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BPP-10-2051Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 165628 Permit Number: BPP -11 -10 -2051 Scheduled Inspection Date: October 20, 2011 Inspector: Bruhn, Norman Owner: CARR, HEIDI Job Address: 150 NE 111 Street Miami Shores, FL Project <NONE> Contractor: B&K CONTRACTOR SERVICES INC Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360040120 Phone: (305)989 -2363 Building Department Comments NEW SWIMMING POOL AND DECK Passed4q, f Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 164933. CREATED AS REINSPECTION FOR INSP- 153439. Provide hand holds at raised wall. NB October 19, 2011 For Inspections please call: (305)762 -4949 Page 15 of 16 Permit Number: BPP -11 -10 -2051 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 164427 Inspection Date: September 15, 2011 Inspector: Dacquisto, David Owner: CARR, HEIDI Job Address: 150 NE 111 Street Miami Shores, FL Project <NONE> Contractor: B&K CONTRACTOR SERVICES INC Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Survey Final Work Classification: New Phone Number Parcel Number 1121360040120 Phone: (305)989 -2363 Building Department Comments NEW SWIMMING POOL AND DECK (244et--PsiCL-- c.-- .15 —54r4e 7j' (L e Inspector Comments CREATED AS REINSPECTION DETAIL OF SETBACKS '� "� FOR INSP- 163718. PLEASE SHOW ON /FINAL SURVEY `' ��' j�-(r4' - � 6 perFailed Passed fly �4/ ' Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until September 15, 2011 For Inspections please call: (305)762 -4949 Page 1 of 1 E • COUNTY -WIDE LAND SURVEYORS INC. N LAND SURVEYORS - PLANNERS 'P.O. BOX 823271 SOUTH FLORIDA, FL. 33082 -3271 (305) 772 -0766 LEGAL DESCRIPTION Lot 13 in B recorde County, COLLEGE HEIGHTS, according to the plat thereof, as k 42 at Page 8 of the Public Records of Miami -Dade SURVEYORS 1). Legal 2). Right 3). Only r `pton provided by client. information obtained from record plat. d plat easements are shown. SEP 1 5 2011 APP �o -20s1 Miami Shores Village APPROVED BY DATE ZONING DEPT A 7JC / G I BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS BOUNDARY & IMPROVEMENTS SURVEY sway FORA Heidi Carr 150 N.E. 111 St. Miami Shores, Fl. 33161 CERTIFICATE NO I HEREBY CERTIF MINIMUM TECHNIC MAPPERS IN CHAP SECTION 472.027 NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYORS SEAL." THAT THE SURVEY REPRESENTED HEREON COMPLIES WITH THE STANDARDS ADOPTED BY THE FLORIDA BOARD OF SURVEYORS AND R 61G 17 -6, FLORIDA ADMINISTRATIVE CODE, PURSURANT TO J�B.I. 9- 14-L.�!! Nth. DE (lc SETBACK �N► Florida statutes. JOSEPH L. MARTIN PROFESSIONAL LAND SURVEYOR * 4368 'STATE OF FLORIDA REVISIONS VPPp11F- SJl905 A®o DRAWN BY )LtN PIME41.N DAT E 1W-S-1,ae9 BY 3 DATE &- II-Zc,41 I „I„ _ _i_ a J' — 1— 1� I7' LO('A1ioN SICCZ I N.'/ T'SCALE f IPF FD N,E , 1/1 S7� PVM% 1V,05' N NPF FD �s7O 'iCU /LCI, tt /Su PCAs4WM V'Zr ephAV 7=3TI 5 11/4: 7/Le- Air pv•o• 08 Fr,• Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 163718 Permit Number: BPP -11 -10 -2051 I Inspection Date: August 24, 2011 Inspector: Dacquisto, David Owner: CARR, HEIDI Job Address: 150 NE 111 Street Miami Shores, FL Project: <NONE> Contractor: B &K CONTRACTOR SERVICES INC Permit Type: Pools/Whirlpools/Hot Tubs Inspection Type: Survey Final Work Classification: New Phone Number Parcel Number 1121360040120 Phone: (305)989 -2363 Building Department Comments NEW SWIMMING POOL AND DECK Passed Failed (274 Correction Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments "As I- 174, fac,„p (efi. 5 ;�f`' ` r f /(I/ / e Sirv,."ra''' For Inspections please call: (305)762 -4949 August 24, 2011 Page 1 of 1 COUNTY -WIDE LAND SURVEYORS INC. LAND SURVEYORS- PLANNERS 'P.O. BOX 823271 SOUTH FLORIDA, FL. 33082 -3271 (305) 772 -0766 LEGAL DESCRIPTION Lot 13 in Block 1 of COLLEGE HEIGHTS, according to the plat thereof, as recorded in Plat Book 42 at Page 8 of the Public Records of Miami -Dade County, Florida. SURVEYORS NOTES: 1). Legal description provided by client. 2). Right of way information obtained from record plat. 3). Only record plat easements are shown. BOUNDARY & IMPROVEMENTS SURVEY SUNEY FOR, Heidi Carr 150 N.E. 111 St. Miami Shores, F1. 33161 CERTIFICATE `NOTE: " NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYORS SEAL." I HEREBY CERTI THAT THE SURVEY REPRESENTED HEREON COMPLIES WITH THE MINIMUM TECHNI L STANDARDS ADOPTED BY THE FLORIDA BOARD OF SURVEYORS AND MAPPERS IN CHA R 61G 17 -6, FLORIDA ADMINISTRATIVE CODE, PURSURANT TO SECTION +72.027 Florida Statutes. REVISIONS JOSEPH L. MARTIN PROFESSIONAL LAND SURVEYOR * 4368 STATE OF FLORIDA BY DATE UPDAlf, SURJI1 Aoo ��r �fi •NS I )•E. -III —r-- n LOCA1JoN 54676,1 No—r 70sCA E 0 AUG 3tJ2011 PIPE Milani Shores Village APPROVED f . BY DATE ZONING DEPT f -BLDG DEPT ,I n 4,11-C i TO COMPLIANCE WITH ALL FEDERAL !P. I 1 AiNJU COUNTY TY RULES AND REGULATIONS F.B. / PG. N /E, 1/1 .5', PvM- Y, PIPS PIPE �n� 7S WWUD r16.4,6? pvr+l• PERMIT # �� it CONTRACTOR: SUBMITTAL DATE: ADDRESS: t SON (1 NAME: t-�i �' RESUBMITAL DATES: ZONING FIRE 27/5, J'h23 /' O STRUCTURAL ELECTRICAL PLU BIND ,( -ll- ff IMPACT FEES HRS /D RM NOC MECHANICAL BLDG 10 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 to -2051 Inspection Number: INSP - 160355 Permit Number: FW -4 -11 -724 Scheduled Inspection Date: June 01, 2011 Inspector: Bruhn, Norman Owner: CARR, HEIDI Job Address: 150 NE 111 Street Miami Shores, FL Project: <NONE> Contractor: B&K CONTRACTOR SERVICES INC Permit Type: Fence/Wall Inspection Type: Final Work Classification: Wood Fence Phone Number Parcel Number 1121360040120 Phone: (305)989 -2363 Building Department Comments INSTALL WODDEN FENCE AND TWO GATES Passed l�/� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 159924. CREATED AS REINSPECTION FOR INSP- 158700. Fence exceeds 5' hugh at rear Gate at east side does not latch. Gates exceed 5' high. NB CC- May 31, 2011 For Inspections please call: (305)762 -4949 Page 16 of 25 Mar.23. 2011 9:52PM No.7376 P. 1/1 CERTIFICATE OF LIABILITY INSURANCE DATE (MwTRYTYYTI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER T03/23/11 HIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE RSSUING INSURER(S), AUTHOR/7ED REPRESENTATNE OR PRODUCER. AND THE CERTIFICATE HOLDER IMPORTAPm If the cortitlesto haler h: an ADDITIONAL INSURED to t and eo»d)ttona of the ) P�IcyC�) must be sndol$wL If SUBROGATION 1;3 WAIVED, subject to am Io :e ent(RaUcies may nequtre an el:dorasment A on this ceRiFioate does net nonfat rights to the the ion and in Neu of soft p:Idot, ceiTx t(9►, PRICER Florida Bankers Insurance 7278 SW 8 Street MUM, FL 33144 Phone (305)266-8493 INSURED B 8 K CONTRACTOR SERVICES INC 2821 W 76 St Ste S. 2D2 MIAMI, FL 33018- ex (305)282-0679 COVERAGES CERTIFICATE NUMBIBt: Ties IS TO CERTIFY THAT THE POLICIES OF INSURANCE UsTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR OR POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY 65 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE RO DESCRIBED HEREIN TO � THE TERMS, THIS I EXCLUSIONS AND CONDITIONS OF SIGH POLICIES. UM}TS SHOWN MAY HAVE SEEN REDUCED BY PAID CLANS, OONTADT MARTA ALONSO ITTsuRBILTm AFFORDING COVERAGE INSURERA: AMERICAN VEHICLE INSURANCE COMPANY INSURER B : JNOURERC; INSURER o INSURER E : INSURER F : NAIL # TYPE OF msuen ct mom LIAg4J1Y COMMERCIAL GENERAL LIABILny d GE J❑ OCCUR GENL AGGREGATE UMITAPPUES PER POLFCY la I❑ LOG ' �r:sm9 ILE LIABILITY ❑ ANYAUTO C ALL OwNEDAUTOS ❑ SCI.IEPULEO AUTOS (❑ HIRED AUTOS LI NOItFDINYED AUTOs U UMBRELIAUAB ❑ n EXCESS LAD f"-I DEDUCTIBLE :TI ReiENnCN $ AND EMPLOYERS' � LIAMUlY R14(ECU7ME Y I N ANY PROPRI romp E OFFIC)BiMETTBER EXCLUDED? In NH) ON O OPERATIONS Wow POLICY NUMBER GL- 05040Q8758 -Op OCCUR CLABIS.MADE ❑ 02/11/2011 02/11/2012 UMn1B EACH OCCURRENCE $ 1.000.000,00 ES (Ea 3 8 100,000.00 MED E*P Wry one vin) $ 5,000.00 PESeoNaL &Am INJURY $ 1.000.000.00 csmeALAGGReC,A'E $ 2,000,0110.00 PRODUCTS - GOMPIOPAGG $ 2,000.000.00 NIA DESCRIPTION 4FOPERATwNB t LOCATKINSt vmDCLES (Ansel, ACORD 1111,A$ Sehadga trnb IG span is raq:►tred) CERTIFICATE HOLDER ACORD 25 (20091O9) QF CANCELLATION CDMBINED SINGLE LIMIT ) BODILY WART (Par paraan) S $ BODILY KIM (Par =Bel $ PROPERTrDAMAGE (Pareaideu) S s EACH OCCURRENCE AGGREGATE $ E.L. MB ACCIDENT $ E.L. DISEASE EA MPL OYE $ E,L DISF.Aft- pouGYLtIWT 8 SFIOULD ANY of THE ABOVE DESCRIBED POUCIEB BE CANCELLED BEFORE THE bIWRATION DATE THERE0F, NOTICE ;RILL BE DELIVERED ltd ACCORDANCE Wrh THE POLICY PROVISIONS. 011988 -2009 ACORD CORPORATOR AU nights reserved.) The ACORD ItemO and 109e are regal marks of ACORD 1 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 10 /29/2011 Applicant 150 NE 111 Street Miami Shores, FL 1121360040120 Block: Lot: HEIDI CARR Owner Information Address Phone Cell HEIDI CARR 150 NE 111 ST MIAMI SHORES FL 33161 -7048 Contractor(s) Phone Cell Phone B&K CONTRACTOR SERVICES INC (305)989 -2363 Valuation: Total Sq Feet: $ 1,600.00 102 Approved: Yes Comments: Date Approved: 4/28/2011: Yes Date Denied: Type of Construction: Wood Fence Classification: Residential Additional Info: Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Wire 8 Wood Scanning Fee Technology Fee Total: Amount $1.20 $2.00 $2.00 $0.40 $102.00 $3.00 $1.80 $112.20 Pay Date Pay Type Invoice # FW -4 -11 -40715 05/04/2011 Cash 04/25/2011 Credit Card Amt Paid Amt Due $ 62.20 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Foundation 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. May 04, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date May 04, 2011 1 5.-1/1/t —Lc4 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. rit4 1 l —11-4- PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): - �-"� � fi`P Phone #: 77 Address: / (/ /I S City: „4)i ! @,,,wA, State: Zip: )33,41 Tenant/Lessee Name: Phone #: Email: Master Permit No. eV? VO 2C5 1 JOB ADDRESS: /�6 iu City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 6 k L+V6- i • Phone #: ." /•Sa Address: City: M14 -10....U, � State: ( ( Zip: .�'/ Qualifier Name: 4 ( .T.- , , % ( (e, : Phone #: State Certification or Registration #: CC) C 1 / � Certificate of Competency #: Contact Phone #: a Q f,. If d Co Email Address: DESIGNER: Architect/Engineer: Phone #: // � � o © Square/Linear Footage of Work: Value of Work for this Permit: $ N Type of Work: ❑Address ❑Alteration brew ❑Repair/Replace ❑Demolition Description of Work: COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: * * * *, * * * * * * + * * * ** * * * * * * * * * * * *** * * *** ** Fees************* * * * * * * * * * * *** * * *** * * * * * *** * * * ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified ied copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of'VDVt X20 M, by who is personally known to me or who has produced As identification and who did take an oath. 0. LA ROSSA � • (/ Public - State of Florida s�rl, .. � f'„ ep2,2014 Sign: / ��;�_',�;:_�.� r4, Sign: Print Print: Signature id` Contractor The foregoing instrument was acknowledged before me this day of 44,„ vt /i , ,- , 20 , by who is personally known to me or who has produced NOT My Commission Expires: •o"' 11, ,,, JOHN D. LA ROSSA 1uotary Public - State of Florida M Expires Sep 2, 2014 °;$ , fission # EE 22854 oath. My Commission Expires: ** *fie * * * * *X• ][] F' X*9f *, 4' Jf9C1Y, Y*3f, Y, Y1Y1Y1F, YlF1YtY] F, Y1Yit, Y1YfF1F] Y1Y141F] hh] Ylk?[4 1FiIC9tit4t?t 1Y1h, 41RnYtY9fdC' IF4[ iC1Y' If ]Y]Y]FiC•lY*** **9[tY1Yx]F*** APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Plans Examiner Structural Review * * ** * * * * * * * * * * * ** is Y Zoning Clerk Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit NO. FW -4 -11 -724 Permit Type: e: FetNceItAf riff ati food Fence Expires:Not Issued Folio Number:1121360040120 Owner's Name: HEIDI CARR Job Address: 150 111 Street Miami Shores, FL Owner's Phone: Total Square Feet: 102 Total Job Valuation: $ 1,600.00 Contractor(s) B &K CONTRACTOR SERVICES INC Phone (305)989 -2363 Primary Contractor Yes 1 Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 4/28/2011: Yes Comments: COUNTY -WIDE LAND SURVEYORS INC • •• • • • • . . • • • • • • • • • • ••. • • • • • . . . • N•• • • • • ••• LAND SURVEYORS- PLANNERS 'P.O. BOX 823271 SOUTH FLORIDA, FL. 33082 -3271 (305) 732 -0 ?66 ••: ••• • • • •• • • • • • • • • •. ••. • • •.• •• .. • • • • • • • • • • • • • • ••.• •.• • • • . • • • . LEGAL DESCRIPTION •• ••• •• • • • •• • • Lot 13 in Block 1 of COLLEGE HEIGHTS, accordkW • • :tl;e�•pl�at @hereof, as recorded in Plat Book 42 at Page 8 of the Public Records ot Miami -Dade County, Florida. SURVEYORS NOTES: 1). Legal description provided by client. 2). Right of way information obtained from record plat. 3). Only record plat easements are shown. BOUNDARY & IMPROVEMENTS SURVEY 80..mVEY FORS Heidi Carr 150 N.E. 111 St. Miami Shores, F1. 33161 CERTIFICA I HEREBY MINIMUM r MAPPERS I; SECTION 4 E NOTE: ' NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYORS SEAL." RTIFY THAT THE SURVEY REPRESENTED HEREON COMPLIES WITH THE NICAL STANDARDS ADOPTED BY THE FLORIDA BOARD OF SURVEYORS AND HAPTER 51G 17 -5, FLORIDA ADMINISTRATIVE CODE, PURSURANT TO Florida Statutes. JOSEPH L. MARTIN PROFESSIONAL LAND SURVEYOR ih 4368 STATE OF FLORIDA REVISIONS BY DATE DRAWN 81' I SCALE I DOTE —14/ 110. Y." r': -Lc; 1% -S -100 'JOB* • • ••• • • •• •• • • • •• •• • • • • • • • • • • • • • • • •• • • • • • • mow • ••• eV LOCA7 /oN 3 t • • •• •• • • • • • • • •••. ••• ••• •. • • • •• • • • • • • • • • ••• •• NiE ° 1/! S7� Pvbi t VZ�+ 093 wo�o4 Wok pue u }° ov Ce }eo col ao+nap u} ssal uo Pa }e o evils load solo -leo a�� 3%,k1 tiuoOl. old +eys Woa :S3 od ...................credo WO SOsJ Zvi ®a x ,. a � _ ,fin � PD lo•us. ";1 u• Z3 •2a° CNII ,,.1 1"' f -n /CF Po 7S' pvMl• NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO, PP /0'a240.S.7 TAX FOLIO NO. )I l34069-01a° STATE OF FLORIDA COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement 1. Legal description of • • perty and street/address: 1 5 0 °'y C / 1 1 S 1 1— 4 e -- 2. Description of improvement 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder. 111111111111111111111111111111111111111111111 CFN 2011R0015778 OR.Bk 27547 Ps 4643; (1os)' RECORDED 41107/2011 15:21 :43' HARVEY RUVIHr CLERK OF COURT MIAMI -DARE COUNTY P FLORIDA LAST PAGE Space above reserved for use of recording office c.vk S des l 3316_1 4. Contractor's name, add an • phone number. g w eJLS t laC • 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(47., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)0), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement one expiration date Is 1 year from the date of recording unless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING OUR NOTICE OF COMMENCEMENT Signature(s) Prepared By Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing In trument was acknowledged before me this / 7 day o By /4%24 Ok I A,& . Q m- ❑ Individually, or ❑ as for personally (mown, or ❑ produced the following type of identifica Signature of Notary Public Print Name: (SEAL) a s VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and ,that•the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or(s)'s Autho Officer/Director/Partner r r(. or Authori * zed liCallirMaMtalM /Director/Partner/Manager Prepared By ` Oaf 61‘,. Print Name Ys.�.9 /3/ 1 Title/Office a 0�..�. �i 3 ^z /7 i f- 2.c9 -d.. t� , 6th JOHN D. LA ROSSA Notary Public - State of Florlda My Comm. Expires Sep 2, 2014 ' ..-. Commission ! EE 22854 anagerwao signWd Mot :—' — — By "f GALA-- — Cl.A a By 121.01-52 PAOE3 3110 STATE OF FLORIDA, COUNTY OF DADE 1 HEREBY CERTIFY that this is a true copy of the n�I day of 20 and County C itte D.C. 33)x( Charlie Crist Governor Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General December 21, 2010 Rafael Gutierrez 2345 SW 131 PI Miami, FL 33175 RE: Contingency Letter Application Document No: AP987788 Centrax Permit Number: 13 -SC- 1292346 OSTDS Number: 150 NE 111 St Miami, FL 33161 Lot: 13 Block: 1 Subdivision: College Heights Dear Applicant: This will acknowledge receipt of an application dated 12/20/2010 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. 1. -There is no increase in sewage flow, change in characteristics compromising the integrity or function of the system installation. 2. -This project entails : "SWIMMING POLL" " From a review of your completed application, it has been determined that your existing system is adequate for the proposed use : " APPROVED ". G/P If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Sincerely, Jo er, Engineer Specialist II Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 Fax: (305) 623 -3645 l\.S\ ■( --utazia-9D ill( Lf6.(v-IN-0 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 9Eagrowlfi) fltiv i 7 MO gy _ - BY. !� BUILDING Permit No. Kt 10 -la 1 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING 13- i/A LY5 X 15' ,- 3 ,94 ,rte / OWNER: Name (Fee Simple Titleholder): t 1 & .I\ e'-- kr r Phone b) 9 l 7 (�@ X7 Address: t S 0 4.1 Hat 3 t if.-9- 6 City: to & k D C State: Zip: 3 2 1( a Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: / 0 ''l "' /1/ 5 City: Miami Shores County: FoliofParcel #: 1 1 a s ? ( & Is the Building Historically Designated: Yes NO Miami Dade Zip: 3-3 / x Flood Zone: CONTRACTOR: Company Name: X ( 1,1111- l'J +A Se i e iJ) ht °Phone#: 3 a 9g c 2 36 3 Address: City: /4-4' OA •@ State: Ft Qualifier Name: 11—. - IrLc-%_k" 62—....73, l) eS g fe 4? Phone #: C- 1 0 a Certificate of Competency #: Contact Phone #: Email Address: State Certification or Registration #: Zip: 330/P DESIGNER: Architect/Engineer: • Value of Work for this Permit: $ Type of Work: UAddress de, z t ".,�� 0 ❑Alteration Description of Work: A) +a_ Pry ° Phone #: 7A6 als ;q - Square/Linear Footage of Work: '346 s -p rho 1 a•I ew ORepair/Replace ❑Demolition f!'t VA,C e Ek azvk. k/, COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ** ** ** * ** ***** * ** *** ** ** *** *** * ** *fir ****Fees******************************************** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Douhle Fee $ Structural Review $ G®° ®o TOTAL FEE NOW DUE $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AI}1H'1DAVIT: 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the firs inspection which occurs seven days after the building permit is issued. In the absence of such posted notice, the inspectio ill not be approved and a reinspectio ee will be charged. Signature Owner or Ag_... The foregoing instrument was acknowledged before me this day oft t/ , 20 j li, by � 1 fit l C who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Prin My Commission P,e..- ,. °e <�; JOHN D. LA ROSSA Notary Public - State of Florida My Comm. Expires Sep 2.2014 stf,„so„ Commission # EE 22854 % 8adasY,43r ****kk4e3e** 3esY*,si �S44E1FaF3rtirsiarsFaYdr9r�F4e *3e3e:YsY9: ****:trtk*** sks4sF** **k$eaY�F*** &*ell; C s tractor The foregoing instrument was acknowledged before me this i day of L,v ,20/v,by t who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print- MY r Inlz ' ExpiresiJOHN O. LA ROSSA 1 • Notary Public - State of Florida i My Comm. Expires Sep 2.2014 APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Plans Examiner Structural Review Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. OF OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. OPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION � BUSINESS NAME: (C k 3 o1 Sa v v I c / c BUSINESS ADDRESS: agR 1 Lk) 1(9 3± a C (" Ck l e CA-k. STATE P 1 ZIP CODE S aJ' Di 8 BUSINESS PHONE: (.SOS) 5 89 236) FAX NUMBER (36() 9 -°4 , `4 Q CELL PHONE ( ) QUALIFIER'S NAME: Leo 1,1 Gw -ck ® G ' . QUALIFIER'S LIC NUMBER: E -MAIL ADDRESS (IF APPLICABLE): Created on 3/19/09 BY MLDV / RV 3/26109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 Gomm LEONARDO BIM C6NTRACTOR SERVICES INC 2821 W 76TH ST, APT 202 HIALEAH FL 33018-5370 Ongratulationl With-this Oconee you become one of the nearly one million loridians licensed by the Department of Business and Professional Regulation. )ur professionals arid businesses range from architects; to yacht brokers, from oxers to barbeque restaurants, and they keep Florida's economy strong. very day we work to improve the way we do business in order to serve you better: -or information about otw services, please log onto vrrammyttoridalicense.cont. 'here you can find more information about our divisions and the regulations that ripaot you, subscribe to department newsletters and team more about the )epartmenfs inithatives. )ur 1111931011 at the Department is: UCellSe Efficiently, Regulate Fairly. We onstantly strive to serve you better so that you =isms your customers. bank you for doing bminess in Florida, and congratulations on your new licensed 4 4, MR: DETACH HERE . . ... P,A-CH NUMBER 11,iTgitka4. 4_,. --,..- _ OS .i,..,!(3-....*..,.....31...,..- ‘la:,—,7::8 - .,'-irs:A SriAN ' 7- _ . - -„„ ...-O• 4, A y _,_ oilTE ;z tpCLIP;radA44..:,_ AEOTEOF SEPT. It[US BE DISKA AT PLACEOF:PIN 610.241 =2. THIS IS NOT A 911 - DO NOT PAY RENEiiAi- NAND _ /LOCA Na 636519~ -1 8 & IC CONTRACTOR SERVICES.TNC 202 STATE#;COC1513926 2821 W 76 ST 33018 NIALEAH FIRST -CLASS us. POSTAGE.. PAID PF nwrNO.231 OWNER 8.8 K CONTRACTOR SERVICES _ INC. Sec. �e efB 1 =�L BUILDING CONTRACTOR •11118 IS ONLY A 20CAL HONNONS -TAX RECEIPT. O' OMR : NOT PILL' THE • HOLDER TO MATE M► MOOMINSTULATOWTOtt TINWIll MAO OP- TM QO[DIEY ON GOER, - OOFB 31• MOW • -TM mom* IOW anon Lam! .. ON IMAM REOMINDATIANVONSIS NOT A ItERARCAMINt OF PRONINTOMMIED OUMr rAX .:. . 07 /16/201.0 6007000007' 000045.:00 SEE OTHER SIDE DO NOT FORWARD 8 & K CONTRACTOR SERVICES INC LEONARDO GOMEZ PRES 2821 W 76 ST 202 NIAEAN FL 33018 !!L!!FL L!!Il1,3f1, 111!„l �IllEiillllll}lll� /r#/.Iilij,ll 09 -16 -2009 ■SEX SINK STATE OF FLORIDA REEF RNAticmi.OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ammo TO BE EXEMPT FROM FLORIDA W TWO LAW * * ONSTRUCTION INDUSTRY EXEAAPTION his certifies that the. individual lister below has elected to be exempt from Florida Workers' Compensation lave. PFECTIVE DATE E RSON: 09/16/2009 EXPIRATION DATE 09/16/2011 GOMEZ EIN: 260185603 1USINESS NAME AND ADDRESS: 1 & K CONTRACTOR SERVICES INC :821 W 78 ST 0202 IALEAN FL 32018 COPES OF BUSINESS OR TRADE - CERTIFIED GENERAL C 4TRACTf3R LEONARDO IFt18TAN14 Pursuant to Chapter 440. 00(14). F.8 an officer of a cmparatloa emu elects exemption from Iola chapter by tiling a certiflCue .1.Sachen tads' tads tNon may not racoaer bemmlis or camponsallen ander this chapter. ?nowt to Chapter 440.051121, F.S., Certificates of eleetien m he exempt... apply only whole the ape of the Maltese or trade listed on the notice of ate to be exempt Pennant to Chapter 440.050* F.S.. Nukes of eleclbe to he attempt end eettglemes of emin to be .3,801 Mil ha subject to reaoatmx hf, at soy throe altar the fling of the entice or the Is.aaace of die cerdlltete, the person tamed on' the notice or stificate no longer seats the tetptitionents of this secaon fer Iasonnca of a certificate. The departmoit shall mate a swath: out at any tree for Ware .1 to person mad on the tertglate to toed the reahaifamsots: of tIda sestina, °BESTOW? (85(0 413 -1809 252 CBfTIRCATE OF ELECTION TO BE EXEMPT REVISED 09 -08 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE E OF Fi.OR1Dl IRTMENT OF FINANCIAL SERWCER ION OF WORKERS' COMPENSATION ISTR UCTIODI INDUSTRY 1RCATEOF ELECTION TO BE EXEMPT FROM FLORIDA IERS' COMPENSATRES LAW :CTIVE 09/16/2009 EXPIRATION DATE: 09/18 /2011 30111: LEONARDO DOM 28018=03 NESS NAME AND ADDRESS: K CONTRACTOR SERVICES WC 1 W 70 ST 8202 !AN. FL 33018 PE OF BUSINESS OR TRADE ERTffIED GENERAL CONTRACTOR F Purstamt to chapter 440.05114), F.S. an officer of a corporation who r elects exemption from this chapter by filing a certificate of election L• under this section may not recover benefits or compensation under this IMPORTANT D chapter- Pursuant to Chapter 440.05(12). F.S. CItificet s of elation to be exempt, apply :ontly within the scene of the business or trade listed an the notice of election to be exempt Pursuant to Chapter 440.05( 131. F$.. Notices of election to be exempt and certificates of election to be exempt: shall be subject to revocation if, at any time after the filing of the notice : on the isstmnce of the certificate, the person named on the notice or certificate no Longer meets the required of this section for isstmiae of a certificate. The department shall revue a certificate at any time for failure of the person name on the certificate to meet the requirements of this section. N E R E QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. 52 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-08 Nov.11. 2010 5:44PM No.3452 P. 1/1 CERTIFICATE OF LIABILITY INSURANCE DATE M7YY)- 11/11/10 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 POUCIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: Fate cerf>t:tate holder Is an*D0nl0NAL MIMED, the polcy(les) must Be endorsed. E88BROGATIONIS WAnIED, subject to ate terms and condliferts alive pokey, certain policies may requke an endorsement. A statement entitle certificate does not confer dips to the certificate Balder In lieu crutch endareententifif. PRODUCER Florida Bankers insLUanc e 7278 SW 8 Street Miarrd, FL 33144 Phone (305)266 -6493 Fax (305)262 -0679 CONTACT NAME: MARTA ALONSO INC. PHONE No. EDIT: (305) 266-8493 1 . Nov: (305) 282 -0679 wsuRED B & K CONTRACTOR SERVICES INC 2821 W 76 St Ste it 202 MIAMI, FL 33018. AD: PRODUCER madaefloridabankeisinstilancazorn • MERID#: INSURERS) AFFORDING COVE INCA; AMERICAN VEHICLE INSURANCE COMPANY NAIC # INSURER INSURER C INSURER : INSURER INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY7HATTHE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FORME POLICY PERIOD INDICATED: NOTi# ITh TmDINGANYREOUIREMENT, 7ERMOR CONDmoN OF ANY CONTRACT OR OTHER DOCUMENT Willi RESPECT TOWHIai THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS, EXCLUSIC�SJSAND CCNDMONS OF SUCH POUCIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. pQ LtYt V(PE of INSURANCE A1XR. Y IWO POLICY NUMBER GL-0504004176-00 imaP itntwywnTEFF 02/11/2010 aligN9 0211112011 EACH O CCURl NCE $ 1,000:00040 A GENERAL uasILrrY ® COMMERCIAL GENERAL u aiLtrr ■ 0 CLAMS -MADE RI OCCUR PREMSES Me ocaccurrrencel 100.000 00 MEDEXP (Am ane ) $ 5,000.00 ' PERSONAL & Am INJURY $ 1,000.000.00 • GENERAL AGGREGATE 3 2,000.000.00 GENT. AGGREGATE LIMIT APPLIES PR n poucv ❑ J ❑ LOC PRODUCTS- COMP/OP AGG $ 2,x.000.00 $ AUTOMOBILE LIABLLITY CONBIPEDSINGLE LIMIT (Es eccidean : $ • ANY AUTO BODILY INJURY (Per person) $ • ALL OWNED AUTOS BODILY LtVJURr Per scc9dant) $ • SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ • HIRED AUTOS • NON-OWNED ED ALrTOS ❑ • UMBRE..LALUAB Q OCCUR • EXCESS U43 • CLAIMS -MADE $ EACHOCCURlR AGGREGATE $ r•{ DEDUCTIBLE 1 1 RETENTION $ 3 $ WORKERS COMPENSATION AND EMPLOY6trLIABLITY Y / N N 1 A WC STAYU- r I—I TORY Uta$TS I^I ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXEOJ1 VE OFRCERI EMBER BLO-UDE7? C EL. DISEASE- EAEMPLOYEE $ (Mandatory In NH) It es. describe uncle It OF OPERATIONS-baba EL DI SEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach AC OROIOM, A4ditIonat Romaine Solndtde, Walton *Pm lsTINtI ed) CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES 10050 NE 2AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATNSt DATE THEREOF, NOTICE POLL BE DELAY ACCORDANCE WITH TFE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009f09) QF 011188-2009 ACORD CORPORATION. Alt riffs reserved. The ACORD name and logo are rimed marks of ACORD Miami Shores Village Building Department 10050 N.E.2nd Avenue 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) acknowled a that a new swimming pool, spa or hot tub will be constructed or installed at /.5c '�`` / 1! 5r® Miami Shores, FL, and hereby affirm that one of the following methods will 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 comp lies 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). A combination of non - dwelling walls and fences (screen enclosure, child fence, masonry fence walls, chain Zink or wood fence, etc.) will protect t he pool perimeter. The plans must specify t he 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 consid red as committing a misdemeanor f the second degree, punishable as provided in Section 775. .2 or Section 775. ;3 .S . This for 1 m st be signed by the ownerlagent and the prime contractor; CONTRACTOR'S SIGNATURE AND DATE C S Y ‘ c w ' c l - ? s ) 6 t wk_` CONT CTOR'S NAIVE (PLEASE PRINT) TARP PUBLI r111114��'' JOHN D. LA ROSSA PO' ��� °Lei s .. Notary Public - State of Ftorlda S' .o:� My Comm. Expires Sep 2, 2014 ;f;ilit: Commission 0 EE 22854 ■ 1 R'S SIGNATURE I -62c1 /t OWL'S NAME (P D DATE l,V SE PRINT) I NOTARY PUBLIC t ?'� Notary Public - State of Florida I u �= My Comm. Expires Sep 2, 2014 4 IA ;� Commission N EE 22854 JOHN D. LA ROSSA Miami Shores Viiiage Building Department 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 is /are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: l,c( —33/62- ( Address: /5o r l 1 r s , ,A4 f ovIAA 5 sl CC�'/'I• Whereas, the undersigned owner(s) 1 desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows: 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 install 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 a a ice of said Vilfa e then in effect. OWNER SING & PRINT I Hereby Certify that on this day personally appeared before me '(`c(1 f VY 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 AND SUBSCRIBED before me on this day of t� 20 (Revised 05/2209 OTARY PUBLI STATE OF FLORIDA "'��� " "'• JOHN D. LA ROSSA Notary Public - State of Florida d My Comm. Expires Sep 2, 2014 C .,��°�,c ommission # EE 22854 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION Date 6 "- L/ c0/ C Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as , e 1 6c.�° c, y_ �- �l a Pay_ i , located at 11 5.1' In accordance with Section 33- 12(f), 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 Xt e pool. Note: This certification is to be submitted with a swimming pool permit application in duplicate. Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT d PERMIT #: &PI v 'DATE: %1.L- GR/71 fit--. “Irc� Contractor o Owner o Architect Picked up 2 sets of plans and (other) H (� 11 Address: 1 5D t\-C- \' 1 1/4.-7 From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Departme , t to contin e permitting process. 04w (Acknowledged by: PERMIT CLERK INITIAL: }e-.54--- RESUBMITTED DATE: O� PERMIT CLERK INITIAL: Permit No: 10 -2051 Job Name: November 29, 2010 Miami Shores Village Building Department Building Critique Sheet 1) Plans must be approved by HRS for the septic system. 2) Corrections for plumbing must be completed. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. i° '7° SO Job Name PLUMBING CRITIQUE SHEET a C)1 sloes 1k6k - �• ,� 4— (5- Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit NO. BPP -11 -10 -2051 Issue Date: Not Issued Expires:NOt Issued Folio Number:1121360040120 Owner's Name: HEIDI CARR Job Address: 150 111 Street Miami Shores, FL Owner's Phone: Total Square Feet: 1015 Total Job Valuation: $ 16,500.00 Contractor(s) B &K CONTRACTOR SERVICES INC Phone (305)989 -2363 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 11/22/2010 : Yes Comments: Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 11 Inspection Number: INSP - 153444 Permit Number: PL -11 -10 -2053 Scheduled Inspection Date: June 15, 2011 Inspector: Hernandez, Rafael Owner: CARR, HEIDI Job Address: 150 NE 111 Street Miami Shores, FL Project <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1121360040120 Contractor: HL SERVICE & REPAIR INC Phone: (786)210 -8072 Building Department Comments POOL PIPING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 14, 2011 For Inspections please call: (305)762 -4949 Page 1 of 23 OVV43 1 Building Department °1i `� -�1�r1 ��)�� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 V ' •"''''... INSPECTION'S PHONE NUMBER: (305) 762.4949 Miami Shores Village BUILDING Permit No. d I PERMIT APPLICATION Master Permit No. W ) 9 °2C 1 FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): M 2 t k CL V Phone #: 3o 7� l �7 Address: / As rb City: A. k cd e -e- S State: I Zip: 3 ? S I Tenant/Lessee Name: Phone #: Email: s JOB ADDRESS: / 50 ``U L / 1/ . -fr i z City: Miami Shores County: Folio/Parcel #: ' ( r6 ( 0 0 Lid, o l a. Is the Building Historically Designated: Yes Miami Dade Zip: '3 3 % NO Flood Zone: CONTRACTOR: Company Name: /i L � tt v`v,i t / ' N (KC: Phone#: Address: / T7SOs "i° (S C0'f rv,i. o City: ,. ikek v1/4 ,--k State: // Zip: 3� Qualifier Name: c_ �----%- Phone #: '76, v . 1t) 307 Q State Certification or Registration #: C.. l 3 i\ 60 55'6, Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: d ti Value of Work for this Permit: $ /1 1 0 Om Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration � ew DRepair/Replace Description of Work: kc� ? DDemolition Submittal Fee $ Permit Fee $ 2) 57 ..! CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ r j iii TOTAL FEE NOW DUE $ 1 O 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 fi st inspection which occurs seven (7) s after the building permit is issued. In the absence of such posted notice, the inspectiorv;11 not be approved and a reinspectisie will be charged. Owner or Agen The foregoing instrument was acknowledged before me this 3 The foregoing instrument was acknowledge before me this day of/tJl3Y , 20 I0, by '‘6 _\ (c`O v , day of Ai) V , 20 Lel, by % ' 2' , Contractor who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: who is personally known to me or who has produced Sign: Print: My Commission 1 axe * * * ** * * ** 41.*** `''01�a�''••, JOHN D. LA ROSSA ft s. Notary Public - State of Florida J My Comm. Expires Sep 2, 2014 Commission # EE 22854 APPROVED BY `( CZ /Y06lans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: t: My C F. ‘"1" "' JOHN 0. LA ROSSA s • NO t: =Notary Public - State of Florida .4 My Comm. Expires Sep 2, 2014 Commission # EE 22854 0011, Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. /COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. OPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: C..--e 11 ° e a BUSINESS ADDRESS: / 9 7 50 s J L 0 �� `fit°, CITY t I 1/ 4 i 2 , STATE F l& ZIP CODE BUSINESS PHONE: (7 ) 7 ' FAX NUMBER ( ) CELL PHONE ( ) QUALIFIER'S NAME: C OV ,(, (—Cr QUALIFIER'S LIC NUMBER: -S C C Q 6 I1 (5 s -��co E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV / RV 3126109 MLDV MIAMI -DADS COUI TAX COLL TOR 140 W. FL ELI: 1st FLOOR, MIAMI, FLE,. 3130 F1RST- cL.ASS' U:S POStAGE PA,D MIAMI, ;FL PERMIT 44o. 640476 -8 BUSINESS NAME / LOCATION. HL SERVICE & REPAIR 14750 SW 66, TERR 33193 UNIN DA COUNTY, THIS NOT A BILL - DO NOT PAY, EEtEWAL RECEIPT 6 rI INC STATE# SCG131150556 OWNER HL SERVI.C1 & Sec. Type of Business I6IS IS A L P N BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS Is NOT A CERTIFICATION OF THE HOLDER'S QUAUFICA- TIONS. PAYMENT RECEIVED MIAMI -DADS COUNTY TAX COLLECTOR: 08/02/201# 090100500: 000075:01'' SEE OTHER SIDE REPAIR T DO NOT FORWARD HL SERVICE & REPAIR INC HECTOR LOPEZ 14750 SW 66 TERR MIAMI FL 33193 1,,11,,,11, „,111, „„ti, „1„1„ .11,1,1,11„,ftt ti� ®Q ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 07 -30 -2010 EFFECTIVE DATE: 07/30/2010 EXPIRATION DATE: 07/29/2012 PERSON: LOPEZ HECTOR M FEIN: 204272964 BUSINESS NAME AND ADDRESS: HL SERVICE & REPAIR INC 14750 SW 66 TERR MIAMI FL 33193 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED SPECIALTY CONTRACTOR 2- POOL PIPING IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 11/15/2010 MON 17:03 FAX 2002/003 14J.�.. .UYL'•PA''.+- '{:'s.''h. \l:. Cy1i!:ifnJ'S' }`re :�}N ':_J \Si "nz':S�yi }= iii£°}::L ) 1' Y$+? l?}: �L} i.` �# iY' i ..'t:{Jk'•+s.•'v{�i:Ti..{°J.R? jiY'itt�.. y:::i. :t %• - �L:i,tr:�"M. }r, ]SF�/Ti1.,4'Yl. •• ;�(k - .Y~ }. . J. from• ,11 •At:• .vvC} to -' S 'rrI -: r•: '...," + r. fly # Win• .+ . t: -- 'r' A 1,. . :i 11 /15/10 :. � 5. A.� J gyp/ v .r'-0 } "3 it•Y.,�.'ht +,3r:i' "0--n- 00- ix �,ht ISSUE DATE '} >i'.6 -i+>. .sti'. �A- 14 }ibvi!•'}... .. +r. }y} iY1�v, ^,.,n�,t,_� .w.. .r -: <i ��E: Yl��h Y.S:iviS�}vh''r'•,v,: ..'i:�;i`v' ir-- "_h>_h};- :v�-'•+/GS{�:'..., .G PRODUCER G. & E. GONZALEZ INSURANCE 9880 SOUTH WEST 40TH ST MIAMI, FL 33165 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY LETTER A Underwriters at Lloyd's, of London INSURED HECTOR LOPEZ HL SERVICE & REPAIR INC 14750 SOUTHWEST 66 TERRACE MIAMI, FL 33193 COMPANY LETTER B COMPANY LETTER C COMPANY LETTER D COMPANY LETTER E T.� -+ :4•i . ""4-.1W e}.A+•. _:+4' :: i^ r:l.,K l 'f: +. tb .. AY1T��.x^' l�:%i •i,YJtY,4•it%�?= \'+ :.Y \v:i C'r:�t�133Ji:::ii t� :K4.y.`S} tiv :t:l�C�^U� /'�:r ^:',4+�jj'� •J!i,'.+i�y �'}:lS�Y'�ft��tYi,:y .-� .•?f . �.}:', va`•'{?.'• t: �; X1=; S�:. y+: t!\ � .'M`.-.'%4'l:J. }swSrw:w!`};}4t; r'.�.,.%"v,.., tv }.fir: . %lefr'•• }'.. '� `42 °�'^: " �'�t- C�}.?Kt�i2:.•?'it:•`',�17: �5-'.?fJ�1' .. J�+1:�+�fiTr •6 �[��'`i�TC: :r - r C \}{, h .h' ..{hX s:6:\ t l ^'S< "Ylf\Yiy, • , �}yl! q'h• Y+. < f°l. ,� Z Srv, vi ti ?"�ij�viiSyi i''�}°,., %�:b:J/S^!-in�,Xi��..f i\ ,!iv>^t"y_;�• Nw�� ; -;{•�. -fir ,�•j .'i..+Ir .. Z >: •vliA`+ft�'CJ.+�. �r+ S' '�.:�f:Cv�t�:.43�- 'vY,{e.[S,$.J 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS A GENERAL LIABILITY AMTE005734 September 23, 2010 September 23, 2011 GENERAL AGGREGATE $600,1130 PRODUCT&COM /OPAGG. 300,000 PERSONAL &ADV. INJURY 300,000 EACH OCCURRENCE 300.000 DAMAGE TO PREMISES RENTED 50,000 MEO. EXPENSE (Any one person} 5.000 AUTOMOBILE LIABILITY COMBINED SINGLE LOW BODILY INJURY (Per Person) BODILY INJURY per Accident) PROPERTY DAMAGE EXCESS LIABLITY EACH ONCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT DISrcASEPOLICY UMrr DISEASE-EACH THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER. DESORPTION OF OPERATIONS / VEHICLES / SPECIALTY SI(IMMING POOLS INSTALLATION, SURPLUS LINES INSURERS' APPROVED BY ANY FLORIDA ITEMS SERVICING OR REPAIR, PLUMBING POLICY RATES AND REGULATORY AGENCY. VQ-w:-- W!'o t3& vty J} r i . x }.: , . ,,•., . r��,JK . . Should any of the above described expiration date, the company shall endeavor notice to the certificate holder named notice shall impose no obligation or company, its agents, or representatives. FORMS ARE .. r - • .k,E .V. �J .. a" ` , • NOT �4 + . --tv • t. :-. : the written mail such upon the • 0 $ v ££.N C • � :.�.,,1' -r - " % % . n�i-:SX:.,0i'M ..:} si. § {t:. :Y. HAL 1 AVE /0'- won1/ .3xc MIAMI SHORES VILLAGE 10050 NORTHEAST 2ND MIAMI SHORES FL 33138 eanntlePI vr : 7'.z^f947 policies be cancelled before to mall 30 days to the left, but failure to liability of any kind AUTHORIZED REPRESENTATIVE VIRGINIA C. PHILLIPS SURPLUS LINES AGENT, 13577 FEATHERSOUND DR., •, PO O BOX BOX 1 7069 CLEARWATER, FL 33762 •: 7' .711 e Mfi l o- E .42W ffiga N/ /.r Inspection Number: I NS P- 153443 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL y,r� Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: EL -11 -10 -2052 Scheduled Inspection Date: July 05, 2011 Inspector: Devaney, Michael Owner: CARR, HEIDI Job Address: 150 NE 111 Street Miami Shores, FL Project: <NONE> Contractor: FLORIDA POWER CONNECTION CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1121360040120 Phone: (786)299 -7372 Building Department Comments SWIMMING POOL LIGHT, BONDING EQUIPMENT TIMER PUMP & TRANSFORMER Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments leoei-i 2 cY// July 01, 2011 For Inspections please call: (305)762 -4949 Page 4 of 32 0` it 0-11 1A Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. IO 2-057 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder). Address: 1 5- 0 1"1: / S ( City: AA CC\ VW\ \ 6V -S S l C C VY Master Permit No. Phone# State: pl 3' i 64-s"7-7/62a7 zip: S 3 % 6 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 1 -C O `° i ( S r ° City: Miami Shores Folio/Parcel #: 1 1 1 `� D Oak Is the Building Historically Designated: Yes CONTRACTOR: Company Name. kir Address: City: Qualifier N 4) eisL) I f&, County: NO � QPQQ Miami Dade Zip: 3 3) 6 ) State: State Certification or Registration #: Flood Zone: Phone#?d 0 oD q /372 2 a7 /a/7 Contact Phone #: 7'c99 7 Email Addres Zip: Phone#: Certificate of Competency #: etar "AI ill DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 13 r Square/Linear Footage of Work: Type of Work: Address ❑Alteration Description of Work: b \ y'v ' v\N- Miami - C ❑Repair/Replace ,r ODemoljtion CA-/ * * * * * * * ********** **** *** ***** * * *** * * * ** Fees************* ** *** ***** * * * * * * ** *** ** * * * * **** Submittal Fee $ Permit Fee $ 5''®' Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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. 1 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 v' 'xceeding $25'r S, applicant must promise in good faith that a copy of the notice of commencement and construction lien brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded noti . o commencement must be posted at the job site for the firs inspection which occurs seven (7) s after the building permit is i i d. In the absence o such po . ted notice, the inspectioi\ 11 not be approves nd a reinspects e will be charged. 4 L Signature Owner or Agent The foregoing instrument was acknowledged before me this 3 day of I Ut) d , 201 , by / £ l _ who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: - Signature Sign: Print: My Commission Expires: kJSSA . .,i State of Florida My Comm Expnes Sep 2, 201 o,s Commission # EE 22854,. Contractor The foregoing instrument was acknowledged before me this day of AJr V , 20 / 0, by 53CLAA (j,-- who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY )°i10-%'kv'K1 ns Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Sign: Prirttf – - M4 '��" '•n Expii3OHN D.LAROSSA Notary Public - State of Florida My Comm. Expires Sep 2, 2014 Commission • C stop # EE 22884 14************************)********* Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. / COPY OF QUALIFIER'S STATE LIC CARD B. V COPY OF LOCAL BUSINESS TAX RECEIPT C. OPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: F l C9 V i (Aa pctp 1A) c2 .V L A Yt 6 �Nk n►r p BUSINESS ADDRESS: 4 3 5 / ` 6 ` \'Q . CITY AA., ) CAL ¥'Lt STATE F i ZIP CODE 33 1 BUSINESS PHONE: (78G) ' ),9 i 1 3 /a FAX NUMBER ( ) CELL PHONE ( ) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: C ( 0 1 E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV / RV 3126109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 MENDEZ, JUAN M FLORIDA POWER CONNECTION CORP 660 E 60 ST HIALEAH FL 33013 Congratulations! With this license you-be-come one of the neei'iy one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and loam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487 -1395 DETACH HERE MIAMI DADE,COUNTY TAX COLLECTOR` 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2010 LOCAL BUSINESS TAX RECEIPT . 2011 MIAMI -DADE COUNTY - -STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A ART: 9 THIS IS NOT A BILL - DO NOT PAY 541902 -3 RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 5658 FLORIDA POWER CONNECTION CORP. STATE* EC13001217 4155 SW 116 AVE 33165 UNIN DADE COUNTY OWNER FLORIDA POWER CONNECTION CORP Sec. Type of Business WORKER /S 1 nas6A faCTRICAL CONTRACTOR a *SINESS TAX RECEIPT. IT MS NOT PERMIT THE ipLbER TO VIOLATE ANY 0 REGULATORY OR ONMNG LAWS OF THE OESOR ES NOR IT EXEMCITIPT . THE OLDER FROM ANY OTHER ED . YRLAW. THIS is 40T A CERTIFICATION OF R#E HOLDER'S OUALIFICA- CONS. 'AYMENT RECEIVED L LECTTOOE COUNTY TAX 09/09/2010 09010055001 000075.00 SEE OTHER SIDE DO NOT FORWARD FLORIDA POWER CONNECTION CORP JOSE GONZALEZ PRES 4155 SW 116 AVE MIAMI FL 33165 11tIIllIII3I 111TH\% U1IjII 11 1111I11II }t*t1111i1AI1111111i7t A CERTIFICATE OF LIABILITY INSURANCE DA 11/0910 PRODUCER First Insurance Group 10967 SW 40 St Miami, FL 33165 Phone (305)221 -7878 Fax (305)554-7090 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLIC OR ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED FLORIDA POWER CONNECTION 4155 SW 118 Ave Miami, FL 33165- INSURER A: AMERICAN VEHICLE INSURANCE INSURER B: SUA INSURANCE COMPANY INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDIYY) POLICY EXPIRATION DATE (MM/DD/YY) 08/07/11 LIMITS EACH OCCURRENCE 1,000,000 A d GENERAL V COMMERCIAL ❑ . ❑ LIABILITY GENERAL LIABILITY CLAIMS MADE ❑OCCUR GL- 0504002347 -01 08/07/10 DAMAGE TO RENTED PREMISES (Ea occurence) 50,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 ❑ PRODUCTS - COMP /0P AGG 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY II PROJECT ❑ LOC ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY ❑ OCCUR • CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? Y If yes, describe under SPECIAL PROVISIONS below AUK) 33416 08/13/10 08/13/11 ❑ TORY LIMITS ❑ ER E.L. EACH ACCIDENT 100,000 E.L. DISEASE - EA EMPLOYEE 500,000 E.L. DISEASE - POLICY LIMIT 100,000 OTHER DESCRIPTION OF ELECTRICAL WORK NS / LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL P III Sr f �oR �C� GROUP 10967 Bird Rd Miami, FL 33165 305.221, 7878 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES FLORIDA 33138 ACORD 25 (2001/08) QF T SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPO NO 08 ., GATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS • + R.` E NTATIVES. In ©AC �� ' •'� T • RATION 1988 4\,/ 1 AUTHORIZED REPRESENTATIVE