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BPP-14-996 (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-224702 Scheduled Inspection Date: December 30, 2014 Inspector: Rodriguez, Jorge Owner: BECERRA, EDUARDO Job Address: 839 NE 97 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: BPP -5-14-996 Permit Type: Pools/Whirlpools/Hot Tubs Inspection Type: Final Work Classification: New Phone Number (786)390-3312 Parcel Number 1132060142610 Contractor: ROSMEL POOL INC Phone: (305)592-7900 tsuna comments BUILD NEW POOL, SPA AND DECK INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-212497. Gates must be self closing \ Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 29, 2014 For Inspections please call: (305)762-4949 Page 10 of 32 aEff-T, ! CONSULTING GROUP. coRP FIELD DENSITY TEST OF COMPACTED SOHO ASTM D -693848a CLIENT: ROWEL POOL Date: December 11, 2014 GEOTEC No. D-141211-439 PROJECT: ELECTRICAL TRENCH AT: 839 NE 97 ST MIAW SHORES, FL MOISTURE DENSITY RELATIONSHIP (MODIFIED PROCTOR) ASTM D-1557-07 GAUGE SERIAL SOIL DERIP 1IO1V SC MAIL DRY ; OP77MUM . Na B. PAID DjNSITY MOISTti(%} 62691 SAND WITH GRAVEL 120.0 9.2 REQUIRED CiJMPACnClN (%) 980% T90 DEPTH PENETRATION (INCHES) 12 ORGANIC % N/A MATERIAL ON SITE BACKFILL X SUBBASE TEST 1 BASE j TEST 2 B. PAID B. SLAB iC MP. LIFTI EXC. X IMPOIIT ''SOURCE 2 ELECTRICAL TRENCH....... BASE 119.6 OThIER 99.7 PASS DENSITY TEST RESULTS TEST LOCATIONS . MELD DRY FI "(%°) FIELD (%) RESMIN Na' DENSrrY • OIST. iC MP. 1 ELECTRICAL T ENCH........SUB-BASE 118.4 9.6 98.7 PASS 2 ELECTRICAL TRENCH....... BASE 119.6 9.4 99.7 PASS 3 4 5 SieveSiu: �" ;' 21/Zei 2,t ll�a+r 14% Y.1' ` 3/8" #4 °/u pmipg Sieve She: #10 #20 #40 #60 #80 #140 #MO WASHED =`I °l° Psi�J DRY MOISTURE I DEIMITY CURVE 140.00 120.00 100.00 80.00 M 80.00 K c 40.00 20.00 0.00 6.52% 9.02% 11.68% 1200"/0 MOISTURE CONTENT % GEOTEC CONSULIT4G GROUP CORP. r No. 56712 ofF1orMs GEOTECHNICAL, CIVIL & STRUCTURAL ENGINEERS -13093 SW 133 CT. MIAMI, FL 33186 - P: (786) 319-03551 P: (786) 380.0734 garcia5229@bellsouth.net 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 BUILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: 83 BUILDING or, CI'7 -.!St �CEIt7ED MA 6 014 BX• FBC 201 J Permit No. Master Permit No. ROOFING City: Miami Shores County: Miami Dade Zip: X313 8 Folio/Parcel#: 1 1- 5--)L-CXo -O 14 - Z 4- l a Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 7E.i�.c�o 0. ^3e -e « Phone#:_�- 3qQ 33 i Z. Address: &JC- 9-7'5-f. City: U-�+44-A 5lt'ores State:: -L Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: "0,o51ylej Pb41 s,-Tne. Phone#: Address: 9045 ULL) 365f. --W s40 City: 'd r4Xk . State: t'(- Zip: '3 3 / 4 Qualifier NameAki m4� vs;� "e - _Phone#: ('B.0 ) -5-)Z- -r� d)o State Certification or Registration #: GtPG 1,45 680¢ Certificate of Competency #: Contact Phone#: t7$6i 545 rPj5Email Address: tyQ90sjP_1 eOSAVJ X15. DESIGNER: Architect/Engineer: 1(""re_ P S. (' as31 Phone#: (305) 5-C-15 s 631 Value of Work for this Permit: $ - Square/Linear Footage of Work: Poc :: Type of Work: OAddition ❑Alteration 7. ONew URepair/Replace ❑Demolition Description of Work: °_bs ilA � ; � • ® d�-� Color thru tile: Submittal Fee $157c%- Permit Fee $ 6 311 , CC) CCF $ va 1 • �� CO/CC $ -0 jn4v In Scanning Fee $ Radon Fee $ DBPR $ p��-�dS- Bond $ Notary $ Training/Education Fee $ Technology Fee $ _CA Double Fee $ Structural Review $ 16C�0_ _ TOTAL FEE NOW DUE $ 26�YS� � 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 approved and a reinspection fee will be charged. l I Signature _�Z� Signature Owner or Agent The foregoing instrument was acknowledged before me this $ day of _, 20 14, by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Contractor The foregoing instrument was acknowledged before me this_g_ day of _�—, 20 l , by� ��,1�'" VD 10 La, who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: :.I iE, �t�' ♦ 1 i. I - f Lit Ii LT:N�E'ae ._Rr 1 tL'7�'�i� i4� •TF • �I L�{�,. r"S"i,7 �fT ur ' rF"ii�'T7I + ���• 1 �k�k�K%k,k�h�ksk�k�k,k,k�-k�k,k•k*&�ksk�F �k�k+k�k�¢kak�k�k�k,kik,k�k�k,k,kik,k�k�K�k**,k�kN�,K,K�k�K�a�k�k�k�k�k APPROVED BY _ ` Plans Examiner Structural Review tRevised 3/12/2012)(Revised 07/10/07)(Revised 06/ 10/2009)(Revised 3/15/09) / ning Clerk 6338596. STATE OF FLORIDA DEPARTMENT•CONSOF' BUSIN9SS AND PROFESSIONAL g GU'L&tION TRIICTION INDUSTRY LICENSING B ARD SEQ# I,220905Q177=, ENSE NBR- Q9` 05 2012 2 8Q69"74�. Tli COMMERCIAL POOL/SPA CONTRk !Oi ,XdMed below IS CEXI'fi.IF'IED. IIrider the 'povisioal� -O'f Chapter Expiration date: A17G ;31, 2014f�^', a"11 IM1{ P VARELA,, 1+RTHA 7 N _ Fd iy4h��` ROSMEL POOLS INC 8045 NW 36'STREET, SUITE 540'.., MIAMI FL 33166 RICK SCOTT REN LAW30N GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW 003017 Tax`Race"tpfi`' F M a.ml ode 6U .;S t F . Ort a-, nay, to a Of I O d i H1S IS lV0 f A BILL —'RO NOT PAY `l�419IN($$$ NdI�VVIIEIt-CJ k 3h� RClavq 40_-, F �xr {+ � X SM L POOL$ INC ; ' x , . RENSVVd�i S E fl air PTE Mgt t R `' M� ," 1,4 8<1451WV 3G ST SfJi `� $n 66091 i'6, be �lipl+�d lel b# bust, pO 66 0� Puauam.td nfi`rp Ghpter 8&4 Art 91?t0 S$OVIER SEC. TYPE OR `BUSINE PAYMENT RECEIVED ROSMEL POOLS INC 196 SPECIALTY PLUMBING CONTRACTOR CPC1456804 BY TAX COLLECTOR VUorher(s) 1 $45.00 08/01/2013 :-` 1XH51-13-040591 JEFF ATWATER DV/B CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * 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: 3/21/2014 EXPIRATION DATE: 3/20/2016 PERSON: MARTINEZ ALINA FEIN: 263013092 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC ROSMEL POOLS & OUTDOOR 8045 NWN 36TH ST. SUITE 54( DORAL FL 33166 SCOPES OF BUSINESS OR TRADE: LICENSED POOL CONTRACTOR -PROJECT CONTRACTOR MANAGER,CO 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 to 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 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 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 * * 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: 3/21/2014 EXPIRATION DATE: 3/20/2016 PERSON: VARELA MIRTHA FEIN: 263013092 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC ROSMEL POOLS & OUTDOOR 8045 NW 36TH ST STE 540 DORAL FL 33166 SCOPES OF BUSINESS OR TRADE: LICENSED POOL CONTRACTOR 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 to 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 be subject to revocation if, at any time after the }ding 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 ' Qe a t a JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * 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: 3/21/2014 EXPIRATION DATE: 3/20/2016 PERSON: MARTINEZ MARCOS A FEIN: 263013092 BUSINESS NAME AND ADDRESS: ROSMEL POOLS INC ROSMEL POOLS & OUTDOOR 8045 NW 36 ST STE. 540 DORAL FL 33166 SCOPES OF BUSINESS OR TRADE: LICENSED POOL CONTRACTOR -PROJECT CONTRACTOR MANAGER,CO 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 to 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 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 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 Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, , omay be personally liable for the worker compensation injuries of gay person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print m�d n. �Ifl — Contractor Print Name: I A yar , Signature: Ae l cl State of Florida ) State of Florida ) County of Miami -Dade) County of Miami -Dade ) Sworn to and bscribed before me this Sworn to at@ subscribed before me this 65 day of , 20 day of Lkuj 20J*_. Gaon„e ` By By 9058 (SEAL): p(PIRM MAY 19, 17 (SEAL) y •••• ; EXPIRES: MAY 19 201 Type of Ident$9'.•. on e _ Type of IdentifiV n p NN®7A xom 05/14/2014 14:07 3052281525 CiTiNSI-RANCE VAL*- Ili/til Mm %4W0KDCORPORATION �A CORD, CERTIFICATE OF LIABILITY INSURANCE DATE og�141�as4' • Poo 9RTRI A CERTIFICATE IS MUED A OF INFOFMflbT ZI'dT8DR1U1TC8 AGS* COJtts ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE HOES NOT AMEND, WMW OR j :., Fia'0'1' FZA014IR 8T SUZTB 213 -- ALTER THE COVERAGE AFFQRDED BY THE POLICIESBELGW�7 ~ FL 33164 a.r INSURERS AFFORDING COVERAGE xoomz s00zo, zmc. MURCRA: COLONY ZJi18UAWC8 COMPAW it». WS{111ET18' ... 8045 RPI 36 9T., 8UX= 540 wsuRERa , oiu, A 33166 nvsursmia nvs E: �:-�,•: ,RAGES okf POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISBUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING•• TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHtH THIS CERTIFICATE MAY BE ISSUEO OR �EQUIREMENT, • . TAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERZIN 19 SUBJECT TO ALL THE TERMS. EXCLUSIONS ANO CONDITIONS OF Sl dS"' CIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOMD BY PMD CLAIMS. y y MI. POUCYNLRA" NETTS •[TENERAL L1A&UTY EACa♦OICCtA1RENCe - -`•� 8 co+AtiLeRCIAI.GENeRALuaaa.m FLREOAraACE A�apRr.) S 100, 000° MED WT are ) $ 0 DO MS CLAMADE ® OCCUR PmOwLAAcywAm s2,000,000 GL4026239 06120113 06120114 Iw " OERAL AGWGATE $3,400, 00 0� +T AOORE6gTGLWiTAi+PLPgR: y PRODUCTS • COAAP/0P AOo t2,000,00 -el, wP POLICY PRii• LOC .�..e. i dWRILB LIABif1Y V r. `ANYAUTO i�N01! LINT a ,� OW WD AUTOS `{ AUTOS tBFtEG 80DLY IN,IL✓TtY a ( PSI (per Now) AUTOS * �`- ►�n,�owN6DAu108 ..� P PROPERTY OAAWfi a ,. 08 L lAsam AUTO ONLY •EAACC=W a OTHER THAN rA ACC a :. ANY AUTO IFq ` AUTOON.V AUG a '{ "• Xxc¢SS LMMUrr FACHOCCURRENCE OCCUR CLAM LAA08 AOLOMQOATE a V!. ' DEDUCTW a s ff" CO IPENSATWN AYD EA.EACHACCIOM a -' 'irt` '�'; i•l 018fAaE • EA EN�PLOYse S : i; �'• Tat_ OISEABE • POLICY LWYT S :' :J .. DHS ON OF aPE1fATt01AQIL00AripkaAlpa1$atp(OLU9101q ADM DY a900Ra1'itJ�yy. Onp r .001i3mcTOit Roomm Foom x9c. ZZCEN58 80. C8c 145680 " ro—Z T8 loa�tas8e 839 S18 97 BT NZANX eiro 88, •j% 33138 !.TA QElTTIPICATE FIILDER ADMONAL OMAN LES CANCELLATION SHOULD AW OP TIN AIIM DWRWD POLIO= 88 CAMMLED EgORB TME 0WIRATON JifZA= SHOR" VZiZa= t. a OATS THRUM, TH9 MUM NSURER MALL ENMVCR TO MAL 10 DAYLTRflY WL1Ha 10050=2AVB NOTICE TO TW CIfiCATE MDUM WMWTO 7NE LEFT. bill FA M TO OD SO SHALL ' KZ Z 880(lSIB, FL 33138 I @ NO OHUOATION 011 UAEIUTY (iP AMY OND UPI TM8 ITS AOENTE OR 1UPROWRM AUTMORRCOAkItylfaiRTATTYE ' �- ' ORD.21�B1i!r97t Mm %4W0KDCORPORATION Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if - 1 . f: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore,_ oy u may be personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS'; • • 19.0• •State of Florida 4 .County ofUimi?--Dade $w@m toiscribe day of .o (SEAL) Type of Identification 090.90 • Jbeforo me this ,20_)3 . Luz Helena Aragon MAY 19, 2017 Contryafctor Print Name: 1 /.I 12-A!�� ie)a . Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this I -C, day of _,20 19. �oa,, Luz Helena Aragon By •.yam,. _yes EXPIRES: MAY 19, 2017 (SEAL) '''n°.'°•u++�' WWW AMONNorAsymm Type of Identification produced V ••.• • • .00 •9999• Ower Nam • • • . • Agqature: 0.000• • • • • •.•� 19.0• •State of Florida 4 .County ofUimi?--Dade $w@m toiscribe day of .o (SEAL) Type of Identification 090.90 • Jbeforo me this ,20_)3 . Luz Helena Aragon MAY 19, 2017 Contryafctor Print Name: 1 /.I 12-A!�� ie)a . Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this I -C, day of _,20 19. �oa,, Luz Helena Aragon By •.yam,. _yes EXPIRES: MAY 19, 2017 (SEAL) '''n°.'°•u++�' WWW AMONNorAsymm Type of Identification produced V Miami shores Village FIC Building Department 10050 N.E.2nd Avenue Y." Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 2, Ur i TI OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at $ a).7 NIE Ct7 -5t Miami Shores, FL, and hereby affirm that 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: 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). 0000 A combination of non -dwelling walls and fences (screen enclosure, child fence, masonry • • •.: -4tce walis,:cha"4nk or wood fence, etc.) will protect t he pool perimeter. The plans must specify t he type ••ar"Ication 8f all Mon dwelling walls. Florida Building Code, R4101.17.1 0000.. . . . . • 0"4TT';ombination of protection which incorporates dwelling walls with openings directly into the ��Pool-perime4er ancrall windows and doors will be equipped with exit alarms complying with Florida Building •..;.� Codg, R4101�,��.1.9 (Submit Manufacturer's Specifications). 0000.. 0 . . • • • 0.- ,:A:x combination of protection which incorporates dwelling walls with openings directly into the .... . p ..pgl perimgtg.-* j j all doors will be equipped with a self -latching device with positive mechanical :.SatOng/locking.igstalled a min. 54" above the threshold. If this option is selected, submit plans showing all •%0.00 0 � and lhacioniof 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 the owngogepian jthe primg$ontractor. COWMCTOR'S SIGNATURE AND DATE OWNER'S SIG4ATURE AND DATE i - ,(,..,_.Q , - ` I r, C,)- 1101 uff 1, iraw" _.,�=,.. ' Ls qa. pW.. :; ;fit 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 ��������` is/are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: 33,1? 0 6L 4" `�—�/ ���'^^ � '�533138 Whereas, the undersigned owner(s)J� 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 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.'.' 1}rat, I/we, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not • • •. •.. , typving the enclosure. '. . V. ; •; • �I:enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is ' lama ed or removed by any case. . . •0 •; 0 • NOW,'f MEOF, for good and valuable consideration, the undersigned do(es) hereby declare that he/she will not • • eawoy or cause fo%econveyed the title to the above property without requiring the successor in title to abide by all terms and • • • • • • conditions set fWhtrein, ';"" ; • • FUR MF_R,•the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant .' • • tortCerning the ule9 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 • 6Moeessors, in accordance of said Village then in effect, ccaosa- OWNERWN PRINT OWNER SING & PRINT I Hereby Certify that on this day personally appeared before me'����"� and has produced ID # as identification and he/she acknowledge that he/she executed the foregoing, freely and voluntarily, for purposes therein expressed. SWORN TO AND SUBSCRIBED before me on this —A—day of d!k 2014 (Revised 05/2209�.PB°PAded Tj ,t�ta,y t A Puff Undena�ters 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, Miami Shores Village Building & Zoning Department Attention: Building Official certify that I am the legal owner of the property described as 0000 'a 2, 0 - ha e � c 13 lo- 37 ,g , located at 9 3 6 97 -n'+ 0000.. • :0000 : • • • • • accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that 0000. ... 0 000006 •••e•• unc�r4god and•ag%e that the swimming pool to be constructed at the above address cannot 0000.. • • •••• :sees: be used or fillettDvM water until separate permit has been obtained for an approved safety 0 00 •sees• WON"i and su'eNN rier erected, inspected and approved. 000 • 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 - Note: This certification is to be submitted with a swimming pool permit application in duplicate, MOUNTING THE SENSORS Make sure that the arrows of each sensor are painted toward;. each other Using either the double -sided tape or the screw, provided, mount the sensors so that they are less than u,r,h away from each other. Sensors must be mow^fed flush ur height and depth, so with some doors x winnows, tipec,al custom fitting may be necessary. Please make sura that the wired portion of the magnetic sensor is mounted on the non-moving portion of the mounting surface and the standalone sensor is mounted on the daor/gate. (See Fig 5 /Fig 6) MOUNTING OUTDOORS ON WOODEN GATES Using the provided mounting_ template printed in this --"-- — ucuxrrpr,ourrx»p� ; manual, mark the position of uv woaaEn P+ r L. '. the screw holes on the desired mountingsudaco, Doll Ole screws onto the i I` metalling surfacemonth ` ,1 !, approximate) 178 Inch of ( }I1,'i thread remaining. Slide theI 4f JI Ir unit over the screws and --y 1- t 1 ?"- secure the unit by pushing Fig 5 rt downward as shown in Fig. 5. You may need t.r ,n.11 r.t Ifur sc.rery . towards or away from the rnountitkq suriau- to pn:vrdc .h nu-rr a i.k_ �, 'n. Make sure that the arrows of each sensor'I frnnic•d m Itlr :ar doe Grnr Note Wooden gates do not reciurre Urs il n..or ho:r.uri. MOUNTING OUTDOORS ON METAL GATE'S Jsnrg the pn,vrded Zip ties. uouvrcm ar rucwi -- - �I attach tic, alarm body to the ar rsr car r r 1 moral elate frame (See Fig. 6) Usrny d small flat head T scrmvd,ww gently pry n ope tt a rt ' es° d sensor spacer p �•,6 lis !� of tit :.cr mor huus,ng ( Fig6) rAake sure that the arrows of i acJt sensor are pointed In the --_— same direction as the sensor r•D 6 hwsing Delete [Racing the magnetic sensors. m,rdc the s,.vsrn hnusrnq. Nate. Metal gates may inter!erk! with thu ...... ser, •:,tntii or funchor Use sparerS provided to ensure sen sur r. rrpernG: proprrrly Secure the sensors using the zip tits onto the g,ote honor M.rk,r Sure that Owl sensors arrows are poiniod towards rar:h ,direr ard Thar itis sensors are less Ihan % inch epdrl MAINTENANCE When the alarm volume becomes low: or the unit does ncrl Produce nor 71a! alarm sound, the red light sviH filum hale. you roust replace the 9 -volt battery. The Safe Pool's plastic parts resists ultravnoret rays Irurn direct sunlight exposure. Howeve- slight dlscoloraUln over time is normal. WARNINGI THE SAFE POOL ALARM IS EXTREMELY LOUD WHEN ACTIVATED. FOR YOUR SAFETY, NEVER PLACE THE UNIT CLOSE TO YOUR EARS. TO TEST THE ALARM. ALWAYS USE EAR PROTECTION AND DIRECT THE UNI I AWAY BEFORE TESTING/ACTIVATING THE ALARM IT IS PROHIBITED BY LAW TO REMOVE THE INSTALLED ALARM AFTER IT HAS PASSED INSPECTION 1 Important Warranty Information: A dated proof of purchase is required for warranty service Customer Service : 1-888-8TECFKO(1-888-883-2456 ) Website www.iechkomaid.com Mfg. By 7EGI,lIffJ' 9767 Research Drive, Irvine, CA 92618-4626 MADE IN CHINA 97D0127 COMPLIES WITH UL 2017 USA Patent: No. 5,473,310 No. 6,727,819 NOTICE THIS PRODUCT IS PROTECTED UNDER FEDERAL PATENT. TRADEMARK AND COPYRIGHT LAWS AND LAWS PREVENTING UNFAIR COMPETITION, NO DUPLICATION OR SIMULATION OF THIS PRODUCT IS PERMITTED EXCEPT BY WRITTEN AUTHORIZATION OF TECHKO, INC. • �f�CI �N� TCE (jP%IGI=RASIOV t? THIS PRODUCT ••IRE WD&MARKSObTC�CHKOINC • •• 1COPYR1GIM19sl11ECHRO,INC, •••••• ••IL1I1RTS•RE�j"ERVj8 MJ[t IfC NA • ••• • ••• • • At • • • • •• • • •• • • • • ••• • ••• • a ••• • • • • ••• • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • Safe Pool TI Model , Area Entry Alarm r' it 1 •�� /f kiPFrrr".A� �awru I� I �5 Eel • Illr-. l I. INTRODUCTION ongratulatians on your purchase of the TECHKO Safe ool model S 187D safely alarm. The Sate fool can be sed to provide a high volume alarm alert when children ave entered a pool or spa area. The S187D can be. used indoors on wood or metal gates, or indoors on doors and indow leading directly to potentially dangerous areas OPERATION he Safe Pool is designed to sound a foud alert when liidren enter through a Safe Pool protected doorIgale /hen properly installed. the Safe Pool wil(allow adults la ass through the protected door/gate and immediately shut I the sounding alarm then powered the Safe Pool is always in prultauton mudki. he alarm will activate the instant when the doorigate opens V more than 112 inch (when the magnetic sensors are apart r more than 112 inch) Once the alarm activates it will sound )ntinuously until the NYI'ASS button is pressed then passing through the doorigate prey the B i Aton, then npen the doorlgate, pass through iod cl , •e dooricTale within 8-12 second; and the alarm will rlo; ,livate FEATURES Easy installation for gate, door or window proteehLn Water r weather resistant 9 Volt battery power (rot included] High output 11 C}-115 d8 alarm siren Low Battery l,ignal LED Indicator Optional adiilional BYPASS button fog delayed gantry from: ither side of door or fence Optional additional rn;agne6c sensor for ecrcura du:,. sxilienlry ARTS LIST 5187D UNIT I—(--_----_ ¢YPASS - I _--ZIP TIE w - I Fig. 1 r �J^� Prw IMPORTANT SAFETY TIPS ,farm siren is VERT` lt�od: NEVER plane the unit Ouse to ars ,stall the: unit rngh anough to be out of reach vi cnsctrrn i4' or higher ;s ieuommended. Keep this manual (or future reference The Safe Pool can provide valuable protectiun when � used correctly. However it cannot guarantee c011, r. protection against accidents or injuries Therefore, Techko cannot be held responsible for any loss, damage. or in;ury that may occur INSTALLATION WARNING: Read all installation and operation instructions thoroughly before proceeding with installation. Note' Not all parts included are needed fur Installation Please read the different mounting instructions to see what is needed for your sperihr application INSTALLING THE BATTERY., 1 When lestintl, before installing the battery, use a rubber band to ternporanly secure the two magnetic sensors together with the arrows pointing toward each other to avoid setting off the alarm unintentionally Duang the actual installation of the alarm. it's best to install the battery after it's mounted to avoid the alarm going off ur-irttenttonally 2 Remove the battery cover of the unit and install o new c; hhalt battery F:eplace cover. (See Fig. 2) If you are. sensitive to loud sound, please wear ear protection against the loud alarm siren before testing the alarm q Once the battery is connected, the I c nil a nuv, ON rind wuiking. To last tI,e alarm siren, make Sure you 4 � , have ear urntect-on before testing , 0. I After ear protection is in place, - ..erpara le the nlaynutrr sensors apart by more than ' i Inch The alarm should sound immediately after the sensors are separated. Preys the BYPASS button and unrned,;ateiy secure the two magnet sensors together tagam to ,avoid the alarm sr,unding uff unintentionally LED LIGHT WARNINGS I When the battery becomes low In charge or Te volunu: becomes weak the LED tight will illuminate Tire a :oll hatlery must be rel' laced ? Upon battery iutallat,on, the unit will beep once and Ihn LED light will f asci 10 limes as it prepares to be,xnnc armed 3. When a bypass. button Is pushed. the LEO fight Illuminates to indicate acknowledgement to PASS through 4 After the hypa.�; hl,rtlorl is pushed in and reieased, the LED light wilt flash 10 tames to allow pass through and to MOUNTING: WARNING: The alarm should be positioned close to the door high enough to be out of the reach of children As each mounting application varies. Techko suggests testing the unit's installation tocalion and effechvenass before permanently mounting the S 187D. MOUNTING INDOORS Using the provided mounting lemplale printed rn this manual, mark the position of the screw holes on the desired mounting surface ,, T ho Additional delay button ma he mounted on I other side of the cmlr loci. When pressed, i( will delay the alarm 8-12 seconds Litfore alarm rs TrigrltD,,d aLovvu I" me to ser ore tf deo `faatt' Fig, 3 • 'h., Al.klittonal magnetic sensors allow the unit to he ;aced ort sliding dr.)r with screens. Alarm wili souoc only when BOTH sets of magr-eti, sensors are apart, there for allowinq the slider to be opor wh ltstil9 providing protection at the screen door. MOUNTING INDOORS USING DOUBLE -SIDED TAPE Make sure that the mounting surfaces for the dou1:31r ides topes cue cor'hp'etely clean. Attach the double -sided tapeas —to Ili,: rr;ar of !he unil, and then secure the unit ont, the- desired niounhng surface MOUNTING INDOORS USING SCREWS Using the ptovidr d rnountinq template printed in this manual, mark t ie position of the screw holes on the desued mounti r I 'urface. Drill the screw, in to the mounting surface nth approximately l,8 etch of thread l remaining. Slide the ur5t over the •••sc/cllii* ae sNcurothe e it4i ••I �� r • pushrr:y i otnytan= uw.`� in I ! • FIg eI*We no eery, I yadWst tit¢ } • • •s` 4uA tc%P a ay�frd�n t� • (___ _ mounting su ace :1, provide a more i q L secure fit • ••• • ••• • • ••• • • • • • • • • • • • •• • • •• • • • %• •• • • • • • ••• • ••• • ••• • • • • ••• • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • TEMPLATE MODEL S187D NOTICE OF COMMENCEMENT c FN 2 014RO333738 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION t!i"' Bk 20146 Ps 3443i QP9 t RECORDED 05112/2014 1+J n 51 n d 3 HARVEY RUVIN? CLERK OF COURT TAX FOLIO NO. '��•a(� �3J`� �•6/� Ma�f"ll��(��E t:pUhdT'►'r FLORIDA PERMIT NO. 7' 1 — LAST 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. of property and street / address: z -_e.. a a PA fD -' 7 Lo+6 I 2. Description of improvement: 3. Owner(s) name and address: Interest in property:+`-►� Name and address of fee simple titl, 1`r'lr-i 4. Contractor's namwd address: o S -r I )4/. 5. Surety:lftlment bond required by owner from contractor, if any) :....: NamtWd Addreo: •• . A.moldpL pt§ond $ • • ':"V.' LendWs ndme arV gddipss: • • • 0000•• •00000 0 •• •• •• •�,��� Persons within th8'si'� Vof Florida designated by Owner upon whom notices or other documents may be served as • prov+�d� t, Sectio�i71`313(1)(a)7., Florida Statutes. 6••••; Name and Addreste"• ...... •;,•$.• In ad�i1pD to himseif'C vners designates the following person(s) to receive a copy of the Lienor's Notice as provide in Se&1;ggf13.13(l)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of 9. n r Print Owner's Name GAL -04/4"o -,t>ee-'r'`'yQ Prepared by f-- 91 A% Sworn to and subs f 20 14 Addres$ 0A'5 a.1uJ Ie s4© ;� + ORIDA, COUNT OF DADE ! - Notary Public, a sisa ruacopy0 S o Print Notary's Nam angina a in is o ice on My commission expires: NITN S my hand and Official Seal. M000ysteun 1%RVEY RUVIN, CLERK, of GhwIt and County Courts � D.C. OWNER f CUST NAME' EDUARDO BECERRA CUST ADDRESS: 839 NE 97 ST MIAMI SHORES, FL 33.138 CUST NUNIBEW 7863903312 CUST EMAIL'. POOLE # UU` 00ORS $D45 NW 36 ST SMITE 540 DORAL. FL 33166 DATE: 4/6/4U14 CPC -14S6804 PHONE; 305.592:7900 MARCO5 1105M E L P OO L& C010 W W W.ROSMEIPOOLA Pool FOWAv RECTANGULAR POOL SITE: 17'X 33 SPA TYPE: RECTANGULAR SPA SIZE: $" X 10' WORK FiEF,i -,FOOL EXCAYAT;0 AND STR3EL FORMATION PM f XCAVATION [NO DE -MUCKING 1 DE•WATERWG INCLUDED IN'PRICEI HAUL AWAY OF EXCAVATEDMATERIAL !POO, DE W1113FT L 5FTd 1 15TE L. nC'NFORCEMENT FORM ip3 RE -BAR (101N[/ ONE LAYER) i stop S,-POOLCq14CRETE,$HELLA,IDBACK ''FLLLS"".:' ¢Jul CONCRETE SHELL [SHOTCRETE USED] k"'N M If STRENGHT: 3500 PSI i10,N . UNCRETE WALLS fy'.!N - 10IN BOTTOMCONCRETE SHELL rNDSTTPS, f SS • ;A iM S:IU f &f NChi-AT DEEP ENQ,'0F POOL wt3ia' Rr U SECONDiiAwKFILLS' STE!:3"PID ipIPLUMBFRYO ISHEDULE40PVCPLUMBING(6YCOOE) ' 124H DOUBLE WIDE MOUTH SURFACE SKIMMER n T! 40RTE'R NIAM DRAINS WITH VENT LINE L +EBUR"d f iNES tVITx AQiUASiABLE HEADS !DEPEND ON POOL SIS£[ • •00000 i_,, ' • 0r4�TEi'•r;0� gLEtlCALMtCt,R#E " r:Et 11 rAL v'IUKISOFTOF EXPOSED PIPE*VCLiDEDI 0 • 0000•• f,ELECFfgi% 6W&GRADE1% UN&*RGROUND4R Ai ffIC WORK WILL BE QUOTED SEPARATE • 0 • 0 ! FELT [fi �Cilil�it30KsLiRS� rR•AMFCDRMER E TOUR TIMER 00.00 • �0000.. J,%F16r YUFiIT& POOL ArWUDED 0••••� �••••� STIP 5 -COUP Msr•6Fi iWALIATION 'I ^•I•a• lD tt1UI0PA0flT�P0L7 000000 tl •• •• IiEl�'sN'l?RO PLIM•P[2• SP�€D) • • • 00•••• -..0000 0 • 11414til 150SQ.FT CART*" FiMER 11% Lit -0 CHLORINATOR (NOT INCLUDED IF CUSTOMER BUYS SALT SYSTEM) STEP 6 :OIVIER COLOR- LEC'EJO)V TRrI VERTINE COPING +z - _'- "t';ZLlrfk TILE Fri A4b S's'titMOIJT 8ftjCH fDCiE TILE ABY CODEY av"I P§Ck0KILF11Y SVRFACEPLASTER ''7+ 6[ALE'ROLESS !'U6 11 CLI AN UP AND 30 DAYS CHEMICAL MAINTENANCE iIIfyAL ViALnIKOGHWITF(,CUSTOMER M11111111^r� POOLS, INC SALES ASSOCIATE Rpsmel PUDE$, INC. OWNER1 EXTRAS OR UPGRADES:(IF ANY) INCLUDEO,IN CONTRACT PLAN / PLAN RUNNER SPA 5' X 10' LEO COLOR LIGHT (2) POOL AND (1) SPA PDA REMOTE SALT SYSTEM HEAT PUMP 140 K BTU CARBON FILTER CONCRETE REMOVAL 750 SCL FT. NEW CONC. Bi'`TRAVERTINE TILE 250 SQ. FT TILE REMOVAL & NEW TRAVERTINE TILE 1,200 SQ, FT. FRENCH PATTERN PAVER DECK SUMMARY OF QUOTED PRICES TOTAL COST FOR Pool + EXTRAS = S 6U,tyLY{t. ^ 15% WHEN, CONTRACT SIGNED 5 1 9,000.tu 25% WHEN EXCAVATION COMPLETED 5 151000.00 25% WHEN SHOTCRETE APPLIED 5 15,000.00 20%WHEN TILE A COPING INSTALLED 5 12.000.00 1039 WHEN PUMP $;FILTER & DECK COMPLETED $ 61000,00 54e' WHEN POOL PLASTE PPLIED S 3.000.00 NOT INCLUDED i4,.fH4VNTRAcr ANY DEWATERING OR OEMU�• i REINFORCEMENT PERMIT FEES ELECTRI UP SEPTIC TANK EVA,. s POOL BARRIER tFENCE TO CODE & BATTERY A N WNER) WARRANTIES LIFETIME WARRANTY ON POOL STRUCTURE 10 YEARS OF DIAMOND BRITE WARRANTY 3 YEARS OF WARRANTY ON ALL POOL EQUIPMENT 1 YEAR OF WARRANTY ON ALL OTHER WORK PERFORMED NOTES •GRASS ON BACK YARD WILL BE REMOVED. • BACK YARD WILL BE GRADED & READY FOR (NEW GRASS/BY OWNER). OWNER'S A04ORITED STOTUTURE THIS CONTRACT IS NOT VALID UNTIL FINAL APPR; <-- FROM ROSMEL POOLS, INC ADMINISTRATION u t ,.^ cv :,4, Te,rm ae a canaations on the reverses'rde hereof; which Are .neotparated herein by reterence, cryn3Mute the entire agreementbetween the patties hereto and is ieci ^^�, J nFpn ra 16r unleks ano unld same .s accepted tip writing bV a duly authorrlafl offit;er ar agent of contractor. Contractor shall not be bound by any Drat or written statements or r +P v'15 nttt urriaded rr tins tunIt,00 arhlCh have been made at maybe made by anv personspurpon.ng to act for or on behalf of contractor, This contract supersedes,, any Prior writtrn o• veruo� ag`ecmrnte which shat^ 80 become null and void lvrth the signing of this Contra". All greth agreements must be included In m 1ting rn this contract in order to be valid �'i` &),;,7-- Is )NWKOI� 174-8PLATMW: SM -PRdpgk.TYIk �!",14461,0 ZONIM 42 RUI I/M, OR VOUVAMMI: No 1: PROPEPSt -SIZ9.z .32 AMM VWUR SURM- I I PRIVAM, OUR= (Vr 1<02400M I 1>204OM is szm AvAnAm As VZR 301.0065, FS? I No I ox.Mxag To SZM; N/A VT -830,NEOI$T 1, 1 Other 96 ttoo L 107.1 DAJMZ Sll� is 44LUMAS WbUh m6y *9.t be %ised) I of 4 STATS OffLORIDA OF PgRMIT so N*tApomved0000 - Date_. C,out* H"Itft DepaWmnt 0:6686 : Soso 00;000 00 kROVED-BYTHRICOUN, W-"HEAIL'TrH DEPARTMENT Pea* 2 Of -4 •sees• • • *Osseo t � � Aft"W , - pfd cif t feat arta ,owwrp dYava.sc, sbowmng boundaries dime 1d df re n or bUff,4 s, .swftmnft pools, p , tho:on s�i she at and d t ay st+ poae �d'��•r'i"s�.•�aaa`#��Si+i�sa'.o�l�,+a�si��+ ftma0vt.ab4 dam: s s,.: a rs and, o rperamearf+e1��3�s ofps• cam, earit o xs.o dj i. Xthe: was;are � 7$ %• tree �R�� the esUmaUd WOO: fi�► •abo' 0t•but motU *avm to'scaTe= ;lomd0n of any -pu e d kigXxater weE, as, deed in Chapter 64E,.6hQ*4)M, wi4n 204ffeet of ft 11 l?'$ fotllbw also to0own,t tli tart indl d from'the sYst to o WOU) a 4 t.lown :ixlsl u p r spm -pr 0tar1cIls;.seet1t.pi ME - U022( ? i a L f licactt lot u t b s o o as Ben in 6�6.0�4�}�a�,xF:�.C., aCin'��•feet�fros�, � pri�'�e �I� r:'Woll {�:'uek '�' by. oeor twvveddenaes). "r24-12(1.0),' nii- fades County C ode: 4WM=. Mica; �b vee�a. a . or-wells.aud possible sources of conte ►a A Sh4H * ,&.f'onction of : t +do ::xo £ius of Ihftiueum of fho ,v pr wells Ipim cam, be ; tcd-loss Om dm.. undyed (1=*00.) hori +dtal,: :frena: y sowoe ofomtawmglion, Teva ri tYio:v�..ta:d best.©£o�ulcde.tba�re.pnov3decl the 1iaxto94iC.vVith f �Aaa�,.p� fomes �.d iire� aeentprapertiies. eiaiaore,.� -understand. ,on dtekgs tri# ¢ ci'jV. 0sai. M p t'isVaedon ft basis of said facilites-and -featm�as pro�0:i8ed byr v�c:and fo to Jugomw! v,al �bPe:s*eet tD r ¢ti0atlotr o dazlce tawlltlt tlxeprovMons• of Chapter 120, Florida SWateg. Property • •••••• • ones Kim Z MJTF'Ofd00111- Maw"O �� 33yyQQ'%6 Rihe ipaf�VV�?, aM r'r �"" -'!ri a•A•. Maw ZM I I I I ! �'y ' �' ��� t1�yt �rt� •r�anv�J (POONrty e men 41apy oatheryiNd a"WO or company name) !ro {�isA�c�'! ;. b.;��r , e �yr�6mm �. � ar �trh�o ..propa�iy �� •� tho wbwo �04 ...... . .. .. .. ..... ... . ...... ...... . .. ...... ...... •••• 0 0 01 U.S. DEPARTMENT OF HOMELANDSE'CURi!Y `ELEVATION CERTIFICATE oMBNo.lsso-0008 FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program important: Read the Instructions on pages 1-9. Expiration Date: July 31, 2015 FILE # S937-DC13 SECTION A - PROPERTY INFORMATION Al Building Owner's Name Eduardo N. Becerra A2. BuiidinR Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 839 NE 97 Street (' City Miami Shores State FL ZIP Code 33136 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) MIAMI SHORES SEC 3 PB 10-37 LOTS 17.18 & W1/2 OF LOT 19 BILK 73 LOT SIZE 125.000 X 112 OR 18417.20891198 4 COC 25222-1611 112006 5 A4 Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residen iat A5. Latitude/Longitude: Lat. 25°51'54.13"N Long. 60°10'49.50' Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number q Ata. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage. a) Square footage of crawlspace or enclosure(s) 2337 sq ft a) Square footage of attached garage 21__,_9.9 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosu(es) within 1.0 foot above adjacent grade 21 within 1.0 foot above adjacent grade 9 c) Total net area of flood openings in A8.b 1387 sq in c) Total net area of flood openings In A9.b 2 sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name & Community Number 62. County Name 83. State j Village of Miami Shores: 120652 Miami -Dade FLORIDA 13�._Msp/Panel Number ! B5�. Suffix B6. FIRM Index Date B7. FIRM Panel B8. FloodB9. _T Base Flood Elevation(s) (Zone 12086CO306 L 09-11-2009 EHective/Revised Date Zone(s) AO, use base flood depth) ® feet ❑ meters 09-11-2009 X -Shaded N/A B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11 Indicate elevation datum used for BFE in Item 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: N/A ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction* ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, VII -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: SEE "D" Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a) through h) below. ® NGVD 1929 O NAVD 1988 C3 Other/Source: Datum used for building elevations must be the some as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 8.9 ® feet ❑ meters b) Top of the next higher floor 12.2 ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N.A ® feet ❑ meters d) Attached garage (top of slab) 2.9 ® feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 14.§ ® feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 2.6 ® feet ❑ meters g) Highest ad)AINtZfinished) grade next to building (HAG) 10.3 ® feet ❑ meters ;.. p Aviest dbAtInt grade acloyl@st glevation of deck or stairs, Including structural support N.9 ® feet ❑ meters 0.0000 •0 0 0 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION chis certification is to be signecl'a�nc>•64led by a land surveyor, engineer, or architect authorized by law to certify elevation • IWilA!ltion. I c:rtirrt,flat the inroom(lea on this Certificate represents my best etrorts to interpret the date available. 6 wadowtand INA ai?yollse stailve � ivy be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. 0 • Cbeck here if cominents ar%arpjided on back of form. Were latitude and longitude in Section A provided by a ,,�� ,� g . �- ••' 'ya, • ❑ Cpeck he?erPA%:hments' • • • • • licensed land surveyor? ® Yes ❑ No 41 } � 0000_•• � : �• ,�'' 1Cert�w ifier's Name 'i0erry L. MacCRiEip••• License Number 4557y 01 ' •. ' -� •: ale Professid��t�LarQ Surve dor Company Nam Ace Flood and Inspections • rtRgfor*vs 480: Welywood Blvd, Su ty Hollywood State FL ZIP Code 33021 Signature00� to 07-12.2013 Telephone 954-924-1808 FEMA Form 086-0.33 (7112) See reverse side for continuation. Replaces all previous editions. 1* IMPORTANT: In these spaces, copy the corresponding Information from Section A. a , WW , Building Street Address (including Apt., Unit. Suite, and/or Bldg. No,) or P.O. Route and Box No. jl ttb8� r;I 839 NE 97th Street : ' ` .,� ti „ , � r City Miami Shores State FL ZIP Code 33138 4? P, �Y �, SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments BM # N-300 ELEV= 9.33'; Centerline of Road= 9.46'; ERP= 9.27' C2e is elevation of a/c pad. Flood Determination is based solely onI.R. o research was done in regards to L.O.M.R/L.O.M.A. documents. This elevation certificate is meant for insurance purposes only, not for constr ur o es. Signature Date 07-12-2013 SECTION E-13UILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT OFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B. and C. For Items El -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter motors. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation Is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace. or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feel ❑ meters ❑ above or ❑ below the LAG. E2 For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG, E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this Information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -Issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here If attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, 8, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 -G10, in Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation date in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (items G4 -G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued 36. Date Certificate Of Compliance/Occupancy issued �a••T,ir, permit hal teen issuefoj••• ❑ New Construction ❑ Substantial Improvement G$. Elevation of asrntyl:lowest fldor (Including basement) of the building. ❑ feet ❑ meters Datum G8. 6FE or (in Zone AIS) depthOf GoodMg at the building site: ❑ feet ❑ meters Datum �"j, Q.•Caojnmunigs desjgn flood e16 _ati'0r ❑ feet ❑ meters Datum • j %449fficial's Name • • • Title "W"nity NanTe • • • • • Telephone •rilYtUre • •• ••i••• Date Comments • • • ' • • • 000600 • • • • • • ❑ Check here if attachments. FEMA Form 086-0-33 (7112) Replaces all previous ealnons. 46 BOUNDARY SURVEY JOB # S937-DC13 PROPERTY ADDRESS: 839 NE 97TH STREET MIAMI SHORES, FL 33138 CERTIFIED TO: EDUARDO N. BECERRA CHICAGO TITLE INSURANCE COMPANY SUPREME TITLE AND ESCROW NEW PENN FINANCIAL, ITS SUCCESSORS AND/OR ASSIGNS, ATIMA FLOOD ZONE INFO: COMMUNITY NAME: VILLAGE OF MIAMI SHORES COMMUNITY NO: 120652 MAP & PANEL NO: 12086CO306 L FLOOD ZONE., X -SHADED BASE FLOOD., N/A FIRM DATE: 09/11/2013 BM: BM# N/A ELEVATION = N/A LEGAL DESCRIPTION: LOT 17 AND LOT 18 AND THE WEST j OF LOT 19 , IN BLOCK 73, OF MIAMI SHORES SECTION NO. 3, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, AT PAGE 37, OF THE PUBLIC RECORDS OF DADE COUNTY, FLORIDA. SURVEYORS NOTES: 1. THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS AND/OR RIGHTS-OF-WAY OF RECORD. 2. VISIBLE ENCROACHMENTS AREAS SHOWN. 3. ELEVATIONS SHOWN HEREON ARE N. G. V.D. OF 1929. 4. NOTICE. THERE MAYBE ADDITIONAL RESTRICTIONS THAT ARE NOT RECORDED ON THIS SURVEY THAT MAYBE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 5. THIS SKETCH IS THE PROPERTY OF ACE FLOOD AND INSPECTIONS, PROFESSIONAL SURVEYORS AND MAPPERS AND SHALL NOT BE IN REPRODUCED IN WHOLGE OR PART WITHOUT THE PERMISSION OF ACE FLOOD AND INSPECTIONS, • • • •; PR6WSSIOMAI, MAPPERS AND SURVEYORS IN WRITING. ..... 6. SLFA INGS.§HQ�W HERON ARE BASED ON THE PLAT OF, PLAT BOOK 00, AT PAGS00, OF ti;"UBLIC RECORDS OF COUNTY, FLORIDA. ::::'7. Q00ALOARrSIMENSIONS SHOWN ARE PER PLAT AND FIELD MEASUREMENT UNLESS 0THERWISE NOTED. '••, 8. ePNlj?ACT�dk h4 RESPONSIBLE FOR VERIFYING ALL SITE PLAN INFORMATION PRION' TO CON&T.f2UCTION. •••• 9. 1j*Lr$S oirAERwIsE SPECIFIED THIS SURVEY IS NOT TO BE USED FOR •' COMTRUCTi)AFAURPOSES. ''• 10. 1=.QVCE O&EkSHIP NOT DETERMINED. 11. DESCRIPTION PROVIDED BY THE CLIENT OR CLIENTS REPRESENTATIVE A Com' FLOOD & //VSPECT/ONS LB#8002 PROFESSIONAL SURVEYORS AND MAPPERS 4801 HOLLYWOOD axD., SUITEC HOLLYWOOD, FLORIDA 3.3020 PHONE: 984-9241808 FAX 984.92¢1809 SHEET 9 OF 2 TfNS suRVEY WAS PREPARED FOR: ED UARDO N. BECERR. A THIS SURVEYS PREPARED FOR THEEXCLUSW USEAND wjaFIToFTHE PARTIEsusTEOHEREON. umuxffmANY S NOT VALIDWITHOUT THF S!WTURE lANDTHE0lWA94-"WD%4AAL0FA THIRDPARnESMAYNOTSETRANSFERREDORASs/ONEO DaM 6Y. FLOROA.LIOEWED SL�Rb' VCI AND mme MAPP - �. � w DA7E � OT117r1019 F/BDBOOK DlflliALFllE , •�;. DRAWNBY EOC Don DR�w�r or/lo a TERRy4- COY O? NAL SURVE?'OtAAV,&4WWA FLORIDA mer. nam U08 ENO.4W7 0000•• 0000 • • • • •e• • • 36" • CORNItR 0000•• 6.•0069 • • 0000•• BOUNDARY SURVEY LEGEND X - FOUND X CUT Q - FOUND 5/8" IRON ROD ® - FOUND 1/2" IRON PIPE RW - WATER METER LOT 15 BLOCK 73 •••• • 0000 • 0000•• LOT 17 BLOCK 73 CHAIN LINK FENCE CONC. O • w O • • ;, n • a 0000 • • • • • • 0000 0000•• • • • • 0000 • •• 0000•• • • 0000• ••. • •• • • • ••• • • • s ABBREVIATIONS: A/C -AIR CONDITIONER SLAB Q - CENTER LINE CB -CONCRETE BLOCK EM- ELECTRIC METER FIP -FOUND IRON ROD FIR -FOUND IRON ROD CONC. - CONCRETE P -PLAT M -MEASURED NO ID - NO IDENTIFICATION OHW - OVERHEAD WIRES R/W - RIGHT-OF-WAY UE -UTILITY EASEMENT 30 0 15 30 (IN FEET) 1 INCHES = 30 FT. 15'ALLEYR/W (9'ASPHALT PAVEMENT) S89°5946 -E 125'(P&M) cd j, LOT 18.. 25'(P)' .2' 25'(P) BLOCK 73 WEST V2 OF EAST 1/2 OF LOT 19 LOT 19 BLOCK 73 BLOCK 73 v NOTINCLUDED O O CONC. 11,0' N COVERED 18.0' TILE N � m 23.9' v v ONE STORY w A/C RESIDENCE 4 #838 37.5' 2 CONC. PLANTER °e 1 .5' °t 10.7' 1.0' Np A i° 5' 25'(P) S90°0000 -W 125' P&M 5' CONC. WALK Ga ASPHALT DRIVEWAY 50' TOTAL RAN (18.5'ASPHALT PAVEMEN7) ACE FLOOD AR THIS SURVEYIS PREPED FOR THEIVE & /NSPEC TIONS LB#8002 BENEFIT OF THE PARTIES LISTED HEREON.LULIABILTYTONANY THIRD PARTIES MAYNOT BE TRANSFERRED OR ASSIGNED DESCRIPTION: DATE: BY.. PROFESSIONAL REWSION.' IDATEINFIELD: SURVEYORS AND MAPPERS 4801 HOLLYWOOD BLVD., SUITE C REVISION: HOLLYWOOD, FLORIDA 33020 07/12/Z013 FIELD BOOK DIGITAL FILE DRAWN BY.• EOC DATE DRAWN: 07/18/2013 PHONE: 954-924-1808 FAX: 954-924-1809 cefloodandins ections ahoo. com CHECKEDBY: TLM JOB NUMBER: S937-DC13 SHEET 2 OF 2 Jgj2p / &/ - �Iw Vicente Franco, PE 10776 NW 84 LN #5 MIAMI, FL. 33178 INSPECTION LOG 839 NE 97 STREET, MIAMI SHORE, FL EDUARDO BECERRA Per4it #:BPPS-14=996 According to visual inspection, I hereby attest that to best of my knowledge and professional judgment that the existing soil conditions are in compliance with the footing allowable bearing pressure of 2000 PSF. Should you have any question please don't hesitate to contact our office, respectfully submitted, #-1,,&,v4 Vicente Franco, PE Lic. No. 62531 07/08/2014 vfranco9876@gmail.com A Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 PERMIT APPLICATION kUlLDING ❑ ELECTRIC ❑ ROOFING FBC 20'(P Master Permit No.j2) Lf - gqc Sub Permit No. QVREVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 13,9 i.S G en 6" re s . :pt- 33 Iva Com: Miami Shores Countv: Miami Dade Zip: 3 138 Folio/Parcel#: 32 06- 014—Zb(0 Is the Building Historically Designated: Yes NO -u Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): €.l.-a.,do $3. Phone#: Address: 'S41 R3+ s cd..i.,P City: t4w.vv: State: `�r_ Zip: 3 313 Z Tenant/Lessee Name: r I Q Phone#: Email: CONTRACTOR: Company Name: Phone#: (30n4'.S. 2 79 c o Address: 8 O 4-5 LXL3 3 (o 5+ 5-)e 5 4 d City: �►.Q.•Q State: 'Pt—. Zip:33t L f: Qualifi r Name: Wr'" 1%'_Sl� Phone#:(3D'\ S9Z -717,00 State Certification or ,Registration #: )4-'5&9c4 Certificate of Competency #: DESIGNER: Architect/Engineer: V rc.-. 4-e =Mx.ncz, P. t. Phone#: 005 305 5 4.3 1 Address: 10'71/o Pu-) 8 4 L iV Ik5 City: `N1 t.G*." State :�Ft- Zip: 33178 Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Iteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: V1, '91 ° ,1&/L/ <9 1251 t y �r Specify color of color thru tile: Submittal Fee $ Permit Fee $ S " 1 CCF $ CO/CC $ Scanning Fee $ Acc)Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ �y ° Bond $ TOTAL FEE NOW DUE $ 6 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) ' Mortgage Lender's Address City State Zi 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �r Signature OWNER or AGENT The foregoing instrument was acknowledged before me this —� day of 20 /S/ . by 0"*------—, who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing instrument was acknowledged before me this / P day of oA-f ✓f , 20/%/ . by 'i%ve4 4/0 - ,who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: mm fl�i`E --- 1 �..rt•,,.,.�,�cn('lu���a.tc AN' PIT as �,le qe,k Ke 1(e Ae g171<$ Ne fk lk Ik,k,k,k,k,k,k,k,k#+k ek 71/8t 8t Ik * $,k 4 * �k,k,k �k,k lk W Ik Nt & Ik Ik,k 4 �k,k,k+k *,k,k,k,k,N,k,k,k �k,k,k �k,k �k �k,k,k �k # �k �k+k lk ek & /k lk Nl lk ffi * Ik lk Ik Ik IR Ik Ik IF ffi,k ffi Ik lk,k �k Ik,k,F �k �k ql lk,k ffi APPROVED BY Ilya( Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i 06/24/2014 11:30 3052281525 CITINSLJRANCE PAGE 05/23 O CERTIFICATE OF LIABILITY INSURANCE `.. ,.. T. 06 9/901'' HIS CORTIFIEVE 19 ISSUED ASA MATTER 0 INFORMATION' AIBDRJI3TCS JLQB'JITCI' C01tF ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR' 5... �10 VZOW PYAAQLSR ST ODY'T8 213 ALTER THE COVERAGE AFFORDED BY THE POLICIES 8EL0 .,. 11d1AMt PL 33186 ;Al5-220-1833 INSURERS AFFORDING COVERAGE ROS1H8'L POOL+9l LNC. MURER A OLONY INS CS C0XPANr INSMRB: 8045 111W 316 ST . , 8GIT8 $40 INI,�IRER c: BoLu, FL 33166 a uRERc _ INSURER •5� • IES „.NE. *PGLICIE9 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANOI . , '; ECWREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 88 ISSUEGOR ' RTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF S'gek I S, A IREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T•� TYPE of BVBUW►NOE POLICY NUl"Int M Lu" LIABILITY mcmoccuaaeNce $1 000 0 or.i FIRE D"011 ( one rm) S ' COMMERCK GENERAL UAIILITY I' CLMMB MAIM [E OCCUR M6D 8XP (Any aw g=) S so 02L.. �' .' GL4oa8a39 06/20/14 06/20/18 PERSONkAADVINJURV $1,000,00 (• EG. CEWAftAGUIOoTE 81,000,0 ' f1 AgGREGATEUNTAPPLIUMA: P%0DUCTS•COMPIOPAGO Slg 000 00"; i. POLICY 0 sm 7 LOO OMQeuE uABRJTT' SSU COMBINED SINOLE LIMIT S ANY AUTO l¢aaeaaaW BQOtLY M NRY i ALL OV44D AUTOS .BCMEMUZOAUTOS (PNpwsOn% •. "+ 'Gt• "mOAUR78 NON4MM AUTOS BODILY NMAY (Por arcOQeftMu) E PPROPERRTYUDAMAGE 8 r m161N6 UABIL" AUTO ONLY• EA ACCIDENT I ANY AUTO OTHER THAN IIA ACC I ., AUTO ONLY: AGO I f ' LIABAM EACHOCCURRENCE S aOCCUR �CLAWIBMAOE AGOREGATE S %•L, ,..v DEDUCTIBLE S S: G S . a• RETENTION 8 40MISPS COMPIRMTION ANI : MPLOYERB• UAI UTY E.L EACH ACCIDENT S E.L OtwABE • EA EMPLOYEE S a E -L DISEASE • POLICY LIMIT 8 •QTN:ER •,• .� . N OF OPEaA1TON CATtCM:SAfEwClB6fD(OL,U910NS 6Y dOmRISM /SPECIAI. PIiOVIBIONB ' COlfl9' MOTOR .Gig ICATC HOLDER 1 ADDITIONAL INSNRMD INSURER LETrCM CANCELLATION .� ii SHOULD ANY Of THE ABOVE DUMBED POLICIES Be CANC66I.W 13UM THE F7fPiRAT1,0(f : a eYiAWi gno=kq • ZYf/AGN eUILDI1110 DPT DATE THWOR TIE ISSUING INSURER VAL ENDEAVOR TO MNL OAYI YaRIT'•jl . a. .100.50 = 2NV AVZ NOTICE TO THE Cls'RTIRCAT6 NOLDBR NAMED TO TO Ll", BUT PAILURB TO DO 60 SHALL. L k' XrA= 080318$, PL 33138 UPOSS NO COLIOAMON OR LIASAM OR ANY KIND UPON THN INSURER, ITA ACENfB oa U, •' FA:a305-756-8972 ._• ..: F -39?- 9,97 '1tC RD 25.5 (7197) 0 ACORD CORPORATION 1858 .