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BPP-12-272Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 175842 Permit Number: BPP -2 -12 -272 Scheduled Inspection Date: July 30, 2012 Inspector: Bruhn, Norman Owner: MARIA GONZALEZ, ISABELLA DCTDI 17C1 1 1 Job Address: 9546 NW 1 Avenue Miami Shores, FL Project: <NONE> Contractor: GRAY DOLPHIN POOL Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010240240 Phone: (305)207 -0606 Building Department Comments POOL AND DECK Failed 7.f3 I Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 175583. CREATED AS REINSPECTION FOR INSP- 170034. all gates must be self closing self latching. NB *open invoice* ec July 27, 2012 For Inspections please call: (305)762-4949 Page 19 of 37 t Miami Shores Village Building Department is 9.2. tl ` SArI DetKA. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 B DING PERMIT APPLICATION FBC 20 Permit No. Master Permit No. Permit Type: BUILDING P' OOH. OWNER: Name (Fee Simple Titleholder): SA 661 A- Pliyw7-244/1.: 3 • 79/- Address: City: 9 4/10, N ) I Ave A 4 iti 5'I4.v '_ state: 17 Tenant/Lessee Name: Zip: 33/ Phone#: Email: JOB ADDRESS: 4511 0 Ai- CO City: Miami Shores Folio/Parcel #: 11 ' 31 01- (2 - Qa.alb Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: City: Qualifier Name: County: I`7 Miami Dade NO Zip: 33/.7 Flood Zone: 001Qh A Pepi �/Tl L7Lp one#: &g - c. oc F ( zip: `-'3 30S- - - O&()6 Phone#: State Certification or Registration #: • / C— % U5 5 1 Certificate of Com tency #: Contact Phone#: Flo (-i ll� l� �J'« ail Address: C-4441 D('/ h fd C(�/� (�/ I DESIGNER: Architect/Engineer: Tf/L.� SI �! z(tpe Z 1l Phone#: 6 6, - 5d- Value of Work for this Permit: $ ' I CD e (7°0 Footage of Work: 3CPC) '41b) / 46.3 s Type of Work: °Addition °Alteration ew °Repair/Replace °Demolition Description of Work: ?oiT\ . ** **a** *a** ***** ****aa *1£1** * *** x******F ****** *****+x ****************e *ae.a * *ova **** ** Submittal Fee $ > d 111, Permit Fee $ L/ t. CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Doable Fee $ Structural Review $ 0 d TOTAL FEE NOW DUE $ • i qw 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 CONDMONERS, 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 c be posted at the job site for the first inspection which occurs seven (7) days after the building permit is • ued. In � / ' such posted notice, the inspection will not be approved and a rpinspection fee will be charged Signature Signs Owner or Agent The foregoing instrument was acknowledged before me this /3 The foregoing ins u' ent was acknowledged before me this I day of fe67a 20 L, by Asa 004 r3-12,02-€1; , day of 20 Irol; by glalei, 4_ who is personally own to me or who has produced ' who is a known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: ************************ �********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (5J1/Ir// * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY G�' "�J `)J t14— Plans Examiner 2 Zoning (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Structural Review Clerk Licensing Portal - License Search Page 1 of 2 3:30 :14 PM 4/27/: Data Contained In Search Results Is Current As Of 04/27/2011 03:28 PM. Search Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Type Name Name Type License Number/ Status /Expir Rank Certified GRAY DOLPHIN Pool /Spa POOLS & DBA CPC1457551 Current, Acti% Contractor CONSTRUCTION, Cert Pool 08/31/2012 INC. Main Address *: 16225 SW 117 AVE # D14 MIAMI, FL 3317/ Certified CPC1457551 Current, Acti% Pool /Spa LOPEZ, RAONEL Primary Cert Pool 08/31/2012 Contractor Main Address *: 16225 SW 117 AVE # D14 MIAMI, FL 3317 * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 : : CaII.Center @dbpr.state.fLus :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Copyright 2007 -2010 State of Florida. Privacy Statement https:// www .myfloridalicense.com /w111.asp ?mode =2 &search =L... 4/27/2011 ' Search 2 of Licensing Portal - License =�uu�u ^ ��� �� �u � Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at �++,~� � � � 1 ^^^�=.'' ,, ,, ,~.^^^�"^�^�~""�^�=����=.=�^^� ,~�" ",��^�^^~^~"= ^~=��°=°=^^ ��..~ .'^~..^~~� ^ 'DBPR - LOPEZ, RAONEL; Doing Business As: GRAY DOLP... Page 1 of 2 Licensee Details Licensee Information Name: LOPEZ, RAONEL (Primary Name) GRAY DOLPHIN POOLS & CONSTRUCTION, INC. (DBA Name) Main Address: 16225 SW 117 AVE # D14 MIAMI Florida 33177 County: DADE License Mailing: LicenseLocation: 3:30:46 PM 4/2712( License Information License Type: Certified Pool /Spa Contractor Rank: Cert Pool License Number: CPC1457551 Status: Current,Active Licensure Date: 10/19/2007 Expires: 08/31/2012 Special Qualification Effective Qualifications Residential Pool /Spa 10/19/2007 Contractor Construction 10/19/2007 Business Fingerprint https:// www. myfloridalicense .com/LicenseDetail .asp ?SID= &id =... 4/27/2011 GRAYD -1 OP ID: NR , t VRE 0.,,.r.- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/07/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 305- 262 -0086 3UTLER, BUCKLEY, DEETS INC. 3161 BLUE LAGOON DR., STE 420 MIAMI, FL 33126 3randon W Butler CONTACT BRANDON BUTLER PHON` PHO (Aic, No, x:305 2620086 (FA/'°xc No): 305-262-0187 LTR6s: BBUTLER@BBDINS.COM INSURERS) AFFORDING COVERAGE NAIC # INSURER A : NAUTILUS INSURANCE COMPANY LIABIUTY COMMERCIAL GENERAL LIABIUTY INSURED Gray Dolphin Pools Construction, Inc. Inc. & J & M Pools 16225 SW 117 Ave #D14 Miami, FL 33177 INSURER B : SCOTTSDALE INDEMNITY NN145257 INSURER C 06103/12 INSURER D : $ 1,000,000 INSURER E : $ 50,000 INSURER F : $ 5,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH 'RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO P&L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR _TR TYPE OF INSURANCE .T•01.. INSR SUBR" WVD - POLICY NUMBER POUCY EFF (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) UMITS A GENERAL X LIABIUTY COMMERCIAL GENERAL LIABIUTY X NN145257 • 06/03/11 06103/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea ocamance) $ 50,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ - 2,000,000 GEN'L AGGREGATE LIMIT APPUES PER POUCY n 578,-- n LOC $ B AUTOMOBILE X LIABILITY ANY AUTO OOVWNED � HIRED AUTOS X X SSCCH.EEDULED OS A QED - CA10048075 06/02/11 06/02/12 COMBINED SINGLE LIMIT (Ea accident) 300,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ +� WORKERS COMPENSATION AND EMPLOYERS UABILI1Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 'f IP yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A WC STATU- TORY LIMITS OTH- ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L DISEASE: POUCY LIMIT $ Commercial Applica . ERTIFICATE HOLDER IS USTED ADDITION AL ACORD NSUUREb WITH IREGARDSS TO GENERALS required) _!ABILITY. CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 N.E. 2 nd Avenue Miami Shores, Florida 33138 305- 795 -2204 fax 305 - 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCP 1 FD BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MIAMI- DADE COUNT" 1""illif + #�e{ r Qpq 2�J$ BSPA�I �IP 11 i 2012 TAX COLLECTOR M AD U ST O L I A 140 W. FLAGLER ST. EXPIRES SEPT. 30, 2012 1st FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL 33130 PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 493287 -8 THIS IS NOT A BILL — DO NOT PAY RENEWAL BUW W WWPO LS & CONSTRUCTION STATE W1N 57551 INC 16225 SW 117 AVE D14 33177 UNIN DADE COUNTY OWVRY DOLPHIN POOLS & CONSTRUCTIO "c1 'OEM Tv PLUMBING CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CMES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUAUFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 09/26/2011 02220026001 000075.00 SEE OTHER SIDE WORKER /S 3 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 515031-3 DO NOT FORWARD GRAY DOLPHIN POOLS & CONSTRUCTION INC ROBERTO LEON PRES 16225 SW 117 AVE D14 MIAMI FL 33177 84 JEFF ATWATER • CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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. 05-05 -2011 EFFECTIVE DATE: PERSON: FEIN: 05/05/2011 EXPIRATION DATE: 05/04/2013 LOPEZ RAONEL 651110609 BUSINESS NAME AND ADDRESS: GRAY DOLPHIN POOLS & CONSTRUCTION INC 16225 SW 117TH AVE # 014 MIAMI FL 33177 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED POOL /SPA CONTRACTOR 2- CONSTRUCTION IMPORTANT: Pursuant to Chapter 440. 05(141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), 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 440.05(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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 -160 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 05/05/2011 EXPIRATION DATE: PERSON: RAONEL LOPEZ FEIN: 651110609 BUSINESS NAME AND ADDRESS: GRAY DOLPHIN POOLS & CONSTRUCTION INC 16225 SW 117TH AVE @ D14 MIAMI, FL 33177 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED POOL /SPA CONTRACTOR 2- CONSTRUCTION 05/04/2013 IMPORTANT • F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who 0 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 R 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 01 -11 A RIMMED MME NC MERLE s:stiE:AT TIM (W Ft CFN: 20120 •7460 BOOK 28074 PAGE 1423 DATE:04/16'.012 0.1:39:47 PM FORVEY R IN; CLERK OF COURT, MIA9ADE CTY DE SIONEI? i' teby gives .notice• property, Oct M:at ordance: with Chapter 713', is provided in thialloticedf Carnritence . . Le9al :des—Oil 2:.Desciiptionaf improver Owner(SI name an Interest in :pt`opy . : Nam*.. and addi 4. Coate or's•I kites- ,?a4m Surety {Payment bond 04u04 Na te, address aiatf'phone riun i err Amgiynt df'bor $ ' 6 ."Lende?s nai: a and address 7 Persciii +4+r iili the - to of Hon da d nated -by.-Owner upon whoiat':r are ott*- dbauments rr j i s n" '13:1.3(.1)(07 floc - Statutes,' nie; 41:tfreig. ';046‘.04.616.67.4 v :A. to adciitiorf to`tir-tseif. OV+ti ti 71'3:13(1`X?)Y idle tatUtes;;= Na iis;. i! 'ts a tci' • icjnitoiimbet "sewed as ded'.b ollowir g; t (s) tO:Receive`i Quilt Lilof's..Notibe Spitiided-'i , tion. e of -thie. -WARNIN ':It ER: 40. PAM PATS MAO E BY IMRAOPER P YMENTS UNDER CHAPTER 713, !. IMPROVEMENTS TO -LOUR PFRORER 'I A NO11 E :FIRSTiNSPECTION: IP YOU INTEND TO OBTAIN FI OR RECORDING PietOriDINC3,1yOUPt NOTICE OF COMMENCEMENT Oriiii0oir:-dattivzi yeear't ii t)ie cii'etr ot rotokiiing twiless'iafterent.date .1 pecifled} EOWNEIAFTERTH1 13ATION.•$F NO11GG'Q�C OMMENCEMENTAttE.CONSIDEREi ' -` i rSEOVON 713:13. FL. $TAT S,.AND.cAN RESULT IN • ! YI' TWICEFQR COMMENCEMENT MUST SE RECoRDE0 ANCIPOSTO ` E JOB. ; ORE THE DING, CONSULT WITH VOW LE DEFTOR AN'ATFORN 0 WORlt ifirr s) n er,/P s::or erts): "AuthOrd . <Prririt-:Name: .Tine/Office,.. STATE `OFtfLOII QA. l' e':foregaiiig instru mCent:wr s.anitFit • p lndluid tally{, or : a;3.. ..:.fora a•, 'f? ilY: uR r Est u4 d t e fbliowi of iidentifi . • $iqr. atiirc f I otary Pithlic* Under .penalties of Pe ry, I. declare Marl d. the fore ping that trio::facts' etated4n it are true, � e;t ofiti y knowi..adge nd: belief:.: Signr re(s) of £ re`{s) p ,q'. er(s)'s At onzet!'.Offi /Director/P` I�ai IL O:�' s -s2 -tea vci IVilami 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: (� j WHEREAS, the undersigned ..7-54444- 1� & ` '' is/are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: 6) 5 WO /V IV /fie' . //�� .� c 9:34 s4 F / 3 3 /S� Whereas, the undersigned owner(s) < Set- ''/�.4 Aik 77 desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) da(es) hereby declare and agree as follows: 1. 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. 11. 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 loci. 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, Uwe, as owners) hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is damaged or removed by any case. NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declares) that this covenant is intended and shall constitute a restrictive covenant concerning the use, enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding upon the undersign 3 , his/her successors and assigns and may only be released by Miami Shores Village, or its successors, in accordan of said Village then in effect. OWNER SIGN & PRINT OWNER SING & PRINT 1 Hereb `Certify thaan this day personally appeared before me . •It Add and has produced ID / AP as identification and he/she acknowledge that a executed the foregoing, freely and voluntarily, for purposes there In expressed. SWORN TO AND SUBSCRIBED before me on this / 3 day of (Revised 05/2209 SAMANTH MY comMissION # EE153071 EXPIRES: December 14, 2015 1.800. 44mARY W. Notary DYtmmnt ASSOC. Co. 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 Date any Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as P- 4rwz2eM ; , located at 0i 5A1(400 tt) A-A- -k $ ,9 )$' In accordance with Section 33- 12(f), Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting and approved barrier prior to final inspection and use of the pool. Legal Owner 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 511 G Ad . 1 r 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. 54U 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. Requirements, and upon expiration of the permit, the pool shall be pr = ed to e . I derstand that not having one of the above installed will constitute a ., an d will be considered as committing a misdemeanor of the second vlded in Section 77 or Section 775.083 F.S his form must be signed the prime co OWNER'S SIGNATURE AND DATE Pool Alarms 1 Techko S 187D 1 Door Alarms' Window Alarm rig Pools Store Search Ice sj ;4i3�$ Page 1 of 3 Find all your pool supplies including pool heaters, liners, filters, cleaners, winter covers, alarms, above ground pool liners, and all your above ground pool products. Home Pool Filters Pool Cleaners Pool Heaters Pool Pumps Pool Alarms Pool Liners Techko Safe Pool - Area Entry Detector with Two Bypass Buttons and Magnetic Sensors - Techko -S187D View Larger Image Our Price: $26.00 Retail: $394G Product SKU: Manufacturer: w Shipping: Stock Status: Techko-8187D Techko Free Shipping, Guaranteed Low Price! Usually ships within 24-48 hrs. of processing order. Pool Parts Welcome SPE Shopper Click Here to Register Your Shopping Cart Qty Product Price 1 Techko Safe Pool- 826.00 Area E Product Information Techko Safe Pool - Area Entry Detector with Two Bypass Buttons and Magnetic Sensors The Safe Pool is designed to sound a loud alert when children enter through a safe pool protected door /gate. When properly installed, the Safe Pool will allow adults to pass through the protected door/gate and immediately shut off the sounding alarm. When powered, the Safe Pool is always is always in protected mode. The alarm will activate the instant when the door /gate opens by more than 1 inch.) Once the alarm activated, it will sound continuously until the BYPASS buttons is pressed. REPLACEMENT FOR THE OLD MODEL S087 - NEW MODEL NOW INCLUDES another bypass button allowing entry back from the pool area without sounding the alarm, and also an additional magnetic sensor - this way your alarm can monitor both the sliding glass door and/or the screen door! Additional Image - Information Features: • Easy Installation for gate or door protection • Water / Weather Resistant • 9 Volt Battery Power — Not Included • High output 110 dB Alarm siren • (2) One button BYPASS Operation • Complies with UL 2017 • 3 Year Warranty This product does not replace the need for adult supervision of all persons In the pool area. It Is not a life saving device. It is an aid to a multi level program of pool safety including adult supervision, knowledge of CPR, and swimming instruction for all persons using the pool or pool area. It is intended for use on residential pools only and the manufacturer assumes NO responsibility for injuries or consequential property damage while this product is in use on a swimming pool. Proper installation and maintenance are the sole responsibility of the pool owner. http://www.swimmingpoolsetc.comitechko:pool-alarms.htm Subtotal $26.00 Gift Certificates SHRRE ` ,-, Support- Returns- Tracking 0243-12 1:173118 PST tweet share 11.17 -11888 f 2/15/2012 18.00' ASPHALT PAVEMENT 2 N.W. 1st AVENUE \xi MOO' PARKWAY .00' (R&M) �.., 4ZZ d 73.50' (R&M) 5.00' CONE SIDEWALK 1.6 ,9fi'0 r 0 50 12.55' 0 3 20.40' 0 1.6' ASS 4, JAYE 73.50'SR &M) 15' ALLEY 8.00' ASPHALT PAVEMENT Property Address: 9546 N.W. 1 AVENUE MIAMI SHORES, FL 33150 249YBYtlR'S ckFf!iF1CAT1I : 1a4EWESYCERrFY -4403—DtM vraoiresw P3if' AT€E%Z AWE ccosteeT SREPRESENIPMN Cir AMINE'? WOWEBak69Efi NY FII;ffiCOICR+T& THE 6i tliSJB! TEPi At' ;.:��s. A� ScY&9R'PiE 9ti 4@L$ titNrE OF FLORZDAEONIO 07 PRO LAM '; y*" ° .-3-- ''"68G97. PLe E3ftA RTiVi'ZOE PAIRERIANT Tba72:071. FIFYFe0M1z SIGNED IIRGUEL E STATE OF RIM P.S.M. NO. 3101 Survey: A -24744 Notes: NO NOTES MIGUEL ESPINOSA LAND SURVEYING, INC. 10665 SW 190TH Street Suite 3110 MIAMI, FL 33157 PHONE:(305) 740 -3319 FAX #:(305)669 -3190 LB # 6463 Accepted By: Page 1 of 2 Not valid without all pages. PROPERTY UNE STRUCTURE = CONC. ROCK WALL CHAIN-LINK FENCE OR WIRE FENCE —, — /f— WOOD FENCE IRON FENCE EASEMENT --- CENTER UNE —x —x- E3 EECO c.u.E. LG /EE U.E. WOOD DECK CONCRETE ASPHALT BRICK / TILE WATER APPROXIMATE EDGE OF WATER COVERED AREA TREE POWER POLE CATCH BASIN COUNTY UTC.IY EASEMENT WGPESS / EGRESS EASEMENT UTILITY EASEMENT END LBI W GUS SET • 0 ELEV P.T. P.C. P.R.M. P.C.C. P.R.C. P.O.C. P.C.P. M LML R.O.E. Surveyor's Legend FOUND IRON PIPE / PIN AS NOTED ON PLAT LICENSE B - BUSINESS LICENSE # - SURVEYOR CALCULATED POINT SET PIN CONTROL POINT CONCRETE MONUMENT BENCHMARK ELEVATION POINT OF TANGENCY POINT OF CURVATURE PERMANENT REFERENCE MONUMENT POINT OF COMPOUND CURVATURE POINT OF REVERSE CURVATURE POINT OF BEGINNING POINT OF COMMENCEMENT PERMANENT CONTROL PONT FIELD MEASURED PLATTED MEASUREMENT DEED C ATED LAKE OR LAIGLSCAPE MAINT. ESMT. ROOT OVERHANG EASEMENT R.R. RAD. TYP. I.R. I.P. 580 PK NAIL D.N. 5.11. 0.N.L .TX CAN W.N. P/E CONC. E5MT D.E. L.R.E. L.A.E. BEARING REFERENCE CENTRAL ANGLE OR DELTA RADIUS OR RADIAL RADIAL TIE 1105 RADIAL TYPICAL IRON ROD IRON PIPE NAIL 8 DISK PARKER -KALOR NAIL DRILL HOLE WELL ARE HYDRANT MANHOLE OVERHEAD LINES TRANSFORMER CABLE TV RISER WATER METER POOL EQUIPMENT CONCRETE SLAB EASEMENT DRAINAGE EASEMENT LANDSCAPE BUFFER EASEMENT LOOTED ACCESS EASEMENT TEL UP. E.U.B. 5EP. O.F. A/C S/W DRY SCR. GAR ENCL. N.T.S. F.F. T.O.B. E.O.W. EO.P C.V.G. B.S.L. S.T.L 1 R/W P.U.E. C.M.E. A.E. TELEPHONE RACWTIES UTILITY POLE ELECTRIC UiIUTY SOX SEPTIC TANK DRAINnflA AIR CONDITIONER SIDEWALK DRIVEWAY SCREEN GARAGE ENCLOSURE NOT TO SCALE FINNISHED FLOOR TOP OF BANK EMIE OF WATER EDGE OR PAVEMENT CONCRETE VALLEY GUTTER BUILDING SETBACK UNE SURVEY TIE UNE CENTER LINE RIGHT-OF-WAY PUBLC UTR.TLY EASEMENT CANAL MAINTENANCE EASEMENT ANCHOR EASEMENT 9546 N.W. 1 AVENUE MIAMI SHORES, FL 33150 0 0 N M A P N 0 T T 0 s c A L E Community Number Panel Number. Suffix: Date of Firm Index: Flood Zone: Base Flood Elevation: Date of Field Work: Date of Completion: MIAMI SHORES/ 120652 0302 L 9/11 /2009 X N/A 8/18/2011 8/19/2011 General Notes: 1. The Legal Description used to perform this survey was supplied by others. This survey does not determine or is not to imply ownership. 2. This survey only shows above ground improvements. Underground utilities, footings, or encroachments are not located on this survey map. 3. If there is a septic tank, well, or drain field on this survey, the location of such items was shown to us•by others and the information was not verified. 4. Examination of the abstract of title will have to be made to determine recorded instruments, If any, effect this property. The lands shown herein were not abstracted for easement or other recorded encumbrances not shown on the plat. 5. Wall ties are done to the face of the wag. 6. Fence ownership is not determined. 7. Bearings referenced to line noted B.R. S. Dimensions shown are platted and measured unless otherwise shown. 9. No identification found on property comers unless noted. 10. Not valid unless sealed with the signing surveyors embossed seal. 11. Boundary survey means a drawing and/or graphic representation of the survey work performed in the field, could be drawn at a shown scale and/or not to scale. 12. Elevations if shown are based upon NGVD 1929 unless otherwise noted. 13. This is a BOUNDARY SURVEY unless otherwise noted. 14. This survey Is exclusive for the use of the parties to whom it is certified. The certifications do not extend to any unnamed parties. Certified To: ISABELLA PETRUZLZELLI AND M ILIA FABIOL GONZALEZ, CLEAR TITLE SERVICES, INC., OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY, , . Its'successors and /or assigns as their interest may appear. Legal Description: LOT 2 AND THENOR"h 1/2 OF LOT 3, BLOCK 5, OF SUBDI fS I BONMAR PARK, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 17, PAGE 11, OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA PRINTING INSTRUCTIONS: While viewing the survey in any Acrobat Reader, select the File Drop -down and select "Print" Select a color printer, if available, or at least one with 8.5" x 14" paper. Select ALL for Print Range, and the # of copies you would like o print out. Under the "Page Scaling" please make sure you have selected "None." ;Do not check the "AutoRotate and Center" button. Check the "Choose Paper size by PDF"checkbox. Click OK to Print. MIGUEL ESPINOSA LAND SURVEYING, INC. 10665 SW 190TH Street Suite 3110 MIAMI, FL 33157 PHONE:(305) 740 -3319 FAX #:(305)669 -3190 LB # 6463 Survey: A -24744 Page 2 of 2 Not valid without all pages. U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -9. SECTION A - PROPERTY INFORMATION Al. Building Owner's Name ISABELLA PETRUZZELLI A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 9546 NW 1 AVENUE City MIAMI SHORES State FL ZIP Code 33150 OMB No. 1660 -0008 Expires March 31, 2012 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 2 & NORTH 1/2 LOT 3 BLOCK 5 P.B. 17 PG. 11 A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) A5. Latitude /Longitude: Lat. 25 °51'47" Long. 80 °12'00" A6. Attach at least 2 photographs of the building if the Certificate is being used A7. Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1258 sq ft b) No. of permanent flood openings in the crawlspace or enclosures) within 1.0 foot above adjacent grade 14 c) Total net area of flood openings in A8.b 1452 sq in d) Engineered flood openings? ❑ Yes No RESIDENTIAL Horizontal Datum: ❑ NAD 1927 ® NAD 1983 to obtain flood insurance. A9. For a building with an attached garage: a) Square footage of attached garage 200 sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes ® 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 12086C / 0302 L Date Effective /Revised Date Zone(s) AO, use base flood depth) 9/11/2009 9/11/2009 X N/A B10. 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) BI2. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes Designation Date N/A ❑ CBRS ❑ OPA ® 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/A0. Complete Items C2.a -h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized DCBM Vertical Datum N.G.V.D.1929 Conversion/Comments NONE a) b) c) d) e) f) g) h) Top of bottom floor (including basement, crawlspace, or enclosure floor) 10.40 Top of the next higher floor 12.31 Bottom of the lowest horizontal structural member (V Zones only) N/A. Attached garage (top of slab) 10.60 Lowest elevation of machinery or equipment servicing the building 10.75 (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) 10.40 Highest adjacent (finished) grade next to building (HAG) 10.49 Lowest adjacent grade at lowest elevation of deck or stairs, including N/A. structural support Check the measurement used. ® feet ® feet ❑ feet 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) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ 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 MIGUEL ESPINOSA License Number 5101 Title P.S.M. Company Name MIGUEL ESPINOSA LAND SURVEYING, INC. Address 10665 SW 190 STREET SUITE 3210 City MIAMI State FL See reverse side for continuation. Digitally signed by Miguel Espinosa DN: cn =Mig ,pirjosa, c=US, o= Miguel E ^. Land Surveying, in 3A S.M. 5101, email=mikeamplesalandsurve ying.com Reason: I am the author of this document Location: Miami, Florida Date: 2012.02.10 18:14:26 - 05'00' Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt, Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 9546 NW 1 AVENUE City MIAMI SHORESState FL ZIP Code 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 HIGHEST CROWN OF ROAD = 10.58 LATITUDE/LONGITUDE PER GOGGLE ATTACHMENTS = BUILDING PICTURES C2e = A/C UNIT Signature Date 1 -31 -2012 ® Check here if attachments SECTION E - BUILDING ELEVATION 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 El -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 are 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. 01. ❑ 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 010. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name Community Name Signature Comments Title Telephone Date ❑ Check here if attachments FEMA Form 81 -31, Mar 09 Replaces all previous editions PERMIT #: ILA 19-- R12-% I, neG.- € d 2 -. Contractor o Owner o Architect Miami Shores Viiiage Building Department RECEIPT DATE: rd0 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Ter: (305) 795.2204 Fax: (305) 756.8972 From the building department on this date in order to have corrections done to plans And /or get County stamps. I un Shores Village Buildin Acknowledged eed to be brought back to Miami PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)758 -8972 Permit NO. B P P -2 -12 -272 Issue Date: Not Issued Expires:Not Issued Folio Number:1131010240240 Owner's Name: ISABELLA PETRUZELLI MARIA GONZALEZ Job Address: 9546 1 Avenue Miami Shores, FL Owner's Phone: Total Square Feet: 360 Total Job Valuation: $ 16,000.00 Contractor(s) GRAY DOLPHIN POOL Phone (305)207 -0606 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 2/21/2012 Comments: POOP EQUIPMENT MUST BE LOCATED NOT LESS THAN 10 FEET FROM SIDE LOT LINE Permit No: 12 -272 Job Name: February 23, 2012 Miami Shores Vuuage . Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Building Critique Sheet 1) Provide approval from Miami Dade County Health Dept. (DOH /HRS) 2) Provide corrections for zoning and plumbing. Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 762 -4859 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: Date: Z— 1 ` — ( Permit #: 7�— Plumbing Critique Sheet Aje,ed /ter — Review Completed by: Rafael Hernandez Chief Plumbing Inspector 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 Folio Number:1131010240240 Owner's Name: ISABELLA PETRUZELLI MARIA GONZALEZ Job Address: 9546 1 Avenue Miami Shores, FL Owner's Phone: Total Square Feet: 360 Total Job Valuation: $ 16,000.00 Contractor(s) GRAY DOLPHIN POOL Phone (305)207 -0606 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 2/21/2012 Comments: POOP EQUIPMENT MUST BE LOCATED NOT LESS THAN 10 FEET FROM SIDE LOT LINE Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \-- Inspection Number: I NS P- 170040 Scheduled Inspection Date: June 29, 2012 Inspector: Hernandez, Rafael Permit Number: PL -2 -12 -345 Owner: MARIA GONZALEZ, ISABELLA ocTDI I7cr 'Avenue Job Address: 9546 NW 1 Avenue Miami Shores, FL Project: <NONE> Contractor: GRAY DOLPHIN POOL Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010240240 Phone: (305)207 -0606 Building Department Comments POOL PIPING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 28, 2012 For Inspections please call: (305)762 -4949 Page 1 of 7 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: PLUMBING OWNER: Name (Fee Simple Titleholder): RECEIVED FEB 16202 TY: - Permit No. R-1 395 Master Permit No. (6PP 1 2 ..7":5;e1 ` '` /4 74 2e // Phone#: 36 ✓i/� -���� Address: cZJr A- / — City: U (44;4, b'ru. State: f( Zip: 33/s—r..7 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: q 5-V 6f N, W / AA City: Miami Shores County: Folio/Parcel #: 1/ — 3/0 O f0 Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: 4c;125 5 . (A) /% tlee. '/ /V•- City: 441 1(4,1 Qualifier Name: 2- 03CAiet State Certification or Registration #: Contact Phone#: 7-56- ` lib . (13 Miami Dade NO / Flood Zone: deikil &,1„9/, Phone#: O &(, State: / Zip: %'3 / 2- Phone#: C /' 5 7 5 V Certificatee/ of d! Co petene & # • , //,h " )Email Address: � DESIGNER: Architect/Engineer: 0 Value of Work for this Permit: $ Type of Work: °Address °AlPIft» tion Description of Work: 1 Phone#: 3%'• ear Footage of Work: DRepair/Replace °Demolition ** ***** * **a *****+a**** x*+r******+ *F ************** ** ****a»a*e **** * * * ***se** *vie *** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ 2,2, CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ TOTAL FEE NOW DUE $ ?. •3'� 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, BOJT ERS, 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 broch livered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of co = - 'r`? must be osted at the job site for the first inspection which occurs seve (7) days after the building permit is is h posted notice, the inspection will not be approved :t a re # ection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 15 day of FeAti4A, , 20 0—, by ,1 , day of who is personally known to me or who has produced Fi 4 U5 who is pers As identification and who did take an oath. Contras The foregoing instrument was acknowledged before me this 13 NOTARY PUBLIC: Sign: Prin My Commission xpires. el- own to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission ******** rA+ R** * **+kB+R*** # *** ** *** * * * ** k+R **i RJR**** *6« k*+ kaRK:***** *+ R*********+ R**************** ****iR *+Y+i**+R** ****** *** APPROVED BY 3-2-(-1.2--- Plans Examiner Zoning (Revised 07 /10107)(Revised 06/10/2009)(Revised 3/15109) Structural Review Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 oi OPP-k2 -212_ Inspection Number: INSP- 170033 Permit Number: EL -2 -12 -271 Scheduled Inspection Date: July 02, 2012 Inspector: Devaney, Michael Owner: MARIA GONZALEZ, ISABELLA Job Address: 9546 NW 1 Avenue Miami Shores, FL Project: <NONE> Contractor: ELECTRICAL MASTERS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1131010240240 Phone: 305 - 265 -7996 Building Department Comments POOL ELECTRICAL HOOK UP Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 29, 2012 For Inspections please call: (305)762 -4949 Page 4 of 38 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) 962.4949 i BUILDING Permit No. — PERMIT APPLICATION Master Permit No. FBC 20 RECEIVED FER 16 2012 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder):, 7a4 V/1 4/Z?%'/' Phone#: 3 , 3V- Address: %'56 4 /14 ti) /# - City: qt • g State: Zip: 3..3/ Tenant/Lessee' Name: Phone#: Email: JOB ADDRESS: 951/1( 4j, /d City: Miami Shores ,' l' County: Miami Dade Zip: "3 34-4`0 Folio/Parcel #: I / " 3/0/ ( p 1 - Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 2X:6 .4. Phone#: ?$ • 3 S P-94- Address: at/00 C -(ev /(s� City: J!M tate: f Zip: 33/4 Qualifier Name: (s l/# (t9, e�+7 eli f 0 'L Phone#: State Certification or Registration #: 1)01 O5 7 Certificate of Competency #: t -WOO 3 Contact Phone#: U Ua, Email Address: DESIGNER: Architect/Engineer: j'P/111., Si t ?L Lk ° Z Phone#: ,:gtA"' ' Value of Work for this Permit: $ 'O 0 / Type of Work: °Address �j°Alteration ►? ew Description of Work: j tj f/9t°., c4 II! 11 ear Footage of Work: ORepair/Replace °Demolition Submittal Fee Permit Fee $ .14V r") CCF $ CO /CC $ Sunning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Eduration Fee $ Technology Fee $ Double Fee $ Structural Review $ 1 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 reinspec '.n fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this dl The foregoing instrument was acknowledged before me this l3 day of ,20 g, by %4' ®izize /�i , day of ,20?�,by f�ci.407 re who is personally known to me or who has produced P1 ARP S 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. Contractor NOTARY PUBLIC: Si Print. My Commission Exp' *} gyp***Ni=k****ev8ath****** APPROVED BY NOTARY PUBLIC: MY COMMISSIDN # EEI53071 EXPIRES. December 14, 2015 1.1100.3.N0TARY F1. Notary Discount Assoc. Co. *************************************************** ********* ******************** ** a / a°8 Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 RODRIGUEZ, OSVALDO ELECTRICAL MASTERS INC 8400 SW 14TH ST MIAMI FL 33144 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our boxers to barbeque restaurants, and they keep Florida's yacht brokers, 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 leam 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! AC# 5p 9771_3 DETACH HERE 487 -1395 STATt OF MOP oa :::. ..: . AC# . 4,417 71- `. T OF BUSINESS O110SION iL: REGULATION HAS 121331STI§Rip :tinder- tifeel of Ch 489 • axg7ration Alto AIIG ,31, 2 012 %3 00$ O 15 63- DATE y ; :, BATCH NUMBER 08/16/2010 107007792, ER001 The ELECTRICAL ELiCTRIdipttklOTRiT Named below HAS RE,GISTE 'Under the prcavis ons of :Cha Expiration date: AUG 31, 2012;, (INDIVIDUAL MUST MEET. ALL.... -LOCH R 'UI - 5 • PRIOR TO CONTRACT' RODRIGUEZ , OSVALDO ELECTRICAL MASTER' 8445 'NE 2 A -: MIAMI HAR-LIE GRIST GOVERNOR LA AS f SQUIRED Bit L 369307 -5 BUSINESS NAME / LOCATION ELECTRICAL MASTERS INC 8400 SW 14 ST 33144 UNIN DADE COUNTY -IBIS IS NOT A BILL 00 NOT PAY OWNER ELECTRICAL MASTERS INC Sec. Type of Business RENEWAL RECEIPT NO. 385790 -2 CC D 97E000003 FIRST -CLASS o U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 23 -? WORKER /S 196 ELECTRICAL CONTRACTOR 3 THIS iS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING Rturvi. TORY OR ZONIND LAWS OF THE 00 NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER PROM ANY OTHER REQUSIRED AY LAW. Tr TIER IS NOT A CERTIFICATION OF THE HOLDER'S OUALIPICA• PAYMENT RECENED MWMI•DADE COUNTY TAX COLLECTOR: 09/07/2011 02290007002 000075.00 SEE OTHER SIDE MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 RECEIPT NO. BUSINESS NAME / LOCATION ELECTRICAL MASTERS INC 8400 SW 14 ST OWNER :ELECTRICAL MASTERS INC ELECTRICAL MASTERS INC OSVALDO RODRIGUEZ SR PRES 8400 SW 14 ST MIAMI FL 33144 It mil Tli7ltdtTltist149:I 2011 MUNICIPAL CONTRACTOR'S 2012 TAX RECEIPT MIAMI -DADE COUNTY • STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10.24 EXPIRES SEPT, 30, 2012 THIS IS NOT A BILL DO NOT PAY 30- 3857902 CC NO: 97E000003 SEE BACK OF RECEIPT FOR A LIST OF NON — PARTICIPATING MUNICIPALITIES Receipt holder must register in rho city whore work is to be done. PAVT40H! ItCLIVI'(1 MAfiU Vg MI IIY I0X ( 07 /21 1 02290007001 I.•■•na• an FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD ELECTRICAL MASTERS INC OSVALDO RODRIGUEZ SR PRES 8400 SW 14 ST MIAMI FL 33144 0 { 0 0 0) V 12Oct 11 14:39 Osvaldo 7864016271 P.3 OP ID: MA ""-'i..." --- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYY1) 10110!11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on This certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 305- 223 -2533 )Sure Insurance Brokers 2700 SW 137 AVE 305 -220 -0765 Miami, FL 33175 Teresa R. Carmona, Agent IMMIDDIYYYY) No. Ern ! Wes, No }: E-MAIL ADDRESS: GENERAL X PCUSTOMER ID SELECT -4 INSURERS) AFFORDING COVERAGE INSURER A: Florida Citrus, Business (FUB) NAIC B INSURED Electrical Masters Inc. 8400 SW 14TH Street Miami, FL 33144 n�aorrm A... -e. - - - - -_ - _ INSURERIS : Travelers Insurance Co. "i. INSURER C • DAMAGE$ PREMISES INSURER 0 : INSURER E : I OCCUR INSURER F: S 1,000 • M.1.iY rVIV1111 $\411YfoGr1. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIRF111ENT. TERM OR • • . OF • OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. • BEEN REDUCED PAID CLAIMS • JNSR LTR TYPE OF INSURANCE ADD thsal. SUB ati c POUCV NUMEER IMMIDDIYYYY) (MMtDD/YYYY) LIMBS B GENERAL X LIABILITY COMMERCIAL NERAL ICLAIMS -MADE LIABILITY C35311100713450 10109111 10109112 EACH OCCURRENCE 5 1,000,000 DAMAGE$ PREMISES S 50,000 I OCCUR (frliMD (Ea occurrence) MED EcP (Any one person) S 1,000 PERSONAL &Ai v INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEAI AGGREGATE LIMIT POLICY f I PRO. APPLIES PER PRODUCTS- COMP/OP AGG $ 1,000,000 LOC $ AU TOMOHILEIJABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON - OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY/Per axidonti 5 PROPERTY DAMAGE (PeraoWanl) $ $ $ UMBRELLA LIAR EXCESS LIAO OCCUR CLAIMS -MADE EACH OCCURRENCE 5 AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR PAR YIN OFFICERIMEMBEREXCLUDED? n Mandatory in NH) (M under ryes. DESSCRIP�TION OF OPERATIONS below N/A 10640035 04/01111 04101/12 41tC STATU OTH- X TORY LIMJTS l72 E.LEACHACCIDENT $ 1,000,000 ' 1,000,000 E.L DISEASE - EA EMPLOYEE. $ E.L DISEASE POLICYLINIIT 1 $ 1r000s000 DESCRIPTION OF OPERATIONS! LOCATIONS l VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Electrical Contractor Miami Shores Village 10050 N.E. 2 nd Avenue Miami Shores, Florida 33138 305 - 795 -2204 fax 305 - 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RBPPREjSENTA,TIVE+ ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved: The ACORD name and logo are registered marks of ACORD