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BPP-12-1815 (2)Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 203343 Permit Number: BPP -10 -12 -1815 Scheduled Inspection Date: November 22, 2013 Permit Type: Pools/Whirlpools /Hot Tubs Inspector: Rodriguez, Jorge Inspection Type: Final Owner: MORGAN, MARY Work Classification: New Job Address: 307 NE 95 Street Miami Shores, FL 33138- Phone Number (305)606 -2098 Parcel Number 1132060136000 Project: <NONE> Contractor: POOL BOY PLASTERING, INC Phone:,(954)571 -8313 comments NEW INGROUND SWIMMING POOL INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 202669. CREATED AS REINSPECTION FOR INSP- 179236. No access, gates locked Pool barrier not installed. Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 21, 2013 For Inspections please call: (305)762 -4949 Page 11 of 20 N' GROSS -I :�. 24, A__"' 0, 7 &cP'WAI T.', 15' A / fi�� wss vo 01/ 1001"o 90 1�111,1111Z =- AC 7 POOL P/ PUMP ota tti, POOL ONE STOP Y ESIDENC No. W c) 2 S.F. .3' t�� iOR I ui X/ 12.0" /Co. .... 9.5 4 2' N. N.E_ 96th STREET 56.98 30,130, ttJ FD* -A'!P 1) 50Y 122-49' r50' 7 6 30.00 3060 9. C.B. 4jX, GROSS -I :�. 24, A__"' 0, 7 &cP'WAI T.', 15' A / fi�� wss vo 01/ 1001"o 90 1�111,1111Z =- AC 7 POOL P/ PUMP ota tti, POOL ONE STOP Y ESIDENC No. W c) 2 S.F. .3' t�� iOR I ui X/ 12.0" /Co. .... 9.5 4 2' N. N.E_ 96th STREET 56.98 30,130, ttJ 11 S.6 -7 Gor C 15", AUXY 4 Q N IZ 44 Q� 40 11 12 13 14 VOCATION M": SECTION 6 TOP. 53S URGE 42 E 30' W '501 50 1 92.87' NE 95th _ S ET LEGS DESQB_lpjL0N: SURVEYOR's NOTE: SURVEY OF LOTS 10 AND 11, LESS THE EAST 5.82 ELEVATIONS SHOWN REFER TO THE NATIONAL GEODETIC VERTICAL FEET OF LOT 11. BLOCK 441 OF THE PLAT "AN DATUM, 1929. (N.QV.D.) AMENDED PLAT OF MIAMI SHORES" SECTION NO, 1, SU-R—Vff OR"S C]9HT=ATlQN., ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10 AT PAGE 70 OF THE PUBLIC WE HEREBY CERTIFY THAT THIS SKETCH OF SURVEY IS RECORDS OF MIAMI—DADE COUNTY, FLORIDA. TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE BEING LOCATED IN MIAMI SHORES. AND BELIEF AS RECENTLY SURVEYED AND PLATTED UNDER OUR DIRECTION AND THAT THIS. SURVEY COMPLIES WITH SKETCH OF SURVEY THE MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYING IN THE STATE OF FLORIDA, UNDER RULE 53 -17 FLORIDA A. R. TOUSSAINT & ASSOCIATES, INC. ADMINISTRATIVE CODE, CHAPTER 472.027 FLORIDA LAND SURVEYORS STATUTES. FLORIDA CERTIFICATE OF AUTHORIZATION NO. LB-273 NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF 620 N.E. 126 ST. NORTH MIAMI, FLORIDA 33161 THE REGISTERED LAND SURVEYOR SHOWN HEREON. TEL' (305) 891-7340 FAX: (305) 893-0325 FB: 553 PG. 46,49-51 DATE: 01/31/2012 A.R. TOUSSAINT & ASSOCIATES, INC. FILE: 2012/14732 SCALE: AS SHOWN ORDER- 14879; 10-11-13: REVISED TO SHOW POOL OTHER aZM_�RES, LEQEND NEW FEATURES ALBERT R. TOUSSAINT AC - AR CONVIEM REGISTERED ENGINEER NO. 8939 C.B. - CATCH BW fl). = FOUND REVISED, 07-03-2013: TO SHOW REGISTERED SURVEYOR AND MAPPER NO. 907 C.SS. - ONXIE &= S740A I.P. - RON PIPE EDGE OF POOL AND EDGE OF STATE OF FLORIDA CO LS I" SO amM DECK AT EAST PROPERTY LINE. FLORIDA CERTIFICATE OF AUTHORIZATION LB-273 CNLCR M(WALL) N&D = NAL AND DISK D.H. DRILL HM PIL PROPERTY UNE DATE: E/F EM OF PAVEMENT RLS FOSTM LW m 84CFAaDimm (WALL) fmwvm ft JANUARY 31, 2012 307 N.E. 95th STREET GWHIC SCALE: SC&E. " MIAMI SHORES, FLORIDA I 10, 20, 40' 60' 1 20' MIAMI•DADE COUNTY DRAWING NUMBER- SHEET DRAWN BY: SCALE: 1 INCH = 20 FEET 1473214879 1 OF 1 WT m 1) 50Y 122-49' r50' 7 6 11 S.6 -7 Gor C 15", AUXY 4 Q N IZ 44 Q� 40 11 12 13 14 VOCATION M": SECTION 6 TOP. 53S URGE 42 E 30' W '501 50 1 92.87' NE 95th _ S ET LEGS DESQB_lpjL0N: SURVEYOR's NOTE: SURVEY OF LOTS 10 AND 11, LESS THE EAST 5.82 ELEVATIONS SHOWN REFER TO THE NATIONAL GEODETIC VERTICAL FEET OF LOT 11. BLOCK 441 OF THE PLAT "AN DATUM, 1929. (N.QV.D.) AMENDED PLAT OF MIAMI SHORES" SECTION NO, 1, SU-R—Vff OR"S C]9HT=ATlQN., ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10 AT PAGE 70 OF THE PUBLIC WE HEREBY CERTIFY THAT THIS SKETCH OF SURVEY IS RECORDS OF MIAMI—DADE COUNTY, FLORIDA. TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE BEING LOCATED IN MIAMI SHORES. AND BELIEF AS RECENTLY SURVEYED AND PLATTED UNDER OUR DIRECTION AND THAT THIS. SURVEY COMPLIES WITH SKETCH OF SURVEY THE MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYING IN THE STATE OF FLORIDA, UNDER RULE 53 -17 FLORIDA A. R. TOUSSAINT & ASSOCIATES, INC. ADMINISTRATIVE CODE, CHAPTER 472.027 FLORIDA LAND SURVEYORS STATUTES. FLORIDA CERTIFICATE OF AUTHORIZATION NO. LB-273 NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF 620 N.E. 126 ST. NORTH MIAMI, FLORIDA 33161 THE REGISTERED LAND SURVEYOR SHOWN HEREON. TEL' (305) 891-7340 FAX: (305) 893-0325 FB: 553 PG. 46,49-51 DATE: 01/31/2012 A.R. TOUSSAINT & ASSOCIATES, INC. FILE: 2012/14732 SCALE: AS SHOWN ORDER- 14879; 10-11-13: REVISED TO SHOW POOL OTHER aZM_�RES, LEQEND NEW FEATURES ALBERT R. TOUSSAINT AC - AR CONVIEM REGISTERED ENGINEER NO. 8939 C.B. - CATCH BW fl). = FOUND REVISED, 07-03-2013: TO SHOW REGISTERED SURVEYOR AND MAPPER NO. 907 C.SS. - ONXIE &= S740A I.P. - RON PIPE EDGE OF POOL AND EDGE OF STATE OF FLORIDA CO LS I" SO amM DECK AT EAST PROPERTY LINE. FLORIDA CERTIFICATE OF AUTHORIZATION LB-273 CNLCR M(WALL) N&D = NAL AND DISK D.H. DRILL HM PIL PROPERTY UNE DATE: E/F EM OF PAVEMENT RLS FOSTM LW m 84CFAaDimm (WALL) fmwvm ft JANUARY 31, 2012 307 N.E. 95th STREET GWHIC SCALE: SC&E. " MIAMI SHORES, FLORIDA I 10, 20, 40' 60' 1 20' MIAMI•DADE COUNTY DRAWING NUMBER- SHEET DRAWN BY: SCALE: 1 INCH = 20 FEET 1473214879 1 OF 1 WT m Miami shores e Y illa :9 Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OF REQUIREMENTS POOL, SPA AND HOT TUB SAFETY ACT i ( acKnowledge that a new swimming pool, spa or hot tub will be constructed or installed at 7 j h Miami Shores, FL, and hereby affirm that one of the following methods will be used to most the requirements of Chapter 515, Florida Statues and the Florida Building Code R4101.17. . Please Initla4he method(s) to be used: OAZ The pool will be equipped with an approved safety pool cover that comp lies with ASTM F1346 -91. (Submit Manufacturer's Specifications). A continuous, one -piece (child) barrier meeting the requirements of Florida Building Code R4101.17.1.15 will protect the pool perimeter. The plans shall show the fence location and method of attachment, including one end that shall not be removable without the aid of tools. (Submit Manufacturer's Specifications). A combination of non - dwelling walls and fences (screen enclosure, child fence, masonry fence walls, chain link or wood fence, etc.) will protect t he pool perimeter. The plans must specify t he type and location of all non dwelling walls. Florida Building Code, R4101.17.1 Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code, R4101.17.1.9 (Submit Manufacturer's Specifications). Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all doors will be equipped with a self - latching device with positive mechanical latching/locking installed a min. 54° above the threshold. If this option is selected, submit plans showing all types and location of all perimeter protection. The plans must also show the location and type of all openings, and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Code, the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements, and upon expiration of the permit the pool shall be presumed to be unsafe. I understand that not having one of the above installed will constitute a violation of Chapter 515, F.S ., an d will be considered as committing a misdemeanor of the second degree, punishable as provided in Section 775.082 or Section 775.083 F.S. This form must be signed by t o wne age t p e cojitractor. CO TRACTOR'S SIG A 1 rA,ATE OWNER'S SIGNATURE AND D TE ,Ile • �. _ PUBLIC'' -A ��s0, 71 0 0RtOP 0111111111101 M _ _ Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SWIMMING POOL OWNER'S CERTIFICATION Date 110XV4012 Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as Loh! )3kk oV , located at C In accordance with Section 33 -12(o, Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting and approved barrier prior to final inspection and use of the pool. Legal Owner !Vote: This certification is to be submitted with a swimming pool permit application in duplicate. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTM POOL ENCLOSURE KNOW ALL MEN BY THESE PRES NTS: / WHEREAS, the undersigned L -r 1� is/are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: '�0 % /ifs Whereas, the undersignedowner(s) ff -WdlA desire to utilize said Lots) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows: I. That the properly will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. 11. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the required enclosure is not on the subject property where the pool is located III. That if any of our adjoining neighbors remove any portion of their fence or wall, or if our/my property shall fail to meet code requirements for pool barriers, we, as owners will immediately install a protective enclosure to meet code requirements and will obtain a permit for such fence. IV. That, Uwe, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is damaged or removed by any case. NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant concerning the use, enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its s i a ordan of said Village then in effect. OWNER SIGN & PRINT OWNER SING & PRINT I Here Certify at on this day personally appeared before meAf ld Pf.J LePr� and has produced ID # G as identification and he/she acknowledge that he/she executed the foregoing, freely and voluntarily, for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this day of C7d ��i .20 0 A (Revised 05/2205 GWENDOLYN . STEWAR My CC)NINRSSION # DD961586 w EXPIRES: APri1 19, 2014 1.800.YNOTARY Fl. Notary DiwOu t A ,a Cu. L21 A L �6f. _qPl4AI T 10- .30.6br C4 5 lo* 8 7 6 00 •�'~ .:5 ?- 15.8' .�1 L21 A L �6f. _qPl4AI T 10- C4 5 lo* 8 7 6 00 L21 A L �6f. _qPl4AI T 10- A �Aftg IYA-.' .r3 77 is L90 11.6' S. 4gs te) . qw4 1 GRASS F 26 / r CBS /2 /,'*' 7*' ' NO. 307/ S.P. LEV 11. Z��/ ri 1 4;Nlv • • _N. N.E, 9 dh STREET 7 6-11 3T ?8 11 5— O 3VI M w 37 50' 5 lo* 8 7 6 00 A �Aftg IYA-.' .r3 77 is L90 11.6' S. 4gs te) . qw4 1 GRASS F 26 / r CBS /2 /,'*' 7*' ' NO. 307/ S.P. LEV 11. Z��/ ri 1 4;Nlv • • _N. N.E, 9 dh STREET 7 6-11 3T ?8 11 5— O 3VI M w 37 50' 5 7 6 119.68 2 r_ _. ► 4 4 �° ©� Li 14 10 11 12 13 me: SWW 61!)P. 53 & RGE 42 E 30' 30' 5-82' SCALE. i"-low an' 1 N E io .i. i _441 3 tl. z A41 31,41 SURVEY OF LOTS 10 AND 11, LESS THE EAST 5.62 ODE, CHAPTER 472.027' FLORIDA SKELC ejo H 0 F C! cq D THE SIGNATURE AND RAISED SEAL OF ATE A. R. TOUSSAINT & ASSOCI I I ; . W-E. LAND SURVEYOR SHOWN HEREON. LAND SURVEYORS FLORIDA CERTIFICATE OF A ORIZATK}N NO, LEI 9.38 620 N.E. 126 ST. NORTH FLORIDA 33161 TOVSSAINT & ASSOCIATES, INC. M- (30) 691-7340 89 5 PIL FB: 553 PG. 46,49— 01 /31/2012 ral FILE- 2012/14732 SHOWN BY,�� S-4 I.P. IVY/ E io 77 i 7- IT A = somad CA cot4m COND - CONCAM CLX CLFAR WHIL EOM OF DOM 1 INCH = 20 ALBERT R. TOUSSAINT REGISTERED ENGINEER NO. SM REMSTERED SURVEYOR AND MAPPER NO. 907 STATE OF FLORIDA FLORN)A CElRlMllE OF AUTIMIZATION L9 -273 307 N.E. 95th STREET MIAMI SHORES, FLORIDA SCALL"' El 60' 1* 2, 0 MIAMI—DADE COUNTY )RAWING DRAWN Eff. 14732 1 OF 1 WT Miami Shores Village 0 1f T 2 Building Department - 0---- ----- e- oe --e� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 L INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING ty ps ° t ��`' M 1 Permit No.. o . PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOFING `- OWNER: Name (Fee Simple Titleholder):__ p w Phone #: 30J i ��g Address: 7 /v/-:, 2L 5yy3 City: a `air i Shores State: ,EL- Zip: 73 3 120 Tenant/Lessee Name: Phone #: Email: Ad dw y-tv 1 Owl JOB ADDRESS: 07 ,�fe 9 5 0, City: Miami Shorest s County: Miami Dade Zip: `� 31,38 ® Folio/Parcel #: [ 1-9-906- ' 00! 3 ° c ✓" Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: Address: S �% A ) 106 City: Qualifier Name: Zone: Zip- 3 7 Y-1 r State Certification or Registration #: 4(S' 7 92 Certificate of1Competency #: Contact Phone #: �y %�/ �L %C� . Email Address: /' /S DESIGNER: Architect/Engineer: Phone#: Value of Work for this 'Permit: $ X'49000100 Square/Linear Footage of Work: 5- -7 Type of Work: LIAddifion DAlteration ® New ORAair/Replace ❑Demolition Description of Work: _Z Submittal Fee $ Permit Fee $ ®� CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ o 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 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 approved and a reinspection fee will be charged. Signature V y " yV ` Owner or Agent The fore oing instrument was ackno led d zo fr me this day of 201, by� who is personally known to me or who has produced_ �v As identification and who did take an oath. NOTARY PUBLIC: Sign: My Commission Exp My conrr asslox po96ise6 g'nV F"1RES: APril 19, 2014 uar sr_a_y°;'com: A. C C. Signature J Contractor The foregoing instrument was acknowledged before me this day of L11 1, 201 �, by who is p nay __ own-�16 e or who has produced as identification and _oath. APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: My Commission Expires: 3 c Zoning Clerk W�,-W 1 ez. of ` i ✓�. ..... a; mom` 3 c Zoning Clerk 1 C NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT. TIME OF FIRST INSPECTION J910 .11,m.?Z6-03,6wc PERMIT NO. T t--1Q_l'Z-1A6XFOLlON0 STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and In accordance with Chapter 713, Florida Statutes, the following Information Is provided in this Notice of Commencement 5.' kiti 102 ova .0 2:3.5 - 1. Legal description of CFN 2013ROOD9031 OR 8k 28429 Ps 2103; (1pq) RECORDED 01/0412013 14918948 HARVEY RUVINv CLERK OF COURT MIAMI-DADE COUNTYY FLORIDA LAST PAGE Space above 3. Owner(s) name and address-; - ' h�!) Interest In property: Name and address of fee simple titleholder: — 4. Contractor's name, address and phone number. M-&,,14 11.4 IS =el SY.9f LAW /a recording !DL1nj11)C f&,, If-jIS7 X�� - 5. Surety: (Payment bond required by owner from contractor, if anylTATIE OPRO91M COLNTY OF 0AnF Name, address and phone number. Amount of bond ib a A. y HEM�B y CERW 6. Lender's name and address: 4100194d' �1'1 M9 of" 47 7. Persons within the State of Florida designated by Owner upon 0 ifl a served y Section 713.13(1)(a)7., Florida Statutes, Wiff NESS 0 Name, address and phone number M 8. In addition to himself, Owners designates the following pers6nos)! calve• a !Lienoo ce as p Sac on 713.13(1)(b), Florida Statutes. Name, address and pho* ne number 9. Expireltion date of this Notice of Commencement: Mm aWration date Is 1 year froin.the date of recording wde-§S a dtfferent date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO 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. Signature(s) Of Ow s) r OwnqWuthorized Officer/Director/partner/Manager Prepared By Prepared By. Print Name d uoozo bkir-kvt Print Name Title /Office o<vd/�✓L Title /Office STATE OF FLORIDA COUNTY OF MIAMI-DADE e this ig day of.... By Personally known, or produced the following type of dentiflca �° Signature of Notary Public: + Print Name: 'V WwLnu I S D. 31 P MY COMAGSSION,0 DD961586 VERIFICATION PURSUANT TO SECTION QZ5.25, FLORIDA TUTES EDOMM: Aprd 19,2014 Under penalties of perjury; I declare that I have read the foregoing and PAR"" F1 Anw. • that the facts stated In it are true, to the best of my knowledge and belief. SIgnature=nMr Owner(s)'s Authorized Officer/Ditector/Partner/Manager who signed above: By By 123.01-82 PAW 3 aMa 14 PERMIT # CONTRACTOR: Jac SUBMITTAL DATE: ADDRESS: NAME: RESUBMITAL DATES, PROJECT TYPE: ZONING FIRE i STRUCTURA IMPACT FEES l ELECTRICAL HRSIDERM PLUMBING j � � � � NOC 1 �1 MECHANICAL n�Q� BLDG -- ! < r r /C PetA,A FPP-10-0-121,s- 't-Irc �yldmw Le�Ke � /4ry- 127 qr�i � S %U✓'c°S� �%L, 3 3/ Z r 1v -- - -- --- q, 134 1 l .` /Oom 1�1 /ex /i°" C�9aj rze9 31 2113 - i * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 07/2512012 PERSON: STEWART FEIN: 41203838/ BUSINESS NAME AND ADDRESS: MARS FOOLS INC 5405 NW 102 AVE. #235 SUNRISE FL 33351 SCOPES OF BUSINESS OR TRADE: 1- CONTRACTOR - PROJECT MANAGER, CO 3- CONCRETE WORK INCIDENTAL TO TH EXPIRATION DATE: 07/25/2014 MICHAEL 2- SWIMMING POOL CONSTRUCTION IWWTANT Pursuant to Chapter 440 . (Ibi14). F.S., an officer of a corporation wba elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Personal to Ckaptor 440.11IT412), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade limed on the notice of election to be exempt. Pursuant to Chapter 440.1165413), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure at the person named on the certificate to seat the requirements of this section QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW 9 EFFECTIVE 07/25/2012 EXPIRATION DATE; 07/25/2014 PERSON MICHAEL STEWART FEIN 412038381 BUSINESS NAME ARID ADDRESS. MARS POOLS INC 5405 NW 102 AVE. #Z35 SUNRISE, FL 33351 SCOPE OF BUSINESS OR TRADE I- CONTRACTOR - PROJECT MANAGER. CO 2- SWIMMING POOL CONSTRRUCTION 3- CONCRETE WORK INCIDENTAL TO TH K�r IMPORTANT F Pursuant to Chapter 440.05{14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt. apply only within the scope of the fussiness or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person muted on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failtare of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED.01 -11 1/14/2013 1:11 PM FROM: Fax Lanza Insurance Agcy Inc TO: 1 305 756 -8972 PAGE: 002 OF 002 1,F\ -.U-3:5 IRX114a7III '�� -- CERTIFICATE OF LIABILITY INSURANCE DATE 01/1412013 01 /14/2013 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 policy()es) 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: 954- 825 -0424 Lanza Insurance Agency Inc. 9900 W Sample Road - Ste 300 Fax: 954 - 825 -0425 Coral Springs, FL 33065 Diana Lanza Schott CONTACT PHONE Ext : FAC, No EMAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC I 0712412012 INSURERA : Mesa Underwriters Specialty EACH OCCURRENCE $ 500,000 INSURED Mars Pools, Inc. 5405 NW 102 Avenue #235 INSURERS: $ 100,000 INSURERC: MED EXP (Arty one person) Sunrise, FL 33351 INSURER D : PERSONAL &ADV INJURY $ 500,000 INSURERE: OENERALAGGREEGATE INSURER F : L AGGREGATE UNTAPPUES PER: POUCY PRO- F JECT 171 LOC PRODUCTS - COMP/OPAGG 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. QTR TYPE OF INSURANCE VAM POLICY NUMBER POLICY PM/DDYNYW LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL UAWrI`Y ms'wDE FK OCCUR M P0009005001387 0712412012 07124/2013 EACH OCCURRENCE $ 500,000 X PREMISES occurrence) $ 100,000 MED EXP (Arty one person) $ 5,000 PERSONAL &ADV INJURY $ 500,000 OENERALAGGREEGATE $ 500,000 L AGGREGATE UNTAPPUES PER: POUCY PRO- F JECT 171 LOC PRODUCTS - COMP/OPAGG $ 500,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRFDAUTOS AUTOS COMBI IEDSINGLE LIMIT acaderrt $ BODILY INJURY (Per person) $ BODILY INJURY (Per awderd) $ PROPERTY DAMAGE accident) $ $ UMBRELLA LIAB EXCESS LAB OCCUR CLAIMo MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in under 99WMA render DESGPoPTION OF OPERATIONS below NIA WC STATU- TH- ITORYUMITS p� E.L. EACHACCdDENT $ E.L. DISEASE - EA EMPLO $ E.L. DISEASE- POLICY UMIT $ DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more space is required) SWIMMING POOL CONTRACTOR MIAMISH Miami Shores Village Fax: 305 - 756 -8972 10050 NE 2 Ave Miami Shores, FL 33138 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 V 1988 -ZO10 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD _ h'311ESSTVCRECEtFT — 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, 000 ; VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: MARS #: Pooi, j 3A8R9r2 0 corrTRAC roR Business Name: ARS POOLS INC Business Type: Owner Name: MICHAEL STEWART Business Opened:02 /02/2011 Business Location: 5405 NW 102AVE # 235 StatelCOUnty /Cert/Reg:CPC1457922 SUNRISE Exemption Code: Business Phone: Rooms Seats Employees Machines 1 Number of Machines: ... Tax Amount Transfer Fee NSF Fee Penalty Prior Years 27.00 0.00 0.00 0.00 0.00 Professionals Collection Cost Total Paid 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Browrard County and is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MARS POOLS INC 511 SE 5 AVE FORT LAUDERDALE, FL 33301 Receipt #05A -11- 00011284 Paid 08/22/2012 27.00 STATE OF FLORI DEPARTMENT OF B SINESS AND PROFESSIONAL RE RATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 STEWART, MICHAEL MARS POOLS INC 511 SE 5TH AVENUE FORT LAUDERDALE UNIT 1522 FL 33301 Congratulations! With this license you become one of the nearly one rrallion DEPT .Floridians licensed by the Department of Business and Professional Regulation. PROS Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. CPC145.1 2 Every day we work to improve the way we do business in order to serve you better. F nfomtatio about our services please ion onto www mgfloridalicense.com. C>E;RT S1 I2$0161SQ:, There you can find more information about our divisions and the regulations that iaTffin1At'', 90 i `< impact you, subscribe to department newsletters and learn more about the PARISt30 N Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. „n yer t3k3 VVi$ioas 4� ra Thank you for doing business in Florida, and congratulations on your new license!$.. _ao1 t,i zn-74c��.a3a Expiraticx. date: 'AU `STEWa�RT,. -. MICHAE MARS POOLS INC RAYN 01 A0,0 g,L, , � � A'tiBNIIL: 235 R: FL. 33351 'T -> DETACH HERE - -- GULATION RD, t!5001.120724 1252 Residential Swimming Pool, Spa or Hot Tub Safety Act Notice of Regtdrements in accordance with the Florida Building Code, a final inspecUon of the pool project will not be approved without compliance with Private SWmming Pool Safety Requirements, and upon expiraon of the permit, the pool shall be presumed to be unsaN. I understand that not having one of the above systems installed wig constibAe a violation of Chapter SIS, P.S., and will be considered as committing a misdemeanor of the second degree, punishable as provided In Section 775.082 or Section 775.003 P.S .TThIs form must be of by the owner{agent and the prime contractor. `l ,J' q (�1*,w of Florida y of Dade I d d beWe me tips A day of 246-3 Lo� who is personally Public, Stat my ""A' A' a...+y�..we E)aIRES: Apra 19, 2014 -- ora..m..... FLNmtwDka dAec�.Cu. of Florida V of Dade i and Suhscribed before me this _ day of . q0— who is personally Kno — duced A - —as -as Identification. of Florida 10/12/2012 14:26 FAX 1 800 683 7330 DATA SCAN FIELD SERVICES * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /RX NO RECIPIENT ADDRESS DESTINATION ID ST. TIME TIME USE PAGES SENT RESULT Miami Building Department 10050 N.E.2rid Avenue : ?shores. Flora -but 33138 (:30,5) 795.2 04 October 12. 201 Permit No: BPP12 -1815 2991 918662148619 10/12 14:25 00'36 1 OK Building Critique Ph 00 1 1) Provide a su. -rvey. Provido a separate permit to replace meter and put power underground per pleart. Provide owners acknowledgment of no fill without pool safety act inspection. The plans show a heater as optional. Remove from plans or provide mechanical and gas perr nits. Norman Bruhn OBO 305 - 762.4859 1) Approvoci. 1) Ponding HRS 1) Approved. Zoning Critique Plumbing Critique — Rafael Herpiggdez Electrical Critique — Michael Devaney Niechaniical Critique — Jan Pierre Perez Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 October 12, 2012 Permit No: BPP12 -1815 Building Critique 1). Provide a survey. Provide a separate permit to replace meter and put power underground per plan. Provide owners acknowledgment of no fill without pool safety act inspection. The plans show a heater as optional. Remove from plans or provide mechanical and gas permits. Norman Bruhn CBO 305 - 762 -4859 Zoning Critique 1) Approved. Plumbing Critique — Rafael Hernandez 1) Pending HRS Electrical Critique — Michael Devaney 1) Approved. Mechanical Critique — Jan Pierre Perez 1) Approved. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. ��,� : ?�� P, 1,4 ®III MAY -21 -2002 12:41 PM KIDSAFE - APPLIED April 11, 2001 954 5234189 RESEARCH LABORATORIES 5371 N.W. 161 st STREET • MIAMI, FLORIDA 33014 -6223 WOW* www.etl taat.aom • Email: adt dOad.con PH. (305) 624.4800 • FAX (301) 624.3652 lvlr. Kim Nothard President Kid Safe Fool Nato 215 SW 14 Way Port Lauderdale, FL 33312 RE: L/N 30137 Dear h4r. Notltard: P. 02 FAX: (954) 523.41W. I This letter is regarding the safety testing of your Pool Safety Net. As you )mow, this teat program has been successfully oomplated. W, The safety net was tested to assure compliance with ASTM F- 1348-91, Standard Performance Specification for Safety Covers and Labeling Requirements for All Covers for Swimming Pools, Spas and Hat Tubs" and the work was performed under the above referenced ARL file number. The model that was tested and found to comply with the standard is trade- naxued "Kid Safe." This letter will serve as confirmation dud these units are Listed by ARL effective March 20, 2001 and you are authorized to label your products with the ARL. Listing Mark. Your Certification Report and Follow -up Service Procedure are in the process of being finalized and will be forwarded to you upon completion. If you have any questions, please do not hesitate to contact ARL. TESTING FOR CONSUMER SAFETY ��d oaf e Pool Nets Product Specifications Main Net Mesh Size: 3.5 Inches (Required to meet ASTM 1346 -91 Standards) Braid: 100% Polyethylene with UV inhibitors built in, for prolonged lifespan Net Braid '/4 Inch Tension Lines 3/8 Inch Nylon Pulleys 2 % Inch Body Length Pulley Wheel, 1 inch diameter, 5/16 Inch width Net Strength: Tested up to 485 lbs for ASTM 1346 -91 standard Expected life: Between 7 to 10 years Installation El ttin>es Surface Mount Plates 3.5 inch plate with two anchor positions and two screw holes Glass filled nylon for increased resistance to sun and chemicals Available in Grey, Terra Cotta and Beige (cream) Flush Mount % inch diameter barrel with flanges 1.5 inch depth Brass or Glass filled nylon for increased resistance to sun and chemicals Available in Grey, Terra Cotta, Beige (cream) and Brass Anchor Hook 4mm Stainless Steel wire hook Alternate Anchors %4 inch x 2 inch Stainless Steel eye bolts '/4 inch Stainless Steel drop anchors Stainless Steel S- hooks (Gate hook), min .141 x 1.5 inch ROMBE® 3101 SW 3RD AVENUE • FORT LAUDERDALE, FL 333153317 • TOLL FREE 1-866-463-5700 • FAX: 954760.9973 WEBS= www.kidsafopoolnets.com f'f"`Y JAsvo �O7. /� 6'a s. 0 `� -'"- 2 �; TO 2 2•�. _ P e to v b-s� av T,kT 43G 6--v" k ��p]g9 ®g9 ®g' IV a s No., 3 �yf�� �WpjP1/Re�