BPP-13-2655Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 205205 Permit Number: BPP -11 -13 -2655
Scheduled Inspection Date: January 03, 2014 Permit Type: Pools/Whirlpools/Hot Tubs
Inspector: Rodriguez, Jorge Inspection Type: Final
Owner: LEE, EDWARD Work Classification: Repair
Job Address: 137 NE 108 Street
Miami Shores, FL 33161-
Project: <NONE>
Phone Number
Parcel Number 1121360090200
Contractor: G.E POOLS CONSTRUCTION INC Phone: (786)355 -3382
tsunaing uepanment comments
RESURFACE SWIMING POOL
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP- 203528. GATE MUST BE SELF
CLOSING FOR CHILD SAFETY
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 02, 2014 For Inspections please call: (305)762 -4949 Page 16 of 20
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
BUIL IN
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: /3? ✓`° e /09 -s
Permit No.
V21 Q� 4
FBC 20 t'D
Master Permit No.SPFA 7 _Xd5s
ROOFING
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO V Flood Zone:
OWNER: Name (Fee Simple Titleholder): �7�lvr D L � Phone #: P57- L16-7-5-91 -7
Address: l 3 `i IU If- % 0 cS S7_
City: 1721 /tv�i i 'S oye.S State—
Tenant/Lessee Name:
, J_F6�tgoln i6 &. Email: e'on.
CONTRACTOR: Company Name: �� e _ PooL $ don,6y 0 G' J7 0,
» 10one #: '?�.3.SS 3391
Address: L4 22,0 SCJ q % PL-
City: fn t A M
Qualifier Name: $rm
Zip:
_ State Certification or Registration #:
Contact Phoneg -7& 5� _3 � _ . Email
DESIGNER: Architect/Engineer:
of Competency #:
Value of W rk ox t Permit: $ `L`30D .� Square/Linear Footage of Work:
,, ,� _
Type. of W, " : ogAddhibh. - ❑Alteration ❑New j epair/Replace
Description vf roc 5W I h;AA(cO e RCb L..
Color thru tile:
❑Demolition
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
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 Xt be approved glad ayfe7nspectionfee will be charged. /]
Signature Signature_ /��
Owner or Agent Contractor
The for omg instrument was acknowledged before me this
day o , 20 0, by ° 7, ,
who is erso y own to me r who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of Nwe -M6l', 20 /3 , by �604led I . b@'e. ,
who is personally known to me or who has produced
NOTARY
as identification and who did take an oath.
APPROVED BY
Plans Examiner
Structural Review
(Revised 5 /2/2012 )(Revised 3/12/2012) XRevised 06 /10/2009 )(Revised 3/15/09 )(Revised 7/10/2007)
LUCAS
N #00960414
Zoning
Clerk
CERTIFICATE OF LIABILITY INSURANCE I DATE (mm""
11/06/13
PRODUCER Tonwis Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
395 S.W. 110 Avenue ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Miami, FL 33165 ALTER THE cnVFIRA[`.,F AFrrwnr-n nv rum oru rrree aw nut
Phone (305)553-9087 Fax
INSURED G.E.Poois Construction Inc
4220 SW 97 PI
Miami, FL 33165-
1305
COVERAGES
INSURERS AFFORDING COVERAGE NAIC #
INsuRERA. COLONY INSURANCE CO I-
INSURER E:
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
LTR
ADD'L
TYPE QF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE fMMfiXVYYYY
POLICY EXPIRATION
DATE
LIMITS
A
❑
GENERAL LIABILITY
QCOMMERCIAL GENERAL LIABILITY
❑ ❑ CLAIMS MADE 0 OCCUR
❑
GL3573986
11/07/2013
11/07/2014
EACH OCCURRENCE
1000000
DAMAGE TO RERfE15--
Ma o=wenoe
50,000
MED EXP (Arty one Ian)
5,000
PERSONAL & AM INJURY
1,000,000
❑
GENERAL AGGREGATE
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
❑ POLICY ❑ PROJECT ❑ LOC
PRODUCTS - COMPlOP AGG
1,000,000
AUTOMOBILE LIABILITY
❑ ANY AUTO
❑ ALL OWNED AUTOS
N/A
COMBINED SINGLE LIMIT
(Ea accident)
El
SCHEDULED AUTOS
El HIRED AUTOS
❑ NON OWNED AUTOS
BODILY INJURY
�r�,)
BODILY INJURY
(Pet acoiderd)
❑
PROPERTY DAMAGE
El
(Per aocidwM
❑
GARAGE LIABILITY
❑ ANY AUTO
❑
NIA
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
❑
EXCESS ! UMBRELLA LIABILITY
❑ OCCUR ❑ CLAIMS MADE
N/A
i
EACH OCCURRENCE
AGGREGATE
❑ DEDUCTIBLE
❑ RETENTION $
WORKERS NAND
EMPLOYERS' LL4 DUTY
N/A
❑ C STATU- E] TH-
FR
ANY PROPRIETOR / PARTNER / EXECUTIVE YIN
OFFICER / MEMBER EXCLUDED?
E L EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
(Mandatory M NH)
If orde
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LINT
OTHER
N/A
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
SWIMMING POOL INSTALLATION
NO POP UP COVERAGE
�......... ^ g c rraurcpr r enniu
W IUM-'LWII AVUKU GUKYUKA 1 IUM All rlgMS reserVea.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
MIAMI SHORES VILLAGE
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
MIAMI SHORES, FL 33138
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORGED REPRESENTATIVE
FAX# 305 - 756-8972
ewwww w�. u.
RAUL TORRENS SIGNATURE ON FILE
W IUM-'LWII AVUKU GUKYUKA 1 IUM All rlgMS reserVea.
The ACORD name and logo are registered marks of ACORD
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t4 ` 2G•38' Q This property described es:
` 9284• Lot 12, Block 216
DUNNING' S MIAMI: SHORES
M• q �, Q t�. EXTENSION NO. 5 , .
� �r ^� t \,��'. according to the) Plat
thereof as recorded in
Good 3.97' Plat Book 48, Page 21
P N / 7.55• of the Public. Records of
N v ` Dade County, Florida,
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PRUPfRTY t7f: E and T. 137 N.Eu 108th Street, Mi. Y° for
'4411 %At 111 Nt111,11tt 1111:MIMAIUpC OUNDARY -•
-41141)111 t1 /NUb t,111411t1it Lqr 1 hetehy tertdy that the survey repreY LANNES AND GARCIA,WC.
Anu nt ►PPa +enter) hereon meets the minimun) 1„8, p 2095 '
let hnitA standards set forth by the Board SURVEYORS!-MAPPERS-LAM land Surveynrs in chapter 61Gt7.6 LA1
Ion
i ilonda Administrative Code pursuant to ' .ERNESTO E. ESPINOSA #2946.
Section 172017. f la. Statutes. There are no
entroathmem%. overlap,, easements -
appea.,ng nn the Plat, other than as
shown te1o. tifgvt address: J39 Aleliistr Awllue. Carol, pbin; Nlorida 33IJ 1
(303) 666 -9Ytl9 •.: 49'.14) 32:1 - J
e1. ►am.suavcrow anatt4u: t`�(s �''� D•�•�1'F:' ..SCALE•
D=Y1 ®m[ti. NO
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