EL-12-384Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170738 Permit Number: EL -3 -12 -384
Scheduled Inspection Date: April 04, 2012
Inspector: Devaney, Michael
Owner: PEREZ, JOEL
Job Address: 1167 NE 99 Street
Miami Shores, FL
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050180080
Phone: (305)758 -2000
Building Department Comments
INSTALLING A FREE STANDING SPA TUB IN BACKYARD.
HOUSE AND EXISTING 200 AMPS SERVICE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
J n�
////-7/2, 6)//e--
April 03, 2012
For Inspections please call: (305)762 -4949
Page 12 of 22
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 N
HAR 0 6 2i12
of :L—?4
Master Permit No.
Permit Type: BUILDING ROOFING f
OWNER: Name (Fee Simple Titleholder): J � pe-req- Phone#: W� 30d- -d-7- P-1
Address: (I (0 N E Pj ft ,4 `
City: `I A W-t 51,AeY -�S State: _L zip: 33 I -3
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: (`L 9- N E cJ "
City: Miami Shores
County: Miami Dade
Zip: 3313
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRAC OR: Company Name: IY)oo (. F r C, (NC Phone #: O C"7Sg -
Address: .ID Q .,AJ / 4() `7
I CN
City: m I lr) State: l "� Zip: /5-6
Qualifier Name: ,-.1 OW L) MOO CMG �19 % C� /�
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
/1/4)/A
Phone #:
DESIGNER: Architect/Engineer:
Phone#:
Value of Work for this Permit: $ G6-0m efb Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace
•
Description o Work: I � _ � � � � � r.� � . ""
S
A ! .16, at-4/
fie, J/ c7
( x f=t)
❑Demolition
***************************************Fee s********************************************
Submittal Fee $ Permit Fee $ / 2 G' C'
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $
CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur
Signature
0 // er or Agent 9 Contractor
The fore oing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20I2�by ��,� day of filet, 20 t2 by TdtttnZT lY',"
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissio
MARY PAT BRIGGS
..* MY COMMISSION # DD 979267
EXPIRES: May 11, 2014
iffi. ?': Bonded Thru Notary Public Underwriters
* *** **** :************ ** * ************************************************* *** * *** ** * * *** ** * **** ****** ****
keaf r
APPROVED BY We /2- �/-7,-/Z Plans Examiner Zoning
NOTARY PUBLIC:
Sign:
Print:
My Co
/Io
MARY PATBRIGGS
?.tjireMY COMMISSION # DD 979267
EXPIRES: May 11, 2014
9ondad Thru Notary PubtC Underwriters
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
REQUIREMENTS FOR POOL PERMIT
***PRIME CONSTRACTOR AND ALL SUBCONTRACTOR PERMITS MUST BE SUBMITTED
PRIOR TO PERMIT APPROVAL * **
Building permit application must be accompanied by:
El Sub permit applications (Electrical, Plumbing, Mechanical)
❑ 2 Copies of survey (no more than 7 years).
❑ If survey is older than 7 years it needs Survey Affidavit.
❑ 2 Sets of plans signed and sealed.
Show on the plans: Location of septic system, all intended setbacks of
pool, location of the pool equipment, deck and fences.
❑ Plans shall be reviewed and approved by HRS department.
❑ Residential swimming pool, spa and hot tub Safety Act form completed
and signed by owner.
❑ Swimming pool Owner's Certification form completed and signed.
❑ Restrictive Covenant Protective Pool Enclosure form completed and
signed by owner.
❑ 2 sets of manufacturer specifications for safety net, barrier or alarm.
❑ Proof of ownership.
NOTE:
1. Application fee of $250.00 due at the time of submittal for Building permit, and $50.00 for each sub permit.
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE
KNOW ALL MEN BY THESE PRESENTS:
WHEREAS, the undersigned d PAP 1 P�� is /are the fee
simple owner(s) of the following described property situated and being in Miami Shores Village, Florida:
Address: Mal" (p." tj E �I " t
Whereas, the undersigned owner(s) (J
desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows:
That the property will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade
County now in effect or hereinafter enacted.
II. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the
required enclosure is not on the subject property where the pool is located.
III. That if any of our adjoining neighbors remove any portion of their fence or wall, or if our /my property shall fail
to meet code requirements for pool barriers, we, as owners will immediately install a protective enclosure to
meet code requirements and will obtain a permit for such fence.
IV. That, I /we, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not
having the enclosure.
V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is
damaged or removed by any case.
NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that he /she will not
convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and
conditions set forth herein.
FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant
concerning the use, enjoyment and title to the above property and shall constitute a covenant running with the land and shall be
binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its
successors, in accordance of said Village then in effect.
NER SI i & PRINT
rib-[
I Hereby Certify that on this day personally appeared before
as identification and he /she
OWNER SING & PRINT
me `(/ ®cL 7 L Z and has produced ID
acknowledge that he/she executed the foregoing, freely and voluntarily,
for purposes there in expressed. ,n, ,A ,w� ��pp
SWORN TO AND SUBSCRIBED before me on this 5 day of / " aA --, 20 , 2-
(Revised 05/2209
NOTARY PUB C STATE OF FLO
MARY PAT BRIGGS
1,4 MY COMMISSION # DD 979287
*z EXPIRES: May 11, 2014
Bonded Thru Nogg Public underwriters
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
SWIMMING POOL OWNER'S CERTIFICATION
Date °‘') `L
Miami Shores Village
Building & Zoning Department
Attention: Building Official
I certify that I am the legal owner of the property described as
1 I[0 • E °I -I'l.t - , located at -C e S (A-err-5
.531-b5
In accordance with Section 33- 12(f), Code of Metropolitan Dade County, I certify that I
understand and agree that the swimming pool to be constructed at the above address cannot
be used or filled with water until separate permit has been obtained for an a pp roved safety
barrier, and such barrier erected, inspected and approved.
I further understand that this certification, however, does not eliminate the need for
obtaining a permit and erecting and approved barrier prior to final inspection and use of the
pool.
Legal 0
Note: This certification is to be submitted with a swimming pool permit application in duplicate.
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
NOTICE OF REQUIREMENTS
RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT
I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at
4q 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 in' al 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 as committing a misdemeanor of the second
degree, punishable as provid d in Section 775.082 or Section 775.083 F.S . This form must be signed
e owneriag- nt and the rime contractor.
zir
CONTRACTOR'S SIGN
mop
•
NTRACTO
,0;
RE AND DATE
'S NAME (PL
j j
NOTAR
SE PRINT)
r
I ." MARY •ie BRIGGS
_« COMMISSION # DD 979267
- *+
EXPIRE.. thy 11, 2014
SiY'd eed Thy, Urtdefwrneis
0
NER'S " "GNATURE AND
)0e p- C�
0W'S NAME (PRASE
n
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INT)
" MARYPATBRIGGS
?o: __* MY COMMISSION # DD 979267
EXPIRES: May 11, 2014
f.W ;, Banded Thru Notary Puhpc Underwriters
5 SGT i >
STATEMENT OF PRODUCT COMPLIANCE
Model year: 2010 and 2011, domestic
Factory-Built Electric Hot Tub Products:
880 Series: Maxxus". Optima TM Cameo TM Capri ", Majesta'M, AltamarTM, MarinTM
780 Series: Hamilton' , Chelsee", CertatM, Camden", Dover"
680 Series: Hawthorne", Hartford", Burlington TM, Denali", Tacoma"
The models listed above meet the following standards:
• UL 1563 (5th Edition) — Electric Spas, Equipment Assemblies and Associated Equipment
. Can /CSA -C22.2 No. 218.1 -M89 — Spas, Hot Tubs and Associated Equipment
• Virginia Graeme Baker Act — Sections 1401 -1404
• ASME A112.19.8 -2007 - Suction Fittings for Use in Swimming Pools, Wading Pools, Spas, and Hot Tubs
• ANSI Z124.7 -97 - Prefabricated Plastic Spa Shells / Uniform Swimming Pool, Spa and Hot Tub Code
. ASTM F 1346 -91 - Standard Performance Specification for Safety Covers and Labeling Requirements for
All Covers for Swimming Pools, Spas and Hot Tubs
. California Energy Commission 2007 Appliance Efficiency Regulations. California Code of Regulations,
Title 20, Sections 1601 -1608
• Products carry the following marks: ETL, USPC
Laboratory Testing Performed at Sundance Spas, Inc. and by:
Intertek Testing Services (ETL)
25791 Commercentre Dr.
Lake Forest, CA 92630
IAPMO R &T
5001 East Philadelphia St.
Ontario, CA 91761
Person Maintaining Records of Compliance:
Tony Sadati
Sundance Spas, Inc.
14525 Monte Vista Avenue
Chino, CA 91709
800 - 883 -7727
www.sundancespas.com
Updated 1 -11 -2011
5582 N.W. 71h STREET. SUITE 202
MINA FLORIDA 33128
TELEPHONE; (305)264-2660
FAX: (305) 284-0229
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TELEPHONE; (305) 264 -2660
FAX: (305) 264-0228
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