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BPP-12-1856 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 inspection Number: INSP-179502 Permit Number: BPP-10-12-1856 Inspection Date: October 02,2013 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: DROPPER,ADAM Work Classification: New Job Address:9901 NE 13 Avenue Miami Shores, FL Phone Number Parcel Number 1132050090480 Project: <NONE> Contractor: FLORIDA POOL PATIO CORP Phone: (305)815-0181 Building Department Comments NEW POOL OVER PILING Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed El Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 October 02,2013 Page 1 of 1 ,.• N OP ID:MS �A11%. °,R°� CERTIFICATE OF LIABILITY INSURANCE DATO�6D�/YYYY) 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). NTACT PRODUCER 904-645-3804 NAME: The Holmes Organisation of FL 904-645-3805 PHONE FAX P.O.Box 16327 A/ No Ext: Arc,No): Jacksonville,FL 32245 E-MAIL ADDRESS: Robert A.Roldan PRODUCER FLORIPO CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Florida Pool-Patio Corp INSURER A:Technology Ins Co P.O.Box 161491 INSURER B; Miami,FL 33186 INSURER C: INSURER D: INSURER E INSURER F 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, pg INSR ADDL SU13R POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED IT—OIMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ I CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X I TWO STATU- OTH- AND EMPLOYERS'LIABILITY TORY S ER Y A ANY PROPRIETORIPARTNER/EXECUTNE 1 N f A TWC333109 09/04/12 09/04/13 E.L.EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Malml Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD f Ate` CERTIFICATE OF LIABILITY INSURANCE DA 2/07"//133Nf' PRODUCER Chaplan&Castro Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2552 NW 7 Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33125 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)541-4009 Fax (305)649-1513 INSURERS AFFORDING COVERAGE NAIC# INSURED FLORIDA POOL PATIO CORP INSURER A: GRANADA INSURANCE CO. 9060 SW 125 AVE#C 204 INSURER B:INSURER C: MIAMI,FLORIDA 33186 INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSRD DATE MMIDD DATE MIDD GENERAL LIABILITY EACH OCCURRENCE 1,000,000 ❑�/ COMMERCIAL GENERAL LIABILITY 0185FL00038979 09/06/12 09/06/13 PREMISES E.occurence 100,000 El CLAIMS MADE ® OCCUR MED EXP(Anyone person) 5,000 A ❑ ❑ PERSONAL&ADV INJURY 1,000,000 Fl GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG ❑ POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY ❑ ❑ SCHEDULED AUTOS (Per person) ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) ❑ PROPERTYDAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND ❑ WC STATU- ❑ OTH- EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS SWIMMING POOL SERVICING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE BUILDING DEPART 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2ND AVE THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25(2001108)QF ©ACORD CORPORATION 1988 C1=iii 2013IFSO 1 176 S OR Bk 28488 F's 1100f (fps) RECORDED 02/1312013 1011:48 NOTICE OF COMMENCEMENT HARVEY RUVIN P CLERK OF COURT A RECORDED COPY-MUST BE POSTED ON THE JOB SI1 E AT TIME OF FIRST INSPECTION MIAMI-LADE t OUNTY P FLORIDA LAST PAGE PERMIT NO. �'O" TAX FOLIO NO. STATE OF FLORIDA COUNTY OF MIAMI-DADS: STATE OF FLORI COUNTY OF Lr�DEy corn I HEREBY CERT,F'r W#9S i5 a fr 00py of the ��va C\E4% origiltal fiW irr this THE UNDERSIGNED hereby-gives notice`thaYimprovements will be made to certain real A p 2J property,-and in accordance with Chapter 713,Florida Statutes,the foUoYl+ Via,3 Is provided in this Notice of Commencement. HARVEY�c1Jyi'N,CL &C. Sped above reserve for use of recording otace 1.Legal description of property and streettaddress: m 0.1 Ae7 2.Description of improvement: 1 77 3.Owner( ess:rs a ice* , Interest in property: C_a bra Name and address of fee simpie;titleholder: 4 Contractor's,name address and phone number �t� 7 c� �f J f® q •, 5.Surety:(Payment bond-required by owner from contractor,if any) Name,address and phone number. rl- Amount of bond$ 21 6.Lender's name and address:- el CIA 'T 7.Persons within the-State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.'13(1)(a)7.,Florida Statutes, Name,address and phone number �t 1 C r i c t" ('!`In Z 9( S,L0 C, i. 8.In addition to himself;Owners designates the following person(s)to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b),Florida Statutes. ( Name,address-and phone number r�t f�r� r -�r +^r t�Z,. 4t'�? S{ YYl i i I 9.Expiration date of this Notice of Commencement: (the expiraflon date is 1 year from the date of woom wises a dilforent date is qm flecQ WARNING`Io QWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I;SECTION 713.13.FLORIDA STATUT=ES;AND CAN`RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS f0 YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE=JOB SITE BEFORE THE FIRST INSPECTION.iF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE.COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT Signatures),of- Officer/Diractor/Partner/Manager Prepared By Prepared By Print Name Print Name Title/Office.. Title/Office STATE OF FLORIDA COUNTY OF MIAMI-DADS The foreg hstni was ackn wledged before me this day of , Wy WIT gV -. : — ❑ divMduaily,or U'as for Personally known,or'l produced the WiOwing type of identificati Slgnatura of Notary Public: Print Name: (SF:P►L) Y, '. KA,RI A PPER VIERIFICATIO 1 0t Under pe Has of perj eciare tha av r' d foregoing and �e Niv COMMISSION#EE032278 t that the cts stated i e true,to owledge and belief. ` �; I~ P1RES October 05,2014 +,n N can Signatures O e (407)398-DICI v.�o[idalJo ( )or er r/Partner/M b s1* ned above: By By