZMHe!OleNWtT.F!AJmin9;0J5nPda , ^_ 4eoe°5eA' L1 uz�Helm Ar ;pnn2COMMISSION#FF01905^ =�• a' =�: -WD o�'e<EXPIRES: �dAY 19,2017 %�� ''t`'E{F,n is (SA(B 2017 :9 4- Bs � o WWW.AARONNOTARY.�v® �'"►,�uie�'° www.AARONNOTARY.60i1 :`,®�• o �` IP:'S: "''C'(19,2017 � r APPROVED BY / Plans Examiner L�„r l S Zoning Structural Review Clerk (RevlWd02/24/2014) l L • t OWB JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 3/21/2014 EXPIRATION DATE: 3/20/2016 PERSON: VARELA MIRTHA FEIN: 263013092 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC ROSMEL POOLS&OUTDOOR 8045 NW 36TH ST STE 540 DORAL FL 33166 SCOPES OF BUSINESS OR TRADE: LICENSED POOL CONTRACTOR Pursuant to Chapter 440.08(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this Becton may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.08(12),F.S.,Certlflcetea of election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.08(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure 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)413-1809 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 3/21/2014 EXPIRATION DATE: 3/20/2016 PERSON: MARTINEZ ALINA FEIN: 263013092 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC ROSMEL POOLS&OUTDOOR 8045 NWN 36TH ST.SUITE 54( DORAL FL 33166 SCOPES OF BUSINESS OR TRADE: LICENSED POOL CONTRACTOR-PROJECT CONTRACTOR MANAGER,CO Pursuant to Chapter 440.06(14),F.S.,an officer of a corporation who elects exemption from this chapter by fling a certificate of elealon under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.06(12),F.S.,Certificates of election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.06(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation M,at any time after the fling of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure 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?(85013-1809 JEFFFINANCR STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 3/2112014 EXPIRATION DATE: 3/20/2016 PERSON: MARTINEZ MARCOS A FEIN: 263013092 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC ROSMEL POOLS&OUTDOOR 8045 NW 36 ST STE.540 DORAL FL 33166 SCOPES OF BUSINESS OR TRADE: LICENSED POOL CONTRACTOR-PROJECT CONTRACTOR MANAGER,CO Pursuant to Chapter 440.08(14).F.S..an oifioer of a corporation who elects exemption from Otis chapter by MbV a cardficale of election under this section may not recover benadis or wmpertsawn under this diaptar.Pursuarrt to Chapter 440.08(12).F.S.,Cerdfkates of election to be exempt.,apply only within the scope of the business or trade listed on the notice of wooden en to be exempt Pursuant to Chapter 440.08(13),F.S..Notices of election to be exempt and certiflaates of election to be exempt shall be subject to revocation B,at any time after the filing of the notice or the Issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a cei tifice .The departnumi shad revoke a cwWb ale at any time for failure of the person named on the certificate to meet the requirements or tris sedlort. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-11309 n Miami shores V R1 ,s► Building Department 90050 N.E.2nd Avenue Miami Shores, Florida 33938 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Com ensation Insurance Exe tion Florida Law requires Workers' Compensation insurance coverage un allows corporate officers in the construction industry to exempt der Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if.- 1. f1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 2 day of "�" lle� By who is ILe sonally kno o me or has produced as identification. Notary: I %y ,�moo;EXMR S: SEAL: '°e�oF M1de`. e WWW.AAR0NNXRY=10 ROSIN ' MEL POOLS & OUTDOOR ENVIRONMENTS Date: P State of �7�0r eA C4, County of Before me this day personally appeared $-Vk!-t Vc�vd a who, being duly sworn deposes and says: He or she will be the only person working on the project located at: i ooso K):E la: Ave.. "I(Aml 15hotes,yl, 35%'5y Sworn to(or affirmed)and subscribed before me this day of �Su- ne201-5 by VInG On air, Personally known Or produced identification Type of Identification produced 3•: .� Print,Type or St M� W019058 9,2017 8045 NW 36 Street-Suite 540 Doral- FI 33166 Sales 305-592-7900 tnWw.AAHorYtmor�r... Fax 305-592-7997 www.rosmelpools.com CPC-1456804 Property Search Application-Miami-Dade County Page 1 of 1 OFFICE OF THE PROPERTY APPRAISER Summary Report Generated On:3/27/2015 Property Information F' Folio: 11-3205-019-0370 ' Property Address: 10050 NE 12 AVE M s. E Owner ANDREW CURZON Mailing Address 10050 NE 12 AVE MIAMI SHORES,FL 33138 , Primary Zone 1400 SGL FAMILY-3001-3250 SQA Primary Land Use 0101 RESIDENTIAL-SINGLE FAMILY:1 UNIT Beds/Baths/Half 3/2/0 Floors 1 Living Units 1 a Actual Area 2,689 Sq.Ft F Living Area 2,093 Sq.Ft Adjusted Area 2,380 Sq.Ft Lot Size 112,148.78 Sq.Ft Taxable Value Information Year Built 1953 2014 2013 2012 Assessment Information County Year 2014 2013 2012 Exemption Value $50,000 $50,000 $0 Taxable Value $338,634 $332,891 $355,805 Land Value $328,227 $221,527 $175,596 School Board Building Value $161,364 $161,364 $180,209 Exemption Value $25,000 $25,000 1 $0 XF Value $0 $0 $0 Taxable Value $363,634 $357,891 $355,805 Market Value $489,591 $382,891 $355,805 Assessed Value $388,634 $382,891 $355,805 city Exemption Value $50,000 $50,000 $0 Benefits Information Taxable Value $338,634 $332,891 $355,805 Benefit Type 2014 2013 2012 Regional Save Our Homes Assessment Exemption Value $50,000 $50,000 $0 Cap Reduction $100,957 Taxable Value $338,634 $332,891 $355,805 Homestead Exemption $25,000 $25,000 Sales Information Second Homestead Exemption $25,000 $25,000 Note:Not all benefits are applicable to all Taxable Values(i.e.County, Previous OR Book- Price Qualification Description School Board,City,Regional). Sale Page 03/05/2010 $410,000 27212-4604 Qua[by exam of deed Short Legal Description 05/01/1987 $133,200 13310-331 2008 and prior year sales;Qual by MIAMI SHORES SEC 8 REV PB 43-67 exam of deed LOT 16&E5FT OF LOT 15 BLK 177 LOT SIZE IRREGULAR OR 13310-3310587 1 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hftp://vvww.miamidade.govfinfo/disclaimer.asp Version: http://www.mianiidade.gov/propertysearch/ 3/27/2015 NEW POOL CONTRACT DATE: 6/1/2015 OWNER CONTRACTOR 'CUST NAME: TIERES TAVAREZ ����A. Pima, CPC-1456804 CUST ADDRESS: 10050 NE 12 AVE-MIAMI SHORES FL 33138 _.____ PHONE'305.592.7900 POOLS & OUTDOORS CUST NUMBER: 786 709 3909 8045 NW 36 ST SUITE 540 MARCOS@ROSMELPOOLS.COM CUST EMAIL: tlePes ITIaC.00111 DORAL,FL 33166 WWW.ROSMELPOOLS.COM POOL FORM: RECTANGULAR POOL SIZE: 9'X 30' SPA TYPE: N/A SPA SIZE: N/A Nk'W POOL SCOPE OF!!NOf K[{NHAT'S INCLUDED] (s�) EXTRAS OR UPGRADES(IF ANY)INCLUDED IN CONTRACT POOL EXCAVATION&HAUL AWAY MATERIAL PLANS&PLAN RUNNER POOL DEPTH[4FT-6FT] 430 SQ.FT.OF CONCRETE WITH CORAL LINE ROCK VX 3'X 3/4" STEEL REINFORCEMENT FORM[#3 RE-BAR[10IN]/ONE LAYER] BADU JET SYSTEM TREAD MEAL PACKAGE"D" 1. h e y Mu 11 "M1 k. #. n° HEAT PUMP 120K BTU UN POOL CONCRETE SHELL 3500 PSI[SHOTCRETE USED] RIVER ROCK PLASTER 6 IN CONCRETE WALLS 4'POOL ENTRANCE 6 IN-8 IN BOTTOM CONCRETE SHELL SALT SYSTEM 3 SHALLOW-END STEPS REMOVE CONCRETE SLAB 5 FT SWIM-OUT BENCH AT DEEP-END OF POOL STRUCTUAL REINFORCEMENT FIRST AND SECOND BACKFILLS SUMMARY OF QUOTED PRICES SCHEDULE 40 PVC PLUMBING[BY CODE] 121N DOUBLE WIDE MOUTH SURFACE SKIMMER ANTI VORTEX MAIN DRAINS WITH VENT LINE TOTAL COST FOR POOL+EXTRAS= $ 47,8S0.00 3-6 RETURN LINES WITH ADJUSTABLE HEADS(DEPEND ON POOL SIZE) 10% WHEN CONTRACT SIGNED $ 4,785.00 VACUUM LINE 20%WHEN EXCAVATION COMPLETED $ 9,570.00 l h5476 ,0Yy�" ..e° 1¢t `a, a, r.koa t,x , A •„ Fk ;t e� i 25%WHEN SHOTCRETE APPLIED $ 11,962.50 IA ELECTRICAL WORK[50FT OF EXPOSED PIPE INCLUDED] 2Wo WHEN TILE&COPING INSTALLED $ 9,570.00 ELECTRICAL UPGRADES,UNDERGROUND OR ATTIC WORK WILL BE QUOTED SEPARATE 10% WHEN PUMP&FILTER INSTALLED $ 4,785.00 ELECTRICAL HOOK-UPS,TRANSFORMER AND 24 HOUR TIMER 10%WHEN POOL PLASTER APPLIED $ 4,785.00 1 JANDY WHITE POOL LIGHT INCLUDED 5% UPON FINAL INSPECTION APPROVAL $ 2,392.50 NOT INCLUDED IN T141S CONTRACT ANY DEWATERING OR DEMUCKING PRE-FABRICATED EQUIPMENT PAD PERMIT FEES BY OWNER JANDY FLOWPRO PUMP[2 SPEED] POOL BARRIER (FENCE TO CODE&BATTERY ALARMS BY OWNER) JANDY 150SQ.FT CARTRIDGE FILTER WARRANTIES IN LINE CHLORINATOR[NOT INCLUDED IF CUSTOMER BUYS SALT SYSTEM] LIFETIME WARRANTY ON POOL STRUCTURE 10 YEARS OF DIAMOND BRITE WARRANTY CEMENT BULL NOSE COPING[4IN X BIN) 3 YEARS OF WARRANTY ON ALL POOL EQUIPMENT 6 IN WATERLINE TILE 1 YEAR OF WARRANTY ON ALL OTHER WORK PERFORMED 4 STEPS AND SWIM-OUT BENCH EDGE TILE[BY CODE] RIVER ROCK POOL INTERIOR SURFACE PLASTER NOS r � t t � ro. yeti sXit•to- �n,, JOB SITE CLEAN UP AND 30 DAYS CHEMICAL MAINTENANCE FINAL WALKTROUGH WITH CUSTOMER // • Y ROSMEL POO ,INC SALES ASSOCIATE OW ER'S AUTHORIZED SIGNATURE THIS CON CT IS NOT VAUD UNTIL FINAL APPR5VAL ts,INC.OWNER G--FROM ROSMEL POOLS, INC ADMINISTRATION" This co ct,Including general terms and conditions on the reverse side hereof,which are incorporated herein by reference,constitute the entire agreement between the parties hereto and is not binding upon contractor unless and until same Is accepted in writing by a duly authorized officer or agent of contractor.Contractor shall not be bound by any oral or written statements or representations not included In this contract which have been made or may be made by any persons purporting to act for or on behalf of contractor.This contract supersedes any prior written or verbal agreements,which shall all become null and void with the signing of this contract.All prior agreements must be Included in writing in this contract in order to be valid. PREPARED BY: ° La. A("'fto Land Surveyors, Inc. - = www.exactalandcom Toll Free 866-735-1916• F 866-744-2882 O PROPERTY ADDRESS:10050 NE 12 AVENUE MIAMI SHORES,FLORIDA 33138SURVEY NUMBER FL1502.0707-01 cV •. rye FIELD WORK DATE:2timms REVISION DATE(S):LAEVO v17=53 ® Fu o7o7 -�Itl� LOT /0 SOUNDARYSURWY CU'N a THE EASTERLI'5'OF M "COMY �,� °"4 M1- LOT 15 >4NOTM: N`y S BLK 177 ry� LOT APPPAR9 TO W 5EMCPD BY CRY WATeR AND SEWER S `S6 e e 1/2'PIP w r>ala owNeregnm near DEIERMMED =v S6°FS Q LOT 1 7 NOD . 2 v , �O?c 4S(�S6O� BLr, 77 ®P.C. L190°0000°E 5.00 N 99°I X29°E 4.95' $�' L2 N 14 13 95.8 D) s�p�iJ 9 14°29'3 I°C 95.95'( 2O20 ALLEY(1 5'RIW) — /.y ply ) 1 10 NO 1NO PIR NOD'. Sq.q'Ct, 9' D =ATIONB ARE DERNED USING GPS OBSERVATIONS AND ADdI0=WITH L-K T GP5 k.1' G Off NtlNropc.HtuAt1ONS 9t106VN ttAYE BEEN t't1 ¢�d pa UMCOWWW1 TO NATIONAL GEODETIC VERnCXE (f DATUM� 929.(NGVD29). ZZ �' Ay Oa OON A �a h NN AAtF. 2q R•EMAINDEI?OF Lor 5 t a 2 BLr. 177 (NOT INCLUDED} cqc& tt V °-0 V 1 J INO PIP G/ G2 R=245.00'(D4M) R=245.00'(DIM) L=52.42'(D)52.GOYM) L—136.36(2)136.36W) \ A—12°1535722)12°19t?91U) d=3/°5337°(2213/5337'(M) 5 27*02'27'W.52.32YD) 5 49°0702°W, 134.62'(0) / v 5 265321 a W,52.58(M) 5 49°0702°W, 134.62YM) V N.E l GOTH 5T. (P,) 1 h eby offt hate yr deaLrffied ftwQW"made -yd*C1b andfa Bre #leak e aMlaoaua bwmeeb ft n**Man me Flafda Boeni 40 0 20 400 Chaptmr5,1.17of tl>a Flarfde o�w GRAPHIC SCALE (In Feet) Z KEITH A.sTEPHENsoN 1 inch = 40' it 4Q s� Ftarida Fta081oveyaettl RAepper p F uaOMNab62+ lhedmisSweyfarPuraosesothmthminte WVAdmgMtenv�mwmbe=V.Userssdr WstandVAdi° LWAVrymUre Aweya. 6 � 1 �, 6L NotMng hereon dap bet°rotruedtoWv°ANY PoghtsmBmrtfissw Argme odeerdwndwse Cadfied. S L 1 TION: POINTS OF INTEREST Y FO 1 IG A SEARCH WITH THE LOCAL GOVERNING NONE VISIBLE U P ORWWW.FEMA-GOV,THE PROPERTY APPEARS TOIBE NEX6� } SH 8).COMMUNITY UNITY AND 1 N)1' 1/0 O` NlAFFILIATE � U ]61 •• •• DA'I�!2/171�15• • � F T 1 1 MEMBERS BEO ID ALL REVOCABLE TRUST®� D- SE EW CURZON• • • • •— 13 > FlE BEYOND ALL REdOCAl1LE TRUST eSKbrRX1Z • UI Q MANDELL SlL1M&SIIAOWITZ,f�'/E •• Z LU it�XACTA L z Land Surveyors, Inc. Pj66T351wwaeumbnimm 916,F ELQ LM7337C11 179�Fa l�es�resadml•FLeymr Rtm3 • ':.• 7, •,• • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • F _ I REPORT OF SURVEY FL150207Q7-01 This is page 2 of 2 and I5 not valid without an MES, LEGAL DESCRIPTION: LOT 16,BLOCK 177,MIAMI SNORES SECTION a,ACCORDING TO THE PWT THEREOF,AS RECORDED IN PLAT BOOK 43,PA3E67.OF THE PUBLIC RECORDS OF MWA&DADE COUNTY,FLORIDA, AND THE EASTERLY S FEET OF LOT 15 BLOCK 177,MULW%WES SECTION 8,ACCORDING TO THE PLATTHEREOF,RECORDED IN PWT SOOK43,PAGE 67,OF THE PUBLIC RECORDS OF MIAMI. DADE COUNTY.FLORIDA,DFSCRBED AS FOLLOWS: BEGIN AT THE NORTHEAST CORNER OF SAID LOT 15 FOR FONT OF BEGINNING;THENCE RUN WEST ALONG THE NORTH LINE OF SAID LOT 18 A DISTANCE OF 5 FEET TO A POINT-THENCE RUN SOUTHEASTERLY PAPAULEL TO AND 5 FEET FROM THE EASTERLY LINE OF SAD LOT 15 TOA PONT ON THE SOUTHERLY UNE OF SAD LOT 15;THENCE RUN IN AN EASTERLY BISECTION ALONG THE SOUTHERLY LINE OF LOT IS A DISTANCE OF 5 FEET TOTHE SOUTHEASTERLY CORNEA OF SAID LOT 1S;THENCE MON NORTHWESTERLY ALONG THE EASTERLY LINE OF SAID LOT 15 ADSTANCE OF 95.89 FEET,MORE OR LESS,TO THE PLACE OF BEGINNING. SAID LAND SITUATED LYING AND BEING IN MIAMLDADE COMM,FLORIDA JOB SPECIFIC SURVEYOR NOTES: THE ASSUMED BEARING REFERENCE OF SOUTH 56 DEGREES 45 MINUTES 06 SECONDS EAST IS BASED ON THE NORTHEASTERLY PROPERTY LINE OF LOT 16,BLOCK 177,LOCATED WITHIN MiAMI SHORES SECTION B,ACCORDING TO THE PLAT THEREOF,AS RECORDED iN PLAT BOOK 43,PAGE 67,OF THE PUBLIC RECORDS OF MIAMI-RADE COUNTY,FLORIDA GENERAL SURVEYOR NOTES: 1.TheLegal Description used to perform this surveywas supplied byothers.This survey does not determine or Imply ownersNp. 2.This surveyonyshows Lmprovements found above ground Underground footmgs,uOdes and encroachments are not located w this survey map. 3. ifthesebamptictankwdrainfWdshamernthbsurvey,theloc3twisapW=ftatemthelomtionoreseMu shownm ExKabyeddrdpartywIwasestimatedbymeWdetection, probing raduand vbud aboveground inspection only.No excavation tvas pefemnedm wdatodomminethe exert and aauraalotaaon. C Thbsurveybed,Ivelyforthe use of the parties to whom lis certified. S. Additiorm or deletions to this surveymap and report byotherthan the"nig pattyarperties is prohibited without wrimn consent ofthe signing perworpardes. 6 DImensWs are in feat and dedmalsthered. 7. Due to vwyag comrruction standstill,house dimensions weaprylrmomate. S, Any FEMA Rood zone data contained on this survey Isfor Informational purposes only Research to obtain such data was performed at wsvwfemagov. 9. AO comets marked as set are at a minimum a X40amaer,Whom rebawih a cap stamped LBe7337. 10.Myo are reading thb survey in an electronicfwmat the information contained on this document is only valid If this document is electronically signed as specified In Chapter 5117.062(3)oftheHands Admirdsomew Code and FbddaStatute 472.025.TheEfettrumc Signature File related to thb document is pr..k- ydisplayed on the Invoice fordd;am"which is sent under sepaate cover.Manually signed andseded logo of all survey signature files are kept in the office tithe performing surveye.Rthis document Is in paperfermaL his notvdid without the signature oral original rehed sed ora Florkda Licensed Survey. 11.Unless otherwise noted,an examination of the abstect of Ude was NOT performed by thedgmng surveywto determinewidch Instrument,dant'are affecting this property. 12.The symbols reflected in the legend and on this survey may have been edaged or reduced for daHtyThe symbols have been plotted athe curter of the field location,and may tat represent the actual shape or size of the feature. 13.Points of Interest(POPS)are selected above-ground improvements which maybe In conflict with boundary,budding setback oreasement lkces, as defined by the parameters of this susvey.There may be additional POIYwhich are not shown,out caged-umas"t or which are oti-ohe urdmown to the surseyar.These PON may not representall items of interest to the viewer. 14.Utilities shown on pl the subject Property may may trot.:.the existence of recorded or unrecorded uttdtyeasements. 15.The hdomtetldn contained on this survey has been performed exclusively,and is the sole responsibility of Exam Surveyors.Additional logo or refinances to third party firms are for Wormetiunal purposes only 16.psrrsuantta FS.558.0035,an LndMdual employee or agent may not be held Individually lublefor nailligence, 17.Heuse measvtenents should not be used for nawcommuctian or Flaming.Measumnums should be verified prim W such act". LEGEND: SUR M LWZMD uurryp r,®aaaa - AC MCONDUNAM W. mmaananw Bal 915:71001 11,11, avgmimns n Co. loc mit 5W. 50111CTM. 6.G m0aw•aTe am. am lea¢wr eo+. Week SPP. Arw an,0rxINOMM W. a1OtdC1mR atm ser GLeome •x. 81,00. L LmID1rr SM WpCINWDeaP NOD, auapan ser ucalazaxro WOMILaamc ahmstarcerwemeara aM 0010aw93. syr le2seer-Seaenm■ am". SGUMPHEr aRL aw81Ra 1100ia&T014 VW eR M'ANA09 W. OWN, V Ir _ 99111. VA99@R MB. WVa00K a.Tb. S1RMTmlxm flea p'VwTmt_--- aw VAUMSOOM W.". mumem SxT10N SV smuvltK 0 CAIGU4A31D WP. IIaMLPBIM �. smew" OR Dface C Cham R.0. MON RAM ave SCAT L WV 0-WW.WICK MTB. MOTTo9fNa 78M 7"Volo m' CVSMMM CA GOI FMINI 0: oCB. f1MOMIMIZ1a SAD 18 T9a11MI'AOUM SURVLYIIe IIIA w®L CHNAW O.D. C.&IMxm TAB. TCP?Roti GIP. CrANDWPpKm OM outiMMSIMm.TPA M TM. l0■1BrP tffiSI.MLOE WYL GO. OrAsict" M OVmOMmi lx 1PAimlOgmt 00110. ooNCafa QA (Woug"18!ffi 1W. Most wxaa 1 ! cm OOMmt ON wworSxIRRPARCm. UA Ima"It mt VNASmtQ C9Iw CONGmm9®1w. 0x OM1fxPLRGmW 90pt VX MnL6CDAM GV.B. 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Nld°t M= PAW P®lWNbe wmgw tBt W09UJaeMIXF9Ar. �fl�0 e1NARW tT ro mm m "M P GMM.su$wv R lP. 1.V0 afar. ,IPG ra"'03)11 P99•CAP AaDIIFPPIX U;La. hAR ORS sly rYen10RANt PS IOlam amid faA P.T. rOOQOPTA16mGY MAP,1@WNQ rA9m0n' • MORS!M01rAOf IaL MomisORstateew R PADW or WDM. AIG MA rA%ma41T • AMMCIa f%a MXWM0W10WA M � P.U.G PUDIC VralMG9Bm1T FWD Hiller, •OmC Nm. nOW W Morcips s- RCw OVWUetG HMI. t� Mall rOwm PAmtB41OVpINM. bow sum&WAY 9.W,G saaevAueAsotosr lltarlYORll6ar Fmm W&K rOMP "D91K S1W[t 9.wM.e.mesa WATmt 11SIL mW3PK QJ11 KAaKOMSVm fa . SOEM culai MAN/GH@,IHAn. Sam OW'!Nd 9.d1 SRM QOSam lamiW]Vmura'se UGIttt9AI. GM OA9 KRimf 9CR 9G®i UP. V1anYPA4a0a' ELECTRONIC SIGNATURE: PRINTING INSTRUCTIONS. OFFER VALID ONLY FOR: hrcr+npk-,J-sathwalaasnmeea[..tusawft-11 1.V4&vWwirgthwaN ymAdoi*Reacierwlectthe BEYOND ALL REVOCABLE TRUST dr Ele-ir sgnanne Act of 19,46«Hwdn 5-TITLE:00aK �• , Chopin baa.it Uas,lory -was racdwdadert Iwgywa PGF, thmtthabemlawfWOy Bernordc*S mad.1harefor Ota survey2 Selacta vriM F--- --- --- nrm 1 r0r.faah-d Aaad,o6ddaudawaablc Normmv c tM9 vasc5lyNme'dPOi suxveyh saNvM - 3.Und.*MmRenge,,fia WnYthe•AU'uWla. d9nri'wduaz:aAnh rakWata Aacahaah ndc,dal«tiav�ublcew a.urderthe•Page Handling-saAon,select the number > 1 _. alp mwdidwttheEkrhanir5lVrwmreamy wt'�7 qtr of copies that you would him im. to Fla•9amcmm /i'•' • • s Unadrttww s a Ab-rlmp dam rsno,R. 1 • t ••• _• • ... • •• • • I is awmamwe5 / Of 1 - � (UP T0$500) or Gem dvaeradseaamnwvwAese7amsmn. • • ! • na1B•-C:- Pa'• 3.t&ktM+mw«Llmwr.i.mmmdw,aq•.aM,ri•nRan.rnNhWa •` iwa by PDF'checkboxI ANY FUTURE 1 t�hcdadmnmradana:datmagadwrAywFmuxaea.arldadu d aids OKtoprft TOPI®YFBSBLAUC+YMBIE SURVEYING SERVICES 4cnrmaedeaodgtmvgdahNaconsndesrwlLnemdWnodpu I I stA-td,Na_maaaNR.wybaM)d,manwww.WawyRwM>ymw,xh 1.In the main print scream, prdpavea•. ON THIS PROPERTY 1 ndmRxaaeamawma err awt DAY. • ••• • • ,!.Wh° Sydo•dytRrY9d9Urldwaaasaeaat)ithes•IemDyWdm i�°�OUa�'°fro�Iha�°W' - 1 bUWN yrkatwwwarugRuscMmt t,th0loh-p-, ore CWN ..•Aute Cdllar• •F�eddy to 1 f °_el dmaaswFnawemeade4Daa �aae�• ••, • • °• • • I MOW, 1 nmrM,eNnuasPOfhabecntem wish nnot •G�ySyyle. • • • - - -- --J Exacta Land Surveyors,Inc. W„*Axacwandcm POW735.1916•F3W7442W • • •��• ••• • • 1194OFahvayLakn DdMSuiaal°FLVtpMFL33913 • • • • • • • • • • • •• •• • r • •• •W ••• • • • ••• • • t , 9R UITY a�n. n n Miami Shores Village h`no$ C Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 758.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRESENTS: WHEREAS,the undersigned t�'✓e.S ware the fee simple owners)of the following described property situated and being in Miami Shores Village,Florida: Address: 10050 N E 1� 'f J-. UJ a tlL,r 1 `a-hDVe, t 1 :L, -baJ%31 Whereas,the undersigned owner(s) -Ti e.r(e S nr,,, ,rC_S desire to utilize said Lot(s)as a single building site,and the undersigned owner(s)do(es)hereby declare and agree as follows: I. That the property will not be used in violation of any ordinances of Miami Shores Village or Miami-Dade County now in effect or hereinafter enacted. II. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the required enclosure is not on the subject property where the pool is Dated. Ill. That if any of our adjoining neighbors remove any portion of their fence or wall,or if our/my property shall fail to meet code requirements for pool barriers,we,as owners will immediately install a protective enclosure to meet code requirements and will obtain a permit for such fence. IV. That,Uwe,as owners)hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property,I agree to maintain&or replace said enclosure in the event that is damaged or removed by any case. NOW,THEREOF,for good and valuable consideration,the undersigned do(es)hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. HER,the undersigned declare(s)that this covenant is intended and shall constitute a restrictive covenant co ming the use,eni d title to the above property and shall constitute a covenant running with the land and shall be nding upon the u igned, er successors and assigns and may only be released by Miami Shores Village,or its sucxsss rs,in a ►clan of said Village then in effect. I OWNER SIGN&PRINT OWNER SING&PRINT I Hereby Certify that on this day personally appeared before me i i ev,eS t ccya reS and has produced ID # Ft. -P L, as identification and he/she acknowledge that he/she executed the foregoing,freely and voluntarily, for purposes there it expressed. SWORN TO AND SUBSCRIBED before me on this--.?—day of 20 .'P•. UE I°IBiBfm Amon 01906^ NO P IC pik yt MAY 19,2017 (Revised 0512209 ,°�;;°� WWW.AARONNotat3ws S%ORE, i Miami hores Village Building Department �C0 10A 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION Date t' 1,;) 1� Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as flit I� ?>1 Y- %11 I Me � arv/% Sinors c $ �V Pb 'LA?S located lat�� I Q= PC 0 7KVe L1 nniS vs , 1�N.3s In accordance with Section 33-12(o, Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected. inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting and approved barrier prior to fin 'nspecti n nd use of the pool. Legal Owner Note; This certification is to be submitted with a swimming pool permit application in duplicate. RES Miami Shores village loss n�P�m Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL,SPA AND HOT TUB SAFETY ACT I (We) acknowledge that a new swimming pool, s or hot tub will be constructed or Installed at ti 10050 �,�� .j �J r'r ' , as &312,6 Miami Shores, FL, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues and the Florida Building Code R4101.17. PI ase initial the method(s)to be used: The pool will be equipped with an approved safety pool cover that comp lies with ASTM I:tU14 1.(Submit Manufacturer's Specifications). A continuous,one-piece(child)barrier meeting the requirements of Florida Building Code 114101.17.1.15411 protect the pool perimeter.The plans shall show the fence location and method of attachment,including one end that shall not be removable without the aid of tools.(Submit Manufacturer's Specifications). A combination of non-dwelling walls and fences(screen enclosure,child fence,masonry fence walls,chain link or wood fence,etc.)will protect t he pool perimeter.The plans must specify t he type and location of all non dwelling walls.Florida Building Code,R4101.17.1 Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code,R4101.17.1.9(Submit Manufacturer's Specifications). Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all doors will be equipped with a self-latching device with positive mechanical latching/locking installed a min.54"above the threshold.If this option is selected,submit plans showing all types and location of all perimeter protection.The plans must also show the location and type of all openings,and the hardware type for each location.(Submit Manufacturer's Specifications). In accordance with the Code,the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements,and upon expiration of the permit,the pool shall be presumed to be unsafe.1 understand that not having one of bove installed will constitute a violation of Chapter 515,F.S.,an d will be considered committin s eanor of the second degree,punishable as provi d in Section 775.082 Section 775. 3 F.S.Thi form must be signed by the o ►agent and h rime contractor. 0,/"/" 3/S CON TRS SIGNATURE AND DATE OWNER'S SIGNATURE AND DATE / r v AL2" & I I lta --I ��✓4�u1 CONT TOR'S NAM (PLEASE PRINT) OWNER'S AME(PLEASE PRINT) 08ha. 0MjVt.- iA Zk'ALI- -&ddol NOTA Y PUB NOTARY 15UBLIC \\191 bI0 9 G#,pn PPI�B Q , 9 b.uz I eler��;fie;�n ��.. ►rP°e',a.uz�-Ieleraa�a�rd �% ifff COM WSSION#FF0190551 ;��CAMA4ISSION#FF 01905^ 0 EXPIRES: ,,m 19.2 P `�o@e�EXPIRES: MAY e ,� nu0 , V14VW./+IARONNoT9ARymn �9 �'�•; �,�•\0 yryVW/.AARONNOTARYA/1 . o�t'��\ e Page 1 of4;not valid widtout all four pages. US.DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY ELEVATION CERTIFICATE OMB No. 1660-0008 FED National Flood Insurance Frogrmn IMPORTANT:Follow the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Buildin Owner's Name Policy Number: A2. REVOCABLETRUST Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company MAIC Number: 10050 NE 12TH NUE State ZIP Code I SHORES FLORIDA 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) TAX ID P11-3205-01!3.0370 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat.25 52 04.94 N Long.80 10 25.15 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 9 A8. For a building with a crawispace or enclosure(s): A9.For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 2093 sq it a) Square footage of attached garage 527 sq ft 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 foot above adjacent grade 15 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 1920 sq in c) Total net area of flood openings in A9.b n 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&Community Number 62.County Name B3.State THE VILLAGE OF WAN SH RES 120652 MIAMF DADE I FLORIDA B4. Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel Effective/ B8.Flood Zone(s) B9.Base Flood Elevation(s)(Zone Revised Date AO,use base flood depth) 120860-0306 L 9/11/2009 09/11/09 1 X SHADED AND AE 8 B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9: ❑FIS Profile RI 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: / / ❑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/A0.Complete Items C2.a-h below according to the building diagram specified in Item A7.In Puerto Rico only,enter meters. Benchmark Utilized:L-NET GPS NETWORK: : Vertical Datum:NGVD29 Indicate elevation datum used for the elevations in items a)through h)below. W 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) 7 .12Fc]feet ❑meters b) Top of the next higher floor -11 .29F(I feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) ®feet ❑meters d) Attached garage(top of slab) -9-.90 ®feet ❑meters e) Lowest elevation of machinery or equipment servicing the building -8 .46-_ ®feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) _8 .59 ®feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 1D it ®feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,Including ®feet ❑meters 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.1 certify that the Information on this Certificate represents my best efforts to Interpret the data available. p STEP I understand that any false statement may be punishable by fine or Imprisonment under 18 U.S.Code,Section 1001. �l�G gT IF 1C.4 ®Check here If comments are provided on back of form. Were latitude and longitude in Section A provided by a `I ❑Check here if attachments. licensed land surveyor? ❑Yes k]No No.6521 Certifier's Name License Number LS 6521 Title Company Name °p O STATE OF PROFESSIONAL EXACTA LAND SURVEYORS,INC. n Q Address City State ZIP Code dd F .MERSFl. D3913 s �4oRt11 FAIRWAY DRI U 1 o O¢ Signature , Date Telephone SURVEY �,) C1211712015 -_E.130568-61Q9. 2117/2015 FEMA Form 086.0.33(Revised 7/12) See reverse side for continuation. Replaces all previous editions. (REVA 2102015) (REV.1 2/12016) y Page 2 of 4;not valid withmn all four pages. FL1502.0707EC 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: 10050 NE 12TH AVENUE City State ZIP Code Company NAIL Number: MAN SHORES FL 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 NOTE:C2.E=AC UNIT PAD.NOTE:THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS CERIIFICATr- THIS(r-1411FIWE IS EnR El OOD INS[IRANCF P1 IRPOSES QN1 V TI-IF INEORMAIMN nN THIR CER31EICATE 81401 It 0 NOT RE USED FOR CONSTRUCTION OR PLANNING.THE ELEVATIONS SHOWA I HAVE BEEN CONVERTED TO NGVD29 DATUM. Signature 'J, Date 2117/2015 CENTERLINE ROAD ELEVATION:9.40 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,crawispace,or enclosure)is ®feet ❑meters ❑above or ❑below the HAG. b)Top of bottom floor(Including basement,crawispace,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 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 A0. G3. ❑ The following information(Items G4-G10)is provided for community floodplain management purposes. G4. Permit Number G5.Date Permit Issued 56.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 Gi0.Commun'ity'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(Revised 7/12) Replaces all previous editions. Page 3 of 4;not valid without all four pages. ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. FL1502.0707EC 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 P0.Route and Box No. Policy Number: 10050 NE 12TH AVENUE City State ZIP Code Company NAIC Number: MIAMI SHORES FL 33138 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. ALL, ACT&t s FRONT PROPERTY PICTURE 2/9/2015 REAR PROPERTY PICTURE 2/9/2015 - ' ;r RIGHT PROPERTY PICTURE 2/9/2015 LEFT PROPERTY PICTURE 2/9/2015 FEMA Form 086-033(Revised 7/12) Replaces all previous editions. � l Page 4 of 4,not valid without all four pages. ELEVATION CERTIFICATE,page 4 BUILDING PHOTOGRAPHS Continuation Page IMPORTANT:In these spaces,copy the corresponding htformation from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or PO.Route and Box No. Policy Number: I W50 NE 12TH AVENUE City State ZIP Code Company NAIL Number: MIAMI SHORES FL 33138 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. FEMA Form 086-1133(Revised 7/12) Replaces all previous editions. :&4 ,7?2C '-° i •. PW Nk" ij..r. 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