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BPP-10-877Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 143649 Scheduled Inspection Date: November 16, 2011 Inspector: Bruhn, Norman Owner: JONES, WILLIAM Permit Number: BPP -5 -10 -877 Job Address: 379 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: BLUE WATER POOLS OF SOUTH FLORIDA Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132060136130 Phone: (305)634 -0956 Building Department Comments POOL Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments (7c November 15, 2011 For Inspections please call: (305)762 -4949 Page 1 of 43 Inspection Number: INSP- 166546 Permit Number: BPP -5 -10 -877 J Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Date: November 10, 2011 Inspector: Dacquisto, David Owner: JONES, WILLIAM Job Address: 379 NE 94 Street Miami Shores, FL Project <NONE> Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Survey Final Work Classification: New Phone Number Parcel Number 1132060136130 Contractor: BLUE WATER POOLS OF SOUTH FLORIDA Phone: (305)634 -0958 Building Department Comments POOL Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments FRANK - 305 -634 -0956 November 10, 2011 For Inspections please call: (305)762 -4949 Page 1 of 1 2011 -07 -27 13:13 BLUE WATER POOLS 305 - 634 -0957 a> 1 800 685 7530 El Of4Y2-4 A- iii . Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FI. 33138 Gentlemen: BLUE WATER POOLS Of sou II-1 FLORIDA " building your backyard paradise " July 25, 2011 Re: William Jones Permits 379 N.E. 94"' Street Miami Shores, Florida P2/2 We respectfully request an extension of the pool permits for Blue Water Pools of So. Fl. on the above property, due to the fact that the house in question is still under construction and not ready for final inspections. These are the permits that we extensions on: FV /GA Building: Electrical: Plumbing: Mechanical: BPP -10 -877 EL -10 -878 PL -5 -10 -879 MC -5 -10 -882 Thank you for your cooperation in this matter. SWIMMING POOL„ CONTRACTORS & CONSULTANTS 4811 NW 32 Avenue, Miami, FL 33142 Telephone 305 - 634 -0956 Fax 305 - 634 -0957 E -Mail: bluewaterpools@msn.com 2011 -07 -27 13:13 BLUE WATER POOLS 305 -634 -0957» 1 800 685 7530 To: ARLENE as- Fax: ":„3,5f056-8972 Phone: 305 - 762 -4858 BLUE WATER POOLS or SOUTIiFLORIDA " building your backyard paradise " Fax Re: William Jones' Permits From: FRANK VAZQUF-Z Ph: 305- 634 -0956 Date: July 25, 2011 Pages: 2 Dear Arlene: Attached please find a letter requesting property located at 379 NE 94th Street ready for final inspections. Please feel free to call my office if you additional information. Sincerely, Frank Vazquez Blue Water Pools of So. FI. an extension of the pool permits for the which is still under construction and not have any questions or if you require any SWIMMING POOL CONTRACTORS & CONSUI TANTS 4811 NW 32 Avenue, Miami, FL 33142 Telephone 305 - 634 -0956 Fax 305 -634 -0957 E -Mail. bluewaterpools@msn.com P 112 2011 -04-25 12;23 BLUE WATER POOLS 305 -634 -0957» 1 800 685 7530 BLUE WATER POOLS or SOUTH Fl ORMMA " building your backyard paradise " April 25, 2011 Miami Shores Village Building Department 10050 NE 2"° Avenue Miami Shores, FI. 33138 Re: William Jones Permits 379 N.E. 941` Street Miami Shores, Florida Gentlemen: k Pr;� n - J :1 !SG' APR 2 5 201-i" We respectfully request an extension of the permits for Blue Water Pools of So. FI. on the above property, due to the fact that the house in question is still under construction, and is not ready for final inspections. These are the permits that we extensions on: Building: BP P-10-877 Electrical: EL -10 -878 Plumbing: PL -5 -10 -879 Mechanical: MC -5- 10-882 FV /GA Thank you for your cooperation in this matter. P 2/2 2011 -04 -25 12 ;23 BLUE WATER POOLS 305- 634 -0957» 1 800 685 7530 BLUE WATER POOLS 01- SOUTH rLoRon " building your backyard paradise " Fax To: ARLENE From: FRANK VAZQUEZ Fax: 350 - 756 -8972 Ph: 305 -634 -0956 Phone: 305 - 762 -4858 Date: April 25, 2011 Re: William Jones' Permits Pages: 2 Dear Arlene: In compliance with our phone conversation with your office, attached is my letter requesting an extension of our permits on the Jones property which is still under Construction and not ready for final inspections. Please feel free to call my office if you have any questions or if you require any additional information. Sincerely, Frank Vazquez Blue Water Pools of So. Fl. SWIMMING POOL CONTRACTORS & CONSULTANTS 4811 NW 35tAve. Miami, FL 33142 Tel: 305 - 834-0966 1 Few: 3fR-634.0957 P 1/2 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 379 NE 94 Street Miami Shores, FL Owner Information Parcel Number PPROV Expiration: 03/16/2011 Applicant WILLIAM JONES Address 1132060136130 Block: Lot: 379 NE 94 Street MIAMI SHORES FL 33138 -2842 WILLIAM JONES Phone Cell Contractor(s) Phone BLUE WATER POOLS OF SOUTH FLO (305)634 -0958 Cell Phone Valuation: Total Sq Feet: $ 29,000.00 584 1 Approved: No Comments: PLEASE VERIFY LOCATION OF DRIVEWAY ON PLAN TO SHOW THAT AFTER POOL IS CONSTR Date Approved: : No Date Denied: 5/18/2010 Type of Work: Swimming Pool Additional Info: NEW POOL & SPA Classification: Residential Occupancy: Private Bond Retum : Scanning: 5 Fees Due Bond Type - Contractors Bond CCF Education Surcharge Permit Fee Plan Review Fee (Engineer) Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $300.00 $17.40 $5.80 $870.00 $60.00 $15.00 $150.00 ($150.00) $23.20 $1,291.40 Pay Date Pay Type Invoice # BPP -5 -10 -37918 05/17/2010 Check #: 711 09/23/2010 Check #: 7300 Bond #: 1989 Amt Paid Amt Due $ 150.00 $ 1,141.40 $ 1,141.40 $ 0.00 Available Inspections: Inspection Type: Fence Final Pool Deck Wall Steel 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. September 23, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 23, 2010 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 --� Permit No.1W l V O �� Master Permit No. BUILDING PERMIT APPLICATION FBC 2004 MAY 1 7 2010 -2� Permit Type (circle): uildin Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) W I t i tel- rti, 1-0>-40 Phone # g 2-4 Owner's Address \k ci `i ‘r City WA. /1-vvt l 'qi, a -0-c State 1 - Tenant/Lessee Name Zip 351 Phone # Job Address (where the work is being done) 2,--k° \ ®L.' c, City Miami Shores Village County Miami -Dade Zip S 2> 1 FOLIO / PARCEL # l 1 ° 2-v (49 " 0 d -,C,, i 3 v Is Building Historically Designated YES ✓ NO Contractor's Company Name 1- U901.1-64- Was 6 C �, %L.44 Phone # (-3 Contractor's Address t 1 1--V tkj, City v4 s) 4 - c,ci;S'te State fit. Qualifier Name (1-0-c-10 (L:- V kett oo -L State Certificate or Registration No. (..,A Zip `I '2 Phone # C� L' s) l 6 - 2_6o Certificate of Competency No. Architect/Engineer's Name (if applicable) i�� VC-lam Phone # ^ �� Value of Work For this Permit $ 'i . 'd Square / Linear Footage Of Work: ?bol i ceq 142 LH• R"--. Type of Work: yp ['Addition 0Alteration QNew ❑ Repair/Replace 0 Demolition Describe Work: ikt� . t co [ � S'ir� �i �.. ` V° 4rz-.1_ lC 4sCs,Pr. * * * * * * ** * ** * **** * * * * * * * * ** * * * ******** Fees * * * *, ************* ** ***,r****** *x **** * **** * ** Submittal Fee $ 1 C2 -��0 Permit Fee $ j CCF $ Notary $ " �%Tli1ining/Education Fee $ Scanning $ Radon $ DPBR $ CO /CC Technology Fee $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -+ 1191.40 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged The foregoing instrument was acknowledged before me this Z" day of 141* 20 10 , by 4, 11, f 16My I' 1P-t who personally kno '' to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Contractor The foregoing instrument was acknowledged before me this et day of 20 L? , by itfek=( me or who has produced as identification and who did take an oath. NOTARY PUBLIC: "°7r.,,.. Frank Vazquez 5iY.`C►� Print °�'' a�`COMM1SS10N #DD740340, ` ; • Po,,,° rani 'r. �� '�. . Print � t�o mN # DD740340 >`� s °ETIRES:DEC.09 2011 My Commission Expires: ® °:; e1;° � ylyy�ygpRONNOTARV.�m My Commission Expu �, `dgf WIRES: DEC. 09, 2011 ®'% is o'' WVYW.AARONNOTARLcom + 4+ E4 9c*aY******** *Ar& aYah9r*aTnY**aY**** alcaciY4eak$ riFar*$, F, h******* aYatr, 4******* akaFvY*aYa' e**** *9e4r**** *4 *aYa' e9c& dc*aFaFitaYacdc4c*ak $tYaF4raka4at *aY*RczY** APPLICATION APPROVED BY: `-.7°" (9 Plans Examiner Engineer Zoning (Revised 02/08106) STATE OF FLORIDA ° DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL .32399-0783 MILLBRAE°, RAFAEL AURELI0 BLUE WATER POOL S OF SOUTH FLORIDA INC 13771 N GARDEN COVE CIRCLE DAVIE FL 33327 . . . . , Congratulations! With this license you becorne one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from • boxers to barbecue restaurants, and they keep Florida's economy strong. Every day we work to Improve the way we do business In order to serve you better.. For Information about our senrices, please log onto wvivanifloridaticanse.cont. There you can find more information about our divisions an the regulations that : impact you subscribe to department newsletters and learn more about the Departments initiatives. Our mission at the Department Is: license Efficiently., Regulate Fairly. We constantly stiive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! •• • •• .!2 DETACH HERE SEP /23/2010/TRU 10:51 AM FAX No. a4cr CERTIFICATE OF LIABILITY INSURANCE P.001 DATE IEEIIW) 09/23/10 PRODUCER Pree m Maumee UIBMWrftrg 4308 SW 74th Ct. Mini, FL 3315 Phase (°$ 7404400 Fax (305)740 -4460 THIS CERTIFICATE ES ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS COMFICATE DOES NOT AMEND, EXTEND OR ALTER THE .CI RAGS AFFORDED SY THE PQ UCH BELOW. INSUmRSAFFORDING COVERAGE NAIL INSURED BLUE WATER POOLS OF SOUTH FLORIDA, INC, 4011 NW 35 Ave, Mian1t, FL 33142 - 306-634 -0056 INSURER k CATLIN SPECIALTY INSURANCE CO. iNturteR IN ASCENDANT INSURANCE CO. INSURER C: INSURER D COVERAGES INSURER B THE POLICIES OF INSURANCE LISTED HAVE MEN ISSUED TO THE INSURED NAMED ABOVE FOR E POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER D0CLIMENT WIITi RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED Ream Is EU:U CT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LISTS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. 021M- A TYPE OF SIBURANCB POW, EFFECTIVE POLICY EXPUIATION ISAIDIMAIYin _ POLICY GENERAL LINIU1 RI COHID RCIAL GENERAL LIABILITY • ❑ CtAD.% MADE ® OCCUR 0 1000 BUFD DED x901300119 05/22!2011 EACH OCCURRENCE 1,000,000 � F RENTED �l 100.000 NED E�IP (AI 1 per=en) 5,000 ■ PERSONAL &ADV INJURY 1,000,000 0 GENERAL MIN NEGATE 2 000,000 - GEN'L AGGREGATE MET APPLES PER: III POLICY O PROJECT ❑ I.WO PRODUCTS - COMPJOPAGG 1,000,000 r- ..�___• H uABILIIY HANY AVM ALL OWNED AUTOS ❑ 60HEDULED AUrQ3 ❑ MIRED AUTOS COMBINED SINGLE LIMIT (Ea moelee BODILY INJURY (2®r pawn) BODILY MIRY (Per ,ti ■ NON OWNED AUTOS 0 PROPERTY DAMAGE (Per In Q GARAGE UABIUTY • ANY AUTO _ AUTO ONLY- EA ACCIDENT OTHEIA THAN FAAOo ❑ AUTO ONLY: AOG mass U BRELLALIAIEIU Y OCCUR 1111 MAIMS MADE CI DEOUCT)BLE ❑ RETENTION 8 EACH OCCURRENCE AGGREGATE II - B WORKERS, COMPINSATION AND EEP1 OYERTO LIABILITY YA1 ANY PROPRIETOR / PARTNER E EXERUTh1E OFFICER 1 diEMBE3t EXCLUDE)? Y ryrresigen wECIAL P .OM ti ONS .. -. t; WC- 60417 -1 09/23/2010 09/29/2011 ©WC ATE+ ■ I • t JGRueers EL EACH ACCIDENT , 100,000 EL DISEASE - EA EMPLOYEE 100,000 500,000 EL o18EAR • PORKY LIMlr WHIM f INCLUSIONS ADM SY ENDOW I SPEDIAL PROYISIONS DESLRiIPTLDN of OPERAT1ON5 I LOCATIONS 1 V!NI0L!S POOL CONTRACTORS ER 1FL ATE HOLDER CANCEILA11ON CITY OF MIAMI SHORE 10050 NE 2Nb AVENUE MIAMI SHORES , FL 33138 ACORD 26 (2009!01) OFF -- - S HGULD ANY OF TiiE AEROVE DESCRIBED POLICIES SE GANSRLLED III3POREWHE EXPIRATION DATE THERIOT, TILE MANG ExsuRER WLL ENDEAVOR To =IL 30 DAYS WRITTEN NOT10ETO THE CERTTICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DQ SO SHALL IMPOSE NO OSLO:UMON 03 UABL].TTY OF ANY KM UPON THE MUM, ITS AGENTS OR REPNESENTATMS. MITHORMED FIEPRESENTAIIVE ISIDRO GUILLAMA FIRST-CLASS. ::. •: MS. POSTAGE : PAID. 4.1 MARE, FL: • PERMIT NO. 231 • . * . - . • . : • THIS 18 NOT A - NOT PAY ...410,01041 „ fit.. * , • • ' • epe1:4p6451. 142 2-9 . • • INC • • • IISMUMNWOW Q.:. LAWS Op. TM COUVric'eft. Mk& NO QOM', r1-• AlltitioPT .11411 .11tOulAtiv liTHER • WORKER/S 4 DO NOT FORWARD BLUE WATER POOLS or SOUTH FLORIDA INC FRANK VAZQUEZ 4H11 NW 35 AVE MIAMI FL 33142 . • • 26 Lith.,11...thilmisiot Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: EPP— l 0 DATE: CO I —1 ht) Contractor ❑ Owner ❑ Architect Picked up 2 sets of plans and (other) f Address: Y ?el 1\1 k- `7`� 5-7 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 Department to continue permitting process. Acknowledged by. PERMIT CLERK INITIAL: J RESUBMITTED DATE: G 10 PERMIT CLERK INITIAL: . NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. 11— 32 — 015 — fvP`30 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. CFN 2010R0647631 OR 8k 27431 Ps 1860: Ups) RECORDED 09/23/2010 11:45:17 HARVEY . RUVIN, CLERK OF COURT i1IAIII —DADE COUNTY, FLORIDA LAST PAGE 1. Legal description of property and street/address: Lop «i is, 14-046-1-119X0 PL* 111441-1 SG-fv1teS 51- reo 1 P 1' ')o of. n rttsCm:ar.r 2. Description of improvement: I40W Pot,/ Sew 4.4w Ofil(L tit 3. Owner(s) name and address: Lt1t Cl 1 t l+Uj `O' 311 "it ' ( ft. r. IM 1 r9wi 1 S t `331 38 -interest in property: Name and address of fee simple titleholder. 4. Contractor's name and address: 131146 Wt . Pcv(g o S, rZN WttW ,t 1 F(. '7i°311c2 4gtt h[w 3,1— -Ave' . 5. Surety: (Payment bond required by owner from contractor, if at3yy►1*g o OK O0u Name and address: HEREBtuy,, y „ , Amount of bond $ ��+B +ne/ le�� 6. Lender's name and address: =- .►`.�i1 HARV 7. Persons within the state of Florida designated by Owner uporfi provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 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)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is pecifie. iI / A /o , Si n: ure o iwner /a® W" . Print Owner's Name J. l I t Rim Or■fe6 Sworn to and subscribed before me this Ve49 day of Notary Public Print Notary's Name —My commission expires: 123.01 -52 PAGE 4 W02 , 20 '10.. 1:. Suez Prepared by Address: aaataurhi � ��n� . - q,gift f' 4O34 3 iDpiRES:t3EC. os, 2011 8 BlitA(o F'ermit No: 10 -877 Job Name: August 9, 2010 Miami Shores Village Building Department Building Critique Sheet 2nd 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Provide a permit to bury electrical line. 2) Provide a fence permit for new wood fence. Fence can only be 5' high maximum. Page 1 of 1 Plan : eview is not complete, when all items above are corrected, we will do a complete plan rt. iew. If any sheets are voided, remove them from the plans and replace with new revised sheets and in, 'ude one set of voided sheets in the re- submittal drawings. 'or. nan Bruhn CBO 30 :795 -2204 Permit No: 10 -877 Job Name: August 9, 2010 Miami Shores Village Building Department Building Critique Sheet 2nd 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Provide a permit to bury electrical line. 2) Provide a fence permit for new wood fence. Fence can only be 5' high maximum. 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 Permit No: 10 -877 Job Name: May 28, 2010 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Plans must be approved by HRS for the septic system. `i2) Provide a permit to bury electrical line. 3) Provide receipt from Miami Dade planning and Zoning for impact fees. 4) Corrections for plumbing and zoning must be completed. At) Provide details for the bbq area shown on plans. 7Provide a signed pool safety act form Provide an owner acknowledgment certification. Provide restrictive covenant of pool enclosure. tee) Provide a fence permit for new wood fence. Fence can only be 5' high maximum. 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 Planning and Zo Crib Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit NO. BPP -5 -10 -877 T, Poois/Whlrl ®� +. Ct Tubs Work Classification: New Expires Not Issued Issue Date: Not Issued Folio Number:1132060136130 Owner's Name: WILLIAM JONES Job Address: 379 94 Street Miami Shores, FL Owner's Phone: Total Square Feet: 584 Total Job Valuation: $ 29,000.00 Contractor(s) Phone BLUE WATER POOLS OF SOUTH FLORIDA (305)634 -0958 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 5/18/2010 Comments: PLEASE VERIFY LOCATION OF DRIVEWAY ON PLAN TO SHOW THAT AFTER POOL IS CONSTRUCTED THERE IS STILL ROOM TO PARK 2 CARS 3(S C C15-} 1 Permit NO. BPP -5 -10 -877 issue Date: Not Issued 05/28/2010 16:22 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES ICJ 0 01 see TX REPORT $sa TRANSMISSION OK TX /RI NO 0109 RECIPIENT ADDRESS 93056340957 DESTINATION ID ST. TIME TIME USE PAGES SENT RESULT 05/28 16:22 00'33 2 OK Planning and Zoning Criteria Miami Shores Village 10050 N.E 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)7588972 Expires:Not Issued Folio Number :1132060136130 Owner's Name: WILLIAM JONES Job Address: 379 94 Street Miami Shores, FL Owner's Phone: Total Square Feet: 584 Total Job Valuation: $ 29,000.00 Contractor(s) BLUE WATER POOLS OF SOUTH FLORIDA (305)634-0958 Phone Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 5/18/2010 Comments: PLEASE VERIFY LOCATION OF DRIVEWAY ON PLAN TO SHOW THAT AFTER POOL IS CONSTRUCTED THERE IS STILL ROOM TO PARK 2 CARS 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 Issue Date: Not Is Permit NO. BPP -5 -10 -877 P It typo PO Trip of ubs "f` i'C New „ sued Expires:NOt I ued Folio Number:1132060136130 Owner's Name: WILLIAM JONES Job Address: 379 94 Street Miami Shores, FL Owner's Phone: Total Square Feet: 584 Total Job Valuation: $ 29,000.00 Contractor(s) Phone BLUE WATER POOLS OF SOUTH FLORIDA (305)634 -0958 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 5/18/2010 Comments: PLEASE VERIFY LOCATION OF DRIVEWAY ON PLAN TO SHOW THAT AFTER POOL IS CONSTRUCTED THERE IS STILL ROOM TO PARK 2 CARS 8/4/10 6 FOOT FENCE IS NOT PERMITTED AND IS NOT APPROVED AS PART OF THIS PERMIT. 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 Expires: N Permit NO. BPP -5 -10 -877 nit T Pe 1po' w, Issue Date: Not Is sued Folio Number:1132O6O13613O Owner's Name: WILLIAM JONES Job Address: 379 94 Street Miami Shores, FL Owner's Phone: Total Square Feet: 584 Total Job Valuation: $ 29,000.00 Contractor(s) BLUE WATER POOLS OF SOUTH FLORIDA Phone (305)634 -0958 Primary Contractor Yes 1 Planning and Zoning Criteria and Comments Approved: No Date Denied: 5/18/2010 Comments: PLEASE VERIFY LOCATION OF DRIVEWAY ON PLAN TO SHOW THAT AFTER POOL IS CONSTRUCTED THERE IS STILL ROOM TO PARK 2 CARS g Pool, Spa or not Tub Saktf Act Nonce of ts AUG 042 E ( we ) K ,.:, : ,,,:. Ace a w po , . o r t b u t t b e or '15 9.F s r a n d ter alarm Mat one of the following methods , 1 i e used to meet the requirements of Rondo Sri Gaper Sts, and Raffia MOW Code Seam 242.2 10 mesa #rem the s) to be used for your pool or spa- • The pool will be equipped wait an approved sang* pool cover that compties with ASTM F1346 -91. (Submit Manufacbser specifications) A removable Old banter (rater we end that shall be retarroabbt utibout the aide of MO) hi compliance wit SC424.17 will meted the pool p (Submit A , ems) eat Prated the Palmate'. The Plans r speciy lire type and batten of aB non:dream A continoldon of peclection which inomporadas dweging web yeah openbegs tiles the ?rte perimeter and onwpWing with FOC Secdon 424.21.7.8.9 (2): AB dooreinal windows porlding direct accesstutbe poc must be equipped with se defie and std teath4oching meedembel devices intlefled a roldamon of 54* awe the ihneteld. (Submit spedOcadoris for awned) . A cognation of ! the perimeter and J/ contplying with g C Section 424.2.12.19 (1): AV cis and tubeless movidsig &sect access to Vie pool shall be equipped wit an eta Vann emptying matt la. 2017. in acasrdance with the Rondo Meng Cods, a tip tropectbon of t poet guest tvO not tie appeared wahout mamba= with piisate Swimming Pool SAW iteoMentents, and upon meat= of ate permit, Ote pad slug he plesumed to he unsafe - I understand that not having one of Vie tialeie miens installed wM sonstilate a violation of Cnapter 515, P.S. . and WS be a mistimemir of the second degree, malshabla as toravidsd in Smart 7751 or Sean 775.083 F.S. This form must be signed by the cannerlagtsl and gm pdme cantractor. Omer/Agent Printed •O of Weida of Code arat delta or me Ws, %t< ibry of le petsonalW v ��V1Lt v Prime Conhoctor Pitted name, 'Ws and &le Y24-64 f61 as ,�aV.7: Go o Frank W a- : _COMMISSION #DD740340 $� 4. EXPIRES: DEC. 09, 2011 of Roritto aud t me tarts 2' tier cdigiva-U 2 2Q 1 rrran�k" Va K 3rttiticaitt+n. ino111104411t4k. 'c31" t*11!r � EXPIRES: DEC. 09,2i 4,„Ni vernYAARON NOTARY, ISSION #DD740 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION Date (2cc fZ-o(c Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as tUt I t , located at ?! 0j167 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 constricted 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 the pool. Note: This certification is to be submitted with a swimming pool permit application in duplicate. 71ligua Vows tiur49e 't efutatmear 10050 NE 2nd Ave Miami Shores, Fl 33138 Phone 305.795 -2204; Fax 305-756-8972 www.miamishoresvillage.com SWIMMING POOL OWNER'S CERTIFICATION DATE 5'I `31'1° MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT ATTENTION: BUILDING OFFICIAL I certify that I am the legal owner of the property located at: ?(sr In accordance with Section 33 -12(0, 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 a 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 an approved barrier prior to final inspection and use of the pool. Legal Owner Note: This certification is to be submitted with a swimming pool permit application in duplicate. Mufti Vow Vamp '& efortemear 10050 NE 2nd Ave Miami Shores, Fl 33138 Phone 305-795-2204; Fax 305-756-8972 www.miamishoresvillage.com NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at '11 6 i Miami Shores, FL, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues. Please initial the method(s) to be used: The pool will be isolated from access from the home by an enclosure that meets the pool barrier requirements of Florida Statute 515.29; The pool will be equipped with an approved safety cover that complies with ASTM F1346 -91; All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that has a minimum sound pressure rating of 85 decibels at 10 feet; All doors providing direct access from the home to the pool will be equipped with self - closing, self - latching devices with release mechanisms placed no lower than 54" above the floor or deck; I understand that not having one of the above installed at the time of final inspection, or when pool is completed for contract purposes, will constitute a violation of Chapter 515, F.S. and will be considered as committing a misdemeanor of the second degree, punishable by fines up to $500 and/or up to 60 days in jail as established in Chapter 775, F.S. CONTRACTOR'S SIGNATURE AND DATE tg(4 ;M:I61.40 CONTRACTOR'S NAME (PLEASE PRINT) ........... Frank Vazquez NO R .c,��COMMI sSioN # D0740340 - 1 Irwz1. lot WW W,AARONNOTARY.ccm t, %✓ 741/v R'S SIG'' 17d AND DATE OWNER'S NAME (PLEASE PRINT) s,.00viiitt, Frank Vazquez ° comissON 0074.D.a4n NO GF RES :DEC. 09, 2011 ono%• WWW.AARONNDTARY.com AUG 0 4 2010 Miami Shores Village 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 WW f ` r r GA-I • is /are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: th Address: 7 -M der l r sr 1/114141 Whereas, the undersigned owner(s) 11,1( 1 ,J 0A[t5 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 declares) 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 accordance of said Village then in effect. OWNER SING & PRINT I H reby Certify at this day personally appeared before me (Pi l i ! (TQ "(S and has produced ID # 14/24,4/4/44( ' ,k 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 2(D day of (Revised 05/2209 120 ( ice! r "rr� Frank Vazquez • °"?nyaCOMMISSION #DD740340 EXPIRES: DEC. 09, 2011 ' 1 ▪ ° tilltAVANNNOTANcom OF FLORIDA Redd/EOM Stekenen- g Pock Spa or Hot Tub Safety Act Nettee ts b() % that a new swloariwg pod, spa, es hot tub viit be constaxted or installed St (.4/� / Z d and of the wM to used to meet the requirements of &side SAM Ostler us, add Reefs latfitting Cade Swam 242.2. PieSse What the metted(s) to be used for your pool or ma. - The Pool will be etwipped With an approved safely pool caw that F1346 -91. (Submit AUG 0 4 2010 Manufaciseer specrmations) A removable chld bidder Nth me end that slue be ternevatie value the aide of hats) ln eseetlance with FIC424.17 wit pent lice A condoination of thon-at .) wa protect die peihnoter. he gem reues the A combination of and complying with PK 5018040 .1.9 (2). tO the pool must be equipped web emit men aral sad' tateibloching veedembel devices testated a adnamen of 54" above the s fiehasil which htemseavites dwegas nets opudngs lido the tool perimeter and complying tkith FRC Secthers 424.2.17.1.9 (1): M Axes and windows psovittes Coact amass to the pool Atall be equipped nth an est dam complying h tt. 21n7. (Sadzialt t In accordance vdth the fledtht Meg Mb, a awl bearecean of t pacra PrWate Swimming Peel Safety denneemeivis, and Ism expleattan oft the try 1 understand that not having one of the a Chapter 515, F .S., and wUI be a ndsmaniesnor of as pasitided in Section 775.082 at Sege 775.083 F.S. 'Tits dorm must be byte tesserfaaad awl the prime ° belie day /465 whe Is <=;42;2;izzz:> j Pdd1 LI as Slate of nada Swan Comb! ef Dade sad fie t dal► at bliA4 (4(2Q tc7 Ifrid �� . (s -fi) ,_ _ who s personalty Knom.._- asp. ,"_ t t BLUE WATER POOLS OF SOUTH FLORIDA "Building your backyard paradise..." September 10, 2010 VIA FAX (305-756 -8972) City of Miami Shores 10050 NE 2nd Avenue Miami Shores, Florida 33138 Attn: Permit Department Re: Pool permit Address: 379 NW 94th Street Miami Shores, FL 33138 TO WHOM IT MAY CONCERN: With regard to process #BPP10 -877, please note that all "Comments" have been addressed. Attached to the resubmitted plan you now have are the signed pool safety act form, the owner acknowledgement certification, and the restrictive covenant enclosure form. As you can see, the plans have been approved by I-IRS. With regard to the barbeque area, these have been eliminated from the plan. Pursuant to the Miami Dade Planning and Zoning Department, pools do not require impact fees. In addition to the above, please note that a fence Permit has been Issued (Permit #: FW- 8- 10- 1522), as well as an electrical, Permit to burn the electrical Dower line (Permit #: EL -8 -10- 1431). The homeowner is anxious to start. Please advise as soon as possible when the approved jag.pj permit can be picked up. 1 can be reached at: Office: 305- 634 -0956 Cell: 305 -218 -9260 Your immediate attention to this matter will be greatly appreciated. Sincerely, BLUE WATER POOLS OF SO. FL. FV /ga Bv: rank Vazque nt 4811 -4821 NW 3e Ave., Miami, FL 33142 — Ph: 305 -634 -0956 - Cell: 305- 218 -9260 ZIBLUE WATER POOLS OF SOUTH FLORIDA " building your backyard paradise " SWIMMING POOL CONTRACTORS & CONSULTANTS 4811 NW 35th Ave. Miami, FL 33142 Tel 305 - 6340956 / Fax 305- 634 -0957 Fax re: Permit Department From Luz Gil fame 305/756 -8972 Pages: 1 pages Pty Date: 9/10/2010 Re: PERMIT # BPP10 -877 cc To whom it may concern: Please find attached a letter requesting the Pool Permit approval for the below address. 379 NW 94th Street Miami shores, FL 33138 Thank you, Luz M Gil 08/10/2010 11:48 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES IN o1 * ** TX REPORT * ** TRANSMISSION OK TX /RX NO 0409 RECIPIENT ADDRESS 93056340957 DESTINATION ID ST. TIME 08/10 11:48 TIME USE 00'16 PAGES SENT 1 RESULT OK Permit No: 10 -877 Job Name: August 9, 2010 Miami Shores Village Building Department Building Critique Sheet 2nd 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Provide a permit to bury electrical line. 2) Provide a fence permit for new wood fence. Fence can only be 5' high maximum. Page 1 of 1 Plan . eview is not complete, when all items above are corrected, we will do a complete plan rt. 'iew. If any sheets are voided, remove them from the plans and replace with new revised sheets and in, •ude one set of voided sheets in the re- submittal drawings. 1or.nan Bruhn CBO 30 :795 -2204 Mc: 3 -(03q -0157 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 143730 Permit Number: PL -5 -10 -879 Scheduled Inspection Date: August 10, 2011 Inspector: Hernandez, Rafael Owner: JONES, WILLIAM Job Address: 379 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: BLUE WATER POOLS OF SOUTH FLORIDA Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1132060136130 Phone: (305)634 -0958 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 August 09, 2011 For Inspections please call: (305)762 -4949 Page 2 of 29 t a Miami Shores Village preaeomons5 Building Department toy 7 2010 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) Owner's Address 7 dls qtf si , it; j0\iI� Permit No. ¶ u 0-55-1 Cl Master Permit No. Phone # (509 S`77 - GNU , City 1 awls Sdvat, State et._ Zip 331 3S Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) 31i d& 1q41- City Miami Shores Village County Miami -Dade Zip `�(3S' FOLIO / PARCEL # 11- 3Z-' I30 Is Building Historically Designated YES NO Contractor's Company Name vi Ekt (414-1611, POOLS ©r s e Ft 4,4 Contractor's Address kfit 4W 3 Phone # (Stns) City Wt t State Zip 33 1 Z Qualifier Name CifFprel rrsil& Th-L Phone# (c') af'6-1Z-C- 0 State Certificate or Registration No. (tit (L$ (AEI Certificate of Competency No. E -MAIL: M rued` - PtV ei . R-4-. Architect/Engineer's Name (if applicable) 1.44;:,-74 Pmt FF 'YL- Phone # `78C ° 2 S S -.2 L(5' S Value of Work For this Permit $ fop Type of Work: ['Addition ❑Alteration Describe Work: PCbt'i a-f Square / Linear Footage Of Work: 14 L - . f7evkz� (ew ❑ Repair /Replace ❑ Demolition xxxxx*xxxxxxxscxx** ***do 4c*******ww** *xx**Feesxxxuxx '''* xxrx zxxxxx** akxx ux * * * wa:** kaex it* e Submittal Fee $ Permit Fee $ Notary $ Training /Education Fee $ Scanning $ Radon $ DPBR $ Bond $ Code Enforcement $ CCF $ CO /CC Technology Fee $. Zoning $ Double Fee $ Structural Review. $ Total Fee Now Due $ a`/?) . See Reverse side 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: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or The foregoing instrument was acknowledged before me this day of,20 to , by Cti4IInvil 4116-5 who is ersonally known-t me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: t + �3�� P IDEWION# DD740340 P "UMW: DEC. 09, 2011 a WWWA411014NOTAIttetth My Commission Expires :'�� xxxxxxxxxxxx xxxxxxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxx &aY * *se *xxx*r***** 4eaY8e, tx, hxk*#, 4,}xdex****Se9eir***** ******** F***** &x Signature Contractor The foregoing instrument was acknowledged before me this c( "4- day of 1-'itiZ 20 10 , by i'liffird 4410204,..) i204,..) who personally kn .T° . me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Si Print: My Commission 7 EXPIRES; DEC. 09, 2011 June WWW.AARONNOTARYcom APPLICATION APPROVED BY: 0,0/42 �- if— ic; (Revised 02 /08/06) e - 471 ra Plans Examiner Engineer Zoning Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ?erznit No. tw f' — Job Name PLUMBING CRITIQUE SHEET f 9 Afeel 4'4 /14 "69 (57-ASit Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 164411 Permit Number: EL -5 -10 -878 Scheduled Inspection Date: September 15, 2011 Inspector: Devaney, Michael Owner: JONES, WILLIAM Job Address: 379 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1132060136130 Phone: 305/556 -5759 Building Department Comments NEW POOL ELECTRIC Passed 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- 164281. CREATED AS REINSPECTION FOR INSP- 143729. Pump needs a G. F. I. breaker. Pump needs F.F.I. protection. Alarms are O. K.. ,CX September 14, 2011 For Inspections please call: (305)762 -4949 Page 16 of 16 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 APPLICATION FBC 20 Permit Type: ELECTRICAL 111/1h Ai MAY1 "14111 BY:...... Permit No. 'E L 1 0 —Si (� Master Permit No. 6PP i ( —i—] Owner's Name ee Simple Titleholder p b (F P ) V�"i, t111411/1 J -7.7 Phone # C3" g `1 7 - 2. 1 ,ti (- Owner's Address e ``31 v$ E- 14 Sl - City i,M 'i cv» ` s i ✓U 4 State FL Tenant/Lessee Name Email Zip Job Address (where the work is being done) Phone # City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # i 1 32.-06 -- 0(3 130 Is Building Historically Designated YES NO _ _r ��p 2e� Contractor's Company Name F , .� 1 v240,- ^Z l��cr -ICW�j "-Phone # Contractor's Address 12.4 tp 1 e.ST R Flood Zone Cs, 51.5i City 1-10 1.4ke'kt tk El cAl2. -CS State Zip 0l E. Qualifier Name f 21 i iC iSC (1/l4 ,.L . Phone # C ;t, ,) State Certificate or Registration No. Certificate of Competency No. Contact Phone 1k, 5- 2 i eD E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ f `ia eo Square / Linear Footage Of Work: J Type of Work: ['Addition ['Alteration [ Tew ❑ Repair/Re lace p ❑Demolition Describe Work: ?4Gw `ter \ CLL.-sr-1-0.A C_ ******** * ** * * * * * * * * * * * * * * ** * * * * * * * * * *** Fees************* * * * ** * * * * * * * * ** * * ** * * *** * * * * * ** Submittal Fee $ Permit Fee $ -7 ®'„ ' '6 A CF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: `� Structural Review. $ Total Fee Now Due $ See Reverse side - 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re- inspection fee will be charged. Signature Signature -` ontractor The foregoin: instrument was acknowledged before me this 11° The foregoing instrument was acknowledged before me this /1 day of 1d1kV , 20 0, by .u)1 qcp46:2-3 - who i day of i"t 1 1 , 20 i 0 , by F121gafclscc a! i oi4CZ , me or who has produced who i As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: °r'o - Frank Vazquez - � ' j lvs4.. .. My Commission Expires: 1601,61EC. 09, 2011 ,AAR0NN0TAR`tcom , , F4t :Y4t9e*4Y****,k9r9:,Yd:dt** k3a*** **** APPROVED BY c o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 1 Sign ra , Print: �;.•• nn . =rank Vazquez k� _ �, r D740310 My CommissiofZ r T =`� � `e won, �•''' WWW ONNOTARYtam ****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** j0'ite Y16 Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Zoning Clerk checked 1 MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. tit FLOOR MIAMI. FL 33130 LOCAL BUSINESS TAX RECEIPT c"l.i: MMAM1 DADS COUNTY - STATE OF FLORA _ U.S �L T1ji EXPIRES SEPT- 30.3010 p,Ia,1 USTBE DISPLAYED AT PLACE OF BUSWES 5 MIAMI, FL °ET TO COUNTY CODE CHAPTER SA - AR?t e E S PIERMIT NO.; RENEWAL RECEIPT NO. 577853 -6 STATE* EC13002779 553806 -2 BUSINESS NAME / LOCATION JIMENEZ F ELECTRICAL CONTRACTOR INC 9002 BIRD RD 33165 UNIN DADE COUNTY OWNER F JIMENEZ ELEC CONTRACTOR INC Sec. Type of Business 416, ELECTRICAL CONTRACTOR E$S TAY RECEIPT. IT NOT P€fiA T THE TO VIOLATE ANY REGULATORY OR LAWS OP THE I OUNTY OR CITIES- OR 1 IT EXEMPT HNE + ou ER mom ANY ER OTH ERlNT OR_ LICENSE REOUIREO EY LAW TNIS 15 T A CERTIFICATION OF 1 ROLDEWS OUALTFICA- kPAYMENT RECEIVED IMAM DADS COUNTY Tax 'W.LECTOR; 07/30/2009 60010000910 000075.00 SEE OTHER SIDE WORKERIS 1 DO NOT FORWARD JIMENEZ F ELECTRICAL CONTRACTOR INC FRANCISCO JIMENEZ PRES 12401 W OKEECHOBEE RD APT 419 HIALEAH GARDENS FL 33018 IITIIIITill ifllllllllilllllll, ifllTTOIiIIIiTiT ,I,IIiII�T�T?Itt STATE OF • FLORIDA DEPARTOENT OF BUSINESS AND PROFESSIONAL REGtULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 TALLAHASSEE AHASS E NROE STREET 2399 -0783 BLUE WATER POOLS OF SOUTH FLORIDA, INC. 4811 MIAMI FL 33142. • Congratulations! With this license you become one of the nears oneRegulation. million Floridians licensed by the Deperhnent of Business and t4 a brokers, Our professionals and businesses range from architects boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the wary we do Witness in order to Serve you bier: Fa< information about our services, pig tog onto war, orldalieertse.corn. There you can find more to i'nf�a newsletters ur divisions s more about the that impact you, sub department 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! DETACH HERE `- F' 4,;tii •igQ: ear r 3° ry L ' • apy s ALFJC sync STATE OF FLORIDA o rAP ?MeNT or riNANCIAL. SERVICES DIVISION or WORKERS' COITION * * r RTDIgATE OF =Cr= TO Iii WSW FROM FLORIDA MEOW COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that th* Individual Mad Introit has etoctel to De exempt from Florida Workers Compensation law. GIMP FTC. OFFICER 041,184008 EFFECTIVE DATE; FERSOnt FEU* 10/23 /1008 EXPIRATION DATE: 10/2312011 'JIMENEZ FRANCISCO 0817113534 BUSINESS NAME AND ADDRESS: F JIMENEZ ELECTRICAL cammunme INC 12401 W 41cEEQmsEE ROAD LOT 410 HIALEAH GARDENS FL 90o1n SCOPES OF BUSINESS OR TRADE: 1- CERT Info E CTRYCAL !.'ON?RACTO notilfTANT: Purlieu to those 445. osttO, r.S., au ottkot of s wreaths who elects aawposo* IWO mi. mopne h 110a0 • *miffed% et RtetWOat NEW . Ra *1 Ttti044f Mete et eat# S ode the d-p° Noma to t e4p.0bf15L F.S.. Centimes at efeeitea re be Reaps.._ ep I Y foe ew o of tho Oeofsaso or trade Wed es tie e.tfse et Omen to hN es I* Psrae. to CIap'er *oehlca. FS„ lte3r os el Weaker 3s he mete eat wtefnvstto of als3Noa to ho some *ail be ubf.S le rrrevslos fl, a ray taw idea Of fNop 0 ate wither or 1M loaesaci of Os cereals. the Peas 0 Hamel RP the Wks e1 certgftete Ra Iaeaer owes co aeositeners of dais sego for istetete et i e 3eete. Tie tepsii*eiK ♦0111 FUYJN o ettmisut a ssy 11121 f0r ft7U[0 Of OM With Used AN ON w efeete to ewe fid tapiramvo[e et 010 ware. MAssuitili tIe0} 413 -1e05 DTWC -252 CERT WICATE OF ELECTLDI TO BE USTI DUMB D9 -08 RI.IAS! CUT NOT THE CARO BELOW AND RETAIN FOR FUTURE REFERENCE grapatORIDA CP Y �� WEEMl10ATR OP TO WI MIMI fittal FLORIDA WORKERS' IXIIIIPENSATIONLAW EFFECTIVE 10123/20031 EXPIWWA'KIRI RATE: 10/23/2011 PEFtsON fRANNI5C4 aII1E16rZ FF..ft OBIT 18'1104 BUSINESS NAME AND ADDHE35 F MENU Q.ECTRICAI. CONTRACTOR 0M altos W oltet0408EE ROAD 1.01 419 *Moat CAROM, FL 331)10 6ccWE OF BliSi ESS OR TRADE ammo ELECTRte s easTeAcTo IMPORTANT e roman to Chapter 444.06(14), F4, an officer of • oerpanniot who O eteCts exemption trans SIN 3 i*,r by fllg3g a certificate of elution tinter tdia wean maq net recover Refits or coetote►tsation wirier this I) chanter. Pursuost to Mow 441).06(1 2), F.9., Certificates of election to ha exempt-. of ele1ptklt within eX L of the laciness el Vedas tinted on c the I pta'siunt to auger 4410603), F= .L, Malian of &&wart to be exempt wad certificates of election t0 ha aslsf0t shalt he Object to remotion if. et any tlm, eftrt the ffiety, of the nuftrs a tht (MOO of the certificate the porMs n*MC on tlm Rate or mortified. no Iat00r men the rOquhooloo s of ifiiw section for imam of u eertificxte. lbw dettertneht Shen ttv k 0 coaliti*11 at any tote for failure of the person wood on to cert(ftcsto to Inset the rogU t manta of this Section. ammo Wei 413 -1609 CUT FERE a Carry bottom portion On the job, keep upper portion for your recorlde. 3WC -222 CERTIFICATE OF ELECTION! TO SE EXEMPT REVISED 09 -Qt • t'e /t•e 3S'Cd 11400 101313 Z3N3WIC LLZ@ 2.B C Be:tef 60t3Zet50 /0T etc-aft& • CERTIFICATE OF LIABILITY INSURANCE PRODUCER (305) 470-8500 FAX: (305) 470-0111 Dopes° and Assoolates 3900 NW 79th Ave Suite 700 Miami INSURED ' Jimenez ileotrioal Contractor Inc 12401 W Okeechobee RD Lot 419 FL 33166 Hialeah 1 VERAGES FL 33010 5 DAT@ ombDIYYYY) 9/16/2009 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 TILL COVERAGE AFFORDED EY THE POLICIES BEI-Ow. 1 . ----- . __ ... .....-____ . . .-....... . INSURERS AFFORDING COVERAGE I NAM 9 INSURER A Charter Oak Fire insurance Co 25615 INSURER 131..._ . INSURER C: #44-1-1Rg311 INSURER El 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCY NUMBER Y EFFECTIVE I UDY PIRA ..... . . ....._ . —.. UNITS ,_ . ,__ _ . . . ... —.. _ . . ....-.-.. . ..... ---. . - • • . ----- • ..---. "--- " - -- ' iiiiiiil ADD' •t V i GENERAL UABIUTT 1 X COMMERCIAL GENERAI.J.IABILITY A 1 1 C LAOIS MADE X 1 OCCUR 60»4318N413 I I GERI AGGREGATE LIMIT APPLIES PER: ' X I POLICY '117 LOC AUT0111151311.6 LIABILITY I ANY AUTO A ALL °MED AUTOS I SCHEDULED AUTOS I HIRED AUTOS NON-0111iNED AUTOS GARAGE uABILirr ANY AUTO ' Exams, UMBRELLA uABILITY I . OCCUR 1 CLAIMS MADE DEDUCTIBLE RETENTION S 9/10/2009 1 AAA 9/10/2010 EACH OCCURRENCE &WWI TO AtferPc — PREMES (Ea =Wren* ..q.ED EXe (As sna PFmr) pgRSONAL fk. NW. INJURy. . $ _ .. 1.2 00 0 AR 0 GENERAL AGGREGATE _. $ _ 2 , ply) , op gl ..pRoDuqs-Dots101, Asp . s . . . ,2 ,. goo , 009 .j,oqpoOO, ,199,,000 - 5,990 00NNNED SINGLE OMIT (Es accident) EMILY INJURY (Per won) • BODILY INJURY (Fel accident) PROPER! V DAMAGE (Pr acident) 6 WORKERS COMPENSATION AND msFLoYERs. LIABILITY YIN ANY PROPRIETORiPARTNERIVEGUTP/d OFFICER/MUM EXCLUDED? (Mandates/ In PI) li ye desate under pRovisIONS OTHER DESCRIPTION OF opErtATIoNsi LocATioNSIVEMCIXS/ EXCLUSIONS AIMED BY ENDORSEMENT SPF-DIAL PROVISIONS Faeictrician — CERTIFIC TE H , City of Miami Shores Mimi Shores, F1, 33138 10052 itTE 2nd Avenue ACORD 26 (2009/01) IN5025 (200'0 TO/TO 3DVd CANCELLATION SHOULD ANY OF THE/180PS DESCRIBED FOUCIES DEcANcELLED BEFORE ME EsPIRATION DATE THEREOF, TIM ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE OfiRTNICATE HOLDER MIMEO TO THE LES', OUT FAILURE TO 00 80 SHALL Gem NO =LIGATION GN LLAmuTy Oi ANY HIND UPON THE INSURER ITS AGENTS OR AUTO ONLY ACCIDENI OTHER THAN g..?Icc. .3 .. AUTO ONLY: AGO $ . AGH CICCURRENcE AGGREGATE ...$ _••• .• _ 5 •4 •• $ 1WItYi M1 ls. t. ADDIDENT, E.L. DISEASE - EA EMPLOYE:13.P .. I E.L. DISEASE POUCY Limn- s AUTHORIzfic REPRESSNTAIWE claim) 1988-2609 ACORD CORPORATION. All rights resolved. The ACORD name and logo are registered marks of ACORD _LNCO 10313 Z3N3AlIf J LLZOGVEGOE IT:IT OTOZ/VO/GO STATE OF FLORIDA DEPARTI4ENT OF BUSINESS AND PROFESSIONAL REGULATION 'ELECTRICAL CONTRACTORS LICENSING ,BOARD (850) 487 -1J95 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 • JIMENEZ., FRANCISCO F JIMENEZ ELECTRICAL CONTRACTOR INC' 12401 WEST •OKEECHOBEE ROAD # 419 HIALEAH GARDENS FL'33018 Congratulations! With this license you become one of the nearly 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.cam. There you Can find more information about our divisions and the regulations that impact you. subscribe to department newsletters and learn 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 licensel DETACH HERE 'N' •OF: BUSINESS ',OW: . Es sIs .: EGULATION' 30, '9 ,` 0 13a01: }8 078175097 ,+ • nra, . P ED E E EIC : ONTRCAOR ; r t t o- 5- h•.a i ate, CM o:;o• IF. • ,'iER'�` 2,, .• D:,vniLbs tad - E�;r rt 4 �: � •>a i'4 =• 9c 4110',3•1f. •.2010 •LQ886C4 00.6W , a; ;a :'$ti`s w' g ! ' `!;ON • SEQ#z,0ea6 0000.4 r ;ta t t.Urr3L .{ an � 1 TG/I0 39'd ;$ AAi r ita�atevt��'E'fa sL•� INO0 10313 Z3N3WIf d LLZ05ZB50E 66:01 0102 /EZ /Z0 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162724 Permit Number: MC -5 -10 -882 Scheduled Inspection Date: August 08, 2011 Inspector: Perez, JanPierre Owner: JONES, WILLIAM Job Address: 379 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: BLUE WATER POOLS OF SOUTH FLORIDA Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Pool Heater Phone Number Parcel Number 1132060136130 Phone: (305)634 -0958 Building Department Comments HEAT PUMP FOR POOL Passed 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- 143771. August 05, 2011 For Inspections please call: (305)762 -4949 Page 25 of 37 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 143771 Scheduled Inspection Date: August 03, 2011 Inspector: Perez, JanPierre Owner: JONES, WILLIAM (y thiLav Permit Number: MC -5 -10 -882 Job Address: 379 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: BLUE WATER POOLS OF SOUTH FLORIDA Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Pool Heater Phone Number Parcel Number 1132060136130 Phone: (305)634 -0958 Building Department Comments HEAT PUMP FOR POOL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 02, 2011 For Inspections please call: (305)762 -4949 Page 1 of 47 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 03/16/2011 Applicant 379 NE 94 Street Miami Shores, FL 1132060136130 Block: Lot: WILLIAM JONES 1 Owner Information Address Phone CeII WILLIAM JONES 379 NE 94 Street MIAMI SHORES FL 33138 -2842 Contractor(s) Phone CeII Phone BLUE WATER POOLS OF SOUTH FLC (305)634 -0958 Valuation: Total Sq Feet: $ 3,500.00 128 1 Tons: Additional Info: HEAT PUMP FOR POOL Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: MECHANICAL Fees Due CCF Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $0.80 $122.50 $3.00 $3.20 $131.90 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -5-10 -37925 05/18/2010 Check #: 7111 $ 50.00 $ 81.90 09/23/2010 Check #: 7300 $ 81.90 $ 0.00 Available Inspections: Inspection Type: Final 1 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. September 23, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 23, 2010 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) Owner's Address City VL%214'rW Tenant/Lessee Name E -MAIL: (Val ',-Z c' � a State Zip 33 't MAY 172010 iY: Permit No. rn Ci 0 - Master Permit No. Phone # ) Si 7 - 1S- Phone # Job Address (where the work is being done) L'1 City Miami Shores Village i e 't-t<Jd FOLIO / PARCEL # d - `Z ( ° County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name F3r11-2 i; °e T v� � ,rte fir.= 6 „ Phone # i�3 °�.� ``i ° �✓ �i to Contractor's Address ` it 4L 3 City Y;i t e h State .- Qualifier Name {iI State Certificate or Registration No. %CV E -MAIL: 4. c4..c - . F t'3 6 c 'n Architect/Engineer's Name (if applicable) IL V.44 c7ES t Phone # `l Zip r4 Phone # '� 2 (C2 Certificate of Competency No. Value of Work For this Permit $ 35t"' Square / Linear Footage Of Work: Type of Work: ['Addition ❑Alteration ErNew Describe Work: �tA ke / " i' t L ' c c'1 ❑ Repair /Replace Pei VI l S fA- • ❑ Demolition xx xxxxx xx xxxxxxxx xrx xxx* ac **xlc**xxicxxx Fee s *xxxxxxxxxxx xxxrxxxxxx x ***war xw xxxxx xx xxxxx Submittal Fee Permit Fee $ -)4, CCF $ Notary $ - Training /Education Fee $ Scanning $ Radon $ DPBR $ Bond $ Code Enforcement $ Structural Review. $ Technology Fee $ Double Fee $ CO /CC Zoning $ Total Fee Now Due $ See Reverse side -* Bonding Company's Name (if applicable) 1 ' Bonding Company's Address City State " _ Zip �:r Mortgage Lender's Name (if applicable) 1li Mortgage Lender's Address ^ r �, City Stoic V �'° 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 first inspection which occurs seven (7) days after the building permit is issued ln- the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or' The foregoing instrument was acknowledged before me this day of m' , 20 pQ, by UJ�1di ° who ersoniUy known t` me or who has produced • As identification and who did take an oath. NOTARY PUBLIC: L. Sign: �; a.• „� e.,i Frank Vazquez Si_.`�%�0W IA. :o. -.'' .. COMMISSION #DD7403 •. rank Vazquez • Print:' . 1�tia �� .ap .. Print: ;�: e''�°..0 «... sr My Commission Expires: �' n a;�:o`re WWW ONNOTARY.com My Commission E - x 2011 09 ********** **xxxx*x**** ***xxxx******xxxx* x****x dxxrxYdxx4**ww**,sx i 9Yl 2# NIcxxm x xxxxxx APPLICATION APPROVED BY: I D Plans Examiner Engineer Zoning Signature Contractor The foregoing instrument was acknowledged before me this Li fik day of , 20 n , by eiciffrliel i i6.14 o me or who has produced as identification and who did take an oath. NOTARY PUBLIC'} erson (Revised•02 /08 /06)