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DS-14-2775 (3) Miami Shores Village Building Department DEC 19 2014 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 2M BUILDING Master Permit No.T)'Ie�) �� 27:�b PERMIT APPLICATION sub Permit No. 2tUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION [:] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /-I F 6 Nh� 1991 J TR FET City Miami Shores County Miami Dade Zip: 3313.0 Folio/Parcel#: 11 -32 OS• 0,11- Q 01 O Is the Building Historically Designated:Yes NO ,a Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): W 111 awn K-40 N Phone#: Address:1.2A06 AM l()1 3 j3fe.e f City: mi'ai-ni .�r,eS —State: F1 Zip: 33/31F Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:/3t.Z..tZ. j4j0,j/L. dY) Phone#: 95Y. 774o•333 Address: 'YY6 o IJ . Fed efa l H .yQ City:-- Fi— L_4,t&e_rct a (A__ —State: )IF- Zip: 333bR Qualifier Name: ��rc.La. 1,. eT7G.La- I tuxy-) Phone#: LOQ/-36.70 State Certification or Registration#:MO,LL/5 7 A3 I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1'�T[Y� Square/Linear Footage of Work: X-1120 Type of Work: ❑ Addition ©`Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: !a\1P jrS cD 1_ q x, n a Dcr ::�t p CAL- Specify color of color thru tile: Submittal Fee$ Permit Fee$ b CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ . (Rev1sed02/24/2014) C P q 4 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �iSignature — Signature OWNER or GENT CONTRACTOR The foregoing instrument/was acknowledge efore me this The foregoing instrument was acknowledged before me this / day of Nd✓ 20 A/ by ,I/day of A4W ,20 /�f ,by who is personally known to kmgm A M c«-1/aMwho is e�rsonahly kn�ow�n to me or who has produced /=L b L_ as me or who has produced as identification and who P,C+nkp an nath identification and w dTpd e t IGH SCHOTANUS NOTARY PUBLIC:, BETH LEIGH SCHOTANUS NOTARY PUBLIC: I:: �: MY COMMISSION#EES80532 MY COMMISSION#EE880532 :�, EXPIRES March04 2017 EXPIRES March 04,2017 „.• Ftorrear�acerY �6"' ` an7`7b95 0153 r4r1T -0153 F. Sign. Sign: Print: A 'W'Lo fid..Aa c"-e Print: Ae#h Le/G ,SIL�?D�Cr17kS Seal: Seal: APPROVED I �� i Y 1 ROV D BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) gOREs 'TIC.1932 Lf� M iami Shores Village soon Building Department `nye 10050 N.E.2nd Avenue ��rEe��►$� Miami Shores, Florida 33138 �lOR1Dp' Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT STATE OF(FLORIDA) COUNTY OF(DADE) The undersigned Affiant, Will llaW RL does hereby attest that (Property owner) The attached survey,performed by —C. �1 (Name of surveyor's company) For address: 101 S+fv—e-A— Performed on `-I I (date of survey)is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Furt eth UJa Z Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this qday of AfFant is personally known to me,produced oeL as identification. Pp.VP6 '1;6' BETH LEIGH SCHOTANUS MY COMMISSION 0 EE880532; Notary EXPIRES March 04,2017 Revised on 5/2M09/Revised on 6)1&OF a x407)390.Ot53 FbrldoNOte roloe.com 1 f 74.s^ OFFICE OF THE PROPERTY APPRAISER Summary Report Generated On: 12/3/2014 Property Information Folio: 11-3205-021-0010 Property Address: 1280 NE 101 ST Owner WILLIAM R ROY SUSAN P KELLEY NE� 101 ST ST Mailing Address 1280 NE 101 ST MIAMI SHORES,FL 33138 Primary Zone 1100 SGL FAMILY-2301-2500 SQ x Primary Land Use 0101 RESIDENTIAL-SINGLE FAMILY 1 UNIT Beds/Baths I Half 5/3/0 Floors 2 Living Units 1 r Actual Area Sq.Ft R ' Living Area Sq.Ft I Adjusted Area 4,256 Sq.Ft Lot Size 21,735 Sq.Ft Taxable Value Information Year Built 1938 2014 2013 2012 County Assessment Information Exemption Value $50,000 $50,000 $50,000 Year 2014 2013 2012 Taxable Value 1 $399,714 $393,068 $385,662 Land Value $586,659 $396,943 $376,512 School Board Building Value $290,518 $290,669 $325,089 Exemption Value $25,000 $25,000 $25,000 XF Value $25,606 $25,757 $32,528 Taxable Value 1 $424,714 $418,068 $410,662 Market Value $902,783 $713,369 $734,129 City Assessed Value $449,714 $443,068 $435,662 Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value 1 $399,7141 $393,068 $385,662 Benefits Information Benefit Type 2014 2013 2012 Regional Exemption Value $50,000 $50,000 $50,000 Save Our Homes Assessment $453,069 $270,301 $298,467 Taxable Value $399,714 $393,068 $385,662 Cap Reduction Homestead Exemption $25,000 $25,000 $25,000 Sales Information Second Homestead Exemption $25,000 $25,000 $25,000 previous OR Book- Note:Not all benefits are applicable to all Taxable Values(i.e.County,School Sale Rice Page Qualification Description Board,City,Regional). 29160- 05/19/2014 $1,150,000 916Qual by exam of deed 4157 Short Legal Description 16354 2008 and prior year sales;Qual by exam MIAMI SHORES SEC 8 AMD PB 42-40 05/01/1994 $273,000 2540 of deed LOT 1 BLK 184 A LOT SIZE 135.000 X 161 03/01/1989 $0 14092- Qual by exam of deed OR 16354-2540 0594 1 1101 01/01/1989 $0 00000- Qual by exam of deed 00000 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp Version: ♦5gO I Li ;.,. ,.,,,I Miami Shores Village - �41 Building Department RADA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. � COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. ` COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 COMPLETE CONTRACTOR'S INFORMATION � BUSINESS NAME: LO Cx- 'Lrn opt IC CX.�<S/� uC J1 a BUSINESS ADDRESS: y/1(AO 'A • lcl�/ 4AACITY L' • � 6l vdd(e STATE FZ- ZIP CODE 33 3 D o' BUSINESS PHONE: 7710. 333FAX NUMBER9r V y9o�• cf'7!s�I CELLPHONE( )A0V•3/y 76 QUALIFIER'S NAME: AICC40- / ff7 QUALIFIER'S LIC NUMBER: t�/ C Iy5 E-MAIL ADDRESS(IF APPLICABLE): Created on 3119109 BY MLDV 1 RV 3126109 MLDV STATE OF FLORIDA -DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MCCALLUM, BRYAN PATRICK WATERMARK CONSTRUCTION LLC 4460 NORTH FEDERAL HIGHWAY FORT LAUDERDALE FL 33308 Congratulationsl With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range --,-STAT---OF FLORIDA - from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTIV BUSINESS AND and they keep Florida's economy strong. PROF ' GULATION Every day we work to improve the way we do business in order to CPC1457231" 7/23/2Q4 serve you better. For information about our services,please log onto x f� www.myfloridalicense.com. There you can find more information CERT COMM ~$ TR �j about our divisions and the regulations that impact you,subscribe MCCALLUM, to department newsletters and learn more about the Department's ;1NATRMAR initiatives. —Ir mission at the Department is:License Efficiently, Regulate Fairly. r . f constantly strive to serve you better so that you can serve your s ` customers. Thank you for doing business in Florida, pi's c �iFiEo ander xt�Q„p'rbvl.etons o c 4¢9.F$ „ u and congratulations on your new licensel rgncam:"AU(332016 q � p�z�oo�szo ;; DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA CONSTRUCTION I�IDUSTRY.LICENSING BOARD 4 DEPARTMENT OF.BUSINESS AND.PROFESSIONAL REGULATIO QP 1457231 w. ' k Tie COMMERCIAL POOL/SPA CONTRACTQR _ 1, Named t�elow I.$ CERTIFIED ' - a 11t5derthe provisions of Chapter 489`FS Expiration date -AUG 3'1: 2010 R h• ° N 14 '` • MCCAt; Ui171;BRYANaP9TT I -°; , 4460 p4ORTFR EC�"/ L' 33308 , 3.d' f .�-..ry,^'" .✓" .• It < �•e,. �,t w w rt � � 5 4'•. � '4 � ■ .�T 'a as ` � � ae ef } cas �,,.e'rr�'n•,ate'`tc. tP '�'+s r 5. N ,t � r�;+f'ly t {� Y nn� ISSUED: 07/23/2014 DISPLAY AS.REQUIRED BYLAW SEQ# L1407230001620 '13"X�'r�F.b}:S!:MtE1f'�TMF EROWAR® COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, 33301 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,12015 000 <Y Receipt#:POOL�i�INE CONTRACTOR DBA:.WATERMARK CONSTRUCTION Business Type: Business Name: YP {POOL/SPA CONTRACTOR) , Business opened:06/09/2006 Owner Name:BRYAN MCCALLUM CPC1457231 Business Location:4460 N FEDERAL, HWY State/COun /Cert/Reg: FT LAUDERDALE Exemption Code: Business Phone:954-804,-367.6 ` Machines Professionals Rooms Seats Employees x For Vending Business only Number of Machines: Vending Type: Prior Years Collection Cost Total Paid Tax Amount Transfer Fee. NSF F.ee ..Penalty.. 0:00 0.00` 0.00 27.00 27.00' 0.00 0.00 l kit; f as a" -"M! m,&= BROWARD COUNTY LOCAL (BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft, Lauderdale, FL 33301-1895—954-8314000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 P Receipt#:180-243642 DBA: GENERAL CONTRACTOR (BUILDI ,. Business Name: WATERMARK CONSTRUCTION LLC Business Type:CONTRACTOR) Business Opened:09/12/2011 Owner Name:BRYAN PATRICK MCCALLUM Bus Business Location:4460 N FEDERAL HWY State1Qount /e CBC1257721 Code: m FT LAUDERDALE N Business Phone:954-804-3676 9Machines Professionals E.Eseats Employees . Rooms 1 m For Vending Business Only 4" Vending Type: Number of Machines: Penal Prior Years Collection Cost Total Paid Tax Amount Transfer Fee NSF Fee 0.00 27.00 27.00 0.00 0.00 0.00 ^L;ht n mail M shoresVillage p.. Miami may° Building Department tpR>rpA 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,youmay 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. Owner Contractor Print Name: 0 14(mom 61 4 a! 190J( Print Name: &Y4241 /►'1 G L�/�m Signature: �� Signature: ,y�F:"• BETH LEIGH SCHOTANUS l""°"®�;' BETH LEIGH SCHOTANUS MY COMMISSION#EE880532 State of Florida) :N• ��;� MY COMMISSION#EE880532 EXPIRES March 04,2017 State of Florida) County of Miami-Dade, y'yR-0153 FlondallotarySeevlce.com County of Miami-Dade ,• EXPIRES March 04,2017 398,,0953 camry&erylce Sworn to d subscribe a ore me s Sworn to and subscrib ' .Flmldg�Ve' day of ,20 / day of !Q P e- ,20_Ly_. By E 0 By d . � 1064 .y, MY COMMISSION#EE8805 2 (SEAL) EXPIRES March 04,20`17 (SEAL) Type of Idea:' n prodwedots Type of Identification produced Moor) "•� BETH LEIGH SCHOTANUS Em '= MY COMMISSION#EE880532 4jfiar'p�-0 EXPIRES March 04,20W r)398-0163 FWV2N01QgSWyJW-com s 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 LAIN C014STRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 6/30/2014 EXPIRATION DATE: 6/29/201.6 PERSON: MCCALLUM BRYAN P FEIN: 412202469 BUSINESS NAME AND ADDRESS: WATERMARK CONSTRUCTION LLC 3045 NE 15TH TERRACE OAKLAND PARK FL 33334 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING LICENSED POOL_ CONTRACTOR CONTRACTOR Pursuant to Chapter 440.05 14,F.S.,an officer of a co oration who elects exemption from this chapter b 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 alter 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 shaft 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 3 , t t' WATER04 OP ID:PR A mF DACE(M Yl CERTIFICATE OF LIABILITY INSURANCE 12/15/20161201 4 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), REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,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 NAMEACT Lynn Dowling,AINS,AAI,AIAM Gulfstream Insurance Group Inc PHONE 954-561-2220 n No:954-566-0673 P.O.Box 8908 AIC No Erd Fort Lauderdale,FL 33310-8908 ADDRESS:lynn@gulfstreaminsurance.net David ArchNAIL 0 INSURERS AFFORDING COVERAGE 71INuReRA:Scottsdale Insurance Company 41297 INSURED Watermark Construction,LLC URERB: 4460 North Federal Highway uRERc: Fort Lauderdale,FL 33308URER D: URER E: URER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTROU'W POLI E POLICY LIMITS TYPE OF INSURANCE POLICY NUMBER (MM(DDIYYYYJMM1DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FRI OCCUR CPS2052887 08/07/2014 08/07/2015 PREMISES Ea occurrence $ 100,000 X Pop-Up Coverage $50,000/$100,000 MED EXP(Any one person) $ 5,000 X Pestic)de/Herb $1,000,0001$1,000,000 PERSONAL&ADV INJURY $ 1,000,000 GEHL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRODUCTS-COMP/OP AGG $ 1,000,000 X JECT ❑LOC $ OTHER: AUTOMOBILE LIABILITY a aen COBINED SINGLE LIMIT $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOSED PROPERTY D GE $ Par acddent HIREDAUTOS AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIDCECUTIVE YIN NIA E.L.EACH ACCIDENT $ OFFICER(MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYE $ Kra describe under DESG�RIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Building License #CBC1257721 Contractor License #CPC1457231 Pavers, pool builder, pool remodeler CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Miami Shwas Villa e PPPOVED BY ATE UITY SaEWr s OF 2 ZONING DEP OP 4z. BLDG DEPT t DEC IS SUBJECT rO CCki L IMV NCE MM ALL;FERAL STATE ANtS CCUN L2S MID REGULATIONS ' III NOT SUBDIVIDED o , (-N FOUND AIL c 6 .iD0(R) fit. z{�} 115.24 P.R.M. � 6.20 41 ' � .�v V �•y._ _ g � dbN,C. DECK--. - 6.57 ,5 5.55 i 3 C.B.S WALL M=CI o• $ 5.50 34.0 : 0 s 1.20- POOL G.O N St07 4 N, Y BRICK •CONC 10,0' i SLAB a` .S,LAQ' :• ' . '1 �r -- POOL :m40.00' 5.87 �• 6 i +o 02, EQUIP. :/�°'- A/C 7. r' 5 4' PLASTIC F. 6.58 /PL f}7;'� K E.45 P 3 6.45 LEV 7`7' �6 37 �L EtEY.q < 23.20'. lbs to## _6.00 1 20.50' } 1 3 o w2• 'r4:8 0`° V3`�'`.' nett v1 6. 36 ao22 _ lx¢ C i 6 .. O : o I-., �. o v Y k a o �o �c� hS J C3 M v, m n 6. 8I..ELEV. n tV N 6 °� 18 60 6.19 % � I p'S I/ 0 8,85'�FL.ELE� $d2 Fes&i10 i 0 ao 0 I J 25.20 F.FL.E 0 7.2 1CL� 67.Od' 24.15' I 17.0' 5 12.0' S'C• I ' 6 6� 0.45' FD.. 6.36 j g { iCL WALL o ao N \41 6.26 N o Z6o ' NAIL ct , 22.00' cl O } ria W 1p 1.00' 5.88 ASPH. DRIVEWAY FD.1/2" 23.5' 1&0' m I.P. _ _ _ P.C. 1 t 4.� 5.20 FD. E'� ��/ 1 ta.5'SIDEWALK DRILL HOLE U.P.O.--T--J PRM. 14 ANCHOR 2' CURB/GUTTER i AH �iI o 24.0' PARKWAY PAV. PAV I 19.0'ASPH.PAV. 5.111 NE �SI�,5.36 _ 3Tf?EEf 6.25 _ TAL R/W NOTES w� OA Ct B S WALL ENC. UP T �•� ^TO �S VR 3.7 INTO A 5'U.E. .dt 41, �0.855IINTO A 5 U.E.UP TQ ©AN IRONGATE ENC. �L INTO A 5'U.E. Itum -" , I-L/I THOMAS J. KELLY, INC. L.S 0 6486 SURVEYORS-MAPPERS-LAND PLANNERS 6125 SW 120 STREET PINECREST, FLORIDA 33156 (786) 242-7692 DADE (954.) 779-3283 6RWD (786) 242-6494 DADE FAX (0-54)779-3260 8RWD FAX DATE :FIEWID WORK SCALE SURVEY NO. 04/ 2014 1"�30' 14-0381