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BPP-11-507Permit Number: BPP -3 -11 -507 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 167213 Inspection Date: November 30, 2011 Inspector: Dacquisto, David Owner: WIESE, HEISE Job Address: 149 NW 93 Street Miami Shores, FL 33150- Project: <NONE> Contractor: DOLPHIN POOLS & SPAS INC Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Survey Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330850 Phone: (954)927 -6537 Building Department Comments NEW IN- GROUND SPA .0475, ..09f/ Inspector Comments Passed pin / 1:. -(( Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 November 30, 2011 Page 1 of 1 BOUNDARY SURVEY WPP FND 1,2" IP NO ID WEST 1/2 LOT 17 0.3' BLOCK 133 15' ALLEY OVERHEAD UTIUTY UNE 9'ASPHALTALLEY LEGEND 0 FOUND 1/2" IRON ROD - FOUND 1/2" IRON PIPE - FOUND DRILLHOLE o - FOUND NAIL AND DISC - WATER METER ABBREVIATIONS: NC - AIR CONDITIONER SLAB rL - CENTER LINE CB - CONCRETE BLOCK CONC. - CONCRETE F - FOUND IR - IRON ROD IP - IRON PIPE M - MEASURED P - PLAT NO ID - NO IDENTIFICATION RN/ - RIGHT -OF -WAY TYP. - TYPICAL FND 112° IP O ID 0.3' 0.2' 0 0 PALM PALM TREE TREE ALUM. SHED; 10.8' z z z LOT 18 tV N N00 °00'00 "E ON PL -Iii ii■ ■ ■iii INGROUND ■nnn�;ma�!!aa!lm�aa!!!1 SPA Aanna ■ nn ■/ 4aaU■■r•i CONC TILE DECK aa�1 I 4a.u■nu•' ui•!■ ■iii■iill LiiiiiuNi' wiii■iiifiiatiiii mini naaannn ..... rrrrrarori NMI NUM ■■uri'lnnaanai ■m.Y ■ ■■i■iri pj maullauuaaa ■i r mail lanaamin� •ini11E•• ■i.uu 26.7' 10.71' N N 0 O 0 O 37.8' 10.44' Y PALM CO Et 0 0 TREE col k NO ID e FND DRILL HOLE NO ID 10.71' 0.7' E r'.JCCT LOT 19 ,,Trvvrt, 1911 0.75' N90 °00'00 "E - 75.497 ,11 ColvFlTrex NOM N iami Shores Village 225.00' °TREE 75' RIGHT OF WAY -19' PAVE NW93STREE A.E'ROVED =HNG DEPT BLDG DEPT CO COMPLIANCE \M fP-1 ALL FEDERAL T7tTE AND vr.;17N iT r(Ut S AND REGULATIONS ACE FLOOD & /NSPECTIONS LB #7699 PROFESSIONAL SURVEYORS AND MAPPERS 4801 HOLLYWOOD BLVD., SUITE C HOLLYWOOD, FLORIDA 33020 PHONE: 954-924-1808 FAX: 954-924-1809 acefloodanclinspections@yahoo.com THIS SURVEY IS PREPARED FOR THE EXCLUSIVE USE AND BENEFIT OF THE PARTIES LISTED HEREON. LIABILITY TO ANY THIRD PARTIES MAY NOT BE TRANSFERRED OR ASSIGNED DESCRIPTION: DATE BY REVISION: ADDED DECK SPA & WALK UP FRONT 10120/2011 TLM REVISION: DATE IN FIELD: 01/182011 FIELD BOOK DIGITAL FILE DRAWN BY TLM DATE DRAWN: 01/21/2011 CHECKED BY: TLM JOB NUMBER S382 -DC11 20 0 10 20 (IN FEET) 1 INCHES = 20 FT. SHEET 2 OF 2 HIM ■ BOUNDARY SURVEY JOB # S382 -DC11 PROPERTY ADDRESS: 149 NW 93 STREET, MIAMI, FLORIDA 33150 CERTIFIED TO: HEIKE WEISE FLOOD ZONE INFO: COMMUNITY NAME: VILLAGE OF MIAMI SHORES 120652 PANEL NO. & SUFFIX: 12086C 0302 L FLOOD ZONE: X FIRM DATE: 09/11/2009 LEGAL DESCRIPTION: THE EAST 1/2 OF LOT 17 AND ALL OF LOT 18 BLOCK 133,MIAMI SHORES SECTION 6, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, PAGE 39, OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA. SURVEYORS NOTES: 1. THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS AND /OR RIGHTS -OF -WAY OF RECORD. 2. VISIBLE ENCROACHMENTS ARE AS SHOWN. 3. ELEVATIONS SHOWN HEREON ARE N.G. V.D. OF 1929. 4. NOTICE: THERE MAY BE ADDITIONAL RESTRICTIONS THAT ARE NOT RECORDED ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 5. THIS SKETCH IS THE PROPERTY OF ACE FLOOD AND INSPECTIONS, PROFESSIONAL SURVEYORS AND MAPPERS AND SHALL NOT BE IN REPRODUCED IN WHOLE OR PART WITHOUT THE PERMISSION OF ACE FLOOD AND INSPECTIONS, PROFESSIONAL MAPPERS AND SURVEYORS IN WRITING. 6. BEARINGS SHOWN HEREON ARE ASSUMED ON THE NORTH RIGHT OF WAY LINE OF N W 93RD STREET. 7. BOUNDARY DIMENSIONS SHOWN ARE PER PLAT AND FIELD MEASUREMENT UNLESS OTHERWISE NOTED. 8. CONTRACTOR IS RESPONSIBLE FOR VERIFYING ALL SITE PLAN INFORMATION PRIOR TO CONSTRUCTION. 9. UNLESS OTHERWISE SPECIFIED THIS SURVEY IS NOT TO BE USED FOR CONSTRUCTION PURPOSES. 10. FENCE OWNERSHIP NOT DETERMINED. 11. DESCRIPTION PROVIDED BY CLIENT OR CLIENTS REPRESENTATIVE. 12. UNDERGROUND UTILITIES NOT LOCATED. 13. UNDERGROUND FOUNDATIONS NOT LOCATED. SHEET 1 OF 2 ACE FLOOD & /NSPECT/ONS LB #7699 PROFESSIONAL SURVEYORS AND MAPPERS 4801 HOLLYWOOD BLVD., SUITE C HOLLYWOOD, FLORIDA 33020 PHONE: 954-924-1808 FAX 954-924-1809 acefloodandinspections@yahoo.com THIS SURVEY WAS PREPARED FOR. HEIKE WEISE THIS SURVEY IS PREPARED FOR THE EXCLUSIVE USE AND BENEFIT OF THE PARTIES LISTED HEREON. LIABILITY TO ANY THIRD PARTIES MAY NOT BE TRANSFERRED OR ASSIGNED DESCRIPTION :: DATE: BY: REVISION: ADDED DECD SPA & WALK UPFRONT 10/20/2011 TLM REVISION: DATE IN FIELD: 011182011 FIELD BOOK DIGITAL FILE DRAWN BY TLM DATE DRAWN: 0121/2011 CHECKED BY TLM JOB NUMBER: S382 -DC11 NOT VALID WITHOUT SIGNATURE AND THE ORIGINAL RAISED SEAL OFA FLORIDA LICENSED SURVEYOR AND MAPP TERRY L. MACDEVIT r PROFESSIONAL SURVEYOR AND MAPPER FLORIDA LICENSE NO. 4557 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 157487 Permit Number: BPP -3 -11 -507 Scheduled Inspection Date: December 06, 2011 Inspector: Bruhn, Norman Owner: WIESE, HEISE Job Address: 149 NW 93 Street Miami Shores, FL 33150- Project: <NONE> Contractor: DOLPHIN POOLS & SPAS INC Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330850 Phone: (954)927 -6537 Building Department Comments NEW IN- GROUND SPA Pass 72 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ec December 05, 2011 For Inspections please call: (305)762 -4949 Page 3 of 31 Permit No: 11 -507 Job Name: April 6, 2011 Miami Shores \lIuage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) Plans must be approved by HRS for the septic system. 2) Corrections for plumbing must be completed. 3) Provide a scope of work. Plans include several renovations but the permit is for a spa and related deck/patio. Remove all work from plans not related to the spa /deck. STOPPED REVIEW 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 -9(0 - Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. gig' 1 -57)7 Job Name PLUMBING CRITIQUE SHEET f-1 /14 D £e vo,e Miami Shores Viiiage Building Department RECEIPT PERMIT #: I ( DATE: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 I, 1.4 L rI'2 j ❑ Contractor ❑ Owner ❑ rchitect Picked up 2 sets of plans and (other) C ` 1 LLN Address: ) U(c-1 N.A.Ajm 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: RESUBMITTED DATE: PERMIT CLERK INITIAL: 04/07/2011 15:59 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES Ij001 * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /RX NO 1256 RECIPIENT ADDRESS 919549276880 DESTINATION ID ST. TIME 04/07 15:57 TIME USE 02'36 PAGES SENT 3 RESULT OK 41 Permit No: 11 -507 Job Name: April 6, 2011 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page1 oft Building Critique Sheet 1) Plans must be approved by HRS for the septic system. 2) Corrections for plumbing must be completed. 3) Provide a scope of work. Plans include several renovations but the permit is for a spa and related deck /patio. Remove all work from plans not related to the spa /deck. STOPPED REVIEW 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: 11 -507 Job Name: April 6, 2011 Miami Shores Vuiage Building Department Building Critique Sheet 2nd 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 1) Provide a completed pool package including the pool safety act and the pool acknowledgement form. 2) The note on the plans for alarms does not meet the code requirements. The pool alarms must sound continuously, not for 30 seconds. STOPPED REVIEW 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 revisedsheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 Miami Shores Viiiage Building Department RECEIPT PERMIT #: f 1 I � DATE: If, 1, IA Oa ontractor ❑ Owner ❑ Architect 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Picked up 2 sets of plans and (other) Address: I ' Li 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: RESUBMITTED DATE: PERMIT CLERK INITIAL: ,A143 a4stele-- Date Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION `1l I f® Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as L'`� ► �-� S ��-� , located at 149 Li uU o 3 5� NiCiVL. t St \o�e.S In accordance with Section 33- 12(f), Code of Metropolitan Dade County, I certify that 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. further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting and approved barrier prior to final pectio and use of the pool. ■ Legal Owner �. O— Note: This certification is to be submitted with a swimming pool permit application in duplicate. Miami Shores Viitage 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 PR SE N kg, / WHEREAS, the undersigned j10 q., �/ I -e. Q , is /are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: l i �%-- 3 < �VttoN.L41 Whereas, the undersigned owner(s) F t k 0111 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. ll. 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 conceming the use, enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding n the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its su , in ac cor an of said Village then in effect. I OWNERS - N PRINT OWNER SING & PRINT I Hereby Ce ' t on this day personally appeared before me and has produced ID # d' 6 vvY1 as identification and he/she acknowledge that he /she executed the foregoing, freely and voluntarily, f rpurposes tire in expressed. SWORN TO AND SUBSCRIBED before me on this _ day of 1 �l' 20 (Revised THELMA PETAS • *: MY COMMISSION # D0935614 EXPiFsES October 25, 2013 (4 �r ..ik,pi�S21tffiPy.rrn�,om 07) 398 -0153 NOTARY P ►, OF FLORIDA Miami Shores Viiiage 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) acknowledge thatra nom swimming pool, spa or hot tub will be constructed or installed at LI � 1,0 �'3 41 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 link 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 considered committing a misdemeanor of the second degree, punishable provided in ection 775.082 or • ion 775.083 F.S . This f • rm must be signed "—by the owner /a ern:, =nd, e prim ontraptor. S— 4- IL(( TE ONTRACTOR'S S GNATURE AND AT RINT) WNER'S SIGNAT NOTARY PUBIC 1 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 -3 -11 -507 Issue Date: Not Issued Expires: Not Issued Folio Number:1131010330850 Owner's Name: HEISE WIESE Job Address: 149 93 Street Miami Shores, FL 33150- Owner's Phone: Total Square Feet: 756 Total Job Valuation: $ 8,000.00 Contractor(s) DOLPHIN POOLS & SPAS INC Phone (954)927 -6537 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: In Review Date Approved: : In Review Date Denied: 3/23/2011 Comments: PLEASE CONTACT BUILDING TO SUBMIT PROPER PERMITS. PLEASE NOTE NOT MORE THAN 20% OF REAR YARD CAN BE PAVERS, ACCESSORY STRUCTURES OR ANY HARD SURFACE. HAVE ARCHITECT CALCULATE THE AREA COVERED THAT IS PAST THE PROPOSED DECK. PUT RIGHT SCALE ON PLANS. 1 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. B P P -3 -11 -507 Issue Date: Not Issued Expires:Not Issued Folio Number:1131010330850 Owner's Name: HEISE WIESE Job Address: 149 93 Street Miami Shores, FL 33150- Owner's Phone: Total Square Feet: 756 Total Job Valuation: $ 8,000.00 Contractor(s) Phone Primary Contractor DOLPHIN POOLS & SPAS INC (954)927 -6537 Yes Planning and Zoning Criteria and Comments Approved: In Review Date Approved: : In Review Date Denied: 3/23/2011 Comments: PLEASE CONTACT BUILDING TO SUBMIT PROPER PERMITS. PLEASE NOTE NOT MORE THAN 20% OF REAR YARD CAN BE PAVERS, ACCESSORY STRUCTURES OR ANY HARD SURFACE. HAVE ARCHITECT CALCULATE THE AREA COVERED THAT IS PAST THE PROPOSED DECK. PUT RIGHT SCALE ON PLANS. 5/12/11 THE SCALE ON PLANS STILL APPEARS TO BE INCORRECT PLEASE CORRECT SO I MAY REVIEW PLANS. 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 Folio Number:1131010330850 Owner's Name: HEISE WIESE Job Address: 149 93 Street Miami Shores, FL 33150- Owner's Phone: Total Square Feet: 756 Total Job Valuation: $ 8,000.00 Contractor(s) DOLPHIN POOLS & SPAS INC Phone Primary Contractor (954)927 -6537 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 5/24/2011: Yes Comments: PLEASE CONTACT BUILDING TO SUBMIT PROPER PERMITS. PLEASE NOTE NOT MORE THAN 20% OF REAR YARD CAN BE PAVERS, ACCESSORY STRUCTURES OR ANY HARD SURFACE. HAVE ARCHITECT CALCULATE THE AREA COVERED THAT IS PAST THE PROPOSED DECK. PUT RIGHT SCALE ON PLANS. 5/12/11 THE SCALE ON PLANS STILL APPEARS TO BE INCORRECT PLEASE CORRECT SO I MAY REVIEW PLANS. 5/24/11 PLAN ON SCALE STILL NOT CORRECT HOWEVER DIMENSIONS ON PLAN SUFFICIENT FOR THIS REVIEW. u 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. BUILDIN OWNER: Name (Fee Simple Titleholder): d Address: / Y� #./V‘ 3 ,1 -chted- City: A e .�' . s" ROOFING State: MAR 2 3 2011 Master Permit No. Phone#:o5-4'`q ?-74 zip:-351<0 Tenant/Lessee Name: Phone #: Finail: JOB ADDRESS: i yY-N ' ?3 J . vc.A6A.ki\or ot- 5s ■ City: Miami Shores County: Miami Dade Folio/Parcel #: r 'j IQ 1 ©33 0 $D Is the Building Historically Designated: Yes NO Flood Zone: 4 zip: 33 1 S' CONTRACTOR: Company Name: ®J2/A'2. /t oC. i -(5,";5 Address: /3'f City: , r& < I State: pi_ Qualifier Name: 4'' e1 3 State Certification or Registration #: CPC 031-7g '‘) p Contact Phone#: 't ? e7.7 ` t f 3-7 F.mail Address: w�aa( 6-,,t„S/0 Au Phone#: 2w ?g,26.--5-3 2 Zip: 3. crii 7,17 CC? 7 Phone #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: �6' 993- 3- S Value of Work for this Permit: $ /4f9e, -(619 Square/Linear Footage of Work: Type of Work: ❑Additionteration / View ❑Repair/Replace 1�,V Description of Work: We_ 441 P /t j f D e' s1 ODemolition *** * *** x*a **.x ********* * * * * * * * * *** * ***F : a********** ***** ***** **:€**** **************** Submittal Fee $" • .,e .► Fern it Fee $ Scanning Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE - Bonding 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 i pkction which rs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil rtyt be approv and reinspection fee will be charged. p Sig Owner or Agent Contractor The foregoing instrument was acknowledged before me this j 7� The foregoing ' � trument was acknowleledgel before me this/ day of C,k, 20 II , by la 5 , day of ` , 20 // , by / S who is personally kn to me or who has produced who As identification and who did take an oath. NOTARY PUBLIC: personally kn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: **** **** ** **** ** * ** **** * ***** ** ************ ***x** * * * * ******** ** ****** * ** ** APPROVED BY(11 Plans Examiner .// Zoning 7 / 7,4/ ? /1a Structural Review Clerk (Revised 07 /10/07)Revised 06/10 /2009)(Revised 3/15/09) 1111111111111111111111111111111111111 STATE OF FLORIDA, COUNTY OF DADE. 41) coukri), HERFBY CERTIFY that this is a true copy of day of 1 n„ MAR ,A.2) 4 2_011 7 - - -I o,,,34 l'171-7TFAH. 22 till ,,/,^ RV ' COLA'S \\ D s I-1AR Ar ac 4% . origioal fUeL+ ii ofico on NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE .JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO.I' -310 033-1) 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 property and treet/agddress: ° / 5; Z/oc/ /33 Pi 9 ALki, ,3f/Sfrev.f 2itf gere-..13 t)—j ff LOT I Cor 151-K 133 CFN 2011R0178219 OR E.k 27623 P3 0969; (1p9) RECORDED 03/21/2011 1125:13 HARVEY RUVINr CLERK OF COURT MIAMI-DADE COUNTYr FLORIDA AST PAGE 2. Description of improvement: Ale et, 47,Poon, _coteg4- 3:tOwner(s) name and address: 42../ /CA- /Via 93"/ fisrzed- srAe. et, F3_. 1st Iftterest in property: r a6.0)10-{"" Name and address of fee simple titleholder: e _r7 se" erre-r1K06,-; 4. Contractor's name and address: eceA 70.• et /r / V 3 o //oily ce00/ p"1., 3 4 0 ) 0 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: 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)(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. Expi diff date of spec otice of Commencement: (the expiration date is 1 year from the date of recording unless a Signature o •wner Print Owner's Name WA- .s' P- 14 day of 1/4°‘' , 201 Sworn to and subscribed before rne this Notary Public “ Print Notary's Name My on commission expirft. EXPIRES October 25. j22LIV12_,..terySer.-20 123.01-62 PACTE 4 &02 THELMA PETA....1 E MY COMMISSION # 009356 Prepared by 'Pit af'al 3/4c.k_. Addrns: ty wt-5 f-tz fix/ H -5 (m-o RESTRICTIVE COVENANTS PROTECTIVE POOL ENCLOSURE PREPARED BYA DECLARATION OF RESTRICTIVE COVENANT KNOW ALL MEN BY TRRSE PRESENTS: undersigned t��i (J460.- situate and being in the Village Lot (s) ) Block 33 of i A.K.A. (address) according to the plat thereof, as recorded in Plat Book Page Florida, and WHEREAS, the is/are the fee simple owner (s) of the following described property of the Public Records of Dade County, • Whereas; the undersigned owner (s) f Q/L , LA) d Q 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: ` 1. That the property will not be used in violation of any ordinances of the Village , or Dade County now in effect or hereinafter enacted. • 2. That the purpose of this covenant-is to induce the VWage , to issue a permit for a pool where the required enclosure Ls not on the subject property where the pool is located. • 3. That if any of our adjoining neighbors remove any portion of their fence wall, or If our /my property shall fall 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. • 4. That, we, as owners, hold the Village harmless for any negligence or injury that results from not having the enclosure 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 the Village i , or its successors, in accordance of said Village then in effect. IN W WHERE , the undersigned has/have caused / hand (s) and seal(s) to be ed hereto on this day of S(ES) Signature and Pria [-1 Signature and Print STATE OF FLORIDA ): COUNTY OF DATE ): I HEREBY CERTIFY that on this day personally appeared before me WVA, /" l'S who Is ersonally known to me or has produced (type of identification) as identification and he/she acknowledge • MTV/she executed the foregoing, freely and voluntarily, for purposes there in expressed. • L WI 44-. Signature and Print Signature and Print SWORN TO AND SUBSCRIBED before me on MY commission expires: Rev. d!2' PERMIT # 'I 50-4 CONTRACTOR: L 1(N TW154'3' SUBMITTAL DATE: m iOs-6 _Q F j gz 1 1 ADDRESS: I Hot t 3 51" NAME: \-{ ,t RESUBMITAL DATES: PROJECT TYPE: F-;P ZONING FIRE" 77&e q STRUCTURAL IMPACT FEES AMINO 16)tkIcl ELECTRICAL RS/DERM PLUMBING N C )\/ \\‘\ MECHANICAL Maffei s6ti ' 10050 NE 2 ^d 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 ew swimming pool, spa or hot tub will be constructed or installed at %I/ //GL 73 til e_a --/its 4 SAerrec 1 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 LEASE PRINT) THELMA PETAS S D935614 IRES 0 25, 2 dallotaryService OWNE 'S SIGNATURE AND DATE e/ A PETAS SSION # DD935614 Oa• 25, 2013 NOT Mufti Sinedfillage D 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 /91 07/1 MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT ATTENTION: BUILDING OFFICIAL I certify that I amt legal owner of the property located at: / Q A/411 93 5:4' ,41,! Sh S /- 33/ v 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 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 prio final insper 'on and use of the pool. p( Legal Owner Note: This certification is to be submitted with a swimming pool permit application in duplicate. • STATE OF FLORIDA) COUNTY OF DADE) Mas S'i vtes *€1ae 'e V 10050 NE 2nd Ave Miami Shores, Fl 33138 Phone 305-795-2204; Fax 305-756-8972 www.miamishoresvillage.com AFFIDAVIT The undersigned Affiant, 41, Catzsia, "property o er) The attached survey, performed by c,e_. 1-,1600/, ivt for address: performed on , does hereby attest that (name pf surveyor's 9 Pim I ompany) ,� FZ" , (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. er, Affian t ay naught. Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this / cl day of A/ Affiant is ZS personally known to me, produced as identification. THELMA PETAS MY COMMISSION # DD935614 CFA 9�, .. • .� PIRES October 25, 2913 .eNota ce.cow Notary 1 Ym ND SJL \0 JAISE E-JUIDENCE CO V r ORM= DECK AV MIAMI PAVE°, T1UCTU11J C thCt1b'111 OMS Yo 2, 3 X011 c On 800 GLOUCHESTER BOCA RATON, FL. LIC. # AR0016( WORK : 561-706 - FAX: 561 -997 -5 Page 1 of 3 J�1 TREET Miami Shor s Village 4..PPROVED BY DATE MING DEPT ^o 9 "JJ PL r3G DEPT 11.11 c I 10 COMPLIANCE WITH ALL FEDERAL I A 1 I ANI) C0tIN IY I?ULES AND REGULATIONS "GRDSLABxis" Program Version 1.4 Determine Estimated Crack Width: Slab -base Frict. Adjust., C = Thermal Expansion, a = Shrinkage Coefficient, c = Est. Crack Width, AL = 1.00 0.0000055 0.00046 0.0882 (assuming no use of stabilized or granular subbase) C = 1.0 (assumed value for no subbase) a = 5.5x10"( -6) (assumed thermal expansion coefficient) E = 3.5x10"( -4) (assumed coefficient of shrinkage) AL = C *L *12 *(a *AT+s) Check Bearing Stress on Dowels at Construction Joints with Load Transfer Pt Le di • 0 *Pc (1- (4- 1) *s /Le) *Pc (1- (3- 1) *s /Le) *Pc (1- (2- 1) *s /Le) *Pc s d4 d3 d2 • • d. d3 1.0 *Pc 0 *Pc (1- (4- 1) *s /Le) *Pc (1- (3- 1) *s /Le) *Pc (1- (2- 1) *s /Le) *Pc Assumed Load Transfer Distribution for Dowels at Construction Joint Le = Effective Dowels, Ne = Joint Load, Pt = Critical Dowel Load, Pc = Mod. of Dowel Suppt., kc = Mod. of Elasticity, Eb = Inertia/Dowel Bar, Ib = Relative Bar Stiffness, a = fd(actual) _ Fd(allow) = 20.631 1.00 500.00 500.00 1500000 29000000 0.0155 0.889 1448.65 3250.00 in. bars lbs. lbs. psi Psi in. "4 Psi (Ref. 2) Le = 1.0 *L.r = applicable dist. each side of critical dowel Ne = 1.0+2*E(1- d(n- 1) *s/Le) (where: n = dowel #) Pt = 0.50 *P (assumed load transferred across joint) Pc = Pt/Ne kc = 1.5x10"6 (assumed for concrete) Eb = 29x10"6 (assumed for steel dowels) Ib =1t *db ^4/64 = (kc *db /(4 *Eb *Ib)) "(1/4) fd(actual) = kc *(Pc *(2 +8*z) /(4 *D "3 *Eb *Ib)) Fd(allow) = (4- db) /3*f'c Fd(allow) >= fd(actual), O.K. References: 1. "Load Testing of Instumented Pavement Sections - Improved Techniques for Appling the Finite Element Method to Strain Predition in PCC Pavement Structures" - by University of Minnesota, Department of Civil Engineering (submitted to MN/DOT, March 24, 2002) 2. "Dowel Bar Opimization: Phases I and II - Final Report" - by Max L. Porter (Iowa State University, 2001) 3. "Design of Slabs on Grade" - ACI 360R -92 - by American Concrete Institute (from ACI Manual of Concrete Practice, 1999) 4. "Slab Thickness Design for Industrial Concrete Floors on Grade" (IS195.01D) - by Robert G. Packard (Portland Cement Association, 1976) Comments: 2 of 2 Page 3 of 3 3/6/2011 8:53 PM "GRDSLAB.xls" Program Version 1.4 Determine Estimated Crack Width: Slab -base Frict. Adjust., C = Thermal Expansion, a = Shrinkage Coefficient, s = Est. Crack Width, AL = 1.00 0.0000055 0.00046 0.0882 in./in. /deg in./in. in. (assuming no use of stabilized or granular subbase) C = 1.0 (assumed value for no subbase) a = 5.5x1 0"(-6) (assumed thermal expansion coefficient) E = 3.5x10 "( -4) (assumed coefficient of shrinkage) DL = C *L *12 *(a *AT +s) Check Bearing Stress on Dowels at Construction Joints with Load Transfer: Pt f di • Le 0 *Pc (1- (4- 1) *s /Le) *Pc (1- (3- 1) *s /Le) *Pc (1- (2- 1) *s /Le) *Pc d4 d3 • • d2 • • d• d3 d4 1.0 *Pc i 0 *Pc (1- (4- 1) *s/Le) *Pc (1- (3- 1) *s /Le) *Pc (1- (2- 1) *s /Le) *Pc Assumed Load Transfer Distribution for Dowels at Construction Joint Le = Effective Dowels, Ne = Joint Load, Pt = Critical Dowel Load, Pc = Mod. of Dowel Suppt., kc = Mod. of Elasticity, Eb = Inertia/Dowel Bar, Ib = Relative Bar Stiffness, (3 = fd(actual) _ Fd(allow) = 20.631 1.00 500.00 500.00 1500000 29000000 0.0155 0.889 1448.65 3250.00 (Ref. 2) in. Le = 1.0 *Lr = applicable dist. each side of critical dowel bars Ne = 1.0+2*E(1- d(n- 1) *s/Le) (where: n = dowel #) lbs. Pt = 0.50 *P (assumed Toad transferred across joint) lbs. Pc = Pt/Ne psi kc = 1.5x10"6 (assumed for concrete) psi Eb = 29x10"6 (assumed for steel dowels) in. "4 Ib = *db "4/64 f3 = (kc *db/(4 *Eb *Ib)) 1(1/4) psi fd(actual) = kc *(Pc *(2 +3*z) /(4 *f3"3 *Eb *Ib)) psi Fd(allow) = (4- db)/3*f'c Fd(allow) >= fd(actual), O.K. References: 1. "Load Testing of Instumented Pavement Sections - Improved Techniques for Appling the Finite Element Method to Strain Predition in PCC Pavement Structures" - by University of Minnesota, Department of Civil Engineering (submitted to MN/DOT, March 24, 2002) 2. "Dowel Bar Opimization: Phases I and II - Final Report" - by Max L. Porter (Iowa State University, 2001) 3. "Design of Slabs on Grade" - ACI 360R -92 - by American Concrete Institute (from ACI Manual of Concrete Practice, 1999) 4. "Slab Thickness Design for Industrial Concrete Floors on Grade" (IS195.01D) - by Robert G. Packard (Portland Cement Association, 1976) Comments: 2 of 2 Page 3 of 3 3/6/2011 8:53 PM BOUNDARY SURVEY WPP FND 1/2" IP NO ID WEST 1/2 LOT 17 m 0 U 0 FND DRILL HOLE NO ID 0.3' BLOCK 133 PlAft ` on 15` ALLEY ` Y OVERHEAD UTILP1'Y° INE9..0......eB„ M 9' ASPHALT ALLEY 25 REE TREE REE 5' CHAINLINK FE T PALM TREE EAST 1/2 TREIE LOT 17 ?REE1 DTREA 1I x I I° M CV 27.2' PALM TREE PALM PALM TREE TREE ALUM. SHED LOT 18 0 0 • 0 LEGEND - FOUND 1/2" IRON ROD - FOUND 1/2" IRON PIPE - FOUND DRILLHOLE - FOUND NAIL AND DISC - WATER METER ABBREVIATIONS: A/C - AIR CONDITIONER SLAB CL - CENTER LINE CB - CONCRETE BLOCK CONC. - CONCRETE F - FOUND FND 1/2 "IP IR - IRON ROD AL" , x'NO ID IP - IRON PIPE 5.17 A 0.3' M - MEASURED P - PLAT 10.8' 0.2' NO ID - NO IDENTIFICATION R/W - RIGHT -OF -WAY TYP. - TYPICAL z uJ z J z U LOT 19 cV N 10.71' —x� O TREE O 0 00 26.7' ONE STORY RESIDENCE # 149 37.8' C*) 16.1' 10.71' x x - 0.7' -- FND 1/2" IR NO ID N90 °00`00 "E - 75.00' 5' CO Miami Shores Village 225.00' DATE 75' RIGHT OF WAY - 19' PAVEMENT COMPLIANCE WITH FEDERAL ST E AND COUNTY FUJI FS AND REGUL N W 93 STREET ACE FLOOD & INSPECTIONS LB #7699 PROFESS /ONAL SURVEYORS AND MAPPERS 4801 HOLLYWOOD BLVD., SUITE C HOLLYWOOD, FLORIDA 33020 PHONE: 954 - 924 -1808 FAX: 954-924 -1809 acelloodandinspections@yahoo.com THIS SURVEY IS PREPARED FOR THE EXCLUSIVE USE AND BENEFIT OF THE PARTIES LISTED HEREON. LIABILITY TO ANY THIRD PARTIES MAY NOT BE TRANSFERRED OR ASSIGNED DESCRIPTION: DATE BY REVISION: REVISION: DATE INFIELD: 01/182011 FIELD BOOK DIGITAL FILE DRAWN BY: TLM DATE DRAWN: 01/212011 CHECKED BY TLM JOB NUMBER: S382 -DC11 Q 20 0 10 20 (IN FEET ) 1 INCHES = 20 FT. SHEET 2OF2 BOUNDARY SURVEY JOB # S382 -DC11 PROPERTY ADDRESS: 149 NW 93 STREET, MIAMI, FLORIDA 33150 CERTIFIED TO: HEIKE WEISE FLOOD ZONE INFO: COMMUNITY NAME: VILLAGE OF MIAMI SHORES 120652 PANEL NO. & SUFFIX: 12086C 0302 L FLOOD ZONE: X FIRM DATE: 09/11/2009 LEGAL DESCRIPTION: THE EAST 1/2 OF LOT 17 AND ALL OF LOT 18 BLOCK 133, MIAMI SHORES SECTION 6, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, PAGE 39, OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA. SURVEYORS NOTES: 1. THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS AND /OR RIGHTS -OF -WAY OF RECORD. 2. VISIBLE ENCROACHMENTS ARE AS SHOWN. 3. ELEVATIONS SHOWN HEREON ARE N. G. V. D. OF 1929. 4. NOTICE: THERE MAYBE ADDITIONAL RESTRICTIONS THAT ARE NOT RECORDED ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 5. THIS SKETCH IS THE PROPERTY OF ACE FLOOD AND INSPECTIONS, PROFESSIONAL SURVEYORS AND MAPPERS AND SHALL NOT BE IN REPRODUCED IN WHOLE OR PART WITHOUT THE PERMISSION OF ACE FLOOD AND INSPECTIONS, PROFESSIONAL MAPPERS AND SURVEYORS IN WRITING. 6. BEARINGS SHOWN HEREON ARE ASSUMED ON THE NORTH RIGHT OF WAY LINE OF N W 93RD STREET. 7. BOUNDARY DIMENSIONS SHOWN ARE PER PLAT AND FIELD MEASUREMENT UNLESS OTHERWISE NOTED. 8. CONTRACTOR IS RESPONSIBLE FOR VERIFYING ALL SITE PLAN INFORMATION PRIOR TO CONSTRUCTION. 9. UNLESS OTHERWISE SPECIFIED THIS SURVEY IS NOT TO BE USED FOR CONSTRUCTION PURPOSES. 10. FENCE OWNERSHIP NOT DETERMINED. 11. DESCRIPTION PROVIDED BY CLIENT OR CLIENTS REPRESENTATIVE. 12. UNDERGROUND UTILITIES NOT LOCATED. 13. UNDERGROUND FOUNDATIONS NOT LOCATED. SHEET 1 OF 2 ACE FLOOD & INSPECTIONS LB #7699 PROFESSIONAL SURVEYORS AND MAPPERS 4801 HOLLYWOOD BLVD., SUITE C HOLLYWOOD, FLORIDA 33020 PHONE: 954 - 924 -1808 FAX: 954-924 -1809 aceloodandinspeaons@yahoo.com THIS SURVEY WAS PREPARED FOR: HEIKE WEISE THIS SURVEY IS PREPARED FOR THE EXCLUSIVE USE AND BENEFIT OF THE PARTIES LISTED HEREON. LIABILITY TO ANY THIRD PARTIES MAY NOT BE TRANSFERRED OR ASSIGNED DESCRIPTION: DATE BY REVISION: REVISION: DATE INFIED: 01/182011 RED BOOK DIGITAL FILE DRAWN BY. TLM DATE DRAWN: 0121/2011 CHECKED BY: TLM JOB NUMBER: S382 -DC11 NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OFA FLORIDA LICENSED SU VEYOR AND MAPPER TERRY L. MACDEVITT PROFESSIONAL SURVEYOR AND MAPPER FLORIDA LICENSE NO. 4557 I PORmANT: In these spaces, copy the corresponding information from Section A. For- ::Insutr ipariy Use: Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 149 NW 93rd Street Poti+ City Miami Shores State ZIP Code FL 33150 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments: BM: # N -568 , ELEV= 9.65' ; Centerline of road= 11.34 ; ERP= 11.08 C2a is elevation of crawl space. C2e is elevation of a/c pad. Latitude and longitude were obtained from field measurements, using handheld Garmin GPS device Flood determinatio Signature n F.I.R.M. No research was done in re • ards to L.O.M.R/L.O.M.A. documents. Date 01 -18 -2011 ❑ Check here if attachments SECTION E - BUILDING EL ATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items El -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6 -9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is _._ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA- issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E am correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA - issued or community- issued BFE) or Zone AO. G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: . _ ❑ feet ❑ meters (PR) Datum _ G9. BFE or (in Zone AO) depth of flooding at the building site: _ ❑ feet ❑ meters (PR) Datum _ G10. Community's design flood elevation _ ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 81 -31, Mar 09 Replaces all previous editions U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -9. OMB No. 1660 -0b08 Expires March 31, 2012 FILE #: S382 -DC11 SECTION A - PROPERTY INFORMATION Al. Building Owner's Name Heike Wiese AP Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 149 NW 93m Street F'ot Ii Pdlicy Numb iy E,1 Numb City State ZIP Code Miami Shores FL 33150 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) MIAMI SHORES SEC 6 PB 10 -39 E1/2 LOT 17 & LOT 18 BLK 133 LOT SIZE 75.000 X 123 OR 20612 -1093 08 2002 1 OR 20612 -1093 0802 00 A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) Residential A5. Latitude /Longitude: Lat. 25 °51'37.9 "N Long. 80°12'02.1'W A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood in A7. Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): A9. For a) Square footage of crawlspace or enclosure(s) 1299.82 sq ft a) b) No. of permanent flood openings in the crawlspace or b) enclosure(s) within 1.0 foot above adjacent grade 9 c) Total net area of flood openings in A8.b 1365 sq in c) d) Engineered flood openings? ❑ Yes ® No d) Horizontal Datum: ❑ NAD 1927 ® NAD 1983 surance. a building with an attached garage: Square footage of attached garage 219.9 sq ft No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 4 Total net area of flood openings in A9.b 128 Engineered flood openings? ❑ Yes sq in No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number Village of Miami Shores : 120652 B2. County Name Miami -Dade B3. State FLORIDA B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone Date Effective /Revised Date Zone(s) AO, use base flood depth) 12086C 0302 L 09 -11 -2009 09 -11 -2009 X N/A BI0. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) _ BI 1. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) _ B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date N/A ❑ CBRS ❑ OPA ❑ Yes ® No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a -h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized SEE "D" Vertical Datum NGVD 1929 Conversion /Comments NONE a) b) c) d) e) f) 9) h) Top of bottom floor (including basement, crawlspace, or enclosure floor) 10.8 Top of the next higher floor 13.1 Bottom of the lowest horizontal structural member (V Zones only) N.A 11.0 11.5 Attached garage (top of slab) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. ® feet feet ® feet ® feet feet _ meters (Puerto Rico only) _ meters (Puerto Rico only) _ meters (Puerto Rico only) _ meters (Puerto Rico only) _ meters (Puerto Rico only) 10.8 ® feet _ meters (Puerto Rico only) 11.0 feet _ meters (Puerto Rico only) N.A ® feet _ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ Yes ® No Certifier's Name Andrew P. Mack Title Engineer Address 4801 Hollywoo9 Signature License Number 58100 Sul -`C Company Name Ace Flood and Inspections Inc. State FL Telephone 954-924 -1808 City Hollywood Date 01 -18 -2011 ZIP Code 33021 FEMA Form 81 -31, Mar 09 See reverse side for continuation. Replaces all previous editions Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 157498 Permit Number: MC -3 -11 -510 Scheduled Inspection Date: December 05, 2011 Inspector: Perez, JanPierre Owner: WIESE, HEISE Job Address: 149 NW 93 Street Miami Shores, FL 33150- Project: <NONE> Contractor: DOLPHIN POOLS & SPAS INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Pool Heater Phone Number Parcel Number 1131010330850 Phone: (954)927 -6537 Building Department Comments SPA HEAT PUMP Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 02, 2011 For Inspections please call: (305)762 -4949 Page 1 of 46 Miami Shores Village Building Department 1005.0 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Mechanical Permit No. Master Permit No. Owner's Name (Fee Simple Titleholder) &2 �Q" °�-r `` - Owner's Address /9? A/td..- City ` cZeree State Zip 1 C Tenant/Lessee Name Phone # E- MAIL: Job Address (where the work is being done) Sea A. t. Joe) ¢, LE MAR 2 3 201i BY: �I I --`51O Phone # O - it- City Miami Shores Village County Miami -Dade FOLIO / PARCEL# 11-3soi-v33-aloco Zip 33/ D Is Building Historically Designated YES NO Contractor's Company Nam, of 1�� / l�p��' t� (�t j Phone # 9S Contractor's Address f g55 (roan U - c City oleyw0 ©d State fe-4: Zip 33 Qualifier Name �i� 3/ ( Phone # ,rry,,2 State Certificate or Registration No. GPC O...r2 YO E -MAIL: Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 0 d co , Square / Linear Footage Of Work: Type of Work: Describe Work: ❑Addition ❑Alteration 1101)1f ew ❑ Repair /Replace ❑ Demolition Submittal Fee Permit Fee $ Notary $ Scanning $ Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ pv v CCF$ Training /Education Fee $ * * * ** * * * * * * * ** CO /CC Technology Fee $ Zoning $ 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: 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 ins tion which o seven (7) days after the building permit is issued In the absence of such posted notice, the inspection w', be approve and a einspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this day of / /:` , 0 ff , by 7 WtAo , who is pe onally kno n to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Contractor The foregoing instrument was acknowledged before e this %Q day office , 20 /1, by ,r dt y j who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Floridallotaryservica com My Commission Expires: ****xx ek,' e****, Yx oY*aYOY4etie****, Y' k' Ar, t************x de, Y**** de &ati*****************.***** &* ** ******** *,taexdc******** ****** APPLICATION APPROVED BY: Plans Examiner (Revised•02 /08/06) Engineer Zoning 1 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954-831 -4000 VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 DBA: Business Name: DOLPHIN POOLS & SPAS INC Owner Name: DAVID A BLACK Business Location: 143 5 GRANT ST HOLLYWOOD Business Phone: Rooms Seats Employees 2 Receipt #:188 L /6M7ARINE CONTRACTOR Business Type. (POOL /SPA CONTRACTOR) Business Opened:io /29/200. StatelCounty /Cert/Reg:CCP 573340 Exemption code: Machines Professionals for Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Coon Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 2x.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is -non- regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it Is in compliance with State or local laws and regulations. Malting Address: DAVID A BLACK 1435 GRANT ST HOLLYWOOD, FL 33020 2010 - 2011 Receipt *15A -09- 00004070 Paid 08/17/2010 27.00 i.sf. " —.itK? 10,7-:.lt:i1'i • BPTC N )Cv B ER. _ • PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DMSION OF WORKERS' COMPENSATION CONSTRUCTION INTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 10/12/2009 PERSON DAVID BLACK FEIN: 651126630 BUSINESS NAME AND ADDRESS: DOLPHIN POOLS & SPAS INC 1435 GRANT ST HOLLYWOOD, FL 33020 EXPIRATION DATE: 10/12/2011 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED POOL /SPA CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who • elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(1* F.S., Certificates of election to be H exempt., apply only within the scope of the business or trade listed on E the notice of election to be exempt E Pursuant to Chapter 440.05(13). 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 an the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. ANC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 MAR /1.7 /2011 /THU 0E:48 All Jackson Agency FAX No. SiJE- 822-853E F, 001 /H4 ACORD„ CERTIFICATE OF LIABILITY INSURANCE DATE`MM/DOTYYYY) 03/17/2011 PROD -CEP (305) 824 -3464 JACKSON AGENCY INC 2075 W 76TH ST HIALEAH , FL 33016 -0006 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 POUCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSLREO DOLPHIN POOLS AND SPAS , 1435 GRANT STREET HOLLYWOOD 51 INC . 33020 - Is,:PEP. A CAPACITY INSURANCE GENERAL X INFO:TT a MERCURY INSURANCE CLMO1001O694A INS,JPp7 r / / 02/16/2011 / / / / INSURER D EACH i,CCLRRENCE INSURER E- DAvAGETCR =VTC-D PREMISES (Ea cccurren ce) COVERAGES 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 IA1TH RESPECT TO W-RCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMrrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LEY LTR NSRD TYPE OF INSURANCE PDUCY NUMBER POLICY E ) PDEXIN ATE (MMrDIDNY) LIMITS A GENERAL X LIABILITY r`OMMER� ALCENE= 2A.I_(.,AEti;_i v CLMO1001O694A / / 02/16/2011 / / / / / / 02/10/2012 / / / / EACH i,CCLRRENCE $ 1,000,000 DAvAGETCR =VTC-D PREMISES (Ea cccurren ce) $ 100,000 1 CLAIMS MADE I X I C`CCUR MEDE<PLAny one weal) $ 5, 000 PER9CNAL a ADV INJURY $ 1,000,000 0 ER ALAGGREG.4TE $ 2,000,000 GENII_ AGGREGATE LIMIT iiPF -t ES PER PRO- POLICY( I L'C PPDDUG S- COMPOP AG G $ 1, 000,000 R AUTOMOBILE INq iii X � LIABIUTY .AJTC ALL OA'b' ^.ED AJ1 O°5 t'('•;EDULEDAU—OE I FI :E) AUTO_ NON- GbVVEDAUT_5 FLC7009557 -3 03/28/2010 / / / / / / 03/28/2011 / / / / / / CNvIBINMSINGLELMIT tiEH accident) BOCILY INJURY (Farpe'scn) 100,000 BODILY INJURY (Per accident) 300,000 PROPERTY DAMAGE (Per accidant) 50,000 GARAGELIABILTY H Ari4.A .JTC / / / / ALTO ONLY- ExACCIDEJT $ OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESSA JMBRELLA LIABILITY T OCCUR U CLAIMS' ADL DEDUCTIBLE J F:ETENTI DN $ / / / / / / / / EACH OCC P.RENr__ $ AGGREGATE $ $ $ _ __. WORKERS COMPENSATOR AND __ _..�.._.. EMPLOYERS` LIABIUTI AN, PPOPPIETURIPARTVEPJEN_CI.TIYE OFFICE IMEMBERE>C LUDECr If yes describe finder SPECIAL PPO+;ISION.Sbelow .... _ _ _. / / / / / / _... / / dYCSIAIL- H TORY L STS ER - ..... E L EAU:H.4SIDENT $ EL. OSHA- E- EAEVPLOYEE$ El. C1SEASE- POLI:YLIVi" $ Tc niER / / / / / / / / / / / / DESCRIPTION OF OPERATIONSILOCATIONSNEHIa .ESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES BUILDING DEPT 10050 NE 2ND AVE MIAMI SHORES ACORO 25 Rz001J0B) g WrK INS025;n1m3) O5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES EE 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 IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE FL 33138- 8 $CTFONIC: LASER FORMS, INC. • ( 2T 2 ?.OF 5 ACORD CORPORATION 1988 Faye ; e 2 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 157495 Permit Number: PL -3 -11 -509 Scheduled Inspection Date: September 09, 2011 Inspector: Bruhn, Norman Owner: WIESE, HEISE Job Address: 149 NW 93 Street Miami Shores, FL 33150- Project: <NONE> Contractor: DOLPHIN POOLS & SPAS INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1131010330850 Phone: (954)927 -6537 Building Department Comments PLUMBING FOR INGROUND SPA AND HEATER Passed Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 08, 2011 For Inspections please call: (305)762 -4949 Page 4 of 19 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 No. Master Permit No. Permit Type: Plumbing Owner's Name (Fee Simple � le Tiitlleholder) (�t/ ® $'4 -1�.Q, Phone # -� J 6 ' 7 Owner's Address 14 / a go, q3,-d 9re,� City J ?Z ,11 ; 3%0re State FL- Zip 3-3 /SO Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) J"/ % 4. 73f1 $ e-0 City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Zip -J 3/ Is Building Historically Designated YES NO Contractor's Company Name 0 42X/A ?400 y? r Contractor's Address lYfr C'— 01,1 City 1 '' /C/�I'101PC State Qualifier Name( ► Csf,VEjA citt- State Certificate or Registration No. C,OC t5tr7,3 re9 E -MAIL: Phone # 2 #y 429-6 s-'3.7 Zip 3 .7�..JV Phone # Certificate of Competency No. Architect/Engineer's Name (if applicable) 4 -e' 144'114 ,6, , a v► a Phone # S°61 ` 206 05 7 - 043 995 Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ['Addition ❑Alteration Pew ❑ Repair /Replace ❑ Demolition Describe Work: Al Ate / 117 o/ A.e.4' **** ******** * *** * ***** **ak*** ****** ***** ees**** ***** **** * ****** *** ** ** * * ********** **** Submittal Fee $ Permit Fee $ / CCF $ Notary $ Training /Education Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -a Technology Fee $ CO /CC 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 insp. on which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi r .e approyd a reinspection fee will be charged. 1111111• 0 \ X, DC Signature Owner or Agent /, Contractor The foregoing instrument was acknowled ed before me this / 4 The foregoing instrument was acknowledged befor e this day of Qt ,20// , by % �"l" "�a , day of /4 ,20i,by a-fso'1 /I x/65.5 who is erso`nally known + me or who has produced As identification and who did take an oath. NOTARY Sign: Print: who is personally know,p_to me or who has produced as identification and who did take an oath. My Commission Expires: FloridalJ gOlarySerme Dorn APPLICATION APPROVED BY: (Revised 02/08/06) My Commission Expires: Plans Examiner Engineer Zoning Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 157502 Permit Number: EL -3 -11 -511 Scheduled Inspection Date: October 27, 2011 Inspector: Devaney, Michael Owner: WIESE, HEISE Job Address: 149 NW 93 Street Miami Shores, FL 33150- Project: <NONE> Contractor: EAST OCEAN ELECTRIC OF FLORIDA Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1131010330850 Phone: (305)879 -1973 Building Department Comments WIRING NEW POOL EQUPMENT AND HEAT PUMP Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Com s i October 26, 2011 For Inspections please call: (305)762 -4949 Page 3 of 24 Miami Shores Village Building Department lm, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: ----- Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit No. Master Permit No. eull-6(( Permit Type: Electrical Owner's Name (Fee Simple Titleholder) /ai Q, €' `c2 "/ Phone # ' T 450- '11.4 Owner's Address %V'2' /� re City / /[ ,JA-,9 State . Zip 3-3 /' O Tenant/Lessee Name Phone # E -MAIL: nn.'� p Job Address (where the work is being done) 149 (J'J 13 5T City Miami Shores Village County Miami -Dade Zip 3 ISM FOLIO /PARCEL# jI j10t ®0'33 —In-tom Is Building Historically Designated YES NO Contractor's Company Name K5i-C./ e--ek."^ alto&G � Pit' Phone # 3O5Y• f75 "M73 Contractor's Address 4--4-7 (04 d 14 at /14c4elt S, City G� �lt a em // / State % Zip 3-5 If Qualifier Name ,o L l 4: oQ k eje—fs t/O Phone # State Certificate or Registration No. 6c41700 0/t1 Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable)1 551g 104 Phone # ' " ��' g7 7 3 9 - 7 / 7j Value of Work For this Permit $ lova Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration [ ew ❑ Repair/Replace ' " � e � 111 Demolition Describe Work: t r/ii��1 /2Q 0 "842/ tea iv, /+1��t(ti a!!��/ ��et�p°P4 /9- *xx** rx xxxx* xxxxx********************* xFeesX 9e xxoYx***x &xxxxx********x* * **x* x*x x x** xx x xxx Submittal Fee $ ), �• ,.rl Permit Fee $ .erA® fe" CCF $ CO /CC Notary $ Training /Education Fee $ Technology Fee $ Scanning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 9 (ob Radon $ DPBR $ Zoning $ 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. l 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 • subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first i A action which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection , .t be appr ve nd a reinspection fee will be charged. Signature \ \65ignature Owner or Agent The foregoing instrument was acknow edged e el , by t day of who is personally know o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: re me this '' The foregoing instrument was acknowledged before me this/ 9- Sign: Print: HELMA PETAS )9,,,1F ES October 25, 2013 14x') 3Ro -Un53 ` PloridallotarySerince.com My Commission Expires: :xx xx Kxx xxx x xxxxx xxx xww lei: *W xxr. APPLICATION APPROVED BY: (Revised 02/08/06) day of who 's .ersonally known, o me or who has produced s identification and who did take an oath. 20/L, by / NOT4,Y I PUBLIC: ;- THELMA PETAS MY COMMISSION # DD935614 Si g(40 ' 0 ,a .tarySennc? corn Prrn : rfor fa My Commission Expires: xxxxxxx xx d:xxxxxxxx xxxxxxx xxxxxxx xxxxxxxxxx x xrxxxxxxxxxxxa:xxxxxxxxxxxxxxxx � e-/ tom.. 4.a. L/ Plans Examiner Engineer Zoning 03/15/2011 01:43 15617903370 CINDY PAPANDREAS -S TAT E FARM INS 00110 P.001 /001 CERTIFICATE OF INSURANCE This =tines that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bapmingtore, Hinds Q STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Ida ❑ STATE FARM F1RE AND CASUALTY COMPANY, Scarborough. Ontario STATE FARM FLORIDA INSURANCE COMPANY, Wader Haven, Florida all STATE FARM LLOYDS. Danko, Texas insures the taming policyholder for the coverages indicated below Name of EAST OCEM ELECTRIC OF FLORIDA, INC. Address of policyholder Location of operations 4787 COCONUT ROAD S . , LAKE WORTS, FL 33461 Description of operations The policies fisted bar have been issued to the poles for tire policy periods shown_ The ins descoled in These poh es is subject to all the terms , and comirtions of those per_ The limits c4 habil sty shcarrn may have been reduced ivy any pa deka. POLICY NUMBER TYPE OF INSURANCE POUCY PERIOD mare Date ; bwatign lade UNITS OF MEIN (at !beginning of Ply Pet 96- BF- E514 -0 This insurance induce: • Comps Br*n LialbBy kg Products - CompleSed Operations kg Corte Lida! hy i 01/05/11 ; 01/05/12 • BODILY INJURY AND PROPERTY DAMAGE . Eadh Oa urren e $ 300,000 General A $ 600,000 Products — Completed $ 600,000 OPeralione Aggregate ►�� Underground Hazard Coverage - Personal injury '_' Adverllline Injury ❑ Explosion Hazard Coverage ❑ Copse Hazard Coverage 0 0 ACCESS LiAB JTY 0 Umbria POLICY Effeetti f PERIOD Dabs BODILY INJURY AND PROPERTY DAMAGE (Communed Snot Umaj Each Occuuence $ Aggregate $ • Other Workers' Compens and Ehmftlifers LtablIty Part 1 STATUTORY Part BODILY INJURY Each Acddent $ DiSeete Each Employee $ Disc - Pdbcy Limit $ PtUCY UMBER YE N ISURANCE POLICY PERIOD Effective Doie EXPird5011 Ebb LoonrS OF UABIIJ Y (at beginnkeg If Policy Iii . THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NETHER AFFIRMATIVELY NOR NEGATIVELY Ate. EXTENDS OR ALTFRR TH F CDVERAnm ADDDnWFn RY sew Dm ow nvorsomFi4'memo Name and Address of Cerlifinsde Holder mama. Shores Village Building Department 10050 NEE 214 Ave Mlan►i Shores Fi 33438 $68-0911g.3 041999 Printed In USA. If any of the described policies ere eared before its expiration date. State Fenn will Try to marl a written notice to the certificate holder 30 days before cancellatien. If however, we fail to mail such notice. no ObrIgatiOn or :, willbeimposedonStateFarm or eirffds 4Atitiortad Representative Agent Tide 03/15/2011 Da Agent's Code Sloop AF©Code 6680 6011 -EL 1059) iSN11LS3f0 10 -GO G3SIA3a 14613X3 01 NmL3 U AO 31V91411030 Z5; isles 4141 P isl*Qi4sfum aip psw y amnIDlfoo sip as pal serve sip i• mops iei asp A onions s Maim Ilsgs *a1441$ Sit lannilin s is assess, ie/ :0974 e41 P BaNI sap was lairs) is sump m slips • 1 as tows omit op 'wawa s1a is mows! sp is AWN me !e genii ep IMP 349 As M 11 sepame•a p WWI eq 11 *PO aq 01 NOW , Inkcitaufa per s4, 3* •q •1 019.41 p MOM "$1 Vero* sotto r1 unsay -skim sa w aalusl. M sawn alp as pun a34 n wawa as ns 14 we ■few Ape Aldo -"ate• eq si aepage Na eeInJ$11e7 "S'! itirn9'e►► Mrdsv a 1•mnald ',WSW 314) 4*in0 30*34 sdna n sltplefi iaea»I PM APO NMI SRI 4•31/1 rene • tie n•a!l1' • Seim Ali meats spa Nay sispahhilair seatga apt sefsu»saoa s p A11M0 W `S'! 'tt1s ' ass 3alr rt! p prpa n wino, assay • u ov9Z /so LVa N 0LLYHJIdX3 ilaZP4 LNCD .W311113313 - 3aVUL *10 Ss3Nlsf18 ) S3d03 Mee lel 0131,14 3X1 1111 OH Ivisson3 ss OM VQiaa -u JO 31040313 NW300 £YS% :SSAIaav 3WVN SS3NISF 6p0vLSBOZ :NI? dwv)13M3031 :NOSH 600Z/9Z160 :3.LV0 3A1133. •Mel uo.3esuedwo3 .QOM ep! way )dwaaa 4 U P91.11141 se4 mi4 Paull lenNAIPul 8114 MP saline sn NOI1dW3X3 AU.LSfahn NOII3 lW SNt * * MV1 NOLLVIN3JWO3 ,SKIM) Vats Mat liiVBX3 30 OL N0113311 MO 31VMI WB3 * NOIIVSN3dWO3 QOM 30 NOISIAI© SCRAMS IV1ONVNId dO INEWILIAMOG VaIbo13 SO 3LV.1.S 6002 -L1 -00 Rio 1Yklt4VNU D )011IS X3' 2OO8 T ®: rid► P FI, x► ^ . . if �CL'Bt ..'i' RIFT' EX P I'R E S: • S'e.P.7"tlif E R • • of . "' LOCATED AAT • • • • ... • 1581 BAiRiat4 PLAGI:. W l'. 04p:rON FL 33'414 Qp' • • • EAST OCEAN. FLORIDA INC . KOENEKAMP ROBERT this rioeigt:is. the`ab 'Adonis for• beginning aI I 1IIat day of October and eliding an the .:ptsay eesideraiiaa s•in•tiea'Bo a; ironisstori or••a�ctslpa $7••• • . ra!A tOtlEgTOk JI BEACH et MEN • Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163101 Scheduled Inspection Date: August 24, 2011 Inspector: Bruhn, Norman Owner: WIESE, HEISE Job Address: 149 NW 93 Street Miami Shores, FL 33150- Project: <NONE> Contractor: ART EXPRESS II LLC (1 -*scl" Permit Number: DS -3 -11 -508 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330850 Phone: (954)921 -5040 Building Department Comments EXTERIOR PAVER PATIO Passed /4( r 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- 157494. Work not ready. NB August 23, 2011 For Inspections please call: (305)762 -4949 Page 14 of 23 Atlantic Exterminating 1831 North Dixie Hwy. Tamping And Spray Pompano Beach, Florida 33060 Telephone 954 -943 -2424 "Serving Dade. Broward. and Palm Beach Counties since 1964" License #172 To the building department of Miami Shores Jn. the County of Dade Nstleo et lireventatlie Treatment hr Subttonranaan Termites. (as required by Florida Building Code (FBC) 104.2.7) (Broward County (FBC) 105.2.3 Art Express II Lot: Block: Address: 149 N.W. 93 Street Sub. Division: Miami Shores Certificate #: B 81773 Permit #: DS -3 -11 -508 Date: 6-20-11 Time: 10:45 Applicator: Tom Product Used: Bifen XTS Chemical used (active ingredient): Bifenthrin Number of gallons used: 29 Percent Concentration: .06% Area Treated Sqft: 290 Linear Feet treated: Stage of Treatment: Horizontal. As per 104.2.6 -(BC 105.2.2) If soil barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. If this notice is for the final exterior treatment, Initial and date this line NOT FINAL ,APPLICATION. leg eitc 6/20!2011 (Authorized Agent for Company) Seal FOR INSPECTION PURPOSES ONLY ** All structural dimensions supplied by contractor ** Ac 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: BUILDING OWNER: Name (Fee Simple Titleholl1er): iZ'Pa r Address: / } 9 /VG-t) 5j — City: "4 ma SLiy✓ecs C RMOTO_TrnE`, MAR 2 3 ,2131` i B Y: o e Permit No. l --":113S.-?. Master Permit No. Phone#:$ i `0 -1-7 State: cL Zip: '53 /CO Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: /1-.17 /l/oti 93/154' City: Miami Shores County: Miami Dade Zip: 33 1 Folio/Parcel#: 1 ® 3101 - d 3 — % Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Aa 6-3,0/44-51 Address: /0- V N !3 *k te, r City:/ Ai 401 / / Qualifier Name: l (0 State Certification or Registration #: CC C1 s7 / is4 a- Certificate afro mp Contact Phone#: 5 SY-N S, 3-i 1 Srj mail Address: `1'0,4$ ® :L. DESIGNER Architect/Engineer: 1+✓I haA 6-110+15- 1 ct v4,0 Value of Work for this Permit: $4434-4--- Square/Linear Footage of Work: Phone #: `' S.)-/ - SZ yv State: /='L Zip: S So/ % Pima: S�®y 9 /- CD 40 cy #: i Phone #: % �� -1/9-3- 419 it 8 oc Type of Work: UAddress Descri , Lion of Work: UAlteration 'C�,t 01— lam. rw New epair/Replace ODemolition COLOR THROUGHROOF TILE IS REQUIRED acknowledged by: 07 ******** ** *** *** ** * * * * * ** * * * * * *** ** **** Fees****** * * * * * * ** * * * * **** * * * * * * * * *** * *** *,air ** ** Submittal Fee $ 1. 1O Permit Fee $ vo CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 6 NOTICE OF COMMENCEMENT ARE S) COPY MUST BE POSTED ON THE JOB STE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO No. j1..310 I —.033 —0 CO STATE OF FLORIDA COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notes that improvements wifi x pvopertlA and in accordance with Chapter 713, Florida Statutes, is provided in thIs Notice of Commercement 11 1111 11111 11111 11 11 11111 11111 11111 111 1111 CFN 2011R01'78220 OR Sk 27623 Pa 0970; tips) RECORDED 03 /21/2011 11:25 :13 HARVEY MIN? CLERK OF COURT MIAMI -DACE COUWTYP FLORIDA LAST PAGE 6 / Space above reserved for use of recotdbsg aloe 1. Legal de/301100n property and street/address: (, ui /V 6 o c, k ineelcs se .c. i o -301 I(?.. L..-or r`1 IQ tsar t$ P Lie. 2. Description of improvement: 3.Owner(s) rare and address: H.-$ Ifs k) /.t f ¢ /4 S ,K./Pk.) 5' "=� St Acorn., tit-ores fG "3S i Interest in property: DG✓h^Ar Name and address of fee simple titleholder: c4. Contractor's mite, addresc phone number: Ir1o�• -ss O GG G _ /1}u II/ a �►-. -s /4411 vv>owl 3101 �'Str i.94 -5p 90 5. Surety: (Payment bond required by ov ner 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 pmvided by Section 713.13(1X47., 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)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Note of Commencement J a/7 ?-v // ( agitation date Is 1 year from the date of recording unless a different date is spaded) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCI3ulENTARE 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 YOUR NOTICE OF COMMENCEMENT. .Signatuie(s) Officer/Director/Partner/Manager Prepared By Prepared By Print Name 1 Wit, 6 Print Name Titles/Office Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The Instrument ww as acknowledged before me this '. Individually, or YO as 3a�Personally known, or 0 produced the following type of Signature of Notary Pubes: Print Name: (SEAL] _ILL. day of fr C.k i�. .�...lY � ..._ 0/11.• Y. # DD835614 Weber 25, 2013 r Under penalties of perjury, I declare that I have read the foregoing and that the stated in It are true, to the best of my knowledge and belief. g " (` or ► _ s)'s Authorized Officer/Director/Partner/Manager who signed above: 11116./►� / 1 123.0142 PAGES 8+10 By 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 AFJ 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 first in ection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil n r t be appr a reinspection fee will be charged. Signature 67 6-1-N Owner or Agent Contractor The forego' g instrument was ackno edged be ore me this The foregoing instrument was acknowledged befor me this day of I , 201 I , by l s> , day of t 9' , 20 1/ , by , who is me or who has produced who is + orally known to e or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My OMMISSION # DD935614 . ?pg.**. bXPIRES October 25, 2013 e' res: FloridaNOtaryService.com NOTARY PUBLIC: (407) 308 -0153 FbridallotaryService,wm My Commission J xpires: er 25, 2013 ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** dear********************** ***** ***** ** **** ****** * * * * * *** *sir * * * * * * * * * * * * * ** *ale ** APPROVED BY J 7-/0 " / Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3115/09)(rev6/4110) Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 SERRA, ALBERT J ART EXPRESS II LLC 900 E HILLSBORO BLVD DEERFIELD BEACH FL 33441 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.com. 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 license! DETACH HERE (850) 487 -1395 08/27/2010 10:41 11953 P.001 /005 AGORD. CERTIFICATE OF LIABILITY INSURANCE OATODA "°°"""'' 08/27/2010 OF INFORMATION THE CERTIFICATE EXTEND OR POLICIES BELOW.. TYPE OFIRSURANCR • Phone: ( 818}445.422 Business First Insurance Agency, Inc. 3684 Tampa Road Suite 6 Oldsmar, FL 34677 License #: 0E61983 THIS CERTIFICATE IS ISSUED AS A MATTER ONLY AND CONFERS NO RIGHTS UPON HOLDER. THIS CERTIFICATE DOES NOT AMEND, ALTER THE COVERAGE AFFORDED BY THE INSURERS AFFORDING COVERAGE RAC 5 INSURED Art Express II, LLC 1120 North 13th Terrace Hollywood, FL 33018 I _ GENERAL X acSuRER a PCICS026- PCA70077 INSURER C: 08/0312011 INSURER D: S 1400.000 INSURER E $ 60.000 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIGATE:D. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDm0N 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 CLAIM$ MR LTR AWL BAWD TYPE OFIRSURANCR POLKlTIRi i PINJCY .t. L 1 i i.;.,iu TEi' r —, Lin A GENERAL X mew', COMMERCIAL GENERAL LIABa}TT PCICS026- PCA70077 08103/2010 08/0312011 EAC+OCCu ce S 1400.000 PREMISES aeeixerwe) $ 60.000 I ClAuS NACU kJ OAR MIT IMPAAny one P 1 s 6.000 PETAL SADV INJURY s 1.000.000 GENT. Ivn GENERAL AGGREGATE s 1.000.080 $ 1 00.000 AG AGGREGATE LIMIT APPUES PER 1-1 c .PRODUCTS - COMPIOP ABC AUTOMOBILE LIABILITY ANYAIX) ALLDAUTOS SCHEDULED All= HIRED AUTOS NONOWNEDAU'TOS COUSTNED SINGLE MT s BOOBY INJURY O'er mono 8 — — Bona INJURY ( ) s PROPERTY CARTAGE (Per s . BABAGS Maury ANY ALM AIM ONLY - EAAGPENT S R cam THAN EA ACC 5 AUTO ONLY: AGG * EACH OCCURRENCE $ a I 71DEDUCTIBLEa MUM OCCUR ri CUUMS MADE RETENTION 5 ABATE S w s $ WORKERS EMPLOYERS M OFFICERABAIBER Sp[iaAL OOTAFENSTWION AND EXCitDEOT PR01l iQNS bow STATLL. I 1 jC t. EL EACH ACCIDENt ELOSEASE.EAE,ZPLDYEE $ EL DISEASE- PCUCY Lour S OWE! OIWORIFTWN OF OPERATIONS/ IODATIONS /TOWLES /EXCL1 ADDED BY13a0JM1SPEC/AL Certificate is for evidence of Insurance Only. TIFICATE HOLDER CANCELLATION City of Miami Beach 1700 Convention Center Dr Miami Beach, FL 33138 ACORD 25 (2i10V08 show; ANY or MBANK OESCRIBEDPOLICIEB BE augcsammvoces ItlEauniumu DATE TRERECIF. TIE Nd,L eet$AVOR TO MAL 10 GAYS vanes NOME TD TNR: DERTWmATR HOLM BMW 10 THE IMF; BUT FAURE TO DO SO SNAIL IMPOSE NO . ,+ OR UA4nY OF ANT KLMO MN THE MURIA ITS AGMS OR (ABP) ACORD CORPORATION 1188 Pied by ABP on August 27, 2010 at 10 4 08 -19 -2010 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. EFFECTIVE DATE: PERSON: FEIN: 08/19/2010 EXPIRATION DATE: 08/18/2012 SERRA ALBERT J 273076239 BUSINESS NAME AND ADDRESS: ART EXPRESS II LLC 1120 N 13TH TERRACE HOLLYWOOD FL 33019 SCOPES OF BUSINESS OR TRADE: 1- GENERAL CONTRACTOR 2- REMODELING IMPORTANT: Pursuant to Chapter 440 . 05(14), 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 ender 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 tiling of the notice or the issuance of the certfficate, 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 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 08/19 /2010 EXPIRATION DATE: 08/18/2012 PERSON: ALBERT J SERRA FEIN: 273078239 BUSINESS NAME AND ADDRESS: ART EXPRESS 0 LLC 1120 N 13Th TERRACE HOLLYWOOD, FL 33019 SCOPE OF BUSINESS OR TRADE 1- GENERAL CONTRACTOR 2- REMODELING IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt E Pursuant to Chapter 440.05(13), 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 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000 VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 DBA: Business Name: ART EXPRESS II LLC Receipt #:180- 235387 Business Type:GENERAL CONTRACTOR () Owner Name: THELMA LINDA PETAS Business Location: 1120 N 13 TERRACE HOLLYWOOD Business Phone: 954 -921 -5 04 0 Rooms Seats Business Opened:08 /16/2010 State/County /Cert/Reg:cGC15118 92 Exemption Code:NONEXEMPT Number of Machines: Employees 1 Machines Professionals For Vending Business Only Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: ART EXPRESS II LLC 1120 N 13 TERRACE HOLLYWOOD, FL 33019 Receipt #03A- 09- 00020234 Paid 08/16/2010 27.00 2010 - 2011 Business: Location: Class: Tax Basis: Receipt #: Begins: Expires! LLYWOOD LOCAL BUS' ■ RETAIMTHIS PORTION EORV tJRRECQ BILL DATE 09/20/10 SS TAX RECEIPT RENEWAL NOTICE ART EXPRESS II LLC 1120 N 13 'That CONTRACTOR/GENERAL 2 - 4 WORKERS 48471 10/01/10 09/30/11 UPI LF H]LLYWlith) �Z (11511M -R fttkJP:f -* i f-Li.1 Pipe: Cn Dramas ! Date_ 10/€14/1a KT Receipt no 349 Description tivantity annum 21! 48471 tJR HMO Ui NSE PAYRAlfS 1.I t1. tender aetail Di ill $ i, 9 total tendered4;I. Total pawed trans date: 18/1$1/118 Fine: 14 :11 :S4 11 l 'KU FLk YOUR PAYI T1 Previous Balance Due: New Charges Due By 09130 *: Plus 10% Penalty If Paid After 09/30: Plus 15% Penalty If Paid After 10/31: Plus 20% Penalty If Paid After 11/30: Pius 25% Penalty If Paid After 12/31: Total Amount Now Due: .00 251.00 276.10 288.65 301.20 313.75 251.00 *Detail of New Charges Due by 09130: Base: Additional Charges: Total: 251.00 251.00 x Receipt will' be issued -upon receipt ofpayment. STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Viiiage Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, ftele, (vr , does hereby attest that (Property owner) The attached survey, performed by A C 10 /vt 5 %f) v IAS (Name of surveyor's company) For address: ( %.9 W q3 5 Performed on 7-7- f (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such stru ' es may ct I inspections as applicable to this or other permits. aught. Property Owner Signature SW0 O AND SUBSCRIBED before me this 1 1+ day of Affiant is , personally known to me, produced as identification. IA lam. ft,St Property Owner Print Name ;.v�YC "•� THELMA PETAS OM" •N #DD935614 (407)398 -U 53 Revised on 5/2212009/ Revise! on 6112(09 Notityotary ernco.com Permit No: 11 -507 Job Name: April 6, 2011 Miamu Shores Y • iiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) Plans must be approved by HRS for the septic system. OK—. 2) Corrections for plumbing must be completed. c1 3) Provide a scope /p of work. Plans e all work from plans norelated tothe spa /deck• a tom - and related deck /patio. Remove STOPPED REVIEW 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 pla drawings lace with new revised sheets and include one set of voided sheets in the re-submittal Norman Bruhn CBO 305- 795 -2204 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Floiida 33138 Tel: (305) 795.2204 A Fax: (305) 756.8972 Permit No. p Job Name PLUMBING CRITIQUE SHEET Iv'fl(flQ and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Owner's Name: HEISE WIESE Job Address: 149 93 Street iami Shores, FL 33150- Contractor(s) DOLPHIN POOLS & SPAS INC Phone (954)927 -6537 Folio Number1131010330850 Owner's Phone: Total Square Feet: Total Job Valuation: Primary Contractor Yes 756 $ 8,000.00 Planning and Zoning Criteria and roved: Comments Date Denied: 3/23/2011 Approved: In Review Date App Comments: PLEASE CONTACT BUILDING TO SUBMIT PROPER PERMITS. ACCESSORY STRUCTURES OR ANY HARD PLEASE NOTE NOT MORE THAN 20% OF R THE AREA COVERED THAT IS PAST HE PROPOSED DECK. SURFACE. HAVE ARCHITECT CALCULATE PUT RIGHT SCALE ON PLANS. (fM692 .36 93 big? 60/ek (Art Express LLC) 1120N13Ter Hollywood, FL 3301f: RE: Contingency Lei: ; r Application Documer : ivo:AP1001607 Centres Permit Numl a r: 13- SC- 1312914 OVTD$ Number: 149 NW 93 St Miami, FL 33150 Lot:17 -18 Dear Applicant: This will acknowledg, existing onsite sewer: From a review of yoj is adequate for the pi If you have any quee Enclosures cc: L00 /L001j Frank Farmer, Jr., M.D., Ph.D. State Surgeon General April 25, 2011 Ilk, ,,,,i, 444.,.,,,,, p Block:133 Subdivision: receipt of an application dated 04/14/2011 for a permit to use an treatment and disposal system located on the above referenced zmpleted application, it has been determined that your existing system posed use (installation of concrete deck and pavers). ,ns on this matter, please call our offioe at (305) 623 -3500. Sincerely, Joseph Piverger, Engineer Specialist it Miami-Dade County HeeJsh Dcparnnent 17251 NW 167 St, Opn Locke, FL 33056 lone: (305) 623.3500 , Fox; (305) 623.3645 . http: //www,MyFloddaEH.com uW.t cn•en Ii67/71 .,.,.