BPP-12-1815Miami Shores Village
Building Department BY;
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Q
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: � 01 l S'
City: Miami Shores
Folio/Parcel #: J / 3 ' 060-1,
Is the Building Historically Designated: Yes
OWNER: Name
SEP 2 4 1013
FBC 20
Permit No.
Master Permit No. 13 P/
ROOFING °
County: Miami Dade Zip:
NO
Flood Zone:
dpe') 0
Phone #: 3e) ) - &�gH420 9
City:
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name:
Address: /1 [ 70/ t illow S le
city: (-re
Qualifier Name: &
State Certification or Registration #:
Contact Phonek °°! W A % -
DESIGNER: Arch itect/Bngineer:
State: ��L,. Zip: %
" f S Phone #: �5R 237%1"i?7W e7
W `V Certificate of Compe ncy #:
Email Address: h0 0400iLOL17
Value of Work for this Permit: $ 9dd, od S inear Footage of Work:
Type of Work: DAddition DAlteration WNew []Repair, eplacce
Description of Work:._ /t lee l'gre v-"I �E��G% %/°J %, y;� ®C�/
Color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training(Education Fee $
Double Fee $ Structural Review $
M
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 apprgved and a reinspection fee will be charged.
Signature &� V Signature
Owner or Agent
The foregoing instrument was ac wl ged befz�me this day of 141, 20 by drew f�ilC
who i rsonally known me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC: l % f
Vo
My
Contractor
The foregoing ' stru ent was aacknowl�449 re me this � r
day of 20 /�, by
who i s r me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Structural Review
(Revised 3 /12 /2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Job Address 40f where work is being done): -W-7-.W67 95-
City: Miami Shores _ State:-,,Flodda Zip Code: X12/
Contractor's
Address:
City:
Qualifier's Name:
Architect/ Engineer of Record Name:
Address:
City:
Describe Work-.
123-
Phone
State: 4,6=
Lic. Number:
State:
Phone #:
Zip Code:
I her ify that the work has been abandoned and/or the contractorlarchitect is
unable or
willing to complete the contract. I hold the Building Official and the
Miami Shores harmless for all legal involvement.
Signature
q elver or.A I
The foregoing instrument was aknowle ed 1pfore mq
this 43day of , ,9,& 20/9,,by aj��
Who ispersonally pown to me or who has produced
as indents ication.
Sign:
Seal:
Vwt,NVULYN B. STEWAU
MY COMMISSION # DD961586
EXPIRES: April 19, 2014
r
- - FL NOMY DWWW A=,L Ca
Signature
1Contractor or Archr
The foregoing instrument was aknowledged before me
this 206y 1541W W 6td1i5
who s personally known to m or who has produced
as Indentification.
Seal:
MY COMMISSION # DD961596
EXPIRES: April 19, 2014
v FL Navy DkZMM AIM CO.
POOLB13 OP ID: .1K
A� R °m CERTIFICATE OF LIABILITY INSURANCE
°"09231013
09/23/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CER71FiCATE 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 pollcy0es) must be endorsed. It 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
certificaie holder in lieu of such endoree s .
PRODUCER Phone: 3214974870
Insurance By Ken Brown, Inc.
PO Box 948117 Fax: 321 4197
D►vida Rd., 117
OT
PHONE Alc No. FM
AUTHORIZED REPRESENTATIVE
INSU AFFORDING COVERAGE
NAIC #
INSURERA:Amerisure Ins Company
19488
INSURED Pool Boy Plastering, Inc.
6601 Lyons Rd 1111-6
Coconut Creek, FL 33073
INSURER B:
07/30/2013
HMRERC:
EACH OCCURRENCE
WSURER D:
pREMISES Ea
INSURER E:
IVIED EXP (Any one person)
INSURER
PERSONAL & AOV INJURY
COVERAGES CERTIFICATF MUMRFR- 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.
TYPE OF misURwcE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miaml Shores Village
10050 N.E. 2nd Avenue
CY N
F
AUTHORIZED REPRESENTATIVE
LINTS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
CPP2078989010013
07/30/2013
09/21/2014
EACH OCCURRENCE
$ 1,000,00
pREMISES Ea
$ 100,0
IVIED EXP (Any one person)
$ 5,00
PERSONAL & AOV INJURY
$ 1,000,00
X
Pool Popping Cove
GENERAL AGGREGATE
$ 2,000,
GEML AGGREGATE LIMIT APPLIES PER:
POLICY F-x1 Z FI LOC
PRODUCTS - COMP /OP AGG
$ 2,000,
$
A
AUTOMOBILE uAlaLnv
IX ANY AUTO
ALL OV ED SSCCHr� LED
HIREDAUTOS Ix AUTOS ED
CA20738280202
09/21/ 2013
M2112014
COMBINED
RCCRIW t 1 G LIMIT
r5w,
BODILY INJURY (Per person)
$
BODILY INJURY (Per aodda M)
$
PROPERTY DAMAGE
$
UMBRELLA Me
EXCESS LIAB
OCCUR
CLAIM
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORiPARTNERIEXECUTIVE YIN
OFFICERMEMBER EXCLUDED? E-1
(Mandatory In NH)
99if yy� destxiW under
6W ON OF OP RA-n tsgiaw
NIA
,0207212003
09/21/2013
09121/2014
X STATU X E -
E.L. EACH ACCIDENT
$ 1,000,wo
E.L. DISEASE - EA EM PLO
$ 110M,
E.L. DISEASE - POLICY LIMIT
$ 11000,
DESCRIPTION OF OPERATIONS I LOCATIONS I VEIBCLES (Attach ACORD 107, AddWo" Rert aft Schedule, H more space is mquhed)
(1FRTWI!CATF HOI. MR CANCFLI -ATION
MIAMISH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miaml Shores Village
10050 N.E. 2nd Avenue
ACCORRDDANCE WITH THEE POLICYPRPao�l� WILL BE uveR� IN
Miami Shores, FL 33138
AUTHORIZED REPRESENTATIVE
'fled eq. p)("
®1988-2010 ACORD CORPORATION. All rights reSOMO.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
HP OfficeJet Pro 8600 N911 g Series Fax Log for
Michael R. Stewart
954 - 990 -5025
Jul 18 2013 5:16PM
NOTE: Blocked calls are not displayed on this report.
For more information, see Junk Fax Report and the Caller ID Report.
Last Transaction
Date Time Type Station ID Duration Pages Result
Caller ID Digital Fax
Jul 18 5:15PM Received 0:41 0 No fax
8506923729 N/A
City of Coconut Creek
BUSINESS TAX RECEIPT
Name of Business: POOL BOY PLASTERING INC Business ID: 130Q000021
Business Address: EXPIRES 9/30/2014
6601 LYONS RD BAY I6
COCONUT CREEK, FL 33073
Development Name: Zoning Certificate On: 9119/2006
DESCRIPTION •
CONTRACTOR OR SUBCONTRACTOR: PLASTERING OR CEMENT CONTRACTOR 052780 BL060D0353 153.14
Exempt Amt:
.00
Delinquent Amt:
.00
Transfer Amt:
.00
TOTAL TAX:
153.14
BUSINESS TAX RECEIPT AND ZONING CERTIFICATE MUST BE
CONSPICUOUSLY DISPLAYED FOR PUBLIC VIEW AT BUSINESS Sustainable Development Designee
LOCATION.
The RESIDENTIAL pOOL/SPA CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 -FS.
Expiration date: AVG 31, 2014
EVANS, SHARON D
'POOL BOY PLASTERING, INC.
6855 LYONS TECHNOLOGY CIRCLE #16
COCONUT CREEK FL 33073
RICK SCOTT KEN LAWSON
SECRETARY
GOVERNOR
DISPLAY AS REQUIRED 'BY LAW
,APP /3 - lY/S-
MARS POOLS INC.
BUILDING POOL OUT OF THIS WORLD a@ DOWN TO EARTH PRICES
5+05 NW 102 Avenue Suite 235 �� ='�
junrise, Fl 33351 SEP 2 4 2013
Cell (954) 214 -2844 Fax (954) 741 -4170 DY.-_ (' -)®
Change of Contractor for Fermit # F)F - 10- 12- 1815£r PL 10-12 -1817
Andrew Lemke and Mary Morgan
307 NE 95', Street
Miami Shores, FL 33138
305 - 606 -2098
I Michael K- Stewart of Mars Tools Inc. wish to cancel the Permit listed above because my
Certificate of insurance has expired and Pm no longer in business, I waited six months for
other contractors to complete their task in order to complete the pool. The Dome owner is
aware of my situation and has agreed with me to do a change of contractor. I helped them by
finding someone to complete the task.
Thank you in advance.
Michael K. 5tewart
5115F. 5t' Avenue (Anit 1522
Form Lauderdale, FL, 33301
Cell -- 959- -529 -6461
Fax-866-21+-861.9
F„ mail— mstewart.poolboy@yahoo.com
r
c Pebble-r PebbleSheerY PlebblePinef
ENDURING NATURAL ELEGANCE ENDURING REFINED ELEGANCE ENDURING CLASSIC ELEGANCE
4 ,
Miami Shores Village
Building Department
10050 REIM Avenue, Miami Shores, Florida 33138
Tel: (305) 7951204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS:
City:
Folio/Parcew.
WAIR AI Z
Is the Building Historically Designated: Yes
FBC 20
Permit No.
SEP 2 4 12013
I
Master Permit No. a ,/
County: Miami Dade Zip:
Zone:
OWNER: Name (Fee
Tenanftessee Name: Phone #:
Email:
CONTRACTOR: Company Name:
Address: a-7 ®/ �,VP6
City:..., oawa, r Pe ' e- State: P: 7
Qualifier Name• � "%G CIM Phone#: 0 5-71 - ,! :T 5
State Certification or Registration #. we TZ Certificate of Competency #• �
Contact Phone#• V Email Address:
1
DESIGNER: Architect/Enginew. Phone#:
Value of Work for this Permit: $ 01 00 5quare/Linear Footage of Work:
Type of Work: UAddress DAlteration ,,/ ew ORepair/Replac ODemolition
Description of Work: ` ® /a/ t[l ,w/;l r ' 5) rf �0 , C i-
Submittal Fee $ Permit Fee $ _ Z LS. x CCF $ CO /CC $
Scanning Fee $ Radon Fee $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $ E
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $_
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
M
zip
h
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 approvef and a reinspection fee will be charged.
Signature Signature
Owner or Agent
The foregoin g instrument was ac Mwl ed be j me this [ 9
day of ti 20 � , by
who is personally known to me or who has produced
As identification and who did take an oath.
Contractor
The foregoing instrument was acknowledged before me thisl*
day of 20 Z ' by 5/1- -14,00 , e �l 4,tIS
who is y know:to a or who ha§ produced as itification and who did take an oath.
Structural Review Clerk
(ReAwa /122012)(Revisad 07 /10 /07XRevised 06 /10/2009XRevised 3/15/19)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Zip Code: 3 31
Job, AddreSS (of where work is being done): —V 7 A/67 �'S- 51j-
City: Miami Shores State:—Florida Zip Code:
Contractor's Comb
Address:
City: o
Qualifier's Name:
Architect/ Engineer of Record Name:
Address:
City:
Describe Work. / dd
Phone #: �,�3-%� Z31 3
State: /--L Zip Code: 73,07-3
V,q,e? $ Lic. Number: -60e -19Y IV3
Phone #:
State: Zip Code:
1,0eFebkcertlfy that the work has been abandoned and/or the contractor /architect is
unable r unwilling to complete the contract. I hold the Building Official and the
Miami Shores harmless for all legal involve
Signature Signature
ownef ; ;or,Ageot ton*tor or Architect
The foregoing instrument was aknowle ed fore m The for instrument was aknowledged ore me
this day of20 /by ��i this
Who is persona (k wn to me or who has produced who is rsonally known to or who has produced
as indentification. as Indentiftcatlon.
'Not rl P : _ Ntry ii
Sign: Sign:
Seal: �,,Y ,� Seal:Y GWENDOLYN B. STEWART
GIVE?, B. STEWART MY COMMISSION # TEWA T
MY COIv1h11SSI0AI ODD 961586
�.RVy �1M: April 19, 2014 pRCa April 19, 2014
1443 NOTARY Fl. N—Y pMMM Aum Ca i aoarxoTUeY FL Nary n eawmi nacoo Ca