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BPP-13-2452Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number. INSP- 207457 Permit Number: BPP -10 -13 -2452 Scheduled Inspection Date: March 13, 2014 Permit Type: Pools/Whirlpools/Hot Tubs Inspector. Rodriguez, Jorge Inspection Type: Final Owner: KUYPER, NICOLAAS C Work Classification: New Job Address: 878 NE 91 Terrace Miami Shores, FL Phone Number Parcel Number 1132060050320 Project: <NONE> Contractor: SUNSET POOL AND SPA Phone: (305)804 -1068 X9191, -uia i I �-] NEW SWIMMING POOL AND DECK PAVERS ' " " " "" INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 202148. Gates must be self closing and self locking 54" afP Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be-scheduled until re- inspection fee is paid March 12, 2014 For Inspections please call: (305)762.4949 Page 17 of 29 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 207200 Permit Number: BPP -10 -13 -2452 Inspection Date: February 13, 2014 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Dacquisto, David Inspection Type: Survey Final Owner: KUYPER, NICOLAAS C Work Classification: New Job Address: 878 NE 91 Terrace Miami Shores, FL Project: <NONE> Contractor: SUNSET POOL AND SPA Buildina Denartment Comments Phone Number Parcel Number 1132060050320 Phone: (305)804 -1068 NEW SWIMMING POOL AND DECK PAVERS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments ff Passed COPY 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 February 13, 2014 Page 1 of 1 I ". rs 10 8 U! in I S' PARKWAY W.M. M M 75 75.00' .00. (p) Fnd. 1/2- I.P. 75.25' (M) (No I.D.) Fnd. 112- I.P. 1 17— Fnd 2 LP I/ Block Comer (No I.D.) (No I.D.) 0.25- O/S West o CONC. WALK 0. q�Ob Y W.F. TILED STOOD 1 & STEPS 20.15' 1.2a Enc--= 0�. 13. 5 �0 10 15.451 Ln go x of V 5' W.F. CONC. 16.60' Lu w -O.gg C. -W4 One Story f w Residence x IAIC No. 878 , 28.75' .4 of V �-4 16.45-1 TILED 70.40' --w� 13.15' 1 1 1 -4- �o 0 01 O.U.L x 0 x .06 4� 1.7U U. 00 w w w w P.P. Fnd. 1/2- I.P. 7ADJACENT 75.00' PLAT LIMIT (No I.D.) q 6* W.F. P F'* CJ 15'. Fnd. 112- LP. I.D.) Iv w 9.35' 9.851- i X, 00 CONC. M X Vol I x ADJACENT z M x 5- CLF vol 0 z 51 CLF x POOL ----;t-29.50- 4.45 x .06 4� 1.7U U. 00 w w w w P.P. Fnd. 1/2- I.P. 7ADJACENT 75.00' PLAT LIMIT (No I.D.) q 6* W.F. P F'* CJ 15'. Fnd. 112- LP. I.D.) Iv w SURVEYOR'S SEAL less it bears the signature i the original raised seal of 7orida ricensed surveyor and ppec this map /report is for imultional purposes only i is not valid - WSED: 020414 BOUNDARYSURVEY MOJARENA & ASSOCIATES, INC. Land Surveyors & Mappers E Certificate of Authorization No. 6698 s P.O. Box 56-0126 Miami, F13325& -0126 (305) 278 -2494 v7L PLOOD ZONE X - BASE: ,N/A NELSON MO NA %. DATE SCALE: DWN. BY JOB N;5 Registered Surveyor & Mapper No. 5504 State of Rorida 05 -13 -13 1"=20' N.M. 13 -0097 LEGEND A m Central Angie A - Arc PAR�FI A/C - Air Conditioner ALT ASPH = Asphalt r _ _ N.E. 91st TERRACE `J Z C m Calculated m CB ® Catch Basin I CBS m Concrete Block structure CH - Chord Chatm - Chattahoochee $ 7 6 5 4 I D s Center Une f4h Z CLF m Chain Link Fence W E I 3 C1 Conc. t - Concrete M D m Deed 0 - Diameter PLAT LIMIT DH m Drill Hole DME - Drainage & Maintenance Easm t Easm't mFasement Location Sketch Erm = Encroachment F.l-L - Fire Hydrant NTS FIP =Found 1/2' Iron Pipe FIR a Found 1/2' Iron Rebar FPL m Florida Power & Light ID = Identification I.P. - Iron Pipe LB - Licensed Business LME = Lake Maintenance Easement LP. = Light Pole M - Measured MAIN'. m Maintenance ME a Maintenance Easement y ° Monument Line Mon. - Monument N/A a Not Applicable N/D s Nall & Disc N' - Number NTS @ Not to Scale O/S - Offset O.I.I.L. m Overhead Utility Lines P ® Plat 3AL DESCRIPTION: PS - Plat Book 3 and the West 11 2 of,Lot,-24 `Block'3, GOLDEN. GATE PARK ADDITION, according to PC - Point of Curvature Plat t o asl ors ed in Plat Book 6, Page 130, of the Public Records of PCP PG - Permanent Control Point Page Wl DADE County, Florida. P•� - PPaint r ayntersectlon Q - Property :PARED FOR: Seth Oliver Herman & Nicolaas Cornelis Kuyper, PL m Planter 878 N.E. 91 Terrace, Miami Shores, FL 33138 PLS P.O.B. Q Professional Land Surveyor a Point of Beginning P.O.C. m Point of Commencement P.P. - Power Pole PRC - Point of Reverse Curvature Aft clearances anc41or enuTOachmerris shown hereon are of apparent nature. Fence ownership by visual means. PRM - Point of Reference Monument Legal ownership offences not determined. PT R - Point of Tangency Underground M ucUaes If any, not located. Res. m Radius > Residence Bearings, if shown, are based on assumed meridian or Plat of Record. R.L.S. a Registered Land Surveyor Lands shown hereon were not abstracted for easements and/or righ"f -ways of records. RNG a. Range Legal dmaiption provided by clienL R/R a Railroad This certification is only for land as described. It is not a certification of title, zoning, easements, or freedom from RSM - Registered Surveyor & Mapper encumbrances. ABSTRACT NOT REVIEWED. R/W - RightoRWay There maybe additional restrictions not shown on this stevey that maybe found in the public records of this Sdwk - Sidewalk county. ABSTRACT NOT REVIEWED. Sec. . Section This BOUNDARY SURVEY has been prepared for the exclusive use of the entities named hereon. The Certificate T ® Tangent does not extend to any unnamed party. TWP =Township This survey was based on the monuments found on the field. No construction in any manner should be made U.E ° Utility Easement without the prior written consent of the Surveyor UTIL W.F. a Utility m Wood Fence WM• ® Water Meter WME ® Wall Maintenance Easement SURVEYOR'S SEAL less it bears the signature i the original raised seal of 7orida ricensed surveyor and ppec this map /report is for imultional purposes only i is not valid - WSED: 020414 BOUNDARYSURVEY MOJARENA & ASSOCIATES, INC. Land Surveyors & Mappers E Certificate of Authorization No. 6698 s P.O. Box 56-0126 Miami, F13325& -0126 (305) 278 -2494 v7L PLOOD ZONE X - BASE: ,N/A NELSON MO NA %. DATE SCALE: DWN. BY JOB N;5 Registered Surveyor & Mapper No. 5504 State of Rorida 05 -13 -13 1"=20' N.M. 13 -0097 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 n t INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. OCT 0 2013 FBC 20 PERMIT APPLICATION Master Permit No. OPP /,3 Permit Type: BUILDING ROOFING JOB ADDRESS: !6 79 � ® ri o 9 I Te rf-at ce- City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: I - 7N2.n (a - to o ® ® -6 a a Is the Building Historically Designated: Yes NO Flood Zone: X OWNER: Name (Fee Simple Titleholder): ti \ C f1 K- si V a le r Phone #: Address: �� .. �, � .r:r Q e-29 1 City: MQy,� 91,� in,e s State: �� Zip: �t Tenant/Lessee Name: Email l CONTRACTOR: Company Name: Y1 7 1 5 SO Phone #: �® o�.r�sr /� (J \yam\ Address: a� G � . V3 C. e% U & ( Y b t City: yy\ <o� VV\ State: FL Zip: Qualifier Name: 7S® l`®. e Piro dl zc t e;� Phone #: A ins - State Certification or Registration #: C IP C. ® `i !{ t) 3 Certificate of Competency #: Contact Phone #: �� ®e ®{� °1® Email Address: ��1 & % -15 A DESIGNER: Architect/Engineer: Y , C_ �*- 4_t_yC CA Phone #: oz- ® ° 3 -,5A31 Value of Work for this Permit: $ 040 Square/Linear Footage of Work: 4 So Type of Work: UAddihon DAlteration %Ne _ i epair lam m ODemolition DeT lftion of Work. _.�_ t� -�' C ... .. � q0. . ra tiler Submittal Fee $_ 450 Permit Fee $ Wlb, 00 CCF $ L • 3 7 CO /CC $ • w_ Scanning Fee $ , j -CQ Radon Fee $ DBPR $ �� • �� 5 Bond $. 0 d D Notary $ Training/Education Fee $ �'I • b D Technology Fee $ Double Fee $ Structural Review $ Lba-lw / r D►�� TOTAL FEE NOW DUE $ / • J �, 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. r the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �� Signature d'" Signature �er or Agent Contractor The foregoing g 5 rtrument was acknowledged before me this _;�J The foreg instrument was acknowledged before me this day of , NO—, by , day of 20 a, by , who is personally known to me or who has produced k,W,,)t,1vq As identification and who did take an oath. NOTARY PUBLILG: Sign: Print: My Commission APPROVED BY Rotary Public - State of FloHda My Comm. Expires Jun 23. 2017 Commission # FF 030252 Bonded Through National Noun Assn w personally known to me or who has produced h as identification and who did take an oath. 'A/ /J /�� Plans Examiner u Structural Review NOTARY PUBLIC: Sign: Print: My Commi i M BULNES Notary Public - State of Florida i2 My Comm. Expires Jun 23, 2017 �'':;FOF: op�`• Commission # FF 030252 canna. Zoning (Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06 /10 /2009)(Revised 3/15/09 )(Revised 7110/2007) Clerk Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 BUSINESS NAME: BUSINESS ADDRESS: �_ � I �3 CITY STATE L- ZIP CODE BUSINESS PHONE: —, �� ' CELL PHONE L22J)5) 90 Y -I ai�O' QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: Created on 319109 BY MLDV I RV 3126109 MLDV 1 RV 6127111 AS ' CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) TYPE OF INSURANCE 10/28/13 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 endorse!. H 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 CONTACT Jessica Cando Tammy Insurance Agency 9821 S.W. 40th Street PHONE (305)485 -3999 FAx (305)485 -3944 ac Nc ADDRESS; - L tammyinsurance@yahoo.com INSU 8 AFFORDING COVERAGE NAIC d Miami, FL 33165 INSURER A: Arch Specialty insurance Company MED EXP (Any one person) Phone (305)485 -3999 Fax (305)485 -3944 INSURED INSURER B: ❑ INSURER C: $ 500,000.00 Sunset Pool And Spas Inc, _ INSURER D: $ 500,000.00 5355 SW 133 Ct INSURER E: Miami, FL 33175 (305) 8041068 INSURER F : L;VVERA1UE5 GERTIFIGATE 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. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MPMM/DDY EFF M(POLICY / EXP LIMA A GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE ❑d OCCUR ❑ 359B005677 09/23/2013 09!23/2014 EACH OCCURRENCE $ 500,000.00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 500,000.00 ❑ GENERAL AGGREGATE $ 500,000.00 GERL AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO ❑ LOC PRODUCTS - COMP /OP AGG $ 500,000.00 Deductible BVPD Per Clai $ 500,00 AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOS AUTOS ❑ SCHEDULED LED NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ aBBIINd'T INGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident ) $ PROPER AMAGE Per.. ent $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS UA13 ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ANY EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? El (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A ❑ WC STATU- ❑ OF E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 Fax: 305 - 756 -8972 ACORD 25 (2010/05) QF CANCELLATION 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 REPRESE TATIVE Jessica Cancio 4 n AP0, ^ (/;Al "1 1" D/1 0 ACORD CORPORATION. All rights reserved. name and logo are registered marks of ACORD * * 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: 2/2042013 EXPIRATION DATE: 2/20/2015 PERSON: GONZALEZ JORGE A FEIN: 650051838 BUSINESS NAME 1110 ADDRESS: SUNSET POOLS AND SPAS IN 5355 SW 133 COURT MIAMI FL 33175 SCOPES OF BUSINESS OR TRADE: SWIMMING POOL CONSTRUCTION -NOT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election lo be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall Pe subject to revocation ff, 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 of the person named on the certificate to meet the requirements of this section. DFS- F2 -DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)413 -1609 RM CA OR Eli 28681 Pss 3361 — 3362; ►. psi RECORDED 06/17/2013 13 :00:22 DEED DOC: TAX 1 r 680.0i_t HARVEY RU11INP CLERK OF COUbl" MIAMI —DADE COUNlTYe FLORIDA Prepared by Eric van der Viugt, Esq. Vice President Clear Title Services, Inc. 1 111 Kane Concourse Suite 209 Bay Harbor Islands, FL 33154 305 -865 -5718 File Number. 13 -0311 BRAUER (Space Above this Line ror Recording Data) Warranty Deed This Warranty Deed made this day of June, 2013 between Jason Brauer joined by his wife Cheri Brauer whose post office address is 1092 Qu a Anue Road, Harwich, MA 02645, grantor, and Seth Oliver Herman, a single man and Nicolass Cornelis Kuyper, a single man, as Joint tenants tvith rights of surviorship whose post office address is 878 NE 91st Terrace, Miami Shores, FL 33138, grantee: (Whenever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives, and assigns or individuals, and the successors and assigns oreorporotions, trusts and trustees) Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO/ 100 DOLLARS ($10.00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, the following described land, shuate, lying and being in Miami -Dade County, Florida to -wit: Lot 3 and West 1/2 of Lot 2, Block 3, GOLDEN CATE PARK ADDITION, according to the map or plat thereof, as recorded in Plat Book 6, Page 130, of the Public Records of Miami -Dade County, Florida. Parcel identification Number. 11 3246 -005 -0320 SUBJECT TO: 1) Taxes for the year 2013 and subsequent years and all applicable zoning ordinances and governmental regulations. 2) Conditions, restrictions, limitations, and easements of record, If any, but without the intention of reimposing same. Together with all the tenements, hereditamems and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever, and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2012. In Witness Whereof; grantor has hereunto set grantor's hand and seal the day and year first above written. DoubleTimes a y State of 4apAV14 County of ,f -- OR BK 2868 L PAGE �ra� uw" Address: 1092 Queen Anne Road, Harwich, MA 02645 (Seal) Cheri Brauer Address: 1042 Queen Anne Road, Harwich, MA 02645 The foregoing instrument was acknowledged before me this // day of June, 2013 by Jason Brauer joined by his wife Cheri Brauer, who L] is personally known or [X) has produced a driver's license as identification. (Nary Sear Mary Public QQ Printed Name: JLYS!off* d�[ LYanwiy Deed - Page 2 My Commission Expires: DoubleTimee PG 3362 T Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 195.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) knowledge that a new swimming pool, spa or hot tub will be constructed or installed at e— Miami Shores, FL, and hereby affirm tRit one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues and the Florida Building Code R4101.17. Please initial the method(s) to be used: Thepool will be equipped with an approved safety pool cover that comp lies with ASTM F1346 -9LZncontinuous, (Su Manufacturer's Manufacturer's Specifications). 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 tilled with water without compliance with the Private Swimming Pool Safety Requirements, and upon expiration of the permit, the pool shall be pr ed to be unsafe. I understand that not having one of the above installed will constitute a vio on of Chapter 5 , F.S ., and will be considered as committing a misdemeanor of the second d e, pu ish le ovided In Section 775.082 or Section 775.083 F.S . This form must be signed by t e o lag t nd th prime contractor. r- lfI ONTRACTO TURE AND DATE OWNER'S TURE AND DATE NAME (PLEASE PRINT) OWNER'S NA (PLEASE M BULNES Notary Public - State of FlotMa 3• . • My Comm Expires Jun 23, 2017 ^,;��,,•�, • °`o; Commission #t FF 030252 Bonded Through National NOV AUIL M BULNES Notary Public - State 01 Florida MY Comn, Expires Jun 23, 2017 commission # FF 030252 Bores Through Nftw No. .— . 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 �� .5 Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the Zeal owner of the property described as Ze 77� %r� located at 7� 0�� 1 -5T In accordance with Section 33 -12(f , 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 Owne Note: This certification is to be submitted with a swimming pool permit application in duplicate. a Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned l V e C-An l t c� S Q �A is /are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: 2A Ale q q 1 (� cry Whereas, the undersigned owners) k fE gpaj- "J I desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare and agree as follows: I. That the property will not be used in violation of any ordinances of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. II. 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 N any of our adjoining neighbors remove any portion of their fence or wall, or N our /my property shag fag 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 shag be binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its successors, in accordance of said Village then in effect. 0 & RINT `' OWNER SING & PRINT I Hereby Cal that on thi day rsonall appeared before me 1 �� `land has produced ID ff�- — Z6 �j�- identification and he/she acknowledge that he/she executed the4a6going, freely and voluntarily for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this c day 00- 2 r NOTl�yt PUBUC STATE OF FLORIDA (Revised 0512209 M BULNES Notary Public - Stake of IElarlde •= My Comm Expires Jun 23, 2017 Conin,rssion # FF 030252 ��O�;i ::pA• N2UOA81NOtaryAm. :Y &--1 +4 gel y *AJ Fnd. 112" I.P. (No I.D.) 0.25'0/S West O� 4 L ADJACENT, 5' CLF 1.70' CI. --�J ��' w w — P.P. Fnd. 112° LP. ADJAC (No i.D.) 0 & W.F. P n Fnd. 1/2° I.P. (No I.D.) Block Comer SURVEYOR'S SEAL BOUNDARY SURVEY MOJARENA & ASSOCIATES, INC. Unless it bears the signature N Land Surveyors & Mappers and the original raised seat of W� e a Florida licensed surveyor and 5 Certificate of Authorization No. 6698 mapper, this map /report is for P.O. Box 56-0126 informational purposes only Miami, FL 33256 -0126 (305) 278 -2494 and is not valid. REVISED: FLOOD ZONE: X BASE: N/A NELSON MO NA DATE: SCALE: DWN. BY I JOB NO. Registered Surveyor & Mapper No 5504 State of Florida 05 -13 -13 1"= 20' N.M. 13 -0097 LEGEND A = Central Angle A =Arc Gt PAR Fc A/C = Air Conditioner — — N.E. 91 St TERRACE �J��E GI Bo C = Barbecue = Calculated CB = Catch Basin m I CBS = Concrete Block Structure CH =Chord 3 Chatta. = Chattahoochee 8 7 6 5 4 1 D q = Center Line �p r � Y m I 0. CI. = Chain Link Fence = Clear Z Conc. = Concrete M D ° Deed 0 = Diameter PLAT LIMIT DH = Drill Hole DME = Drainage & Maintenance Easm't Easm't = Easement Location Sketch Enc. = Encroachment F.H. = Fire Hydrant NTS FIP = Found 1/2" Iron Pipe FIR = Found 1/2' Iron Rebar FPL = Florida Power & Light ID = identification I.P. = iron Pipe LB = Licensed Business LEGAL DESCRIPTION: LME = Lake Maintenance Easement Lot 3 and the West 25 feet of Lot 2, Block 3, GOLDEN GATE PARK ADDITION, according L.P. M = Light Pole = Measured to the Plat thereof, as recorded in Plat Book 6, Page 130, of the Public Records of MAINT. = Maintenance MIAMI -DADE County, Florida. ME �. = Maintenance Easement = Monument Line Mon. = Monument CERTIFIED TO: Seth O. Herman & Nicholas C. Kuyper, Mark L Rivlin, P.A.; Old Republic N/A N/D 0 Not Applicable =NaX,& Disc National Title Insurance Company, JP Morgan Chase Bank, N.A., its successors and /or N° =Number assigns. NTS = Not to Scale O/S = Offset O.U.L = Overhead Utility Lines PREPARED FOR: Seth O. Herman & Nicholas C. Kuyper, Ps = Plat 878 N.E. 91 Terrace, Miami Shores, FL 33138 PC = Plat Book = Point of Curvature PCP = Permanent Control Point PG = Page Encroachments: P.I. = Point of Intersection 1. Overhead utility lines. PKWY = Parkway 2. Portion of the concrete drive and portion of the concrete walk are encroaching into e PL = Property Line = Planter the street Right -of -Way (N.E. 91 st Terrace). PLS = Professional Land Surveyor 3. Portion of the adjacent 5 foot high chain link fence is encroaching over the West P.O.B. P.O.C. = Point of Beginning = Point of Commencement boundary line. P.P. = Power Pole PRC = Point of Reverse Curvature • All clearances and/or encroachments shown hereon are of a / apparent nature. Fence ownership by visual means. PRM = Point of Reference Monument Legal ownership of fences not determined. PT = point of Tangency cY • Encroachments Noted: 3 R Res = Radius • Underground structures, if any, not located. R.L.S. = Residence = Registered Land Surveyor • Bearings, if shown, are based on assumed meridian or Plat of Record. RNG = Range • Lands shown hereon were not abstracted for easements and /or right -of -ways of records. R/R = Railroad • Legal description provided by client. RSM = Registered Surveyor & Mapper • This certification is only for land as described. it is not a certification of title, zoning, easements, or freedom from R/W = Right-of-Way encumbrances. ABSTRACT NOT REVIEWED. Sdwk = Sidewalk • There may be additional restrictions not shown on this survey that may be found in the public records of this Sec. = Section county. ABSTRACT NOT REVIEWED. T = Tangent • This BOUNDARY SURVEY has been prepared for the exclusive use of the entities named hereon. The Certificate TWP = Township does not extend to any unnamed party. U.E = Utility Easement • This survey was based on the monuments found on the field. No construction in any manner should be made UTiL = Utility without the prior written consent of the Surveyor. W.F. = Wood Fence W.M. = Water Meter WME = Walt Maintenance Easement SURVEYOR'S SEAL BOUNDARY SURVEY MOJARENA & ASSOCIATES, INC. Unless it bears the signature N Land Surveyors & Mappers and the original raised seat of W� e a Florida licensed surveyor and 5 Certificate of Authorization No. 6698 mapper, this map /report is for P.O. Box 56-0126 informational purposes only Miami, FL 33256 -0126 (305) 278 -2494 and is not valid. REVISED: FLOOD ZONE: X BASE: N/A NELSON MO NA DATE: SCALE: DWN. BY I JOB NO. Registered Surveyor & Mapper No 5504 State of Florida 05 -13 -13 1"= 20' N.M. 13 -0097 L r 5" OCT 3 0 2013 POOL FENCE SPECIFICATIONS About safety fence is a removable tension based system which provides a barrier a barrier taht separetes your child from the pool . The following. product specifications meet or exceed the Florida Barrier Code # 424.2.17 The installed fence Is a minimum of 48" high from the decking surface to the top of the mesh The spacing between poles is 36" . The latching system that connects the sections of the fence together utilizes a Stainless steel safety latch. The use of a toll will be required to use for completely remove the fence from deck. Below are the product specifications POOL FENCE DATA Poles- One -Inch diameter reinforced aluminum Mesh- Polyester fabric, bordered on all four sides Border - twelve ounce reinforced marine grade vinyl that is attached to the mesh using a 3 stitch of Aqualon UV , resistant thread Screws- Stainless Steel #8 powdered coated Sleeves 4" long by 1.125" diameter Polythylene non - conducting plastic Latches -Child resistant Stainless steel safety latch ASTV F .8 s About Safe v Pool Fence About Safety Installation addendum As per code section R4101.17.1.2, the barrier may not have any gasp, opening, Indentations, protuslons or structural components that could allow a young child to crawl under, squeeze through or climb over the barrier as herein described below. One end of the barrier shall not be removable without the aid of a tool. Openings in the barriers shall not allow passage of a 4-inch dameter sphere In order to comply with R4101.17.1.2 you must Install an angle bracket constructed of 118" thick x 3/4" wide aluminum bent at 80 degrees each side 1.5" In legth . Fasten one side of the bracket to a vertical pole using one #10 x 1/2 'screw so the other side is flush with the foundation On the end flush with the foundation, install one 3116" x 1.5" Tapcon fasterner into the foundation ( see ilustration below) Vertical Pole #10. W WMW Bracket 3/16" x 1.5" Tapcon