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BPP-15-1880 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239941 Permit Number: BPP-7-15-1880 Scheduled Inspection Date: October 14, 2015 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: ENGEL,JERRY AND SARAH Work Classification: Repair Job Address:351 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122310130290 Project: <NONE> Contractor: ALL FLORIDA POOLS AND SPA CENTER Phone: 305-893-4036 Building Department Comments RESURFACE EXISTING SWIMMING POOL, NEW Infractio Passed Comments WATERLINE TILE INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 13,2015 For Inspections please call: (305)762-4949 Page 8 of 69 t Miami Shores Village k, Y ) �� 10050 N.E.2nd Avenue NE .... �� 008 epair, Miami Shores,FL 33138-0000 � Phone: (305)795-2204 i Expiration: 02/21/2016 Project Address Parcel Number Applicant 351 N E 105 Street 1122310130290 JERRY AND SARAH ENGEL LMia.mi Shores, FL Block: Lot: Owner Information Address Phone Cell JERRY AND SARAH ENGEL 351 NE 105 Street MIAMI SHORES FL 33138- 351 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 5,100.00 ~ ALL FLORIDA POOLS AND SPA CENI 305-893-4036 _....... .. Total Sq Feet: 0 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final Date Denied: Review Planning Type of Work:Swimming Pool Occupancy:Private Review Building Additional Info:RESURFACE EXISTING SWIMMING POO Bond Return: Review Building Classification:Residential Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# BPP-7-15-56484 DBPR Fee $2.30 DCA Fee $2.30 08/25/2015 Check#: 176.20 $ 176.20 $0.00 Education Surcharge $1.20 Permit Fee $153.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $176.20 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 ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS, ORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information ' cc rate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above name tr o do the work stated. August 25, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 25,2015 1 41 or Miami Shores Village JUL " �P` IV 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 FBC 20 LA BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. �BUILDING ELECTRIC F-1 ROOFING n REVISION ❑ EXTENSION [---]RENEWAL ❑PLUMBING ❑ MECHANICAL (PUBLIC WORKS F-1 CHANGE OF F-1 CANCELLATION 0 SHOP CONTRACTOR DRAW INGS !OB ADDRESS: ZIS1 J- Cit y: Miami Shores County: Miami Dade Zip: N!A Folio/Parcel#- 0b)_ Is the Building Historically Designated:Yes NO-- Occupancy Type:_Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �SkrQnmv.' —Phonell. Address: LAE City. &M% SAOfttl State: Tenant/Lessee Name: .--Pfione#: Email: CONTRACTOR:Company Name:. e TLOLII,Q* P60%.1 Phoneft: �'f Address: (bly— 61", city: w State: Pl_ zij`wl Qualifier Name: Phonell: State Certification or Registration it, A*-4-1$4 Certificate of Competency ff: DESIGNER:Arch itect/Engineer: tA& Phone#: Address-. --City. zip: Value of Work for this Permit: Square/LinearFootage of Work: Type of Work: 11 Addition 0 Alteration M New E10'Repair/Replace 0 Demolition Description of Work- 6'.jrj!jCe q3yAft %"&A4M_1M Pook-, U Specify color otgo ,#r thru tile: Submittal Fee$_1 —Permit Fee$ CCF$ CO/CC$_ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee Training/Education Fee$ Double Fee Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ iRieviwol)2/2412014) 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 low 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 occur even (7) days after the building permit is issued, In the absence of such posted notice, the inspection will not be approved and einspection fee will be charged. a A Signature_ Signature_ or AGENT CONTRACTOR The foregoing instr 7 nt w s acknowledged before me this The foregoing instrument was acknowledged beforeme this day of IA�l 20 IS by day of MAN 20 IS by Ter* 1CtPNKJ- who i ersonally knav 10 DW,D who" personally known me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: "L,C* oo"EN ,I*� Sign, PU Sign, 01 sto EE Pust 431 Print: 0 �C-S'.0—mm'N Print;,, 0 a�Ngo opo Bonded Seat- eat: AIre Of tAPPROVED By v'P*lans Examiner Zoning Structural Review Clerk (RevisedO2124/2014) 2015-07-27 10:27 All Florida POOL 3058954557 >> Transferring Fax P 1/1 ALLFL-2 OP ID;GJ TE(mWODreMI CERTIFICATE OF LIABILITY INSURANCE on06/30/2015 06130!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 tho cortlficAtO hOldor is an ADDITIONAL INSURED,trio poilcy(los)must bo ondomad. If SUBROGATION IS WAIVED,sub)oct to tho torms and conditions of tho policy,cortain pollclos may roqulro an ondo►somont, A statomont on this eortifleato doos not confor rights to tho cortlflcato holdor In liou of such ondorsomont s. Insuurran o B Kon Brown,Inc. NAME" David R.Griffiths _ PO BOX 94817 vkoNe 321-397-3670 �^ ++ac�N,>e�al �[ag�:321.397.3888 Maitland,FL 32794.8117 E-MAIL — -- David R.Griffiths ADDRESS: INSURER(S)APPORDINO COVERAOC NAIC a ,INSURER A:Amorlsuro Ins Company 19486 INSURED All Florida Pool&Spa Cantor wsuRERs:Amerisuro Mutual Ins.Co 23396 All Florida Distributors,Inc. 11720 Biscayno Boulevard INSUReRC: Miami,FL 33181.3110 INSURER D: INSURER C: INSURER P: w 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 WAVE BEEN REDUCED BY PAID CLAIMS, i- TYPE OP INSURANCE D D POLICY NUMPIM �ro YWl IMMIODNYYYI LIMITS A X COMMCRCIALOENERALLIAOLUTY EACH OCCURRENCE S 11000100 CLAIMS MADE 7xOCCUR CPP2030800080015 07/1512015 07115/2018 UAMAGL TO TEU PRE MISS Ef,n Ioccyr(encn S 100,00 _MCD EXP(Any One porson) S 6.00 PCRSONAL&ADV INJURY S W 1,000,00 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGR40ATC _ y 2,000,00 POLICY L=J JGPRO- ❑LOC PRODUCTS•COMP/OPAGG S 2,000,00 OTHER: S AUTOMOBILE LWBILITY ,a aWdw BINED SINGLIC-U MIT S 1,000,00 A X ANy AUTO CA20562960901 07115!2015 07/1512016 0001 LY INJURY(Por porton) s ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Por m1dont) S X HIREDAUTCS X AUTOCDS r netl Wwll $ X UMBRELLA Luo I X OCCUR EACH OCCURRENCE S 2,000,00 B excess LIAD CLAIMS.MADG CU20682970702 07115/2015 07/15/2016 AGGREGATE S 2,000,00 OGD RCTENWIONS S--_— WORKERS COMPENSATION AND EMPLOYERS*LIABILITY Y/N X >'AT TETX A ANY PROPRIETORIPARTNER/O(ECUTIVE WC205116707 12/31/2014 12/31/2015@.L.EACH ACCIDENT s 500 OFFICERIMEMSER EXCLUDED? N 1 A ,00 (Mandatory In NH) N ppae deatUlbe Undar E.L.DISEASE.EA EMPLOYE S 600.00 DFOWIPTION OF OPERATIONS belDw C.L.DISEASE-POLICY LIMIT S 500,00 DESCROMON OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,AndlOurml Remulu Schodulo,may be attechod If mon epaca le mqulrad) Swimming pools-installation,sorvice,or ropair-bolow,ground. CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Villago of Miami Shoros THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building&Zoning Dopt. ACCORDANCE WITH THE POLICY PROVISIONS. Angio 10060 NE 2nd Avonuo AUTHORIZED REPRESENYATIVE Miami Shoros,FL 33138 �a d e;Z. a.-A 01988-20144 ACORD CORPORATION. All rights rosorvod, ACORD 25(2014/01) Tho ACORD nano and logo aro rogistorod marks of ACORD 2015-08-25 14:16 All Florida Pool 3058954557 >> Transferring Fax P 1/1 �� • ALLFL-2 OP ID:GJ �..� CERTIFICATE OF LIABILITY INSURANCE OATL'(MMjDO;yYYY) THIS CERTIFI /2015 CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDCER,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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Oortificato holder Is an ADDITIONAL INSURED,the policy(los)must b0 Ondorsod. If SUBROGATION IS WAIVED,subject t0 the terms and conditions of the Polley,cortaln POIIClos may require an Dndorsomont. A statement on this COrtificato does not confer rights to the Certificate holder in lieu of such endorsomont s. PRODUCER CONTACT David R.Griffiths Insurance By Kon Brown,Inc. AMI:;_. PO Box 9481.11 PNONB Maitland,FL 92794.8117 cAraca o.a■II,321397.3870 _ n .Ool,321397-3888 David R.Griffiths A0_ekZ'88: -- INSURER(S)AFPORDING COVERAGE MAIC A INSURED Ali Florida Pool&Spa Center _ �NsueeRA;Amorlsure Ins Company • 19488 All Florida Distributors,Inc. WSURdRD;Amorlsuro Mutual Ins.Co 123396 11720191saayne Boulevard INSURP.RC7 Miami,FI.33181-3110 INSURERD; ^' INSURER E: INSURER F: COVERAGES CERTIFICATES NUMBER; REVISION NUM13Eit: 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. INTA TYPE OF INSURANCE D O VOII Y 10 POLICY EXP "— POLICY NUMBER YYY MMI O YYY LIMITB A X COMMERCIAL GENERAL LIABILITY tEACHCCURRENCE s 1.000,0001 CLAIM&MADE 0 OCCUR CPP2030900090015 07/15/2015 07/15/2016 �REIcal S 700,00 P e„o S 5,00 ALAADV INJURY $ 1,000,00 GCNL AGGREGATE LIMITAPPLIES PER L AGGR6GATF S 2,000,00 POLICY j LOC TS.(,OMP�OPAf,,�O 2,000,00 AUTOMOBILE LUwgrTY i A X �,AW0 _([-&000 U s 1,000,00 CA20562960901 07/15/2015 07/15/2016 00DC.Y INJURY(Par pony,) 3 AUTOS �OSULED X HIRED AUTOS X NONOWNCO BODILYIWURY(Paaccldont) S AUTOS K RPor a� S S X unlDReILALIAb X OCCUR 1 9HQCCURRENCE S 2,000,0 00 B EXCESSI.IAa cuIMS.MADG CU20562970702 07/1512015 07/15/2010 AGGREGATE 5 2.000,00 0£0 RL•TCNTION h'ORKCR6 COMPENSATION S AND EMFLOYCRS'LIABILITY x X t _ A OOFFICREwMMEMRREEAXCLUDED? UTtvE Y'N N/A WC205115707 12/31/2014 12/31/2015 E,L EACH ACCIDENT y 500,00 IM�daewr In N!q If y�a.,doxdba txldor EL DISEASE.U EMPLOYE• S 500,00 OCSComcr N F FRAT E.L.DISEASE•POL.Cv LIMIT S 500,00 09MAIPTION OP OPdRATIONs/LOCATIONS I VeHICLe9(ACORD 101,AddlOonal Remarks Schedule,maybe mumbod H mora&Paco in roqulmd) Swimming pools•Installation,service,or ropair-below ground, CERTIFICATE HOLDER CANCELLATION 7AnglMIAMISH SNOULO ANY OF TMC ABOVC DESCRIBED POLICIES BE CANCELLED BEFORE o i Shores THE EXPIRATION OATI: THEREOF!, NOTICE WILL BE DELIVERED IN ng Dept ACCORDANCE WITH TWE POLICY PROVISIONS. venue AUTHORIZ80 RepRgeeNTATIVE L 33138 d ACORD 25 2014!01 m 1988-2014 ACORD CORPORATION. All rights reserved. ( ) The ACORD name and logo aro registored marks of ACORD ` FLORIDWr - - - - - - - - - - - - - - - - - - - nRT T FHFAPPLICATION P ITItE�IA6E t�'OOSAL SYrtePer+rRT I SITEPLAN- - - --- - - - - - �= �A - - - - - �`'�`� _1T �• S ale T lock repr eats 10 feet and 1 inch=40 feet. -_ —_-- /L C� 10 } — i s , .. } ! to p} It coy, 7 cn c� a2�ax �. 1Ln, � k y f. t { W►•Awt E `'-., j !•( i17 Gam.. `.•• •••'' y ..t �I j Notes ^ye ....�L „_ r L,, - ;,._,. C:� ;4 G.? >t:_I:..% Iii Ls”t '•i �c-• yyll_�°._.... • 3 .%j .. . .............. Site P;' L hbmitted Title Plan ,l � ; � d .._.._... Not Appr ved Date_,_—, County Health Department ALL CHANGES WIU T SE APPROVED THE COUNTY HEALTH DEPARTMENT DH, _ 4;f'.,E 15 t .rn 4Ci s, ,.,,h .;, rave 2 `4 (StocP. 44-002-401 �}