Loading...
BPP-15-171 Inspection Worksheet P j� Miami Shores Village 9 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-256746 Permit Number: BPP-1-15-171 Scheduled Inspection Date:April 15,2016 Permit Type: Pools/Whirlpools/Hot Tubs Inspector. Naranjo, Ismael Inspection Type: Final Owner: GRIMALDI,KARINA Work Classification: New Job Address:1125 NE 91 Terrace Miami Shores, FL Phone Number (786)285-5527 Parcel Number 1132050010140 Project: <NONE> Contractor. DOLPHIN POOLS&SPAS INC Phone: (954)927-6537 Building Department Comments NEW SWIMMING POOL AND PAVER DECK. Infractlo Passed Comments INSPECTOR COMMENTS False nspector Comments Passed CREATED AS REINSPECTION FOR INSP-254353. CREATED AS E�r REINSPECTION FOR INSP-254139. CREATED AS REINSPECTION FOR INSP-227128. Need access to home to verify alarms Gates must be self closing and locking with lock min 54"from grade Failed ❑ 03-09-2016 Missing as built survey -Provide final as-built certificate. Correction ❑ -finish landscaping Needed Equipment pad of approved plans. 71 GAP Re-Inspection Fee C No Additional Inspections can be scheduled until re-inspection fee is paid April 14,2016 For Inspections please call: (305)762-4949 Page 20 of 31 c 1 Y_ Inspection Worksheet U All, Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FLGO,. r Y Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253451 Permit Number: BPP-1-15-171 Inspection Date: February 23,2016 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Dacquisto, David Inspection Type: Survey Final Owner: GRIMALDI, KARINA Work Classification: New Job Address:1125 NE 91 Terrace Miami Shores, FL Phone Number (786)285-5527 Parcel Number 1132050010140 Project: <NONE> Contractor: DOLPHIN POOLS$SPAS INC Phone: (964)927-6537 Building Department Comments NEW SWIMMING POOL AND PAVER DECK. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed , Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid For Inspections please call: (305)762-4848 February 23,2016 Page 1 of 1 "• intm" 1 OIL 6 a ` _ - + _ w �.5- 4- 5- '7 8 9� io `Il �/� l4 wopy #ff `d `NJ G w"Co - J V� �lb� soca -ale �, ..- o,N• ii�y Genes 0000 0000 f5�2O �'► DOL • p,1Q�••••• •••••• •••••• •s••••I •t• Q S 020' •Ct ... • •• This :property 0drscAbotfil as: GTc. ... . : •..' 0000:. Loteele•and g'7,0 B1o0d107, } O . ID ... . . . . . 000000 Q 00 0 •0 • 0 according t® t►he Pl% 00 0000. .. 0. 00 0 ;• NOTE: PAGE 1 OF 2 IS NOT COMPLETE vi o • • there* as regordeA.j v H 0, �' • v 0 0 .0..0 0 .►• • WITHOUT PAGE 2 OF 2 WITH z v M . ...000 000000 Plat..$9Ak 9:.%4ge l�.l` •• CORRESPONDING SURVEY �z���-QTor y: �,�. of tyle Public. Record%.of m 0 . 00... 000000 miand oa�de �'©un+Ly, ;'iorida. 00 � • • 0000.. .000.s 0 . %a � COi?C. 00 '00 Line 9' � 19.Go oe n: 3S.So' hn jalq. q 017e -- a 1� F i �F16t�Yt:6tT�YTHATTt93 . •• N LL � tY SURVEY WAS MADE t�OER x/.40' ,, OFpRAC AHDMEETSSTANDARDS le" A, e .00�•p..- OF PRACTICE SET FORTH BY THE FLORmA 1 _TR BOARDOF AND x C3' b :� � 6J FL ADE TRRAA r //t cJ s ��1 h a�'Gi�vf/ !%* r TO s 4T2.�7,FtORICA CtN11 $ I-P..CA STATUTES.AND.THAT THES!(ETCH H ` < ISTRIl mlrwRRECTTOTFMECBEST OFMY . ,0,10 mr 'awi"`�oEawDea�H m C EREWL A 18,ZO x a rcRlG• m �G�C'GtJC3�� r�tt,�f !q� Iw Uj --Nr . w PROPERTY OF:GriJci , 112 .E. 91st, Terrace, ores; _Florida Q o m �\ l t6 !` o` o.o ' V m CO CO HOTVALMYMOUTTHEs�a►TURE A BOUNDARY SURVEY L A N N E'S md d A R C 1 A, 1 N C. s AHDTta:oRamAl.Ra�sea.oF ` CO C,• ``� ry �wkf slsr raRAem 1 hereby certify that the survey repre- u hereon meets the min'Hnum sented PROFESSIONAL SURVEYING AND MAPPING 1}� G techn' I standards set forth by the � LANNES&GARCIA INC Boar of Land Surveyors ursuant to _ L.S.#2098 4 472027,Fla. There are no chtneltts,ov FRANCISCO F.FAJARDO PSM#4767(QUALIFIER) . a rt on the 386 Alhambra Circle,Su#e#C,Coral Gables,Florida 33134 PH(305)666-7909 FAX(305)442-2530 F n ' la.naes2garamail.com i Y /� T G SCALE l DRAWN HY . Ems.-NO • Q Fla seg.L _ 9 P/ - 193-235, RB I1*IEU, (FIM y�gg , 9-15-00 Recert3. ied, Certified To, Name and Flood Information Revised. 2 13243 OZ-10-2016----��. ?(0—P(,0 �- ' c3-- 60382 LEGEND I.C.V. ffiib anoNCONTROLVALVE P.C.P.P�1`CoNT1iOL PONT W/M WATERMEM au-7m comwriamw I.P. IRON PIPE PLS PROFESSk*AL L OD SURVEYOR W.V. WATER VALVE AVE. AVENUE FPL FLORIDA POWER&LIGHT PSM PROFESSIONALSURVEYORANDAMPPER W.U.P.WOOOU7TLITYPOLE BLVD. BOULEVARD ` FLA FOUND IRON PIPE PL PROPERTYLINE 8M BENCHMARK FRR FOUND IRON ROD P.O.B.POINTOPREGAW&G CATV CABLE TELEVISION BOX FND. FOUND P.O.C.POINTOFCOA&AWCEMENT C.B. CATCH BASIN L ARCLENGrH P.R.C.POINTOFREV0MECURVATURE SYMOLS CBS CONCRETEBLOCKSTRUCARE W LEGAL P.&M.PY:RAMENTRF_FERENCEMONUMENT a xawxa. CHB CHORDBFARLNG L.P. LIGHTPOLE P.T. PowroFTANGENCY OVERHEADUTILITYUNES CH CHORD DISTANCE LB LICENSED BUSINESS R RADIUS ^'' WIRE FENCE I COR CORNER LS LAND SURVEYOR (R) RECORD ++++ WOOOFENCE CT COURT (M) MEASURED RE RW ELEVA770N —p—PR0P5RTYCORNER CCENTERUNE NAVD NORTHAb(ERICANVERWALDATUM RAW RIGHT-OF -WAY —o WATERFLOW CLEAR NGVD MA77ONAL GEODETIC VERTICAL DATUM$AM. SANITARY �9.B0 ,EVST1NG GRADEELEVATAW CONC.CONCRETE NO ID.NOTIDENnIFAKE S.LA SEFIRONPIPE Zwrw,PROPOSED GRADEELM rION C.O. CLEANOUT NO. NUMBER S.LR SETIRONROD WATER VALVE E.B. ELECTRICBOX NTS 'NOTTOSCALE Sr STREET SIGN ELEV. ELEVATION O.RB OFFLCIALRECORDSOOK TANGENT DRA/NAGIEMANHOL.E ENCR. ENCROACHMENT ONPL ONPROPERTYUNE TB.M TEMPORARYSENCHMARK b� SoANITARYMANHOLE' £RP. ELEVATIONR&F&wvCEPOINT O.UL OVERHEADUTLUTYUNm TEL TELEPHONE FIRE HYDRANT F.F. FINISHFLOOR P.C. POINTOFCURVATURE TYR TYPICALW LIGHT7NGF"TtW F.H. FIREHYDRANT P.C.C.POINTOFffOMPOL/NOgAWATURE U.E. UM1TYFASFMFJVT 17 RREDEPARMENT CTTON Li9.le�s ' • • SSSS SSSS• a) All Clearances and/or encroachments shown hereon are,of apparent nature. Fence ownership b". ual nibarIM Legal ownership of fences not determined. b) The issue of this survey is only for the exclusive and specific*use of those persons, parties or ipgjt**IDns shown*ai iq the :0000 certification. Any other intended use will require written approval from the certifying surveyor 0101 •••• c) Code restrictions and title search are not reflected on this survey. • 6 • • • • • • Sasso d) Underground utilities and encroachments, if any, not located. a**:* e) The flood information shown hereon does not imply that the referenced property will or will not be free from flooding or damage and does not create liability on the part of the firm,any officer or employee thereof,for any damage that results from reliance on said information. 0 The lands depicted hereon were surveyed per the legal description and no claims as to ownership or matters of title are made or Implied. g) This survey is not to be relied upon for construction. FLOOD ZONE: AE NOTE: PAGE 2 OE'2 IS NOT COMPLETE WITHOUT FW1Q0 INEQRMAII,ON: PACE 1 OF 2 WITH-CORRESPONDING SURVEY Community Number: 1.2.46.5.2 Panel NumberA(ap:', i2086CO3f}6' Suffix: > F.I.R.M.Index Date: 09-11-2009 Base Elevation: +8.00 NGVD Bearings,if any shown based on (reference) ' CERTIFIED TO: Karina Grimaldi A BOIAYDARYSURVEY Y CERTIFY THAT TMS BOUNDARY SURVEY WAS MADE UNDER MY SUPERVISION AND MEETS STANDARDS OF PRACTICE SET FORTH BY THE FLORIDA BOARD OF PROFESSIONALSURVEYORS AND MAPPERS IN CHAPTER W47.060 THROUGH W7.06$FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION 4M.027.FLORIDA STATUTES.NO.THAT THE SKETCH HEREON IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.SUBJECT TO NOTES AND NOTATIONS SHOWN HEREON. FLORIDA PROFESSX*M SURtV�EEYYOR AND MAPPER REGISTRATION NO,,-j Ki'ltac ( a �s'GLlJ�am PROPERTYOF: Grimaldi, Karina 11.25. N.E. 91st Terrace, Miami Shores, Florida 33138 NOTVALORIGINALRAIESIGNALOF A B12UNDARY. SURVEY AND THELICEN LICENSED LANNES AND GARCIA INC. MAPPER.uCENSED� �AND I hereby certify that the survey represented T hereon mets the minkmm technical. standards set forth by the Board or.Land L.B.#2098 Surveyors In chapter 61017-6 Florida Admin'-,Orstivs Code pursuant to Sectloa /� II��„. PROFESSIONAL SURVEYING AND MAPPING 4721127 Fla.Statutes. There are no encroach 1' '°'& ; LANNES&GARCIA, INC rants, overlaps, easements appearing on L.r FRANCISCO FBFAJ RA DO PSM#4767 F ) the Plat,other than as shown hereto _ 386 Alhambra Circle,Suite NC,Coral Gables,Florida 33134 PH(305)666-7809 FAX(305)442-2530 lannes2Gamatafornaii.com e FIELD DATE SCALE DRAWN 13 -DRAWING NO FL.PROF.SURVESO .Y. AND MAPPER NO.!X / —!S IN 213243 02-10-2016--RECERTIFIED, FIELD W 260382 FLOOD INFORMATION REVISED. y t .-/ - Miami Shores Village 10050 N.E.2nd Avenue NE 3 Miami Shores,FL 33138-0000 Phone: (305)795-22043 I � Expiration: 01/12/2016 3 Project Address Parcel Number Applicant 1125 NE 91 Terrace 1132050010140 Miami Shores, FL Block: Lot: KARINA GRIMALDI Owner information Address Phone Cell KARINA GRIMALDI 1125 NE 91 TERR (786)285-5527 MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone $ 32,000.00 Valuation: DOLPHIN POOLSV&SPAS INC (954)927-6537 (754)2447727 _ Total Sq Feet: 624 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fence Date Denied: Final Type of Work:Swimming Pool Occupancy: Pool Deck Additional Info:NEW SWIMMING POOL AND PAVER DEC Bond Retum: Wall Steel Classification:Residential Scanning:3 Review Mechanical Review Plumbing Review Plumbing Review Electrical Review Electrical Review Electrical Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural Bond Type-Contractors Bond $500.00 Review Structural CCF $19.20 Invoice# BPP-1-15-54252 Review Structural Change of Contractor Fee $75.00 01/26/2015 Credit Card $50.00 $2,184.00 Review Structural CO/CC Fee $50.00 07/16/2015 Credit Card $2,184.00 $0.00 Review Structural DBPR Fee $14.40 Bond M 2792 Review Planning DCA Fee $14.40 Review Planning Education Surcharge $6.40 Review Planning Permit Fee $960.00 Review Planning Plan Review Fee(Engineer) $40.00 Review Building Pian Review Fee(Engineer) $80.00 Review Building Plan Review Fee(Engineer) $80.00 Review Building Plan Review Fee(Engineer) $80.00 Review Building Pian Review Fee(Engineer) $80.00 Review Building Plan Review Fee(Engineer) $120.00 Plan Review Fee(Engineer) $80.00 Scanning Fee $9.00 Technology Fee $25.60 Total: $2,234.00 G July 16, 2016 Authorized Signature:Owner / Applicant Contractor / Agent Date Building Department Copy July 16,2015 2 A Miami Shores Village IEE Building Department ' iir`'-_ .N� ; VD 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 JUN 262015 Tel:(305)795-2204 Fax:(305)756-8972 iBY:---A2INSPECTION LINE PHONE NUMBER:(305)762-4949 . — FBC 2010 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑CANCELLATION ❑ SHOP rtt CONTRACTORA40fia�X DRAWINGS JOB ADDRESS: 'C-,k- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: ,d/• Load: Construction Type-f le g^.Flood Zone: BFE: FFE: OWNER:Name(Fee Simples Titleholder)-/.�®/ � fY�,�/� Phone#:-06 v' Y; W Address City: /v/oa wt State: t�L zip-3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:d,j�f S27.s Phone#: Address: City: �v o� cz-�;� ) State: Zip: �s _ Qualifier Name: tel/ �d /,� Phone#:-f2-Z:KaA-y!/7?r-� State Certification or Registration#: e�C 1416 9a-20 Certificate of Competency#: 4� DESIGNER:Architect/Engineer: �/"� �t �e�.an a//Jv�F Phone#: Address: D ;tg N aod,A city: f+ v�� State: Zip: Value of Work for this Permit:$ C717 0. a. uare/Linear Footage of Work: Type of Work: ❑ Addition� / ❑ Alteration P<w / ❑ Repair/Replace ❑ Demolition Description of Work: /1F�� S ty i �►�,,,.-�,�s ®.9L fi.w�/ o��.� Specify color of color thru tile: Submittal Fee$ Permit Fee$ !g 03.Co CCF$ CO/CC$,_ „ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ � Q-4-4�N GE (IF TOTAL FEE NOW DUE$ (Revised02/24/2014) l / 1 j ^ 1 Bonding Company's Name(if applicable) f , 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 approvedand reinspection fee will be charged. Signature Signatur OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I day of rLA—fe�— .20by day of J�-'��- 20 S ,by who is personally known to (7mIn 'Pt'6'C—"4;vho is personally known to A� rew aVspqr fZU�J/ZL as me or who has produced for—(-- ZXPW 4 V as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: N\\00%% NOTARY PUBLIC: ��`tiaTo•o. . 9���% �� 0 II riir�'i Sign: _ `r �, = Sign: • ���'• (/.�� � ;•fes O � ••• /i Print: �'� `�= C o Print: cu Seal: ,9 �� Seal: =o b �; XNk V " G tl'O APPROVED BY 7 /1-1—Plans Examiner Zoning Structural Review Clerk (Revlsedo2/24/2014) l (01z's I 15 -` Miami Shores Village 1 p�' Building Department 10050 N.E2nd Avenue Miami Shores, Florida 33138 Tel:(305)795.2204 Fax(305)756.8972 CHANGE OF CONTRACTOR/ ARCHITECT Permit N. V - 7/ Owner's Name(Fee Simple Title Holder): " ' ��d'" Phone#; Owner's Address: 1/ AS /Sd� 7va C4. City:9,cAAI' -' lh00- State ��:�r!'��. Zip Code. Job Address(Of where work is being done):&2 6 � 9l.S'!etel + C-C City: Miami Shores _ State:,_Florida Zip Code: Contractor's Company Name: Phone#; Address: City: State: Zip Code: Qualifier's Name: Lic. Number: Architect/Engineer of Record Name: Zt c/ Z),AkC5 Phone#:W172Z ?0497�/ Address: /S City: a. I.AvA44 t. State: /j Zip Code:33.3W ';` Describe worn" 3Y00. A�i' �' loor ..Surf F 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Buildin Official and the iami Shores harml o III involvement. Signa Signature �( Owner Agent Contract,or it The foregoing in rument�w�as a ,led d beef r me Th oregoing instrument was aknowfedged before me this��day of 20/�,by �" this day of, ,2016by Who s -ripma ,� nown o me or w o s uced erso - me who has pr T HEINRICH C. = Notary Public-State of Florida my E Catattisslat#Ff 231075 My Comm.Expires Sep 30,2018 My Comm.Expires May 17,2019 `.• Commission#FF 164339Notary James Biagi P.E. I Mr. Biagi give C arlos Morales P.E. the authority to reproduce plans or documents only for Grimaldi Residence at 1125 N.E. 91st Street Miami Shores Florida. Permit # BPP15-171 James Bi i , Sign The forgoing instrument was acknowledged before me this !� day of JU4-,Ir J2015 by who is personally known to me or produced as identification Notary Public 1 , �' WaKe Sign •. E.4 N ..lNaf 24,20,8 Seal ANNE M. G AN N O N P.O.Box 3353.West Pa&n Beach,FL 33402-3353 "LOCATED AT" COMMITtoRAL TAX COLLECTOR WWW pbcWx-aun Tet:(561)35.5-2264 saving Palm Beack county 601 HERITAGE DR STE 481 DR SeMngyou. JUPITER,FL 33458 TYPEOFIRIMBOW CER IWMTM B NOWT WDATE PAID AMT PAID I BOL i 23-M P001APA C OMRWM SLADC DAVID U15.S3921-1WAM4 $U.W 1 BC WNW Thi dmiInent Is vaW only when receipted W the Tax Qftc es Ottwe. STATE OF FLORIDA PALM BEACH COUNTY 2014/2015 LOCAL BUSINESS TAX RECEIPT DOLPHIN POOLS AND SPAS INC LBTR Number: 201578104 DOLPHIN POOLS AND SPAS INC EXPIRES: SEPTEMBER 30 2015 801 HERITAGE DR STE 481 JUPITER,FL 33458 This receipt grants the pfirasp of ening in or nllnrlloluldr�delrmanaging any bum Procession orocagndm W"Its Wackdon and MUST be consPkxmisty displayed at the place of hotness and In such a manner as to be open to the view of the pL&W— ACa® `' DA,E rn CERTIFICATE OF LIABILITY INSURANCE 1/21/2015 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: N the cerd iaate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. B SUBROGATION IS WAIVED,subject to the teens and conditions Of the pollcy,certain polio may require an endorsement A statement on this certiil(aIn does not confer rights to the cerft ate holier In lieu of such endorsement(s). PRODUCER CONTACT Fannie Baez Jackson Insurance Agency PHONE (305)824-3464 Fax .(305)822-8535 2075 West 76th St fbaea@jacksonagency.com AFFORDING COVERAGE MAIC S Hialeah PZ 33016 INSURERA4Capacltv Insurance Co. 32930 INSURED INSURERS: Dolphin Pools And Spas Inc. INSURERC: 3096 West Comm i ty Drive INSURER D: INSURER E: iter P% 33458 DaUIMF: COVERAGES CERTIFICATE NUMBER:2014-2015 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. LTR TYPE OF INSURANCE mm POLICY NUMBER POLY EFF POLICY Mvrfym LIMITS GENERA.LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY $ 100,000 A I CLAIMS-MADE OCCUR D2182014 2/16/2014 2/16/2015 MED EXP(Myone $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENAL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ Included ]I: POLX:Y PRO LOC1 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (FaamMerM ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per acmes $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (per acdderm $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB Cog MgpE AGGREGATE $ DED I I RETENTION $ WORKER$COMPENSATKXN WC ATU OTH AND EMPLOYERS LIABILITY Y/N ANYTORIPARTNIE❑ N/A E.L.EACH ACCIDENT $ OFREXCLUDED? l yesesy to NM E.L.DISEASE-EA EMPLOYE $ under DESCRB'TX?NOF OPERATIONS below, EL DISEASE-POLICY LIMIT $ DESCRIPI OF OPERATIONS I LOCAR N S I VEHICLES(Attach ACORD 101,Addifforad Remi Safitadu1%If more apace Is rsqumaM License #CPC 1458270- swimming pool builder. This certificate is solely for the use as " 8vidence of Insurance" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village bldg dept ACCORDANCE WITH THE POLICY PROVISIONS' 10050 ME 2nd ave. Miami Shores, PL 33138 AUTHOR¢M REPRESENTATIVE 8d Jackson/rAMMM c� -- ACORD 25(2010/05) ®1888-2010 ACORD CORPORATION. Ali rights reserved. IN8025 rmmvom m Tho A(,nRn nnni.and Innn ara reniafamd markka of ernan 'o-29-2014 JEW ATWATER STATE OF FLORIDA . �ARTpIlEN1` OF FINANCIAL SERVICES DIVISION IF VVOMWW COMPENSATION W OF a== TQ .119 BUM FOU RMM--WMW =IPENSAT0l LAW CONSTRUCTION INDUSTRY EXEMPTION This clfffies that the hdividual listed below has elected 10 be ega"t from Florida W*kW Compensetion law. EFFECTIVE DATA 0812212MS EXPIRATION DATE: 0812212MS PERSON: MACK DAVE SINEW NAME AND ADDRESS: pip 1pWLS & SPAS DC Sol "Emmen DRIVE 0011 FL 39M jwrrmt SCOPES OF BUSINESS OR TRAM I- SVU@Wn POOL 00W51WM0K-WT pIiTAifi ptrsas9t Bt !» 40 . dftw of a ttO elects atem,I a ho= ads cbww by of a cedfacdo Of dud" ashes 8f. �8s dw b F's d to be eao sag= My an r beefs W UdW dit d� Pass"to now4w0.e511�, AA tent Of 01"d= 10 heaaatept... -1 0* e� *0sop d Are b W uda 8ste/ as as MUM d ehaiaa to be e�tetr�t Psraamt m tD� ric" empt as d is be sump did! be ei 1M se raseaaat IL at=y UM after ab MW Ste scum or dro Issasae of so pma Sol"e 08 or adoomsp es are r d ttl+t setdea htr Is:sme d • 71� ° resata . c at my am far 1 11, date pum as to .tea dre d t� sasdaa QIRS7�iS7 1860) 413- OWC-262 CH rifir E OF EMM TO BE EXEMPT REV= 01-11 --------- --- -: .w..,.-.—..-.._...-------- ..-.--------------- - . STATE Of:FLOPJDA DEPARTMENT OF BUSINESS AND CPCI458'd70 t.a_ 08/05!L094 CERTC�M! �� BJACK,DAV�A � r� OOIpto Poa Nr �l IS CERTIFIED under the prorislons of`h.48sFS.- �on 6data:N1G81.1M8 I DOLPHIN POOLS & SPAS CPC1458270 AFFIDAVIT Date State of County of Before me this day personally appeare"A v`a0e" who being duly sworn, deposes and says; He will be the only contractor that 1 am the only contractor that will be working on job at 1125 91 Street Miami Shores, FL. Sworn to and subscribed before me this X/ day of 7Z7- ���r ,2015 by (A-Cbr Personally know Or Produced Identification Type of Identification Produced Print,Type or Stamp Name of Notary stag 420 UPAY4 svtdo 4 . S#t40►SSIWWOC)AW =*: L K " Miami Shores Village Bul 1i Deartmer . 10050 KE2nd Aventie, Miami shores, Fladda 36138 Tel: (305)795.E Fax: (305)756.8872 Notice to Owner —Workers' Compensation insurance Exemption n E n 25„ 1 Z"aax Florida Law requires Workers' Compensatiotm insurance covemge under Chapter 440 of.the Florida:SWutes-: :Fla> Stat: § "Us allows co porate officers in the construction industry to exempt*0ruselves hom this requirement for any orans ion. eet;prior to Wining a building permit. Pumuairt to the l?loribM-.oi of V9 orkrW Comgensatiot t l3trtpksyer Facts B:raC*htare: An employer in the construction industry vvho employs one or more part-time,- or WI-time, employees,including tlie owner,must obtain workers'compensation coverage. Cotp01*0 officers or members of a limited liability company (LLC) in the construction iWWAry niuyelect m be exeraipt if 1. The.officer ovans,at least 10 percent of them:stock of the corporation,or in the cam of an LLC,a statement attesting to the minimum.10perc ent:ownershhip; 2. The officer is listed as an officers of the ootrparal op.in the records of the.Florida Department of State,Division of Corporations;oad 3. The corporation is registered and listed as Active with,the Florida Department of State,Division of Corporations. No more than three corporate officas per corporation or limited liability company members ant Allowed to be exempt. Construction exemptions ore valid for a period of two years or until a voluntary revocation is filed or the cumptiort is reed:by the Division, Stour Gojaumtor is requesting a permit under this workers'compensation exemption.In the5e circuxnstanc*Miami Shores:Viiia does not require verification of workers" **W* ne coverage from the contractor's company, � v be. "` . Please'' with.your Droll i le f r the co work insurance carrier since.most property insupmce policies Tim NOT oover°this type of liability. -BY SIGNjN(j BELOW YOU ACKNCOWLED THAT YOUR HAVE READ THIS NOTICE A ilMMSTAND. rrS CONTENTS. towneryo- Go#ttcaetor I'rintName: PR Z�6_ � Signature:. 07-1 Silly State of Florida.) StateofFiorida} County of iwDade} County of ll aimtmmade) ��.` l�q�s'�,,; "to d subscribed before res this o� Swotrm to and:subscribed before nmt ms y ., S. Of dayof _ �� U A�m. CDG r •a,,� HEWACH C.HUECK av NOVI` Riddift of Florida By '`>) s my Comm.boresSep 30,2018 = effimW5810#►FF 184339 (SEAT.) T ofldentificatic T ofIdentiticaton ,4 �rrhritattli4«�` law MM Miami shoresviliage .... Bing Department ent 10,050 NE 2nd Avenue I Shores, Florida 33138 Tet (3Q5)785.2204 For.(3t }756.8972 NOTICE:OF REQUIREMENTS RMEN •M SNWHO Pool,SPA ANWW TUB SAFEW ACT I (We)ackri Ah a swimming pool,sp or hot tub w ffi be con44OWd or hob"at Hiatal Shmrw FL,.Md.h_. AM that one.of the foaowin$ modes s wil be used to moist the "lrements of Chww 515, oridaStaibm and Ow FWdat Sulam Code 84101.17 lnitlal:tlto awthod(s)to be rel: The pool"wM be equippW.w h an.aper ►,mol c ovarlhat oOmp'des with AAS F1346,91.(St unit Manufaoturees Sp ions). Coda A corftous,a piecoa(child) medrVthe r"Wemeft of Florida Bunding. R4 01.17.1.15 will protect the pod perimeter,Thr lfiene sf llshow the#mtoa Dation and m of attachment including one end that shall not be removalile without the ail 040018.(Submit Manulac-Wre>'s Slns). A combination o[non-dwelling vdls and fermi(smWOF1010surO,chit fenm,.masonry fence walls,chain fink or vel fence,etc)vAt prQW the pool perimeter.The plans must sp?e y t he:t ype and location of all noel dueling walls.Flodda. `" t ode.R4101-171 IL—my combinafion of protection which 1AMPtaW Owe tins with gs*a*into tha Pool pelimeter and ail windows and cars will be equippe v aw"00moft with FloridaBuilft Code,R410147.1.9(SubMit Manufsotumm's S Ac8b; Ms)» _Anycortibination of ppowetion which incorporates dwelling walls with.o nings diteetly into the pool perimeter and all doors will to equip*with a self4atching device with positive mechanical l ing inst�d a min.W above the threshold.If this option is selec i,submit plans sho irlg al and location of all perimeter li n.The plans rrnA also show the location and type of al oW1rigs,an d::the hardware type for each lotion.(,%b mlk ManuWurees Specifications) In accordance with thwooftas pw fuY nd be lviod we water pfia�nca r the Phttrata ung Pooh retvMeMrrts*and of per,�e pal shall*b+e prewmed to be unsafe.I u that.opt having one offt ,1 1 wld &.a violaticut of t�ispter 515,F.S;,an d Ali t� aid+ t comms a mis+dsrtre�ar af�the ' degree,punishabla&S woliided in Sewn 7TLOMU or 7?6WF.S.This frogM.101st be std day tt a owrterl d pri" co"b2dor. _ CON TRACT(?Ii S SIGNATURE AND(DATE OWN RE ANDDATE- c �� a0not 10 ONCTO x �:. ,, NN�Y wHjUMIi C.JJUECK w, x Notaq pdMit.State of Florida f? k7Sl:IC` My Comm.Uors&Sep 30.2018 NOTARY PfOU ��y pU9l1C - Commission�FF 184339 CP'.Commission WWO .�'•.EE173py9 .•' L{Jw�,e\\��� 111111,111101 Miam, 1 Shores V.a, e Bufn Beprtment WOW N 2nd Avenue Mtarni Shores,Florida 33138 Tol. (306) 706.2204 Fax:(305)766.8872 RE � �STWMW COWXW Rid M L ENQQW. MOW ALL MEN BY THESE t GENTS; WHEREAS,1he uralQrstgnM,,, simple owlar(s)of the fOROwlag described prnparty situated and bei Itt MOO Staotes Villap,1900at Whereas;the undaisWied ot+ (s) tii ez a w desite'to u8za said Lol(s)as a"e buldbg site Wd-#w s d ow r(s)do(es)try dedw and as fi +s l That the property will rot be uW.1a . . ." ;of°arty atrianoas of Miami Show Verge or MbW4U6 county now inetted or weinafw 1f That the p goes ofthe cDvmtant:ls t6tiduce Miami Sho"Vftp ttissue a pe m1for a pad wham ie mgtd W wWosura 1s not on the std property where the pts is . Ill. That If arty ofour aIning r�igtttwrs twnove any pmt of tt rf cs ,.orif oudmy pity sI�faE torr ode Rents for OW WMIM,wa;as own win fmm edi y it a mest;code requiremeftaW wIN of its permit for suc h fence. !V. Ttrat. #o>n*(s)hoW gni MOW vilgap harms ibr any MEge m or inj"t# ids f f M trot: haft ttro ettdosurd. V. If enclosure be forip to said propedy,.I"Ao,trWnW &*reams saidaftsure In Me strut dtatis dammed or removed by any cue. NOW,THEFtr F,forgt land vat .cx i t,the ed ( ) 4Y tltat tte/Sh wry n wavey oat s ht be c mveyed tf to tMe to the aklgve arty whirr regal"tt>s rbt tilbto:af ter aN 1 wd conditions set fore 1n. FU WHER thaunderskpad ;. s)tftafitiscaoverottIs and MOW a tit cormft the use,enJoyment and We to thoabove ptaperty and:shahcmftft atwvena d nmddq WM the land aril shall be OWN4biri tig upon wto rsowd ' successors and rs' only be:r Ram!Shoff Verge,:orb ,rt ordartce of said the th effect 1 N&PRINT OWNER SINQ&PR1NT . II 1 . N!P ripp ed i>e raOwl � N/ as Ufic�cxt and tom. tt�. . ;. . �e fiber, arid'rol�Iy' for pulposestwefrr.eaPOSSO& SWQRt3 TO AND gUD t ma on ihisday 2D .S HEINRICh • e�. NOT ATE ORtDA (Revised 0 tQ9 = Notary Public-Sta;e �=My Comm.Expires Sep 3. 2 u 8 ConmWNon#►FF 164339 y f Miar"I Shores Village Building Department lvxs 10050 N.E.2nd Avenue Miami Shoreg, Rcwida 3W38 Tei: (305) 795.2204 Fax:(305) 75&8972 I V IG POOL QW__NER16 CERTIFI Miami Shores Village Building$Zoning Departmont Attention: Building Official 1 cert y that 1 am the legal owner of the property described as located at 1/;2.,5' my,er In mrdance,w h Sermon 33-12(f); Coln of NbUq3olitan Dade Cour jt, I certify that l understand and age that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this cerhfieation,however,doe not eliminate the need for obtaining a permit and erecting and approved bang prior to final inspection and Use of e Wil• Legal Own ft icon in du 1tca�. Note:Tt�i�cettli�cafion is to be sabmiif�sd a�a ttnmirg i Pemt aPP� A. Q A ® 77115/2015 (MM/ Y) CERTIFICATE OF LIABILITY INSURANCE 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 terns 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 endomement(s). PRODUCER CONTACT Fannie Baez Jackson Insurance Agency PHONE (305)824-3464 FAX No:(305)822-8535 2075 West 76th St ADDIRLF-SS:fbaez@Oacksonagency.com INSURER(S) AFFORDING COVERAGE NAIC# Hialeah FL 33016 INSURERA:Covin ton Specialty 13027 INSURED INSURER B: Dolphin Pools And Spas Inc. INSURER C: 3696 W Community Drive INSURER D: INSURER E: Jupiter FL 33458 1 INSURER F: COVERAGES CERTIFICATE NUMBER:2015-2016 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. INSR TYPE OF INSURANCEADDLSUHR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMID MMIDD % COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A AGE TO RENTED A CLAIMS-MADE ®OCCUR PREM SES Ea occurrence $ 100,000 B Contractual Liability VRA362614-00 2/16/2015 2/16/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 % POLICY❑JERCOT F1 LOC PRODUCTS-COMPIOP AGG $ Included OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOgPeraocident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN STER ER ANY PROPRIETORMARTNERIEXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space is required) license CPC1458270 This certificate is solely for the use as it Evidence of Insurance" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Ed Jackson/FANNIE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IN8025(munit CERTIFICATE OF LIABILITY INSURANCE DAT 3i4/2o016 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 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 CONTACT Maria Benitez NAME: Jackson Insurance Agency PHONE : (305)824-3464 FAX (305)822-8535 WA Y% AIC No): 2075 West 76th St ADD�:mbenitez@jacksonagency.com INSURER(S)AFFORDING COVERAGE NAIC# Hialeah rL 33016 INSURER ACovin ton Specialty 13027 INSURED INSURER B Dolphin Pools And Spas INSURERC: 3696 West Community DR INSURER D: INSURER E: Jupiter rL 33458 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1621601809 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 PppAIILLD��CLAIMS. ILTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MNI/DD EXP LIMITS % COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE a OCCUR DAMAGE T RENTED axa100,000 PREMI ES Ea occurrence) $ VRA444384-00 2/16/2016 2/16/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 B POLICY E JPRCOT 7 LOC PRODUCTS-COMPIOP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL UTO ED AUTOESS BODILY INJURY(Peraccident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAR E]OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKED COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECU71VE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? El NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ W ea describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) License # CPC 1458270 This certificate is solely for the use as Evidence of Insurance" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN 10050 N.E. 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Ed Jackson/PCAMP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD IN8025 tgmanii