Loading...
BPP-15-959�s•',y Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Applicant 53 NW 97 Street 1131010330280 DEAN ANTHONY DENT II Miami Shores, FL 33138- Block: Lot: DEAN ANTHONY DENT II 53 NW 97 Street MIAMI SHORES FL 33150- 53 NW 97 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone BLUE COAST POOLS INC (954)9647687 (305)962-8911 In Review Approved:: In Review Denied: of Work: Swimming Pool Occupancy: Private ional Info: APPLY DIAMOND BRITE SURFACE FOR Bond Return: oification: Residential Scanning: 3 Fees Due Amount CCF $1.80 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.60 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 Cell (414)581-7334 Valuation: $ 3,000.00 Total Sq Feet: 110 Pay Date Pay Type Amt Paid Amt Due Invoice # BPP -4-15-55295 05/12/2015 Credit Card $ 118.30 $ 50.00 04/22/2015 Cash $ 50.00 $ 0.00 Avaiiame In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for,5kECTRIC_AL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT:I� I�oreg�q�q information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin . u rm0 u 0nze t a ove-named contractor to do the work stated. / Contractor / Agent Building Defaftment Copy May 12, 2015 May 12, 2016 BUILDING PERMIT APPLICATION 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 ❑ ELECTRIC ❑ ROOFING APR 9 2 20S FBC 20 CO Master Permit No. TF ®5 — d F:� I Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: OWNER: Name (Fee Simple Address: S-3 ev City: M [ 14- 54ew State: Zip: -5 SIT V Load: Construction Type: Flood Zone: BFE: FFE: Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: L ✓� � Phone*Address: (5 _S l t S � 3y City: A -,d / &­'I� 1/4- Le State: C Zip: 3 3 ei Qualifier Name: -T(9"6F Phone#: -3 OT ` C((o 2 PY // State Certification or Registration #: Certificate of Competency #: -1) q FO OC DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $_ ®� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration [:1New E:1Repair/Replace ElDemolition Description of Work: APZ!/ ®I-m&o-o 13,s; -Air=- .5w4 r- ^ cc' Specify color of color thru tile: Submittal Fee Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) CCF $ DBPR $ CO/CC $ 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 hm=tion which occurs seven (7) days after the building permit is issued. In the absAnce of such posted notice, the inspect' will not be proved and a reinspecWn fee will be charged. k� ER or AGENT The foregoing instrument was acknowledged before me this day of 1 20 I T , by � who is personally known to me or who has produced�as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) Theii, foregoing instrument was ackl owledged before me this U10 day of 20 15 , by 57-3 IW6�who is personally known to me or who has produced '��--� as identification and who did take an oath. NOTARY PUBLIC: Van - Structural Review �x�ixw�x��x�s�*wax*�x l� Zoning Clerk r Oct 28 13 08:21a Jorge Estupinan 19549641646 p.1 K Nm con 1 Quarifying Board 3NESS CERTIFICATE OF COMPETENCY COAST POOLS INC .A.. ESTUPtNAN JORGE Is certified under the pmvwons of Chapter 10 of Miami -Dade County 005983 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY LBT___1 6648621 RECEIPT NO. EXPIRES BUSINESS NAME/LOCATION BLUE COAST POOLS INC RENEWALSEPTEMBER 30, 2015 DOING BUS IN DADE CO 6919451 Must be displayed at place of business Pursuant to County Code MIAMI FL 33000 Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED OWNER 196 SPECIALTY PLUMBING CONTRACTOR BY TAX COLLECTOR BLUE COAST POOLS INC 09P000728 $75.00 09/09/2014 Worker(s) 1 CHECK21-14-063471 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles - Miami -Orale Code Sec Ba -276. For more information, visit www.miamidade aov/taxcoli,_. Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL -DO NOT PAY CC NO: 09F000728 BUSINESS NAME/LOCATION BLUE COAST POOLS INC DOING BUS IN DADE CO MIAMI, FL 33000 OWNER BLUE COAST POOL Nc MC RECEIPT NO. EXPIRES 7465385 SEPTEMBER 30, 2015 TYPE OF BUSINESS SPECIALTY PLU;JBE :VG CONTRACTOR Restricted to City of Miami Shores asFor more iaformadoa,visityy�ty lq[ gge,gghaxcollector Pursuant to County Code Sec 10-24 PAYMENT RECEIVED BY TAX COLLECTOR 8.75 04/2V2015 0239-15-005734 OP ID: LEGO CERTIFICATE OF LIABILITY INSURANCE DA04/20/201 1r) ILTR 04/20/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Avante Insurance Agency, Inc. 7490 West FlagI@r Street Miami, FL 33144 Gabriela F. Dominguez CONTACT NAME: PNCNNo Ext): A/C No): E-MAIL ADDRESS: PRODUCER BLUEC-1 CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC 0 INSURED Blue Coast Pools, Inc. 6311 SW 34 Court INSURER A: Scottsdale Insurance Company Miramar, FL 33023 INSURER B: INSURER C: INSURER D: CPS2169264 INSURER E: 02/10/2016 INSURER F: MED EXP (Any one person) $ 5,000 COVERAGES CFRTIFICOTF NIIIUIRFR• octllelnN 1jnIU112G12. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE D BR mmn POLICY NUMBER POLICY EFF M D POLICY EXP (MM/00 LIMITS AUTHORIZED REPRESENTATIVEMiami GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR CPS2169264 02/10/2015 02/10/2016 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 1,000,00 POLICY I17JEC PRO LOC $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ HIRED AUTOS $ NON -OWNED AUTOS $ UMBRELLA LUU3 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU-OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? El N / A TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below__J E.-7 L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more space is required) Swimming Pool Maintenance License #0913000728 CERTIFICATE HOLDER rlamrp:i 1 ATInN MIAMSH1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVEMiami Shores, FL 33138 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD AAk JEFF ATWATER STATE OF FLORIDA C'NtFEF lPINJWCIAL ORWER DEPARTIAENT OF FINANCIAL SERVICES AIVISlON OF WORKERS' coMPENSATION •'' CERTIFICATE OF SLE:Cti lON TO BE EXEMPT FROM FLORIDA WORKERV COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the Individual listed below has eW- ed to be exempt from FIotlda Workers' Compensation taw, E +'MCTNE DATE: 911312013 EXPIRATION DATE: 9/1312015 PERSON: ESTUPINAN JORGE FVN: 01076257D BUSINM !'TAME AND ADDRESS: BLUE COAST POOLS INC (1317 SW 34CT MIRAMAR FL 33023 SCOPLS OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Fu to (;ttP,pW4411,08114), 3., an oflfW&Fa c**0 att A'W110 OW015 examptlantram this *mFW rr,y %1ng 8 =0=10 0000W umbrthTs sit"On may not r eco�es asrrs5ts as campansettan under W s chaplet. Parauw. to Qmpsst 440 050X4 F.S.. cwttft ates of wactlan to to afcempt... sp* a* tete soopa of the business or rude tied on tyre notice of scion to bgematttat. Ptt unlit to Chapter 540.05(13?, F.S., NOCK aF etedion to t@ Pt oo earifficatea of eieci;Ran !{o be exenpl IN!! be sub°,eat to ravaaa6an lf; at any tIM4 after ,,% ft V of lite rt *g ar as Issrranae 0f tr.e ce►titie b, tits parson, 1181111641 Orr the nt lice ar cwwt11 no ♦ger meets the mqulr>3rwts cithis sadlon to., i%uartca of a asi11 -te. The aeCatknent shat♦ MOM a CO"cate at any fto for (stints of the Person named on ttte eert;Rcrte I# meet 11111 r®qutrsmeats of this sed*n. D'FS. 2-DWC462 CER'TIFICATS OF ELEC11ON TO BE EXEMPT REVISED 07.92 QLW. i i I0N9? {8Wj4M1809 superior pool service P.O.Box 4615, Hollywood, PL 33O83-4615 Tel.: {954} 964-7687 • ,dux: (954) 964-1646 Date: State Of r �. county of Before me this day personally appeared JV a,&C% p 1 j`p4A--, who, bang duly swom, deposes and says. t• That he or she will be the only person working on the project located at: 53 A/L'f q7 54 'L Sworn to (or afi'ijrme nd subscribed before me this day of am- ..,,+_,,., 20 � , by Personally know DR Produced Information?? fq T� - Tt�Sr2� ype 61 r'jdentification Produced '9 ...... Print, Type or Stamp Name of Notary 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 and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YDIJ ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this l day of 201 S By who is personally known to me or has produced tyon. Notary: : • O ��® �f'� SEAL:- �c� �,® `'0.to SO r R/DA 11 C b1h -.'-V .1 C' ASP H4LT PAr> Mt leis •••• •• • .•••wi d� • • • ,, V t_.C(4 8 ,pb ...•.• )' >L 3= fW+.r t GSL 1 I 14 1 0 E C K 5.0� E K� %J "APIR 4 ��.5�r. 4.70' C�, • D015 .� r �✓,b OrlpaONF STORY, RE! I10LNCE 21+.P.M _ Acr i 0 301 77 t 10. I `, s '� �� *� � ._ `"� 9 50' •ate " �� '3 w `� '� � � �, w ,%fit t fold' +1vA s r� P � s 11 2O M`i •.. �g 111 AA 75-00 p PAVES ;I \ o ??.7"�l fi«KINLU AY LL P3LU J f is fly ASP-iA--- FAVEVC^JT C' 00. IT +d J w z c)::) 0 d ® LU0 OU �Aw eptsd By iftoWfty Address: 53 N.W. 97 STREET � � ?� � � ��,� 271 MIAMI SHORES, FL. 33150 ; �� � -1�1 �4M Wiwi w ,7 i1741i/1""..h'4� ,ry,5x�tp t.rw,lt `d'�5 ;e •r �.: S.Aa..S` r.ry 2 �1n i 3�..u,1„ .,rv..0 �t: ,► 5 1 i My+ WGUK ESPIMSA LAND SURVEYING, lNC. AIq AS �T ;&Y; if QF 1 02YB% SlaTuiEs a IfutmAw