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PL-15-2490 i M Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-244551 Permit Number: PL-9-15-2490 Scheduled Inspection Date: December 16,2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: FARACH, RUBEN M Work Classification: Pool - Private Job Address:114 NE 109 Street Miami Shores, FL 33161-7042 Phone Number (305)281-7790 Parcel Number 1121360090150 Project: <NONE> Contractor: SUNSET POOL AND SPA Phone: (305)804-1068 Building Department Comments POOL&SPA PIPING Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Eo/. Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 15,2015 For Inspections please call: (305)762-4949 Page 19 of 51 PermNib. PL-9-15.2490 Miami Shores VillagePermit Type:Plumbing-Residential 10050 N.E.2nd Avenue NE e'r � n Work Classificatiart.Pool-Private Miami Shores,FL 33138-0000 P Permit Status.APPROVED Phone: (305)795-2204 issue Date.- 10/2612015 Expiration: 04/23/201 Project Address Parcel Number Applicant 114 NE 109 Street 1121360090150 RUBEN M FARACH Miami Shores, FL 33161-7042 Block: Lot: Owner Information Address Phone Cell RUBEN M FARACH 114 NE 109 Street (305)281-7790 w MIAMI SHORES FL 33161- ._.._.__ 114 NE 109 Street MIAMI SHORES FL 33161- Contractor(s) Phone Cell Phone __._ ... :..600.00 m SUNSET POOL AND SPA (305)804-1068 Valuation: $ i Total Sq Feet 0 Type of Work:POOL&SPA PIPING Available Inspections: Type of Piping: Inspection Type: Additional Info: Main Drain Bond Return: Final Classification:Residential Scanning: 1 Rough Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PL-9-15-57262 DBPR Fee $4.50 10/26/2015 Cash $263.60 $50.00 DCA Fee $4.50 Education Surcharge $0.20 09/30/2015 Cash $50.00 $0.00 Permit Fee $300.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $313.60 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 either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WIND S,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing inform tion is curate n at all ork will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above n med ntractor t o the w rk stated. October 26, 2015 Authorized Signature:Owner / Applicant / o t ctor / Agent Date Building Department Copy October 26,2015 1 Miami Shores Village � SEP � � 2U1U Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 T4 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20IS BUILDING Master Permit No. U PERMIT APPLICATION Sub Permit No.PU 5r'2_4 c�0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP pp CONTRACTOR DRAWINGS JOB ADDRESS: L I ® �n \9L �' City: Miami Shores County: Miami Dade Zip: 331.6 Folio/Parcel#: 11 _ (o --, ®f)q—0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: X, BFE: FFE: Z OWNER:Name(Fee Simple Titleholder): N)t—tnr-CG GC\ Phone#:� 9 ( --725o Address:�1� � , u� pp City:��,\�.A'w 1 �� r s StateZip: _2133161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: G u_s S?��®el a,,nASQSPhone#: Address: cr�r-- City: State: Zip: ��L Qualifier Name: Lj n CQ e, Phone#: �;65® (4:JD6& State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ !�®� Square/Linear Footage of Work: IL Type of Work: ❑ Addition ❑ Alteration ET-New ❑—Repair/Replace ❑ Demolition V Description of Work: Cn VA- Specif color of color thru Submittal Fee$ ��� x rrrfi�##L.V �t' CCF$, 'CO/CC$ Scanning Fee$ Radon Fee$ DBPNouty " Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 0'- (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;porxnencement must be posted at the ' b site for the first inspection which occurs seven (7) days after the building permit is iss ed. 1 the absence f such posted n rce, the inspection will not be approved and a reinspection fee will be charged. -- Signatur Signature a' NT CONTRACTOR The foregoing instrument was acknowledged before me this The fore g instrument was acknowledg before me this day of 20 , by day of Je4-k1 20 by w<6ispersonally kno to ��rf �,�,UP -.�P 7 ,who is��rs=ono 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: Sign: Sign: Aa�44� Print: �' Bea �A/� Print: -1.4--r 0a ✓�Ar� oiiraija, Seal: Seal: M BULNES ? `�- Notary Public-State of Florida •'"v"`'••. M BULNES • :•-My Comm. Expires Jun 23,2017 Notary Public-State of Florida +. �,�:� Commission FF 03025? BaThr ' My Comm.Expires Jun 23,20�x17 �'' � �•••, (PagOnal w,- Be MW•` Bonded Through National Assn, APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) CERTIFICATE OF LIABILITY INSURANCE DATE[MNilODlYYYY) •�� osiz2/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOCS NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICA E OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cartifiw%I older is an A1313MONAL INSURED,the pollcy(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the polity,certain policles may require an endorsement- A statement on this certiOCate does not Confer rights to the certificate holder in Ilou of sueendorsament(s). PRODUCER CANE: Jessica Cando Tammy insurance agency PHONE , (305)485-3999 Arc N (305)485-3944 9821 S.W.40th Street AOORIE tammyiinsurance@yahoo.com Mislml,FL 33155 INSURESS1 AFFORDING COVERAGE NAIc it Phone (305)485-3999 Fax (305 85-3944 INSURERAr Granada Insurance Company INSURED INSURER 13: Sunset Pool And Spas Inc, INSURER C: _ 5355$W 133 Ct INSURER 0: Miami,FL 33175 (305)804-1068 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT TH POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAND NG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE OR MAY PERTAIN,THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO S OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSTYPE OF INSURAN:E ADDL UBR POLICY NUMBER WD OFF OQ� LIMI I9 WNERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 © COMMERCUIL GENERAL I IABIL{TY RMAGE TO-RENTED EM SES ErrentB $ 140,000.00 A .❑ ❑ CLAIMS-MADE © OCCUR 0186FL00461743-1 09/23/2015 09/23/2016 MED EXP one person $ 5,000.00 ❑ PERSONAL&ADV INJURY S 1,000,000.00 ❑ GENERAL AGGREGATE S 2,000 000.00 GEML AGGREGATE LIMIT APPIES PER:PRODUCTS-COMP/OP Ace S 2,000,000.00 ❑ POLICY ❑ PRO- LOC Deductible BIIPD Per Clai S 500,00 AUTOMOBILE LIABILITY E8M91N®DISINGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED ❑ I,HrEDULED AUTOS BODILY INJURY(Per eddent $ �y ❑ HIRED AUTOS ❑ N 0 ED F eOr psoEcjtl AMAO15 $ ❑ UMBRELLA LIAR ❑10CCUR EACH OCCURRENCE $ E] EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ El DED ❑ RETENTION' $ WORKERS C011O2NSATION WC STATUS [:]OTH- AND EMPLOYERS LIABILITY Y/N • U T -� ANY PROPRIETOR/PARTN6 - CUT" E.LPACHACCIDENT $ OFFICE-WMEMBER D(CLUDE 7 ❑N I A (Mandatory in NHI 11 yea dQsolbe under E.L.DISEASE-EA EMPLOYE S DE66RIPTION OF OPERATIO 5 below E.L.DISEASE.POLICY LIMIT $ i DESCRIPTION OF OPERATIONS/L 3CATIONS/VENICLES(Attach ACORD 10i,Addihanal Remarks Schedule,If more space le raguimd) Pool Contractor License#:CPC 044089 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores illag9 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ye ACCORDANCE WITH THE POLICY PROVISIONS- Miami Shores,FL 331$8 AUTHORIZED REAR NTATIVE l Far.305.756- 972 Jessica Cancio Vol ® 98 2010 ACORD CORPORATION. All rights reserve ACORD 25(2010105)OF a ACORD name and logo are registered marks of ACOF