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RC-16-594 0 � ' IN Miami Shores Village reM 10050 N.E.2nd Avenue NW sm q 2 Miami Shores,FL 33138-0000 Phone: (305)795-2204 g "F12Expiration: 09105/2016 Project Address Parcel Number Applicant 165 NW 99 Street 1131010230390 LEONARD WATSON Miami Shores, FL 33150-1742 Block: Lot: Owner Information Address Phone Cell LEONARD WATSON 165 NW 99 Street MIAMI SHORES FL 33150-1742 Contractor(s) Phone Cell Phone Valuation: $ 25,000.00 HOME OWNER Total Sq Feet: 590 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Drywall Date Denied: Miscellaneous Type of Construction:RENEWAL OF EXPIRED PERMIT R Occupancy:Single Family Window Door Attachment Stories: Exterior: Tie Beam Front Setback: Rear Setback: Final Left Setback: Right Setback: Framing Bedrooms: Bathrooms: Insulation Plans Submitted:No Certificate Status: Final PE Certification Certificate Date: Additional Info: Truss Insp Bond Return: Classification:Residential FoundationWindow and Door Buck Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Columns CCF $15.00 Fill Cells Columns DBPR Fee Invoice# RC-3-16-58922 Wire Lathe $11.25 03/09/2016 Credit Card $823.50 $0.00 DCA Fee 811,25 Review Building Education Surcharge $5.00 Review Mechanical Notary Fee $5.00 Declaration of Use Permit Fee $750.00 F.Termite Letter Scanning Fee $6.00 F.Elevation Certificate Technology Fee $20.00 Review Planning Total: $823.50 Review Structural Review Electrical Review Building Review Plumbing 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 information is ccurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named ntractorto the or''��ed. — the March 09,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 09,2016 1 � ^, '.;-f , ,,'. , }ur .f�'• �`'-•. � t�, -:,"Y ''.^`'t4„ 'Y -ti 4i 'Y�' ra x.. •cr_: mac- ., ...,h..... ..'... 't, K .. .._r-" K .. ,: r,`-.;,s ,..., ,,' :'t,;..u'-Cy. 7; .sig xis.;i ,!'•,:. z'wt..�* .a,x�, -.'Y2' "� yXS'.7,"✓�_ii•,!O my'+ �,. 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R FOR EXPFf�SE I_Nk1AIl ED IN TIMI=�2EhIIt AL Q�t�€Pd.ACERENT'QF AWMATE THE BUIIla�04I QFFIC,�AL�'TI +"SHALL 1�€LIABLE REOLIIRED TQ ALLOW 94SPEQTIM �;, . , WARNING Tt3 OU�NER YOUR'-"-"" 1=AILURO TO RECORD A Ni3TIGE }I %f COMMENCEMENT MAY RESULT IN YC, UR PAYING TWICE FC?R I�tIPR�?V�M:ENT i�TO YOUR PROPERTY,'' A NIO ` OMMENCEMENT MUST B R CORC�EI3 1„ .�4ND POSTED ON THE JOB ST� EFRE THE FIRST 1NSPECTN. 1 YOU N`TE111D TO OE�1`AIN ' FIN;RI\It; O, ; CONSULT WITH Y( L OE , OR AN % ,ATTO.RNEY BEFORE COMMEND N -,WORK OR RECORDING 1 O R NOTICE OF COMMENCEMENT, f , ,F r ✓ r r�' 1'%� Y <„ ":, t ..'. o� .,,.ji �F /, l, `yr d/ rf/✓1 r / .(r`�,x/`� ,,.... , / /,a,/< l f� Y r = /! ,6/i ,%'i,�'�J y ita/!^xrr sYs /Fyf,, STRUCTURAL PLUMBING IN$PEC'FtON_ Q.l<E_ INSP, INSPEC7"ION _ L tNS f '1NSPSCTION _ DATE INSP Foundatrc�n /, ,, Zan) ZONING COM!!E - iA��t#�'`'SOrt�ica� Y-� — -- q' so — / Y twa - - Sewer Iooka� - - Ate# it�s Bucks - Ir►tenor Fram' ELECTRICALS <. 1�findows/Doors = (tel DAl'E� NSP.; P'Tanl Iaulatisan _- -- Tem- r - '`,Pole 1, Well - „fir#d; 30 Day Te 9 a `S ranklers ' Pool=Bondln [fain Drain firewall Pool Deck Bondua Wire at �� _ /_�` Pool Wef Niche Prevents - Poc3#Steel ,,F - Undo roon lntert - -- _ or DA-0 - - - Footer Groond sins _`' Catch Ba - - Final Pool ' Stab - - x f nsate Drams -- Final Fence _ Wall -_ - ' N Final - - � x . Scre�ra_Enclosure _ Ceiling Roue t rivevrray - - Rc u h_ - PL)MOING C. NiMI�NTS - l�ttvGt�d P,r cess .: -- - - -- - u f fitters Attachment_ - - Final utters erg�h. - -- - j! Nts' d Guardrails tnt�eraom # FOECHANICAL m ;�/ / ,9, /Apr � „, ADA oo flame - - Al�n�a -, iNSPECT�ON bA - _ tNSP Alam Finsi_ P _ CtJIMENNTS l='treAlann - 60-4 Fite Alarm Fnai ggph Sol FF F ar% entillttoTl Rough— — -- F� i13f 1.1 riT ICAC Roklgh - - - PtQssure F1nal alit r � - - - ,f F! f 5; Fin - C r tion Pool Heerer .�..�f■..fff�ffffff, � - - - MUCTURAt. IN P C' ICIN �` DAIM i INSP_ - Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-270747 Permit Number: RC-3-16-594 Inspection Date: November 07,2016 Permit Type: Residential Construction Inspector: Dacquisto, David Inspection Type: Survey Final Owner: WATSON, LEONARD Work Classification: Addition/Alteration Job Address:165 NW 99 Street Miami Shores, FL 33150-1742 Phone Number Parcel Number 1131010230390 Project: <NONE> Contractor: HOME OWNER Building Department Comments Infractio Passed comments EXTENSION OF EXISTING FAMILY ROOM AND ADDITION OF A KITCHEN INSPECTOR COMMENTS False RENEWAL OF EXPIRED PERMIT RC12-1969 6 Passed Inspector Comments VV Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 November 07,2016 Page 1 of 1 9/11/2014 Silverman, David S 6:23:53 PM Lead/Branch.- 7784332-Miami FAY BullditnCoda R+sululremen4a' Price Books Miami 9/12/2014 2:30:00 PM ; All Areas Impact Protection i Baee Store: 6322 N MIAMI/BISGAYNE Required Reatrral Store: 5322 N MIAM BISCAYNE Interest: Ursuhtlon Stare Associate.-Gonzalez Carlos --------------------------------- ----------------- Customer Referrals Homeowner Name&Address: Home Phone: (305)333-5192 leonard watson Work Phone: 165 n.w.99 street Cell Phone: MIAMI,FL 33150 Pager: Work Phone 2: Call Phone 2s County:MIAMI-DADE H ner`s emall: jrminiO4@"hoo.com Neares Crm Streerb SC Conlin"rl"61 OLS Additional LOOrmadon: Interested 1n:R00fing Ins#tdlations Scheduled for 9112/2014: 30" Homeowner I Address Home Phone Worts Phone Galt Phone 7707527 Ivan Rosa/9213 nw 45th st,FORT LAUDERDALE (954)513.9573 (754)234-7759 Sales Consuftnt 1: Project Coordinator: PC Unassigned-(770)779-1300 Saks Field Insi;ecbor: .. 'itant 2 CHRLSMPHER Gilliam -(954)415-6227 (List smnd mnsugnnt only if commission is split) Renu is(Comphfe the applicable secdmsc) tf appaU►tawnt le a AM #11. llsutt your Sale on the Web Siding `Windows _Roofing Insulation OL FAX the DocxunsMs IN TH9 ORDER SPECIFIED beioW to: Entry Doors _Storm Prot Gutters/Leaf Prot. (W0)203-8M- 03. Motor Contract doss(when resulting muitipie products)as Sale _ Credit Reject Contract Amount$ Wows: Appt. Reset Reason: >Sales Contract(top page only) 114. Rret Job docs"follows: }Pre-Renovation Form No Good >Spec Sheet(w1 signeiurelall Paw) _Sit No Sale Price Quote Follow Up Call Date: >Pricing worksheet(all pages) a Measure Shaegs) Objections or Issues: >Diagram(if applicable) >Contract Amend.(if any) _ >Dead CA(if appueebpe) A. Repeat aU section#4 docs far second,third&fourth Jobs ONLY FAX ONE JOB AT A TIM 9A d SHV zodaa awOH <a £t+ 6LV t5G £6h6LVt56 M9520 tiV LO %-64-tLOZ HOME 1S19PROV9MENT CONTRACT PLEASIC READ THIS y / c NSold,Furnished and Installed by: Branch Name:Miami Date:`N . THD At-Home Services,Inc. MAL The Homc Depot At-Home Services 674 S.Military Trail, Dcafieid Beach,FL 33442 Braneb Nmnbera 60 Toll Free 877-903-3768 //,,�^ / Fein#75-26984(i/()�,FL tic#CC 27,000507093.QtC04M58 installation Address: 1 '^'�'J A kd 9PAr � _ / ,`�2 t I �Ui�T� /Sc-� City State Zip PorrlUteer(s): Work Phone: Home Phone: Cell Phone: ( 1 f 1 ( l Home Address: (If different from Installation Address) City State 'Lip E-mail Address(to rc mve project communications and Home Depot updates): ❑I DU NOT wish to receive any marketing entails from The Hume Depot Protect information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,and THD At-Howe Services,Inc.("The Rome Depot")agrees to furnish,deliver and arrange for the installation ("Installation")of all materials described on the below and on the referenced Spec Sheet(s),all of which we incxupcx*cd into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively,"Contract"): Job#:amuRIK—.W Products SPW She ws)# Project Amount ❑Roofing Siding Windows budistim 7 f 7 G"��l L33 z-- ❑Gutters/Covers❑Entry DOcus 13 �� _�� r � 4e� Roofing LJSiding U Windows Insulation $ ❑Gutters/Covers❑Entry Dom ❑ RemfinK Lisiding U Windows Crinsioution $ ❑Gotten/C.ovem ❑finny lkmrs❑ Roofing Sidi--L1 Windows LJ Insalfttion ❑Grtters/Covers❑Entry Doors ❑ 10%orCou traict Amount due upon oxcutlen orllaLs eosin ecu.Ctataht rarats Total Contract Amount $ dpayment may require 100%payirienL prig to the start artbe P�cct Customer agrees that,immediately upon completion of the work liar each PrMuet.Customer will execute a Comphxion Certificate(one for each product as defined by an individual Spee Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order ox terminate this Ccmtrad or any individual Product(s)included herein,at its disexetion.If The Home Depot or its authorized service provider delerminc.4 that it canmt pallium its obligations due to a structural problem with the home,environmental hazards such as mold,asbesur;cu lead paint,other safety ecnc:erns, pricing errors or because work required to complete the job was not included in the C:cmtract. Payment Sommarv: The Payment Summary ff .included as part of this Contract,sets forth the total Ccmtraci amount and payments required for the deposits and final payments by Product(as applicable). NOTICE.TO CUSTOMER You are entitled to a completely fitted-in copy of the Contract at the time you sign, Do not sign a Completion Certitleate(note:there is one Completion Certificate for each Bated Product as defined by Individual Spec Sheets) before work on that Product Is complete. In the event of termination of this Contract,Customer agrees toy The Home Depot the costs of materials,labor, eapertscs and services provided by Thr Home Ilepot or Atttharized aRerviee Provider through the dale of termination, pplum a�other amountr set rorUt in this Agreement or allowed under applicabfr law. TIHI HOME DEPOT MAY WTf IiHOi.D AMOUNTS OWED TO TIIE HOME DEPOT FROM THE DEPQSTT PAYMENT OR OTHER PAYMMNTS MADE,WTTIIOUT LIIVHTTNC THE HQME DEPOT'S OTHER RIIVIEDFES FOR RECOVERY OF SC?CH AMOUNTS. Acceptance and Authorization: custcmn r agrees and understands that this Agreement is the entire agreement between Customer and The home Depot with regard to the 1'roduct¢and Installation services and supersedes all prior discussicros and agreements,either oral or written,relating to said Products and htstalla. . is Agreement cannot be assigned or amended except by a writing signed by Customer and The Home De sot.Cu ac owledges and agrees that Customer has read, understands,voluntarily accepts the terms of and has received s cop this t. Ac f S fled by Customer's Signature Date AS nsultrmes Signature Date X ZP Tclephunc No. Customer's Signature Date Sales Consultant Licunsc No. �Nt'G I T.A7TON: CUSTOMER MAY CANCEL TMS fns applicable) A REF.N>ENT WTTROV P PENALTY OR OBL1GA710N BY WAVERING VVRPITFN NOTICE.TO'IM NOW DEPOT BY MIDNIGHT ON THE TMRD BU NESS DAY AFTER SIGNING THIS AGRE MEff. THE STATE gL1q'LMMNT A1TACEM ISO CONTAINS A FORM TO USE IF ONE IS SPEMCALLY PRESCRIBM BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT' VW I of 2 06-18-14 White–$ranch File Yellow–Cusinmer 9/Z d SHy 40dea QW0H « M61WtG6 M62W096 HMO 56 60 %-60-tW 11/4/2016 3:12 PM The Home Depot At Home Services 674 S Military Trails HOME Deerfield Beach, FL 33442 I SE�V��ES Toll Free: (877) 903-3768 Local: (954)379-1500 Customer Invoice Job#: 7789332 Store: 6322-N MIAMIBISCAYNE Homeowner. Mr.Leonard Watson Branch: Miami Mrs.Chantal Watson Product: Insulation 165 n.w.99 street Consultant: David S Silverman MIAMI,FL 33150 (786)285-5796 Original Contract Amount: $969.00 Deposits/Payments: Contract Amendments: 9/12/2014 $100.00 HD Consumer XXXX-)O=-XXXX-6415 11/5/2014 $869.00 Customer Check XXXX XXXX-XXXX- Adjusted Contract Amount: $969.00 Balance Due: $0.00 No Balance Due Certificate of Completion Please note additional comments below,including any open Items still to be completed: The Installation has been completed to my satisfaction,subject to the open Items listed above. Homeowner Date Subcontractor's Waiver and Release of Lien Upon Subcontractor's receipt of the check from THD At-Home Services,Inc.with respect to the above referenced job,this document shall be effective to waive and relinquish and forever release the right of the Subcontractor or any right of any other party claiming under Subcontractor,to any lien,stop notice or arty other right against a labor or material bond on the job.Subcontractor represents that all partes or laborers furnishing services or materials on the job have been fully paid for their services or materials.Subcontractor agrees to cause the prompt release of any liens claimed by these partes or laborers.Subcontractor further agrees to hold harmless and Indemnify THD At-Home Services,Inc.and the above named customer and the owner of title to the above referenced job she from and against all costs and expenses arising from or by reason of any lien or any release or discharge of any such lien.This waiver and release covers the final payment to Subcontractor for all labor,services,equipment,or material furnished on the job,except for disputed claims for extra work.Before any recipient of this document relies upon It,the partes should verity evidence of payment to Subcontractor.Lead Paint—If lead paint was present 1 confirm that Lead Safe Renovation practices were followed and a certified renovator was on site during the operations. Subcontractor acknowledges and agrees to the above terms and conditions. Subcontractor Company: Individual Subcontractor-Signature: Data. Individual Subcontractor-Print Name: Branch: HOME INSULATION SPEC SHEET spec Shoet#: 4 7 Branch#: DESCRIPTION OF WORM Job tt, Irk G1 E33-- CUSTOIIlIER:INFORNIAT1ON customar Name: .'06/3 r""d rf' cf� Home Phone#z Work Phone*P Cell Phone#: Job Address stlrQst / LSI' '4,t 4 .J G "�� Cf J'? /Si:' e-mail: Co? city state zip acxie 711 •..AIR'$EAI.'::• .'• ' ` 'MASS;lMSUL:JA'I?iQN ;'.. � . •• •'RApi'A•�IT:BAi�?l�R,•• _.,.:�:.:`.:. We Pico, AtliKilos Wall R-34 V �R-fi0� Foil- ced� Spray anc Floor 1-1 UU R Value:inrTret the amount beho added(Not I owl)LLL��� JJJ i—J Closed Cavity installation Pup-dawn S13i1Wnf__1 Attic Hatch s inch�ti inch I 11 tI inch 0 1 steinuell U SoMl.Ventso Fan Venting❑ C:ovrr, Cover U 1 II Knee Wall brsWation Whole House ❑ Recessed I�j R-1 1 E R-13 E] R-19 D Fan Cover Light u Batt Bata Batt (NSSJI iiLTttlll!RiE�uIQVA� Crawl space • 4ISGELLANEOUS' Lass than Mara tttsn R-13 ❑ R-19 R-3{} R-38 I� 8 inohas Air+c�uis Bait Batt Batt Hao I I SPECIAL C0N5i81_RAM0NS I List kasadons of any Own special considerations including arena that VIII he excluded from the scope of work. SPECIAL TERMS&CONDRIONS Home as a Construction Site :i Your home will be a construction site during the installation of your Insulation,and it will be noisy. Remove All Items from your Attic i•Attics must be clear of all stored/personal items. This includes,but is not limited to,items such as clothing.trunks,boxed Items.bicycles,toys, valuables,furniture,etc. Job Site Access i I Keep in mind that everything we use needs to be as close to the house as possible and our workers need access to a grounded electrical source If lighting Is required. i I The attic access hole or pull-down stairway location must be idea iried and tho path must be free and clear. If the attic access Is located in a closet,then shelving,clothing and all other items in the closet need to be removed. ❑All floored and carpeted areas in the path to the access need to be covered by poly sheeting to protect against installation hoses and worker trnffic. The installation crew will provides the poly sheeting,but the homeowner must ensure the path is Gear. :.i The installation crew may need to apply tape to comers or to furniture in the path from entry to the home to the access. Homeowners should bo prepared for this to happen or should move items that could be affected. J Please ensure all petsianimals are properly secured. Radiant Harrier Please note that during the radiant barrier installation.boards must be placed on c Biting joists to allow the installers to roach all areas of the attic. If additional attic Insulation Is not purchased as part of the radiant barrier installation final R-value cannot be guaranteed. Job Completion G Upon completion of your job,your Installer or Field Inspector will ask you to sign a Completion Certificate I;If you are paying by check;please make the chock payable to"The Homo Depot". NOTE:Verbal promises cannot be honored.Pksase verify that everything you expect is detailed in the Home Improvement Contract or this Spec Sheet I have reviewed and agree the job specifications described abovo and have reviewed and agree with the Special Terms and Conditions listed on this Spec Sheet Customor Signature Date. / 91-11 While Copy-Home Depot Yellow Copy-Customer ruin-Ina 9!£ d SHV 40dea GWOH << 9061W tS6 £6�i ILtS6 U900 SOLO 9L-60-*t60C tolp Mal. LTi{6SDI/Yfl (N41Wtl lPmMDl 11 men pan- �� .waa./AIYFtR<RC► t • t f "m ILPL • t s t♦a�//� : : : . . . . . . 41 cl • • . . t f • • l . ! • • • f t ♦ Y • . • . l a • ♦ ��fiF �OC�f 76AY169F a . • L • • f . • • t + i . i . . �wf�` t ' • t • r • • a • • f 1 t • a . 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Y • • " • • / • • I • n • r . • • 4 • Y r . • a • • • . • e •h • . • . r a . ♦ L r • • • ♦ r • ♦ r • f • • . . . . . • • . ♦ . a { f r . • s . . a ' . . . • ♦ • t . r . . • . . > . • . • . . ♦ . . . s . . . • f t r • • . r . a • I . . > r . . . > .. . . 1� R r C> e.iaarairota cm IN-HOME SALE OR SERVICE NOTICE OF CANCELLATION YOU MAY CANCEL THIS ENTIRE TRANSACTION OR ANY INDIVIDUAL PROGRAM AS DEFINED BY A SPEC: SHEET, WITHOU1' ANY PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS (MONDAY- FRIDAY, EXCLUDING HOLIDAYS) Ole TILE DXLE OF 'TBE HOME IMPROVEMENT CONTRACT ("SALES CONTRACT- .). IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMEN'T'S MADE BY YOU UNDER THE SALES CONTRACT,AND ANY NEGOTIABLE LNSTRUMENT EXECUTED BY YOU WIIJ,BE RETURNED WITHIN IU BUSINESS DAYS FOLLOWING RE'CF43PT BY SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. THEREW111111, BE A SERVICE CHARGE EQUAL TO TEN PERCENT (10%) OF'I'NN; TOTAL CONTRACTAMOUNT IF YOU CANCEL THIS TRANSACTION AFTER THE THIRD BUSINESS DAY FOLLOWING THE DA'Z'E OF;TALE,BUT BEFORE MATERIALS ARE ORDERED. THERE WILL BE A SERVICE CHARGE EQUAL TCD '1'WEN'I'V-FIVE PERCENT (25%) OF THE 1'0'1-AL CONTRACTAMOUNT Il'' YOU CANCEL TRIS TRANSAC:'1'1ON AFIXR MATERIALS ARE ORDERED. I'k YOU CANCEL,YOU MUST MAKE AVAILABLE TO SFI,LFR AT YOUR RESIDFN(.E.IN SIIBST'ANTIALI.Y AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVEREDTO YOU UNDER THE SALES CONTRACT, OR YOU MAY C:OMPI.Y WITH THF, INSTRUC.'TIDNS OF SELLER REGARDING THE RETURN OF THE GOODS AT SELLER'S EXPENSF AND RISK. IF YOU MAKE THE GOODS AVAILABLE TO SELLER RUT SEIJ,ER DOES NOT PICK THEM UP WI'T'HIN 20 DAYS OF THE DATE OF YOUR NOTICE OF CANCF:IJ ATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WrMOIJT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE. TO SELLER. OR IF YOU AGREE TO RETURN THE GOODS TO SELLER AND PAIL TO DO SO, YOU WILL REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS'UNAL,RPITT:SALE,S CON'T'RACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DA'Z'ED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRI'I'1'EN NOTICE TO HOMEPOT �°I' THF DD Ste; AT THE TOP OF THE SALES CONTRACT NO LATER THAN MIDNIGHT OF� ! � � � �F 'DATE MUST BE WITIMV TFT.R.F.F. RUSI1VF£S DAYS OF DATF. CONTRACT IS SIGNED, MONDAY-FRIDAY.. EXCI IMING ITOI..IDA Y. TO CANCEL EACH PRODUCT: CHECK APPROPRIATE PRODUCI(5) BLOCK BELOW; LIST EACH SPEC; SHE l'T#AND CHECK CANCEL JOB BLOCK(YES) Job#: Cancel Job Internal Reference _Products Spec Sheets # es J no ❑Roofing ❑Siding ❑Windows LdInsulation {^j U ❑Gutters/Covers ❑Entry Doors 1 9? j�P ❑Yes ❑No -11 I ❑Roofing ❑Siding ❑Windows ❑Insulation i ❑Gutters/Covers QEntry Doors ❑ Dyes ONO Roofing Siding ❑Windows ❑Insulation f ❑Gutters/Covers ❑Entry Doors Q j ❑Yes []No ❑Roofing Siding Windows ❑Insulation ❑Gutters/Covers ❑Entry Doors ElI ❑Yes ❑No ACKNOWLEDGEMENT OF RECEIPT OF NO'FICE OF CANCELLATION I/Wc hereby acknowledge receipt of two copies of the c mpieuxi No iuc or QmwNtion sct forth above and that;seller has ovally in fikmwd me/ 1'0utight t[ti` Go(L1 Date C.ustomor Signature I Date Customer SIgnature I HEItEBY(,AN(,EI.'1'III$TRANSACTION:_ Date Customer Signature 8-5-08 5FC White—PlomeDepot Yellow—Cussiomer Pink—Customer THD 473 9/9 d SHV 40daa aluoH ct £6M61�ZtG6 E ML's G6 U9520 9V L0 %-60-WZ • .ii I" Iii i .. '��,r��.�A`�1"e•'`1� �3�'t +i:.2�'3.c�''�^„- •"'z4 ''� .7,� -�ti+= `r=��"'1 i'-'1�rr"�`i^?�t"'""ii�"�� a r` W"�� ' �� - •.�IITa�X '.��Iv�..�^tY, .St+�i'�'' 43i�L'Z��2�����yt'. .i!�} - 1T.iVrfZi+[Y`+L -MULL—ME-71:. WIN .,2 ,! _r�•_— U�'_'u`�.,,.•.:�t�S'.�"��%iii`:_�`nu"�"�� t'.tr',��s'tf`'`�`-�.'��.r i:�1�+�ro�,'�4� �`l':�.��s'1�1u'�" ., `i°.�i�` iLer:1+•� ��ti I SHEET N (PER PLAT) IJ�A 1 O � � � � 12V 1/1 r '' I ' - ieo _ tz,• ,4W •mss• fo,•iE' ....i... SCALE:1"=20' , I Ww-lopV.* jr. t Ioe Sb •ry 3s sam. •_•_•�- 1 9 e 9 to 11 121 I I I LOT 10, BLOCK 5 LOT 11, BLOCK 5 ' LEGEND "BONMAR PARK ADDITION" i "BONMAR PARK ADDITION" I S p I AC A/C UNIT I + f i 5 � P.B. 24, PG. 71 P.B. 24, FG.71 I, Iiii� 4 j (Lo° CENTER LINE / F.LP.1/2"0 ��-'"'tttt �5 �'�' Se• Sb.}I _R_.�_. ! F.I.P.1/2'0 I 75.00' (R & M) I (NO ID.) J n _ ELEVATION (NO ID.) rr .t� Q� PUMP _ _ _ _ x—x—x—x—x—x—x—x—x—x x—x—x —x—x—x—x—x—x _ _ _ _ _ _ _ T 1 7Y*�/• ✓� s • x—x—x—x—x—x—x x—x—x —xx——x x—x—x—x—x ---3JS4d' _- 25.0' 25.0' NW 99M STREET i 35' ABBREVIATIONS POWER i` POLE N I I _ z I AERIAL MAP N LOCATION MAP A/C=AIR CONDITIONER UNIT yti Lo Z o I Y D I (NOT TO SCALE) Y 0 I _ 0 HI= TO SCALE) CONC.=CONCRETE 0 H O0 - 0=DIAMETER I 17'9 POOL I Cfl Q I m Q (ry F.F.EL.=FINISHED FLOOR ELEVATIONOf F.I.P.=FOUND IRON PIPE I O QD. N I a N J H=HEIGHT I I N m i .-1"Q I REFERENCE BENCH MARK:N-444 ELEVATION:10.79 FEET ID.=IDENTIFICATION I I U j I U) Z I PROPERTY ADDRESS: (N.G.V.D.1929) 2 6' w Z W m 0 165 NW 99th STREET MIAMI,FL.33150 PG. PAGE 3: m IF SHOWN ELEVATIONS ARE REFERRED TO N.G.V.D.OF 1929. = I I I Z / 4 9, / - = I DESCRIPTION: WELL-IDENTIFIED FEATURES AS DEPICTED ON THIS SURVEY P.B.=PLAT BOOK 0 I 1. . / I pl I THE WEST 1 OF LOT 14 AND ALL OF LOT 15 BLOCK 5 OF" P2 AND MAP WERE MEASURED TO AN ESTIMATED HORIZONTAL 1= 9 / /F .E // /cq I 3'No I I BONMAR PARK ADDITION"ACCORDING TO THE PLAT THEREOF POSITIONAL ACCURACY OF 1/10 FOOI•UNLESS OTHERWISE Lo / / M AE .-� AS RECORDED IN PLAT BOOK 24 AT PAGE 71 OF THE PUBLIC SHOWN. • •9. ••••• •••••• RECORDS OF MIAMI-DADE COUNTY,FLORIDA. • • • • Y / / / // e j' 9' 0 I THE SURVEYOR MAKE9T4O RtPRESE "Tj�AS TO _• FLOOD ZONE INFORMATION: OWNERSHIP,POSSEE•JIOItlOR OCCUPATION OF THE SWRAEC • m I / / // / / / / / i I COMMUNITY NO.120635 PROPERTY BY ANY EjgWl QW INDIVIDUAL•T- 1 Y, • • 0- Nv PANEL NO.0302 •••••• SUFFIX:L SUBSURFACE IMPR0.AW1;S AND/CjrLpNCRQACHMENTS • F- W CoW Co �g // / ��I N / / / I I FIRM DATE:09-11-2009 WITHIN,UPON,ACRO36*ABUTTING ORO"ACENT TO J"•• 9' / 0 FLOOD ZONE:X SUBJECT PROPERTY•�t"I`JOT LOC�JE�D ANp ARE NOT• • p /, ••••• z r I / �L / / / I/ / 91 I I SHOWN. • • • • ` 0 ( Esf)�/ /. LEGAL DESCRIPTION WAS FURNISHED BY THE CLIENT. •• •• •• •••••• p y 90 I FXIL. / / / / y / / o� I I NOT VALID WITHOUT•TJ W4W.*NATURE AND&ORIGINAL RAISV• I LEGAL DESCRIPTION SUBJECT TO ANY DEDICATIONS, SEAL OF A FLORIDA ICERSM SURVEYOR AND MAPPER. • 0.5' t� f / o/ / 8 5' / 10.0' I LIMITATIONS,RESTRICTIONS,RESERVATIONS OR RECORDED ADDITIONS AND DELETIONS TO THIS� eQF•SURVEY%t"MI'R RECEIVED W 7' 0. C 1 5' / GATE I EASEMENTS. THAN THE SIGNING I&ARTY74RE PROMIBITED WITHOUT•THE • �- x—x -x—x— •••••• > Q Q OT 15,BLOCK 5 ui 8•UU' WRITTEN CONSENTbFTAE:IGNING Pj WTY• • • Q � "BONMAR PARK ADDITION" I THERE MAY BE LEGAL RESTRICTIONS ON THE SUBJECT • • LL F- w PROPERTY THAT ARE NOT SHOWN ON THE MAP OF SURVEY THIS MAP OF SURVEY HAS BEEN PREPARED;OR THE ¢O? P.B.24,PG.71 5' C.B.s F- w F- I I WALL I THAT MAY BE FOUND IN THE PUBLIC RECORDS OF MIAMI-DADE EXCLUSIVE USE OF THE ENTITIES NAMED HEREIN AND THE ` COUNTY,OR THE RECORDS OF ANY OTHER PUBLIC AND CERTIFICATION DOES NOT EXTEND TO ANY UNNAMED PARTY. r (9 0 I I I PRIVATE ENTITIES AS THEIR JURISDICTIONS MAY APPEAR. N U \ I I N I THE MAP OF SURVEY IS INTENDED TO BE DISPLAYED AT THE CERTIFY TO: \y' CHANTAL J.&LEONARD F.WATSON STATED GRAPHIC SCALE IN ENGLISH UNITS OF MEASUREMENT. ATTENTION IS BROUGHT TO THE FACT THAT SAID DRAWING SURVEYOR'S CERTIFICATION: IL I F.I.P.1/2"0 '.°• F.I.P.1/2"O I MAY BE ALTERED IN SCALE BY THE REPRODUCTION PROCESS S o F.I.P.1/2"0 ^/o O. I HEREBY CERTIFY:THAT THIS BOUNDARY SURVEY"AND THE UNOID.) (NO ID.) 1 (NO ID.) MAP OF SURVEY RESULTING THERE FROM WAS PERFORMED Z _ _ / - _ THIS SURVEY WAS CONDUCTED FOR THE PURPOSE OF A UNDER MY DIRECTION AND IS TRUE AND CORRECT TO THE ��( � L 7/ BOUNDARY SURVEY ONLY AND IS NOT INTENDED TO DELINEATE BEST OF MY KNOVA-EDGE AND BELIEF. _ 150.0' 75.0 (R THE REGULATORY JURISDICTION OF ANY FEDERAL,STATE, BLOCK I I REGIONAL OR LOCAL AGENCY BOARD,COMMISSION OR OTHER 360°SURVEl'INC,AND MAPPING,LLC - ._C^RI tGR I I ENTITY. FLORIDA CERTIFICATE OF AUTHORIZATION NO.LB 6356 Shoes Villa e b a —- - I, ui I THE ELEVATIONS OF WELL-IDENTIFIED FEATURES AS DEPICTED F `� C1 ON THIS SURVEY AND MAP WERE MEASURED TO AN ESTIMATED ���I I RAEZ \/�(� $�( DATE VERTICAL POSITIONAL ACCURACY OF 1/10 FOOT FOR NATURAL OSCAR E.B&Z-MSTE50,P.L.S. e GROUND SURFACES AND 1/100 FOOT FOR HARDSCAPE REGISTE D SURVEYOR SUR DEPT 1 7 I ° NW 99th STREET FACES,INCLUDING PAVEMENTS,CURBS AND OTHER AND MA40PER NO 5034 -O% MAN-MADE FEATURES AS MAY EXIST. _ STATE OF FLORIDA. REVISIONS: 60'PUBLIC RIGHT-OF-WAY I c ORIGINAL i 02-14.2G03 � NO.LS 5034 r�T 02-28-2012 UP-DATE SURVEY 360 SURVEYING AND MAPPING LLC = _ - I ASPHALT PAVEMENT I s FIELD DATE — STATE OF 11-06-2012 UP-DATE SURVEY Land Surveyors-Land Planners JOB NO. 0302-0072A.1 CT IO C c'P,IPIVMCE WI FH ALL FEDERAL OR 10, .j�C; HU---'S Af10 REGULATIONS 08-16-2016 UP-DATE SURVEY 2000 S.W.83rd Court MIAMI,FLORIDA 33155 �, �I LI�S�Q' PHONE: (305)265-1002 Miami Shores Village Building Department ! S P 01 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC20 � �F BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. E�fBLIILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION kPEXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I6 .54– City: Miami Shores County Miami Dade Zip: - Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: - 1 Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): dP�o►�G �� G✓ Soon Phone#: 305- 233- 502— Address: 05-333` 502.Address: l G t/ L.) C'! q City: twj&� S la®Y-S. State: Zip: 3 9 t$® Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �t'���1/ ow 1/L.eJ, Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ C-'000 Square/Linear Footage of Work: ®•4 Type of Work: LY Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: s�I Submittal Fee$ Permit Fee$ CJ1 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ CIO Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature tj 0271, Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 01 day of ��E -�s5 20 { ,by day of ,20 , by IEOV912--D TV-JZDg(c–,e ��is personally known to ,who is personally known to me or who has produced a. ��� �.i—as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLI NOTARY PUBLIC: Sign: Sign: Print: �1 NDI� �'��)Q� Print: Seal: o, Seal: °deo Nota:p Public State of Florida Sindia Alvarez DAy Com mission FF 15E150 P o,,,oP� Expires 09;03!21018 v #yah#a{C**�kkkIIek�k�k�N*k�k�#ski* ffe�effi*k9kIIa�kY�**�kk*k#*###sk**�k4�kdexek�k�k*�k�k�k#�kak*�k�k&�Rk*N�k�F*#�k*�k APPROVED BY �'� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r ' a m(,(iv4, U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name CHANTAL J.&LEONARD WATSON Policy Number A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 165 NW 99TIl ST City MIAMI SHORES State FL ZIP Code 33150 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) THE WEST 1/2 OF LOT 14 AND ALL OF LOT 15 BLOCK 5 OF BONMAR PARK ADDITION PLAT BOOK 24 PAGE 71 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat.25°51'57.65"N Long.80*12'03.73'1N 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 crawlspace or enclosures) N/A sq ft a) Square footage of attached garage N/A sq ft b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade 7 within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b 1300 sq in c) Total net area of flood openings in A9.b N/A 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 VILLAGE OF MIAMI SHORES 120652 1 MIAMI-DADE I FLORIDA B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12086CO302 L Date Effective/Revised Date Zone(s) AO,use base flood depth) -09/11/2009 09/11/2009 X N/A 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(Describe) Bl 1. Indicate elevation datum used for BFE in Item 69: ® NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes 0 No Designation Date N/A ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized N-444 Vertical Datum N.G.V.D.1929 Conversion/Comments WA Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)10.3 ®feet ❑meters(Puerto Rico only) b) Top of the next higher floor 10.35 ®feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 9.63 ®feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 9.55 ®feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) D Lowest adjacent(finished)grade next to building(LAG) 9.44 ®feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 9.47 ®feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including WA. ❑feet ❑meters(Puerto Rico only) 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 r information. I certify that the information on this Certificate represents my best efforts to interpret the data available.) s , understand that any false statement may be punishable by fine or imprisonment under 98 U.S.Code,Section 9009.® 74` Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a y licensed land surveyor? ® Yes ❑ No ���, Certifier's Name OSCAR EMILIO BAEZ-CUSIDO,PSM License Number 5034 r a H ER E Title REGISTERED SURVEYOR AND MAPPER Company Name 360°SURVEYING AND MAPPING �? Address 2000 SW 83RD CT. City MIAMI State FL ZIP Code 33155 ¢p Signature Date 02/28/2012 Telephone 305-265-1002 FEMA Fo 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spacep,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 165 NW 99TH ST City MIAMI SHORES State FL ZIP Code 33150 Company NAIC Number SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments SECTION C.,C.2.,e,TYPE OF EQUIPMENT=A/C UNIT SECTION A-A5.LATITUDE AND LONGITUDE FROM GOOGLE EARTH CROWN OF ROAD ELEVATION=10.34' ENCLOSED GARAGE FF 10.35' MAIN F.F.ELEVATION=12.38' Signature ) Date 02/28/2012 ❑ Check here if attachments SECTIO 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)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 and G9. 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 AO. 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(PR)Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum G10.Community's design flood elevation ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions DEPARTMENT OF PERMITTING, ENVIRONMENT AND REGULATORY AFFAIRS Em IMPACT FEE RECEIPT PROCESS t. B29121101969.0 BATCH: COLLECTION NO.: 107549 FOLIO it 1131010230390 SITE ADDRESS: 165 NW 99 ST FEEPAYER: WATSON LEONARD DATE: 10/24/2013 165 NW 99 ST MIAMI FL 33150 FEE DIST. CAT. CATEGORY UNITS FEE EXTENDED TYPE ID CODE DESCRIPTION AMOUNT AREA 1.0 5002 00 UNIT SIZE(SO Fn 536 0.9180 492.05 TOTAL AMOUNT DUE: $492.05 PAID CHECK: $0.00 PAID CASH: $492.05 IFSRP_0005T Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-254459 Permit Number: RC-3-16-594 Scheduled Inspection Date: March 11,2016 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: WATSON, LEONARD Work Classification: Addition/Alteration Job Address: 165 NW 99 Street Miami Shores, FL 33150-1742 Phone Number Parcel Number 1131010230390 Project: <NONE> Contractor: HOME OWNER Building Department Comments RENEWAL OF EXPIRED PERMIT RC12-1969 Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-254040. Noaccess no one home PLEASE NOCK AT THE DOOR Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 10,2016 For Inspections please call: (305)762-4949 Page 28 of 34 Miami Shores Village MAR 0 4 2816 Building Department : 10050 N.E.(ndvenue,Miami Shores,Florida 33138 C j Tel: 305)795-2204 Fax:(305)756-8972 V<otC,, I,-A(L(gEF; luct�3S TDCLS.-INSPECTION LINE PHONE NUMBER:(305)762-4949 awr Feaku-j FBC 20 BUILDING Master Permit No. j2— jq t0cj PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSIONENEWAL R r—jPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:] SHOP ff a/ rs�n CONTRA/C,TO_R DRAWINGS JOB ADDRESS: f 6 S `�l 6 °Y' c ��47 P'�-Q City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): (�/G ® Phone#: 3 r9�7-'3 yl'J,r Address:_ / (a y /`l/- CJ 57T- 2 City: A2j4- �� �e S State: C l Zip: J 1�© Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:, ��/� 'Y�^f Sb`L :DtJ-0-41�� 8.JJ0-4-Phone#: 36 -333 Address: City: "m..cc' -c;`�"'� State• 15�2- Zip: Qualifier Name: A hone#: State Certification or Registration#: Certifi to #: DESIGNER:Architect/Engineer: Phohe#: Address: City: State: Zip: Value of Work for this Permit:$ , Square/Linear Footage of Work: Type of Work: fiZ Addition VXAlteratio ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: (C-0 0 K. V� Specify color of color thru tile: Submittal Fee$ 16 Permit Fee$��� CCF$ '5ii• Z) CO/CC$ ca Scanning Fee$ / 6D Radon Fee$ DBPR$ l• GS Notary$ L<::1-CQ Technology Fee$ 26 .(Z Training/Education Fee$ �> Double Fee$ Structural Reviews$ Bond$ _ TOTAL FEE NOW DUE$ (9 2-3 c� Q (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. IJ e Signature A- Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,�� ,20 by day of 20 by who ,known .who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: int Seal: ti�cr coo Ndtary Public State of Florida Seal: Joanna M 1 epcian0 �a My Commission FF 082753 �p Expires 01/1212018 ******* * *** *** ** *********************************************************************** " l APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r 5t;D Miami Shores Village p,,.M Building Department lions10050 N.E.2nd Avenue TVs' �` Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE: ADDRESS: 16,5— AO ?Q s-�— Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,FS 489.103(7). And I have read and understood the following disclosure statement,which entities me to work as my own contractor;I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must supervise the construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a cost of$25,000.00 or less(The new form states 75,000).The building must be for your own use and occupancy.It may not be built for sale or lease.If you sell or lease a building you have built yourself within one year after the construction is complete,the law will presume that you built for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on your building who is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and with- holdings tax and provide workers'compensation for that employee,all as prescribed by law.Your construction must comply with all applicable laws,ordinances,buildings odes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that,as an owner builder,I am the responsible party of record on a permit I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name.I also understand that the contractor is required by law to be licensed in Florida and to list his or livens tubers on permits and contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve a commercial building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy.It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or Wstantially improved it for sale or lease,which violates the exemption. Initial 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. Initial 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence.It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that erroneously implies that the property owner is providing his or her own labor and materials.I,as an owner-builder,may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property.My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by me,which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employee.I understand that my failure to follow these may subject to serious financial risk. Initial �- 9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all applicable laws and requirement that govem owner-builders as well as employers.I also understand that the Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations. Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,the United States Small Business Administration,and the Florida Department of Revenues.I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or h :/Avww.m floddalicense.comidb r/ ro/cilbfindex.hti a Initial 11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that I am the party legally and ancially res ns le f r the proposed construction activity at the following address: ( Initial 12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the information I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who does not have a license,the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit.A copy of the property owner's driver license,the notarized signature of the property owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this _day ofZW066 ,20 who was pe�knownr who has Produced there License or as identification. IT OWNER NPARY E�- ► Notary Public State of Florida Joanna M FelicianoMy Commission FF 082753OF IV Expires 01/1212018 Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number 165 NW 99TH ST City MIAMI SHORES State FL ZIP Code 33150 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View' and "Rear View"; and, if required, "Right Side View' and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page, following. 02/28/2012 FRONT VIEW a � i "r. F'• `: - - f ! tom` RIGHT SIDE VIEW y f ,v ' •mow i Building Photographs Continuation Page For Insurance Company Use: Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number 165 NW 99TH ST City MIAMI SHORES State FL ZIP Code 33150 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." 02/28/2012 LEFT SIDE VIEW I E � % a ..f � 4 r {t REAR VIEW 1 e F