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PL-12-19-2960, 1665 NE 104th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: Issue Date: 01/14/2020 Expiration: 07/13/2020 Location Address Parcel Number L665 NE 104TH ST, Miami Shores, FL 33138 1122320320200 :ontacts HECTOR LONDONO Owner GRAY DOLPHIN POOLS & CONSTRUCTION Contractor 1665 NE 104 ST INC Home: 7862085518 SANCHEZME48@YAHOO.COM RAONEL LOPEZ 16225 SW 117 ST D14, MIAMI, FL 33177 Business:3052070606 graydolphinpools@bellsouth.net I Luxapatio Agent Steve Abreu 3305 NW 79th Ave, Miami, FL 33122 Business: 3057732603 steve@thepatiodistrict.com A Inspection Requests: Description: NEW POOL CONSTRUCTION, Valuation: $ 2,200.00 0 305-762-4949 TotalSq Feet: 260.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Plumbing - Pool - Residential $100.00 Scanning Fee $3.00 Technology Fee $3.75 Tota I : $163.15 Building Department Copy Payments Date Paid Amt Paid Total Fees $163.15 Credit Card 01/14/2020 $113.15 Check # 872 12/17/2019 $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 authojze the a e named contractor to do the work stated. n Authorized Signature: Owner / Applicant / / C ractor / Agent Date January 14, 2020 Page 2 of 2 ' . RECEIVED ?1 77hor e s (II e 142020 Building Department BY: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 (0� FBC 20 BUILDING Master Permit No. BPP-10-18-2988 PERMIT APPLICATION Sub Permit No. - , (C Z_ ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑■ PLUMBING ❑ MECHANICAL [:]PUBLICWORKS HANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1665 NE 104th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1122320320200 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: POOI Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): HECTOR LONDONO Phone#:786-208-5518 Address:1665 NE 104th STREET City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: GRAY DOLPHIN POOLS & CONSTRUCTION, INC. Phone#: Address: 16225 SW 117th AVE STE D14 City: MIAMI State: FL Zip: 33177 Qualifier Name: RAONEL LOPEZ Phone#: State Certification or Registration #: CPC1457551 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $1200 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition Description of Work: PLUMBING FOR NEW POOL Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF S DBPR $ CO/CC $ Notary $ Double Fee $ _ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ ( 17? I r` s Bonding Company's Name (if applicable) N/A Bonding Company's Address City State _ Mortgage Lender's Name (if applicable) N/A 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 mu pos2� the ' b site for the first inspection which occurs seven (7) days after the building permit is iss —1n tea ce pasted no tic ,the inspection will not be approved and a reinspection fee will be charged. Signature ER o 4 The foregoing instrument was acknowledged be or his day of - 20—, by HECTOR LONDONO "........r.,°,. who i 2rsonally knowno me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ature CO The foregoing instrument was ackric3W[Mged-before me this day of , 20 , by RAONEL LOPEZ who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC; - Sign: Print: :✓'•. RA AGUDEL.O :� M� cot iI SSION # GG105888 Seal: 'AX,.Aboev = Seal: EXPIRES May # G2025888 E PIRES May 17,2021 . aik, as ************************************************************************************************************ APPROVED BY Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) 002710 Local Business Tax Receipt Miami -Dada County, State of Florida -THIS IS NOT A RILL -DO NOT PAY 4932878 L'BT BUSINESS NAK(LOCATiON RECEIPT NO. EXPIRES GRAY DOLPHIN POOLS & CONSTRUCTION IN(KNEWAL SEPTEMBER 30, 2020 16225 SW 1 17TH AVE P 14 6160313 Most be displayed at place of business MIAMI FL 33177 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER GRAY DOLPHIN POOLS & CONSTRLICTION SEC, TYPE OF BUSINESS 196 SPECIALTY PLUMOINC, PAYMENT RECEIVED CONTRACTOR eYTAXCOLLECTUR RAONEL LOPEZ QUALIFIER CFC14si557.. ,-- - $75.Q0 09/03/2019 Workers) 3 ECh1ECK-19-225722 This Looai Business Tax Receipt only confirms payment of the Looai Bu3ines2 Tax. The Receipt is nut 6 license, Permit era certification of the holder's uatification$. to do bwiness. Holder must comply viiih eny governmental 'Or nongovernmental regulatory laws and requirements which apply to the business. The RECOPT NO. above must be displeyed on all commercial vehicles - Miami -Dade Code Sec 8­276. For more information, visit wtivs miamidedggovAs eniiectrg r GRAYD-1 A RC3 CERTIFICATE OF LIABILITY INSURANCE DATE7 7/011201(MYYY) 71:01 9 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(ics) must have ADDITIONAL INSURED provisions or 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 - PROPUCER 305-262-0086 BUTLER, BUCKLEY, DEETS INC. 8161 BLUE LAGOON DR., STE 420 r• cT BRANDON W BUTLER PHONE 306-262-0088 FAX 305-262-0187 INC. No, Ext): (AIC, No): R-L S: MIAMI, FL 33126 Brandon W Butler IN URER S AFFORDING COVERACir NAIC A INSURER A; FCCI COMMERCIAL INSURANCE CO, 33472 _ INSURED GRAY DOLPHIN POOLS CONSTRUCTION INC. INSURER A: 16225 SW 117 AVF STE D14 Ih1SURER C INsu ER D MIAMI, Fl- 33177 INSURER E: INSURER F : COVERAGES CERTIFICATE UMBER: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, TURM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THC POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DOL UDR ppLIcv NUMBER POLICY EFF POL ICY EXF LIMITS A X COMMERCIAL GENE RAI. LIABILITY I EACH Or,2t1RREN E S 1,000,U00 CLAIMS -MADE OCCUR Gt I0004G4&<"01 06103/2019 06/03/2020 DAMAGE TO RENTED $ 100,000 M O EXP (Arn one arson 5 5,000 RS NAL a ADV INJURY 1,000,000 ;FN 'I_ AGGREGATE LIMIT APPl g5 PER: X POLICY C] JET LO., GENERAL Any TF 3 2,000,000 f CID TS-COMPNPAGG $ 21000,000 OTHER: _ AUTOMOBILEI,IASILITY .C�MBINEDISINGLELIMIT $ BOCILY INJURY {Par per.vnl„ ANY AUTO I EODILYINJ RY Perac ident S CANNED SCHEDULED AUTOS ONLY iUTNOCS,V4�Ep AUT05ONLY 25% l� ' + IPe�B .REjn1nAMACE S A X I UMBRELLA LIAe EXCESS LIAR X OCCUR CLAIMS -MADE UMH700074403-OR i 0610312019 06/0312020 EACH O'CURRENCE S 3,000,000 AGGREGATE S 3,000,000 DELI t RETENTION E $ A WORKERS COMPENSATION ANDPMPLOYERS'LIABILITY ANY PROFRIETORiPAkTNER/r=XECUTIL'E YIN �yFFICER/ME h7 EriCLUDEI jMaoa,tary In INIA ou1WC17A7s'2e 11/0112019 11101120Z0 X PER YH- T Tf X E. ESf=H=Cc:I:iENT ,T� 1,000,00 E.L. DISEASE_ FA F_MF Y . - 3 1,000, 00 E.L. DISEASE- POLICY LIMIT 1,000,00 If yes, d"Cnbe Under D�SCRIPTIO OF TIONS belmx DESCREPnON OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Re,narke Schedule, may Pa attached tf more space is required) POOL CONTRACTOR, LIC #CPC1457551 CERTIFICATE HOL N MIASHVI SHOULD ANY OF THE ABOVE DESCRIBER POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2 AVE. MIAMI SHORE$ VILLAGE, FL 33138 AUTHORIZED REPRESENTATIVE I ACORO 25 (2016103) tw 19Iia-2015 ACORD CORPORATION- All rights reserved. The ACORD name and logo are registered marks of ACORD BUILDING PERMIT APPLICATION �,,Aiami Shores Village ���► Building Department 17 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY.-!_ Tel: (305) 79S-2204 Fax: (30S) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 20LO-�I" Master Permit No. (�IPP- Sub Permit No..?L- 1 2. - 19 ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL UMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP T� CONTRACTOR DRAWINGS ,� JOB ADDRESS: t �' 'J �i O -1 E � t —A S�-T , City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I ZZ FZ _ ���Z QQ) Is the Building Historically Designated: Yes NO'X �� Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):_Aec--(C)2 L-1c) 7 Phone#: 'l�(z, �JLO'Fi' A Address: Lpl0 iQ)�-k T+} S--t , City: ` (."- ,, D-s` S State: F Zip: Tenant/Lessee Name: Phone#: Email: r. rA, t L-L'S CONTRACTOR: Company Name: CA)" 'If'L QPAjg �3tj 1 NL Phone#: IS L Address: I -J30 ,k) -* II City: JJA Lt—"Ap, State: F\ Zip: 3�IZ /� Qualifier Name: IT1� c�'%IV; O n-w - Phone#: State Certification or Registration #: CiC H2-?9 3M Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ � �� �-� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ I I (Revised02/24/2014) Bonding Company's Name (if applicable) i" I rt Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip sm 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 low brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencem ust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. ,,in the a senge of such posted notice, the inspection will not be ap roved and a relihspection fee will be charged. fI SignatureOE s .i Signature ..... ,..Q NER or AGENT The foregoing instrument was acknowledged before me this day of` I ( 20 1 �1 by l f''(xi` loyi o,i u , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Seal: .�w''►�:• C-ARA AGUDELO MY COMMISSION # GG105888 Vo,EXPIRES May 17, 2021 as R The foregoing -instrument �was acknowledged before me this 1 day of 20 l by I�.(( who is personally known to me or o has produ e-� �' as identification and who did take an oath. NOTARY PUBLIC: Sign: � t! Print: r6 Seal: ARA AGUDELO ;i��'a"°"!ii.; MY COMMISSION # GG105888 EXPIRES May 17, 2021 APPROVED BY IC -- - -� N / 1 z�//mil Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014)