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BPP-13-1246ra Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 192870 Permit Number: BPP -6 -13 -1246 Scheduled Inspection Date: January 17, 2014 Permit Type: Pools/Whirlpools/Hot Tubs Inspector. Naranjo, Ismael Inspection Type: Final Owner: MILVERTON, SYLVIE Work Classification: Addition /Alteration Job Address: 79 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ALL FLORIDA POOLS AND SPA CENTER Building Department Comments TEND PATIO AROUND POOL (EXISTING), a DD SUN PLATFORM TO SHALLOW E D OF THE POOL Phone Number Parcel Number 1132060130130 INSPECTOR COMMENTS False k- 1 spector Comments Passed Failed V Correction ❑ Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 17, 2014 For Inspections please call: (305)762 -4949 Phone: 305 - 893 -4036 Page 3 of 25 "P- Ac Miami Shores Village Buildin g Department artment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 T Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 10 ` 2 1 � -TAww BUILDIN PERMIT APPLICATION FBC 20 JUN 0 6 2013 ` . /, 0=4 Master Permit No. Permit Typ : BU K ROOFING OWNER: Name (Fee Simple Titleholder): 'J'{t -VJE 1 G aILVEKICO1j Phone #: Address: City: ti (Am 1 Sl S State: FL- Zip: Ja 3 (3 �3 Tenant/Lessee Name: Phone#: — Email: 6!� k ! MAV Qi o NCLe . fir` JOB ADDRESS: -79 WE i�SY EA City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO )< Flood Zone: ►JC7 CONTRACTOR: Company Name: 't`IL` �o-AO A kt-ls Phone #: Address: AA �� `\,.l & "\ , IJA- 0 City: 1V l \i4dh1 State: Zip: Qualifier Name: State Certification or Registration #: LXC o Dy -t'�:O- Certificate of Competency #: Contact Phone #: '5�s %i3 -45b G Email Address: coN ! NL.- �" Y *a<- . Cc-,4 DESIGNER: Architect/Engineer: Phone #: aCXD Value of Work for this Permit: $ _ Square/Linear Footage of Work: Type of Work: ®`Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: ESC -cE J rk'tto kkwu l 1100L (1PK 6- r(1V4, , e Submittal Fee $ Permit Fee $ 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) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City ' State VJ(4 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 r, 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 Signature x/ 7 —A, Owner or Agent Contractor The foregoing instrumeig was acknowledged before me this The foregoing instrument was acknowledged before me this 3 day of OZ x A120 r13, by l j / ✓!' 16 ,day day of , 20 !�L, by W-t .J3 Co 41L, , who is pe onally known to me or who has produced who is personally known to me or who has produced poAs identification and who did take an oath. as identification and who did take an oath. NOTAR ,PUBLIC - NOTARY B C: I Sign: Sign: 1 Print: Print: e u C.4 4 ON- Zp13 COMMARM My Commission Expires: 1 `�`' M� ES• 3° y Notary Pubfic State of Florida y C ssion Expired E e Commission # EE * @ eu`a My oo m. @7tp M t y 2016 areoFF° �kH+, kikHa�kH�nkakHakdaa�aakskskskakak�kaksksk $ask ,kakaksk $=sk,Is sk,k+k + k��k�I+ ak�Iaskskskskaksksk8+ daak�Iaga$ askskskBsHcsk, kskskaksk�kakak�Fs, kd: �k�akikak��ksk�I +ak$=�HaskskHa$msksksksk�iask lv L r� APPROVED BY lans Examiner l Zoning 1® Structural Review Clerk (Revised 07 /10 /07)(Revised 06 110/2009)(Revised 3/15/09) NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. I I - 3�rS(, --1) ° �1�0 STATE OF FLORIDA COUNTY OF DADE STATE OF FLOPd0k I HEREBY CERTFY 6W THE UNDERSIGNED hereby gives notice. that improvements will be in #a a certain real property, and in accordance with Chapter 713, Florida Statutes the following information is provided in this Notice of Commencement:... _.... 1. Legal description of property and street 2. Description of improvement: 4. �Vss• 511jcWE FAMiL °rte SNAI.�.cs�..i i= 3. Owner (s) name and address• 'b j 0A C _'i q W 9 [ se e`T . r► LqM t Interest in property: _ 0 Ta WEt � Name and address of fee simple titleholder( 4. A, Contractor's name and address: 6 ls... C:FN 2013RO3 5587 0' Bk '28615 Ps 2268i Ups) RECORDED 05/0612013 13 :00:2 HARVEY RUVItle CLERK OF COURT MIAMI -DARE C:OUNTYr FLORIDA LIST PAGE MTY OF LAM b ® ®f tripe day of Ceae�a G?1 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond: $ 6. Lender's name and address: NA 0 c 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) fa) 7., Florida Statutes: Name and address: m93- 8. In addition to himself, Owner designates the following person (s) to receive a copy of the Lienor's Notice as provided in Section 713. 13 (1) (b) 7., Florida Statutes. Wore and address: 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date in s ed) Signature ofbliAj s VO Print Owner's Name Sworn to and subscribed be ore me this day of 203 Prepared by: p>r�. ALLFL -2 OP ID: GJ CERTIFICATE OF LIABILITY INSURANCE DATE( TYPE OF INSURANCE 12/06/20M6120 2 12 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). Insurance By Ken Brown, Inc. Phone: 321 - 397 -3870 PO Box 948117 Fax: 321 -397 -3888 Maitland, FL 32794-8117 R• David Griffittls NC.0NNTEA: cr NN o Ext : A No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 Miami Shores, FL 33138 WSURERA:Amerisure Ins Company INSURER 8:Amerisure Mutual Ins. Co 19488 23396 Pool Spa Center INSURED All Florida Dis butors, Inc. All Florid a tri 11720 Biscayne Boulevard INSURER C: EACH OCCURRENCE Miami, FL 33181 -3110 INSURER D: PREMISES Ea o=vrence INSURER E: MED EXP (Any one person) INSURER F: wwa Tr.. wow - • Vf \19VGV "Y w 11F11 =nil- NI IM4iFO• Pala nlalw�l M .•Ia71V19 I11Y11112C1[: 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 kEDUCED BY PAID CLAIMS. 1L TR TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores POLICY NUMBER MM/LIDD EFF MAOrILIDD EXP LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX OCCUR Miami Shores, FL 33138 CPP2030900070012 07/15/2012 07/15/2013 EACH OCCURRENCE $ 1,000,00 X PREMISES Ea o=vrence $ 100,50 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,004,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: 1=r1T —1 POLICY PRO- LOC PRODUCTS - COMP /OP AGG $ 2,000,E Emp Ben. $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS X NON -OWNED AUTOS CA20562960601 07/15/2012 07/15/2013 COMBINED SINGLE LIMIT 1,000,00 X BOD81LYd INJURY (Per person) $ BODILY INJURY (Peraoddent) $ X PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CU20562970402 07/15/2012 07/15/2013 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DED I X I RETENTION $ $ A WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? r7 (Mandatory in NH) If yes, descdbe under DESCRIPTION OF OPERATION below NIA WC205115706 12/31/2012 12/31/2013 X WC STATU- X PET TORY LIMIT ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYE $ 500,00 E.L DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Rellmrks Schedute, H more space is required) Swimming pools - installation, service, or repair - below grotmd. VGR I IrlVfl l C nVLUCK f`Alalf`CI l ATlflhl MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building 81 Zoning Dept ACCORDANCE WITH THE POLICY PROVISIONS. Angie AUTHORIZED REPRESENTATIVE 10050 NE 2nd Avenue Miami Shores, FL 33138 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD .. 6EQ# L1205110'0915 Expiration. d a SxPi!20 a9te.s AUG 31, .4 `�,��rti�• . ::`.�,� '.feu;• �• . s3 ;��oi'r: §�� •f .rd � ''��•`�N i �: d,t ��� V,j�. �� "• • 11720 `.$�$. g�••�.;: ��•� �► „� •� ��� �••�. :.xa -:,• °::yes MIAMI FL 33181- ,�•' ''!' : "A7 :s,': �lii i i t 5• �� •�`' ..��: �ba ¢� 4:�''i� +¢•rA f• r .': a:'`;S'..! . .' ':[.a. �j�y '�,:i t:. �••• j' ,����' 'w. i:,�i p% 1' :l'.P' 't'. � fA it''•' `. �19'�.`% �. D¢' ,'� •+ :k'E. � v SECRETARY _ r'� KEN yt1 �ISi?•1�4AS s ; `i ;jA�' REI�JIRED•�'►'t.AW .l�• , ,� �1y031322� -7 THIS suii?s ���$ 0kAP88LS 33181 UNIN DADE COUNTY a . U-& POSTAaE ! PAS MUft FL 281 IS NOT A BILL — Do NOT PAY RENEWAL STATEIM 4450 103132 -7 0WRT FLORIDA DISTRIBUTORS INC %RftTY BUILDING CONTRACTOR WORKER /S TH18 � %y A ►.ocAi, 10 TAX REQEp+,; (p DON NOT PEp,07• THE ULM TO EM TO Zomm OF THE COMM -o cm DO NOT FORWApp CR UCEW ALL FLORIDA POOLS N,Kof °� l DAVID COHEN PRES TONS WAUMA- 11720 BISCAYNE BLVD PAYB,Mracm eD NIANI FL 33181 C0UMYTAX. 07/18/2012 60010000399 .000075.0o SEE OTHER SIDE 8 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: /l .,"'e"V-&-- z 4i-r Permit #: ,_'M:M � - - - Date: % / Lrax/ & Z a f 3' Review Completed by: Jan Pierre Perez Chief Mechanical Inspector Miami Shores Village Building Department RECEIPT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT «13 T13-12 DATE: _7 -�29-1 EC • Contractor • Owner o Architect (NAME) LaL 10 P1 ate. q15$ From the building department on this date in order to have corrections done to plans And /or get County stamps. I the plans need to be brought back to Miami Shores Village Building Dep continue permitting process. Acknowledged by: ignature) PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: 3 Rick Scott iNllssilon. Governor k �a4 To protect, promote & improve the health of all people in Florida through integrated John Armstrong Atatanty & community efforts. HEALTH 1 TLS State Surgeon General l & S ecretary FAGS �i3 Vision : To be the Healthiest State in the Nation October 09, 2013 (All Florida Pool) 11720 Biscayne Boulevard Miami, FL 33181 RE: Contingency Letter Application Document No: AP1120025 Centrax Permit Number: 13- SC- 1494544 OSTDS Number: 79 NE 91 St Miami, FL 33138 Lot:21 Block:1 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 09/12/2013 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. This permit is granted for the construction of a new pool deck. There will be no increase in sewage flow or characteristics and no impact on the unobstructed area. *********************APPROVED********************* If you have any questions on this matter, please call our office at (305) 623 -3500. Sincerely, Betsy Lange, Engineering Specialist II Enclosures cc: Florida Department of Health www.FloddasHoolth.com in DADE COUNTY TWITTER:HealthyFLA 1725 NW 167 St, Opa Locke, FL 33056 FACEBOOK:FLDepartmentofHealth PHONE: (305) 623 -3500. FAX: (305) 623 -3645 1 YOUTUBE: fldoh c A z9 a ��6 3 mill MPH � _r �,�vi I 1Z 98 N O � � o L 12' PARKWAY P � N. E..9 loll, -- o� 4� .11 n " LOT 22, BL l 0 A/C Z 178' rj h .. , .. now oa'w Bf.77' P. ,-:2 ,, 2� ASiPNAL TPA ! AF1PP,o 77D BY 1 TL 97ONIN G DEPT ld l6 03 BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS o ON 0 , loll, -- o� 4� .11 n " LOT 22, BL l 0 A/C Z 178' rj h .. , .. now oa'w Bf.77' P. ,-:2 ,, 2� ASiPNAL TPA ! AF1PP,o 77D BY 1 TL 97ONIN G DEPT ld l6 03 BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS £NT POOL REQUIREMEN1111 -� � C-) SELF - CLOSING/ SELF-1.0046, GATES REQUIRED o FENCE: 4' HIGH (MIN. �'I AND NON- CLIMIBABL Og A WALL, OWNER MUST ROPLE WITH A 4' FENCE ON OWNER'S PROPERTY 1% 4� wail IN T "N■ MN g .Vf.�rN �.aGOm 5 G � � C an r .. a�