MC-17-2782�` gNORES Y�!
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F�OR'lOA
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. MC-1 1-17-2782
tPermit Type: Mechanical - Residential
enn' Worts Classification: Pool Heater
Permit Status: APPROVED
Parcel Number
Issue Date:1214/2017 l Expiration: 06/02/2018
Applicant
10125 BISCAYNE Boulevard 1132050190190
Miami Shores, FL 33139-2647 Block: Lot: BISCAYNE 10125 LLC
3wner Information Address
BISCAYNE 10125 LLC 10125 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
10125 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
FLORIDA POOL PATIO CORP (305)815-0181
Tons:
Additional Info: NEW HEATER FOR POOL/SPA
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Fees Due
Amount
CCF
$1.80
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Permit Fee
$122.50
Scanning Fee
$3.00
Technology Fee
$2.40
Total:
$134.30
Date Approved:: In Review
Type of Work: NEW HEATER FOR POOUSPA
(786)390-3177
Valuation: $ 2,500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-11-17-65730
11/22/2017 Credit Card $ 50.00 $ 84.30
12/04/2017 Credit Card $ 84.30 $ 0.00
Available Inspections:
Inspection Type:
Final
Review Mechanical
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, serva s, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING an ING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contra o the work stated.
Authorized Signature: Owner / Applicant
/ Agent
December 04, 2017
Building Department
December 04, 2017
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
RE c r
NOV 2017
BY: _GUI
S+M
FBC 20) 9
Master Permit No. �)-pP 1-7 ---z -SS
Sub Permit No. MC 1-7" -78 2
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10 2 S CICayn
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): Phone#:
Address: 101 Do'S Cavou M 0,
City: State: Zip: 33 1 38
Tenant/Lessee Name:
Email
CONTRACTOR: Comoanv Name: }-IOn�c, 0G) �G1'P U C Oe %>. Phone#: -?WS J/S0I1"
Address: 12 Z k I S10 Cj Ct S +
City: �i AL-ll State: F(, Zip: -33�8G
i
Qualifier Name: C IGIC Uo t c9 \/CIUA-P-- Phone#: 4,1 rej k %
State Certification or Registration #: C PC I ti 5 $ I gZ Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address
City:
Phone#:
Value of Work for this Permit: $` Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color oof� color thru tile:
Submittal Fee $ ✓ 1 Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Zip:
❑ Demolition
CCF $ CO/CC $
Radon Fee $ 2 - CK�l DBPR $ 2 - rj�) Notary $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 19Y • 30
LA,
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 at the" b site
for the first inspection which occurs seven (7) days after the building permit is issued. In the abse such pos notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged beforemee th4-
ZC� day of t oljR,-AL- . 20 r J-/ , by
102'5 6t3cD(,,,- Q -c who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
'I'Fie foregoing instrument was acknowledged before me this
—2 0 day of �`�' 20 by
who is personally known to
as me or who has produced
Sign:
C*
Print:
f, to `\( I e
identification and who did take an oath.
NOTARY PUBLIC:
Sign: () C,
Print: f"tQ C<< 0-C
as
Seal: Seal:.,,,
NADINE AGUAS ;;� '�`'S''�;: NADINE AGUAS
MY COMMISSION * GG090407 '= MY COMMISSION N OG090407
EXPIRES Aprm 04 ?0 1 EXPIRES Afd p;j
APPROVED BY Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
A C Q®
l"`...►//v� 12 CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
ri 1/15/2017
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 be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements .
The Holmes Organisation of Florida, Inc.
11512 Lake Mead Ave, Ste 802
Jacksonville FL 32256
CONTPRODUCER NAME: Jaclyn Scharf
PHONE 904-645-3804 FAX N ; 904-645-3805
E-MAIL
.jscharf@holmesorg.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURER Ajechnology Ins Co
42376
INSURED FLORIPO
INSURER B :
INSURER C :
Florida Pool -Patio Corp
DBA: FPP Construction
Claudio & Sebastian Valero
INSURERD:
PO Box 161491
INSURER E :
INSURER F :
Miami FL 33186
COVERAGES CERTIFICATE NUMBER: 914939904 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
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYV
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$
PREMISES Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO JECT LOC
OTHER:
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
$
AUTOMOBILE LIABILITY
ANY AUTO
AUTOS NED SCHEDULED
UTOS
NON -OWNED
HIRED AUTOS AUTOS
COMBINED SINGLE 0MT__
Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE$
Per accident
UMBRELLA LIAB
EXCESS LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y
OFFICER/MEMBER EXCLUDED?
(Mandatoryin NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
TWC3664654
9/4/2017
9/4/2018
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Swimming Pool Construction
GLK I IFIGAI L HULULK GANL LLLA I IVry
Miami Shores Village
Building Department
10050 NE 2nd Ave
Miami Shores FL 33138
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
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD