BPP-14-2663 . '2 Miami Shores Village r=—
` Building Department L M '
10050 N.E.2nd Avenue,Miami Shores,Florida 33138a .
\ Tel:(305)795.2204 Fax:(305)756. 72
��� INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20(0
BUILDING Permit No. —
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: 164 NE 105 STREET
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-2136-013-0660
Is the Building Historically Designated:Yes NO X Flood Zone:
OWNER-Name(Fee Simple Titleholder):GLEN FORD AND CATHERINE HABERMANN phone#:305-505-7104
Address: 164 NE 105 STREET
City: MIAMI SHORES State: FL Zip: 33138
Tenant/I.essee Name: NA one#:NA
Email: NA
< "\\�
E1 Phone4 -3377CONTRACTOR:CompanyName: STAR- P
Address: 10875 NW 52 STREET, E 8
City: SUNRISE State. Ftp% Tap: 33351
Qualifier Name: CV0,0A D,16-% Phone#: 954-747-3377
State Certification or Registration#: CPC ky—j i3 Certificate of Competency#:
Contact Phone#: 954-747-3377 Email Address. STARLITEPOOLBLDRS@HOTMAIL.COM
DESIGNER:Architect/Engineer: DAVID FAERMAN Phone#: 561-445-1787
Value of Work for this Permit:$26275.00 Square/Linear Footage of Work: - (4 1 G
Type of Work: OAddition DAlteration Wew ORepair/Replace ODemolition
Description of Work: CONSTRUCT A NEW SWIMMING POOL
Color thru tile:
Submittal Fee$ T=Q • Permit Fee$ CCF$ CO/CC$ ��
Scanning Fee$ Radon Fee$ (92— DBPR$ Bond VSJ3 e (1)
Notary$ it Tmining/Education Fee$-5-4 6 Technology Fee$ 21 -Go
Double Fee$ Structural Review$ QD
n
TOTAL FEE NOW DUE$ vl �
Bonding 2ompany's Name(if applicable) NA
Bonding Company's Address NA
City NA State NA Zip NA
Mortgage Lender's Name(if applicable) NA
Mortgage Lender's Address NA
City NA State NA Zip NA
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT. MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approv and a reinf' tion fee will be charged.
Signature `d Signature_
caner
,gent Contractor
The fore oing instrument was ackno;04iged before me this The foregoi instrument was acknowledged before me thisr.-
day of kkWy ,20 T.by � day of J _ 20 A,by
who is personally known to me or who has produced Ft--'' who is rsonally known to meter who has produced
F:_-. As identification and who did take an oath. As identification and who did take an oath.
NOTARY I PUBLIC- NOTU11-i
IC:
Sign: ':�4' l C!GC-�� Si t✓` / L�
Sign:
Print: Print• ^
M Co M Co e5 "L
Y DALE A MASKER Y Commis
99426 DALE A.A4'.SKER
EE 0 _,: uu, = _ _�..�:7�siioi�EE 09942&
:.✓ z r�cpir�s.J�ljne6,2095 r: `.: xpire;.isne 205
' iAsi»Ish�s4+� � $�A:evY�s ��+L� a�F*�k��A�esz8=saEs+xgsk�a� -•' � _ � �
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/122012)(Revised 07/10/07)(Revised 06/102009)(Revised 3/15/09)
954PSTATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487
-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
BIXLER, MICHAEL D
STAR-LITE POOLS
733 SE 9TH AVE
DEERFIELD BEACH FL 33441
Congratulations! 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
STATE STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND
and they keep Florida's economy strong. vim PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to CPC1458513 ISSUED: 06/29/2014
serve you better. For information about our services,please log onto
www.myfloridalicense.com. There you can find more information CERT COMMERICAL POOL1SPA CONTR
about our divisions and the regulations that impact you,subscribe BIXLER,MICHAEL D
to department newsletters and learn more about the Department's STAR-LITE POOLS
initiatives.
Our mission at the Department is:License Efficiently,Regulate Fairly.
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS.
and congratulations on your new license! Eve date:AUG 31,2016 L14Q8290001660
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION = -
CONSTRUCTION INDUSTRY LICENSING BOARD
CPC1458513
The COMMERCIAL POOL/SPA CONTRACTOR f
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
4A-:
BIXLER, MICHAEL D kv.
STAR-LITE POOLS
10875 NW 52ND ST SUITE 8
SUNRISE FL 33351
.�........-.. ..... .... ..� ..................---
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000
VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,201S
DBA:STARPOOLS Receipt#:pOOL�NAR
R LITEINE CONTRACTOR (CERT
Business Name: Business Type:COMMERCIAL POOL/SPA)
Owner Name:MICHAEL D BIXLER Business Opened:lo/03/1994
Business Location:10875 NW 52 ST 8 State/COuntylCertlR@g:CPC056418
SUNRISE Exemption Code:
Business Phone:954-747-3377
Rooms seats Employees Machines Professionals
3
For Vending Business Only
Number of Machines: Vending Type:
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid
27.00 3.00 0.00 0.00 0.00 0.00 29.70
I
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:
MICHAEL D BIXLER Receipt #OlA-13-00005526
10875 NW 52 STREET #8 Paid 07/21/2014 29.70
SUNRISE, FL 33351
2014 - 2015
STARL-1 OP ID:CH
CERTIFICATE OF LIABILITY INSURANCE °A1y��''
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 policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the term 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 s).
PRODUCER CNA0 A,CT David R.Grifllths
Insurance By Ken Brown,Inc. PHONE 321Ax
PO Box 948117 N -387- 70 :321-397-3888
Maitland,FL 327948117
David R Griffiths _--
INSURER(S)AFFORDING COVERAGE NAIL§
KWRERA:Amerlsure Mutual Ins.Co 23396
INSURED Star-Lite Pools wwRERa:Amerisure Ins Company 19488
Star4 ite Pool Builders Inc. wSuRERc:B' efleld Cas Ins Co. 10335
10875 N.W.52nd Street Unit#8
Sunrise,FL 33351 INSURER D:
INSURER E:
INSURER 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.
IN
TYPE OF INSRIRANCE POLICY NUMBER EFF LINM
B X com IFRCUILGENERALuABILITY EACH OCCURRENCE $ 1,000,00
CLAIMS-MADE a occuR GL20789230301 09/13!2014 09113!2015 PREMISES a occurrence
MED EXP(Ain'ors person) S 5,
PERSONAL&ADV INJURY $ 1,000,000
GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
X POLICY❑JEC_TT F LOC PRODUCTS-COMPIOP AGG $ 2,000,00
OTHER $
AUTOMOBILE UAHILRYOM(EaBII.ED?INGLE LIMIT $ 1,0iI0,
B X ANY AUTO [A2CU9870601 09113/2014 09/13!2015 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY eracdderd
AUTOS AUTOS ) $
X
HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (per $
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 3,000,00
A ExcFss Liaa CLAIMS-MADE CU20032831302 OW13/2014 0911312015 AGGREGATE $ 3,OW,WO
DED I X I RETENTION$ 0 --- - $
WORKERSCOMPENSATI°N X I ER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
C ANY PROPRIETORIPARTNERlEXECUTIVE 19601875 06!2612014 08/26!2015 E.L.EACH ACCIDENT $ 100,
OFRCERIMEMBER EXCLUDED? ElNIA
(� r1r in NM
EL DISEASE-EA EMPLO S 100'wo
H es,desafibe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 500,
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 10%Addidunal Renwft Schedule,may be aftwived H mamspace is required)
License 9: CPC1458513
CERTIFICATE HOLDER CANCELLATION
MIAMISH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shares Villa Building
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ng ACCORDANCE WITH THE POLICY PROVISIONS.
Department
10050 N.E.2nd Avenue AUTHORQEDREPRESEWATIVE
Miami Shores,FL 33138
moo.► d q. %4
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD