BPP-12-2356Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 182907 Permit Number: BPP -12 -12 -2356
Scheduled Inspection Date: December 27, 2012
Inspector: Bruhn, Norman
Owner: VILLAR, ALBERTO
Job Address: 195 NW 103 Street
Miami Shores, FL 33150 -1235
Project: <NONE>
Contractor: ALL FLORIDA POOLS AND SPA CENTER
Permit Type: Pools/Whirlpools /Hot Tubs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)758 -0971
Parcel Number 1121360131510
Phone: 305 - 893 -4036
Building Department Comments
POOL RESURFACING
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed ?//j--/
bDcei
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 27, 2012
For Inspections please call: (305)762 -4949
Page 8 of 17
12.19.12
Miami Shares 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
INME V air
DECO 1 2012 I,
BY: ®. ®m®®®®®®amo®mmaom..
Permit No. l i ) 0, -an CP
Master Permit No.
Permit Typ UILDING ROOFING
OWNER: Name (Fee Simple Titleholder): 14 0 e_i ICC DA v t 1 \ Phone #: 1/0. 3S) " S- 1 7
Address: li \\S N,w 1 O 5 A1"
M. City: v `d Afteb a oie State: `1h. > Zip: 3 S) S 3
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: \ g 5 KAI...) NO 3 N1
City: Miami Shores County: Miami Dade Zip: 3 .s1$3
Folio/Parcel #: \ \ ° Z' 1 b ta — OVIa - 1 S I°
Is the Building Historically Designated: Yes ' NO Flood Zone:
CONTRACTOR: Company Name: NA, "TL®ii.c 0w ' o3 %.. Phone #: o S 25) - qo 34
Address: 111 am3 61
JLl (+ M,..,0 City: i t jnnt
State: Zip: 3S I ? I
DA„,,4 -0� t*£.A.,
State Certification or Registration #: CPC 0 e 4 `{ So Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: •1\ 4.
Qualifier Name:
Phone #:
Value of Work for this Permit: $ 00 Square/Linear Footage of Work:
Type of Work: DAddition
Description of Work:
G1A1teration
SN4 r�y�c
New
7.tJ�'j�
pair/Replace
•
ODemolition
* * * ** ************* *** * * * * ** x********** *Fees `* �n�x�x�xa��x�n�a�xa: �x�x+ xx��x�xx��x�x�x�x *�xa��xx��x+x ********** ***
d
Submittal Fee $ Permit Fee $ ./Od
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 1, Ql
■
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
ortgage Lender's Name (if applicable)
ortgage Lender's Address
ity 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
onstruction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
LLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
pplicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
XMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
CORDING 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
' nspection will not be approved and a reinspection fee will be charged.
ignature
Owner or Agent
he foregoing instrument was acknowledged before me this % 1 The foregoing instrument was acknowledged before me this I' cl
day of F e c , 201 L by AD f DA "/G 4� day of 1� ¢c 20 1 Z, by Di i,o �L }F �.
who isElonally known o me or who has produced who perso ally kno to me or who has produced
As identification and , o did take an oath. as identification and who did take an oath.
Signature
Contractor
NOTARY PUBLIC:
4
Sign:
Pug JO, %I.HEN
My - +mmi; sion Ex gS ' my "FIRES: �SION -IDD 964307 My
PIRES:June25,2013 ,ISSICfI�
Banded TMu Budget Notary Servlos �' ' ;;• ' EXP IRES: June 25, 2013
********x� ,. __. , :, * : **** **** :+x�x�x **** :* e: �x�xx��xx�x��x�x* �x�x�x�x�x�x ****�xx��:x:�x�x�n** **** *st e t ***5anxe=k E:17�u�x�x5* :*** *x��:�x***
PROVED BY 4(1 / 1x 1 Plans Examiner Zoning
Structural Review Clerk
evised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
ALLFL -2
OP ID: GJ
'`;I,c °R°� CERTIFICATE OF LIABILITY INSURANCE
DATE(MNUDD/YYYY)
12/06/2012
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(les) 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 Phone: 321 - 397 -3870
Insurance By Ken Brown, Inc.
PO Box 948117 Fax: 321 -397 -3888
Maitland, FL 32794 -8117
David R. Griffiths
CONTACT
(Tel), Ext): FAX , No):
E-MAIL
INSURERS) AFFORDING COVERAGE
NAIC #
INSURER A :Amerisure Ins Company
19488
INSURED All Florida Pool & Spa Center
All Florida Distributors, Inc.
11720 Biscayne Boulevard
Miami, FL 33181 -3110
INSURER S :Amerisure Mutual Ins. Co
23396
INSURER C :
07/15/2013
INSURERD:
$ 1,000,000
INSURER E :
$ 100,000
INSURER F
$ 5,000
•
LAJV CINJ14.7G0 ...LC, 1 11 ,vr. . v .11v.•.v■. S. - -.
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 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MMIDDIYYYY)
LIMITS
A
GENERAL
X
UABILITY
COMMERCIAL GENERAL LIABILITY
CPP2030900070012
07/15/2012
07/15/2013
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100,000
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
POLICY
LIMIT APPLIES
PRO-
JECT
PER:
LOC
Emp Ben.
$ 1,000,000
A
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
SCHEDULED
NON -OWNED
AUTOS
CA20562960601
07/15/2012
07/15/2013
CO BIN rDrtSINGLE LIMIT
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
B
X
UMBRELLA LIAB
EXCESSLIAB
X
OCCUR
CLAIMS -MADE
CU20562970402
07/15/2012
07/15/2013
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
$
DED
X RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' UABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
Ii yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N / A
WC205115705
12131/2012
12/31/2013
X
WC STATU-
TORY LIMITS
x
OTH-
ER
E.L. EACH ACCIDENT
$ 500,000
E.L DISEASE - EA EMPLOYEE
$ 500,000
E.L DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required)
Swimming pools - installation, service, or repair - below ground.
ER
‘..crti iriwA 1 c HOLD
Village of Miami Shores
g
Building & Zoning Dept.
Angie
10050 NE 2nd Avenue
Miami Shores, FL 33138
MIAMISH
..r..----- ..._._
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 REPRESENTATIVE
1
.1)+2 O � . �A
ACORD 25 (2010105)
- . .
The ACORD name and logo are registered marks of ACORD
THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK' PATENTED PAPER
TION
SEQ# L12051100915
103132-7
8uSAT.FesetOk L S
11720 BISCAYNE BLVD
33181 UNIN DADE COUNTY
MATI FLORIDA DISTRIBUTORS INC
THIS IS ONLY A LOCAL
SeciftellIgnITY BUILDING CONTRACTOR 10
WORKER/S
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT 'THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY OR
ZONING LAWS OF THE
COUNTY OR CITIES. NOR DO NOT FORWARD
DOES fl• EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR LICENSE ALL FLORIDA POOLS
REQUIRED BY LAW. IBIS IS
RCATION OF DAVID COHEN PRES
TIONS.
THE HOLDER'S OLIAIJFICA-
NOT A CERTI 11720 BISCAYNE BLVD
MIAMI FL 33181
KEN LAWSON
SECRETARY
BUSINE TAIC RECEIPT 2013 FIRST-CLASS
OF FLORIDA U.S.POSTAGE
EtSEPt. , 2013 PAID
1,e el
'AT PLACE OF BUSINESS MIAMI, FL
HAPTER-8A,- ART. 9 & 10 PERMIT NO. 231
THIS IS NOT A BIU. - 130 NOT PAY
RENEWAL
103132-7
STATEISM4450
PAYMENT RECEIVED
MIAMI-DADE COUNTY TAX.
COLLECTOR:
07/18/2012
60010000399
000075.00 stio isi3 rids oit2iij
SEE OTHER SIDE
7154 SW 4i STREET,,SgHITE S
MIAMI'FLORIDA 35155
• SI��%s I�IC1.. PNoNE: (305) 512 -4225
Land Surveying Services FAX: (305) 512 -1914
FORS THOMAS ROMANIC
•PROP. ADDS. _1 i MN 103 STREE MIAMI SHORES Fi LOT. 1344'
FNDJ.P.1i2"
ID •
SCALE 1'=20'
JOS NOS 0607-187
FIELD DAM 08
TYPE OF PROJECTS
BOUNDARY SURVEY
LEGAL DESCRIPTION: AN AMENDED PLAT OF
mak 127 $UOM SECTION NO. 5 OF
MIAMI SHORES.
PLAT Bo0It1 10*. PAcE 47 OF MIAMI -DADE COUNTY, FLORIDA.
ALLEY 100.60" 10' Asphalt FNDJJ .1/2"
(kit e•
o•
J'o01 Deck CD
18.00'
LOT 15 BLK 127
20.00'
18100' •18.40'
L
The
720' Porch
As1Tha t Driveway
28.50' 15.00'•
FNDJ.P.112"
.:'APPROVED
y.` i^ 1 NG DEPT
TAI
_ aEPT
2' Gutter
54' Asphalt
SUBJECT TO COMPLIANCE WITH ALL FEDERAL'
I STATE AND COUNTY RULES AND REDUL,ATIONIS
4
r,
THISPRbPRTYIS 310.RE..THAN2 l LEB AWAYPROMTHEM'AAIf A
F 0E COUNTY LAKE BELT AREA.
SURVEYORS NOYES: .
i.)THE SURVEY OF THE PROPERTY.SY OMF EON ISBdAcCORDANCEWITHTHE
DESCRIPTION . W a ,\ k;,.T •
2 UNLESS A •• ( �; • ALB ,i ,.� ANGLES AIDMUMS MOM
ARE . &) THE DE �i . NOT : • ° FOR EASEMENTS'OROTh t
a 1: ,v; • • e •N THE PLAT AND THE SAME, IF ANY MAY '
NOT y `' 6' OF F OTINOSrFFANWATIONS OR OTHER IMPROVEMENT
NOTL••• .
B.) MI. TI
7.
75.00' Total RAN
NW 103 STREET
0
1i
C. °:9 I, 9f
re, r . •r a IP ;•p ia
//
0 4 ' • GEODETIC VE TTICALTIATI M
• p THER THAN THOSE WOK%
o SS LY,NOT.TOBEUSEDFOR
CERRT1RBD TO:
INONIAS ROMAMK.
CHASE BANK USA, N.A. IT'S SUCCESSORS AND/ORASSIGNS.
KEY TITLES ESCROW.
SIEWART TITLE GUARANTY OOIIIPANY. • .
ABBREVIATIONS: •
INK» S1deN*, CBS» Comte BlockShudule, CV= Chain Unk Fetae,
PL■ Properly We, DUE. WN & IP» bon ,
AKmAkCo ►PeLPA;° caw. WA tledNal0.
YIUPoYVoodcamRES.Rialdana, »Clear, Ram Raba; UE LNMy
Eeaenaed, COW. Coae. Stab. RAM. Rtit otWa91, DE' Drainage Easement,
Ob. CeaNrLlee,O. Matter, T» R»
ENCR»t ment,COP»
141 NenB Roar wOv edPo na erMete. P1P» Power Fde. •
(FLOOD ZONE INFORMATION)
ZONE' X COMM• ANEL:12025G 0 SUFFIX: J DATE. 7 -17*i BASE' NlA
NOTES ALL REARING NEON ARE BASSI TO THE PLAT BEARING OF
ON THE CENTER LINE OF PROPERTY UNE:
. EASEMENT VIOLATION& O YES 21 NO
APPARENT VISIBLE ENCROACHMENTS: OYES 22 NO
COMMENTS:
MEOW CERTIFY Tea TIBA1TACBi°DSU ROFABOVESORVESOFTSE
ABOVE DESMUSED F ROFERTYISATRYSAMOCO RRBCTREPRESERTATWR
OFARELOSSRVRY WOE SEBERSTf02 DMH518I611MaM
TItCBttMAL *TAIWAN B STFOR188YT811 BOARD OP
R�ORBDAi17118T8B.
• FR�emD1u►;wo>wRYRr• . � .�
. DAVID L -F
REGISTERED LAND SURVEYOR # 4843
STATE OF FLORIDA LS # 0006874
NOTE:NOTVAUD UNLESS
SIGNED AND SEALED
I SHEET L _ OF 1'