BPP-12-3340 Permit NO. BPP-12-16-3340
Miami Shores Village t Permit Type:Pooistwhliripools(Hot Tubs
M10050 N.E.2nd Avenue NE ON Q Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000 PumrlllPermit Status:APPROVED
Phone: (305)795-2204
s
FLORIDA
Issue Date: 1/5/2017 Expiration: 07/04/2017
Project Address Parcel Number Applicant
1130 NE 91 Terrace 1132050010410
Miami Shores, FL Block: Lot: BARBARA TER HORST
Owner Information Address Phone Cell
BARBARA TER HORST 1130 NE 91 Terrace (305)432-1775
MIAMI SHORES FL 33138-
1130 NE 91 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
Valuation: $ 3,800.00
NATIONAL POOL DESIGN LLC
(305)559-1020
.. v.� �e..... Total Sq Feet: 450
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:REPLACEMENT OF POOL WATER LINE Bond Return: Wall Steel
Classification:Residential Scanning:3 Review Planning
Review Electrical
Review Building
Review Plumbing
Fees Due AmountPay Date Pay Type Amt Paid Amt Due
CCF $2.40
DBPR Fee Invoice# BPP-12-16-62315
$1.71 01/05/2017 Credit Card $82.82 $50.00
DCA Fee $1.71
Education Surcharge $0.80 12/12/2016 Check#: 1072 $50.00 $0.00
Permit Fee $114.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $132.82
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.
OWNER AFFIDAVIT: I c ity t tall the going information is accurate and that all work will be done in compliance with all applicable laws regulating
constr adz Hing. F ter re, I a orize the above-named contractor to do the work stated.
January 05, 2017
Authorized Signatur wner / Applicant / Contractor / Agent Date
Building Department Copy
January 05, 2017 1
' C _'VED
Miami Shores Village o .2 Zoos
Building Department Y:_
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBc 20145+h
BUILDING Master Permit No. bpp 16 – `i O
PERMIT APPLICATION Sub Permit No.
.BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [--]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: II 3 0 A/TG)I �� r►�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: SEP_ Load: Construction Type: 900Flood Zone: BFE: FFE:
L•
OWNER: Name(Fee Simple Titleholder): I la✓b&li r a ?r r Aai- i- Phone#: 77j,
Address: /l 2 0 NF 91 7-er✓
City: CA02 i �h o rc I State: r—L- Zip:_ 3�l 3f
Tenant/Lessee Name: A.l/!4 ` Phone#:_T
Email: Qrf 6 �0 577 0 J / i G U JZ
CONTRACTOR:Company Name: _ (0/ P#d / el J-6 4 L LC__ Phone#: 9 o r S5-!/d a-O
Address: 9U-3 JW /(47 OVL !/Y)►� a �-- -78 b— Z.6-1` 55q 5 0-F4-0
City: 11-4'Li ►')'1 ► State: FL Zip: %j 1®■'(-
Qualifier Name: r1 Z Phone#:
State Certification or Registration#: O—PC /L�,- 7k-L}.- Certificate of Competency#:
DESIGNER:Architect/Engineer: y>, {,,�✓ fZcG✓Q-I Phone#:
Address: I3 r 3 a So 75-/. S j City: /A 1 Arn State: AL Zip:33 / 77
Value of Work for this Permit:$T 9 ADD. 06 Square/Linear Footage of Work: 4,1 �0 c�
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
n.; �6D / G AHI'Afv.t 2614) oil
Specify color of color thru tile: Q
Submittal Fee$ Permit Fee$ �'—_!_ CCF$ 2~'��1d CO/CC$
Scanning Fee$ Radon Fee$ —1 ' DBPR$ ' T Notary$ `—
Technology Fee$ Training/Education Fee$ 030 Double Fee$
Structural Reviews$ Bond$ gyp,
TOTAL FEE NOW DUE$ �• �1
(Revised02/24/2014)
Bonding Company's Name(if applicable) {V
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.
I
Signature i Signature
OWNER or AGENT CONTRACTO
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 1�C e s,4 ase✓ ,20 I by day of L %7)�wlr 20 16 by
�! A/b A✓�' V JS who is personally known to �I�`• y� who is personally known to
'�- r Y '� `1 r Y
me or who has produced as me or who has produced I/AJ as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
�• p ,, r Piy'' MARIA THERESA PINO
Sign: ..�' �e a, MARIA THERE7FIorida
Sign:
Notary Public tMy Public-StatePrint: 12 Ion# Print: �c Commission#FF 15368
My Comm.Expires May 7,2017 -%,,os�n•.: y comm.Expires ay ,
Seal: Seal: RP W co
APPROVED BY u�- v Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
5�1OR10c. Es G,
s� �� Miamishores Village
••-s~ Pill ""'�' Building Department
7181 10050 N.E.2nd Avenue
�LORIDp' Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
NOTICE OF REQUIREMENTS
RESIDENTIAL SWIMMING POOL,SPA AND HOT TUB SAFETY ACT
I (We) acknowledge that a new swimming pool, spa or hot tub will be at
1(ba Ay87 0 ( .T t?#)CG ? N�:?g Miami Shores, FL, and hereby
affirm that one of the following methods wi be used to meet the requirements of Chapter 515,
Florida Statues and the Florida Building Code R4101.17.
Please initial the method(s)to be used:
The pool will be equipped with an approved safety pool cover that complies with ASTM
F1346-91. (Submit Manufacturer's Specifications).
A continuous,one-piece(child) barrier meeting the requirements of Florida Building Code
R4101.17.1.15 will protect the pool perimeter. The plans shall show the fence location and method of
attachment, including one end that shall not be removable without the aid of tools. (Submit Manufacturer's
Specifications).
_ V _A combination of non-dwelling walls and fences(screen enclosure,child fence, masonry
fence walls,chain,link or wood fence,etc.)will protect the pool perimeter. The plans must specify the type
and location of all non dwelling walls. Florida Building Code, R4101.17.1
✓ Any combination of protection which incorporates dwelling walls with openings directly into the
pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building
Code, R4101.17.1.9(Submit Manufacturer's Specifications).
Any combination of protection which incorporates dwelling walls with openings directly into the
pool perimeter and all doors will be equipped with a self-latching device with positive mechanical
latching/locking installed a min. 54"above the threshold. If this option is selected,submit plans showing all
types and location of all perimeter protection. The plans must also show the location and type of all
openings,and the hardware type for each location. (Submit Manufacturer's Specifications).
In accordance with the Code,the pool may not be filled with water without compliance with the
Private Swimming Pool Safety Requirements,and upon expiration of the permit,the pool shall be
presumed to be unsafe. I understand that not having one of the above installed will constitute a
violation of Chapter 515, F.S.,an d will be considered as committing a misdemeanor of the second
degree, punishable as provided in Section 775.082 or Section 775.083 F.S.This form must be signed
by the owner/agent and the 'me contractor.
,priC2 2 . 201
CONTMCT&SIGN URE AND DATE WNER'S SI NA E AND DATE
lfr4dal Udr ./ee- /ffa hor
r ;ot�a MARIA THERESA PINO
CONTRACTOR'S NAME( E PRINT) OWNER'S NAME(PLEASE PRINT) = Notary Public-state of Florida
PL AS
Commission#FF 15368
My Comm.Expires May 7,2017
NOTARY PUBLIC NOTARY PUBLIC
ORES h
t,,, ,,,Nrm Miami Shores Village
Building Department
�LOiR1Dp'
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 266PA9 —T?;?Z 16�r &Qis/are the fee
simple owner(s)of the following described property situated and being in Miami Shores Village, Florida:
Address: (130 A)-G- Q I • 7W-P-Iq-c ,
Whereas,the undersigned owner(s)
desire to utilize said Lot(s)as a single building site, and the undersigned owner(s)do(es)hereby declare
and agree as follows:
I. That the property will not be used in violation of any ordinances of Miami Shores Village
or Miami-Dade County now in effect or hereinafter enacted.
II. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a
pool where the required enclosure is not on the subject property where the pool is located.
III. That if any of our adjoining neighbors remove any portion of their fence or wall,or if
our/my property shall fail to meet code requirements for pool barriers,we, as owners will
immediately installs a protective enclosure to meet code requirements and will obtain a
permit for such fence.
IV. That, I/we,as owner(s)hold Miami Shores Village harmless for any negligence or injury
that results from not having the enclosure.
V. If enclosure belongs to said property, I agree to maintain &or replace said enclosure in
the event that is damaged or removed by any case.
NOW,THEREOF,for good and valuable consideration,the undersigned do(es)hereby declare that
he/she will not convey or cause to be conveyed the title to the above property without requiring the
successor in title to abide by all terms and conditions set forth herein.
FURTHER,the undersigned declare(s)that this covenant is intended and shall constitute a
restrictive covenant 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.
OWNER SIGN &PRINT OWNEft SIGN WIRNT
I Hereby Certify that on this day personally appeared before me
and has produced ID# as identification and he/she acknowledge that he/she
executed the foregoing,freely and voluntarily,for purposes there in expressed.
SWORN TO ANDS y of 20_6,
MARIA THERESA PINO
Notary Public-State of Florida
Commission#FF 15366
�FF;�;: My Comm.Expires May 7,2017 OTARY PUBLIC STATE OF FLORIDA
(Revised 05/2209
StIORPS G�
logo n...� Miami Shores Village
Building Department
�L�iRIDA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
SWIMMING POOL OWNER'S CERTIFICATION
Date b e ce.•h n ✓ oZ, 2-0) 6
Miami Shores Village
Building &Zoning Department
Attention: Building Official
I certify that I am the legal owner of the property described as
13ar,b r-A 12K6d,-fit" , located at 1 l � AJV q i T%2404}CS
UbhymL GrTea-E55. 0. 3 g
In accordance with Section 33-12(o, Code of Metropolitan Dade County, I certify that I
understand and agree that the swimming pool to be constructed at the above address cannot
be used or filled with water until separate permit has been obtained for an approved safety
barrier, and such barrier erected, inspected and approved.
I further understand that this certification, however, does not eliminate the need for
obtaining a permit and erecting and approved barrier prior to final inspection and use of the
pool.
Legal Owner—1)�
Note:This certification is to be submitted with a swimming pool permit application in duplicate.