BPP-15-3198 EMILTANO OBOZCO, P.E. 7-0
Professional Engineer
817 8W 122 AVE.
MIAMI FL. 331 B4
PHONE: (7a6) 715 - 7125
February 10th,2016
Building Official
Building and Zoning Department
City Of Miami Shores
Project:Mr. DINO PEREGALLO
Address: SS NE 97 STREET MIAMI SHORES FL
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 786 715-7125 at your earliest convenience.
Sincerely,
EMILIANO OROZC , P.E.
Professional Engineer
License No. 66341
n E a £ ��YtTlt tB �•s i 3
Miami Shores Village riril� U
10050 N.E.2nd Avenue NE �fflt/t77a'
M
'•'• Miami Shores'FL 33138-0000 3
Phone: (305)795-2204 �.. "Ah
bOROJII`
X311 Expiration: 08/01/2016
Project Address Parcel Number Applicant
55 NE 97 Street 1132060130990
DINO&IRENE PERAGALLO
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
DINO&IRENE PERAGALLO 55 NE 97 Street (305)995-5224
MIAMI SHORES FL 33138-
55 NE 97 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 42,000.00
ROSMEL POOL INC (305)592-7900 __ _ Total Sq Feet: 1429
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 AND SPA Bond Return: Wall Steel
Classification:Residential Scanning:4 Review Electrical
Review Plumbing
Review Plumbing
Review Planning
Review Building
Review Building
Review Structural
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Mechanical
Bond Type-Contractors Bond $500.00 Invoice# BPP-12-15-58180
CCF $25.20
CO/CC Fee $50.00 12/29/2015 Check#:13229 $50.00 $1,997.00
DBPR Fee $18.90 02/03/2016 Check#:13299 $1,997.00 $0.00
DCA Fee $18.90 Bond#:2973
Education Surcharge $8.40
Permit Fee $1,260.00
Plan Review Fee(Engineer) $120.00
Scanning Fee $12.00
Technology Fee $33.60
Total: $2,047.00
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 informs n is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-na d contr ct r to do the work stated.
February 03, 2016
Authorized Signature:Owner / Applicant Contractor / Agent Date
Building Department Copy
February 03,2016 1
Miami Shores Village
DEC 2 g 2015
!
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tei:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FC 201, .��
BUILDING gaster Permit No.B0F f
PERMIT APPLICATION Sub Permit No.
�UILDING ❑ ELECTRIC ❑ ROOFING [� REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL (PUBLIC WORKS [] CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �5 N C Oi 1 5t e
City Miami Shores County Miami Dade Zip: 3313% /
Foilo/Parcel#: 1 "32-0U-0Q> ` OgCi0 is the Building Historically Designated:Yes -NO �e
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
;
OWNER:Name(Fee Simple Titleholder): �F)'%An 'PI-W!2 01 Phone#:
Address: 5J b•➢
City: 1 Gunn r Shore State: r L Zip: 6513
Tenant/Lessee Name: Phone#: -
Email:
CONTRACTOR:Company Name: 205=1 pboLn' II m , Phone#: 30S R SCG?°lei 0 0
Address: 9 30c) Q L,) 'g5 51 , =41-05
City: State: EL Zip: 3311 a
Qualifier Name: "i r-16c. mcLye.1r. Phone#: 5ov. 40A.')'lCt®O
State Certification or Registration#: C-PC-145UW4 Certificate of Competency#:
DESIGNER:Architect/Engineer: 11 G►r.c ®Irlaz, c_o i PCIP 3 0 Phone#:
Address: 5s®I cll)� 1 t a City: i✓19ic m a State: Zip:'
1�
Value of Work for this Permit:$ L4 A.6 o u Square/Linear Footage of Work: �®�1
Type of Work: ❑ Addition ❑ Alteration ❑ New � S® -
❑ Repair/Replace Demolition-�_v��%vu
Description of Work: `� Po®1 , i4E e-- t 6� 1"� t I'
Spec*color of color thru tile: �C r�� (�
Submittal Fee$ �® Permit Fee$ 1( ���' �/" CCF$ S e_4b CO/CC$ L
Scanning Fee$ i 2 . W Radon Fee$ s ' 0 DBPR$ 1 ® Notary$
Technology Fee$ c� Training/Education Fee 40 Double Fee$ g��
Structural Reviews Bond$ "DO
TOTAL FEE NOW DUE$
(Rev�sedo2/24/2014)
1; �� co
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) 1, A
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or Installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
""WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COiVIMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. . IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such pasted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Q day ofr ,,� .20 ,by day of c by
i personally kno to1�1•� r-1��.�. �� -eAc h is personally know to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: C�' Sign:
Print: �y ►� 1 @ Z Print: v✓ "
Ina"s' MARCOSAMARTINEZi�
Seal: 'pay Seal: I' MY COA MiSSION#FF 0Q8969
=Q. s •,, MARGOS A MARTINEZ ; :: a
MY COMMISSION#FF 008989 EXPIRES:May 15,2017
EXPIRES:May 15 2017 Bonded Thru Notary Public Underwriters
Bnded Th.Notary Public Underwriters
k Fqa jt#•h Yak$#i<7k$�rkA k ep ok 4c#dn�ticd+k4aRt =P da ak tkitokekok�4t�kk okt:#sk>kix=k kk�cst akk sk R�>k+kkskw$'F��K>Rk�k��C+k.{e kaF fa iN>RQ+Rk�•sR�w$�IeInds✓F
APPROVED BY A B Plans Examiner �,oning
U Structural Review Clerk
(Revised02/24/2014)
I
b �, ALOCATION MAP
Assoc ates Services;Inc $ (N.T.S.)
fessional Land Surveyors,Mappers&Engineers
rtificate of Authorization NO.29o56&NO.L87538
Main Line:(3o5)953-2600 I Fax:(305)953-z603
WWW.DAVILAASSOCIATESSERVICES.COM 1 0 -
16 17 19 20 21 22 23
4.
....................................... 7-'-'-*-*-'-'-*-*-*................ _
Z
BOUNDARY SURVEY �„h R
: LEY' :10.00 ASPHALT::::::::::: :::::::::::::::':::.::.:.:: SCALE=1:20 - -
t '\'' • •
75.00(M&P) :� 3.0 GRASS , �••°•• 0.00.0
A90°00'001, o o ' 0 25.00
i %4• . N °I ,\ h�8� N LEGEND&ABBREWA77ONS RECEIVEDLO�A�JQ�I l�T •a••s•
' : p A SBMALE-N.T.S.
q; z .5 \22.40 LL 12.00 L C6 64 I�: C A-ARCDISTANW FNP.-FEnenuNanowc ^/ 1/pv a••a a e
tL, �� L -3 Y•: y NC-AIRCONDIDd•FRPAD ISURANCEPROGRM7 (RYREVRDOISTiWCE CT 1 Lo 1W sees • • i •
LL L �O POOL 4: AE-ANCHOREAMWENT FN-FOUNDNAIL R.R.-RAILROAD
AR..ALUMITNMROOF IMMG.-NGRESSANDEGRESS REB-RESI09YM LEGAL NOTES TO ACCOMPANY'SKF CW OFS?If'i1&'Y.
•(�' �/? GARAGE In L L -1• PUMP AS ALUMNUMSE�D EASEMENT RAD-RIGHT-0FWAY .THERE MAY BE EASEMENTS RECORDED IN THE PUBLIC RECORDS NOT SHOWN ON THIS SURVEY.#•`•••
'\ 3x3 ASPR-A-%'*MT LP.-LTGHTFOLE RAD.-RADIUSORRADIA
• N F. .30 '-' LL '6 ac-jx=a ER LF.E-LOWESTFLOORELEvanON RGE-RANGE �&A •EXAMINATIONS OF THE ABSTRACT OF TITLE WILL h"#ME MADE TO D9T*'t.11NE AFCORDED&SrALWAITS,
N BLDG.-BUILDING LM.E-LAKE MANTENAGCE ROE RODFOYFRHAroEASBOW IF ANY,AFFECTING THE PROPERTY. • a • •
O L L L • W'H aM-BENCHMARK EASEMENT SEC-SECTION .THIS SURVEY IS SUBJECT TO DEDICATIONS,UMITA11(%S,RESTRICTIONS,RESERVMNS OR EAS&AV W
U 10.50 aO.a-aASISCF�RIN(i -MRNTE8 STY.-STORY
'•'l ' LL N g L 14.90 �1r (L9-CA-anATED (My MEasw=mTmgm SWK-SwEwax RECORD. •r•••• • •
• � Ca-C4TCHBA8N M.E-MANIENANCT&WWENT SLP.-SETIROMPPE . LEGAL DESCRIPTIONS PROVIDED BY CLIENT OR ATWSTINO T7AE COMPANY •
Vr.J Cas-CONCRETEBLOQK M.H.-MANHCLE SLR.-SETSEONRCD . BOUNDARY SURVEY MEANS A DRAWING ANDI OR AAGRAPHIC IEPRESENTATION O)WHE SURVEYWiiA(•••
Q, 22.40 M L CS.WSTRUCYURE NAP.-NOTIONAL F SPSEWRVALW R01 PERFORMED IN THE FIELD,COULD BE DRAWN ATA SHOWN SCALE ANDIOR"ft%4ALE.
ce.W-coNarETEmoaKwAi NGw-NanoNa.cE�nc sV-sEwmvavE
3 L CR-(WORD VERTKALDATUM sEmNas . EASEMENTS AS SHOWN ARE PER PLAT BOOK UNL &P OTH8%*SE •
(W.a-CHORDBEARNO RT.S-NOTTOSCALE T-TANSW J R 7G 00009*
LL L ppOl L O (n CHL-CHORDUNM #o NO-NUMBER TVTP-TOWA&W .THE TERM•ENCROACHMENr MEANS VISIBLE AND WI .f ND ENCROA�F�1�(P • •
LLLLLLC L CL- p/S.OFRET UTIL-UTIUTY •ARCHITECTS SHALL VERIFY ZONING REGULATIONS,RESTRICTIONS,SETBACKS Aj'D�WLL BE RESPONSIBLE FOR
O Q LLLVl,r..L 8,00 N U CO.-CLEANOUT O.H-OVEWGEAD UE-UnUTYEASEMBVT SUBMITTING •s a
L1 f��.� O CLF.-CHAINUNKADTE CHL-OVERHEAD UTMTTYLNES U.P.-UTILRYPOLE . PLOT PLANS WITH CORRECT INFORMAT70N FOR'APPROVAL FOR AUTHORIZAT(ONTO THE PROPER
L L cM.E-caNAl MAcvrEawrl� o.R.a-oRaC1a.RECDIGOS8001K WM.-waTERMETER AUTHOPJ71ES IN NEW CONSTRUCTION.
L L 20.00 EASEWSW OV.R-OVERIGANG W.F.-WOODA9CE
LLL M r CONC-CO�+E� PVMT-PAVEMENT W.P.-WOODPORCH .UNLESS OTHERWISE NOTED,THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTING AND/OR FOUNDATIONS.
+� cuP-coNaEMPORCrYFm.E PL-PIANTEE WR.-wTERVALF .FENCE OWNERSHIP NOT DETERMINED
W CP.-CONCRETESLAS 1 P.L-PR PERTYLUErKraFoom W.Y.MONO iNTU
� L L L L L L'I1R�V�tiTIAtd1.L L VE
U CS-coNwETEs(Ae P.CC-PDINT�CDMPDILIEI M-MONUMENTLNE • THIS PLAN OF SURVEY,HAS BEEN PREPARED FOR THE IXCLUSIVE USE OF THE ENTITIES NAMED HEREON,THE
V r- LLLLLLLLLLLLLL L r- CW-CONOWIEWALK CISEYATORE t-CENTERLNE CERTIFICATE
x LLL L L L L 1.6 x OE-DRAINAOEFASEMENT PQ
-PONTOFC1WA7URE A.DELTA •DOES NOT EXTEND TO ANY UNNAMED PARTY.
10.5 ONIX-ORANMEMANTENAMM P.0.T.-POWrOFTAMiENCI' t-PROPERTYIAE
EASEMENT ROD PONTOPCOMMENCEMIXf ELEVATION DATUM USED:NAVD 1929
U 10.8 L Qro \ a' O0 U ORWY-DRIVEWAY PO.a-PONT�EE(YMNAtG SURVEYOR'S NOTES:
10 11,0 O W.DECK 5 O L �. °� ELEV.-ELEVATION
.-ELEs P.RAILME OFREYERSE 1.CER77RCATE OF AUTHOPJZ477ON LB#753a NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC SIGNATURE
CQ ENG7d-ENCROAOnHENT PwY-PARMVAY AND AUTHENTICATED ELECTRONIC SEAL
O F.H-RREHYDRANT
6.0 U c P.R.M.-PERMANINTREfFRENff
D 16.80 _ CD PLP-FOUNDEEONPWE MONUMENT
�"I Q E., FF.E-AN19HEDFLOORELEVATM SURVEYPROFESSIONALLAND OR-R
F \ F.R.-FOUND OMROD PLa
H.FF:ELEV. w� F.HO.-FOUNDNAaADISK AP-POWERPOLE LEGEND
Oq�7 N 12.75 ONE STORY N w W O FT-FEET PUE-RT&FCUTIUWEA4EMENT --OvEwr6wUmffLm S
zr� cONc%-MELOCI(WAu(cas)
RESIDENCE M F 3\ A ¢ _(WAWLWK,?7�E(CLF)
No 55I I z -PiOf,FEAOEnF)
U M` wuonK)FS (VF)
I L.FF:ELEV. -Oa F
I 10.8 20.70 3i II w .. - AVILA
U \ r�i ii 12.20 1.0. a - 3 �1 tm.ciates Services, Inc.
M awaa so>r�asra a
W \ Q� �) \ Miami Shores Village CF.R„FICATEOFA„THCRIZAMONNO.2MM
�+ .10-,NY
`� 11.60 19.80 12.10 CERTIFICATE OF AUTHORIZATION NO.7538
A it 14750 NW 77 CT SUITE 204
Q APPROVED BY DATE PHONE(305)853 2BDI
Q CONC. ,• (+� MIAMI LAKES,FL33016
g M LOT 17 ^o/ Q go EBLDG
RIG DEPT �� / c
BLOCK 7 A ` CD '� o eq S C(�` ev:
M - I N N M x DEPT FRANCIS AAGUIRREP.E,RLS. 7--2016]
_ AaF¢ u
^A O A OO A I PROFESSIONAL LANG S SURVE WL: FART S&MOSSE SFAL O
_ ()R,IFCT TO COMPLIANCE WITH ALL FEDERAL LAND SURVEYOR)OFTH3S RVEYWLL BEAR THE EMBOSSED SEAL OF7HEAT ESTNO
� p a O LANOSURVEYOI#.
yQ O_ USURVEYOR'S CERnRC4770N:
a Z o 3 u: z SAN COUNTY ACOUNTY RULES AND REGULATIONS
q oz I � 1 HEREBY CERTIFY TO:
}J THAT THE ATTACHED BOUNDARY-SURVEY OF THE ABOVE DESCRIBED
aro y • •'' 75.00(M&P) -•';5.0 SIDEWALKyj . .' • ��, PROPERTY,IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND
275.00(P) (N.T.S.) BELIEF, AS RECENTLY SURVEYED AND PLOTTED UNDER MY RESPONSIBLE
• DIRECTION, AND THAT THERE ARE NO ABOVEGROUND ENCROACHMENTS
• UNLESS SHOWN THEREON.I FURTHER CERTIFY THIS SURVEY MEETS THE
CLIENT.DINO P PERAGALLO STANDARDS-0F-PRACTICE FOR BOUNDARY-SURVEYS,PURSUANTTO SECTION
21.5 PARKWAY ; . ,c� .•e : PROPERTY ADDRESS:55 NE 97 STREET.MIAMI SHORES,FL 33138 472.027, FLORIDA STATUTES, AND ADOPTED IN CHAPTER 5J-17.050,FLORIDA
o' • .; c LEGAL DESCRIPTION: ADMINISTRATIVE CODE.EFFECTIVE DATE JANUARY 1,2010; AS AMENDED
•'•'.e'i, •: :-"' .CONC.', LOT 17 WJ LOT 18,BLOCK 7,MIAMI SHORES SECTION NO 1 SUBDIVISION,ACCORDING TO THE PLAT THEREOF AS FEBRUARY 23,2005.
�:°, •' '•'� • to RECORDED IN PLAT BOOK 10,PAGE 70,OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY.FLORIDA
M
/6
' ' • •'. ELEVATION INFORMATION:
•� B.M.USED N-568 ELEVATIONS 9.65(NGVD 1929)LOCATED NE 95 ST-35'NORTH OF CIL DRAWN BY: NH
11 C.8O 16.SO . ••, BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY DA7ED OR_ FIELD UPDATE:
REVISED ON 09 1108 THE HEREIN DESCRIBED PROPERTY IS SITUATED WITHIN ZONE X BASE FLOOD ELEVATION N/A 09-07-2016
COMMUNITY 120652 PANEL NUMBER 0302 SUFFIX L EFFECTIVE PANEL DATE 09-11-20FN
...................................................................................................................
.......................................
CONTACT YOUR PROCESSOR CHECKED BY: R.A.S
NE 97th STREET SCALE. 1 20'
PAVEMENT:::� TOTAL R(W 75.00 ::::::::::::: CERTIFIED TO: FIELD DATE: 11-11-2015
^"' """"""" ,� """•""' DINO P PERAGALLO&IRENE PERAGALLO
'1.:.':.:'::.'::.'::::.':.'::::::.':::.'.:'::.'..'S.
...................... :::::::. JOB NO: 16-0951353
....... ............ .......... .... ... ...
SHEET: 1 OF 1 SEAL
(VA.o
'A VILA LOCATION MAP
ciates Services, in
CE&COti
oA
m m m a a a
in Am
9
M AV
C(YPMK
BOUNDARY SURVEY
SMILE.
............................. ...............................
....... ............................... ...............................
............
b. 7MMMMAMP) 3D ORAB4 IRIE E LOCATION Slft7'CN
ba I SGY6
11 DEC 2 9 2015 LEOALNOTFSTOACCOMPANY SI ETCH OF HY:
.TIS&WYfFi16H0fBMfl®%QIG WR9pR.01R®JX>R1BY.
11 t6t I �vAi ePiWPeRrc�mtE,LmLwve roeewm roa�ETsumemm+RULanx
13X73 SAO .�18a8R.Tro0�IWROM9,tAOpTX1AtR�ll61ai119,�vATe�80R6t4�BPre6
A,C (090 BY: •D3dN 'OPRDVD®IrvgaltltAJliSilIMB RREOp�itlW.
3 230� q re �revrwFawnre r®o.aarmroarwmaiA alaouRacaLa<mrDVRA wrroacue
W �1- 6 8 � .B9BB®Vl8A8 WIOMiA3�P9tPLLteO[YC U�MNBLBLT®Oil6Cph9E
g .msroarstnaoa�r�umvlraaB.unXeasaaa�•acna�oa®us.
� �..
13«65 to � � I .aRmUrDOresR.Bl.vDvsaYOA+tYD1AATrarlAaatPoe++am UURURamalmwleUeRdr
S arelarrPg7
i "d O I.EOHVOdaBBREWaTlONS 4I� TIOII0R 7wawxRnRALmmwuRRrronr&wapeR
`«Y� eca�
w ,....»acLucc.c®ea •racedoroLmmimmreaa�Ras.crAnewimmwmremoo�oromRrowanarn
los _ .®mio®emam maomeimme . ttara ,":mnmLs1°0 •*,.accv,oPawroe,'.I«s�awrw,ReeaaLanarnean neam,marwe�+�oa„s
itA� w'°aCK."..0 O ( � .w.a�0°nr� oALJL-J.aP®rwlar. Lara. _ ��amremc ,.win,,,, TsercJrwre
P � .noE.axorcxremroAwLeawe®Pum
Lp. 9 ftPF:EI.BY. � vt Lv�� � Q � O�g.g�.�y ao�n-� � 81WATIOND11WfW®tRAYD1�/Ib1'D tYBB
�✓b r -aLOspKD .Xay nloLa SEMMYOR'SNOTM
A 1275
ONE STORY Q � •'� er.emm io�_ exa�uwe�eoa mrww�weaw®rt r.oerrorare tr AvnpRaaroR=e�=me.ror nxm t»nrovJwv wmm�rax®sEClRam aaRaru�
� ;,lux X70 LMLEV
�Ep�DtII.aCe I yI � � m-"q0'® in1°-,.�aa•Dm.Jam "�''°'� °^'-�vr Juown�Encu®ascrRalxs�c
S° n..w�rw eJm vPs`r.'�'aa�oormn w.m�®awe
,Lm
0 tLeB 'A V 1 L A
tsao ® JrovwAweonJar�LN -raalSaFXL
Rloctete8 e7YiceRr,lac.
g � O O ��1O° ��m.�Jm w APOd CERTfFU)ATB OFA7RIWR®Jt710N N4
yy 10.0x7 O � � pppinnn �•.a.�� wn� .�.�.,. i w�Nw crn �eNo.7s�e
B >• I - �„� I �ol�mr-< I bl
PM95390t8
qq y$L q ,�„e3•aBBo
dp 3 ti
::75R)D(N@!7:!';SD ♦ =i•'�."''•t 275.OD(P)(KT&) BY:
EFRW C LOPEZ,PLS(11-11-2018)
�233PARKWAYJ _:�:-'..:.•.
.$i;,L•"!•Oft PIAL twwasntlgaLw:2300 BIJLmaPliael0l
K:v!, . - f.'ONC,,,+. 8L RYARIDLGW690F TlOSSIAPIEYORa BENt RA°9�SFX Y"IJEATTBSR6 '
.�' f';_•i
SURVEYOR'S CERIIFWATM
.....:..:.
MEREST CERTIFY TO,
::.. :. .::.::::: :•::::::::::•:::.::: THAT THE ATTACK®RWNOARY-BUAVEY OF THE ARtlYE DESCRIBED
NB 97Th PROPERTY,®1RUEAND COW�TTO THEISM OF NY KNOY49M
.i::i:::::•:i::: ffitKIPAVFA•rAT:.:: TOTAL Rlw 73A0^::::.•:.:•:t•...•..•. •• ••• • • • • • •• AND BELIEF AS RECENTLY SURVEYED AND PLOTTED UNDER MY
i::"'�t`.•ii'2:'':;t''•:: •:::: :;:::.:::.:: ?:- ::::•.;:•.�:�,•:•:.•.::.•.:•::yit:''^"':.:: • • • • • • • • • SLE DIRECTION.AND THAT THERE ARE NO AB�RaRRD
CLIP .WNOPPERAGALIO •• • • • • • E MB1�SSS INN THEREON,FURTHER COMPYTHIS
PROPERTY
SURVEY MOM T/E:ST�FORBOUNDARXSFAVEYS.
R ER,Y ADDRESS:SS RES EER,fAI O S,F`JTr� • ••• •
DIN
LEGAL DESCRIPTION: - - • • • • • CHAPTEPURMINTTO 4MFLORIDA A OUSTRA IVEOCFLORIDASTATUTE$AND TIVECAADOPTE
......................................................................................................
r4 CHAPIERI1.2DIM,AS MME)EBRIL 23.2006FFFBC7IVEOA7B
LOT 1T\Y: jO BLC DS IQ IAMISMOH S Tb UBON ION A �NGIyFL R4T THEREOF AS .UN{IARY,•'AHD•ABA 1 13•mB�
REGORUEU IN VLAT BOOK 10.•/.eE T9 UBLIC ORUS 0.11AMI- E COUNTY,FLORIDA
ELEYATIONwPORARAVON ��� ARM
EIEV4TIO —ItIGW)lW9INAV IM)LOCATED ,„w•,ws..ya
BASED ON THE FLOOD INSURANCE-TE OF THEFEDERAL EWRCENCYMANAGEMENTADENCYDATED ON �ntN.0 LpAA�
REVISED ON 9 l I-W THE HEREIN DESCRIBED PRCPEPTY IS SITUATED WITHIN ZONE X&ASE FLOOD ELEVAPON WA
C0.4/M14UNIl Y'I10S57 RAIJ£L NDMBE P UFtIX L FFF�C�VE I�(�I�ATE D?I•t�Qj •r/•
• 5.i4�� • . a9nraarrataPRocEsSoav cl1ErlWer: R.as
• • g
CERTIFIED TO: •• • • ••• •• • •• • �7
SCALE !'�ZO'
• •• • • • • • • •• pOa !l-112013 •:9�'
RIND P PEEVW4408 MME PERAGALLO• • • • tt•4 •..••.O"
r�,- JOB NO: 13•1143196 m�,„,w""
8REET: !OF! SEA!
••• • • • • ••• • •
• • • • • • • • • •
• •• •• • • • •• ••
••• • • • ••• • •
� t
;�C'" "� fix•� -
FEMA
Elevation Certificate
k
0000.
0000.
DWVILA .. 0000'
0000.
& I� "mial�es Services, Inc. ••••' ••: •
0000. 0000.
ds
Land Surveyors& Engineers •• •• 0*:* ••••••
0000..
. 0000..
0000..
0 . 000.0.
00 . . ...
H-
AOL
y
=f
,
WAV/!A
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program IMPORTANT:Follow the instructions on pages 1-9. Expiration Date: July 31, 2015
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name DINO P PERAGALLO IRENE PERAGALLO Policy Number:
A2. Build5g NE StAddressreet
S ((including Apt.,Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No. Company NAIL Number:
City MIAMI SHORETS State FL ZIP Code 33138
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
MIAMI SHORES SEC 1 AMD PB 10-70 LOT 17 W1/2 LOT 18 BLK 7 LOT SIZE 75.000 X 115
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude:Lat. N25051,52" Long. W80°11'47" Horizontal Datum: ❑NAD 1927x❑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 R
A8. For a building with a crawlspace or enclosure(s): A9.For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1254+- sq ft a) Square footage of attached garage N/A sq ft
b) No.of permanent flood openings in the crawlspace or 9 b) Number of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade WA
c) Total net area of flood openings in A8.b 1248+- 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 B3.State
MIAMI SHORES- 120652 MIAMI-[ ADE I FL
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 A0,use base flood depth)
12086C 0302 L 09/11/2009 09/11/2009 X N/A(NGVD 1929)
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89:
❑FIS Profile X FIRM ❑Community Determined ❑Other/Source:
Bll.Indicate elevation datum used for BFE in Item 69: K NGVD 1929 ❑NAVD 1988 ❑Other/Source: • •
**sees
B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? p Yew e
®No ••••••
Designation Date: / / E)CBRS ElOPA • •
e s
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRF•QI;e• •
Cl. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction* fPh"id Cons:rectio" • •
*A new Elevation Certificate will be required when construction of the building is complete. *000 • so e•e e•
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'R"%0Complyteltb% 00:006
C2.a—h below according to the building diagram specified in Item A7.In Puerto Rico only,enter meters. •• •• •see 000000
Benchmark Utilized: MD Vertical Datum: NGVD 1929 ••••e• s e•
Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 E]NAVD [1988 OthejSource;e e.;e "e e•'
Datum used for building elevations must be the same as that used for the BFE. ' •
Check the me;�uj m tt used.• e • ::0000:
a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 11 00 N feet ❑meters • • •
b) Top of the next higher floor 12 75 X feet ❑meters
c) Bottom of the lowest horizontal structural member(V Zones only) N/ A N feet ❑meters
d) Attached garage(top of slab) N/ A X feet ❑meters
e) Lowest elevation of machinery or equipment servicing the building 11 40 X feet ❑meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 10 . 80 X feet ❑meters
g) Highest adjacent(finished)grade next to building(HAG) 11 00 N feet ❑meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/ A N 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.I certify that the information on this Certificate represents my best efforts to interpret the data available. ���„�,,,,,,,,,,���
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. �. C
.,
XCheck here if comments are provided on back of form. Were latitude and longitude in Section A provided by a c° F�P,SE N C0'O<c`''�
El Check here if attachments. licensed land surveyor? ®Yes ❑No zlvG�t� 23000M��?
Certifier's Name License Number
EFRAIN C. LOPEZ 2300&LB 7538 _ _
Title Company Name
P.L.S. D'AVILA&ASSOCIATES SERVICES, INC A., STATE of
Address CityState ZIP Code 0 FLORIDAQ}`t
14750 NW 77 CT, STE 204 MIAMI LAKES FL 33016 S -
Signature Date Telephone00,,naiSurveyor���.`��,
11/11/2015 305 953-2600 "" �
FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions.
WAVILA
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 PO. Route and Box No. Policy Number:
55 NE 97TH ST
City State ZIP Code Company MAIC Number:
MIAMI 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 C.2.E REFERS TO AIR CONDITIONER MACHINERY SERVICING BUILDING
LATITUDE AND LONGITUDE OBTAINED BY GPS/FLOOD ZONE DETERMINATION IS FURNISHED BY FEMA
THIS ELEVATION IS INTENDED FOR FLOOD INSURANCE PURPOSES ONLY; NOT TO BE USED FOR LOMA OR ZONING
DETACHED GARAGE FF: 11.30 C.O.R= 11.00 A/C FF: 11.54
Signature Date
11/11/2015
SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items E1—E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,and C.
For Items E1—E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters.
E1.Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the LAG.
E2.For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),
the next higher floor(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
E3.Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG.
E4.Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or ❑below the HAG.
E5.Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance?❑Yes ❑No ❑Unknown.The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE) CERTIF,CATbN •
The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEV ijsued or cormn&itY-Issued BFELor•
Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. • : . • as •..
Property Owner or Owner's Authorized Representative's Name 0090 :see*:
Address City State •••• ZIP COde •• •••••
Signature Date Tele49rler • • 'so0000• ••0 0:•
•
Comments :60:0:
�.
• • • • ••••••
.•...•
.• �]Check t6-ra 4 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 G8-1310. 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—G9)is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum
G10.Community's design flood elevation: ❑feet ❑meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
❑Check here if attachments.
FEMA Form 086-0-33(7/12) Replaces all previous editions.
1
ELEVATION CERTIFICATE, page 3 Building Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number:
55 NE 97TH ST
City MIAMI SHORES State FL ZIP Code 33138 Company NAIC Number:
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions
for Item A6. Identify all photographs with date taken; "Front Vie\&" 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.
y. 111• � ;
s F it
•
• • Y
r • •
• • Y
•
•
v:
t
4,4 4
FEMA Form 086-0-33(7/12) Replaces all previous editions.
r ,
ELEVATION CERTIFICATE, page 4 Building Photographs
Continuation Page
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number:
55 NE 97TH ST
City MIAMI SHORES State FL ZIP Code 33138 Company NAIC Number:
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
1
y M
1a
•
• •
•• ...•.
• • • •010 0
••••••
_ 4
x
Y,
4,
- F
t
.1
FEMA Form 086-0-33(7/12) Replaces all previous editions.
Pod NIOM
Btu: its/o. j04+sgilehe , U.V irMbUm W&U in. fry
Net Bred V4 Inch
Tette Les 3/9 Inch
NAn P:itieys 2$14 Inch Body I-Mgth .
Pulley WbOCL1•kWh ,5/16 b0h with
Not•SbOn9ft Test €up to 40 Ras for ASM 134&-91 sWgdmd r
1% 10}mss •
1.5 iiwh ptae MM twos abohor pOsitbrns�.� mew-
holes
w- �....
holes ....
msuak is C'lm%Tela•tea mdbeiges° ••
Flush otz�t 'S4 ih mer b whh S ..::.
....:.
1.3 imh dept . . .
$rm =Glum filled ny1m for incased Msistce to•sir.: ;••••
and dketakds •• •
Avwbble m Croy,Term Cotta,SOW(ate)and Brass
Air Kook 4mm StaWass S*1 wire hook
Ahanrate Anchors K ixtchxZ�=h Stayi�nim Ste4 eyebolts
1/4=1Sy� ,IHSS Str�d1 6rOp ar-bM
Stainiess Steel S.hoaks.(Gate how},rniti.141 x 1.S i
3101 VW SWpV&4X•� Ri3Ak.ft 8331'$33 t f•?�Ll�i$66 d83�5TC10•gAX:95b?b494'73
lB:77''.. »_ 19_s _ 2...C2 .-r
4�R1v-71-268:6 i-2t41 PM K3f3$APTB
P.82
FAX
• iota 0.4'a. ,fiat[i'
1151W 14
• • •• FL'33=3� '
3013?
Thkhmiw to
rmshy mvmsjestea its asom cnmpHarme AMU F•1346-91,Swndwd peoxrgmp SpcW4Mn ......
for U"Cogs aad Lits Peqwmmts Por A9 Coven for S Anm ft Fools,Sys sad HotTw* +atd •
LU'Dl!t&was pafonned underthe above refacacad ARL file sLl mber, •••�•• : •••' ....:.
t lgat was zestcdarAfoulto�vAththostaWardls trade n�ea�" .«"P�� :so**:
3worptisttr=rmtt=-ihm sm em L :#x}.ARL die.Math le,2M)ff ••�.:•
to mei yeasr @te Ate.l.isi uric. : .
••.•". •••••
.. ..
YOW Ccdfica0 .Regort and•FoHot-ttp Semce Prcccdw*alb In the pmom oto JaWi aiand wHl •
be ftwwwded to you upon oompk6m If you bm*q quesiaas,pkm d&im�' ID w ••:•••
y t s !t
1
'�y
:! t £ !£.
y }
4
Cr j i.� 3 tt i} }� iy £ x.i l,,,, t�F. , tl lyi l�,t!{s ! v itt r t� .r y ! r �•
:«
.�J�ti £': 'y3ii ttit Nir s, x•tdu. -.i.., .t 'o ;•:-f�i b. t �
.4!. . 7 t. L ,"i"A% ,.yJ 4 i "+,>r `} ! y,.�,}: 7. ! r!. r }', a s:a n
tn,..rt ''�ti b.c.£y{i.j�..y r"� °�+v:°rnts. h= �} `r .:� t b �i! <i( \ !. s� �3. .>: t P,.,
", y...t, I t; t' i ! r! 4 m (! t s { ;l
�.��"Ti `Y,x r {r} 3r(�t �� f (ri s4 ,Fi,:�{r 9 i S r f
�.�. r � �h ! � § y... �ti if (
r;l�$.
r �
t- rh 2,+} �, ,t,i.1 >..y .,,,l Jr`,!,�;•:: v..i�.•,.:,< X '�/SY,".; t )`.;...k Irr ,-. i. .J. y. 'a �.i F �,
'.:,1..r�i' 7,.:Iii l ..�. sn �'-�i..�f .S Y - ! :r..: 1. 2' F.'):t✓�. fr,t .y 1..^.1.:! :�.,,. (:. .��..' � t.i l t.� - f
� .,<.:i,-+x .lrl�+ls.1 ,l,r r �. ),. .{� t Yr�;�,•,, Ys #ix{�a�a. i€� !�� �i, 1 '?.� F.e. ? !�_1, �2 )�y,.,�. °:�1 x�,�' S t t ;, ?;,. i iY'.�.s r r�.n� s ..b � � ��%..� .;l}.'.
.! ! �•et .f�`:.f:..�`t � y.y .-v.,��at: 4rfiF� 4 � �,:<. .5* .�i,'.n } ,�ly � h! �+.. y sl.rx,,., -�.,.,�: ;:. ,l,t t l f ,., t i .,, ,.., � s.-�{
„s �7 .. r y s } £ 3.3 !
5 FAN' e S g.. y �:.d�. � �b. � / .L�, t f!i)r,+ 7 l ( titt 4 s��t $.t!
zf` y 2•� t +.t rt i r-'
q,y,t .�f,� i e...1.:f l„ S {{ �•r.,�itt- N�I.Js.• 1 ,•k K, t.F�sl... i-- � �.)( �f St 1 sf' �`. ,/ ..l�.t i y� '� $.l4 ttetF a� 1 nli '+1 7kA'
..t r.,•- � ,..}�}.;�. o- 't ) r16 !Y^+'.,4`b`b''..y'. re, s` y�. zi .,�k su-,. .:, £ �.�„c ,..w�* r 1.v I .,. ,-.
4 !.....5
r
' 1 , l .t
*
S s j
£,L,,_.., t jsw` y
5 (
° ,.rttC II I.,:v, }".1}, a,. ..}�f ! t � i. .t..� ya. ,{t rr. Y ,}; t (✓d. t,,,r d. rM a? ,�: <�� t's.:. ast �1�1, C �. u!1 t+ .�x ,�� ...� � +,l. ,� r + rr �¢tfJ 'iiP
,y;: •4„,,_,,a !, *r ;,�. �{. ,rS. r ,..k.,� £ k t�.;t--� �`t.,,;;,! �;.: '�` -” -.,,. i i y 1�.,, � 's 4 c,.. e„-
.i..: ! :,.r, -.�..k��g:k�•..t, a f i 5....a Jho 4£t i '-;.�.§.p�,l... ,: ! t �,.,f,: ss, .,..,.: ,. �,:,i� t � ;. -.er,'e .:.f Y i...t�f, ,!r � t f 1.7. fry tilt y,: t£ �.
><
!<e' .:9�.£c3^h. t .r i2. 5r:r r".+5: r� 5 l!': .f i mt 3 t i5 /- 1 a..�F isF� ;e.. �. �.I.i�'.t y� ! t r..4, :f• ^s`, � ;fi,
��•!., ( .,}. r Gi s`1 7.Y) a. t ! �..&t�> s�i #. t.
t
t
J
N
i.>
i
IA�p W
1 ko
�• Alk
old
.. .goo 0
. . . . . . . . . .
. .. .. . . . .. ..
... . . . ... . .
I
�i27!2 1 4 _c.4s 75£76.9973 s,_ ?.�3e
RM
APOLM
�t1 N.W. St"* ,F 0d8=14
�ISOPEtoae{806?t3t4•"We frit{R8$}M-sem o Eeae3 AMTMONLOM
kL '
eLl
to
a
f�woraannrn•g se.tamY+a�+v aware�b�a*Yeump L '[ao4plh ca �i+oasf+e4s00.nooni?p •
• aa@diat0i�4C•aCaoyoctmaFaxsiOn.s+ihe+el� •. • • •
Installing the Platte BFw5'.=V.0�"°`"`'`°°","°� ••••••
afficanaarAoti•tAoyp�{ppgs!lGts'saa41n01eiA0Aet •• �+• +• •. •
ids at�3ortbaadetart!•o�+gnis+sotenP
➢fmslis>ID6 art6ltP ateubaiawalmtlea4st +iPbaa �Aa�aR�Wend+ap�/a.dc=wwctft • •• •••••
C1a•ppa
Iptg•o••aaietb4Waramln�em9t0iQ.stlfweiassaeofopO$tRatiasraYote40ora0eae4lttYsaeelmielaune+fl�VailomrNaPreeRoyabaae?asaidttAmesaa�uat•7er
adttaaiitodespa�rela&elaaaeaesaaaOmaoa�dasssaaaedt+satoepectfbe�ttinst••teialeas0s6
ras•edl•t0So•po•s•
••
64:000•i•••QynT �d%�Oatpea+tasn • • •Kow9-00411 tow •••• ••••••aRbitoo" mnwwwakwAYA"d
Sae aiaaewweprOstO�oat•oeataot7tr» i Beer+twos.sn«eatae•eo•rtia•elJpsu>aapot+ii�ouawa• •
mo-q Pt+iea 9�Pe I bae6ae�acemtsrayprwat6etaga • • •
froo0taeabatoaybm••ranmc deaaaa,n+pasoi•ep-• •
tPaH�bCtCapiQa9tgqW4�tebpi•fr•�t�n.8spttimJ•rt•tttblwwMat�dteesDi7dtsiCD+eefiaQos J - tF{} � • :066•
• .
••••••
enoq qg the not.
•
•
bt�apaadt• Aag1O;0 19► ptstasi4Oa N84a1QUILty ir0b=WIAwa m, to •
�sbe"rar ��att0wdpm[ vw�etaaOAr tabwri�aOTnultoae�OwMedOpB
P,*GK woasonF4aeamoin0 Kiooamipyi npd,Ja6nlmeb7l! m oaf+
�.itt;ie imaP aA►jxivoZd D+0 4
elQ �Qp�eTo16 Oab
• AOsas-'+Oesno�►wayt,a�sfea�q�iko�taAi�sa[�r?ass'
• �pbt�otta►eo�sea>mosaastoerAtaCrtooaL '
Uf1iF1 -the-net ; asntetaq�stsmtealsaaeedwoam•sdpe�at•aanmaiNl+sa
�pqq ��gg yYaa��low8�m•d ltopta4aYaibosldb•a►@�IORORRO
3� !" �eCatV'!�!t!e3tRpa aaaoaa•anstindsrtk•9.4�e, .
aaanimman +aBtrar�es,o�a.ei sio aaaat�a,aasamraa}eesei+eeeaes,ratrab.�sau
o+Jpsetmauac aadwaC+oa•d+eaaosed sot aiHBs q�ggw�tlwmial�adype� t2WlCkekesabt�ege0t '
,qq.abpilmaetia woos ste�gn ae a�+aaK p�y,s wofaoe arras"moo
6 s�s°4Qstio�a+eA b atlas weft
tdeaotmmem•a�t+aa aav ano+sa�}9tY r�mnna,a.r�i�s�o�at� aea•me+atssaaaetio •
fla+o? ++e�m�a7osataw�wbr�e gcsa raes�ussa�4wme" .oe.rp�oteb>aro� •
ii"iovrtonomtwtQst+oe�a+eivi+�attfaom+e�t.nb �Do1� pw+lt,tYo .soaa,rebasdtRefS�•NH
.sa►w,ts»>mrr�a witW istaoto�es. '
YT 30511 Kid Safe pool Ncb4 lac. Issued-14118/04 Page P-24
Axau�tPamd�droia�a,ds .dxeoa�otlA§ xdn>sseo�d �adxm•ga�atAs�l.n�d,ta4a.at�S.Wt A�+�oatorp�bz�aaa<:: ,
mtda}4esaor 'tlftrepoccarte+styrwdu a9ne v,ia�p4#,l usasstgkraupeewen mads.{ +cdaa+t+s
area dgsaa•d«+�»asYonv ara�+wbeac r.errw=*N Kd,6%i-w-ddabt4omvW.ftam*"mbksaaet *Us"«tomcrprai8ffi«,
APPLJM RESrAnCH LABORATORMS
6371 N.W.161sf shd.mwrd Fkft 33014
Ptd(9D5}9t6-4MsFuMM-W4sRwdAMMT
4
x: .•x•1.9 w;•
O
•
Binding the not ® •
gsasso+aF---PW q»atr»roe+cabeaYsmwiwd@+kecac • • • • • •
Na+0Oi tna aot aarslbebosaSA�di••iAerO.0411 t6 r •• • •• •••••
mia.���a 'Te• aeeoes�asaRknria•dntdM • •
fiat pv aaRiaRnfl asaw piiulo ta4atlraOb • ••• • •• •••••
,rmsmatsssnmgp,s•aca �' a�sinai5•not • • • •
Lebwe�hoNo�Wlr4tsowonbbY�iiDsOb�arawuore+wlw ••••
siy2R{tabmxesrm�srgpawi.bato.Waa6eL^a�M • •• ••••••
arasaa m�mta•aeybp +�ia.O�saa Haas joia an •
ZrafOtWaWHaM a�•n.Axrrps+•i9p�aa�yR V: • •t
**ValKvbK* BD tSWho ast+'sa.reeaa•mpmq=war • • • 00#0
`•
aiatopotmaam7a+rraV,'acT rOiOa}rs ataatv�oaoc •♦••••
bawai+vacrspib aaa ooaraoao cpodo yon • •
• r•
@_M3NlAlblty>e�aera+ta0bdr,v�ar ••• 0
' a�aap�ny��a • 99994
agtaftj&lOOaitOM4MNwft3at&lw ♦ * : • •
&MO ♦ %wkonaa�R Isam
Y
K :•
mom
Trimming the net
4cm+slbo btadknts Cse eeae
�+•iAlDiaS,ep3ait♦!•aaRr sbaot6eaf
me�orom.►+o•os.dWvbAds++•�0��, +��xsl tror�YwMranassv a+�era.�monoaat�ranamon
Com oiooia6aqumnC'•o.a♦e brt�iodCYBb •��° b ^�
ciapnamro�oxm�tsdateoarareaaats ` �+��ooaaepaa� _
6acw+rar Ndt9 tACsr�C C[laOa�cq �,tR .
dq p Ap ty Sdosawaft =01
oms4furtf fiB '
c�ttaRraoe.eutt+�et rgaa0aall�tte®oaaepa
' •. .a�,adsa?o'•o �i�raaa6do�Fa.s•youar.rw+•aaa
.raining thi.'Rgpes
W►•a39tr�aPlR, iaaoaiaMoiaa•adsgaae,�a+orceoa�, Ftnfi..hing.the- net
tr.eaa�ermg.aasvmxtser+aypur+nomoaaswe6�,00•� � ..
tosmabobrooaru+atsbwmeerd.ave+amiac'4�Sn .
orsaoab,:.cmaeerm®«eosa.eQ..sl,.ad.aaiwam�d.:: tori m.aa•sp06atsoaDmdxafb°`tsar
M •aRr, BbsR1Ri9:ibq ia•rl5r•astbaOeairer.`., Her i�ca<m►knanaardaaerWdraavabtr8n
rgre�5r.watiwaxbtm�roassasbi•gmn�ea�ateeaaseq:,• �� s!t �Ao$�Ea�eramrmforiusOFYet•.
Rgp[4kic9sla&aiy011i►ibp¢a'�eseatA$adti6ly'QQfLe b .^ v id4 . 6a9YoYi4ih6OfOt
L 30511 77.
Kid Safe fool nets,Inc. Issuedi�ll$!{1�6 Page F-25
l�tsa+�ty�Naa .�+ass�a«:sd�.,fra�araofnr.t�eeemaRim�s6aroa�o,eleyropaq��A�xa�dtsbaeam.iao.6ae. b.pe6�„a�>naar,,,,,
eoadmauoraraxaireaxrt�lL�riportinryeP6a�aararamaa�aavn!Thar•e;gasapp6a�+A'taOoafQirdoWiaesod+aha}araadmrd+ertea•Qe-ue�otao�aies
RibWahrtardot SPoesgo•r raa•ti 4,a Vropomaumnaidr@a64naid•bafrmr*hke ds&VRAw Ulm"w ofa i •r4.1w- oor•�au�b
APPLIMlee
CHLABORATORIES - - - -
5371 N.W.161 st Stept Agwit Fbft 33014
B
Jr
v •
• i 0000••
• 0000••
• a • •
0000• • •• •�••••
•
000 0 •• •0•e�•
•••e9006 • •
09 0006 •••R••
• •••• 0 1•
a•:, = may • • 0000••
• ._ :.•.'ais 0000••
� "s'arO'Q•oa ayeemail*
c::2
LaOn�aOtek•edadll�wo�rsat+A•a4�Pbki{b•aa7Ntfm�aaw6lr.so•aaa6boomaeN+qlvovh�Xn a+e+e•u•0at�m: itt1� 731s�a�eCnB�t4i�aKu4d�Ymw�+ril.••• •a
00190 saw Pollan rms used. . • • t{t{`
•
.• wtt►2nqup�seeSYtp�t•aateatte6�L: ;'� •-'
l�sl�Pta7pdd•stlyRbO+gi�e10404a1�eCo�9t'C¢.9ke(d0i6.� , • '�
'9aaoorae�tweaeaiyA+ffnOaEA�tatYs9 ..t Mchmro. '&manmviaa:ieriai�tSnWWaOAa�ixbmr .':•'
•+e3.ibatb�;etysamm+a,teea•nomrievapicea'.
'rars�ori6nm�eanephstscaa ft�aspmm�oytL' uom?o• M ?q;�:•c::• :' . ` •'
ostia ms�a�eta�m6.a+•e•ade�ryr»yaaa8 • ,E+�: �g�am4ssEtQ tnoao Imp•'.='d}
Cn16eY 4tJulfe4yCa f6�fola4lw0�A00�!t{4�?:'.• .. •. s ,sa0'�0'�M h106 pq�.y r�t�
�Royty ao•ab�•rae�ats+e�ptYgteae� RBf�f,{tmea':' .. , 'batistl6dYt•a•t temu�91+ i ,
�tOIeiGld��ufQldeaetutdAeLe®aa p�oq�t .tom bomarsedOtsa lmtsaae�e. •.;�
topaaom amtdadswaa55�mmeeam�MeYen� p� aamiw-. •:
Sw►+orfaK.fvywa�a�ao,amaaes
.1�itla+0=C!e dwlya4bo {460eaaaameasaemr '•YY9a� Sho tliC(tta06
.Oait¢69clbrlCw�rr/.7Ais aaetA6 aqt ' 9a��laeAibay. '.
aadosp�S.rri�.�uMpatmoraaW PtWb!k. V"enwoft no Weeoos�vnarocw.
�`17�ae(tes�x+ a �, A•aope6ddc�asx•e�tflw&aY.e^'�I�'FsV96,':,.::....
•�,,�_:.' t: ani � ._
RM
L/N 30511 Kid Safe Pool Lets,lit. Issudlo/181 l4 page P-7.6
�K-
aa,moria KftMftmnotkewa a+ 'eotehequaoSderwtPerowbxhSounk"MwMorof toramarwe&=ergs
STATE OF FLORIDA PERMIT NO
DEPARTMENT OF HEALTH DATE PAID: _
ONSITE SENAGE TREATMUT Am DISPOSAL FEE PAID:
RECEIPT :
SYSTim
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR: Holding Tank { } Innovative
{ } Nev System { Existing System [ I
t ] Repair [ l Abandonment [ ] Temporary [ ]
APPLICANT: 7D`��. � �•
AGENT:
�, ��I� L. .)2- TELEPHONE: ��i� l�itD®
Com,r��
MAILING ADDRESS:To BE COMPLETP By APPLICANT OR ADPL;CANT'S AMORIZED ACsEI*• SYSTEMS MUST BE CONSTRUCTED
By a PERSON LICENSED PUPBOANT TO 489.105(3) (m). OR 489.552, FLOR� STATUTES. IT IS THE
APPLICANT'$ RRSPONSIBILITY TO PROVIDE DOMERTATION OF THE DATE THE IAT WAS CREAM OR
PLATTED (M/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRMFATHER PROVISIONS.
PROPERTY INFORMATION `
IAT: Is BID=: SUBDIVISION: PLATi'Ea:
PROPERTY ZD ( Q • �, �®` C i 3^QC>Ci®ZONING: 'aU) I/N OR EQUIVAI W: t y N ]
PROPERTY SIZE: 6 CA ACRES WATER SUPPLY: { ] PRIVATE PUBLIC t <=2000GPD { ]>2000GPD
DISTANCE TO SEWER: -A "
IS SEVER AVAILABLE AS PER 381.0065, FS? t Y N • 0900••
0
00*
•
PROPERTY ADDRESS: �7�� �1 �tl__�._ i�'�'�' r� 5�, ��••�- 0•
0000..
DIRECTIONS TO PROPERTY: �l � kid 6 t�_ �' • 0 0 0000
• • • •
• 0• • •
000• • 00 00009
••• • •• 00000
• 0 • • •
•• •• 0000 0••000
•
0000•• 00
0 0 0 •
• • 0 • 000.0•
BUILDING INFORMATION { ] RESIDENTIAL { ] IAL • • 60000• • •
Unit Type of No. of Building Commercial/Instituta.ohlil Syster Dpttgn 6•••06
No Establiebment Bedrooms Area S t Table 1,
Chapter 642-6, FAC 00 0
AA
2 ���
3
4
{ ] Floor/Equipment Drai { ] city)
ell DATE: Q-0 t.S�
SIGNATURE:
DH 4015, 06/09 (Obsoletes previous editions whicb may not be used) Page 1 of 4
Incorporated 64E-6.001, FAC
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
---------------------------PART 11 -SITEPLAN---------------------------
Scale: Each block represents 10 feet and 1 inch=40 feet.
LOT It,HU)UK 7
(NO ID) WMCE 115A0(M&P) Ix
?No CBS WALL (NOID)-\.
3730-
11.70 XoNe
31LW
1.09
tp r
5.0 3.2
r
f 21.50
2
ID;
r bPAVERS
v- 10.2
1U.0
N
P/L
ou
216.90
r.La
•
11.15 ris 1106 -
•
11.10 940 70[ffiWALL4
F.LP.ur 115.00(M&P)
A •
P (NO 10)
V
•
REMAINDI-W oF Loris m.(xw 7
(No TD)
: 0 0
I T to 1* -4*-ol*: •
• I •
w.iRLOCK7
I FTT i T77-
Notes:
Site Plan submitted by: 15/20 OZ t
Plan Approved 1Ropproved Date
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,W09(Obsoletes previous editions wtdch may not be used) incorporated: 64E-6.001,FAC Page 2 of 4
(Stock Number. 5744-002-4015-6)
Charlie Crist Ana M.Viamonte Ros,M.D.,M.P.H.
Governor State Surgeon General
DOH#
Chapter 64E-6.004(3)(a),F.A.C.:
A plan or plat of the lot or total site ownership drawn to scale,showing boundaries with
dimensions,locations of any existing or proposed residences or buildings,swimming pools,
recorded easements,the on-site sewage treatment and disposal system components and their
location on the property,the slope of the property and any existing or proposed wells,..potable
and non-potable water lines,including valves,drainage features,filled areas,unobstructed areas,
and surface water bodies. The site plan shall indicate the location of wells,on-site sewage
treatment and disposal systems,surface waters and other pertinent facilities or features on
contiguous or adjacent property. If the features are within 75 feet of the applicant lot,the
estimated to the feature must also be shown but need not be drawn to scale. The location of any
public drinking water well,as defined in Chapter 64E.-6.002(44)(b),within 200 feet of the
applicant's lot shall also be shown,with the distance indicated from the system to the well,and
the location of limited use public water system or other public wells,as defined in Chapter 64E-
6.002(44)(b), within 100 feet of the applicant lot must also be shown,or as defined in Chapter
64E-6.002(44)(a),F.A.C.,within 75 feet from a private potable water well(well used only by
one or two residences).
:000:6
Chapter 24-12(18),Miami-Dade County Code: • • • ••••••
The minimum separation between a well or wells and possible sources of contMAfion sh%U Be• '""`
a function of the drawdown radius of influence of the well or wells. In no case s*IM1 the well be
located less than one hundred(100)horizontal feet from any source of contatna�Ott gn. 0'6.0 0 6-•
...666 .
I have read the above and to the best of my knowledge I have provided the DeBaht wi , jj,• ••,•.•
information regarding pertinent facilities and features on all adjacent properties,Awhermore,el .'
understand that any on-site sewage treatment and disposal system permit issuel on tte basis of
said facilities and feature as provided by me and found to be incorrect will be subJeet to :'6.6 6 6 .
. . 0000..
revocation in accordance with the provisions of Chapter 120, Florida Statutes. •• • •• 00*
• •
Property Address: ISS 0-i E c7 S+ 1"i: 5 P e g r 1
Date:_k 17 Signature:
Samir Elmir,PhD,PE,DEE,CEHP,Director
Environmental Health and Engineering
tiicr Miami-Dade County Health Department
1725 N.W. 161h Street,Miami,Florida 33056
Tel:(305)623-3500 Fax: (305)623-3502 ob8o
AUTHORIZATION LETTER
Department of Health
O.S.T.D.S.
Corporate Park Office
7769 N.W. 48 St.
Suite 175
N iaami, Fl 33166
Ref. Permit No: Date: 1 4-1 J.;10%S7
Address:
Street number/name
City, State
Trp Code
0000..
Property ID: I 1 - 32-c-)(— ®l3 a00000
00 0 ..
069.0 .. 0000..
And/or Legal Description: ®�
000000 •
CJS! .0000.
e � 0000 ..
. .
0000 .. 00000
i
.. .. 0000 0000.0
000000 0 0
0 . .000... 000000
g� 0
. . 0000..
(Property owner full name ori 0 0 0 0 0 0
dal represen a of bre'property)
In representation of: 55 mg- q-, St . �'�� 5 �� �� 63�3'6
(My self or property entity full name)
(Owers or position into entity) . -
Hereby attthop. L—%j Z�
(Property owners agent or COMM_-
To process and obtain the Septic System permit for this property located at the above refer site.
SIGIMTlIQE
OFFICE ONEP �PERS' APPRAISER
Summary Report
Generated On: 11/17/2015
Property Information
Folio: 11-3206-013-0990
Property Address: 55 NE 97 ST -
Miami Shores,FL 33138-2330
Owner DINO P PERAGALLO
IRENE PERAGALLO
Mailing Address 1270 NE 98 ST
MIAMI SHORES,FL 33138 USA
Primary Zone 1100 SGL FAMILY-2301-2500 SQ
Primary Land Use 0101 RESIDENTIAL-SINGLE
FAMILY:1 UNIT
Beds/Baths/Half 4/3/0
Floors 1
Living Units 1
Actual Area 2,396 Sq.Ft
Living Area 1,808 Sq.Ft
Adjusted Area 2,361 Sq.Ft Taxable Value Information • •
Lot Size 8,625 Sq.Ft •2015 •2014 ••2013
Year Built 1938 County •• • •
Exemption Value $5Q QQQ•• $50,0 $60,000•
Assessment Information •
Taxable Value $223_,499• $221!031 • $217,026•
Year `- 2015 2014 2013 School Board •••• • •• • •
Land Value $164,082 $164,082 $112,453 Exemption Value i $2 ,Q6q•' $25 $y5 •
Building Value $154,533 $150,748 $150,977 Taxable Value $248,4 •• '
$246,031' $242,0
XF Value $3,557 $3,576 $3,596 City • • ;••••• •
Market Value $322,172 $318,406 $267,026 Exemption Value $50,Q • $J6,* 0
$50DOG •
Assessed Value $273,199; $271,031 $267,026 Taxable Value $223,199 $221,Wl • $217,026
Regional
Benefits Information Exemption Value $50,000
$50,000 $50,000
Benefit _ Type 2 2014 2013
- Taxable Value $223,199 $221,031 $217,026
Save Our Homes !Assessment
Cap Reduction $48,973 $47,375
Sales Information
Homestead !Exemption $25,000 $25,000 $25,000 Previous Sale Price OR Book-Page Qualification Description
Second Homestead !Exemption $25,000 $25,000 $25,000
--
-- _�_ 06/15/2015 $565,000 29667-2684 Qual by exam of deed
Note:Not all benefits are applicable to all Taxable Values(i.e.County, p7/01/1 gg4 $122,000 16447-0765 Sales which are qualified
School Board,City,Regional). - -.-
06/01/1983 $90,000 11817-0133 Sales which are qualified
Short Legal Description
MIAMI SHORES SEC 1 AMD PB 10-70
LOT 17 W1/2 LOT 18 BLK 7
LOT SIZE 75.000 X 115
OR 16447-0765 0794 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://www.miamidade-govfinfbidisclaimer.asp
Version:
s
� S
axis nmtsl Miami shores Village
res Building Department
IORID 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tei: (305) 795.2204
Fax: (305) 756.8972
SWIMMING POOL OWNER'S CERTIFICATION
Date I I I-gI aol'-3
Miami Shores Village
Building &Zoning Department
Attention: Building Official
I certify that I am the legal owner of the property described as
Lot0 � ►% Y'►t--► . . .
...... . .. ......
",I613nw Synre5 SP-C ISA PPS 10--10 , located at '
'15-ct) KIE 9`1 SA 5313C6 •
.... . .. .....
...... . .. .....
In accordance with Section 33-12(f), Code of Metropolitan Dade County,1.6mlfy, thatl:••' ••••:•
understand and agree that the swimming pool to be constructed at the above iddreis catty®t:.
. . Soso.*
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.
ORES Lrt
4141.. 41,41
'..
�. Miami Shores Village
�
Building Department
�L0 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE
KNOW ALL MEN BY THESE PRESENTS:
WHEREAS,the undersigned -Dtrg�i 'pe-rC�a a 11 Ca is/are the fee
simple owners)of the following described property situated and being in Miami Shores Village,Florida:
Address: 5f�> W4E 9"1 S t "i corn e 51%ore S R FL 33 fb
Whereas,the undersigned owner(s) n® a-rct.q C�l 1
desire to utilize said Lot(s)as a single building site,and the undersigned owner(s)doles)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. :0041%
III. That if any of our adjoining neighbors remove any portion of their fence or wall,or if our/mypropgRy�shall fail' ••••••
to meet code requirements for pool barriers,we,as owners will immediately install a protectivmriclOsure to • •41 •
meet code requirements and will obtain a permit for such fence. 000000 • 41• ••••••
IV. That,I/we,as owners)hold Miami Shores Village harmless for any negligence or injury that wJ%1rom not
4141...•
having the enclosure. .41.0 4141
V. If enclosure belongs to said property,I agree to maintain&or replace said enclosure in the%VgJtb1t is
damaged or removed by any case. 0.0,41. . . 0 41;0 0•
4141 .41.41 41041414141
NOW,THEREOF,for good and valuable consideration,the undersigned do(es)hereby declare that he/shy'I.!In of .. •
convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by*sITteams�nd
. 4141..
conditions set forth herein. ...0.41
. . . 4141....
FURTHER,the undersigned declare(s)that this covenant is intended and shall constitute a restrictive c*8nan? 41• ;•; • •
concerning the use,enjoyment and title 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. I�
6/16'"0
WNER SIGN&PRIN 0 NER SING&PRINT
I HerebLGarffy that on this day personally appeared before me �t c1® epi eYal t a and has produced ID
# L_ DL— as identification and he/she acknowledge that he/she execut6ekhe foregoing,freely and voluntarily,
for purposes there in expressed.
SWORN TO AND SUBSCRIBED before me on this _day of 20
l
NOT RY RIDA
(Revised 05/2209
?a�P% MARCOsA.MARTINEZ
My COMMISSION FF 008ggg
EXPIRES:N V i5 201
Bon larJ 7hru Notary Public Undo waters
t` `yoREs Lit
Miami bhores Village
Egli Basi' Building Department
10050 N.E.2nd Avenue
LpRIpA Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972-
NOTICE
56.8972NOTICE OF REQUIREMENTS
RESIDENTIAL SWIMMING POOL,SPA AND HOT TUB SAFETY ACT
I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or Installed at
S5 OCI Si• �- %Sha3&,AEl 5515% Miami Shores, FL, and hereby
affirm that one of the following methods will be used to meet the requirements of Chapter 515,
Florida Statand the Florida Building Code R4101.17.
Please snitI the method(s)to be used:
The pool will be equipped with an approved safety pool cover that comp lies with ASTM
F1346- 1.(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,nftonry :•. •. •�
fence walls,chain link or wood fence,etc.)will protect t he pool perimeter.The plans must speer i type
and location of all non dwelling walls. Florida Building Code, R4101.17.1 000000
••••••
Any combination of protection which incorporates dwelling walls with openings diieet1 Vi*to the" 00
pool perimeter and all windows and doors will be equipped with exit alarms complying with Floji�la utlding •�; •
Code, R4101.17.1.9(Submit Manufacturer's Specifications), • ••
Any combination of protection which incorporates dwelling walls with openings directlyinto the;••• ;• •
pool perimeter and all doors will be equipped with a self-latching device with positive mechanidal.' : ;••••;
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,punish ble as provided In Section 775.082 or Section 775.083 F.S.This form must be signed
by the owne t and the pri eco tractor.
0141101411,1-
CONTRACTOR'S SIGNATURE AND DATE OWNER'S SIGNATURE AND DATE
"i myla V&vQ lex �,�ML _
CONTRACTOR'S M (PLEASE PRINT) OWNER'S NAME( I 14,&� S PRINT)
-11M,w
NO N
E:::7
14
RCOS A.MARTINEZ
CC 'MMISSION FF 008989 <�" '. MARCOS A.MARTINQ mIRES:May 15,2017 + MY COM MISSIONVFF008989
h:u Notary Public UndenvMers ;'?_;
EXPIRES:May i5,2017
i w: Bonded Thru Notary Pul.-lic Underwriters