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PL-15-3208 33 �yno s t, Miami Shores Village �... #fie TYi i pItit bing o id »tial ' 10050 N.E.2nd Avenue NW e ,�"�r fflr.8tf011 Pool-Private Miami Shores,FL 33138-0000 Permit Status:APPt"}4�?E `tea Phone: (305)795-2204 " P� Ex iration: 07/10/2016 1112201 Project Address Parcel Number Applicant 260 NW 112 Terrace 1121360010280 Miami Shores, FL 33168-3332 Block: Lot: GILDA DENTICO Owner Information Address Phone Cell LGILDA DIENTTICO 260 NW 112 Terrace i FL 260 NW 112 Terrace FL Contractor(s) Phone Cell Phone Valuation: $ 900.00 GATOR POOLS AND SPA CONSTRUC (305)222-2220 ..._ _ ., _ Total Sq Feet: 0 Type of Work:POOL 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 DBPR Fee Invoice# PL-12-15-58195 $3.38 01/12/2016 Check#:1336 $ 186.36 $50.00 DCA Fee $3.38 Education Surcharge $0.20 12/30/2015 Cash $50.00 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $236.36 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,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore,I authorize the above-named contractor to do the work stated. January 12, 2016 -Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy January 12,2016 1 Miami Shores Village --- Building Department DLC30 ,015 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 y FBC 201"{ BUILDING Master Permit No.or Z�T PERMIT APPLICATION Sub Permit No. I19 �- 31zos ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CAN ELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores Countw Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO v�- Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ��F.e� 9`>`�,� Phone#: Address: 1 ) ?_-7 City: C G K State: Zip: �6 9 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: e9� fl ,r� � � �1 �'���a�e�+ Phone#: 3�,�S Address: I �- ,'� City: E=:�L A a.-,I State: Zip: B e Qualifier Name: i� �' �JA. Phone#: _ 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: Type of Work: ❑ Addition ® Alteration ❑ New ❑ Repair/Replacg ❑ Demolition Description of Work: i ra ( d f I,� Specify color of color thru tile: Submittal Fee$ Permit Fee$ IS- CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) r " . 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. r Signature Signature OWNER or AGENT TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 I , by Z� day of R C- ,20 IS by I ) _D,--�C® ,wh rs personal) known to 1�0 —.p�Zrr'►'L�y.�► ,who is personally known to me or who has produced as me or who has produced ��+ l7Ql �c�rmiirrr�r�,, as identifica ' n a d who did take an oath. identification and who did take an oath. \ NOTA PUBLI NOTARY PUBLIC: A'3 o Sign: Sign: Print: ANA WATSON Print: 44P 9,��\ �ao� ,zoi9 minim Seal: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) DEC-28-2015 14:25 AMERICAN TRUST INSURANCE 305 270 2496 P.01/01 a� CERTIFICATE OF LIABILITY INSURANCE DATE12/28/1D15 n — II �� ( THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGERIGHTS UPON THE CERTIFICATE HOLDER.THIS j AFFORDED BY THE POLICES ; BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. read. if SUBROGATION IS WANED,subject to IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the pol'lcy({es)must be endo 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). —_ ._ ...___ _... .... ._... .. _I PRODUCER �MNEACT Edna Sanchez _. .. P- 305 270-2220 I Fax (305)270-2496 American Trust Insuranceg.FxlL_.�-_- ) lA No);. ..._ .. _... 9360 Sunset Drive Suite 240 I ADI}�E —ednasaamericantrustins.com Miami,FL 33173 __LNSURE� Phone (305)270-2220 _ Fax (305)270-2496 — INSURER A Granada Insurance Company — I _ —._C — INSURED INSURER B- I � Gator Pools$Spa Construction,Inc.(Uc#CPC1456729) _IwsURERc 13295 SW 2DO Street I INSURER D__.—._ _.._._....__....._ ..__-- .._. _. ._ __..I ...... Miami,FL 33177- (305)278-0529 I INSURERF: -- —— — _ . . - L 1 '-- NSU -: -- - -- --------... --..—...--. .—.._._...— . REVISION - COVERAGES _ _ CERTIFICATE 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, i EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _...—--- ADD SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE — �.NS13 . POLICY NUMBER, ...-,__(MMIDDIYYYY)�M/DDlYYYYII_. .—..._.... INSR _. ... _..._. _ GENERAL LIABILITY I I EACH OCCURRENCE_.,._. $ .1,000,000.00 DAMAGE TO RENTED $ ,000.00 1® COMMERCIAL GENERAL LIABILITY ( i P EMI'3�ES�Ea pccurr�nce100 ) I -- . -- ❑ ❑ CLAIMS MADE 1 OCCUR II 0185FL00040000 MED EXP(Any one parson) T$ 5,0000.0- 0 A I I i 10/12/2015 10/i2/2016 I PERSONAL&ADV INJURY s 1,000,OOO.00 ❑ —-- -- -- —-' I I GENERAL AGGREGATE s 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: I I I I I PRODUCTS•COMP/OP AGG $ 1,000,000.00_ L ❑ POLICY D PR,IE(OL _❑ LOC E---- __ _ _ $ 1 (Kaacriognt) AUTOMOBILE LIABILITY C C MINED SINGLE LIMIT. j ❑ ANY AUTO B OILY INJURY(Per per on) $ ALL OWNEDSCHEDULED I I I I BODILY INJURY(Per accident) $ ❑ AUTOS El AUTOS -- ❑ ( HIRED AUTOS ❑ AUT SEED I I I r V2 ERTY DAMAGE- $ feat acc dent) ❑ UMBRELLA UAB ❑❑OCCUR EACH OCCURRENCE $ --_ __. ❑ EXCESS LIAS LJ CLAIMS _ ❑_DED ❑ RETENTK)N$-..--- $... - WORKERS COMPENSATION I E WC STATU- AND EMPLOYERS'LIABILITY YINI I i 4 LJ9ii�4iM s....-0 ER --.... ..... _ ANY PROPRIETORIPARTNERIEXECUTNE I I E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? I- 71 N I A I I __. . ..... ... (Mandatory in NH) E L DISEASE-EA EMPLOYED$._.._... .. ......... ... yunder ( ---- - ... -- �_ DESCRIdP 0 OPERATIONSbelow —...�._.. L. __—_....—........ —..__. fff I E.L_DISEASEIPOLICY LIMIT'.$ I , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ff more space Is required) Swimming Pool I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 119 10050 NE 2ND AVENUE I ACCORDANCE WITH THE POLICY PROVISIONS. i MIAMI SHORES,FL 33138AUTHORRED RE PRESENTATIVE ATT:Building Dept. • FAX.•305-756-8972 ®1988-2010 ACOIRD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD TOTAL P.01 DEC-28-2015 14:32 AMERICAN TRUST INSURANCE 305 270 2496 P.01i01 ' "CC> '°' CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DI]/YYYYy �..-- _ _ 12/28/15 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. PORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. I If SUB_.ROGATION IS WAI1%ED,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.. .. _._..... _.._. _ _ _.. NAME: Edna Sanchez American Trust Insurance PHO..NNEo (30 5)270-2220 --_ �Lo^��); _(305)270-2496 9360 Sunset Drive Suite 240IAL ednas@amedcantrustins.com Miami,FL 33173 INsure ra�s)aFFORrnu�covERAc>_ Nalca Phone S3051270-2220 Fax (305)270-2496 INSURERA: Granada Insurance Company i INSURED .. ..... ... INSURER B• I Gator Pools&Spa Construction, Inc.(Lic#CPC1456729) INSURER C: 13295 SW 200 Street L INSURER D: Miami,FL 33177- (305)278-0529 _ _ _, INSURER F; COVERAGES CERTIFIC_AT_E NUMBER: _ _ J_ __ REVISION NUMBER: _ r THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS i CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, i EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i INSR - ADD 18116R - -...-.. . LTR TYPE OF INSURANCE ----- (POUCH)'�4A/ODr YY)LL�i OMITS ---------- --- IeLSH1-1�CD�.------ POUCYNURABRt MMID--.. --- - GENERAL LIAeJUTY OCCURRENCE _-._.___ _ 1,000,000_.0 COMMERCIAL GENERAL LIABILITY GE TO RENTED ` - ❑ ❑ CLAIMS-MADE ® OCCUR I I PR�MISLS(Ea ocourrenw�_,__$ 1 OO,OQD.00 - - A El �0185FL0004000D 10/12/2015!10/12/2016 MED EXP(Any one person) $ 5,000.00 j PERSONAL&ADV INJURY $ 1,000,DOO.DO GENERAL AGGREGATE $ 2,000,OOO.QO GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPiOP AGG! $ 1,000,000.00 ❑ POLICY ❑ PRO- ❑JFCT LOC _.. AUTOMOBILE LIABILITY OMBINED SINGLE LIMIT, �aacc-dsntl--._....._ $_._.._, ._....._......._....... ❑ ANY AUTO I BODILY INJURY(Per person) $ ❑ ALL OWNED SCHEDULED -------.__.._..__._....... .. . ! AUTOS ❑ NON-OWNED i BODILY INJURY(Per accident $ HIRED AUTOS ❑ AUTOS PRS PI nt AMAGE $ -- O---- - --0 ------ --- - -..— ! ! $ ❑ UMBRELLA UAB ❑OCCUR EXCESS LtA6 EACH OCCURRENCE_._......$_......._._..----_-....--•_ , AGGREGATE $ DED ❑ RETENTION$ IS I WORKERS COMPENSATION AND EMPLOYERS'LIABILITYY/N WC STATU- OTH- I ;�.L46YJlMIIS .Q. ... ANY PROPRIETOR/PARTNER ERIMCUTIVE OFFICER/MEMBER EXCLUDED? I N/A i E.L.EACH ACCIDENT $ (Mandatory In undue E.L.DISEASE-FA EMPLOYE $ Meg DESCdescribe under OF OPERATIONS ! E.L.DISEASE-POLICY LIMIT S --� DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES{Attach ACORD 101,Additional Remarks Schedule,if more apace is required) —' Swimming Pool I CERTIFICATE HOLDER -------- ----------- _..—_.------ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 - ... -- -- AUTHORIZED REPRESENTATIVE ATT:Building Dept. -+— - --- ----- -- -- ����� FAX:305-756-8972 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05}QF The ACORD name and logo are registered marks of ACORD TOTAL P.01