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MC-08-19-1865, 1234 NE 94th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 1234 NE 94TH ST, Miami Shores, FL 33138 1132050100210 Contacts ELI BRAVO Owner FOREVER POOLS Contractor 1200 NE 97 ST, MIAMI SHORES, FL 33138 FERNANDO MORALES Other: 3054942371 2655 LE JEUNE RD 905, MIAMI, FL 33134 Business: 3054481517 ............. _... _._._.....____. _ _ __. _ .._._ __-� _-, Description: POOL HEATER FOR NEW POOL Valuation: $ 4,300.00 N Inspection Requests: 3(K- 4 9 TotalSq Feet: 360.00 Fees Amount Application Fee - Other $50.00 CCF $3.00 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $1.00 Permit Fee $79.00 Scanning Fee $3.00 Technology Fee $3.23 Total: $143.23 Building Department Copy Payments Date Paid Amt Paid Total Fees $143.23 Credit Card 08/26/2019 $93.23 Credit Card 08/13/2019 $50.00 Amount Due: $0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner ! Applicant / Contractor / Agent Date August 26, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION ❑BUILDING "ELECTRIC Miami Shores Village A 13919 Building Department B - 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 20 ! Master Permit No. �`� H o`r Sub Permit No.�e ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL "PLUMBING M MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 10B ADDRESS: k—a24 INL 474 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): fl 1,(A O -, CA Cr , a( a s*5Phone#: (3-aS ) a4—R - Z3 1 Address: 12 z A. bl-r' !74- City: 0 M , ssAo C,5>- S State: ,i-- �„ Zip: Tenant/Lessee Name: T Phone#: Email: CONTRACTOR: Company Name: _ Address: City: (_ C>"(- Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Address: Value of Work for this Per Type of Work: ❑ Add Description of Work: Phonei7�b�� Zip: J� Phone#: icate of Competency #: Phone#: State: Zip: k!!�}-(-n IL Sq/iare/Linear Footage of Work: ❑ Alteration ❑ Ng01v ❑ Repair/Replace Specify color of color thru tile: Submittal Fee $ (;;b I CO Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ ❑ Demolition CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ /� 2 TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 Zi 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 �q�'rnI o OWNER or AGENT The foregoing instru ent was acknowledged before me this �^ day of /;,` 20 /' by ! ,ol ,'`who is personally known to me or who has produced —Z f / ���'n Ste. as identification and who did take an oath. NOTARY Print: f F'b1li Commis:bn F 901;8 Seal: My Comm. Expires May 13, 2020 •�•, at► Bondedift. A.NatiunalNotary Assd. APPROVED BY Signature CONTRACTOR The going instrument was acknowl dged before me this 1_ day of (�7 20 Z f by -FeQ P 1-1- o is personally known to me or who has produced `¢z• // & ' as identification and who did take an oath. NOTARY Sign:_ Print- Seal: cYommission N FF 991980 Comm. Expires May 13. 2020 9onded through.National Notary Assn. Ir ***************************************************** miner Zoning (Revised02/24/2014) Structural Review Clerk CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1 07125/25/20/92019 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(les) 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 endorsement(s). PRODUCER Estrella #123 CONTACT NAME: RAISA GARCIA (PA NE , (305) 553-4800 aC No): (305) 553-9050 12460 SW 8th Street AI ADDRESS: RAISA.GARCIA@ESTRELLAINSURANCE.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: COLONY INSURANCE COMPANY Miami, FL 33184 INSURED INSURER B : INFINITY COMMERCIAL AUTO INSURER C : FOREVER POOLS, LLC INSURER D : 2655 S Le Jeune Road, Suite 905 INSURER E : Coral Gables, FL 33134 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 ADDLSUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR 101 GL0059412-03 07/23/2019 07/23/2020 EACH OCCURRENCE $ 1,000,000.00 PREMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OX AUTOS SCHEDULED AUUTOSS /� NON -OWNED HIRED AUTOS AUTOS 509820036516001 11/04/2018 11/04/2019 COMBINED IN L LIMIT Ea accident $ BODILY INJURY (Per person) $ 50,000.00 BODILY INJURY (Per accident) $ 100,000.00 PeOac dent AMAGE $ 25,000.00 PIP $ 10,000.00 UMBRELLA LIAB EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ D? OFFICER/MEMBER EXCLUDE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A 1 1 X STATUTE ERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) POOL CONTRACTOR CERTIFICATE HOLDER CANCFLLOTInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 10050 NW 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD