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BPP-13-2286Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226154 Permit Number: BPP -10-13-2286 Scheduled Inspection Date: January 12, 2015 Inspector: Naranjo, Ismael Owner: NUGEN, JOHN Job Address: 375 NE 99 Street Miami Shores, FL 33138-2436 Project: <NONE> Permit Type: Pools/Whirlpools/Hot Tubs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132060135530 Contractor: WATERMARK CONSTRUCTION LLC Phone: (954)776-3338 comments NEW SWIMMING POOL 05-09-14 As per owners request this permit has been place in hold due to fact that Gator pool is no longer involve in the project. A new pool contractor is required for the project. 05-27-14 INSPECTOR COMMENTS False the pool wall top. Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-226027. ACCESS WILL BE GRANTED ON THE ALLEY WAY ANY QUESTIONS CALL OWNER JOHN 260-908-3004 Failed ❑ Rear gates lock. no one home. 1/9/2015 - ACCESS THROUGH THE BACK GATE IN THE ALLEY MUST PUSH HARD TO OPEN. Correction ❑ Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 09, 2015 For Inspections please call: (305)762.4949 Page 15 of 26 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 l®/r01/3 Permit No: Structural Critique Sheet WD 7 US E LJ+1,L-S /'A/ Page 1 of 1 STOPPED REVIEW Plan review Is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and Include one set of voided sheets in the re -submittal drawings. Mehdi Asraf 0 0 OR i?•k 28873 Ps 3776; (1pe) RECORDED 01/02/2014 13:17*'50 HARVEY I ACNP DANO E OF COMMENCEMENT MIDDS OUTFORIKU A RqDORDED Copy MIST IfE Po$TED ON aT T!1" = : popwo LAST PAGE n i a .. a r PERMIT NO. I' 1];1— , 06 U, go. ` STAT" 61F FLOt1DAt , ,d COUNTY OF MIAMI -DARE: . THE UNDEtiSIG Feby 'rtte�� �mproyements will be made to c Main real proles k atxesicli a vv t o► f iorida statutes, tate fot mvbV Wmnoom Is provided in this Notice of Commencement. 0 7. LeBaidescripticut of`prtlperty► and strseti 2. tlan , imnrovem�nt� e y Space d w o reserved for we of oiflce Intompt.411 Name and :address of fee simple tMomiderr ✓ a/ 5 „ter, S 4 C'ro ctor's,r�me;:addres and p fw*numbet ' �✓ actio fY.. 3/�� 5 Suret�C (PaY o_M bqN rec uW by ow w from o b*aor, ff any} Nage, ��_ atld, phone numb': g • 8 I_etul�r'a flames and. $ddrgss:_ . e�"f � Peraa�rts whin # ,date pf--Flori4la:designated tjy Owner upon whom notices or otter documents may'le served as, provided by Sr3ctTc�fi�'�1'3 i��Xai�..�iaa statutes. tllante, a��ir' and aTATE OF FLORIQq, COUNTY OF RADE r e rue COPY the ng designates the following p®rson, NITNESS my 9: Expfft;tion plate of this Notice of Comm" F t:ernent: dale Is 1 Ym tm #m'dft of rWrOV w*m a sped i) it//►A P. NTS MADE ' THE QWfdptAFTER T}IE �0 , OF TWN,OTICe OF COMMENCEMENTARE CONSIDERED tMt'R e 793. PART 1, t�E4^TtON T93:1$. ELdR1D4'S 11tiTES; ,Akb. CAtd RESULT IN YOUR PAYINQ TWICE FOR iMft *'�� TO.YOUR F!ROPERTY. A IVf3TtCE OF COA+IfiA iCEMENT mustBE Ep AND,'f�OST� ON THE JOB S11t* THE OA) Il? YOU IIyT ENp TD OfiTAeJ' FlNA1d . t pNSULT WI tN YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR' F��rr'�3RWtV�3'�fOUIi NOTICE OF COMMENCEMENT. .: • Signature(4) sj or int, r(s)' !4iig tgri ed Met r/Parbu dManager pt hint NameYgy . j .Pfint Name 1- STAT tlwomce C$U O'F MIA !. D . Q wainacknowlecIpoibetbre nne theday atr� r- d .. u---.� of_:,_ 1 �nruuiurr, ❑ ividuagy, m for �,,,: � ox ,per ty�o�klentiftcatian: � .�; Si9na�.ife af,Nptar� F'#io: �;' Print Name: {AQ Of , I perkydeclare that 1 have read tis foregoing aho taom �' '' . 3��9 •.: ' std g to R are true. to the best of my, and belief. �'�•oFr7 ' OQ' �����• FLOC\ Snz 8) of s)or Ow wgs)°s Authorized Officet'0•ector/Partner/MBn m t�ho fa� r ce✓ P., � By 0 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225822 Permit Number: BPP -10-13-2286 Inspection Date: December 29, 2014 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Dacquisto, David Inspection Type: Survey Final Owner: NUGEN, JOHN Work Classification: New Job Address: 375 NE 99 Street Miami Shores, FL 33138-2436 Phone Number Parcel Number 1132060135530 Project: <NONE> Contractor: WATERMARK CONSTRUCTION LLC Phone: (954)776-3338 Buildina Department Comments NEW SWIMMING POOL Infractlo Passed Comments INSPECTOR COMMENTS False 05-09-14 As per owners request this permit has been place in hold due to fact that Gator pool is no longer involve in the project. A new pool contractor is required for the project. Ora 27 44 Change of contractor approved. Will need to submit a revision ans t"figliddltop.e ciegarol�c�gnments 14 Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. For Inspections please call: (305)762-4949 December 29, 2014 Page 1 of 1 NORTH SCALE: 1"=20' a FIR 112" NO ID s C I e y 0 LOT 21 BLOCK40 9$ x ALLEY •a..tUr:}0.0'. PAVEMENT '<'• '�; ';•`•, - r1 35.0' d 27f W POOL (-�-- 27.6' ,p o co of 4.0' r7 "' FIR 112" NO ID I 0� .70' CBS FENCE y ON UNE 1 6.0' 1.59' 1z1.3 m ON UNE 4.0' 3.0 17.4' N 16.3' 0 '4.0', N X21.3' n 2' NI 4 0" B M al Grp N OF SWK (50.00' FIR 112" NO ID e' ". N90000'00"E 75.00' 6.o' sWK' O I N A LOT 22 Q.O ti`! 13.2' LOT 24 BLOCK 40 � DE = DRAINAGE EASEMENT r O ONE STORY y r' CBS o "' RES.# 375 PE = POOL EQUIPMENT PAD FINISHED FLOOR ELEV. = 11.75 (MAIN) LOWEST FLOOR ELEV. = 11.0 (REAR) GARAGE ELEV. = 10. 7 6.0' 1.59' 1z1.3 m ON UNE 4.0' 3.0 17.4' N 16.3' 0 '4.0', N X21.3' n 2' NI 4 0" B M al Grp N OF SWK (50.00' FIR 112" NO ID e' ". N90000'00"E 75.00' 6.o' sWK' O j 0 N PLAT IMAGE: O LOT 23 LOT 24 O BLOCK 40 BLOCK 40 DE = DRAINAGE EASEMENT PB = PLAT BOOK m o� CERTIMCATE OF AUTHORIZATION ¢ LB -7104 D/W =DRIVE—WAY BCR =BROWARD COUNTY RECORDS sLaa!'caz curve in 8c rna Y 9 pping, inC. PE = POOL EQUIPMENT PAD U7 —CBS FENCE ON UNE 10.20' DEC 2 201 53.19' `o Miami Shr_res ViAaae m S m BLOCK CORNER O\fED BY DATE p4 2 �d �• • �N t G DEPT PT :r, F:Q.&•;..N so 0.• �tG DEFT I."".*.. :5oaznhf' ":' " SECT (0 CrMPLIANCEWITHAIlFEDERAL STATE ANL) Cr ljk# Y R IJUS AND REGULATIONS C&G = CURB & GUTTER AM LEGEND CLF = CHAIN UNK FENCE PLAT IMAGE: ABBREVIATIONS: 376 NE 99TH STREET, MIAMI, FLORIDA 33138 CONC = CONCRETE A = ARC DISTANCE DE = DRAINAGE EASEMENT PB = PLAT BOOK A/C = AIR CONDITIONER PAD CERTIMCATE OF AUTHORIZATION ¢ LB -7104 D/W =DRIVE—WAY BCR =BROWARD COUNTY RECORDS sLaa!'caz curve in 8c rna Y 9 pping, inC. PE = POOL EQUIPMENT PAD BLDG= BUILDING BM = BENCH MARK 15190 SW 136th Street, Suite 20, Miami, Florida 33196 EP = EDGE OF PAVEMENT BOB = BASIS OF BEARINGS Tel: 305.596.1799 Fax: 305.596.1886 PI= POINT OF INTERSECTION = PL PLANTER CBS = CONCRETE BLOCK & STUCCO OF MIAMI-DADE COUNTY, FLORIDA FF = FINISHED FLOOR (C) = CALCULATED www.suarersurveying.com 53.19' `o Miami Shr_res ViAaae m S m BLOCK CORNER O\fED BY DATE p4 2 �d �• • �N t G DEPT PT :r, F:Q.&•;..N so 0.• �tG DEFT I."".*.. :5oaznhf' ":' " SECT (0 CrMPLIANCEWITHAIlFEDERAL STATE ANL) Cr ljk# Y R IJUS AND REGULATIONS C&G = CURB & GUTTER AM CLF = CHAIN UNK FENCE PLAT IMAGE: COL = COLUMN 376 NE 99TH STREET, MIAMI, FLORIDA 33138 CONC = CONCRETE NOT TO SCALE DE = DRAINAGE EASEMENT PB = PLAT BOOK DME = DRAINAGE &MAINTENANCE EASEMENT LEGAL DESCRIPTION: D/W =DRIVE—WAY ASPHALT CONCRETE PAVERS TILES COVER EB = ELECTRIC BOX PE = POOL EQUIPMENT PAD ENC. = ENCROACHMENT MIAMI SHORES SECTION NUMBER 1, ACCORDING TO THE PLAT THEREOF, EP = EDGE OF PAVEMENT STATE BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 5J-17 FLORID MINISTR CODE RSUANT TO'SECTION EW = EDGE OF WATER PI= POINT OF INTERSECTION = PL PLANTER FDH = FOUND DRILL HOLE OF MIAMI-DADE COUNTY, FLORIDA FF = FINISHED FLOOR 07�15�2010 FIP = FOUND IRON PIPE POC = POINT OF COMMENCEMENT MR = FOUND IRON ROD FLOOD ZONE 1NFORMATION: FN = FOUND NAIL (NO ID) UAN A. SUA z PROFESSI NAL SURVE R & MAPPER CAD FILE(N): NUGEN FND = FOUND NAIL & DISK PRM =PERMANENT REFERENCE MONUMENT = PT POINT OF TANGENCY FPL = FLORIDA POWER & LIGHT TRANSFORMER PAD EMERGENCY MANAGEMENT AGENCY REVISED ON 09/ 11/ 09 AND INDEX LE = LANDSCAPE EASEMENT LME = LAKE MAINTENANCE EASEMENT (R) = RECORD (M) = MEASURED M TY D SHOWN ON THIS MAP OF SURVEY IS WITHIN ZONE K. BASE FLOOD 5p . . n . . I � ^ 6D• rc ft to g S,T 6ts 4 � z t_ 1� t4 tli 16 7 IB ti 20 PI P4� so sa ME 99th STREET DCR=MI I—DADE COON RECOR S MH =MAN HOLE PROPERTYADDRESS: ML = MONUMENT UNE JOHN BRYAN NUGEN 376 NE 99TH STREET, MIAMI, FLORIDA 33138 (P) = PLAT -- = OVERHEAD UTILITY WIRE PB = PLAT BOOK REVISION(S): LEGAL DESCRIPTION: PC = POINT OF CURVATURE = PCP PERMANENT CONTROL POINT ASPHALT CONCRETE PAVERS TILES COVER LOT 22 AND WEST 1/2 OF LOT 23, BLOCK 40, OF AMENDED PLAT OFF PE = POOL EQUIPMENT PAD MIAMI SHORES SECTION NUMBER 1, ACCORDING TO THE PLAT THEREOF, PG = PAGE STATE BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 5J-17 FLORID MINISTR CODE RSUANT TO'SECTION AS RECORDED IN PLAT BOOK 10, PAGE 70, OF THE PUBLIC RECORDS PI= POINT OF INTERSECTION = PL PLANTER SEAL OF MIAMI-DADE COUNTY, FLORIDA POB = POINT OF BEGINNING 07�15�2010 SURVEY SHALL BEAR THE POC = POINT OF COMMENCEMENT ORIGINAL SIGNATURE AND FLOOD ZONE 1NFORMATION: PRC = POINT OF REVERSE CURVATURE UAN A. SUA z PROFESSI NAL SURVE R & MAPPER CAD FILE(N): NUGEN BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL PRM =PERMANENT REFERENCE MONUMENT = PT POINT OF TANGENCY EMERGENCY MANAGEMENT AGENCY REVISED ON 09/ 11/ 09 AND INDEX R = RADIUS DISTANCE MAP REVISED ON 09/11/09 THE GRAPHICALLY DEPICTED BUILDING(S) (R) = RECORD SHOWN ON THIS MAP OF SURVEY IS WITHIN ZONE K. BASE FLOOD R/W = RIGHT OF WAY ELEVATION N,/& COMMUNITY NAME & NUMBER MIAMI SHORES 120652 RES. =RESIDENCE = SIP SET IRON PIPE MAP & PANEL NUMBER 12086CO302 SUFFIX L SND SET NAIL & DISK (PK) STL = SURVEY TIE UNE SURVEYOR'S NOTES: SW = SIDEWALK 1. ELEVATIONS WHEN SHOWN REFER TO 1929 NATIONAL GEODETIC (TYP)= TYPICAL VERTICAL DATUM (NGVD 1929). 2. NO ATTEMPT WAS MADE TO LOCATE UB UTILITY BOX - UE =UTILITY EASEMENT FOOTINGS/FOUNDATIONS, OR, UNDERGROUND UTILITIES UNLESS W/F =WOOD. FENCE OTHERWISE NOTED. 3. THE LANDS SHOWN HEREON HAVE NOT BEEN ABSTRACTED IN REGARDS TO MATTERS OF INTEREST BY OTHER PARTIES, SYMBOLS: SUCH AS EASEMENTS, RIGHTS OF WAYS, RESERVATIONS, ETC. ONLY p - TELEPHONE RISER PLATTED EASEMENTS ARE SHOWN. 4. THIS SURVEY WAS PREPARED FOR ® = CABLE TV RISER AND CERTIFIED TO THE PARTY(IES) INDICATED HEREON AND IS NOT N = WATER METER TRANSFERABLE OR ASSIGNABLE 7. ALL BOUNDARY LIMIT INDICATORS SET X 0.00 = ELEVATION ARE STAMPED LB# 7104. 8. THE BOUNDARY OMITS STABLISHED -ON THIS (00') = ORIGINAL LOT DISTANCE SURVEY ARE BASED ON THE LEGAL DESCRIPTION PROVIDED BY CLIENT A = CENTRAL ANGLE OR ITS REPRESENTATIVE 9- FENCE OWNERSHIP NOT DETERMINED. 10. = CENTER LINE ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED WITHOUT WRITTEN = WATER VALVE CONSENT OF THE SIGNING PARTY OR PARTIES. 11. BEARINGS WHEN = CURB INLET SHOWN ARE TO AN ASSUMED MERIDIAN, THE CENTERLINE OF NE 99th STREET HAS BEEN ASSIGNED A BEARING OF N 90'0'00" E. FIRE HYDRANT BENCHMARK. = LIGHT POLE NAME -N-802 ELEV(NGVD29): 8.98 Q = CATCH BASIN LOCATIONI: NE 102 ST --- 46' SOUTH OF CA = UTILITY POLE LOCATION2: NE 6 AVE --- 25' WEST OF C/L = DRAINAGE MANHOLE DESCRIPTIONI: PK NAIL AND BRASS WASHER IN CONC CATCH BASIN. S = SEWER MANHOLE --oO- — = IRON FENCE CERTIFIED TO: --� = WOOD FENCE JOHN BRYAN NUGEN —•— = CHAIN LINK FENCE -- = OVERHEAD UTILITY WIRE Box REVISION(S): 11-08-2013 UPDATE A ADDED ELEVATIONS, JOB# 131118857 ASPHALT CONCRETE PAVERS TILES COVER 12-10-2014 UPDATE VEY, JOBS 1 220757 SURVEYORS CERTIFICATE: I HEREBY CERTIFY THAT THIS SURVEY IS TRUE AND CORRECT TO THE BES MY•KNO DGE AND BELIEF AS RECENTLY CTI E THEMINIMUM C ICA ST ARDS OR SURVEYED D DRAWN UNDER MY DIRECTION AND MEETS L SET TH BY THE FLORIDA VE AN WN�F STATE BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 5J-17 FLORID MINISTR CODE RSUANT TO'SECTION 472.027 FLORIDA STATUE. ®®� SEAL DATE OF SURVEY AUTHENTIC COPIES OF THIS 07�15�2010 SURVEY SHALL BEAR THE 7 JOB „/-- 100715099 ORIGINAL SIGNATURE AND FILE #. C-11411 RAISED SEAL OF THE ATTESTING REGISTERED UAN A. SUA z PROFESSI NAL SURVE R & MAPPER CAD FILE(N): NUGEN SURVEYOR AND MAPPER STATE OF FLORID LIC. # 6220 SHEET 1 OF 1 d I 6 PERMIT APPLICATION Miami Shores Village Building Departmen 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 /0 Master Permit No. 6 PP 10 13 a-$� Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING 4�R ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �j % 5 i G% 6�e-ewL City: Miami Shores Countv: Miami Dade Zi D: 33 / 3 d' Folio/Parcel#: // ° 3 AQ% , 0 /3 • 5530 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): UGen Al en Phone#: Address: 375 1& -IE qq ��e� a City: M I aml Sb o re S State• �2 Zip: 33139 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: W C.7 /'r 'K 0,VY76hr—tJC;h O/'7 Phone#: qS'! 77& • 333, Address: gg6O`SAL Eia/� &Lt v City: 'rj- 4:J2 �/��C� & State: ,fi Zip: �3.33 Z� Qualifier Name: g rL/a- to. /�G C l m Phone#: 9✓ YA911% 964& State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: A9,21147 47q� Phone#: Address: � �S'l.�J o2 .S'%� �l f®✓� City: Of, /Ow'L� State: J7,6 Zip: 33��� Value of Work for this Permit: $ r �Dd ®� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑® Alterations ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ��/s Qui• -a a Specify color of color thru tile: Submittal Fee $ Permit Fee $ 7- 5'- Z CCF $ CO/CC $ Scanning Fee $ e Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews$ (RevisedO2/24/2014) Double Fee $ Bond $ TOTAL FEE NOW DUE $ OCIF— 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 00, A 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. /? or AGENT The foregoing instrint was acknowledged before me this day of . 20 . by who is personally known to me or who has produced D4 ,1.,e•✓ S L E G- -v-was CONTRACTOR The foregoing instrument was acknowledged before me this day of `m �`l' . 20 1Y . by of who is personally known to me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLI `\`���� NOTARY PUBLIC: �yeya Sign: ~ °' ' = Sign: %A4ez Print: Print: ��� \y5`�oy� a Print: Seal: %. G" Seal: MY COMMISSION # EESM 2 O� EXPIRES March 04. 2017 a�tJ):tg8-U933 FiOAdeNO N�#�k4rk�k&S��FileB�kah�k�k�kt&�b&�kak�de�Ie�b�k8e� �e dt �ge�ie�(t& �kA�*&&�k �N&il��kN�[��kN�N�i�k�k9��6$�k�k�N�k�k�Rtl�N��M�k�k�k8l��k�69effi�k�k�ktl��R�k�k*�k�k�k$��R�k�k�k�k�ktRtl�9��k�k�Itfk�sk8��k�k r APPROVED BY � Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) A Miami Shores Village 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, you may be personally liable for the worker comensation 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. Print Nam( Signature: State of F14 County of Miami -Dade ) Sworn to and subscribed before me this day of VV-, P%&C - , 20 �419 Owner M (SEAL) .I -t r -J Contractor Print Name: I 1VWOL -) 1P. M cz—OA IiLAXY) Signat State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this a } day of M ati , 20 ISI Lo (SEAL) ?�°�i�'�r.• BETH LE1GH gCHOTRMUS A nu c. � csY DATE: .... L . L k N6 . i FFI E L --j S ,t.,-IUR L CIS � P ,Ilk f Mf;i ALL FEDERAL. O!iNft RJt.ES.AND.REGULA[IONS jo QL LAO ' 1 rn 0 Co 07/0212014 09:08 9544928769 WATERMARK CONSTRUCTI PAGE 01/01 JEFF ATINATIM STATE OF FLORIDA CHIEF FINANCIAL OPFICf:R DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * • CERTIFICATE OF ELECTION TO HE 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: WO/2014 EXPIRATION DATE: =mole PERSON: MCCAL.LUM BRYAN P FEIN: 412202469 BUSINESS NAME AND ADDRESS: WATERMARK CONSTRUCTIO1 3045 NE 15TH TERRACE OAKLAND PARK FL 33334 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING LICENSED POOL CONTRACTOR CONTRACTOR Pureneant to Chapter 440.05(14), P.S., an 6mm of a awpomffan who eleda exempltar Atm this cMptnr by ffiq a certglgle arelecom untuu tnts section may AM recover bene8ta or aemPensatioa under Ma chapter. Purl W is Chapter 440,06(12). F.S.. Cerilflc*bue ar election tab* ammp .- apply only wmdn the amw of tho owirtm or bade ftW an the notice of eivow to be exempt Pwwent to Chapter 440.05(13). F.S„ NOVO& of election to be exempt acrd ceNBaetea at election to be exempt Ad be sOPW to wwallon W, et any time aftertho filing efthe notice or the Issuance of the adMeate, the peram named on the notloo or oeNtiwte ft longer meets the requIranwis of thle section for tasuamm of a 4artllk8tm The depertMent Mall rmlw a certificate at any Ilms for fafiure of the pexaon named on the exutlflcate to ousel the requirements of fhle sewon. DF"2-DHC4.52 CERTIFICATE OF FLECTION TO BE EXEMPT REVISED a7-12 QUESTIONS? (850)4131600 Miami Shores Village 171 Building Department MAY 22 94 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B�,; Tel: (305) 795-2204 Fax: (305) 756-8972 - INSPECTION LINE PHONE NUMBER: (30S) 762-4949 0'4�10f>&Az FBC 20 9 BUILDING Master Permit No. 8jeP io 13 aa�lo PERMIT APPLICATION Sub Permit No. _41AUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKSHANGE OF ❑ CANCELLATION r-1SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 3 7 S 067 99 6ed.- - City: Miami Shores Countv: Miami Dade Zip: 331340 Folio/Parcel#: //• ,310 & o Jj .5S 3 n Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): %77 bf4L'l &c. —ri Phone#: Address: J75 A f, 99 .5-f ee. City: in / Gtm i S / I or e_.5 State: )z Zip: 3 313 6 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name:tza_je_rry-)r _,-6 &i'15�YY.1G as Phone#: kV- 7 7lo - 333 F Address: City: 't*- L.g,t,&&VGiGi'.� State: FZ zip:—j33 6 P Qualifier Name: 614—CLn P • mccawa1"/71 Phone#:. W&D�/- �� 7b State Certification or Registration LK6131 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: State: Zip: Value of Work for this Permit: $ 0c9 -0o o / Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: v - Specify color of color thru tile: Submittal Fee Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ Z_ CCF DBPR $ ❑ Demolition Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ _ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for 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. 117 Signature WNER or AGENT The foregoing instrument was acknowledged before me this day ofL1%i _ . 20 , by who is personally known to me or who has producedas identification and who did take an oath. NOTARY PUBLIC: CONTRACTOR The foregoing instrument was acknowledged before me this ePCD day of /7'M!5gtg . 20 /Y' , by M0° 0-/1ct�y) . who 4 �ersonally kno to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: P Print: ` Seal: #VNotary Public State Of Florida Seal: ' Joanna M Feliciano My ComftiIlWW FF 082783 V,,d E4*6$0111212018 **as�a��aaaa**aux+x*�xa�x+x*s��a****x�x��x�x�ams��xx�s�*aawrx��x�xs��xa�xa**�x�xa*a APPROVED BY , Plans Examiner Structural Review (Revised02/24/2014) e'gh S� Aaiv1?4 !r BETH LEIGH SCHOTANUS MY COMMISSION # EE8WM EXPIRES March 04.2017 as Zoning Clerk Miamishores* � Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit NSM 3 Owner's Name (Fee Simple Title Owner's Address: (3,)s City: /%law.,.WOW-A Job Address (Of where work is being done): City: Miami Shores_ Phone M -99-L0 9 9 1 300 V State : iZZip Code: State:—Florida_ Zip Code: 3313 Contractor's Company Name:%A4e K. CoS'FY u C4011 Phone Address: I/VbO F de Q4 tA, City: � Q State:_ Zip Code: 33'O Qualifier's Name: Lic. Number. jVC I 6 y�3/ Architect/ Engineer of Record Name: Phone #: Address: City: Describe Work: W State: ZIP Code: I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal lnvolrpmqnt. Signature Signature otA d_ orAm*d The foregoingstrument was aknbwiedged before me The forgoingstrument was aknowledged before me this 7— day of L,20,1�,by hit this 40 day of �._, 2Wby c-C�n Who Is personally known to me or who has produced who Is perorally known to me or who has produced it)o?So/-/rS06 as indentiicauon. as indentiticetlon. Notary Pubii Nfty Public: Sign: Sign.. + S8NoterY Cin , � Joanna FF OB21 Seal: ;so` BETH LEIGH SCHOTANUS mycompVnzWs '= MY COMMISSION # EE880= EXPIRES March 04, 2017 +ml nos-o+s3 1 7 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) acknowledge t�t anew swimming pool, spa or hot tub will be constructed or installed at 3"75 `i 6+- • 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). _ 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 latchingAocking installed a min. 54° above the threshold. If this option is selected, submit plans showing all types and location of all perimeter protection. The plans must also show the location and type of all openings, and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Code, the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements, and upon expiration of the permit, the pool shall be presumed to be unsafe. I understand that not having one of the above installed will constitute a violatio of Chapter 515, F.S ., and will be considered as committing a misdemeanor of the second deg r punishable as provided in Section 775.082 or Section 775.083 F.S . This form must be signed by owner/age pri or. _ C T OR'S SIGNATURE AND DATE - TUR "ATE, Gin 8• Me Ca�LL�ur�r �' -- r ,����,,. CONTACTOR'S NAME (PLEASE PRINT) OWNER'S (PLEASE NOTARY PUBLIC NOTARY PUBIIM F-.-o BETH LEIGH S MY COMMISSION # EE880532 EXPIRES Mamh 04.2017 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 T. !3►'cl �L'? is/are the fee simple owner(s) of the following described property situated and being in Miami Shores Village, Florida: Address: -375 Of, q9 �5 Whereas, the undersigned owner(s) (7- 6 rUa., 1i 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. That, I/we, as owner(s) hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the event that is damaged or removed by any case. NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant concerning the use, enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its success accordance of said Village then in effect. SI3N & PRINT_ OWNER SING & PRINT I Hereby Certify that on this day personally appeared before m" ell n and has produce ID # as identification and he/she acknowledge thbihe/she executed the foregoing, freely and voluntarily, for purposes there in expressed. 0\wiiuiuurii SWORN TO AND SUBSCRIBED before me on this day of 20.` �,0 31b1 S NOTARY PU%l 'Tl Q ei4 (Revised 05/2209 ��•�®\��,����� ' sp�'' D a, s, 2' 2 R�`5����`�� 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 Date2-I`l Miami Shores Village Building & Zoning Department Attention: Building Official certify that I am the legal owner of the property described as Rlaql SIMrfes S;Z / 4nb P8 /v- 76 , located at d76- AM 79 J/ i%7/moi ShL-.eg & <3r3I3f . 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 Owner Note: This certification is to be submitted with a swimming pool permit application in duplicate. STATE OF FLORIDA DEPS OF BUSINESS ADM PROFESSIONAL REGULATION CONSTRUCTION iwUSTRY. LICENSING BOARD (8.50) 487-1395 1940 NORTH MONROX STREET -- -0783 TALLARASSER' FL 32399 MCCALLUK BRYAN PATRICK• CONSTRUCTION LLC 3045 NE 15TH TMULUM ommm PARK - FL 33:934 Cbngratulationst With this license you become one of the nearly one miMon Floridians licensed by the Department of Business and PmkwJonW Regulall Out professionals and businesses range from architects to yacht brokers, fro boxers to barbeque restaurants, and they keep Florida's economy strong.. Every day we work to Improve the way we do business In order 10 serve YOU For ftrMatlon-about our services, please tog onto wwwxWflorldalicense-4 There you can find more Information about our divisions and the regulations Impact: you, subscribeto deparim.ent newslatlers-and learn more about the Ddparlmenrs Irdfladves. 'Our rnisslon at the Department w Ljcanse Effidently, Regulate Fairly. We constantly strive to serve you biter so that you can serve your customers. Thank you for doing business In Florida, and congratulations on your now lic DETACH HERE 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: WATERMARK CONSTRUCTION LLC Business Name: Owner Name: BRYAN PATRICK MCCALLUM Business Location: 4460 N FEDERAL HWY FT LAUDERDALE Business Phone: 954-804-3676 Rooms mplciy n� {1 For Vending E Receipt #:G»>L CONTRACTOR Business Type:CONTRACTOR) Business Opened:09/12/2011 State/Co u my/Ce rt/Reg :CBC 12 5 7 7 21 Exemption Code: ••' Tuna• Professionals THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS -BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the . business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: WTATERMARK•CONSTRUCTION LLC 4460 N FEDERAL HWY FORT LAUDERDALE, FL 33308 2013 -2014 Receipt #031-12-00002980 Paid 07/22/2013 27.00 I4u111�1 VI M-..... - - Tax Amount Transfer Fee NSP fee Penalty Prior Years Collection Cost I Total Paid 27.00 0.0 r OH OP 0,00` c;{0+OC1N 0.00 27.00 E r br THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS -BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the . business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: WTATERMARK•CONSTRUCTION LLC 4460 N FEDERAL HWY FORT LAUDERDALE, FL 33308 2013 -2014 Receipt #031-12-00002980 Paid 07/22/2013 27.00 05/22/2014 11:00 9544928769 WATERMARK CONSTRUCTI PAGE 01/01 5/22/2014 10,57 AM FROM' Fax BaUthgate ;nsurance Agency of Powaha Reach ZnO TO, 9544998769 Il 002 OF 002 TM8CERTIFICATE OF LIABILITY * 1NSURANCI: EAR CEgTlFICATE IS 18SUED A8 A 16ATTER OF INFOItg►ATION ONLY ANp CONFERS NO ttlU'llTg UPON THt; CERTIFICATE BELOW, Dpi NOT AFFlRIIAA77YELY 01� Nk"GA 00/22/2054 BELOW. PIIS CBRTIFIGITE OF INSURANCE GOES N�OTLCONSrI�` AA EXTEND OR ALTER THE CO HOLDt6i. THIS REPREBEN=A111/E OR PRODUCER, AND THECERTIFICATE]DOEOT HOLDER, VEIiA43B AFFORDED BY ?HE pOLIC1ES CT BETWEEN THE IS9LINO ININURE ig). AUTHORIZED ANT: ff a cert Date ho der s an ADol to L �e terms and contlRfons of the Ahoy, o4�n pollutes euRED, the polkypes} moat 6® aadarsed. U S BR certFRcate hol4tar In Ileo of such andorsomen s ' quire an endorsement, A >Eatement am thls cartlAe T()l Ies IS AIV6D, wpjd to peo°uaaa ata does not confer dots to the Southgate Zug A93t of 24V 2ch I-na wm. Trishk�ravata 699 Nam reditvaZ itdghmdy Na ig84) 9 2�dd00 P 0 Sox 928 A trisautrhgates as . �am meal 992-roe2 ao Shonraum 3+ 53062— �°' e��ark Callsat4on LLC fttG r7c C=gtxuctjcM L=CA �NAt ,HS Halo• 8480 Np= 8'ed®ts�1 ti55 oPay Mum e s mea; Portw4ma o u�i"d�33@ pia ame- wcvim E INDICATED. N STArul fME FOL1ClES OF 4W�IRMICE LISTED BELOW RAVE BF,I�} fSSir OTUVITNsTANOpH�ANY RJ QtJIREMENT, REVISION NUMBER: CERTIFICATE MAY BE watJED OR Nb4Y PERTAIN TN TERM OR C01VDrilON pp ANY � � THE INSURED NW913 ARMI! FOR THU PORKY PERIOD EXCLttS(ONs ANO COIVdITIONs OF SLI 6 NISURANCQ AFPORDL'D BY THE PO ICu ICu AOR OTHER OOCUM6IVT WITH RESPECT TO VUI4tCH THIS 4TIr CFI POLIOIES. R@tITS IOU6tu MAY HAVE BEEN REGUOELI BY PAIDD CLAt ED Ha9w 03 SUBJECT TO ALL THE TERI i11•e Y� 1aQURIWEq A mom"L <yoeem wea taro Pell" ..�_� OM4MAL 4d4BJLr,Y CLAIMS -MAI [72 O=, GEN" AGGREGATE LW APPLIES PER: Z POLICY PRO. AI Lknr?V LO ANYAUTO ALL OV#= Al • S0i0:.+LED AUT08 NREO AUTOS NON-Ol AUTOS U 1LA uI aMom LAS OCCUR DEDtJCfI@LE SMS MADE F:1ENiION uwLarE�� �enrpa Allp ANY " pQt MpM%8 Ecutva / I %r cp marARoxe , LeeATmm r 6aaaan / P, .1 ceamxaceor >%�aeaselp C@C245723Z A rot. Aa4nunu / J 6 d t man atmh H fol } See mca l BODILY SNJLIRY ECD14Y INJURY PROPRO TYPSRi 4 (Pareaa9Nj J.wa I 2,000 1,000 SHOULD µ14Y OP THE ABOVE 13MMRIBLO P12LIOM aS QANCELI.I3D 1dEPaRB BnQrE:S Vtxla TIRE CC 9XRQRA'IWrtHT THS POLCI TM OFi NC71Cfi Wtl l BE D6CNrsRgp OV 2.0050 �52.3ag t AQCORDANCE � 2aaZ Avenue PRovlOaRa. miand shares INI {awens) RZ �j�** js ".^"'moo aur+maseNranve �43V� � •,�••�IrY._Mv7e.M . Tha ACORD name and logo are registered reiv�l� M RD CORPORq SON. All neI OS -14-2012 �e JEFF Ai WATER STATE :OF FLORIDA r,HWFiNMC1ALOFF10ER, DEPARTMENT OF .FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION' CERTIFICATE OF. ELECTION TO BE EXEMPT FROM' FLORIDA WORKERS' COMPENSATION LAW -PONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE:. 06/30/2012 EXPIRATION DATE: 06/30/2014 PERSON: MCCALLUM, BRYAN P FEIN: 412202469 BUSINESS NAME AND ADDRESS: WATERMARK CONSTRUCTION LLC 3045 NE 19TH TERRACE OAKLAND PARK FL 33334 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED •POOL/SPA CONTRACTOR 2- CERTIFIED BUILOINQ CONTRACTOR IMPORTANT. Pmsnest.to Chapt.hr 44.0 . oti(14, F•s•, as officer of a corporation who elects exemption from this chapter by filing a certificate of electioon ander this within 'he section may not recover benefits or compensation ander this chapter. Pormant to Chapter 440.06(i?J, F.S , certificates of , elecUop m be exempt.x app Y Y scope of the business or trade listed on•the antics of sluing to be exempt. Pursuant to Chapter 440.Ord1S), F-3, Notices of OIOctIou to he exempt and certificates of election to be exempt shell be subject to revocation 0, at any time after the filing of the notice or the Immeacs of the cettincato, the pamu named on the notice or certificate oo longer meats the requirements of this section for issuance of a certtffcete. The department shall revoke a certificate at any time for failure of the prs eon named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 C-252 CERTIFICATE OF ELECTION TO BE EXEMPT -REVISED 01-11 ............ --•• PLEASE CUT OUT THE CARD BELOW AND RETAIN•FOR FUTURE REFERENCE TATE OF FLORIDA BpARTMENT OF FINANCIAL SERVICES MSION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY ERTIFIR3' COMPON LAWBE EXEMPT. FROM FLORIDA . YORKEFFECTIVE: 06/30/2012 EXPIRATION DATE: 08/30/2014 ERSOM BRYAN P MCCALLUM EIN: 412202489 USINESS NAME AND ADDRESS: #ATEFWm CONSTRUCTION LLC 3o4.a NE isTH TERRACE. OAKLAND PARK, FL' 33334 COPE OF BUSINESS OR TRADE: 1- CERTIFIED POOL/SPA CONTRACTOR 2- CERTIFIED BUILDING CONTRACTOR N IMPORTANT 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 L under this section may not recover benefits, or compensation under this D chapter. Purgusnt to Chapter 4 •0.05(12),. F.S., Certificates of election to be H exempt- apply only within the scope of the business or trade listed on E the notice of election .to be exempt R exempt EandPursuant certificates�of eectioh toter �be exempt hall.beesubjF.S., Notices of elctlo 6 to e ect 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 certifitrete. The department shall revoke a certificate at airy time for failure of the person named on the certificate to meet the requirements of this; section. QUESTIONS? (850) 413-1609 CUT HERE Carry bottom `portion on the job, keep upper portion for your records. ' : CERTIFICATE 'OF ELECTiG: 7. 7- EXEMPT REVISED 01-1' Psl .7"A co,�vee 4 4- on b-ewJ ��, d.-�' ort =- %✓ v° ©P✓ 1l � �-� re eJ n �v 1 W plptary Public Site Of FWda 1 Jot+rine M F@Ndl: 0 y Commiaeien FF 82759 E,q es a,�42rz�►ta vt - ��-►"fit ti a� � �"` ��'�G� �,.,r�°� 1��J�'/ ? � 6 D �s`°�� ��0"�/�`� �-' A C L T .�. Notary Public State of Florida JoONOW- 140 anna RR 082783 wd� Bxplree b1t12f2018 j .e ,.,T 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 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING MAY 222014 FBC 20 l -Z5 Master Permit No. 8 PP /U /3 d;090 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL "PLUMBING r-1MECHANICAL❑PUBLIC WORKS �NGEOFCANCELLATION ❑ SHOP TT��'' CONTRACTOR DRAWINGS JOB ADDRESS: tt n 695 IV t q'7 T �T L City: Miami Shores Countv: Miami Dade Zip: p c33 13O Folio/Parcel#:I-&.d)6 • ®13 " 55W Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): --r ""f li�i r"9 Phone#: a& - ?000 .3®0 7 Address: 3 7 5 /R _6- 51 e9- City: Aff/77/ .Sj )Ieg State: Zip: 3c313r Tenant/Lessee Name: Phone#: Email: CONTRACT``O //,,R: ``//Company Name: / h` 12.22 (�U/Z�66917 Phone#: �� —/ 76 -✓✓& Address:W/00 City: State: Zip: 00 Qualifier Name:A file, C,C i'l') Phone#: 9�'V-W' 3& 7(e, State Certification or egistration #: "A Aff 713 Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ V*fit, Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 7 AWX'k Z11 %'���- RICA x, Specify color of color thru tile: Submittal Fee $ Permit Fee $ 5 CCF $ CO/CC $ Scanning Fee $ Radon Fee,$ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (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 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 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. Signatu ER or AGENT The foregoing instr°Gment was acknowledged before me this day of q 20 —� by who is personally known to me or who has produced �k. a as identification and who did take an oath. NOTARY PUBLIC: Seal: Joanna M Feliciano +� d� My Commission FF 082783 ' M1.14 Exp'aes 01/1212016 Signature CONTRACTOR The foregoing instrument was acknowledged before me this c�0 day of i't f / by who i sonally know to me✓or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: 14/7Lt.5" Seal '= MY C©N1MtSSItJtd M EE880832 it EXPIRES March 04.2017 ») 39H t�153 f Ab APPROVED BYPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) MCCALL'K, BRIAN PATRICK WATERMARK CONS ION LLC 3045 NE 15THTERRACE . ©ASID PAR'S FL 33334 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895— 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: Business Name: WATERMARK CONSTRUCTION Owner Name: BRYAN MCCALLUM Business Location: 4460 N FEDERAL HWY FT LAUDERDALE Business Phone: 954-804-3676 Rooms5eats k Emplq�M For Vending Bush ReceiptType: ype: POOL/MARINE CONTRACTOR Business Type:(POOL/SPA CONTRACTOR) Business Opened:06/09/2006 State/County/CorUReg: CPC 14 5 7 2 31 Exemption Code: 52 vpndtnh rvnQ� Professionals Tax Amount Transfer Fee , e Cost Total Paid 0.00 -r tY t00'! 0.00 27.0 027.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS ¢ECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is.in compliance with State or local laws and regulations. Mailing Address: BRYAN MCCALLUM 4460 N FEDERAL HWY FORT LAUDERDALE, FL 33308 2013 -2014 Receipt #13B-12-00010704 Paid 07/24/2013 27.00