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BPP-13-1048Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 193719 Permit Number: BPP -5 -13 -1048 Scheduled Inspection Date: June 18, 2013 Inspector: Bruhn, Norman Owner: ALLEN, SUSAN Job Address: 1234 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: CUSTOM POOLS Permit Type: Pools/VVhirlpools /Hot Tubs Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1132060143930 Phone: (305)255 -5315 Building Department Comments RESURFACE POOL Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 191411. Dogs in yard. Unable to perform inspection. June 18, 2013 For Inspections please call: (305)762 -4949 Page 18 of 25 pERmrregPP2 - ia97 CONTFtACTOR: Cack,Th paitc- _ SUBMITTAL DATE: 5 / 41-(722/ 3 ADDRESS: /,723`-/ 416 -- 9614 .E:eivries ;,_Csan g1/07, RESUBMITAL DATES: PROJECT E: #__6;'„sorkr-0 51/4f (3 ZONING FIRE STRUCTURAL ELECTRICAL PLUMBING IMPACT FEES HRSIDERM NOC MECHANICAL BL 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 7, CEIVED MAY 14 2013 FBC 20t't BUILDING Permit No. r�-� PERMIT APPLICATION Master Permit No. VJ 1 P 3 ) 0 1 Permit Type: BUILDING ROOFING ,,' JOB ADDRESS: I a 314 N c q ±re City: Miami Shores County: Miami Dade Zip: ,.3 1 of Is the Building Historically Designated: Yes NO x Flood Zone: OWNER: Name (Fee Simple Titleholder): 06 r(25 a" jsort /41l er) Address: a3 T N g 9(0 City: N (am/ 'kO State: F - Tenant/Lessee Name: J Email: 3Q 11 e rt ��5- -�°r rt t dew - Co r CONTRACTOR: Company Name: Cii S ro e'W %ate' Phone#: 305- d55 -551 5 Address: /363750 Sa) /3/ 51- /00 City: N /// State: �L Qualifier Name: c' 4A) State Certification or Registration #: d 056/ 3I Certificate of Competency #: Contact Phone #: 305 a 55 53 15 Email Address: 0.2C.5 teas ,e tsou /i . ®7 ei DESIGNER: Architect/Engineer: Phone#: Phone #: 305 7s-6-5259 Zip: 33I v 2- .30s-- 7S9 -7 /t/ zip: 33/6 Phone #: Value of Work for this Penult: $ 0 3 0969 Square/Linear Footage of Work: Type of Work: °Addition °Alteration New Aepair/Replace Description of Work: ye St 1 r f t3Cc" 0 °Demolition Color thru tile: Submittal Fee $ 1‘D Permit Fee $ At CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE$ . Bonding Company's Name (if applicable) 41/49 Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) %YOiVt 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 FT.RCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AWIDAVIT: 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 o, uch posted notice, the inspection will not ' e approved and a reinspection fee will be charged 4 ` 4 I� Signature )(Owner or Agent The foregoing instrument was acknowledged before me this 'e day of 1141,, , 200 ), by�1'� , who is personally known to me or who has produced (-t."1/3 As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY RID�\��`° A. Contractor The forego' instrument was acknowledged before me tthi`s. /07 day of , 20%/3 , by 14/v h:,str d , who is personally known to me or who has produced as identification and who did take an oath. kNOTARY PUBLIC: Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) My Commission Expir * . ; ** ;. * *+sir *** **** **** ** *** S" /Y /YZoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: COPY OF QUALIFIER'S STATE LICENCES COPY_ OF_LOCALB.USINESS TAX RECEIPT'' COP' -OF LIABILITY1NSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 C4c'L MPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: 6,57-004 BUSINESS ADDRESS: /3a 50 si..0 mist-44/60 CITY N14-M / STATE r=L ZIP CODE 3 l Si/' BUSINESS PHONE: ( 305 ) 0Z 5 5 5 31 5 FAX NUMBER (305 ) & 55- 9' 7 a/ 0 CELL PHONE (3O5- ) dig -38'44 QUALIFIER'S NAME: JoL'v /W 144/k QUALIFIER'S LIC NUMBER: (PC 0.56,/3`f E -MAIL ADDRESS (IF APPLICABLE): GUS k$14 poo is .4ei.sou $ , ,S Created on 3119109 BY MLDV I RV 3126109 MLDV 1 RV 6127111 AS From:Nancy Richards FaxID:lns by Ken Brown Page 2 of 2 ,3 P i3 /( £) ' Date:5f2/2013 04:02 PM Page:2 of 2 CERTIFICATE OF LIABILITY INSURANCE CUSTO27 OP ID: NR DATE (6114/DDIVYYY) 05/02/2013 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 pollcy(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 Insurance By Ken Brown, inc. PO Box 948117 Maitland, FL 32794 -8117 David R. Griffiths Phone: 321 -397 -3870 War Fax: 321497 -38 :: PHQIN E>di' EMAIL ADDRESS: FAX (A8C. No): INSURED Custom Pools Certified Gunite Company, Inc. 13230 S.W. 131st Street #100 Miami, FL 33186 INSURERS) AFFORDING COVERAGE INSURER A:Amerisure Ins Company 1NsuRERB:AmerisUre Mutual Ins. Co NAIL A 19488 23396 INSURER C INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICA ---- - - - - -- --- - - - - -- 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. TV TYPE OF INSURANCE ■ ■_ {r POLICY NUMBER POLICY EFF r. -MIDD POLICY EXP MID ■ LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY L20193380902 04/01/2013 04/01/2014 EACH OCCURRENCE $ 300r00I' ■ • c de s .1Y ` o PREMISES tEa ccurreneel 100, ta1:t{ $ , CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 5, 1.11;,; PERSONAL & ADV INJURY $ 300, GENERAL AGGREGATE $ 800,001 GEM. AGGREGATE X POLICY . LIMIT APPLIES PER: JEL'i LOC PRODUCTS- COMP /OP AG G $ 800, $ AUTOMOBILE ■ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ee accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ •Re• • YDAMAGE Per accident $ UMBRELLA LIAB EXCESS LAB ■ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PR_OPRIETOREXCNERD? /EXECUTIVE (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS belay Y 1 NJA C201933709 04/01/2013 04/01/2014 X ' TWTATIU- S OR - EL. EACH ACCIDENT $ 100,1'0I E.L. DISEASE - EA EMPLOYEE $ 100, I, 1't' E.L. DISEASE - POLICY LIMIT $ 500,'0 I'i: DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace le required) CERTIFICATE HOLDER CANCELLATION MIAMISH Nam Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1)o.►• -: 't9 . '... ACORD 25 (2010/05) ®1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK " "' PATENTED PAPER :H NU[NF3R STC' 296284-4 BUSINESS NAME/LOCATION CUSTOM POOLS 13250 SW 131 ST 33186 UNIN DADE COUNTY THIS 1S NOT A BILL - DO NOT PAY OWNER CERTIFIED GUNITE COMPANY Sec Type of Business RENEWAL FIRST -CLASS U.S. POSTAGE R . PAID MIAMI, FE PERMIT NO. 231 RECEIPT NO. 309764-9 STATE* CPC056434 100 WDRI ER /S Sec. BUILDING CONTRACTOR 6 THIS IS ONLY A LOCAL sUSINESs TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO YIOLAT'E ANY OR EXISTING ZONING LAWS OF i DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE mum) BY LAW. THIS IS CUSTOM POOLS NOT A THE D DER'S HOLDER'S IRVING CHAZEN PRES MOW 13250 SW 131 ST #100} PAYMENT RECEIVED MIAMI FL 33186 MIAMI -DACE COUNTY TAX COLLECTOR: 07/18/2012 09010158001 000075.00 SEE OTHER SIDE 111 Tlilifdlllt1 I111Jti11tlitttt1ti1t1t1/11fl,i uihhtitilli 3 QV (,% S;JB ECI O (;GMPs i, NCE Wrri i S !y E (f 11hr i ^1 „N I IONS P:. CITY COPY BY: MAY 14 13