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PL-17-2269Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -9-17-2269 Permit Type: Plumbing - Residential Work Classification: Pool - Private Permit Status: APPROVED Issue Date: 101412017 Expiration: 04/0212018 Parcel Number Applicant 141 NE 109 Street Miami Shores, FL 33161- 1121360040520 Block: Lot: REGINA PAVONE Owner Information Address Phone Cell Contractors) Phone NATIONAL POOL DESIGN LLC (305)559-1020 Cell Phone Type of Work: PLUMBING FOR A SWIMMING POOL Type of Piping: Additional Info: PLUMBING FOR A SWIMMING POOL Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $3.37 $2.25 $0.20 $225.00 $3.00 $0.80 $235.22 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -9-17-65119 09/20/2017 Check #: 20981 $ 50.00 $ 185.22 10/04/2017 Check #: 21169 $ 185.22 $ 0.00 Available Inspections: Inspection Type: Main Drain Final Rough 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: construction and zon rtify that athe for the ore llautho iz mation is accurate and that all work will be done in compliance with all applicable laws regulating or o do the work stated. Authorizedfignatu�e: Owrler\ / .plic. / Contractor / Agent Building Department Copy October 04, 2017 October 04, 2017 Date 1 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 , p_ECFI\TED SEP 21 2017 FBC 201+ s+h Master Permit No. 6 PP ey Sub Permit No. PL fl - Z269 ❑BUILDING 0 ELECTRIC 0 ROOFING 0 REVISION• ❑ EXTENSION ❑RENEWAL .UMBING 0 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF 0 CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ' 1 N 6 tog C n q t" "T City: Miami Shores 2004— County: Miami Dade Zip: 3 31 (a1 Folio/Parcel#: 11-- 113 to— 00 4 ^ 0520 Is the Building Historically Designated: Yes NO Occupancy Type: 11/j1.71-'6 oad: Construction Type: Flood Zone: 1\-' BFE: FFE: OWNER: Name (Fee Simple Titleholder): 6-1 A PA-vo,46 Phone#: 3 • 1 1 Address: (y 1 IJ 6 ID t f\ ST City: j 41 1"41 Sti01265 State: Zip: 331 b 1, Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: jI' ` f o)..—s '1-' POOL 6 (261 CYO Address: ,f23Z4 SLJ i t1`{i.5 City: tri State: Qualifier Name: f L -C 9'6 QO -oD )&) 6-2_ Phorie#: 3 \ 5 —/020 Zip: 5J 1 0s - Phone#: 35- S "l -- a: 10?_a State Certification or Registration #:- (USS S Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Square/Linear Footage of Work: Value of Work for this Permit: $ /f 0 0 Type of Work: ❑ Addition ❑ Alteration Description of Work: n New poii-4GiNr(r- • C . • ..i y� f ,� <Yf 5 .rye �� Yr�• �} r 4VSpecify color of color thru tile: ,i El Repair/Replace n Demolition Submittal Fee $'" ,�.�--c( Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ (e ry ' i 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 1 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. 1 Signature ::_114 / Signature OWNER or AGENT The foregoing instrument was acknowledged before me this Z6144" day of Au&USS 20 r by -666-11'` A PA -\1 , who is personally known to me or who has produced D L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Notary blic - State of Florida Commission ; GG 105164 My Comm. Expires May 16, 2021 Bonded through hatioral Notary Assrr. _The foregoing instrument was acknowledged before me this ��k�,d�ay of /411(13 /'7 v� , 20 l 7 , by i t Pad t S .62, -who is p na ly known me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal:' 'P ***************************************************************************** APPROVED BY (Revised02/24/2014) Plans Examiner v ^ ;Nja P n n ;�lo4ilryfPubtic' Ste{go Mori •0" mC2lirtmission # GG IQSl64 /C` Iy�nrt4iiim. Expires May i6, 20 * * * *********************** Zoning Structural Review Clerk Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 141 NE 109 Street Miami Shores, FL 33161- Owner Information Permit Permit NO. EL -9-17-2301 Permit Type: Electrical -Residential Work Classification: Pool - Private Permit Status: APPROVED issue Date:10/412117 Expiration: 04/02/2018 Address Parcel Number 1121360040520 Block: Lot: Phone Applicant REGINA PAVONE Cell REGINA PAVONE 541 NE 105 ST MIAMI FL 33138-2044 Contractor(s) Phone F JIMENEZ ELECTRICAL CONTRACT( 305/556-5759 Cell Phone 1 Valuation: Total Sq Feet: $ 1,000.00 0 Type of Work: ELECTRIC FOR SWIMMING POOL. Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $0.60 $4.50 $3.00 $0.20 $300.00 $3.00 $0.80 Tota l: , $312.10 Pay Date Pay Type Invoice # EL -9-17-65153 09/26/2017 Check #: 21132 10/04/2017 Check #: 21169 Amt Paid Amt Due $ 50.00 $ 262.10 $ 262.10 $ 0.00 Available Inspections: Inspection Type: Final Light Niche Bonding Review Electrical Alarms 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'AFFIDA)itT'1 I certlfv that construction and Futkermore I the fo authoriz Authorized Signa mation is accurate and that all work will be done in compliance with all applicable laws regulating -named contractor to do the work stated. cant / Contractor / Agent Building Department Copy October 04, 2017 Date October 04, 2017 1 b9/28/2017 11:48PM 2396749514 F JIMENEZ ELECT CONT PAGE 01/02 Local Business Tax Receipt Miami -Dade County, State of Florida —THIS IS NOT A SILL —00 NOT PAY 5938062 — • UUSINES9 NAME/LOCATION. JIMENEZ F ELECTR3CAI.CONTRACTOR INC DOING BUSINESS IN DADE COUNTY fECSIFr NO. RENEWAL 6?78686 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of DUstnass Pursuant to County Code` Chapter $A— Art. 9 & 10' OWNER WC. TYPE OF RUMNESS F JIMENEZ EIEC CONTRACTOR INC 196 ELECTRICAL CONTRACTOR C/O•FRANCISCO JiMENELRRES,..., WOrkitt(S) 1 PAYMENT REC&1VEO BY TAX COLL2CT st $7500. 09/05/2077.. FPPU14=FT-037438 /As Local Basitfass Taw Recei mdy�� nnes�met of tie t oceJ BV ees Tex. no Rete9pt m nota knee.mak, or a Carobs Won of tha older's se An lattunles. Holier muss amply wdfresy govertvnotkel at neapoven aenpd regafatory taws ruquiraauafs wMcb apply to the business. The MEVJPf Mobiles saw be Naplsyai as all eamonnviat For Para iaformali n. tuft • . 004463 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6698774 BUSINESS NAME/LOCATION NATIONAL POOL DESIGN LL`C 15665 SW 10 LN MIAMI FL33194 OWNER NATIONAL POOL DESIGN LLC Worker(s) RECEIPT NO. RENEWAL 6971858 °oU EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPECIALTY PLUMBING CONTRACTOR PAYMENT RECEIVED CPC7457845 BY TAX COLLECTOR $75.00 07/25/2017 ECHECK-17=188068 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental of nongovernmental regulatory laws end requirements which apply to the business.. The RECEIPT NO. above must be displayed on'all commercial vehicles - Miami -Dade Code Sec Ba -276. For more information, visityy►Yyvralemidade,aovftexeolleelpt a Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 51- FBC BUILDING Master Permit No. 6F' E(-11- 11 b/ PERMIT APPLICATION Sub Permit No. ,Lt.4 2301 ❑ BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL 0PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS j q I N6 log +i' s T JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 331 folio/Parcel#: I I - 2,13(G-- 0 a 0-52,D Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): e6 6 tJ A pkv31.3 t Phone#: 3 - S(k - 3 ch �1 Address: IL-8 Ne /675---r City: Hb44.7/ State: Zip: '3/ b / Tenant/Lessee Name: Phone#: Email: r ur"`��,` ` 01--el--0 CONTRACTOR: Company Name: f---141‘1 5 i 'S C - (D. �i N4 -61/4-62, • Phone#: .7s6 275 7I 6 Address: 12 'Il U ( ini 66(.6.�-c_tim, LQ- e.o City: (4 4-1,2A-1-1- t ZN.S State: .%Z Zip: 3 31f5 Qualifier Name: iA 5 15 co "S (1'/L2. Phone#: 796- 2q 5 - 218b State Certification or Registration #: eL 130a 2717Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 4 ! 100 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: et-C—C'f Q) C �-cs g St -JP it k -r /ii a--- por) t Specify color of color thru tile: Submittal Fee $ r - r Permit Fee $ ,l©49,00 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ '3 - DBPR $ ` g0 Notary $ Y �j} Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 2--G2- • 10 (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 OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1I day�of �.2n )'91 'tom- , 20 i , by /I day of f i- I , 20 1 ? , by 2•t(�N, l /' 6N , who is personally known to -113I,5i'1 SI14-5.0 2, , who is personally known to me or who has produbd ®L as me or who has • d ed D(., as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: /"d CQ�J -TiN•�24d�2i�l%�L ************* APPROVED BY (Revised02/24/2014) CRISTINA RODRIGUEZ Notary Public - State of Florida Commission 4 GG 105164 My Comm. Expires May 16, 2021 Banded through National Notary Assn. %Z ,2 SSt )" P Plans Examiner identification and who did take an oath. NOTARY PUBLIC: Sign: Print: eigisi-,,v,9 go Seal: ■�s PJ •.. CRISTINA RODRIGUEZ �1 i Notary Public - State of Florida .�` Commission 4 GG 105164 tm l� P` My Comm. Expires May 16, 2021 �FQ �}? ii thr hN ti nal t sn Zoning Structural Review Clerk ARD® ‘1..... ------CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD YYYY) 09,06,2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the po icy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Dopazo & Associates Inc 8725 NW 18th Terr Ste 300 Miami FL 33172 CONTACT Alexander Dopazo NAME: PHONE (305)470-8500 FAX (A/C, No, Ext): (A/C, No): E-MAILalex@dopazo.com INSURER(S) AFFORDING COVERAGE NAIL # US Specialty Insurance Co INSURER A: P tY 29599 INSURED F Jimenez Electrical Contractor Inc 4910 5th West Lehigh Acres FL 33971 Bridgefield Employers Ins Co ' INSURER B : 9 10701 INSURER C : 09/10/2018 INSURER D : $ 1'000'000 INSURER E : INSURER F : DAMAGERENTED PREMISESS( (Ea occurrence) COVERAGES CERTIFICATE NUMBER: CL179618133 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE.INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE IN D SWVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITYEACH U17AC100163-00 09/10/2017 09/10/2018 OCCURRENCE $ 1'000'000 1 CLAIMS -MADE X OCCUR DAMAGERENTED PREMISESS( (Ea occurrence) 100,000 $ MED EXP (Any one person) $ 5,000 PERSONAL8ADVINJURY $ 1,000,000 GEN'L X I AGGREGATE LIMIT APPLIES PER: POLICY PRD JECT LOC OTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILE • LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ { UMBRELLA LIAR EXCESS LIAB - OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ I DED RETENTION $ $ BANY WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PROPRIETOR/PARTNER/EXECUTIVE OFF CER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N Y N /A 083026529 01/02/2017 01/02/2018 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1'000'000 E.L. DISEASE - EA EMPLOYEE $ 1'000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Electrician. Loc #001: 4910 5th West, Lehigh Acres, FL, 33971 Licesnse #: EC13002779 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave Miami Shores ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE FL 33138 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD