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BPP-16-999 - �oq 3® A-adrtes Inspection Worksheet Miami Shores Village A �QI� 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-264824 Permit Number: BPP-4-16-999 Inspection Date: August 04, 2016 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Dacquisto, David Inspection Type: Survey Final Owner: PUENTES,ANDRES Work Classification: New Job Address:354 NE 91 Street Miami Shores, FL 33138-3130 Phone Number (786)606-9930 Parcel Number 1132060190220 Project: <NONE> Contractor: ROSMEL POOL INC Phone: (305)592-7900 Building Department Comments NEW POOL Infractio Passed Comments INSPECTOR COMMENTS False GlY Inspector Comments Passed � t Failed El Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 August 04,2016 Page 1 of 1 • • ... . . • •e• e •e• • • • s ••• - NE 91 Street (70'Right-of-Way) • • • • • • • • • s s • •• x • • • • • • •••• • • • GEIPortat • • • • st --- — — ..a'^ vet --,�•---i• ••• • 000 • `t' - 9 _18'AB Row.- n� T3 C? a' rmmd Ire 75.00' � '`� • :.: : :• •. 1 • LOCATION MAP Na -- .. Mak Sbak D a Mia ardf (NTS) 0o SAwk KW M1 �6 endpbdaryd`' P�rPEPry DD�Ess Fbwd fla, 17.Y 0°j 354NE91STSTREET &W Rod 1445 MIAMI SHORES,FL 33138 4 5 4'ajain Li*Feme I FLOCDZONE W 0.3'fmatmfcest Panel No: 12086C 0302E j 'fB.95 i Dda: SEPTEMBER 11,2009 0.CatdeteshekkSSmrmurn I C'ER�'F!ED 71,. #354 I W 1. ANDRES M.PUENTES AND MARLS CAMILA ARANGO cal plow �, ! 65 fzb• Lca4L DEscWrloN gI e' 323b' I I O 7HEWEST NAI.FOFLOT5,ANDALLOFLOTB,BLOCKZELPORTAL, 5 WoodFerace Cae I Coe I ACCORDING TO INE PLAT THEREOF ON FILE M THE OFFICE OF THE arwesrawear p CLERK OF ME CIRCUIT COURT(NAND FOR AWN-DADECOUNTY, Prwag f wa Bilk I FLORIDA RECORDED INR AT BOOK 9,PAGE 101.SAID LAWS SIRMTE Vol I ME I LYING AND BEING IN AD{MI-DADE COUNTY,FLORIDA 90.0 I � WenFfa9 I EMJlfeg SURifEYORS'NGTES . Lm7 Lmb Lmb l.fHlYC9tT1FYBdasrareymeeb Ra+Ma Sterdardsml�moapwmadPo . _ 0002 I P Bkwir2 BAwk2 Sem'a14T2.027,Florida . F 2 The aPbwm andrepodawftca a llmnmerenotvwwftdee h1' i4a, a8nmue anrlde arraMdaealmafkaMa&errsedaoreymardmappec rp0� I Ld8 Oo�, a Wdmgmwdwob=mdkrpvmwb vmm dbmW a 18rrmnakreae ramrdeod89fdar.ssa0lerwlsBrd. BIaPr2 I 7P°.,. 4'glob)Link F&W 59meddk feMlce arer�medokaeroMns. an PmP&ry Lk* B TMe NW8000099 ofAa9wm f onNwlWfa LB 8788. 7.AddbYveordda&ae baofeyaepaorrapGrlB byoBerBen de ---- – -- ;-- -- i— ParYapa�eMwm�andwBemw�nmammmBed�if>aN�na�Bea — -- - aSwreyadRdfo ramrmBme,+asr�ru,easnrmmbaMr�Mae1-v>BY ' , mreoad llbdessaTMnl7eNew,C,om�e9remBnrkrp,arQwe�pardBrxfan5eakeRedanb Otsdead FOW PT I pre9amanOce fmof 4ada;;n ovnam h.keafarnpmedin eeabaem me!ffin Fwd Pr Ld 10 X20 MIDAt ID keuawe Bkmk2 SWoodFeace Sock 8.teca8or rrepbgkerredtmm aSnenm�tngsflesaMendlaatlyepparh�. 02SCAof YS. TFg YLi" mkml Rod 512010118 UPDATE AR CO or-22- SeEY12 ABBREWA80UNDRC 2- 1B O.Fr WE LAcommm Y BOUNDARY SURVEY fm T - PM SURVEYING "uR WF W=LM�W C���.ji if far LICENSED BUSINESS Na 6786 Fmc D F`& cavn IM WAIM METER fres cmmm am$=arURE StG1dIB) WEST AMB IDGE SW33415 POB P=OF BFGO•IBiB POC POW OF COMMENCEMENT ONp..f;SgNDSURVEYORANDMAPPER OFFICE 561478-7764 t�ORt(d4t".ER7TA7E'No.Fi04a FAX 561478.1094 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-265132 Permit Number: BPP-4-16-999 Scheduled Inspection Date. October 03,2016 Permit Type: PoolsMhirlpools/Hot Tubs Inspector: Mesa,Michel Inspection Type: Final Owner: PUENTES,ANDRES Work Classification: New Job Address:354 NE 91 Street Miami Shores,FL 33138-3130 Phone Number (786)606-9930 Parcel Number 1132060190220 Project <NONE> Contractor: ROSMEL POOL INC Phone:(305)592-7900 Building Department Comments NEW POOL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP 256896. 8-9-16 need to finish landscaping(sod), need to replace sections of broken sidewalk. Failed Correction D Needed Re-Inspection ❑ Fee No Additional Inspections can he scheduled until re-inspection fee is paid 6 September 30,2016 For Inspections please call: (305)762-4949 Page 12 of 31 E311LIANO OSOW0, P.E. ProfeWenal Engineer 949 SW 1 22 AVE. MIAMI FL. 33184 PHONE: (786) 715 - 7125 MAY 12,2016 �a Building Oficial City Of Miami Shores Building and Zoning Department OWNER: Mr. ANDRES PUENTES ADDRESS: 354 NE 91 ST. MIAMI SHORES FL. 33138 For design purposes, in this project a bearing value of 2000 psf has been utilized. This bearing value is typical of a soil with combination of undisturbed sand and limerock. The pool has been excavated and after a visual inspection we are attesting that the soil conditions are similar or better to the used in the design. Should you have any questions or require additional information, please contact me at(786) 71 5 - 71 z s at your earliest convenience. Sincerely, EMILIANO OROZCO, P.E. Professional Engineer License No. 66341 y� ( tg Miami Shores Village Htit i� tC a 10050 N.E.2nd Avenue NE i Miami Shores,FL 33138-0000 AFi�� dR Phone: (305)795-2204 ?r r Expiration: 11/05/201 ,. "K Project Address Parcel Number Applicant 354 NE 91 Street 1132060190220 Miami Shores, FL 33138-3130 Block: Lot: ANDRES PUENTES Owner Information Address Phone Cell ANDRES PUENTES 354 NE 91 Street (786)606-9930 MIAMI SHORES FL 33138- 354 NE 91 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 24,000.00 ROSMEL POOL INC (305)592-7900 Total Sq Feet: 392 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 Bond Return: Wail Steel Classification:Residential Scanning:5 Review Electrical Review Planning Review Building Review Building Review Plumbing Review Plumbing Review Structural Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# BPP-4-16-59406 CCF $14.40 04/14/2016 Check#:13343 $50.00 $1,415.00 CO/CC Fee $50.00 DBPR Fee $10.80 05/09/2016 Credit Card $1,415.00 $0.00 DCA Fee $10.80 Bond#:3077 Education Surcharge $4.80 Permit Fee $720.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $15.00 Technology Fee $19.20 Total: $1,465.00 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 info ion is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abo -named c ntr r to do the work stated. t May 09,2016 Authorized Signature:Owner / Applicant ontra / Agent Date Building Department Copy May 09,2016 1 is Shores Village \° �Q l�IlIrI APR 14 2016 \ eael�tt 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 - - --- INSPECTION LINE PHONE NUMBER:(305)762-4949 BUILDING [faster Permit No. P?BUILDING IT' APPLICATION sub Permit No. ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL []PLUMBING (❑ MECHANICAL ❑PUBLIC WORKS ❑CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:`�r7y city: Miami Shores Caun : Miami Dade Zi : 3'J138 Folio/Parcel#:__ It •3 2(D(j, • O l G • b?71 Is the Building Historically Designated:Yes -NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE OWNER:Name(Fee Simple Titleholder): S �uer�}'�S Phone#: "R SCO C00(p C( 3� Address:: { (V t► c) City: 1✓1 lam!�C31ry ✓PS__State: zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: IACPhone#: - � er' -"1ejp� Address: `���-lr7 1`1� �J(O _ S.S - City: Qualifier Name: State:_ _ ^ Zip: 331toto 1�.�1 ' Phone#:_.3OS•Sq 2.1 qC�O State Certification or Registration#:_GAG 11 �p�pf Certificate of Competency#: DESIGNER:Arch itect/Engineer: �' 'A l at Phone#: `1 $(o • � ^-� I a� Address: ) _a-, , City:_ M i a ,=,:. State: Zip: Value of Work for this Permit: ii F614 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New E-1air lace Re Re P / p •IID—emolition Description of Work: 945,*j 11 DO[ Specify color of col®r€`hru me: Submittal Fee Permit Fee$ () - c CCF$ I `1 H C CO/CC$ Scanning Fee$ CQ Radon Fee$_ 1 U 3_ DBPR$ ` PO }' Notary$_ Technology Fee$—L—q—. l- Training/Education Fee Double Fee$ Structural Reviews$J2 � � � Bond$ T {Revised02/24/2014} TOTAL FEE NOW DUE$ � p 9 L—> - Cam Banding Company's Name(if applicable) r Bonding Company's Address a'► cm, State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address 13 City State Zip permit to do the work and installations as indicated. I certify that no work or installation has Application is hereby made to obtain a 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..... OWNEWS 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 AY RESULT iN YOUR PAYING TWICE FOR IMPROVEMENTS TO R PROPERTY. IF YOU®RAN ATTORNEY BEFORE RECORDING TEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENGE 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 goad falth that a copy of the notice of commencement and cconstructiononotice lien low brochure rtceme will b d epostelivere d at the person site whose property is subject to attachment, Also,a certified copy of the e 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 �z Signature CONTRACTOR OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this t� 20 15 by -j-q-day of_ V ZO��by ILA day of '��1 —= who is ersonally kno to Ye'c';! -?UeA+1I!1Swho is rsonally known to as me or who has produced 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: Sign: Z Print: Print: ✓ ,2v1 "Pyr MARCOS A, TINEZ MARCOS A.MARTINEZ Seal: +: My COMMISS ON#F 008989 Seal: FF�gg8g 9 o EXPIRES. =_,• _;, MY COMMISSION# oQ: a +; 15,2017 Y Public 2017 <e EXPIRE :�aY A;„�•' Bonded Thru Notary publ c Undernrtiters tary Public UndervAers Bon Zoning Aakdhk�ahk #x��ak�akkkd+�+i�k� a eak �: 3+ekM1 hdk#�ok��k�da' k•kkF#�kat�ae+xak+k++kas#skRat+i;dsas�sitte3'e#��&� E� .Zoning APPROVED BY Plans Examiner Clerk Structural Review (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION e� r CONSTRUCTION INDUSTRY LICENSING BOARD � a k CPC1458804 The COMMERCIAL POOUSPA CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 a�� o VARELA,MIRTHA { ROSMEL POOLS INC 8045 NW 36 STREET SUITE SO--' � - MIAMI Ft331SS M. JI ISSUED: 0910212014 DISPLAY AS REQUIRED BY LAW SEos L1409020001833 i I ),'F '. I {,k � i t ■, ., .}` �� 1 f 3 1fyST .�'"� t. �L,¢Y j L�ca1u�ineSST a Recei f T r. mf W,"'fade Counry,.Mate#o#Ftorrda Y3' s t t 1 a t z .a' �tit�r.1•}' 't` i � 7 k jz 3�i � F t".t � y -: s �U',ityyl� t l� 6333306s e w 4 sa j( § s 3 sa v t l 4 �"a�wx4e'e � "'> &, r yt} * { A,`i �d rye��1, n�"k`'�_'""'�'� SIWINE$S� f.00ATfONr S ( P tECEtpTiI O" Ybdr < >_� s3o , s ��oa / 76< � SEPTFR 30f 2016 66004J 3*i,! mki ( z ri > stUe s 18 ig¢at PI of Iyuslaess; i ei. iP tStt r. ?fit.. `u .f x'" a•c Ca '"{J`u - `�sa L�".t �tj i .3"s.� . F O gR SEC.TYPE OF BUSINESS!t. � z RO11�EL POOLS INCZ t i' r ; z PAYMENT RECEIVED r <� 196 : SPECG I`(PLU BY,TAX COLLECTOR CIO IitTHA VARELAQUALIFIER , CONTRFAG[ORS 4 k " �3 n rx R",; k 4500 09/03/2015 2 xNtilice�(s) 1 CPC18804 Nj sr � GHECK21 15-120656 xhis loaai reals Tax�iec�i�rt only congRim paymeni% Me Local 9estnesd TOx tie ileceipt is not a license permit,or aeriicatiott oEt(ta daldefs quali8cdtions to do besiness Holder must complq wffh at�i gavernmeutat or nattgavenunettml regutaipry fawn and ceyatrenreats which apply to the business s t The Q&T NO.abare mai;be on atl cc rctai Code Said$a-276 .MIAMMD For nore ittioratation,visitwNiwmiamidad(ig�tazcolteNo CERTIFICATE OF LIABILITY INSURANCE �9 f1Q PwAsw THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORA MWT 41+ill1TS0RA14TCE AGENCY CORP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ` HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR } .. WE$T FLAQLER ST SUXTE 213 ALTER THE 2OVER10.GE AFFORDED BY THE POUCIES MOW_.... FL 33144 3 '281533 INSURERS AFFORDING COVERAGE Rosim FOOLS, INc. INSURERa COLONY XMSUJULMCS COMPANY INSURER S. :"s 9300 NW 25 STRLET, BQITE 103 INSURERC: k DORAL, FL 33272 INSURER O. -: INSURER E. "LIClES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDI ANY. QUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED M�iY'PES.AIN G THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUr:FI #�OLRCIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. jmr TYPE OF INSURANCE pOLICy Ht BER EFFEcnVE FgkMODDrMTxY TI4movnON LIMITS ERALLIABiUTY EACH OCCURRENCE $-1 0001000--. COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any cm bre) $ 100,000, CLAIMS MADEOCCUR i MED EXP(Any one Fe+son) s 5 0 0 a ` 010GL0023895-01 06120113 06120116 PERSONAL aAmiN,NRY s1 000,000.: . GENERAL AGGREG4TE st,000,000 AGGREGATE LIMB APPLIES PER' { PRODUCTS'COMMOP AGO 31,000 0 LO - Y 71 PR(,T- LOC OpILEL(ABILitY '^ t COMBINED SINGLE LIMIT =ANY AUTO (Ea accident) i -- ALL OWNED AUTOS �t I�— s } BODILY INJURY S SCN." HEDULED AUTOS i (Pat p"m) f1RED AUTOS i BODILY INJURY 1VONCRWNEO AUTOS )Per amtlaru) Is r t PROPERTY DAMAGE I S (P accident) i J ;i,.,GARAOE UA8lUTY AUTO ONLY•EA ACCIDENT S ANY AUTO ( OTHER THAN EA ACC s l AUTO ONLY. AGG S n=,7 EACH OCCURRENCE S CLAIMS MADE AGGREGATE $ is -DEDUCTIBLE ? I S } .,DETENTION COMPENSATION ANDA z UA&%M T .Y t om, E L.EACH ACCIDENT S I I E:L-DISEASE-EA EMPLOYEE S E.L.DISEASE-POLICY LIMIT S -- -, - OTs�©R ( i I - t DESL'RIPTION OF OF�iAT(ON&F OCATI(NV131V&{tCL 8itCLUbYONS ADDED BY Eta MEMENTWECWL PROVISIONS CONTRACTOR MFICATE HOLDER ADDITK?NAL INSURED.L UIm LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BOXIM THE E70 MTION XYAMI SHORES VILLAGE BUXZDINQ DPT DATE THEREOF,THE ISSUING INSURER VALL.ENDEAVOR TO(NAIL DAYS VOWrT04 10050 HE 2ND AVN• NOTICE TO THE CERTIFICATE HOLDER(NAMED TO THE LEFT,BUT FAILUR8;TO 00 80 SMALL.'-' .;.. y ° MIAAdI SHORES, FZ 33138 IMPOSE NO OBLIGATION OR LIABI.ITY OF AHY KIND UPON THE INSURER ITS AGENTS OR', z $10 REPRESENTATIVES.ftw auTHDRIZEo ZlZe *0010 (7197) ®ACOROZORPORATION-1 Miami shores Village Building Department Rte► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-rime 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 0 4 day of �l�aV S'4 ,20 1 S. Bwho i rsonally known me or has produced as identification. Notary: Gil�1 SEAL: n�yq"YrsMARCOS A MARTINEZ MY COMMISSION#FF 008989 :o Q;,';?e Bonded Thru Notary Publ c UrMerwdtere r--' • •-..". Page I of 1 , Am JEFF ArMTER CMFFINAW AL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW" CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has eteoted to be exempt from Florida Workers'Compensation law, EFFECTIVE DATE: 3/23/2016 EXPIRATION DATE: 3/23/2018 PERSON: VAREtA MIRTRA FEIN: 263013092 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC. 9300 NW 25 ST STE 103 DORAL FL 33172 SCOPES OF BUSINESS OR TRADE: SWIMMING POOL CONSTRUCTION-NOT Pmtwnt I+CPayW 4W.Ob(+4L R.S.,an olflwr of a oorgretlan waw ettat atlryl9pn han tldt en+0� �9+oanlAotq o/ekow under tldt tycoon fa"W N0aar be" t er o�rryientWon WNW M di�yr qu7WM W CMPW 440 04121 P.8.C of oAo>fa�tOOe a •..ppif prtry' axtmpe+4*affin 00 sew of on bobw of tSoh t 0e sdecu"tu0ltol rowatla�iw8 undioCMpterf48.0�13ZR.S..Notbtsolt bntpbo N e Ct�+�neU ms e+e rtetee er ooWflettt ne bit+meNt Mt r"Uln enb of vib"00"fw b�stwn Of*COMM*.Tbod"Oramv am r e OF$-F2•DWG252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED OS-13 QUESTIONS?(890)4131609 i i t Report Viewer Page 1 of 1 JW ATWATER CNIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION •'CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This Certifies that the individual listed below has elac W to be exempt from Flaw Workers'Compensation law. EFFECTIVE DATE: 3/23/2018 EXPIRATION DATE: 3123/2018 PERSON: MARTINEZ AUNA FEIN: 283013092 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC. 9300 NW 28 ST STE 103 DORAL FL 33172 SCOPES OF BUSINESS OR TRADE: SWIMMING POOL CONSTRUCTION-NOT Pm�uaffpnnm�aM to CI»pta 440.05(14),F.8.,an af8oer ots eoryaation who alma eza from gW*be ,"fmv a audffoab of o1scoa n under 66otlon w afew b a "cru ft uW*a mtbe otallodon b OeGXO n~ P wm�rt C 08(R to eaeeWn' io a au�taatl�oe oletoctlaah�5ked ao Ns tla paws names on tlm n0ikea aeMuetewmWaver muftt the r"uks Of0ft ssec0a+for kwenp at*�ei e.M depoirmi s�ReO a=8F2-010,282 CERTIFCATE OF ELECTION TO BE EXEMPT REVISED 08.13 0UESTWN8?(850)413.189 Report Viewer Page 1 of 1 JM AIWATER CWW flN►NCfA-0FFtCER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION ••CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW" CONSTRUCTION INDUSTRY EXEMPTION This oertifces that the Individual wed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 3!23/2018 EXPIRATION DATE: 3/2312018 PERSON: MARTINEZ MARCOS A FEIN: 26301 M2 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC. 8300 NW 2$ST STE 103 DORAL FL 33172 SCOPES OF BUSINESS OR TRADE: SWIMMING POOL CONSTRUCTION-NOT Puttust4 t0 Chapter 640.DX16J P.O,an ofOtsf of a oaporedon who ekGd ezemFtlon kers tide 0 p�any•cookets of Sweden Order Odd ssctton �myy Mum bwwb or emrysnswon wrier Odd q�pa.Pursuant to Chapter 440.Od(12�P.O...BON= �y�p�to ue mcempf...sy0y oNy 0".tlm sofgM of the tpidYma W Netle ondM roCehaesu a nror��n 7,e1 any �C�=4ae00 1iF.S.,t er n ED e. thapersen on the ormoe iw1D t::mats ae re4uirs W of thb eeetkn kr Ft 01•ar SDe.The department slmam c west e DFS-P2-DW—'252 CERTIRCATE OF ELECTION TO BE EXEMPT REVISED 06.13 QUESTIONS?WO)413-1609 Miami shores Village Building Department �ORIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION Date %1141.6 Miami Shores Village Building &Zoning Department Attention: Building Official 1 certify that I am the legal owner of the property described as El Pov+a 1 Pfb q-101 �t� vJ o located at 35y we: q 1 St . W i anal SmyeS.FL 3- In accordance with Section 33-12(f), 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 final inspection and use of the pool. Legal Owner Note:This certification Is to be submitted with a swimming pool permit application In duplicate. S�OR�s Gr Miami Shores Village Building Department - -�� 10050 N.E.2nd Avenue �ORIDp' 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 (Welacknowledge that a new swimming pool, spa or hot tub will be constructed or installed at 54 QE a► 331 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. Please ini the method(s)to be used: The pool will be equipped with an approved safety pool cover that comp lies with ASTM F1346-91.(Submit Manufacturer's Specifications). A continuous,one-piece(child)barrier meeting the requirements of Florida Building Code R4101.17.1.15 will 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.I understand that not having one of the above installed will constitute a violation of Chapter 515,F.S.,an d will be considered as committing a misdemeanor of the second degree,punishable as provided in Section 775.082 or Section 775.083 F.S.This form must be signed by the owner/agent and the,prime contractor. C TRACTOR'S SIGNATURE AND DATE OWNER'S SIGNATURE A DDA E CONTRAC OR'S NA E(PLEASE PRINKNER'S NA E(PL S PRINT) AI TARY PU LIC MARCOS A.MARTINEZ i; MY COMMISSION 0 FF 008989 EXPIRES:May 15,2017 t•••N��• MARCOS A.MARTINEZ Bonded YhNNotary Publ o Underwriters - :_ MY COMMISSION#FF 008989 } EXPIRES:May 15 2017 Bonded Thru Notary Public Undmriters I i t SNORES Ar Miami Shores Village Building Department fil R ►p► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTNE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRESENTS: AA WHEREAS,the undersigned '7' reS -RcMeVk-_-S is/are the fee simple owners)of the following described property situated and being in Miami Shores Village,Florida: Address: 354 N)E' 0111 51. M igvY6 15borcS.JFV 331'31 Whereas,the undersigned owner(s) --po-Ni nt 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 located. III. 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,I/we,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 doles)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. FURTHER,the undersigned declare(s)that this covenant is intended and shall constitute a restrictive covenant concerning the use,enjoyment and fitle to the above property and shall constitute a covenant running with the land and shall be binding upon the undersigned,his/her successors and assigns and may only be released by Miami Shores Village,or its successors,in accordance of said Village then in effect. 4e!!!t� �LA g0WO 1 M1 A WNER SIGN&PRINT OWNER SING&PRINT I HerebyOrtify that on this day personally appeared before me -hr)tArCS RO'AC> and has produced ID # L DL_ as identification and he/she acknowledge that he/she executed the foregoing,freely and voluntarily, for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this l y day of 20 VS NOTA7Y PUBLIC S� T 0 OA (Revised 05/2209 - ----------- - ;pY IS SSSQ o MARCOS A.MARTINEZ f. MY COMMISSION#FF 008959 9 a EXPIRES:May 95 2097 F'y°f N `' Bondeo•Thru Notary Pu Underwriters IZOS , . MEL POOLS & OUTDOOR ENVIRONMENT'S Date: 1 y State of Floriplch County of 17avlC� Before me this day personally appeared it+lnr Vuvr IG who, being duly sworn deposes and says: He or she will be the only person working on the project located at: 36A K)f, FL MW1 Sworn to (or affirmed) and subscribed before me this L L1 day of A nst 20 15 -by 0✓�i r°t hc. �Ire�c. Personally known Or produced identification Type of Identification produced MARCOSAMARTINEZ ° Y COMMISSION#FF 008989 EXPIRE May 15,2017 %•,S pF Bonded ru ry Pup Underwriters Print,Type or Stamp Name of Notary 8045 NW 36 Street-Suite 540 Doral-FI 33166 Sales 305-592-7900 Fax 305-592-7997 www.rosmelpools.com CPC-1456804 ACORLIP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY1r) `.� 1 03/23/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERCONTACT Pablo M Conde NAME:: A&A Underwriters Inc. PHONE (305)220-7447 ac wo: (305)220-4821 8778 SW 8st ���: pmc@aaunderwriters.com INSURER(S) AFFORDING COVERAGE NAIC# Miami FL 33174 INSURERA: BUSINESSFIRST INSURANCE COMPANY 11697 INSURED INSURER 0: Rosmel Pools Inc INSURER C: 9300 NW 25th St Ste103 INSURER D: Doral,FL 33172 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEim POLICY NUMBER MMMD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCURPREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- ❑ LOC JECT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS accident Per BODILY INJURY( ) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER ETH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? ❑Y N/A 521-13922 02/28/2016 02/28/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ` Y ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD a ' r 0 v •Y Sheet 9 of 2 �] �T � Job Number 512020118 'j�Fp. r... , r PROPERTYADDRESS. 354 NE 91ST STREET MIAMI SHORES,FL 33138 a " Va FLOOD ZONE: "X" PR �01� Panel NO: 12086C 0302L Date., SEPTEMBER 11, 2009 r CERTIFIED TO: 1.ANDRES M. PUENTES AND MARIA CAMILA ARANGO 2.REGIONS BANK,D/B/A REGIONS MORTGAGE,AND/OR THE SECRETARY OF HOUSING AND-URBAN' DEVELOPMENT,its successors and/or assigns as their interests may appear 3.LANDMARK TITLE SERVICES, INC. 4.OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY LEGAL DESCRIPTION. THE WEST HALF OF LOT 5,AND ALL OF LOT 6,BLOCK Z EL PORTAL, ACCORDING TO THE PLAT THEREOF ON FILE IN THE OFFICE OF THE CLERK OF THE CIRCUIT COURT IN AND FOR MIAMI-DADE COUNTY,FLORIDA,RECORDED IN PLAT BOOK 9,PAGE 101.SAID LANDS SITUATE,LYING AND BEING IN MIAMI-DADE COUNTY,FLORIDA. POINTS OF INTEREST' There are no Survey issues on this property. •• ••• • • • • • •• • •• • • • • ••• • •• ••• •• • • • •• 03-UE+-2012 ••0 r:-I F :�' • • •. PM SURVEYING I Paas-FW6•A*mC+ 1 aM48CARfBR1DtdESTr6EEr BoundarySurvey I 1 v.FSTPALYBEACH,F1.1305 sCBte'1 Inch= 0 ke1 I SE4vW I or-RCE 561-478.7764 •• RiH 7r�6 rar�rry• •• •• FAX 561478.1034 3/20tD118 BDUA�iRYSURVEY +M IOC OiDb • • faR4[M • • I. AUAPOSE F1EtD DAAFf LWTE i I— 7J i • 6!8836 vis4 us OA NIB tv8b({D,um w.pmsurbBy�il0.nB1 ••• • • • ••• • • Sheet 2 of 2 Job Number 512020718 NE 91 Street (70'Mghf-of-Way) ...�• cam'.T,•.r-+..�.-+-r_••�•n:•- �i,C.: -ytr:�%::' " �.;�C%._�•.. :•�='-" "�i. �t ': �r.: :`.•i8•AFphBA.Rid..,* •�"'s..;:�f:.�,;:,::tf• :�•• .. •r: _rt;f.:- V1. Rod 9 75.00' nD Liinee � 225.00 to snck cotn�t Ineva o Meas<rredandPa{ a WaftBtxk Waft � b� $o " and Ptntet I 9yg I Fmm9ln• I I � la.as 4'Chain Link fence �~OPmAwryOwone I I •1�1�/ � I e � ICanrret s> .s 4 334 I Gt I I I to �, ! s5' rzs 32.35'. I6'Woad Fence I 0.f WM of We& � B• Conu6te I Pmpe tyuna sup ; sAmp I I I I � I s 1 I I � I yre�� Ee�Ha9 i I Lot 1 i {, Lot 5 Lot 5 8*k2 Stock 2 Blasts 2 81ock 2 I �' � Overhead � y9 UFAY Lh"Mood e9 ' jorsawh oisoum I ize °o'i 4'cetaht Li2k Fence I I Pmpo#y ow I on Pmpedy Um I ---------- --- ----- 7 -- - — - -�_. .----------- t a � I f01md t,R' i Found 1f+' I t�19 + Lei 20 I lrmt D N.,, ! � p1 2 fta2 ( I y�ood Pip I GRAPHIC SCALE 7r2 East o 15 30 45 so Imfl Rad { I a• Ir tKi• .. . I k, �. ti+t� ��'t''�'p"fir}:•-�{ BoundarySurvey .; `' r= ~ { ,. Scale:1 Inch=30 t9e! •• •••1 in•ch•= 30•R. • • •• ,c �•1tMM!ii �,•-r-, St20tet t8 MUMMYm Jcc 02-0&1? • • •• • • • • • c.' O 4 .` 1.. SI PlRPM PEtD DRAFT DATE • •• • • • • ••• • SURVEYORS,r.'aTES •• 000 •• • • • •• SICs 1.fHFRE6YC�4RFYarsawwymw# teahrJcd6�sds. �.'� f, a .ks�. PQ?09rRfOSttGMl7?021.F'k�rid9SffiRde. �}.2-�'-iL o •� � .4�`a• 2.nnamveymaaenetepaedwaRaasr rarer�.Era anre oerF PR ag.'47Rrc0 MdfAe ratsads�otat'7 '.h tS9rldeda$vBjLrfl'�dmJft. ••• •:• i •Y• • •`• f�.Q 'e '. 3.�pardorss m at%cwed rmprmer�Ms wme nm bated • • • ••• • • f.Dine�ansmeremcuerdTEkfar�oumnisera'� •• • • • • • • • • p �1�J � fp�/'� b StateOdanetWo�crrrJ�oPmasdaaceoerata�arltsaxvm. • •• • •• r Vrl•-�r.'L•7 lIVV BTlntGmsCetaeeladauamad�r+Nukrlbl86f89 •• • • • 4546 CAMBROGE STREET r.Ad4rAM of 08te M to wwy maps at rapmfs by OW Men me*eng 1 WST PALM BEACH.FL 33498 PRAY apm503Isp du�ilbalwn'RA* N011D>3*ftWiofpallo. MI.E 56t-:T&i78; a Swveyatsjad rorawa.'mns,+Qskthm emm2ro awrtft4t-sap ••• • • • • •0:0 '• FAY. 59!•478.1094 ofxwxr tsMwiAsebencamlawilwebaamdet3et pautri a w6p neva era*m;-Adbtm wm1rV;OV ses&doe ornj opmttmm • i i i•r i • Nease visit us on the web(�1t wwa pmswveytng.net ••• • • • ••• • • c � U.S.DEI'ARi#51ENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name ANDRES PUENTES Policy Number. A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No)or P.O.Route and Box No. Company NAiC Number 354 NE 91 ST City MIAMI SHORES State FL ZIP Code 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) FOLIO 11-3206-019-0220,WEST 112 OF LOT 5 AND ALL OF LOT 6 BLOCK 2 OF EL PORTAL PB 9 PAGE 101 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat.25°51'30:59"N Long.80°11'24.16'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 8 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage; a) Square footage of crawispace or enclosure(s) 1510 sq ft a) Square footage of attached garage - 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 foot above adjacent grade 14 within 1.0 foot above adjacent grade WA c) Total net area of flood openings in A8.b55552 sq in c) Total net area of flood openings in A9.b NIA sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name 63.State VILLAGE OF MIAMI SHORES 120652 MIAMI-DADE FLORIDA B4.Map/Panel Number B5.Suffix I B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12086CO302 L 09/11/2009 EfPectivelRevised Data Zone(s) AO,use base flood depth) 09/11/2009 X NIA B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: 0 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:NIA ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings" ❑ Building Under Construction" ® Finished Construction "A news 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/Al-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified In Item A7.In Puerto Rico only,enter meters. Benchmark Utilized:65-3-R Vertical Datum: N.G.V.D.1929 indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 ❑NAVD 1988 ❑Other/Source: 'Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a)Top of bottom floor(including basement,crawispace,or enclosure floor) 8.9 ®feet ❑meters b)Top of the next higher floor 11.35 ®feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) NN/A. ❑feet ❑meters d)Attached garage(top of slab) 9.82 E9 feet ❑meters e)Lowest elevation of machinery or equipment servicing the building 9.24 ®feet ❑meters (Describe type of equipment and location in Comments) 0 Lowest adjacent(finished)grade next to building(LAG) A,88 ®feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) •" "; ; :8.18• : ; •" ®feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including stAtural wJpV N a : :.; '• ❑feet ❑meters SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or rchit��tt authorized by law to certify elevation - information.!certify that the Information on this Certificate represents my be efforfs�to interpret Rip Idat8 alraflaWe:. I understand that any false statement maybe punishable by fine or impriso ftot uOder j e:P$.Cate,,�elvbo 900?, - ® Check here if comments are provided on back of form. Were latitq'andsdhg'itude IQ SeVon A prolld84 by ati ® Check here if attachments. licensed land surveyor? ® Yes ❑ No = e A Certif es Name OSCAR EMILIO BAEZ CUSIDO ••I.kwse Nlrn�i 5PH . • - - - Title REGISTERED SURVEYOR Company Name 360'SURVEY*8 -ftP&; j.LC; * . - - Address 2000 SW�3RD CT. City MIAMI "State FL• ZIP Ctll3b 35155• A.: 1 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. 354 NE 91 ST City MIAMI SHORES State FL ZIP Code 33138 Company NAIC Number. SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/oompany,and(3)building owner. Comments SECTION A-A5.LATITUDE AND LONGITUDE FROM GOOGLE EARTH. SECTION C.,C.Z.,e,TYPE OF EQUIPMENT=A1C CROWN OF ROAD ELEVATION=S.S3' Signature Date 08/31/2015 SECTION E BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C.For Items E1-E4,use natural grade,if available.Check the measurement used.in Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawispaae,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG. E5. Zone AO only: If no flood depth number Is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address city State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8-G10.In Puerto Rico only,enter meters. G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who Is authorized by law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.) G2.❑ A community official completed Section E fora building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for ❑New Construction ❑Substantial Imprrov"t G8. Elevation of as-built lowest floor(including basement)of the building: ��� -fee!•�E jaer• Datum G9. BFE or(in Zone AQ)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevatlow ❑feet ❑meters Datum Local Official's Name •ii e• • i i• • • i i r Community Name Telephone Signature •••Dste • • Is ••• • • Comments • • • • • • • . . • Check here if attachments. ` ��/2%J2v"2;� :Os44 957603973 —. . . KD—SA�'8 ,. '.. • -_' :_ ���?i $.v32 i��". . Nk, Btu: two. w*. Uv ism in. Pjspgu No Bid vsh T n motes 31$high limeys 2%Tmh Body I,en& . ?W*Wbe4 Vhwh&=%M 5136 bah wift -Net. 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