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BPP-12-1340Q4 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176108 Permit Number: BPP -7 -12 -1340 Scheduled Inspection Date: August 06, 2012 Inspector: Bruhn, Norman Owner: HUBER, PATRICK & XIMENA Job Address: 1150 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: VAN KIRK & SONS INC Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050190420 Phone: (954)755-4402 Building Department Comments RESURFACE OF POOL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 03, 2012 For Inspections please call: (305)762 -4949 Page 24 of 61 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 $ DING Permit No. BPP— VZ- 134 0 RECEIVED JUL 19 2012 PERMIT APPLICATION FBC 20 Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): ?Wig.` 0 Phone #: Address: 1 1 S. efo LS City: rya State: s Zip: °1 -1 3 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: It S ;:57 1¢. 1 City: Miami Shores county: Miami Dade Zip: Folio/Parcel #: ! 1 A C 1 4 ® ' Is the Building Historically Designated: Yes r` NO Flood Zone: CONTRACTOR: Company Name: V A. _ %5,.1 � a c_Phone #: — `3 kk-d Address: 51 StokA 120" State: .-• City: Qualifier Name: e w V 'LA 0-• Phone #: c$SiP— 166 ' •-a 2 State Certification or Registration #: GP C— ®� SR S L Certificate of C ompettircy #: 7s,S. / Contact Phone#: 9 . - ° -4 .-4-0-4, Email Address: ; = DESIGNER: Architect/Engineer: N 1 fk- Zip: Phone#: Value of Work for this Permit: $ ca • Square/Linear Footage of Work: DDemolition Type of Work: ❑Addition DAlteration ONew t ►k ' epairlReplace Description of Work: gs.a ®-L •L ( ************** * * * * * * * * * * * * * * * **:x*******F ****+ a************+x***** *** *** ** :*:x**:x******* Submittal Fee $ 5.0100 Permit Fee $ CCF $ CO /CC $ Scanning Fee $ ' ro Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ O ' 1O 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 AFNIi)AVIT: 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 c- i ' opy of the recorded notice of commencement must be posted at the job site for the first inspection which occu,. ,en (7) days after 'he building permit is issued. In the absence of such posted notice, the inspection will not be appr.. ► ► einspection fe i l be char ed. 01//1 Signature Owner or Agent The foregoing instrument was acknowledged befor7 me this , I 20114 \ r� , known to me or who has produced 1) I As identification and who did take an oath. NOTARY PUBLIC: day of who is personall Sign. Print: NOTARY PUBLIC STATE OF noRmA My Commission Expires ','''''._Robert P. Van Kirk III �,, ;���.: Commission #DD873761 Expi ,•• res: JUNE 07, 2013 BONDED Tan ATLANTIC BONDING CO., INC. Signature �d `t The foregoi day of ontractor g instrument was ac 20 ., by ledged befor met ths w is personally kn wn NO o me cr who has produced as identification and who did take an oath. PUBLIC: Sign: Pri: My Commission Expires: ************************************, k, k*, k+ k*** *+ k*** *** ****+k*** **,k ****** F******* tri) NOTARY PUBLIC -STATE OF FLORIDA _.-°;g .., • Patricia L. Cobban Commission # DD845967 Expires: FEB. 02, 2013 BONDED MU ATLANTIC BONDING CO., INC, * * * * * * * * * *** kBs,k*,k********** ** APPROVED BY Y ?? ' Mk. Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 7 Zoning Clerk GENERAL NOTES AND CONDMONS n��a gwaeo,w.mneaurx�u...,®mac mmaov.13M1.9aneanoem aea.mw.st®.wmaaame6tanemmenm vnN MOR604.10,18111.3=1111.117011 SWIM CONSIVICIMPIUSBOASOCRABen „,t�nw<m�rm e�tm� 1.10031CLIUMICAZIMACIWW'REIDAND 1.11 4YLmflt Wmm.aammnlmea./41ttmM1wemaeasa. 6}a ®lfB6eB .11888�tnH snit. mt ®wave Omr aamMOINCI EMD>axt107 nay.nmLIMaaa avmm®werem¢aoeTHIS n41BUmr _ ��saves rnavusmot arw� n ams>i i�niv wrw aim en�amuw®6u see.. U.11ciromrao(reouev masmvs • ommomalrenar m�eeomasom. wmvevwo�amsmormmm. ewmm�ve®w anzasoa. mt ®vusornws>mwnmra nmawnvro amatmewneewmwr Maaagoalesst mn...+w..� maw�»m wmevnwee� xtC.1. 3.211 "¢mmtnertneemv�s raamsV iCSOMMImM8419aema.'�a [190.2758.0:011071.1.48170.2M0117MMXIS mancelalitereautormastomentate=0aloari ac s min°a.O96 • m 'n • w w' d�OO1rm DMMI wm 30.amaM913•mISaOIIIIMPCIPM0.1 08 6mwnm�anvwmamanewaa MmONVIDA mS601.e ®.1.nemeemfmmttva, • �me� vs�mmam is au Oran wrrm� aanmeuxn6x....t1 vms: 4811 mosAIrmatioismgormeaus. ®awm0P10=0109.n tmivss)wvemr(my Oa a ThwannaseasumaxesTaralavnaleq, aamtnrallom 011uvxxemmawemn 6yutma®awwmmuno easmsseamwmcrm wemwtnwmneuaaroeawmaves¢ecmt aaOoomwmm a rce n aw �wma° • q.amsnemm a aarec8v tmsemsam ea®a ffi a w WOaem name 'IM..ea>m.ae 1.0.09.10ew01911 082872021, m • O MMPa!bmWmm1 tessoltaatoroarrorfaIMWates • VitAnenaeOMMUMIXICatemillla ViMov• Alamminsuzatniorr was.. sumaral=.4 MAPIOMIVACteraff Wain exmemainseorapraW, Acemyiu ONIIM.6111147413131CIEWIMMIl . ten moorromemceeraa.p.suchnS) v.Fr'Ri7ursa 1rLE�1? 9ehvi'ce e/".A.A C. wag MAP SCAM NM tragaMONte ;gym/� waaunaaxe. agtaRana SIART " �.m�tm.tm ilMnamti. mes ta amasea t: 4w• bm1eN6T RAT io fl (101 11/ seVU ma mws� Omtme won WO ei4 wlne Woe aSwkepmxee oats roRn laterkboirt 4 �,.waae W eue awee We IYrtm simaraLA c #e>kapoiorrr�.r o Miami Shores Village APPROVED ZONING DEPT BY DATE BLDG DEPT 1 jj,i 7/4y1 Z SUBJECT TO COMPLIANCE WITH ALL FEDERAL. STATE AND COI INTY RULES AND REGULATIONS CI i i 7 08- 02 -'12 11 :55 FROM- T -074 P0001/0001 F -181 DA7 t taw•., ..., �'�°J''xO. CERTIFICATE OF LIABILITY INSURANCE 06/29/12 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 F'. W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMvORTANT: If the certificate holder IS an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 15 WAIVED, subject to the terms and Conditions of the policy, certain policies may require an endorSoment. A stateplent on this certificate does not confer rights to the certificate holder in lieu of such endorsement is` PRODUCER BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite#200 Miami Lakes, Ft- 33018 -5869 Fred Zutel INSURED Van Kirk & Sons, Inc. Van Kirk Construction, Inc. Van Kirk & Sons Commercial Pools & Spa, Inc. 3144 SW 13th Drive Deerfield Beach, FL 33442 305- 3844800, NAME "�T 305-714-4401 - (INE E.MAI Ss: INSURER 5 AFFORDING COVERAGE INSURER A :Valley Forge Insurance Co. INSURER S :National Fire Ins Co Hartford INSURER C :Transportation Insurance Co. INSURER D i INSURER E: INS RERF: Arc NAIL 20508 20478 20494 COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED TERM OR CONDIITTION OF ANY COQ NTRA INSURE cT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VRR TYPE or INSURANCE ONSR wv POLICY NUMBER IMMID FF IMMIDDIYYY L GENERAL LIABILITY A X COMMERCIAL OENFRAL LIABILITY 5086401878 CIAIMS•MADE © OCCUR X Oikt Addt Insrd X Blkt Waiver GEN'L AGGREGATE LIMIT APPLIES PER B x X POLICY ©rn' - LOC fOMOB1LE IJABILIVY ANY AUTO LOOSn4ED O HIRED AUTOS X AUTTOOSSULED NON -OWNED AUTOS BROAD FORM PD INCL 'CONTRACTUAL LIABILITY 5086401001 07/01/12 07/01/12 A X UMBRELLA UAB EXCESSL}AB DEP 1 X 1 RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANy ERP RXECUTNE O CERMEMB EXCLUDED? (Man4atery IR NH) If yes, devorem under DESCRIPTION OF OPERATIONS below X OCCUR etAlMS -MADE 10,000 DESCRIPTION OF OPERATIONS / LOCATION 5086401864 07101/13 07/01113 07/01112 07101/13 5086401801 N/A 07/01/12 07/01/13 I VEHICLES IAeaeh ACORD 101, Additional Remarks Schedule It more spate Is required) CERTIFICATE HOLDER MIAMICI City of Miami Shores Building Department 10050 NE 2nd Avenue Miami Shares, FL 33138 • D NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS 0 HEREIN IS SUBJECT TO ALL THE TERMS, METE EACH OCCURRENCE $ 1,000,000 -11.1WG-EVRERTED 300,00 ' PR , FRES P., $ MED EXP (My une PUMA $ 10,00 • PERSONAL &ADV INJURY S 1,000,00 GENERAL AGGREGATE $ 2,000,00' PRODUCTS • COMP /OP A(IG $ 2,000,000 Emp Ben. $ 1,000,000 cacrPr COMBINED IiINGLE LIMIT $ 1,000,00 • sfra BODILY INJURY (Per Demon) $ BODILY INJURY (Per aoddent) $ TOPEIANIAG (NI' accident) "�$ $ EACH OCCURRENCE $ 5,000,00 AGGREGATE $ , 5,000,00' $ _X WC � L TTSI FR El. EACH $ 1,000,00 fE.L DISEASE - EA EMPLOYEE $ 1,000,00 • E.L. DISEASE - POLICY LIMIT 5 1,000,00 ' CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES OE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4$ 1900-2010 ACORD CORPORATION, All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES OE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4$ 1900-2010 ACORD CORPORATION, All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD